Borough of Tottenham TOTTENHAM'S HEALTH 1961 The Annual Report of the Medical Officer of Health Borough of Tottenham TOTTENHAM'S HEALTH 1961 The Annual Report of the Medical Officer of Health Public Health Department, Town Hall, Tottenham, N. 15. 30th July, 1962 To the Worshipful the Mayor, Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, It is my duty and pleasure to submit this my twenty-fifth Annual Report on the administration of the environmental and personal health services within the Borough. The population as estimated by the Registrar General was 113,480 a decrease of 1,550 on the previous year. The birth rate of 16.91 was the highest since 1948. Illegitimate births rose from the previous highest figure in 1960 of 8.5 to 9.8 per cent, which can only be regarded as a social problem of grave public concern. A further disturbing feature was an overall rise in the infantile death rate to 26.58 per thousand live births: the highest since the year 1947. Much discussion has taken place, nationally and locally, on how existing maternity services may be further improved. Some of the more urgent local problems are set out in the body of this Report. Special stress is placed on the shortage of domiciliary midwives; and consequent physical exhaustion at times of those who, though depleted in number, have had to cope with the needs of a rising birth rate and a growing trend for early discharge of mother and infant from maternity hospitals necessary to enable a quicker turn-over of beds. Unsuitable housing and other adverse social problems, not least of which are those associated with immigration, aggravate the present general shortage of hospital maternity beds. The health of children of all ages has been well maintained. Apart from an outbreak of measles, which was anticipated, no epidemic occurred during the year. As a matter for encouragement, but not complacency, a higher acceptance rate for vaccination and immunisation was noted. Adversely the condition of children's teeth showed deterioration. The recently published results of a five year study in Britain on fluoridation of water supplies, would seem to open the way to make this highly successful means of preventing dental caries available to a wider, or indeed the whole, population. The Tottenham Education Committee some years ago pressed for action to implement this urgent public health measure being satisfied then as to the claims made for it in other parts of the world. As early pioneers in the establishment of special schools for handicapped children the Council will note with interest the progress outlined in the school health section of this Report. Equally they will have much cause for satisfaction in recalling their pioneer efforts for supervision of the health of mothers and young children, the work of health visitors and building of clinics and centres when legislation to do so was merely permissive and not as it has been since 1948 obligatory on the local authority to make such provision. At the other extreme of life much has been done locally for the health and well being of senior citizens. The aim of voluntary organisations such as the Old People s Welfare Committee is to make the years of retirement a happy and worthwhile experience, free from boredom and loneliness; and, as the Report of their Chairman shows, this covers a wide range of services and activities. Special consideration is given by the Borough Council to the housing needs of elderly people, particularly those in need of ground floor accommodation or specially adapted amenities in their home because of some crippling defect. Close co-operation exists with the Geriatric department at St. Ann's General Hospital, with the welfare department and with the home help, home nursing, and health visitor services of the local health authority. Under the supervision of my deputy, the retirement advice clinic for men reaching the age of 65 continues to function well. Here in an unhurried atmosphere a man, who more often than not has given no previous thought to his retirement, may have a medical check and be encouraged to discuss his possible problems and how he wishes to occupy his new found leisure. So far as possible he is then put in touch with those who can help him. Action under the Housing Acts and Clean Air Act occupied much of the time of the public health department during the past year. Representations were made, after detailed house to house inspection by the chief public health inspector, of 205 houses for slum clearance and 12 individual unfit houses closed or demolished. New standards were adopted by the Council in relation to houses in multiple occupation. An adequate survey of such properties, however, proved impossible owing to the inability to fill three vacancies in the inspectorial staff throughout the year. The remaining all highly experienced staff were hard pressed to cope with their many other duties, some involving new legislation, and with many hours of overtime in connection with the slaughtering of animals. Applications for rehousing on medical grounds numbering 108 were visited and investigated by my deputy or myself. The ill effects of atmospheric pollution upon the health of the community is widely appreciated and the Council resolved to do everything in its power to ensure that progress is made as rapidly as possible. A third Smoke Control Order was confirmed during the year which included 8,441 dwellings, the largest so far tackled at one time. In addition to the heavy task this meant to the health inspectors, an area of such size involves very considerable clerical work only made possible bv a successful reorganisation of that department by the chief administrative assistant. This brief introduction read in conjunction with the Report itself, seeks to make clear that while the pattern of the public health services may remain basically the same, from year to year, the reshaping and necessity to tackle new problems must form a constant challenge to Committee members and their officers. In such a spirit the initial problems associated with proposals for merger with neighbouring authorities to form a new Greater London Borough, will be faced with confidence; and in the knowledge that Tottenham has much to give and much to gain in a single unit cf local government of sufficient size and resources to provide full and comprehensive services to the public. Last of all I wish to thank all members of the staff for their whole hearted co-operation; and to express my gratitude to the Council and to Chairmen and members of Committees for their understanding and encouragement. G HAMILTON HOGBEN Medical Officer of Health 1 MEMBERS OF BOROUGH COUNCIL MAYOR Alderman W. S. Herbert, J.P. DEPUTY MAYOR Alderman L.R. Harrington (Mrs.) J.P. ALDERMEN E.J. Field H. Langer * A.F. Remington (Mrs.) R.W.H. Ford * A. Reed, A.C.I.I., J.P. * A.R. Turner F.A.F. Keay, J.P. * R.H. Warren H.W, Turner COUNCILLORS * E.E. Brown (Mrs.) Sir Edward Brown, M. B.E. J.W.H. Brown E.J.J. Carter A.W. Catley A. J. Chaplin Douglas Clark * L.H. Col lis D. Cunningham (Mrs. ) * G.A. De Vote J.C. Dibble * E.C Elphick E.V. Garwood L. J. Goldman W. K. Gomm * F.E. Haynes (Mrs.) F.A. Knight J.D. Mcllwain, B.A. G.W. Malin, A.C. A. * G.C. Marson J. Mather * A A. Miller (Mrs.) * M.T. Morris * S.C. Morris I L. Peirce A.T. Protherœ * M„E. Protherœ (Mrs.) E.A, Remington A.B Russell J.R. Searle * S. A Berkery Smith (Mrs.) J. Watkins J. Wolsey The Mayor and Deputy Mayor Note * Indicates members of Health and Housing Committee. are ex-officio members. Committee Chairman - Alderman R.H, Warren Vice-Chairman - Alderman Mrs. L.R Harrington, J.P. Deputy Mayor Town Clerk: Medical Officer of Health: M. Lindsay Taylor, I.L.B. G. Hamilton Hogben, M.R.C.S., D.P.H. 2 AREA HEALTH COMMITTEE Members of Hornsey Borough Council Councillor Miss CXR. Anderson Councillor F.C.V. Hayward Councillor Mrs. J. Carter Councillor B.D. Smith Councillor J.T. Wilkins (Chairman) Members of Tottenham Borough Council Alderman Mrs. L.R. Harrington, J.P. Alderman R.H. Warren (Vice Chairman) Alderman A. Reed, A.C. I.I., J.P. Councillor M.T. Morris Alderman Mrs. A.F. Remington Members of Middlesex County Council County Councillor Miss J.H. Damant County Councillor Mrs. M.E. Protherœ County Councillor F.P. Lloyd County Councillor P.P. Rigby County Councillor N. Muldoon County Councillor Mrs. ME. Soall 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 Committee) Mr. R.W.D. Brownlie (Middlesex Local Dental Committee) Mr. L. Hayward (Middlesex Local Pharmaceutical Committee) Miss V. Edey (Royal College of Midwives) TOTTENHAM DIVISIONAL EXECUTIVE EDUCATION COMMITTEE Aldermen E. J, Field " R.W.H. Ford " F.A.F. Keay, J.P. Councillor E.J.J. Carter " Dauglas Clark " L.H. Collis Mrs. D. Cunningham " Mrs. F.E. Haynes „ G.W. Malin, A.C.A. " J. Mather Alderman H. Langer " A. Reed, A.C. 1.1., J. P. " Mrs. A.F. Remington (Chairman) Councillor J.D McIIwain, B.A. " M.T. Morris " I.L. Peirce " Mrs. ME. Protheroe (Vice Chairman) " JR. Searle " Mrs. S..A, Berkery Smith " J. Watkins Representing County Council County Councillor H.H. Godwin-Monck County Councillor Mrs. M E. Soall Co-opted Members Mr. V.J. Pitcher Mr. D. Edgington Mr. H.R. Cheetham Mr. H.. H. Stacey Borough Education Officer - J, Power, M A. 3 GENERAL STATISTICS Area of District (in acres) 3,013 Population Census, April, 1951 126,929 Mid-year; Registrar General's 1960 1961 estimate 115,030 113,480 Rateable Value as at 1st April ,964,652 £1,976,413 Sum represented by penny rate £8,020 £8,060 Approximate Number of Dwellings in District 30;946 30,998 Registered live-births Males 979 977 Females 947 942 Total 1,926 1,919 Birth-rate per 1,000 estimated population 16.75 16.91 No. of live-births which were illegitimate 164 188 (8.5%) (9.8%) Stillbirths Males 16 18 Females 12 17 Total 28 35 Stillbirth rate per 1,000 total (live and still) births 14.38 17.91 No. of Stillbirths which were illegitimate Nil 7 (20%) Deaths Males 660 724 Females 670 692 Total 1,330 1,416 Death-rate per 1,000 estimated population 11 56 12 48 Maternal Mortality Puerperal Sepsis 0 0 Other puerperal causes 1 1 Total 1 1 Rate per 1,000 total (live and still) births 0.501 0.501 Deaths of Infants under 1 year of age (Infant Mortality) (a) Legitimate Males 22 21 Females 20 26 Total 42 47 Death- rate per 1,000 legitimate live births 23.84 27.15 (b) Illegitimate Males 1 2 Females 2 2 Total 3 4 Death-rate per 1,000 illegitimate live births 18.29 21.28 4 (c) Total Males 23 22 Females 22 29 Total 45 51 Rate per 1,000 total live births 23.36 26.58 Deaths of Infants under 4 weeks (Neo-natal Mortality) 36 37 Rate per 1,000 live births 18.69 19.28 Deaths of Infants under 1 week (Early Neo-natal Mortality) 29 31 Rate per 1,000 live births 15.06 16.15 Stillbirths and deaths under 1 week (Perinatal Mortality) 57 66 Rate per 1,000 live and still births 29.17 33.78 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 1961, although there was a natural increase in population arising from births exceeding deaths by 503, the Registrar General's estimate of population shows a reduction of 1,5 50 meaning that the outward movement of population was greater than the inward by 2,053. 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 has been a patient for six months or more. Comparability Factors To enable local vital statistics to be compared with other districts or with national figures the Registrar General issues comparability factors for correcting crude birth and death rates. These factors make allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. The death rate comparability factor has been adjusted specifically to take account of the presence of residential institutions in the area. To compare the crude birth and death rates for Tottenham with the national rates, Tottenham's figures must first be multiplied by the appropriate comparability factor 1.00 for births and 1.03 for deaths. 5 Birth-rate The birth-rate 16.91 per 1,000 population was the highest since 194-8. 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 1961, 9.8%or one in ten, were illegitimate compared with the previous highest figure in 1960 which was 8.5%. Between the two world wars the rate never exceeded 4.6%. Infantile Deaths A total of 51 deaths under 1 year of age is recorded by the Registrar General, giving a rate of 26.58 per thousand live births, the highest rate since 1947. Thirtyone of the deaths occuried in the first week of life and a further six in the first four weeks. Lung Cancer Deaths from Lung Cancer locally continued to rise, thus conforming with the national increase in deaths from this cause now sixty deaths a day or more than three times the mortality on the roads. All the evidence shows that deaths from lung cancer should be much more easily preventable than those from road accidents. Chronic Bronchitis This "English Disease" is the major problem in respiratory complaints in this country. The causes are manifold, and include atmospheric pollution, smoking, respiratory infections, and occupational hazards. Men in the 50-60 age group are the principal sufferers, and those with outdoor work in towns have four times the death rate when compared with similar workers in the country. During the last year the Tottenham figures showed an increase in deaths from this cause in elderly men. Bronchitis and Lung Cancer Death Rates per 100,000 Population Year Bronchitis Lung Cancer Tottenham England & Wales Tottenham England & Wales 1952 109 62 45 32 1953 106 69 55 34 1954 80 58 46 37 1955 116 65 58 39 1956 80 66 70 41 1957 72 60 68 43 1958 81 65 64 42 1959 80 64 62 46 1960 69 58 62 48 1961 92 Not available 66 Not available 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 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 1961 113,480 1,416 12.48 1,919 16.91 51 26.58 10 60 1 50 8 303 6 INFANTILE DEATHS IN AGES AND SEXES 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 2 5 1 1 1 1 1 1 11 4 7 Bronchitis 1 1 — 1 Hæmolytic Disease of Newborn 1 1 1 1 Congenital ation 1 2 1 1 1 1 7 1 1 1 10 5 5 Prematurity 8 2 2 1 13 13 4 9 Atelectasis 4 1 1 6 6 3 3 Birth Injuries 3 1 4 4 3 1 Gastro-Enteritis 1 1 2 2 Accidents 2 2 - 2 Hæmorrhagic Disease 1 1 1 1 Total 16 4 2 6 .. 1 2 2 1 3 37 4 1 2 1 3 1 - 1 1 51 22 29 7 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 2 2 - - - - - - - - - - 1 1 - - 1 1 Tuberculosis, other 1 - - - - - - - - - - - 1 - - - - - Syphilitic disease 2 - - - - - - - - - 1 - 1 - - - - - Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - Meningococcal infection - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic disease 1 1 - - - - - - - - 1 - - 1 - - - - Malignant neoplasm, stomach 19 15 - - - - - - - - 1 - 6 3 6 8 6 4 Malignant neoplasm lung bronchus 70 5 - - - - - - - - 4 - 36 1 23 1 7 3 Malignant neoplasm breast - 26 - - - - - - - - - 3 - 10 - 6 - 7 Malignant neoplasm uterus - 11 - - - - - - - - - 1 - 6 - 3 - 1 Other malignant & lymphatic neoplasm 74 76 - - - - 2 - 1 - 1 4 18 25 25 25 27 22 Leukaemia, Aleukæmia 4 3 - - - - 1 - 1 - 1 - - 2 1 1 - - Diabetes 1 13 - - - - - - - - 1 - - 3 - 5 - 5 Vascular lesions of the nervous system 52 84 - - - - - - - - 2 1 9 11 9 22 32 50 Coronary disease, angina 132 108 - - - - - - - - 5 2 53 7 42 42 32 57 Hypertension, with heart disease 12 18 - - - - - - - - - - 3 2 7 7 2 9 Other heart disease 64 100 - - - - - - - 1 1 3 3 14 18 18 42 64 Other circulatory disease 46 32 - - - - - - - - - - 8 5 19 4 19 23 Influenza 3 1 - - - - - - - - - - - - - - 3 1 Pneumonia 45 56 4 7 - - 1 - - - 2 2 8 5 9 11 21 31 Bronchitis 77 28 - 1 - - - - - - - - 19 4 22 4 36 19 Other diseases of respiratory system 15 7 - - - - - - - - 1 - 3 2 7 3 4 2 Ulcer of stomach & duodenum 14 2 - - - - - - - - - - 7 1 5 - 2 1 Gastritis, enteritis & diarrhœa 3 5 2 - - - - - - - - - - 2 1 - - 3 Nephritis & nephrosis 3 4 - - - - - - - - 1 - 2 1 - 1 - 2 Hyperplasia of prostate 5 - - - - - - - - - - - - - 2 - 3 - Pregnancy, childbirth & abortion - 1 - - - - - - - - - 1 - - - - - - Congenital malformations 6 6 5 5 - - - - - 1 - - 1 - - - - - Other defined & ill defined diseases 38 56 12 13 - 1 - - - - 1 1 10 11 8 9 7 21 Motor vehicle accidents 12 8 - - - - 2 - - 1 2 1 5 - 2 3 1 3 All other accidents 10 18 - 2 - - - 1 - 1 1 - 6 2 1 4 2 8 Suicide 12 6 - - - - - - 1 - 6 - 3 2 2 4 - - Homicide & operations of War 1 - - - - - - - - - - - 1 - - - - - Total 724 692 23 28 - 1 6 1 3 4 32 19 204 121 209 181 247 337 8 9 SANITARY CIRCUMSTANCES OF THE AREA Water Supply Dr. E. Windle Taylor, Director of Water Examination of the Metropolitan Water Board, has kindly supplied the following information regarding Tottenham's water supplies:- "The supply to the Borough of Tottenham has been satisfactory both in quantity and in quality during 1961. The Borough is supplied mainly with New River-derived water from Stoke Newington and Hornsey pumping stations with some well water at Northumberland Park from Park pumping station. 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. Details of the analytical results of the water passing into supply are set out in the following tables. In all cases the supply is direct to the houses 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 Borough, but new mains were laid to the extent of 118 yards." Fluoridation of Water There has been no real change in the position since the last report, nor is any action likely before the result of the experimental period in selected areas is published next year. Most established public health measures have met emotional and particularly ill-informed opposition in their early stages, but it is to be hoped that in time this practical application of known facts for the benefit of London's future citizens will be put into effect. Radiation Hazards No notifications were received from the Minister of Housing and Local Government of any registrations of users of radioactive substances during the year under the Radioactive Substances Act, 1960. Drainage and Sewerage There are separate systems of drainage for soil and surface water. From time to time this has lead to surface water pollution where unauthorised soil connections have been made to the surface water system. With the co-operation of the Lee Conservancy Board's Inspectors every effort is made to trace and deal with these is expeditously as possible. AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OF TOTTENHAM FOR THE YEAR 1961 (Milligrams per litre (unless otherwise stated)) Description of the Sample No. of samples Ammonia Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as Cl Oxygen abs. from Permanganate 4 hrs, at 27 °C Turbidity Units Colour m,m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (noncar bonate) pH Value Phosphate as po4 Silicate as S102 Sulphate as so4 Fluo ride as F Magnesium as Mg. Surface Active Material as Manoxol Free co2 Electrical Conductivity (gemmhos) New River derived 104 0.038 0,060 5.2 33 0.52 0.1 7 304 66 7.9 0.45 10 63 0,20 6 0.08 625 Park well 3 0,100 0.064 2.6 26 0.48 1.5 10 280 56 7.4 18 575 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1961 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 coll count 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Pet cent samples negative in 100 ml. New River derived 510 10.1 - 100.0 100.0 Park well 112 0.4 16. 