439 TOT 37 Borough of Tottenham TOTTENHAM'S HEALTH 1962 The Annual Report of the Medical Officer of Health Borough of Tottenham TOTTENHAM'S HEALTH 1962 The Annual Report of the Medical Officer of Health Public Health Department, Town Hall, Tottenham, N. 15. 24th July, 1963. To the Worshipful the Mayor Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, I submit herewith my Annual Report on the health services provided by local government in this Borough for the year ended 31st December, 1962. The census population figure of 113,249 was 13,680 less than ten years ago, showing a decline at the rate of 1.3 per cent, compared to the county average of 0.15. Density, expressed as persons per acre, was 37.6 compared to the county figure of 15. The birth rate of 19.76 was the highest since the peak post-war year 1947. The number of illegitimate births 256 (11.5 per cent of all births) was regrettably, the highest ever recorded in Tottenham. Incidence of notifiable disease was once again low - no case of smallpox, poliomyelitis nor diphtheria occurred, and the number of new cases of tuberculosis the lowest recorded in any previous year. Of serious importance was the estimated rise in the spread of venereal diseases, not compulsorily notifiable in this country, but known to be a growing national problem for social and preventive medicine. Application of housing legislation and the Clean Air Act have been the main preoccupation of the public health inspectors during the past year. Clearance of unfit dwellings and raising standards in houses let off in multiple occupation taking priority. More than one half of the Borough is now subject to smoke control orders and at the present rate of progress will be complete within the next three years. As in the environmental health services so in the personal and school health services, the past year has been an extremely busy one; and only by an all out effort of the whole staff has it been possible to meet increased demands on the comprehensive range of services set out in some detail in the following pages of this Report Shortages in professional, technical and certain administrative staff have been present for all or most of the year. Of particular difficulty was obtaining a full establishment of public health inspectors, health visitors, physiotherapists and chiropodists A tragic and unexpected shock to the department was the loss by death of Mr. E.T Jenkins, Chief Public Health Inspector whose loyal and devoted work in Tottenham was so widely appreciated Of members of the staff who retired during the year special mention is made of Dr Nora Webster who had worked mainly in the school health department and was appointed to that office more than 20 years ago by the Tottenham Education Committee. Also Miss Helen Townsend who, as Superintendent Health Visitor had a long and distinguished record of public service locally; and nationally by her service on a number of government department and professional committees. In conclusion I wish to express my sincere gratitude to the Chairman (Alderman R H Warren) and to all members of Committees for their encouragement and support. Also to acknowledge my indebtedness to colleagues who have made possible the presentation of this Report. I have the honour to be Your obedient Servant, G HAMILTON HOGBEN, Medical Officer of Health 1 MEMBERS OF BOROUGH COUNCIL MAYOR Alderman L .R Harrington (Mrs.) J.P. DEPUTY MAYOR Councillor Douglas Clark ALDERMEN E.J. Field H. Langer *A.R. Turner (deceased) R.W.H. Ford I.L. Peirce H.W. Turner W.S. Herbert *A. Reed, A.C.I.I., J.P. F.A.F. Keay, J.P. *A.F. Remington (Mrs.) *R.H. Warren COUNCILLORS *E.E. Brown (Mrs.) E.V Garwood *S.C. Morris Sir Edward Brown, M B.E. L.J. Goldman A.T. Protheroe J.W.H. Brown W.K. Gomm *M.E. Protheroe (Mrs.) E.J.J. Carter *F.E. Haynes (Mrs.) E.A. Remington, M.Ch.S. A.J. Chaplin F.A. Knight A.B. Rusell *L.H. Collis J.D Mcllwain, B.A. J.R. Searle R.L. Singer D. Cunningham (Mrs.) G.W. Malin, A.C.A. *S.A. Berkery Smith (Mrs.) E.P. Deakins *G C. Marson J. Watkins *G.A. De Vote *A A. Miller (Mrs.) R.G. Wigley *E.C. Elphick *M.T. Morris J. Wolsey NOTE: * Indicates members of Health and Housing Committee. The Mayor and Deputy Mayor are ex-officio members. Committee Chairman - Alderman R.H. Warren Vice-Chairman - Councillor Mrs. F.E. Haynes Town Clerk; Medical Officer of Health: M. Lindsay Taylor, LL.B. G, Hamilton Hogben, M.R.C.S., D.P.H. 2 AREA HEALTH COMMITTEE Members of Hornsey Borough Council Councillor Miss O.R Anderson Councillor F.C.V. Hayward Councillor V.P. Gellay, B.Sc. Councillor B.D. Smith Councillor J.T. Wilkins (Vice-Chairman) Members of Tottenham Borough Council Alderman Mrs. L.R. Harrington, J.P. Alderman R.H. Warren (Chairman) Alderman A. Reed, A.C.I.I., J.P. Councillor M.T. Morris Alderman Mrs. A.F. Remington Councillor J R. Searle Members of Middlesex County Council County Councillor M.K. Bulmer County Councillor Mrs. M.E. Protheroe County Councillor Miss J.H. Damant County Councillor P.P. Rigby County Councillor H.H. Godwin-Monck County Councillor Mrs. M.E. Soall Members nominated by appropriate Hospital Management Committee Mrs. R.M. Fry Mr. L. Hayward, Ph.C., M.P.S., F.S.M.C. Member with knowledge and experience of Home Nursing Miss S.M. Quinn, B.Sc.(Econ.), S.R.N., S.C.M.., S.T.D. Persons who may attend in an advisory capacity Dr. L. Posner (Middlesex Local Medical Committee) Mr. W.P. Beresford (Middlesex Local Dental Committee) Mr. L. Hayward (Middlesex Local Pharmaceutical Committee) Miss V. Edey (Royal College of Midwives) Miss M.A. Brown (Royal College of Nursing) TOTTENHAM DIVISIONAL EXECUTIVE EDUCATION COMMITTEE Alderman E.J. Field Alderman H. Langer " R.W.H. Ford " I.L. Peirce "F.A.F. Keay, J.P. " A. Reed, A.C.I.I. J.P