85.71 0.3 97.32 - 115 0.2 9 100.0 100.0 10 11 Public Baths and Laundry Establishments The Baths Superintendent supplied a full report on these services which appeared in ray 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 capacity is 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) Pool 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 (c) 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 Cinemas and Halls Complaints Investigated Conveniences and Urinals Drains defective Drains tested Factories with Mechanical Power Factories without Mechanical Power Food Poisoning Food Premises Bakehouses Butchers Cafes Dairies Factories 534 38 3,138 5 78 223 261 36 20 40 112 81 19 43 12 Food Premises (Cont'd.) Factory Canteens Fishmongers Greengrocers Ice Cream Premises Slaughterhouses Other Food Premises House to House Improvements Infectious Disease Other Visits Outworkers Rat Infestation Re-Inspections Rent Act Schools S.D.A. A. •& Housing Act Advances Smoke Control Order Smoke Observations Stables and Mews Workplaces 53 39 34 28 823 228 352 88 63 1,979 68 398 7,204 9 17 308 9,076 174 3 1 Defects Remedied Drains reconstructed Drains repaired Drains cleared W.C. Cisterns repaired or renewed W.C. Pans renewed W.C. Pans cleansed Waste pipes repaired or renewed Rainwater pipes repaired or renewed Roofs repaired or renewed Eaves gutters repaired or renewed Drinking water cisterns renewed Drinking water cisterns covered Water service pipes repaired Water supply reinstated Yards repaired or reconstructed Sinks renewed or provided Floors repaired or renewed Floors ventilated Dampness remedied by insertion of damp proof course by pointing of brickwork by internal rendering by miscellaneous remedies Window frames and sashes repaired, or renewed, or painted Coppers repaired or renewed, or provided 14 52 38 75 38 15 96 90 404 183 3 - 18 5 21 25 171 42 30 82 245 179 324 13 Fireplaces, Stoves & Ovens repaired or renewed Flues and Chimney Stacks repaired Brickwork of walls repaired and walls rebuilt Ventilated Food Stores provided Rooms cleansed Staircases, Passages & Landings cleansed Staircases, Balconies and Steps repaired or renewed Noxious Accumulations removed Nuisances arising from Animals abated Miscellaneous Defects remedied 26 26 57 3 14 49 4 451 Notices Served Statutory:- Housing Act, 1957: Section 9 41 41 Public Health Act, 1936: Section 39 26 " 45 3 "56 4 " 79 5 „ 83 1 " 84 1 " 92 187 227 Tottenham Corporation Act, 1952: Section 36 18 " 43 _46 64 Tottenham Urban District Council Act, 1900: Section 48 1 1 Total 333 Informal Notices 1043 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1961. Housing Act, 1957 Section 9 11 Premises £480 4. 8. Public Health Act, 1936 Section 39 12 Premises £141. 10. 10. Section 92 1 Premises £136. 10. 0. Tottenham Corporation Act, 1952 Section 36 9 Premises £ 61. 9. 4. " 43 7 Premises S 234. 19. 11. £1,054. 14. 9. 14 Public Health Act, 1961 This Act received Royal Assent on the 3rd August, 1961 and became operative two months later with the exception of the part relative to the making of building regulations which are to replace local building byelaws. Although a number of the provisions were previously operative locally under the Tottenham Corporation and Middlesex County Council Acts, additional powers under the 1961 Act have strenthened the public health legislation. These include S.20 Proceedings may be taken if drainage or sanitary appliance is improperly installed or repaired. S.31 & 33 Local authorities may reject plans for new or converted dwellings if they do not provide for food storage accommodation and a bathroom with a fixed bath or shower and provision for the supply of hot and cold water to the bath. S.27 & 34 Local authorities are empowered to take action to deal with ruinous and dilapidated buildings, neglected sites and accumulation of rubbish where the conditions are seriously detrimental to the amenities of the neighbourhood. S.35 & 37 Strengthen the precisions relating to filthy or veriminous premises or articles. S.74 Local authorities may take steps to reduce the numbers of pigeons, starlings or sparrows in built-up areas. Abatement of Statutory Nuisances The number of complaints investigaged was a little higher than in 1960. Most of these related to defective conditions in dwellings. The defects were remedied in the majority of cases as a result of informal action but in 187 cases it was necessary to serve abatement notices under the Public Health Act. Summonses were issued in eight instances for non-compliance with the statutory notices. In six of these the work was carried out before the hearing and proceedings were withdrawn on payment of the Corporations costs. Orders were made in respect of the remaining two cases. Noise Nuisances No formal action has been necessary when dealing with complaints of noise. In each case the persons responsible were co operative and prepared to take steps to mitigate the nuisance. The passing of the Noise Abatement Act, however, brought the subject of noise nuisance to the notice of the general public and undoubtedly facilitated the Council's approach to the person concerned. 15 The following are examples of complaints received and the action taken. (i) Noise from flushing cistern while filling up. Oner of premises fitted silencer and noise considerably lessened though not entirely abated. (ii) Noise from radiogram in private house; children forbidden to operate it. No further complaints. (iii) Noise from yard and asphalting plant belonging to roof tilers; manager agreed to take all practicable steps to reduce noise; No further complaints. (iv) Noise from banging of metal - industrial concern; manager was interviewed and promised to co-operate by keeping noise to a minimum: No further complaints* (v) Noise as of whistle in factory; the particular type of work involving this ceased. (vi) Noise from juke-box in private premises: Owner has since removed this from premises (vii) Noise from compressors at a factory. Manager was interviewed and he promised to keep noise to a minimum: No further complaints. (viii) Noise from brewery of crates being moved, of a steam boiler, machinery bells, and lorries starting up; noise usually confined to period 8.30 a.m. to 5.30' p.m. but these hours were extended owing to Christmas demands. The manager was interviewed and he agreed to use only wooden crates during the evening, to discontinue bells during late evening and night, and generally do everything possible to minimise noise; No further complaints. (ix) Noise of factory boiler's safety valve during night; noise sometimes unavoidable but engineer promised to do his best to avoid this during the night; No further complaints. Cleansing and Disinfecting The cleansing and disinfecting station sited at the Refuse Disposal Works has proved efficient and flexible in meeting requirements made at short notice. Summary of Disinfection Work during 1961 Rooms disinfected after occurrence of infectious disease or death 12 Bedding disinfected after occurrence of infectious disease or death 10 Library books disinfected 107 Baths for verminous persons 19(3 females)(4 males) 16 Insect Pests There was a further reduction during 1961 in the number of bug infestations reported. Other pests which gave rise to most complaints were beetles, where 45 infestations were dealt with, and wasps; 18 nests were destroyed. Inspections prior to removal to Council houses numbering 355 have been made on notification by the Housing Manager and disinfestation was required in 20 cases, the furniture being treated in a cyanide chamber. Premises Treated Houses Other Premises Ants 8 3 Bees 1 - Beetles 45 11 Bluebottles 1 - Bugs 105 - Distemper - 1 Fleas 9 - Flies 2 4 Lice 1 - Maggots - 1 Mosquitoes - 1 Moths 1 - Red Mite 6 - Silver Fish 1 - Wasps 18 - 198 21 Rodents The use of sodium fluoroacetate for rodent control in treating the sewers continued 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 was used. The following is a summary of dwelling houses and business premises etc. treated during 1961:- (1) Dwelling houses 661 (2) Factory premises 38 (3) Shops 41 (4) School canteens 64 (5) Miscellaneous 32 (6) Total change for 2/5 above £125.11. 0d. 17 Factories The borough has many diverse light industries scattered throughout the area in addition to a highly industrialised zone along the western side of the River Lea. Visits are made to enforce those parts of the Factories Act for which the local authority is responsible and a good liaison exists with H.M. Factories Inspector for the exchange of information of mutual interest. Premises No on Register Number of Inspections Written Notices Occupier Prosecuted (1) Factories in which sections 1, 2, 3, 4 & 6 are enforced by local authority 55 36 - - (ii) Factories not included in (i) in which section 7 is enforced by local authority 675 261 15 (iii) Other premises in which section 7 is enforced by local authority (excluding outworkers premises) 7 7 - - Total 737 304 15 - Stannary 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) - - - - Overcrowding (s 2) - - - - Unreasonable temperature (s 3) - - - - Inadequate ventilation (s.4) - - - - Ineffective drainage of floor (S 6) - - - - Sanitary conveniences (s 7) (a) Insufficient 3 3 - 3 (b) Unsuitable or defective 24 24 - 17 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to outwork) 10 - 10 - Total 37 27 10 20 18 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 320 Household linen 2 Curtains & furniture hangings 1 Unbrellas 1 Artifical flowers 15 Paper bags 4 Cardboard boxes 23 Brushes 23 Boxing, carding of buttons 6 Christmas crackers & stockings 20 Lamp shades 1 68 visits were made during 1961 to outworkers' premises. No contraventions were reported. Shops Inspections of shop premises under the Shops Act, 1950 have been carried out during the year. Also, observations have been made during week ends and in late evening to ensure that the regulations are complied with. Modernisation of many shop premises has taken place during the past year. Some departmental stores now take advantage of the High Court decision given in the Brighton Corporation v. Fine Fare Ltd. case recently and open all day Thursday (Wednesday in Harringay), closing all day Monday. Inspections 1726 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 has been maintained. 1957 male assistants and 2563 female assistants, and 132 male and 299 female young persons were employed at the premises inspected. During the year the following contraventions were noted Section 17(2) Assistant weekly half holiday notice not exhibited 99 Section 32(2) Record of hours of employment of young persons not maintained 28 Section 32(3) Abstract of provisions of employement of young persons not exhibited 26 Section 37(2) Notice re. seats for females not exhibited 81 19 General Closing Hours Section 2(1) Failing to close at prescribed hour 1 Weekly Half Holiday Section 1 (1) Shops not closed at 1 p.m. 6 Section 1(2) Alternative closing notices not exhibited 18 Section 13(1) Exempted trade notices not exhibited 45 Section 1 Sale of unscheduled articles 1 Sunday Trading Section 22(3) Record of hours of employment not maintained 1 Section 57 Exempted trade notices not exhibited 24 Section 47 Sale of unscheduled articles 13 Middlesex County Council Act, 1944: Street Trading Twenty-three trading sites were licensed. One site was not re-allocated on surrender of the licence. Seven warning letters were sent and three prosecutions taken for unlicensed street trading. In connection with infringements recorded above, 79 re inspections were made and 22 formal notices served. Fabrics (Misdescription) Act, 1913 The Fabrics (Misdescription) Regulations, 1959 Inspections carried out at premises selling fabrics and/or articles of clothing 212 Some improvement has been noted in the number of shops stocking flareproof materials and clothing, but these articles still remain much more expensive than traditional materials and consequently are in much less demand. Prosecutions Shop Act, 1950 and Middlesex County Council Act, 1944. Offence Section Fine Costs Total Case 1 Gale of packet of detergent on Sunday 47 £1. 0. 0 £1. 1. 0 £2. 1. 0. Case 2 Failing to close motor car showrooms on Sunday 47 Discharged £2. 2. 0. £2. 2. 0. Case 3 Failing to close on weekly half holiday 1 £2. 0. 0. £2. 2. 0. Sale of tea on weekly half holiday 1 £2. 0. 0. - £8. 2. 0. Failing to exhibit notice 13(1) £2 0 0 - C/Fwd. £7. 0. 0. £5. 5. 0. £12 5. 0. 20 Prosecutions (Conued.) Shops Act, 1950 and Middlesex County Council Act, 1944 Offence Section Fine Costs Total B/Fwd £7 0 0 £5 5 0 £12 5 0 Case 4 Sale of Custard powder on Sunday 47 £1 0 0 £2 2 0 £3 6 0 Failing to exhibit notice 47 Discharged 4 0 Case 5 Sale of soap pads and disinfectant on Sunday 47 £5 0 0 £1 1 0 £6 1 0 Case 6 Sale of evaporated milk and oats on Sunday 47 £10 0 0 £5 5 0 £15 5 0 Case 7 Sale of hair shampoo on Sunday 47 £2 0 0 £1 1 0 £3 1 0 Case 8 Employing young persons more than maximum permitted hours 27 £8 0 0 £2 2 0 Working young persons without a break 27 £4 0 0 £17. 2. 0. Failing to keep records of hours worked by young persons 27 £3. 0. 0. Case 9 Unlicensed street trading 320 & 10 0. 10. 6. £1. 0. 6. 329 Case 10 Unlicensed street trading 320 & £1. 0. 0. - £1. 0. 0. 326 Case 11 Unlicensed street trading 320 & £1. 0. 0. - £1. 0. 0. 329 £42 10 0 £17. 10. 6. £60 0. 6 Rag Flock & Other Filling Materials Act, 1951 There are no establishments licensed for the manufacture of rag flock. At 31st December, 1961 there were 19 premises registered for the use of filling materials. Pet Animals Act, 1951 At 31st December, 1961, 11 premises were licensed as pet shops in accordance with the Pet Animals Act, 1951. Middlesex County Council Act, 1944: Part XII Seven establishments were registered for chiropody and special treatment, at 31st December, 1961. 21 CLEAN AIR ACT Smoke Control Areas The second smoke control order came into operation on the 1st September, 1961, and the emission of smoke in an area along the southern portion of the Borough is now controlled. A third Order which was made by the Council on the 23rd November, 1961, received the confirmation of the Ministry of Housing and Local Government on the 8th February, 1962. When this comes into operation on the 1st November, 1962, another 8441 dwellings will be restricted from causing the emission of smoke. The Order also affects 119 factories, 544 shops and 37 other buildings. It will be seen that the Council are resolved to do everything in their power to ensure that progress shall be as rapid as possible in their programme to make the whole of the Borough a smoke control area. The ill-effects of atmospheric pollution upon the health of the community is fully appreciated. Health statistics clearly show that chest diseases such as bronchitis and lung cancer, are much more common in the urban areas where atmospheric pollution is heaviest. For this reason alone, the expenditure of public funds in making grants towards the adaptation of fireplaces to enable smoke less fuels to be burnt is a wise investment for the future. Furnace Installations Fourteen notifications under section 3 of the Clean Air Act, 1956, were received and examined of proposals to install industrial furnaces. In two cases formal approval under sub-section (2) was requested and this was agreed to in both cases. In December 1961, with the co-operation of the Tottenham Chamber of Commerce, a circular letter was sent to industrialists reminding them that the seven year exemption in respect of existing buildings and equipment will expire on the 5th July, 1963, and that any necessary alterations should be undertaken at an early date. Investigation of Atmospheric Pollution The Council agreed to take part in the national survey into atmospheric pollution which is being conducted by the Department of Scientific and Industrial Research. For this purpose the number of sulphur dioxide and smoke recorders in the borough has been increased to three. These are sited one in the North at Devonshire Hill Branch Library one inthe South at Markfield Secondary Modern School and one centrally at the Tottenham Technical College. 22 ATMOSPHERIC POLLUTION RECORD, 1961 Month St Ann's Tottenham Technical College Rainfall (ins ) Insoluble Deposit Soluble Deposit Smoke Sulphur Dioxide Monthly Average Highest Daily Reading Monthly Average Highest Daily Reading (Tons per square mile) (microgrammes per cubic metre) January 2.30 6.47 5.78 200 430 140 312 February 2.25 6.51 5.68 160 280 160 417 March 0.10 6.36 2.58 152 320 289 495 April 2.41 7.18 5.62 67 110 172 621 May 0.88 4.93 2.57 39 90 120 192 June 1.31 6.04 3.07 33 60 106 343 July 1.13 4.13 3.00 22 50 62 129 August 2.93 6.38 5.29 23 50 47 114 September 2.15 3.67 3.91 41 110 67 166 October 3.19 6.78 8.19 64 220 110 220 November 3.31 6.80 8.59 144 428 212 446 December 2.91 5.66 6.02 310 608 231 580 HOUSING Action under the Housing Act, 1957, to deal with unfit houses continued throughout the year. Amendments to the housing legislation were made by the Housing Act, 1961, which came into operation on the 24th November. 1961. Apart from the alterations in the provisions as to Government Subsidy in respect of housing accommodation provided by local authorities, the most noteworthy part of the Act is that relating to houses in multiple occupation. Some amendment is also made to the provisions relating to standard grants for improvements, but there is still no power for the local authority to require the installation of the additional amenities. In November the Council decided to support the resolution of the Association of Public Health Inspectors requesting the introduction of legislation empowering local authorities to enforce the improvement of houses, so as to satisfy modern standards of of comfort and convenience, and giving statutory recognition to an improved standard of fitness. Unfit Houses During the year official representations were submitted in respect of areas comprising 205 unfit houses. 162 of the houses were in areas in the north of the borough between King's Road and Whitehall Street. The redevelopment of the area will form the second phase of the White Hart Lane scheme. The other houses were in Tewkesbury Road and Seven Sisters Road and, apart from a small pocket in the north-east corner, forms the final phase of the redevelopment of the Tewkesbury estate. 23 In May, 1961, the Minister of Housing and Local Government confirmed the Council's Northumberland Park Nos. 2, 3, 4, 5 & 6 Clearance Areas Compulsory Purchase Order. Twelve unfit houses were dealt with by individual closing or demolition orders and 41 were repaired following action under Section 9. In 11 instances it was necessary to carry out the repairs in the owners* default at a cost of £480. 0. 0. which was recoverable from the owners concerned. 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 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 but, many tenants probably are under the impression that applications for certificates of disrepair could only be made when the rent increase was imposed originally. Part 1 - Applications for Certificates of Disrepair (1) Number of Applications for certificates 24 (2) Number of decisions not to issue certificates 2 (3) Number of decisions to issue certificates (a) in respect of some but not all defects 15 (b) in respect of all defects 7 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 10 (5) Number of undertakings refused by Local Authority under paragraph 5 of the First Schedule 2 (6) Number of Certificates issued 14 Part II - Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 5 (8) Objections by tenants to cancellation of Certificates 1 (9) Decisions by Local Authority to cancel in spite of tenant's objection Nil (10) Certificates cancelled by Local Authority 4 Houses in Multiple Occupation Sections 12 to 23 of the Housing Act, 1961 gives local authorities wider powers to control houses used for occupation by more than one family. The Minister is empowered to make management regulations, which the Council may by order apply to houses where it appears that proper standards are not being maintained. 24 Section 36 of the Housing Act, 1957 is replaced by section 15 of the 1961 Act, which includes additional factors which the Council may consider when deciding whether action should be taken to require works to be carried out to render the premises suitable for multiple occupation. The Council have adopted the following code with a view to standardising procedure under this section. STANDARDS OF ACCOMMODATION FOR HOUSES IN MUTIPLE OCCUPATION 1. Natural and Artificial Lighting. -Every habitable room being a room used or suitable for use for living or sleeping purposes, shall be provided with one or more windows in the external walls of the room and having an aggregate area clear of the window frame amounting to not less than one tenth of the area of the floor of the room. Every kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage shall, where practicable, be provided with one or more windows in the external walls and adequate to provide a reasonable degree of natural lighting therefor. Every habitable room and every kitchen, scullery, bathroom, water closet, staircase, landing, corridor andpassage shall be provided with adequate means of artificial lighting which shall be available during the hours of darkness and the means of operating such lighting shall be readily available to all persons properly within the said habitable room, kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage. 2. Ventilation. - Every habitable room shall be provided with one or more windows which can be opened directly into the external air to an extent equivalent in aggregate area of not less than one twentieth of the floor area of the room. Every kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage shall be provided as far as practicable with one or more windows which can be opened directly into the external air sufficient to provide reasonably adequate natural ventilation and where the provision of such reasonable ventilation by means of a window or windows is not practicable there shall be provided adequate permanent ventilation by other approved means. 3. Water Supply. - A sufficient supply of wholesome water for domestic purposes shall be provided on the storey or one of the storeys in which the room or rooms in separate occupation of each family occupying the house are situated. 4. Personal Washing Facilities. - Where the sink and water supply required under paragraph 6 below are shared by members of more than one family or are in a position which does not ensure reasonable privacy to the members of each separate family, there shall be provided within the room or rooms occupied as a separate dwelling, or in some readily accessible separate apartment, a sound and suitable lavatory basin properly connected to the drainage system and provided with a constant supply of cold water at such lavatory basin. 25 5. Drainage and Sanitary Conveniences. -The number of water closets to be provided in a house let in lodgings or occupied by members of more than one family shall be as follows:- (1) One water closet for every four habitable rooms (2) One water closet for every eight persons (irrespective of age) and the number of water closets provided shall be adequate to meet both the conditions of (1) and (2) providing that not more than one w.c. shall be required for one family. The water closets shall be readily accessible to the persons by whom they are intended for use and adequate provision shall be deemed to have been provided only if at least one water closet is situated not more than one floor distant from any room or rooms occupied as a separate dwelling. 6. Facilities for the storage, preparation and cooking food, and for the disposal of waste water. - Adequate facilities for the storage, preparation and cooking of food and for the disposal of waste water shall be provided for any room or rooms occupied as a separate dwelling and such facilities shall include a food store, sink and waste pipe, water supply and utility services. Such facilities shall not be installed on any common landing or staircase and the size of the food store shall be adequate having regard to the number of rooms occupied as a separate dwelling. Where such facilities and utility services are intended to be used in common by members of more than one family separate food storage and cooking facilities shall be maintained for each family. 7. Installations for Space Heating or for the use of Space Heating Appliances. Within every room used or suitable for use for living and/or sleeping purposes there shall be provided: - (1) Adequate fixed space heating convection appliances properly connected to and served by a suitable hot water or other heat transfer medium; or (2) A proper hearth and chimney opening and flue suitable for the reception of a proper and adequate space heating solid fuel, gas or liquid fuel appliance, and where the fuel to be used is gas an adequate proper convenient gas supply; or (3) Adequate and properly positioned number of electric power points. The Council may give directions under section 19 of the 1961 Act limiting the number of individuals who should live in houses in multiple occupation. Locally it has been decided to adopt the permitted number standard as defined in the Housing Act, 1957 with the proviso that where rooms are used for sleeping only and occupied by by lodgers of one sex there shall be provided not less than 55 square feet of floor space per person. 26 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 2 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 Con firmed 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 4.62 5.62 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/ Richmond Road Nos. 1, 2, 3 & 4 200 4.6.57 30.9.58 and 2.12.58 13.5.59 - - Tewkesbury No. 5 4 1.4.58 17.12.58 Demolition Orders - - Tewkesbury No . 6 88 14.10.58 1st: 2.6.59 2nd 15.3.60 8.7.60 - - Tewkesbury No 7 3 14.10.58 - 27.10.59 - - Markfield Redevelopment 1958 50 18.11.58 5.7.60 4.10.60 - - Tewkesbury No. 8 6 30.6.59 Inspector's visit 17.6.60 7.9.60 - - Northumberland Park Nos 2. 3, 4, 5 & 6 58 12.1.60 17.1.61 30.5.61 - - Durnford Street/ Gourley Street Redevelopment 74 12.1.60 (40 Purchased by Agreement) Whitehall Street/ Stanley Grove 86 23.1.61 20.3.62 - - - Church Road/ King" s Road Nos 1 2. 3 & 4 36 23.1.61 20.3.62 - - - Church Road / King's Road No 5 40 23.1.61 20.3.62 - - - Tewkesbury Road and Seven Sisters Road Redevelopment 43 13.2.62 - - - - 27 HOUSING ACTS 1936 & 1957 SECTIONS 9 & 10 WORK IN DEFAULT Year Number of Houses Cost £. s. d. 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 1960 9 543 9 10 1961 11 480 4 8 Premises the subject of Demolition Orders not demolished as at 31st December, 1961 Premises Date of Order 5-8 Union Row 11.8.43 78 Stamford Road 29.1.57 33 Waverley Road 4.11.57 58 Tewkesbury Road 12.5.59 28 Avenue Road 23.10.59 15 Bræmar Road 28.6.60 40 Church Road *26.7.60 33 Tewkesbury Road *28.10.60 35 Tewkesbury Road 28.10.60 37 Tewkesbury Road *28.10.60 39 Tewkesbury Road 28.10.60 72 Tewkesbury Road 1.3.61 74 Tewkesbury Road *1.3.61 10 Langham Road *1.3.61 76 Tewkesbury Road 13.7.61 78 Tewkesbury Road *13.7.61 80 Tewkesbury Road 13.7.61 265 White Hart Lane *28.11.61 * These premises were still occupied at 31st December, 1961 28 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 Sub-Committee. To meet this need arrangements exist for the Housing Manager to forward to the Medical Officer of Health details of housing applications where medical evidence has been submitted supporting the need for rehousing. These cases are then visited and an assessment made of the medical grounds and the amount of priority which could be recommended, special regard being given to the relationship of housing to the 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. When any doubt exists and it is not possible to give unqualified support for medical priority, the facts are placed before the Sub-Committee for their consideration and decision. Assessments of 108 cases were made where applicants had submitted medical certificates in support of their application for rehousing. After investigation the following recommendations were made:- 1. Urgent medical priority justified 18 2. Refer to Committee 27 3. Allow medical points 28 4. Unable to support 32 5. Circumstances changed making further action unnecessary 3 FOOD CONTROL Food hygiene is a matter of prime public health importance and for this reason the public health inspectors continue a careful supervision of all food premises in the borough not only to ensure that premises and equipment are well maintained and also to keep before food handlers the need for a high standard of personal hygiene. Legal proceedings were taken in two instances of persons smoking in food rooms. Following confirmation of the Council's Slaughterhouse Report in 1960 it was anticipated that the appointed day for the application to existing slaughterhouses of the Slaughter of Animals (Prevention of Cruelty) Regulations 1958 and the Slaughterhouses (Hygiene) Regulations 1958, would be the 1st January, 1962. The Minister, however, decided to defer this date until the 1st July, 1962, after considering representations from one of the slaughterhouses, where difficulties were being experienced in bringing the premises up to the required standard. 29 The total number of food shops as at 31st December, 1961 was 1,050, made up as follows:- Bakers 50 Butchers 91 Coffee stalls & cafes 25 Confectioners 332 Dairymen 33 Dining rooms 93 Domestic stores 127 Fishmongers 49 Fruiterers & greengrocers 119 Grocers & provisions 288 Ham & Beef Dealers 4 Off-licences 82 Public Houses 58 Registered Food Premises At 31st December, 1961 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 422 Manufacture and sale of ice-cream 1 Storage of ice-cream 1 Cooking of hams and other meat 35 Fish frying 40 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:- Articles No. of Hawkers Registered No. of Storage Premises Registered Fruit and vegetables 99 87 Shellfish 18 7 Pish 8 4 Ice-cream 5 - Light refreshments 5 1 Peanuts 3 1 Eggs 1 - Groceries 1 1 30 Milk and Dairies Regulations During the year 9 applications for registration as milk distributors were dealt with. No applications we re received in respect of dairies. Of the 9 new registrations, 4 were for new premises and the other 5 were in respect of the change of proprietorship of previously registered premises. The number of premises and distributors registered at 31st December, 1961 was as follows:- No. of distributors 161 No. of Dairies 8 Meat Inspection Close supervision of slaughterhouses has been maintained, notwithstanding difficulties in filling vacancies in the establishment of public health inspectors and the 100% inspection of animals slaughtered has continued as far as practicable. This has been achieved by all inspectors taking part in a duty rota, including evening work and sessions on Saturdays and public holidays. Condemned meat is either incinerated at the Refuse Disposal Works or disposed of through the knackers yard which adjoins one the salughterhouses. Slaughtermen Fourteen men were licensed as slaughtermen, of whom eight were licensed to slaughter horses. SUMMARY OF CARCASES INSPECTED 1961 Horses Cows Calves Sheep & Lambs Pigs excl Sows Sows Goats Number killed 632 78 1,445 4,505 13,458 1,710 154 Number inspected 632 78 1,424 4,505 13,452 1,710 154 All Diseases except Tuberculosis and Cysticercosis Whole carcases condemned 3 5 1 7 8 1 1 Carcases of which some part of organ was condemned 116 34 3 304 1,629 111 18 Percentage of number inspected affected with disease other than tuberculosis and cysticercosis 18.83 50.00 0.28 6.93 12.02 6.55 12.34 Tuberculosis only Whole carcases condemned - - - - - - - Carcases of which some part of organ was condemned - - - - 142 48 - Percentage of number inspected affected with Tuberculosis - - - - 1.06 2.81 - (Note: No case of cysticercosis was reported during the year) 31 Condemned Food Tinned Articles Apricot Pulp 2 Meat Pudding 1 Baby Foods 372 Milk 317 Bacon 3 Pease Pudding 5 Beans & Sausages 2 Pie Filling 5 Beans baked 123 Pineapple Curd 3 Bolognaise 5 Potato Salad 3 Cream 69 Rice 81 Custard 25 Soup 439 Egg - Frozen 1 Spaghetti 72 Fig Pudding 1 Steak Pies 9 Fish 291 Steak Stewed 6 Fruit Cocktail 3 Stew, Irish 2 Fruit Juice 693 Syrup 1 Fruit Mixed 607 Tomatoes 28 Fruit Salad 7 Tomato Juice 2 Jam 1 Tomato Paste 13 Lambs Livers 2 Tomato Puree 49 Lambs Tongues 2 Treacle 6 Lemon Filling 2 Treacle Pudding 2 Marmalade 4 Vegetables 779 Meat Processed 880 Vegetable Salad 1 Other Articles of Food Condemned Bacon 948 lbs. 8 ozs. Mallows 197 lbs. Beverages 1 jar Marmalade 1 jar 4 packets Mayonnaise 42 jars Cheese 18 lbs. Meat 822 lbs. 8 ozs. 8 boxes Meat Paste 184 jars Chickens 36 Mincemeat 1 jar Coconuts 6 Oatmeal 5 packets Dairy Mousse 16 Pears 316 lbs. Dates 70 lbs. Peel 48 packets Doughnuts 1 packet Pickles 7 jars Fish 13 stones Pomegranates 30 Frozen Foods 147 packets Rice 2 bags Fruit dried 197 lbs. Rice-ground 1 cwt. 14 cases Salad Cream 10 jars 56 packets Salmon paste 1 box Fruit Mixed 1 jar Sandwich Spread 3 jars Haricot Beans 112 lbs. Sauce 6 bottles Honey 43 jars Sponges Cream 5 Horseradish 142 jars Suet 92 packets Jam 14 jars Tomato Ketchup 7 bottles Lemon Curd 5 jars Vegetable Mixed 5½ bags 6 boxes 7 jars 32 Legal Proceedings (1) Unsound Food (a) Sale of mouldy pies; plea of Guilty, fine of £5 and £1.1/- costs. (b) Piece of glass in bottle of milk; plea of Guilty; fine of £2 and £2.2/- costs. (2) Smoking in Food Rooms (a) (In butcher s shop) Plea of Guilty; fine of 4.0/- and £2.2/- costs. (b) (In butcher's shop) Plea of Guilty, fine of 4.0/- and £1.1/- costs. 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 1961:- Article No of samples procured Unsatisfactory Milk (various) 38 1 Butter 10 - Bread and Cakes 7 - Coffee 4 - Cream 7 - Drugs 17 1 Pish and Pish Products 42 -- Fruit (fresh) 154 2 Fruit (canned and dried) 6 - Ham; Bacon 3 - Ice Cream 3 - Margarine 11 - Meat and Meat Products 111 - Preserves 7 - Sauce and Pickles 3 - Sausages and Sausage Meat 21 - Sweets 4 - Soft Drinks and Fruit Juices 11 ; Vegetables 17 - Vinegar and N. B.C. 11 - Miscellaneous 16 - Totals 503 4 Commenting upon the unsatisfactory samples, the Public Control Officer makes the following observations:- "Milk. Milk supplied by a large dairy in a third of a pint bottle for consumption by a scholar was found to contain part of a drinking straw. In subsequent investigations it proved impossible to show at what stage the straw had got into the bottle and no action was therefore taken against the supplier. 33 Drug. A sample of cough pastilles labelled "Wild Cherry and C" was found not to contain ascorbic acid and it was alleged that "C" meant Vitamin "C". The manufacturer withdrew the label and substituted one which merely stated "Wild Cherry Pastilles". Fruit. For selling Laxton Bountiful Plums as "Victoria Plums" and for displaying Laxton Bountiful Plums falsely described as "Victoria Plums" a retailer in Tottenham was prosecuted and fined £2 on each of two summonses and ordered to pay £4.4.0d. towards the costs. A greengrocer was sent a caution for selling to the purchaser oranges described as "seedless" which contained substantial numbers of seeds". The Public Control Officer has also furnished the following report upon associated work under other Acts:- "Merchandise Marks Acts, 1887-1953. Inspections were carried out under the above Acts to ensure that the requirements of the various Marking Orders relating to the indication of origin of imported foodstuffs are applied. Inspections were made at 449 premises and a total of 1,821 displays were examined. Minor breaches of the Orders were dealt with by verbal warning. A caution was sent to a butcher who displayed for sale imported beef which bore no indication of its origin. For displaying imported beef labelled "Scotch" and "English" another butcher was prosecuted and fined £5 on each of 22 summonses. He was also ordered to pay £5.5.Od. towards the costs. A letter of caution was sent to a manufacturer who did not mark his butter in accordance with the requirement of the appropriate Order. A butcher who marked two joints of imported beef as "Scotch" was sent a letter of caution. One greengrocer who described by means of tickets citrus fruits as "Jaffa" when in fact the fruit was of Cypriot origin was prosecuted and fined £1. Another greengrocer was sent a letter of caution for a similar offence. Safe Milk. From the 1st January, 1961 the County Council became the licensing authority for the issue of licences to dealers with premises within its area and 161 licences were issued in respect of the sale of milk to which the special designations "pasteurised", "sterilised" and "tuberculin tested" could be applied. The period for which these licences were granted has been extended from one year to five years. One hundred and twenty nine samples of milk were obtained to test that heat treatment and subsequent storage were properly carried out. All were satisfactory. Inspections were carried out at 116 premises to ensure proper compliance with the Milk (Special Designation) Regulations, 1960. Labelling of Food Order, 1953. The labelling of Food Order requires prepacked food to be marked with the name and address of the packer or labeller or to bear a registered trade mark; to be marked with its common or usual name and to bear a statement of ingredients if the food consists of more than one ingredient. It also controls the manner in which the presence of vitamins and minerals is disclosed. 34 In the borough of Tottenham a total of 945 articles were examined at 175 premises. One infringement was disclosed. A tin of fruit juice bore a label which claimed the presence of Vitamin "C" without disclosing the quantity of that vitamin as required by Order. A letter of caution was sent to the manufacturer. Labelling and Advertising Infringements. In addition to the detail given above, a considerable volume of work was done in the period under review, which did not arise from samples procured in the borough of Tottenham, but which had the effect of protecting the residents in each county district. The matters dealt with were in respect of nationally retailed articles of food. Several manufacturers were required to designate the ingredients on labels of Instant Coffee. As a result of a complaint of the taste of a soft drink, investigations made in my Department showed that there was phenolic contamination which arose from a chemical reaction between chlorinated water and phenol formaldehyde stopper. The manufacturer has modified the ingredients of this product to prevent the chemical reaction. The manufacturer of a non-alcoholic wine was challenged on the ground that the description was a contradiction in terms, and the label was amended to non-alcoholic beverage. The importer of a slimming food was challenged on claims made in advertising literature as to the Vitamin concentration, and the literature was corrected. A manufacturer's claim of slimming properties for "reducing perles" was challenged and the product withdrawn. The claim relied on the presence of purgatives and bladderwrack. The slimming claims made for a lemon juice in a television advertisement were modified after the manufacturer had been challenged as to the efficiency of the product as a slimming agent. Modifications to the labels of several brands of canned chicken were secured, where it was not apparent from the label that the contents of the cans were not solely chicken, but chicken in jelly or broth." CONTROL OF DISEASE The incidence of serious notifiable diseases during the year was low. There were no cases of poliomyelitis. Altogether 1,952 notifications were received, compared with 791 in 1960, but this increase was due to the normal biennial epidemic of Measles, which accounted for 1,722 notifications. Tuberculosis There were 58 notifications of new cases, the lowest recorded for this disease in Tottenham. Fifty of these (41 males and 9 females) had lung infections, and the remaining eight (5 males and 3 females) had involvement of the meninges in 1 case, lymphatic glands in 3 cases, peritoneum in 1 case, axilla in 1 case, endometrium in 1 case, and kidney in 1 case. There were only 5 deaths from this disease. 35 Distribution of New Tuberculosis Cases and Deaths in 1961 Age Groups 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 „ 2 - - - - - - - 10-14 „ - 1 1 - - - - - 15-19 „ - 1 - - - - - - 20-24 „ 3 3 3 2 - - - - 25-29 „ 6 1 1 - - - - - 30-34 „ 2 - - - - - - - 35-39 „ 2 2 - - - - - - 40-44 „ 5 - - - - - - - 45-49 „ 5 - - - - 1 - - 50-54 „ 3 - - - 1 - 1 - 55-59 „ 3 - - - - - - - 60-64 „ 3 1 - - - - - - 65-69 „ 4 - - 1 - - - - 70-74 „ 2 - - - - - - - 75 years and over - - - - 1 1 - - Total 41 9 5 3 2 2 1 - Changes in the Tuberculosis Register During 1961 Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1961 Add 824 648 83 103 1,658 New cases notified in 1961 41 9 5 3 58 Transfers into Borough 31 15 1 2 49 Restored to Register - - - 1 1 896 672 89 109 1,766 Deduct Transfers out of Borough 14 18 - - 32 Deaths 16 2 2 - 20 Recovered Cases 17 27 1 - 45 Cases lost sight of 16 23 8 6 53 63 70 11 6 150 ^Number of Register at 31st December, 1961 833 78 602 103 1,616 36 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1961 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 10,760 106 12 65 8 191 17.8 Park 10,108 75 13 68 14 170 16.8 Coleraine 11,198 71 7 53 8 139 12.4 West Green 10,597 54 1 54 10 119 11.2 Bruce Grove & Central 10,545 52 3 45 4 104 9.9 High Cross & Stoneleigh 10,491 75 12 52 10 149 14.2 Green Lanes 9,960 100 8 61 13 182 18.3 Chestnuts 10,467 74 6 56 11 147 14.0 Seven Sisters 9,502 74 6 53 7 140 14.7 Town Hall 9,892 75 4 53 10 142 14.4 Stamford Hill 9,960 77 6 42 8 133 13.5 Total 113,480 833 78 602 103 1,616 14.2 Note: To obtain the estimated population for each ward, the Registrar-General's estimate for the Borough has been divided in the same proportion as number of persons on the Register of Electors for each ward. Tottenham and Wood Green Chest Clinic Dr. T.A.C. McQuiston makes the following comments on the work of the Chest Clinic during 1961. So far as tuberculosis is concerned the pattern of recent years stays at about the same level in this borough. From the Chest Clinic point of view however, our work does not diminish with the overall decline in the number of new notifications; the function of the Chest Unit here has changed considerably in recent years and ray colleagues and myself find that the chronic bronchitis patient is becoming an ever increasing problem. During the winter months particularly, the beds in the Chest Unit were in very great demand and we did, in fact, have quite a waiting list at one time. The incidence of bronchial carcinoma has, as in many other areas, risen quite steeply and we work in close co-operation with the Thoracic Surgical Unit at the North Middlesex Hospital in the prompt diagnosis and treatment of such cases. The recent nation-wide publicity given to smoking and lung-cancer had its effect here too; we found that in the month following the Commission's Report, our figures for miniature X-rays rose quite sharply, although they seem to have resumed their normal pattern now. 37 Attendances Total attendances during 1961 21,015 Total of new cases sent for diagnosis by G.Ps in 1961 4,517 Those of above total notified as T.B. 87 Those of above total having full examination 2,004 Those of above total having miniature X-ray only 2,513 Total number of new contacts seen in 1961 822 Those of above found to be tuberculous 19 Diphtheria There was one confirmed case of faucial diphtheria which occurred in a boy aged 7 years. The patient was admitted to hospital on the 17th February and was discharged recovered on the 10th April. The child's family had come from Ireland and although the mother stated the children were immunised, no records were available to confirm this. The family were living in very overcrowded conditions, with the mother, father and eight children all sleeping in one room, but there was no spread of infection. Efforts to trace the source of infection amongst school and home contacts proved negative. Poliomyelitis The benefits of vaccination against poliomyelitis are now being reflected in the greatly reduced incidence of this disease. For the second year running there has been no notified case amongst Tottenham residents. Acute Encephalitis There were two cases of acute infective encephalitis notified in 1961, one in a man aged 22 years and the other in a baby boy aged 10 months. There were two cases of post-infectious encephalitis following vaccination against smallpox in a boy aged 11 months and following measles in a girl aged 4 years. Meningococcal Infection There were two notifications of meningococcal infection. Both cases related to babies aged 1 year. Smallpox No case of smallpox occurred in the Borough in 1961. 38 Scarlet Fever The incidence of scarlet fever remained about the average expected in recent years. There were 60 notified cases and the disease continued to be of the mildtype with few complications and no deaths. Measles The incidence of this disease continues to have its biennial cycle, 1961 being a year of high incidence. There were 1,722 notifications compared with 246 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 available. The effects of previous immunisation campaigns are now becoming apparent and only 10 cases were notified in 1961, the lowest recorded for the Borough for any year since the disease was made notifiable in 1940. No deaths from whooping cough were recorded. Food Poisoning There were 21 notified cases of food poisoning and the agent giving rise to the illness was identified in thirteen instances. The causes were salmonella "yphi murium 10; salmonella newport 1; salmonella anatum 1 and staphlococci 1. Dysentery There were only 11 cases of dysentery compared with 66 in 1960. 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 104 candidates for appointment to the Superannuation Scheme were medically examined. Four failed to pass for the reasons below 1. Tuberculosis 2. Chronic Bronchitis 3. Hypertension, Bronchitis and nervous debility 4. Neurasthenia and Varucose Dermatitis 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. 5 cases were recommended for lighter duties 4 cases were superannuated Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1961 in the Borough of Tottenham, classified according to Disease and Age 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 P M F M F Scarlet Fever - - 1 1 2 2 3 3 5 6 9 20 2 3 - 2 - 1 - - - - - - 60 Measles 28 44 82 74 109 123 135 103 129 139 342 344 19 23 4 5 7 11 _ 1 - - - - 1,722 Whooping Cough 3 - 2 - 1 3 1 - - - - - - - - - - - - - - - - - 10 Pneumonia 3 - - - - 1 - - - - - - 1 - 1 - 3 3 2 1 4 7 8 5 39 Erysipelas - 1 - - - - - - - - - - - - - - 1 1 - - - 1 1 - 5 Pood Poisoning 1 - - - - 1 - - - 1 3 4 - - - - 1 4 - 1 1 3 - 1 21 Puerperal Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorun - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infective 1 - - - - - - - - - - - - - - - 1 - - - - - - - 2 Post-infectious 1 - - - - - - - - 1 - - - - - - - - - - - - - - 2 Acute Poliomyelitis Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Non-paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - 1 1 - - - - - - - - - - - - - - - - - - - - 2 Diphtheria - - - - - - - - - - 1 - - - - - - - - - - - - - 1 Typhoid - - - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery - 1 - 1 - - - - 2 - 1 1 1 - - - - 1 - 2 - 1 - - 11 Scabies - - 1 - 1 2 - - 2 1 - 3 1 1 2 1 3 1 - - - - - - 19 Tuberculosis Respiratory - - 1 - - - - - - - 2 - - 1 - 1 11 4 7 2 14 1 6 - 50 Meninges & C. N. S. - - - - - - - - - - - - - - - - 1 - - - - - - - 1 Other - - - - - - - - - - - - 1 - - - 3 2 - - - - - 1 7 Total 37 46 88 77 113 132 139 106 138 148 358 372 25 28 7 9 31 28 9 7 19 13 15 7 1,952 39 40 OLD PEOPLE' S WELFARE For many years to come there will be an increasing proportion of aged persons in the community, partly as a result of the high birth rate in the Victorian and Edwardian years and partly because of the advances in medical science which have considerably lowered the death rate. In the underdeveloped countries, apart from the very high mortality in children, the death rate is about the same in each of the other age groups. In developed countries such as this it is rare for a child to die and the maximum death rate is in the seventy-five year old region. Today most people live their three score years and ten and more, but unfortunately are not always able to avoid increasing frailties of the flesh. Sooner or later, despite a vigourous spirit of independence, they need assistance from their relatives or from public or voluntary agencies concerned with their health and welfare. In addition to diminishing faculties many old people find it extremely difficult tomaintain a reasonable standard of life and the chief cause is lack of money, and this shortage influences their diet, their housing, their clothing, and their personal pride. In Tottenham various services have been created under the auspices of the Old People's Welfare Committee, the Women's Voluntary Service, and many other voluntary organisations, to give help to the needy senior citizens of the Borough of Tottenham, Retirement Advice Clinic In this country more than five hundred men a day reach the age of retirement and most of these are obliged to leave their work to fit the requirements of pension or superannuation schemes and rarely because they are no longer able to continue their job with efficiency or because of ill health, or failing powers. Very few, in fact, want to give up work. For one thing, the pensions to which they have been subscribing for many years and which on the basis of the original contract would have kept them comfortably, have been prejudiced by inflation and the steadily falling purchasing power of the pound over the last twenty or thirty years. Again, the men and women of this age group were brought up to consider that independence was a virtue and most of them have a deep aversion and sense of shame about claiming National Assistance to assist their pensions. It is becoming increasingly clear that very few men in particular make any preparations whatsoever for their retirement, on the whole preferring not to think of it at all, or if they do, think it might be rather a pleasant holiday. Few seem to realise it is going to be one of the biggest and most important changes in their lives. And when the day comes, their workmates give them a cheer and present them with a clock or some other token, and when they have been at home two weeks they are often miserable and bored, not knowing what to do with themselves all day long. It is easy for a decline in morale and self respect to set in. 41 Preparation for retirement should ideally begin years before as it is notgenerally possible late in life to cultivate new interests and skills. These have to grow from small beginnings. Every man should have some personal interest in life in addition to his work and his immediate family affairs. It matters little what this is, be it bowls, politics, church activities or absorbing hobby, something in which he is interested and can be cultivated to fill the larger place in his life after retirement from full-time work. In many parts of the country both voluntary bodies and enlightened local authorities have tried to get to grips with this problem and the national press radio and television have pointed to the necessity for more understanding. At the end of 1960 a Retirement Advice Clinic was started in Tottenham, to assess the health of and give advice to men approaching retirement under the direction of my deputy (Dr. Wright). His clinic has been running steadily now for over a year. Here in an unhurried atmosphere it is possible to discuss individual problems (social, financial, welfare, health, diet) and interests, followed by a full medical check-up. The interview and findings are reported to the retiree's own doctor, but no treatment is undertaken. The year's findings endorse the fact that most men hope to find some alternative full or part-time work and also throw light on the general reluctance of employers to take them. Also, many have minor indispositions of which they were unaware, or which did not trouble them very greatly. Advice for retirement is as necessary as school is for children. Laundry Service for the Incontinent Aged The service is provided under section 84 of the Public Health Act, 1936, and in 1961 843 collections were made by the Public Health Department, an increase of 143 over the 1960 figure. 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 6,500 books were delivered in this way and 62 infirm old people are now receiving this service. 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. 42 OLD PEOPLE'S WELFARE COMMITTEE Visits and General Welfare There are now 2,350 old people registered for periodical visiting, an increase of 3 50 over the previous year. An essential part of the service is visiting where the patient does not have a family, as often a seriously ill person cannot be admitted to hospital and has to be cared for until admission can be arranged. Many also need a watchful eye kept on them, but it is not always possible to visit as often as one would like. During the year 946 visits were made by the Organiser and her assistant and 264 visits were made by voluntary workers. In addition social calls made by voluntary helpers are of great value and are very much appreciated by those visited. Many pensioners bring their problems to the office and during the year 2,304 interviews have been conducted. Meals-on-Wheels The work undertaken by the Committee has shown a great increase during the year, and meals are now distributed on five days each week, making a total of approximately 250 meals delivered weekly. 122 new applications were received for this service and 11,651 meals have been delivered, an increase of 3,567. In addition the Women's Voluntary Service delivered 1,026 meals before the rounds were taken over by the Committee in July. This service is dependent upon voluntary workers, who deliver these meals and a friendly relationship is established which facilitates the introduction of other welfare services should the need arise. More helpers are needed for this work however if the work is to be effectively maintained and the steadily increasing demand is to be met. A small van purchased during the year for the use of the Committee has proved very useful in the delivery of meals. Chiropody Service The Chiropody Service is at present still operated by this Committee with grants from the Middlesex County Council. During the year 1,035 old people received foot care at clinics and 4,442 treatment were given. New equipment has been installed at two of the clinics, so that a better service can now be given and voluntary receptionists do much to assist the old people at the clinics. The waiting time between appointments has been reduced from sixteen to ten weeks and it is now possible to give new patients appointments within two weeks of their names being added to the list. Domiciliary Chiropody Service has been increased by two sessions during the year and 30 patients are now seen each week. The total amount of treatments given during the year were 1,432, an increase of 517 on last year. 43 Clubs The four clubs continue to flourish, and there is now a total membership of approximately 520. Each club enjoyed the summer outings and Christmas parties. The Entertainments Committee arranged concerts for each of the clubs. Meals are served at the St. Ann's Memorial Hall and the Lord Morrison Hall clubs twice weekly, and during the year a total of 8,393 meals were provided. Holidays and Outings During the year 190 pensioners enjoyed a week's holiday at holiday camps, the first party being in May to Dymchurch followed by another in September to Minster. The cost of the holidays were approximately £5.15.0d. including return coach fare from the Town Hall, payments were made each week to the office to cover the cost of this. With the co-operation of the Women's Holiday Fund 50 pensioners were able to enjoy a holiday by the sea at a minimum cost of £4.10. 0d. per fortnight including fare. Many outings have been arranged for the housebound, due to the generosity of local organisations. The ladies of the Inner Wheel arranged an afternoon tea and entertainment on two occasions, and due to the generosity of Messrs. Ardleys and the legacy received from the late Mr. Tant it was possible to give an afternoon drive and tea to sixty-eight housebound people. A Christmas much generosity was shown to pensioners. The Prince of Wales's Hospital arranged for lonely old people to attend a pantomine and tea on Boxing Day. Local residents also showed hospitality to many old people and two local schools arranged for parcels to be taken to those who were unable to go out. Harvest Festival Local schools and churches again, very kindly gave their harvest festival produce for distribution to the old people, and a total of 650 parcels were packed and delivered to the sick, housebound and club members. Christmas Parcels Approximately 1,500 parcels were packed and delivered by voluntary effort to those who were housebound or over eighty years of age. Optical Service This service proves very helpful to housebound people and 30 housebound people were visited. Shoe Repairs Unfortunately pensioners do not appear to take advantage of this service, and only 3 dockets were issued during the year. 44 Barber Service This has proved another very useful service, and during the year the barber attended 105 old people in their own homes, at the cost of one shilling each. Disposable Bed Pads The Borough of Tottenham Aid in Sickness Fund has made it possible to obtain a supply of disposable pads and plastic sheets to be given whereseriously ill incontinent patients are being cared for by relatives. It is hoped that it may be possible to obtain a further supply of these as they have proved invaluable. GENERAL Health Services provided by other Authorities (a) Hospital:- 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 and clinic. (1) Bearstead Memorial Maternity Hospital with Annexe at Hampton Court (2) St. Ann's General Hospital (3) Prince of Wales's General Hospital with Annexe at Nazeing (Princess Louise Convalescent Home) (4) Tottenham Chest Clinic Out-patient clinics provided at the Prince of Wales's General Hospital areset out on the following page. The Government's Ten-Year Plan for the Reconstruction of Hospitals provides for the rebuilding of the Prince of Wales' General Hospital on the site of the present St. Ann's Hospital. 45 Prince of Wales' 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. - a.m. - - - Genito-Urinary - a.m. - - - - Psychiatric - P.m. - - p.m. - Physical Medicine a.m. a.m. a.m. a.m. a.m. a. me 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. 10.0 a.m. - 10.0 a.m,- 7. 0 p.m. 7. 0 p.m. 12.0 p.m, 12.30 p.m. 4.30 p.m. 7. 0 p.m. Females - 4.30 p.m.- 10.0 a. m. 2.0 p.m.- 10.0 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 46 (b) Personal Health Service The personal health services for the area are administered from the Area Health Office at the Local County Offices, Somerset Road, Tottenham, N. 17. (TOTtenham 4500). (c) Area Welfare Service The welfare service is administered in Tottenham by the Area Welfare Officer, Local County Offices, Somerset Road, Tottenham, N. 17, (TOTtenham 4500). This officer deals with the admission of persons to residential homes provided by the Middlesex County Council. (d) Mental Health The local offices of the mental health service are at the Local County Offices, Somerset Road, Tottenham, N.17, (TOTtenham 4J00). (e) Ambulance Service Ambulances arestationed at the Edmonton Fire and Ambulance Station (ElMonton 55 44), but a vehicle is retained at the Tottenham Central Fire Station for accident and emergency cases. To call an ambulance 999 should be dialled. Public Health Laboratory Service The Public Health Laboratory service provides a comprehensive service for the bacteriological examination of specimens submitted by general practitioners and local authorities. Outfits may be obtained from the Public Health Department where specimens are collected daily by a special messenger for examination at the Hornsey Branch Laboratory, Coppett's Road, N. 10. Collecting times are 3.00 p.m. Monday to Friday and 10.00 a.m. Saturday. A twenty-four hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of work carried out for Tottenham by the Laboratory Service: RECORD OF EXAMINATIONS Throat/Nose Swabs:- Total Specimens 196 Haemolytic Streptococci 3 Negative 103 Faeces:- Total Specimens 212 Shigella 14 Salmonella Typhi-murium 11 Negative 187 Sputum:- Total Specimens 4 Negative 4 Miscellaneous Specimens:- 33 Total number of specimens 355 47 PERSONAL AND SCHOOL HEALTH SERVICES TOTTENHAM AND HORNSEY (Joint Population 210,540) 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 since 1947 and the percentage of hospital confinements was 79.2% compared with 79.6% in 1960. 1961 1960 1959 Live Births (a) Domiciliary 853 799 649 (b) Hospital or Nursing Home 3219 3084 2881 Still Births (a) Domiciliary 7 3 4 (b) Hospital or Nursing Home 52 55 49 4131 3941 3583 Ante-natal Clinics Throughout the year there was much discussion in the press, on television and at conferences, and even in the House of Commons, on "Human Relations in Obstetrics" as a result of an outburst of complaints by women of the way they were treated while having their babies. There were complaints of long waits at ante-natal clinics, impersonal treatment and of being left alone when in labour; also of lack of ordinary respect in the attitude of staff to patients with no consideration for personal feelings. The Ministry of Health issued a circular asking local authorities and hospitals to review their services in the light of these complaints. At all the ante-natal clinics in this area an appointment system exists and efforts are made to reduce waiting time however difficult it may be to do so. An attempt is also made to give each mother a chance to voice her anxieties and to answer Her queries. All are invited to ante natal mothercraft sessions where the health visitor gives informal talks and demonstrations with opportunity to discuss any worries and fears that may arise. The smaller numbers attending local authority clinics as compared to hospital help to avoid the "conveyor belt" atmosphere of which patients sometimes complain. Anxiety is more often associated with arrangements for the confinement and it is necessary to stress that there has been no improvement in the supply of maternity beds in the Area though the demand far outstrips supply. Patients who come late for booking find that the hospitals are already fully reserved and have either to be in the anxious position of depending on the Emergency Bed Service to find them a bed when 48 labour commences or have to arrange to have the confinement at home which may bring them into conflict with their landlord and reluctant relatives. This is a frequent source of worry and an improvement in the situation shows no sign of appearing. Another hindrance to helping mothers to a calm readiness for labour is the language difficulty. There appears to be an increase in foreign-speaking patients at all the centres. It is becoming a practice throughout the country to use an ante-natal record card which is carried by the patient herself - called the co-operation card - to facilitate exchange of information between hospitals, general practitioners, clinics and midwives. This has been introduced in a limited way in the Area and if it is successful it is hoped to extend it to cover all patients. During the year an improvement has been made in the collection and despatch of blood samples. Plastic disposable syringes and bottles are now used. The purpose of the change has been to improve the service for early diagnosis of anaemia during pregnancy. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 61.2% in 1961 compared with 61.3% 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. Ao No P.N. Burgoyne Road 76 246 119 1639 122 23.2 Church Road 73 151 66 970 67 14.1 Fortis Green 101 234 114 1725 118 18.2 Hornsey Town Hall 158 415 142 2791 174 18.8 Mildura Court 63 215 69 1502 71 24.9 Stroud Green 53 189 70 1004 72 20.3 The Chestnuts 156 503 153 2561 154 17.4 Lordship Lane 153 280 111 1630 134 11.5 Park Lane 103 294 138 1512 138 16.0 Totals 1961 936 2527 982 15334 1050 17.5 Totals 1960 923 2416 1082 16151 1094 18.7 Totals 1959 936 2289 1092 15243 1131 17.5 49 Midwives Ante-natal Clinics The following table shows the attendances made during the year: - Midwives' Clinics Number of sessions held Total number of attendances Average attendances per session Burgoyne Road 23 158 6.9 Church Road 23 85 3.7 Fortis Green 21 120 5.7 Hornsey Town Hall 19 252 13.3 Mildura Court 22 168 7.6 Stroud Green 25 336 13.4 Chestnuts 45 675 15.0 Park Lane 96 479 5.0 Lordship Lane 48 181 3.8 Total 322 2454 7.6 Mothercraft and Relaxation Classes The following table shows the attendances at Mothercraft Clinics during the years:- Clinics Number of sessions held Number of new cases Total number of attendances Average attendance per session Burgoyne Road 32 31 139 4.3 Church Road 47 60 255 5.4 Portis Green 49 66 392 8.0 Hornsey Town Hall 38 150 535 14.1 Mildura Court 44 42 184 4.2 The Chestnuts 49 84 482 9.8 Lordship Lane 51 61 369 7.2 Park Lane 52 64 307 5.9 Total 362 558 2663 7.4 Infant Welfare Clinics There is no sign of a diminishing need for the instruction and guidance offered to mothers at infant welfare sessions. There are more young women not long out of school with babies of their own and a greater proportion who do not receive help from their mothers or mothers-in-law. Also there is a noticeable increase in the number of immigrant mothers. The West Indian patients may not understand English ways when they first come but on the whole they are eager to learn and attend the clinics loyally when they are invited. They usually take the advice given and make competent and happy mothers. Their main disadvantage is that as many are single, or have high rents to pay they go back to work as soon as possible and leave the baby with a neighbour or relative. 50 Another group, the Cypriots, also seeks help eagerly and accept advice from doctors and health visitors. These are more difficult to help because of the language barrier though because of this many of them do not work and are able to be full-time mothers and housewives. It is not uncommon for Cypriot wives to be unable to speak English even after many years in this country. Such families form their own little communities and when the young children reach school age they become an education problem. The number of children attending 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. 0. Average attendance per- session Under 1 year Over 1 but under 2 Over 2 but under 5 Burgoyne Road 152 353 5362 646 149 6157 1687 40.5 Church Road 209 261 3584 566 100 4250 1437 20.3 Fortis Green 185 378 5056 627 219 5902 2064 31.9 Hornsey Town Hall 205 597 5962 1003 260 7225 2753 35.2 Mildura Court 104 258 3391 532 45 3968 1373 38.1 Stroud Green 102 270 3116 333 161 3610 1450 35.4 The Chestnuts 203 612 6228 700 223 7351 2129 36.2 Lordship Lane 256 458 6025 944 271 7240 1807 28.3 Park Lane 206 395 4863 739 337 5939 1763 24.0 Somerset Road 148 354 3960 644 281 4885 1121 33.0 Totals 1961 1770 3936 47547 6934 2046 56527 17584 31.9 Totals 1960 1729 3782 45230 7489 1879 54598 17853 31. 6 Totals 1959 1749 3460 46625 8272 1808 56705 18075 32.4 Toddlers Clinics A much smaller proportion of mothers take their children to toddler clinics than to infant welfare clinics. If a special effort was not made to remind them and to specially appoint them the numbers would be even less and yet experience has shown how extremely important this age is in the physical, emotional and social development of the child. The staff at these sessions are convinced of the value of routine inspection at this age and find it clinically rewarding. So many abnormalities, such as speech defects, visual defects, behaviour disorders, mild spasticity, can be detected and improved before undesirable habits become established. Parents of these children fully appreciate the work that staff and voluntary workers put in at the clinics to make the room attractive with toys and posters particularly at Christmas time. 51 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.0 Average attendance per session Burgoyne Road 29 552 534 19.0 Church Road 24 380 348 15.8 Fortis Green 27 420 420 15.5 Hornsey Town Hall 46 635 635 13.8 Mildura Court 50 696 640 13.9 Stroud Green 23 329 329 14.3 The Chestnuts 50 716 709 14.3 Lordship Lane 52 703 702 13.5 Park Lane 24 293 291 12.2 Somerset Road 40 577 531 14.4 Totals 1961 365 5301 5139 14.5 Totals 1960 373 5186 5065 13.9 Totals 1959 378 5043 4946 13.3 Parental Guidance and the Young Child It is being increasingly felt that emotional disturbances can occur very early indeed in the life of the child. The form that such disturbance takes varies with the age of the child. Too frequent crying, disturbed sleep, poor feeding, failure to gain weight in infancy; disturbance in bowel habit and toilet training, nightmares and restlessness in the toddler phase; excessive destruction and temper tantrums in the pre-school years, are all indications that the child may be emotionally distressed. It is becoming increasingly recognised that such disturbances are best helped in the very early formative months and years as soon as signs and symptoms appear. For this reason, the Regional Hospital Board, together with the Health Department of the Local Authority, have made it possible to have one weekly half session of consultant psychiitric time for advisory work with the problems of the under-fives. Its prime purpose is to bring the psychiatric problems of this group to the notice of health workers in this field, and so bring about increasingly early diagnosis and treatment. It is hoped that with growing awareness of their problems and the approach to them, workers in touch with these children can themselves help the distress which results from a disturbed mother/child relationship. This appointment is one of the very few in existence in the country. Dr. Nina Meyer, therefore, has paid visits tc infant welfare, toddler clinics and nursery schools in order to meet doctors, health visitors and teachers who are working with this age group. Discussion and observation during the sessions of normal infant welfare and toddler clinics have resulted in fifteen children being referred by medical officers and general practitioners for investigation, recommendations and treatment. The results have been encouraging. It has now been found desirable to institute a regular under-five clinic, held on Friday mornings at the Lordship Lane medical centre in conjunction with monthly visits by Dr. Meyer to outlying clinics. 52 It is hoped to extend the contacts with workers in this essential aspect of the field of child health. Dally Guardian Scheme There has been a decrease in the number of children minded by the day under this scheme although they have been minded for longer periods as can be seen from the following table:- 1961 1960 1959 Number of Daily Guardians on register 263 197 166 Number of Daily Guardians minding children 103 111 90 Number of children being minded 114 141 106 Total number of children minded during the year 252 297 231 Total number of days minded 30,420 29,128 23,591 Day Nurseries There are three day nurseries in the Area, one in Hornsey and two in Tottenham, provided for daytime care of certain children in the under five years of age group. Intrinsically, admission to a day nursery is based on health grounds, but to ensure that the limited accommodation is used for children in most need, a scheme xs operated to confine addmissions to certain categories. These are children whose mothers are unsupported (i.e. unmarried, widow, etc.) who are anxious to keep their children with them but who must necessarily go out to work, or where the home conditions are in themselves unsatisfactory, or where mother is incapable of undertaking full care of her children so that the children's health is likely to suffer, or where the mother is compelled to work as an economic necessity because the father's net income is below a certain level, or where the child itself is handicapped, being either a deaf, partially deaf, partially sighted child, etc. Certain other conditions must also be observed and these include:- that there are no other satisfactory means of daily minding. that it will not be detrimental to the child's health to be admitted. that the placing of the child is necessary to assist in its support. that any mother desirous of placing her child in a nursery by reason of her employment must be employed for at least 30 hours each week. 53 Certain categories are regarded as priorities and where others are admitted when vacancies permit, children in the non-priority groups may have to be withdrawn. The day nursery service is not a free one and the full charge is 15s.6d. per day. The majority of those making application are unable topay this amount and can therefore be assessed on their income. A Day Nursery Panel is appointed by the Area Health Committee each year to deal with appeals against assessments, refusal to admit and other matters. There are a great many enquiries regarding the possibility of day nursery admission from all sections of the public. Some of these realise the difficulty of securing a vacancy and make other arrangements. Those accepted for admission are encouraged to visit the nursery of their choice with the child before the date of admission. This is in order that the mother may see the nursery matron to discuss details with her and to give the child an opportunity of seeing and mixing with the children before the appointed day. Training of Nursery Nurses All three day nurseries are approved as training nurseries by the Ministry of Health. Six student nursery nurses are appointed each year and attend the Tottenham Technical College on two days each week during term time for theory and further education. Practical training is given at other times in the nurseries. Handicapped Children Five handicapped children have attended Stonecroft Day Nursery, Hornsey, during the year. Two are partially deaf (one of these a child of deaf mutes'), one has multiple handicaps ( is blind deaf and retarded), one other is mentally retarded and the fifth was a child who had motor limitation of one side due to poliomyelitis. Only two of these fit into the local authority's provision for the admission of handicapped children. These two are the partially deaf children. Attendances The overall attendances during the year show an increase above those in the two previous years of 1959 and 1960, and more children in the 2-5 year age group have been accomodated during 1961 than those in the 0-2 years group. The reason for the latter seems to be that vacancies offered in the younger age group have not always been taken up. Waiting List For the first time we have a sizeable waiting list for accepted cases for the Hornsey day nursery. 54 The following table 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 Total Average daily attendances Under 2 2 - 5 Under 2 2 - 5 Under 2 2 - 5 Stonecroft 15 43 18 46 3145 9372 12517 49.3 Park Lane 20 30 17 34 3001 7055 10056 39.6 Plevna 20 30 12 39 3356 6454 9810 38.6 Totals 1961 55 103 47 119 9502 22881 32383 127.5 Totals 1960 55 103 52 112 10890 21273 32163 126.1 Totals 1959 55 103 59 103 9795 20168 29963 117.5 Distribution of Welfare Foods As from 1st June certain changes were made in the arrangements for issuing welfare foods and in particular economic prices were introduced for orange juice, cod liver oil and vitamin tablets. The result of this policy is reflected in the following table:- Year National Dried Milk (Tins) Orange Juice (Bottles) Cod Liver Oil (Bottles) Vit. A & D Tabs (Packets) 1961 30801 67012 10038 9428 1960 32910 99584 12790 12213 1959 36350 98855 11676 11048 1958 39005 104980 12571 10420 Priority Dental Service for Mothers and Young Children Dtntal officers devoted 7% of their time to the inspection and treatment of the priority classes. The number of expectant and nursing mothers inspected remained constant but the arftount of treatment carried out has increased in all categories, and proportionately the number of attendances. This also applies to the children under five. The average number of conservations, i.e. fillings and silver nitrate dressings, was three, and extractions 0.77 per child. In some cases multiple extractions were unavoidable, and seven partial dentures were fitted. Every opportunity is taken to give advice on oral hygiene and diet as preventive measures against dental diseases. Eating habits are formed early in life and can be controlled, and there is no doubt that the excessive consumption of sugar and lack of cire are largely responsible for the deterioration of the teeth of these young children. 55 The following table gives details of attendances made:- 1961 1960 1959 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 158 492 162 539 131 572 Number referred for treatment 156 402 160 459 127 467 New cases commenced treatment 187 359 149 351 127 421 Cases made dentally fit 66 227 46 176 55 178 Forms of dental treatment provided: Teath extracted Anaesthetics: 340 276 243 334 159 369 (a) Local - - - - 68 26 (b) General 33 142 81 179 24 156 Number of fillings 328 911 249 628 220 474 Number of inlays 2 - 2 - - - Scalings and gum treatment 130 - 133 - 90 - Silver nitrate treatment - 285 - 440 - 478 Dressings - - - - 114 162 Other operations 500 476 240 151 10 1 Number of radiographs:- (a) at County Council clinics 10 1 21 1 16 2 (b) at hospital - - - - 1 - Denture dressings - - - - 163 - Dentures fitted:- (a) Full 20 - 24 - 16 4 (b) Partial 42 10 28 5 32 - Number of attendances 884 1159 736 1061 588 872 Number of appointments not kept 279 325 208 216 138 199 Number of half days devoted to treatment 244 194)4 155 MIDWIFERY SERVICE (Section 23) It was reported in 1960 that four midwives were recruited to the service. Unfortunately, early in May three of these resigned. In addition to this, difficulty has been encountered in obtaining accommodation for pupil midwives. Consequently, the number in training in the Area has been reduced from six to four. These two factors seriously depleted our resources and once again increased the work of the remaining midwives. The reduction in the number of pupil midwives is a matter for special regret since their training helps maintain a consistently high standard in the domiciliary midwifery service. 56 The question of increasing the number of midwives is very pressing and a new concept of the midwife's hours of duty must be envisaged. The time of the midwife remaining on duty for 24 hours a day must go for with the increased pressure of work fatigue becomes an increasingly important factor. It is becoming more and more obvious that a day and night service is required. During 1961 the number of midwives varied between six to nine and 842 women were delivered, 14,795 post-natal visits were paid and there were 160 early discharges from from hospital who received 1,439 visits. Because of the shortage of staff it became necessary to refuse to take all the early discharges the hospitals wished to send home and the majority of the 160 mentioned are patients booked for home confinements and sent to hospital for delivery by the midwife. There is a large and seemingly increasing number of pregnant women who move into the Area almost at term, having made no prior arrangements for their confinement. These women must be delivered at home or sent to hospital by their general medical practitioner through the Emergency Bed Service Scheme, The latter is often found to be impossible and when there is delay in obtaining a bed the midwife must undertake the delivery. In spite of pressure of work the midwives have continued to attend their ante-natal clinics and also to attend at clinics held by several general practitioners. These clinics make valuable contact between doctor, midwife and patient. The table is given below showing the work for the past three years. 1961 1960 1959 Number of deliveries attended 842 792 640 Number of visits made 14795 15223 13572 Number of hospital confinements discharged before 14th day 160 143 231 Number of visits made 1439 1288 2424 Number of cases in which medical aid was summoned 265 282 287 Number of cases in which gas and air analgesia was administered 402 508 470 Number of cases in which pethidine was administered 510 481 418 Number of cases in which trichloroethylene was administered 380 189 121 Number of cases in which gas and air and thylene were administered 11 32 - HEALTH VISITING SERVICE (Sections 24 and79) The establishment of Health visitors/school nurses remained fairly stationary during the year as it had acquired the maximum number of staff allowed for this Area. The fraction (four elevenths) which is cast as the proportion to be included in the establishment f6r each student health visitor did not affect the number of health visitors here since no sponsored student was engaged. 57 The health visitor's function under the National Health Service Act is to give advice as to the care of young children, persons suffering from illness, expectant and nursing mothers, measures necessary to prevent illness and the spread of infection. Illness includes mental illness and any injury or disability requiring medical or dental treatment or nursing (Section 79). Since by this definition the health visitor is required to give advice (and not treatment) she has become engaged in the promotion of a healthy home background for an infinite number of families and persons whatever their environment may be. Social problems of all kinds arise in the course of home visiting and the health visitor is at the focal point to give advice and to guide the necessitous to those services or agencies which can render immediate or suitable help. The work of the health visitor was considerably extended by the Act to include the care of the whole family. One tends to think of the family unit as father, mother/ and children, but the health visitor is also called upon to visit persons unattached to a family as far as housing is concerned. Many of such cases live alone and are referred to the health visitor by hospital almoners family doctors and others. The increase in the number of such referrals shows a greater awareness of the need to provide adequate care in the home where the extrinsic patient becomes a member of the community again and whose rehabilitation is often incomplete. This mixture of advice on social and health matters given by the health visitor cannot be separated in the field work of home visiting and is recognised by all who seek her help. The actual number of home visits made by health visitors this year was as shown in the following tables:- Number of visits paid by Health Visitors working in the Area 1961 1960 Expectant Mothers First Visits 1796 2084 Total Visits 3120 3436 Children under 1 year of age First Visits 4737 4837 Total Visits 12997 15295 Children aged 1-2 years Total Visits 6704 7090 Children aged 2-5 years Total Visits 10524 11526 Other cases Total Visits as Health Visitor 6102 6219 - Total Visits as School Nurse 978 776 Home visiting figures have dropped slightly this year. This is due to more time being spent on individual visits, particularly those referred from outside the department. Health visitors have also attended Claybury Hospital on Mental Health courses in time which would otherwise have been devoted to health visiting. Health Visitor's attendance at Hospital Paediatric Clinics As in previous years, a health visitor has attended two paediatric clinics each week at the Prince of Wales's General Hospital. Her function there is to be present with the Consultant Paediatrician and to give him information as required of the home conditions or past history of cases known to her. Where particulars are not known, 58 information is passed on to the health visitor concerned so that she may provide a report for the Consultant if necessary. This arrangement of health visitor attendance keeps the health visitor informed of the cases which need particular advice and support and each can be followed up more closely. In our experience it is useful to have a rota of health visitors to undertake to be present at these clinics to take part and to be known in the hospital. Special Services Health Visitor s Reports Miss Spooner in Tottenham takes over families with special difficulties and gives them intensive attention and guidance. Her report on the work during the year is as follows: - "As previously reported, most of the families which come under my care have one or other parent either suffering from mental ill-health or are of low intelligence. There are the people who have too many children that they are incapable of managing, but it does not necessarily follow that these children are unintelligent; given help and opportunity, as they grow up these children often have a marked upgrading influence on their parents. The voluntary associations have helped a great deal in giving the children extra activities outside school and home. This year seven children had holidays with the W.V.S. at the seaside or in the country where they made good friends and very much benefited from living in a good normal home with other children of their own age. This year Highgate Camp increased its number of Tottenham boys to four, and thanks to kind help from the Rotary Club, this wonderful camping holiday was very much appreciated and enjoyed by the four boys who went. It does help these boys tremendously. In one case particularly there was an impending Court cast postponed to allow the boy to keep the camping fixture and to have one more chance, there has been a great change of outlook of this boy, there has been no Court case and no further trouble reported since he returned from camp in August. This year ten children had a seven week holiday at the Save the Children Holiday home - Hill House, near Kelvedon, Essex. All these children very much benefited from staying in this lovely country House in its own grounds with all the play facilities, etc. They all gained at least 41bs. in weight while there, andparents reported that it had benefited them in many ways. It was also a great help to the parents and was appreciated. Also this year with generous help from the Mayor's Fund in Tottenham, I arranged an outing to Walton-on-the-Naze in the summer and to Bertram Mills Circus and the Wembley Ice Show at Christmas. These outings are very much enjoyed as well as providing an ideal opportunity for a general clean up and improvement in relationships. I think as with all members of society, a day's outing away from the household chores helps these mothers to go back with a better outlook to the daily routine. I certainly feel these outings are of benefits to both mother and children. Over the two years I have been visiting problem families all the families visited have kept out of serious trouble and are considered to be less a nuisance to all around them than they were before, so that I do feel with concentrated visiting and the building up of a relationship with families that do need help (although they do not always realise it not will seek it for themselves) has had some effect in keeping families together, and slowly improving standards." 59 Health Education The health visitor's advice is now generally known as being part of the health education programme. It can be given individually in the home or elsewhere on any matters relating to health including the passing on of information connected with changes in prophylactic measures such as immunisation and mental health. Industrial and commercial concerns are very much aware of this function of the health visitor and seek to engage her interest and recommendation for their various commodities. The total number of attendances madebyhealth visitors at clinic sessions provided by the local health authority during the year was 4,550. Group Medical Practice Centre The record of attendances mentioned above does not include those at a local centre for group medical practice. Miss Marriott, the health visitor concerned, is present on two sessions each week, to give advice to those who need it. One of these is an infant welfare session. At the other there are some mothers attending for ante-natal care and a mixture of all other age groups as at a doctor's ordinary surgery. The health visitor makes known the voluntary and statutory services and puts them into motion as required. She also undertakes home visiting for certain cases and refers the others to her colleagues covering districts on which the patients' homes are situated. Health education in welfare centres throughout the Area continues all the time. Parents are quick to recognise that the health of their offspring is more important than anything else. At all the infant welfare sessions a health visitor is present to discuss the child's progress, to give advice on general care, behaviour and feeding and to refer for further advice where this seems to be adviseable. Group Teaching Parentcraft and Relaxation Classes are held in the majority of welfare centres and are attended mainly by expectant mothers. A health visitor is present to be in charge of relaxation instruction and to promote discussion on a variety of subjects dealing with pregnancy, confinement and various matters connected with the upbringing of children. Midwives also attend certain of these sessions as part of the team and 'specialise in subjects such as the preparation for confinement and the use of analgesia labour. There appear to be more mothers referred to these classes by family doctors than formerly. Health Education in Schools and School Clinics Health visitors in this Area are appointed as health visitors/school nurses. In this dual capacity trained health supervision is given to children from birth to school leaving age. Mich of the school nurse's work is, however, undertaken by clinic nurses as auxiliaries to the health visitor. Attendance at specialist and minor ailment clinics, following up defaulters from school clinics, routine medical inspections and hygiene inspections in schools is part of the work of the school nurse. A'full time school nurse, Mrs. Hurrell, is also provided for the School for the Physically Handicapped. 60 Group discussion as part of health education in schools is undertaken by health visitors and one school nurse. All these have special training and aptitudes for enlightening young teenages on the principles of healthy living. The aim is to make these occasions easy and informal so that these young people are free to ask questions as they will. Pupils take part in the demonstrations, the use of visual aids and discussion on a film or film strip. Many pupils keep their own written and illustrated books as a record of the matters discussed. This activity appears to be very much enjoyed by the school children. Many girls, too, make an opportunity to speak alone to the health visitor/school nurse about personal matters. Two hundred and fifty-six classes of this kind were held in schools during 1961. Visiting the Aged Much of the work of home visiting in the Area is undertaken by the Old People's Welfare Associations of Hornsey and Tottenham. The visiting of the elderly by health visitors falls mainly into two groups. The first is those aged people who are referred by hospital almoners and family doctors who ask for social visits to be made following hospitalisation or illness. Most of these are elderly people who are unable to care for themselves properly and may be an anxiety to their relatives or neighbours or may be expected to return to hospital at a later date. The second group are those who are reasonably healthy, housebound and limited by reason of their advanced years from doing as much for themselves as formerly and who need the various services available explained to them and arrangements made to put them into effect when they are acceptable. Visiting following application for Recuperative Holidays At these visits health visitors are mainly concerned with the arrangements to be made for the care of children in the absence of the mother and in certain cases to see that the plans for travelling and other details are known and possible. Mental Health Case Conferences Dr. J.C. Sawle Thomas, Consultant Psychiatrist to the Prince of Wales's General Hospital, Tottenham heard cases presented by health visitors at monthly intervals until August. His counsel and help sustained members of the health visiting staff in their handling of special cases. It is hoped to be able to re-establish these case conferences when health visitors' attendances at Mental Health courses come to an end next year. Talks and Local Campaigns Health visitors have given a number of talks to local groups during the year such as Young Wives' Clubs and youth organisations. They also assisted in the Fire Prevention Campaign in July particularly by displaying posters and demonstration materials and by drawing the attention of the public to them in welfare centres and during home visiting. Lectures on the social aspects of disease were given each term by the Superintendent Health Visitor and the Deputy Superintendent tostudent nurses at the Prince of Wales's General Hospital and the Preliminary Training School. 61 HOME NURSING SERVICE (Section 25) The treatment of cases during the year may be classified as follows-- Injection 845 General nursing care 575 Blanket baths 304 Enemas 173 Dressings 258 Preparation for diagnostic investigation 53 Pessaries changed 53 Wash-outs, douches, etc. 34 Attendance at minor operations 2 Other treatments 50 The sex andage of patients at the time of the nurse's first visit may be classfied as follows:- Age Males Females 0-4 24 18 5 - 15 32 23 16 - 39 70 150 40 - 64 156 413 65 and over 368 1093 650 1697 Cases attended during the year were referred from the following sources;- General Practitioners 1841 Hospitals 489 Chest Physicians 9 Public Health Department 1 Direct 7 The work of this service remains unchanged and staff has been maintained at near establishment level. A good deal of absence through sickness in this service is brought about by the nature of the work which involves much heavy lifting. The hoist is in constant use and mitigates the strain where possible. Nevertheless, there is a constant level of sickness in the service. No special surveys or investigations were carried out in 1961. 62 The following table shows the work of the home nurses during the year:- Type of Case Number of new cases attended by home nurses durirg year Number of cases on register at end of year Number of visits paid by home nurses during year M P Total M P Total Medical 517 981 1498 109 399 508 62439 Surgical 73 102 175 15 25 40 8355 Infectious Diseases 2 3 5 - - - 66 Tuberculosis 17 15 32 5 1 6 2695 Maternal Complications - 4 4 - - - 15 Totals 1961 609 1105 1714 129 425 554 73570 Totals 1960 676 1179 1855 162 471 633 69318 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox during the year was 49.67% compared with 48.7% for 1960. The following table records the number of persons known to have been vaccinated or re-vaccinated during the year by general practitioners and clinic medical officers:- Under 1 year 1 year 2 - 4 Years 5-14 Years 15 years and over Total Number of primary vaccination 2022 244 128 74 122 2590 Number of re-vaccinations - - 21 57 384 462 Immunisation against Diphtheria, Tetanus and Whooping Cough The scheme for immunising children against diphtheria, whooping cough and tetanus using a triple antigen was continued during 1961. 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 to two months. There is provision for following up defaulters to achieve maximum acceptance rates. Parents have the option of taking their children to their own family doctors for immunisation or attending at the clinics, and the following tables show the results:- 63 Age at date of immunisation Number of Children who completed a full course of Primary Immunisation Diphtheris only Whooping Cough only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphtheria Tetanus and Whooping Cough Under One 24 19 12 12 1 1560 One 102 64 25 43 6 1645 Two to Pour 137 44 26 17 11 233 Five to Fourteen 320 12 26 2 30 110 Total 583 139 89 74 48 3548 Number of Children who received at Secondary (Re-inforcing) injection Diphtheria only Whooping Cough only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphteria Tetanus and Whooping Cough Under One . - - - - - One - - - - - - Two to Four 152 8 13 8 7 103 Five to Fourteen 1490 3 5 42 28 115 Total 1642 11 18 50 35 218 Poliomyelitis Vaccination The work of vaccinating persons up to the age of 40 continued to be undertaken both by general practitioners and at the clinics. The following table shows the number of persons completing courses of injections during 1961:- Number of Persons who completed a course of: - Two injections Three injections Children born in the years 1943-1961 3994 3000 Young Persons born in the years 1933-1942 1487 1326 Persons born before 1933 who had not passed their 40th birthday 2319 2809 Others 423 344 Total 8223 7479 In April the Ministry of Health authorised the administration of fourth (reinforcing) doses to children between the ages of five and twelve, and 6,538 children were given such doses. 64 PREVENTION OF ILLNESS, CARE AND AFTER CARE (Section 2 8) Recuperative Holidays The Area Health staff continued to be responsible for dealing with applications for recuperative holidays and during 1961 180 applications were received conmared with 176 the previous year. Of these, 164 were approved. Chiropody Service Following approval of the Ministry of Health to the Local Authority's proposal for the extension of the Chiropody Service under Section 28 of the National Health Service Act 1946, the establishment of chiropodists for this Area was increased to two. Hitherto we had employed chiropodists in the School Health Service for five sessions a week and in February one of the existing chiropodists increased her sessions by two a week to enable a clinic to be established at the Welfare Centre, 162 Stroud Green Road for the treatment mainly of old people. At the end of the year in spite of all efforts it had been impossible to increase the number of sessions further, but early in 1962 another chiropodist was appointed for two sessions a week which enabled a weekly session to be held at the Fortis Green Welfare Centre and another session at the Hornsey Town Hall Clinic, both devoted mainly to treatment of old people. The following table shows the treatment carried out at ail clinics during the year:- Category New cases First attendance during year of old cases Reattendances Total Elderly persons 106 4 341 451 Physically handicapped persons 2 1 2 5 Expectant and nursing mothers 8 - 4 12 Others 4 - 2 6 School children 283 55 1405 1743 Total 403 60 1754 2217 65 DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 2,001, the bulk of the cases comprising the chronic sick, including aged and infirm, who need more or less permanent help. Following the County Council's decision that from 1st April 1961 free Home Help service should be provided for mothers suffering from toxaemia in pregnancy, nine such cases were attended during the year. The total number of domiciliary visits made by the Home Help Organiser and her assistants during the year was 6,095. 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 1960 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) 125 3 128 5 Tuberculosis 14 24 38 28 Chronic Sick (including aged and infirm) 567 1108 1675 1168 Others 142 18 160 33 Total 848 1153 2001 1234 SCHOOL HEALTH SERVICE Area School Population The school population for the Area is 28,708 (10,665 in Hornsey and 18,043 in Tottenham), showing an overall increase of 530 children compared with the previous year. Hornsey Tottenham Primary Schools and Nursery Classes 5 860 9068 Nursery Schools - 202 Secondary Modern Schools 2929 5826 Grammar and Technical Schools 1876 2752 Special Schools - Physically Handicapped - 99 Blanche Nevile School for the Deaf (including Classes for the Partially Deaf) - 96 10665 18043 66 Routine Medical Inspections 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 % 1957 & later 492 487 99.0 5 1.0 1956 1128 1101 97.6 27 2.4 1955 501 492 98.2 9 1.8 1954 310 297 95.8 13 4.2 1953 1261 1252 99.3 9 0.7 1952 1641 1633 99.5 8 0.5 1951 192 190 99.0 2 1.0 1950 473 470 99.4 3 0.6 1949 1585 1575 99.4 10 0.6 1948 788 784 99.5 4 0,5 1947 1074 1069 99.5 5 0.5 1946 & earlier 3478 3470 99.8 8 0.2 Total 12923 12820 99.2 103 0.8 For the second successive year there was an increase in the total number of children examined, but in 1961 there was a small rise (0.4%) in the proportion of pupils deemed to be of "unsatisfactory" general condition. The term "unsatisfactory" itself leaves a lot to be desired, since the assessment cannot be based entirely on objective criteria, but must to some extent lie in the eyes of the beholder. Thus, a child might appear thin to one medical officer, but wiry to another, and be assessed differently in consequence. It needs reiterating, however, that the terms "satisfactory" and "unsatisfactory" apply only to the child's general physique and many a "satisfactory" child is referred to the appropriate specialist for minor defects of sight, hearing and posture. Infectious Diseases in School Children, 1961 Apart frommeasles, which showed the sharp increase anticipated in the alternate year, there were no epidemics throughout the Area in 1961. Poliomyelitis As a matter for encouragement but not complacency, it is a pleasure to record that there were no cases of poliomyelitis in school children in either borough. In July, a 12 year old Hornsey girl was admitted to hospital as a suspected case, but subsequent laboratory investigations confirmed theultimate diagnosis if staphylococcal septicaemia. 67 Dysentery The smouldering infection in a day nursery, which had clouded the summer of 1960, did not recur; and only six cases of dysentery were notified, three from each borough. This shows a most satisfactory improvement over the two previous years; for there were 66 in 1960, whilst, in 1959, 251 cases occurred in Tottenham alone. Tuberculosis Five new cases of tuberculosis, of which four were due to pulmonary infection, were notified in Tottenham during 1961. In each case the source of the disease lay in the home environment, so that an epidemiological survey in the respective schools of these children was not deemed to be necessary. Diphtheria A seven-year old boy was admitted to the Infectious Diseases Unit at St. Ann's Hospital, Tottenham on the 17th February 1961, having presented to his general practitioner on the previous day with acute tonsillitis. Re-examined by his doctor on the day of admission, the boy was found to have a severe infection of his neck glands, despite treatment with penicillin, and suspicions of diphtheria were aroused. On admission to hospital, the diagnosis was confirmed and prompt anti- diphtheriotic measures were instituted. Simultaneously, the school nurse examined the throats of all the children in the boy's school, paying home visits to those who were absent from school on that day. The nurse reported that no other child showed evidence of an inflamed throat, and the subsequent absence of secondary cases confirmed the efficacy of her follow-up. Meanwhile, the patient responded to treatment and, on discharge from hospital in early April, he had made a complete recovery. From time to time during the second half of February, the medical personnel of the public health department were asked to see cases where the possibility of diphtheria had been mooted. Fortunately, in each case the diagnosis could be refuted on clinical grounds; but the episode emphasised the fact that few doctors under the age of 45 year have seen a case of diphtheria in this country. These incidents served to stress how necessary it is to maintain a high level of immunity against this disease in the population, if diphtheria is not again to become epidemic; and, at all clinics in the Area, the immunisation of infants was actively pressed. B.C.G. Vaccination The table following bears record to a year of steady accomplishment in the maintenance of a B.C.G. programme amongst the thirteen-year old population. Much of this work is of routine nature, a considerable chore to medical and clerical staff alike; but there can be no doubt that the pin-pointing of children in contact with tuberculosis, with early referral to a chest clinic for observation or treatment, and the measure of immunity given by vaccination to the remaining pupils, are vital, if unspectacular, forms of preventive medicine. For the second time students from two technical colleges were incorporated in the scheme and there was a gratifying increase in the proportion of those approached who received vaccination (74.2% as against 29.4% last year). 68  School Children Students Total Number % Number % Number % Parents approached 3630 31 3661 Parents accepting 2778 76.5 28 90.3 2806 76.6 Number tested 2622 27 2649 Number found to be Mantoux positive 181 6.9 4 14.8 185 7.0 Number found to be Mantoux legative 2295 87.5 23 85.2 2318 87.5 Number failing to attend for Mantoux reading 146 5.6 _ _ 146 5.5 Number vaccinated (% of those approached) 2281 62.8 23 74.2 2304 62.9 School Dental Service The Area Dental Officer, Miss Hunt, reports the staff consisted of five full-time dental officers, the area dental officer, and sessional dental officers ranging from two to five at times working from five to eighteen sessions per week. One full-time dental officer has reached pensionable age and is re-employed on an annual agreement. The orthodontist undertakes six to seven sessions weekly. The dental surgery assistant situation has been variable. Difficulty was experienced at the beginning of the year as replacements were unobtainable. Later there was an improvement which was maintained. Sick leave of dental officers and surgery assistants on occasions caused some disruption of the service. 16,904 pupils were inspected, being 61% of the school roll, and of these 11,078 (67%) required treatment. 54% of this number received treatment, and made an average of three attendances per child. Our aim is to conserve the dentition, and 14.5 permanent teeth were filled for each permanent tooth extracted for disease. Nevertheless, 57 children were fitted with dentures. Although it was obvious at routine school inspections that a good deal of treatment was carried out by practitioners in the National Health Service, the demand for the services of the dental officers in the clinics was considerable. Broken appointments for all patients amounted to 25%, a further disappointing increase of 3% over those for 1960. Evening sessions numbering 154 were worked and were well attended showing their value. Appointments after school hours are appreciated by older children who may not want to miss lessons. 411 sessions were devoted to orthodontic treatment, and 122 of these were carried out bydental officers. This emphasises the long-standing inadequacy of the orthodontic arrangements, and the urgent need to expand and improve the service. Plans have been approved for the building of a new dental clinic at High Cross, Tottenham, It will have two surgeries, and will be a welcome replacement for the one at the rear of the Town Hall. 69 The following cables show the work undertaken during the year:- DENTAL INSPECTIONS AND TREATMENT Number inspected 16987 Number found to require treatment 11047 Number offered treatment at the County Council's Dental Clinics 10955 Number of pupils treatment commenced 5957 Number of pupils treatment completed 4619 Number of attendances made by pupils for treatment 17605 Number of appointments not kept 4713 Number of half-days devoted to:- (a) Inspection 132 (b) Treatment 2683 Fillings: Permanent Teeth 12128 Temporary Teeth 3956 Number of teeth filled: Permanent Teeth 10430 Temporary Teeth 3629 Extractions: Permanent Teeth 759 Permanent Teeth for Orthodontia 268 Temporary Teeth 3319 General Anaesthetics 1529 Other operations: (a) Permanent Teeth 3975 (b) Temporary Teeth 2837 Number of pupils supplied with dentures 57 Number of crowns or inlays 28 Number of radiographs 160 ORTHODONTIC INSPECTIONS AND TREATMENT Number of pupils inspected 133 Number of pupils found to require treatment 131 Number of pupils commenced treatment (first attendance) 101 Number of cases carried forward from previous year 221 Number of cases discontinued during the year 22 Number of attendances for all purposes 3097 Number of appointments not kept 519 Number of impressions, adjustments and other alterations 3245 Number of pupils treated with appliances 299 Number of fixed appliances fitted 14 Number of removable appliances fitted 252 Number of radiographs 789 Number of pupils treatment completed 60 Number of orthodontic sessions (half-day) 411 70 Ear, Nose and Throat Clinics. In his comprehensive report, Dr. F.P.M. Clarke, the visiting consultant at the Hornsey clinic, remarks that, although there has been a very good average attendance of patients, both at his weekly E.N.T. sessions and the bi-weekly treatment clinics, yet there has been a marked decline in the number of children found with discharging ears. In the treatment of tonsils and adenoids, Dr. Clarke feels these glands should be conserved as far as possible since they form an important protective ring of lymphatic tissue surrounding the entrance to the chest and alimentary tract. He considers that, in the majority of cases, enlarged and infected tonsils and adenoids are the effect of a diseased condition elsewhere, such as sinusitis, and that, therefore, the correct procedure is to seek and treat the cause rather than to remove the effect. Dr. Clarke found that the majority of children attending his clinic suffered from nasal defects, particularly from nasal obstruction. He stresses the need for adequate treatment of this condition if such ills as mouth-breathing, hearing loss, enlarged tonsils and adenoids, sinusitis and chest infections are to be avoided. He points out that the majority of cases readily respond to such procedures as nasal diastolisation and vibration or to colloidal silver packs, without recourse to surgery. Reviewing his fortnightly visits to the Park Lane Clinic, Tottenham, Mr. William McKenzie, F.R.C.S., the Aural Surgeon, comments on how little is necessary or him to do compared with even five years ago, and he feels that the improvement in children s health is more striking in his specialty than in any other. He instances the fact that the chronic discharging ear has nearly completely disappeared and that he seldom sees a child who needs urgent tonsillectomy. That the general standard is so high, Mr. McKenzie attributes to the better housing and the prosperity of the families in the borough. Audiology Unit The team at the Audiology Unit remained in charge throughout 1961 and the table below bears witness to a year of steady expansion. Nevertheless, despite a full number of appointments per session, so that an additional 89 children were seen during the year compared with the previous twelve months, it was still not possible to keep pace with the list of children waiting to be examined. To remedy this, plans were well advanced by the end of the year for the introduction of a second weekly session for, as Dr. Fisch, the consultant otologist, states in his report, no child should wait longer than two weeks for examination of his hearing. Dr. Fisch points out that some of the equipment is still not installed; an unwelcome delay, since without this apparatus it is not possible to carry out speech audiometry. This, in turn, would permit more exact evaluation of the efficacy of a hearing aid in certain cases, andwould allow observations to be made on the usefulness of amplified speech in varying types of hearing loss. As a natural outcome of an expanding unit, an additional burden has fallen on all the members of the team, more especially upon the audiometrician and the peripatetic teacher of the deaf. As the year closed, steps were to be taken for a second audiometrician to be added to the establishment; and Dr. Fisch stresses the need for another peripatetic teacher, whose work must be considered as one of the more important factors in the care of the child with impaired hearing. 71 Additional personnel, however, require adequate facilities and, although the audiology room provides excellent conditions in which to test the children, ancillary accommodation is sadly lacking. For example, the audiometrician has perforce to do her work in the Headmaster's study and, whilst his full co-operation is forthcoming, such an arrangement cannot be considered satisfactory. Moreover, the peripatetic teacher needs a room in which to give the individual tuition so essential for certain children and, as adumbrated in last year's report, the time must come when impressions for ear moulds can be taken, and hearing aids issued, at the unit itself. AUDIOLOGY UNIT 1961 Number of cases seen: Age in years 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17+ Total New cases 6 5 4 6 13 18 21 24 8 16 10 13 8 9 8 4 4 1 178 Re-examinations - 3 2 2 8 8 12 7 - 5 3 7 2 2 2 - 1 1 65 Total 243 Pre-school children 35 Attending Infant and Junior Schools 147 Attending Senior Schools 52 Over five but not at school 9 Reasons for referrals among new children were as follows; For diagnosis 132 Auditory training 2 Immigrants to Area known to be deaf 4 Partially deaf children, advice as to placement 12 Children known to be deaf - application for admission to Blanche Nevile School or partially deaf units 7 Transfer from hospital out-patient departments or E. N. T. clinics 13 To ensure that deafness is not the cause of backwardness or ineducability 8 Source of referrals Tottenham and Hornsey 129 Other boroughs in Middlesex 44 London - neighbouring boroughs 3 Essex 1 Hampshire 1 72 Vale Road School for Physically Handicapped Children Cerebral Palsy Unit Dr. William Dunham, the visiting consultant in charge of the unit, writes that while there has been no major change in the arrangements for the care of children with cerebral palsy at the school, the year hat seen the development of closer collaboration between those working with the children at the school and the consultant in the hospitals visited by the children; there can be no doubt that this will benefit all concerned. Dr. Dunham continues that, as hitherto, special training will be given by the therapist at the school, under the immediate supervision of the visiting consultant, but the closer contact with the hospital concerned will ensure that this training is directed in accordance with the general plan advised at the hospital. Meanwhile, the necessity for the child with cerebral palsy to have help in developing good habits of posture and movement is becoming increasingly widely recognised, and it is hoped that the new arrangements will improve the co-ordination of the efforts of parents, school teachers, therapists and doctors, all of whom have a part to play in providing this help. ANALYSIS OF CASES SEEN AT CEREBRAL PALSY UNIT IN 1961 Male Female Total Under Five years 3 2 5 Five to Ten years 2 1 3 Ten to Fifteen years - - - Over Fifteen years - - - Total 5 3 8 Diagnosis Male Female Total Cerebral Palsy 1 - 1 Cerebral Palsy and Partial Deafness - 1 1 Mental Retardation 3 2 5 Paraplegia 1 - 1 Total 5 3 8 2 CONFIRMED CASES OF CEREBRAL PALSY - ACTION TAKEN Admitted to Vale Road Physically Handicapped School 1 Admitted to Rial Handicap Group at Vale Road Physically Handicapped School 1 1 CASE OF PARAPLEGIA - ACTION TAKEN Admitted to Vale Road Physically Handicapped School and supervised by Cerebral Palsy Unit 1 73 5 CASES OF MENTAL RETARDATION - ACTION TAKEN For report to local health authority as unsuitable for education in school 2 For trial period in day nursery and, probably. Later report to local health authority 1 Under Supervision of Cerebral Palsy Unit 1 Under Supervision of Cerebral Palsy Unit and Audiology Unit 1 Orthopaedic Cases Mr. E. Hambly, F.R.C.S., the orthopaedic surgeon at the Prince of Wales's General Hospital, continues to supervise the physiotherapy of a large number of dystrophy cases at the school who are under the immediate care of Miss Marcus, the physiotherapist. Mr. Hambly emphasises the excellence of her work and her enthusiasm, which has done much to make this unit one of the best of its kind. In conclusion, Mr. Hambly comments on the close co-operation which exists between Dr. Dunham and himself in the running of these quite separate units at the school. Orthopaedic Clinics Once again the orthopaedic clinics in both boroughs have been very well attended throughout the year. 163 new cases of whom 68 were pre-school children, have been seen by Mr. E.G.M. Palser, the visiting consultant who has taken charge of the Hornsey orthopaedic clinic in place of Mr. E. T. Bailey. 527 children were re-examined by the consultant and there were no less than 3,04.0 attendance for treatment by the physiotherapist. An increase in the number of cases of knock-knee seen during the year posed the question as to whether Hornsey children are becoming more liable to this condition, or whether more of the less obvious cases are being picked out by school medical officers at routine medical inspections. A longer period of observation will be necessary before the answer can be forthcoming. Meanwhile, a new appliance for the treatment of spinal curvature has been designed, made and used in a temporary setting. Now that the extension to the Weston Park Clinic premises is completed, the apparatus will be permanently installed. In Tottenham Mr. E. Hambly comments enthusiastically on the full attendances at the Lordship Lane Clinic, being particularly impressed by the frequency with which parents, and often both parents, accompanied their children. This, he feels, reflects a very high standard of living in the borough and the keen interest of both parents in their children's medical welfare. Ophthalmic Clinics As in previous years, the correction of errors of refraction and the diagnosis and treatment of a convergent squint comprised the bulk of the work undertaken by Dr. R. Welch, the visiting consultant to the Hornsey Eye Clinic. In his experience, the commonest error of refraction found in Infants' Schools is "long-sightedness"and, if this is of only moderate severity, when combined with astigmatism, it invariably requires correction with glasses which must be worn constantly. Moreover, the child's general health and progress at school may show remarkable improvement following the correction of a refractive error previously unsuspected. In the secondary school age group "short-sightedness" is the predominating defect and such cases require regular refraction since the condition tends to increase during the years of growth. 74 In the treatment of convergent squint, anew advance has been the used of eye drops causing contraction of the pupil. This has resulted in dramatic improvement in carefully selected cases since, with contracted pupils, the habit of over-convergence for near object is broken. Needless to say, such children require constant supervision by the consultant and, whilst treatment may sometimes be an alternative to surgery, it is usually complementary. Similar eye defects have been the chief concern of Mr. T. Kletz, the consultant at the Tottenham Ophthalmic Clinic. An indication of the value of early investigation in cases of manifest or suspected squint is reflected, he feels, in the statistics of the orthoptic department where the number of cases treated is now less than the number of new cases referred. With recent advances in treatment and investigation of certain types of squint and amblyopia, a number of cases previously considered incurable are now being treated by special techniques. At present, such cases have to be sent to hospital for both investigation and treatment, but in the new year it is hoped to purchase the necessary equipment to enable these techniques to be practised in the clinic. Child Guidance Clinic 1961 saw the appointment of Dr. Nina Meyer, as Consultant Psychiatrist and Miss C. Tibbetts, as Play therapist, to the Tottenham Child Guidance Clinic, which has enabled more children to be seen for diagnostic purposes and to be taken on for psychotherapy. In his report. Dr. Wi11iam Craike, the Senior Consultant Psychiatrist, focuses his attention on the so-called school phobias where, he points out, the anxiety is'centred round the home relationship rather than the school itself. The early referral of these cases to the clinic is of cardinal importance, for it is often too late to do anything by the time the child has reached the age of fourteen. Nevertheless, in these older children, Dr. Craike feels that a forced separation from the mother, through the intervention of the Juvenile Court, and aperiod in a Remand Home, might be helpful for some of them, as long as psychotherapy is immediately available when they return home. During the year under review Dr. A.K. Graf took up his appointment as Consultant Child Psychiatrist and Medical Director of the Hornsey Child Guidance Clinic. Here, the approach to the problems of the maladjusted child is based on the team work of psychiatrist, educational psychologist, psychiatric social worker and psychotherapist; and the opinions of all the members of the team are pooled at weekly case conferences, before any action or treatment is undertaken. A useful innovation has been the introduction of an evening session which has enabled the consultant psychiatrist to meet working parents, and adolescents who do not want to miss time from school or employment. Particularly encouraging has been the attendance of the father at these interviews, hitherto the somewhat neglected partner in the investigation of a child's difficulties; and, in many cases, Dr. Graf has found that he can make a valuable and crucial contribution towards the treatment. Speech Therapy Throughout 1961 children continued to be referred for speech therapy from a wide variety of sources. From teachers, health visitors, school medical officers and specialists came a steady stream of cases; the mothers, too, whose older children had had speech therapy in the past, brought younger siblings for similar help, or were sometimes instrumental in sending new cases. 75 Visits from doctors studying for Diplomas in Child or Public Health, and students training for teaching or health visiting have been welcomed by Miss Joan Came, the senior speech therapist, as leading to the recognition that speech disorders affect the total personality. Thus, treatment, which can restore adequacy of speech and language for communication and expression, enables the patient to function at greatly improved social, emotional and educational levels. The Handicapped Child Rheumatism Supervisory Centre 4-8 children made 94 attendances during the year at fortnightly sessions held in the Paediatric Department of the Prince ofWales's General Hospital under the direction °f the Consultant Paediatrician, Dr. I.M. Anderson, M.D., F.R.C.P. Seven of these were new cases, one girl and six boys, and in them the following diagnoses were established: - Total In Tottenham Outside Areas Rheumatic Fever 3 1 2 Rheumatic Carditis 1 - 1 Congenital Heart Lesions 2 2 - Other caser- Innocent Murmur) 1 1 - Distribution as at 31st December, 1961 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 1 - - - 1 - - 5 2 Partially Sighted Pupils 2 2 1 1 - - - - - - 3 3 Deaf Pupils 5 5 2 2 - - - - - - 7 7 Partially Deaf Pupils 8 8 2 2 1 - - - 1 - 12 10 Educationally Subnormal Pupils 63 46 12 2 3 2 . - - - 78 50 Epileptic Pupils - - 1 1 - - - 1 - - 1 2 Maladjusted Pupils - - 15 1 10 3 14 7 1 - 40 11 Physically Handicapped Pupils 17 13 1 3 1 - 1 1 4 - 27 17 Pupils with Speech Defects - - - 1 207 113 6 3 10 - 223 117 Delicate Pupils 2 8 9 8 2 - 1 - - - 14 16 Pupils with Multiple Defects 4 3 3 2 2 - - - - - 9 5 Totals 101 85 54 24 226 118 22 13 16 - 419 240 Grand Totals 186 78 344 35 16 659 76 There were seven removals during 1961 leaving 202 children on the register of the Supervisory Centre at the end of the year. These 202 have been classified as follows: - Total In Tottenham Outside Areas Rheumatic Fever 66 42 24 Rheumatic Carditis 42 29 13 Rheumatic Carditis with Chorea 4 4 - Chorea - uncomplicated 5 4 1 Rheumatic Arthritis 5 1 4 Congenital Cardiac Lesions 54 34 20 Streptoccocal Allergy 3 2 1 Other cases 23 19 4 Total 202 135 67 Hospital School I am indebted to Mr. J. Power, M. A., Borough Education Officer, Tottenham, for the following report:- "During the past year, the teaching of children at St. Ann's Hospital and at the Prince of Wales' s Hospital has progressed most favourably. Both long and short-term patients from the age of 4½ years to 15 years are catered for. Although a well equiped schoolroom is established in one of the wards, teaching is individual and follows the child's school curriculum as closely as possible, particularly in the case of long-term patients, where a close liaison is maintained with the schools. For children who are not well enough to go to the schoolroom there is bedside tuition and this takes place in several wards. Four teaching sessions each week are given at the Prince of Wales's Hospital. Children are, on the whole, eager to have lessons, while the development of a particular hobby or interest gives great pleasure to a child. Letters from head teachers show that the work of the hospital classes is much appreciated and many pupils benefit greatly from the more individual teaching. The link made with the children often continues after they have left hospital. Many keep up a regular correspondence and it is interesting to find that the experience of school in hospital is not forgotten by them or their parents. The help given by the Tottenham Library Service and the co-operation of the Sisters and hospital staff in the success of the classes is very much appreciated." 77 SCHOOL HEALTH SERVICE STATISTICS FOR 1961 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 1957 & later 6 86 89 1956 18 207 214 1955 14 132 144 1954 24 68 81 1953 130 322 412 1952 214 368 486 1951 19 39 51 1950 75 72 133 1949 265 388 574 1948 150 169 274 1947 147 154 262 1946 & earlier 804 598 1262 Total 1866 2600 3982 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 0 T 0 T 0 T 0 4 Skin 30 50 135 185 448 441 1188 7 5 Eyes (a) Vision 37 39 679 76 1866 398 227 70 (b) Squint 60 10 45 3 297 30 13 4 (c) Other 17 4 14 7 110 26 145 3 6 Ears (a) Hearing 15 21 23 18 151 74 176 25 (b) Otitis Media 9 74 14 42 55 210 20 4 (c) Other 9 3 10 4 44 23 118 3 7 Nose and Throat 92 271 47 107 301 761 120 43 8 Speech 23 24 3 13 73 70 58 13 9 Lymphatic Glands 1 60 - 6 4 127 1 1 78 DEFECTS FOUND BY MEDICAL INSPECTION (Cont'd.) 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 10 Heart - 29 5 53 53 167 13 10 11 Lungs 50 59 64 58 291 206 42 22 12 Developmental: (a) Hernia 4 5 - 1 11 10 1 1 (b) Other 10 14 25 19 59 113 18 8 13 Orthopaedic: (a) Posture 6 8 29 158 83 324 9 18 (b) Feet 70 88 114 178 446 591 44 36 (c) Other 28 54 40 74 232 286 100 11 14 Nervous System: (a) Epilepsy 3 2 8 5 32 14 5 2 (b) Other 1 11 18 12 68 64 27 7 15 Psychological: (a) Development 3 21 5 9 31 62 39 9 (b) Stability 12 177 15 147 115 712 80 29 16 Abdomen 7 15 11 23 50 91 14 4 17 Other 28 20 20 101 109 394 481 80 T - Requiring Treatment 0 - Requiring Observation TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) Group 1 Eye Disease (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 168 (b) Errors of refraction, including squint 1830 Total 1998 (c) Number of pupils for whom spectacles were prescribed 963 79 Group 2 Diseases and Defects of Ear, Nose and Throat Number of cases known to have been treated Received operative treatment for: (a) Diseases of the ear - (b) Adenoids and Chronic Tonsillitis 210 (c) Other nose and throat conditions - Received other forms of treatment 616 Total 826 Total number of pupils in schools known to have been provided with hearing aids: (a) During the current year 27 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year 41 Group 3» Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out patients departments 983 Group 4 Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp _ (ii) Body 1 Scabies 12 Impetigo 27 Other skin disease 1176 Total 1216 Group 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 173 Group 6. Speech Therapy Number of pupils treated by speech therapists 250 Group 7 Other treatment given (a) Number of miscellaneous minor ailments treated by the County Council 426 (b) Treatment other than (a) above and excluding convalescent treatment 220 80 EDUCATION ACT 1944 - SECTION 57 Cases dealth with under Section 57, Education Act 1944; 3 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 1 MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 26 (b) Number of Students examined as to fitness for first appointment 68 (c) Number of Students examined as to fitness to undertake training course 81 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. P.A.C. Wright, M.B., B. S. , D.P.H. 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 4 81 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 and Home Nursing Superintendent Home Help Organiser Assistant Home Help Organisers Area Chief Clerk Deputy Area Chief Clerk Section Heads G. S. Udall, M.B., B.Chir., D.P.H., D.C.H. Ruth Golder, M. B., Ch.B., D.R.C.O.G., D.P.H. Miss W.M. Hunt, L.D.S., R.F.P.S. 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., M.I.H.H.O. Miss J.E. Chaplin, M. I.H.H.O. Mrs. A. Orchard, M. I.H.H.O. W.L.N. Relleen, T.D., D.P.A. H. J. Dunham, B.A. A. Balls N.P. Child S. E, Woodroffe Classification of Staff Full-time Part-time Medical Officers 10 6 Dental Officers 6 6 Supervisory Nursing Staff 2 - Administrative and Clerical Staff 37 6 Health Visitors/School Nurses 27 2 Student Health Visitors - 1 Clinic Nurses 8 - Midwives 10 2 Home Nurses 23 4 Speech Therapists 2 2 Physiotherapists 2 - Occupational Therapist 1 - Chiropodists - 2 Gramophone Audiometrician 1 - Orthopists - 2 Dental Attendants 8 2 Day Nursery Staff 33 2 Home Help Service 7 154 Manual workers, domestic grades, etc. 10 24 187 214 82 INDEX Page Abatement Notices 14 Aged, Welfare of 40 Ambulance Service 46 Ante Natal Clinics 47 Area Health Committee Area Health Service 46 Area Health Staff 81 Area Welfare Service 46 Atmospheric Pollution 21 Audiology Clinic 70 Baths and Laundry Services 11 B.C.G. Vaccination 67 Births and Deaths 3 Births, Notification of 47 Borough Council, Members 1 Bronchitis 5 Cerebral Palsy Unit 72 Certificates of Disrepair 23 Chest Clinic 36 Child Guidance Clinics 74 Chiropody & Special Treatment Establishments: Licensing 20 Chiropody Service 42, 64 Clean Air 21 Cleansing and Disinfecting Station 15 Clearance Areas 22, 26 Comparability Factors 4 Council, Members of 1 Daily Guardian Scheme 52 Day Nurseries 52 Deaths, Classification of 4, 8 Defects, Sanitary". Remedied 12 83 Page Demolition Orders 22,27 Dental Service, Priority 54 School 68 Diphtheria 37, 67 Diphtheria Immunisation 62 Disinfection 15 Disinfestation 16 Domestic Help Service 65 Drainage and Sewerage 9 Dysentery 38, 67 Ear, Nose and Throat Clinics 70 Education Committee 2 Encephalitis 37 Fabrics (Misdescription) Regulations 1959 19 Factories 17 Fluoridation of Water Supply 9 Food - Condemned 31 Control 28 Hawkers 29 Hygiene 28 Labelling 33 Poisoning 38 Prosecutions 32 Registered Premises 29 Samp1ing 32 Shops 29 Furnace Instal1a11ons 21 Handicapped Child, The 53, 75 Hazards, Radiation 9 Hawkers of Food 29 Health and Housing Committee 1 Health Services provided by other Authorities 4.4 Health Visiting Service 56 Home Nursing Service 61 84 Page Hospital Services, Old People 41 Hospitals 44 Hospital School 76 Houses Unfit 22, 26, 27 Houses in Multiple Occupation 23 Housing 22 Housing Act, s.9 & 10 23, 27 Individual Unfit Houses 22, 27 Part III 22,26 Illegitimate Births 5 Infantile Deaths 5, 7 Infant Welfare Clinics 49 Infectious Diseases in School Children 66 Infectious Diseases, Table of Cases 39 InsectPests 16 Inspections carried out by Public Health Inspectors 11 Labelling of Food Order, 1953 Laboratory Service 46 Laundries, Public 11 Laundry Service for the Incontinent Aged 41 Lunacy and Mental Treatment Acts 46 Lung Cancer 5 Maternal Deaths 3 Meals on Wheels 42 Measles 38 Meat Inspection 30 Medical Grounds for Rehousing 28 Members of Borough Council 1 Meningococcal Infection 37 Mental Health 46 Merchandise Marks Act, 1887-1953 33 Midwifery Service 55 Midwives' Ante-Natal Clinics 49 Milk and Dairies 4 Mothercraft and Relaxation Classes 49 85 Page Noise Nuisances 14 Notices Served 13 Nurseries & Child Minders 52 Old People's Welfare 40 Ophthalmic Clinics 73 Orthopaedic Clinics 73 Out-Patient Clinics at Prince of Wales's Hospital 45 Outworkers 18 Parental Guidance and the Young Child 51 Personal Health Service 46 Pet Animals Act, 1951 20 Physically Handicapped - Housing 28 Poliomyelitis 37, 66 Vaccination 63 Population, Movement of 4 Preserved Foods 29 Prince of Wales's Hospital, Out-Patient Clinics 45 Problem Families 58 Public Health Department, Staff 80 Public Health Act, 1936 Legal Proceedings 14 Public Health Act, 1961 14 Radiation Hazards 9 Rag Flock and Other Filling Materials Act, 1951 20 Recuperative Holidays 64 Rehousing on Medical Grounds 28 Rent Act, 1957 23 Repairs in Default 13,27 Retirement Advice Clinic 40 Rheumatism Supervisory Centre 75 Rodent Control 16 Routine Medical Inspections 77 Sanitary Circumstances of the Area 9 Scarlet Fever 38 School Health Service 65 86 Page Sewerage and Drainage 9 Shops 18 Prosecutions 19 Slaughterhouses 30 Slaughtermen Slum Clearance 22, 26 Smallpox 37 Smallpox Vaccination 62 Smoke Control Areas 21 Speech Therapy 74 Staff Medical Examinations 38 Statistics 3 Stillbirths 3 Street Trading 19 Superannuation Medical Examinations 38 Swimming Baths 11 Tetanus Immunisation 62 Toddlers' Clinics 50 Tuberculosis 34 In Schools 67 Unfit Houses 22,26 Vale Road School for Physically Handicapped Children 72 Water Supply 9 Welfare Foods Distribution 54 Welfare Service, Area 46 Whooping Cough 38 Immunisation 62 Work in Default 13,27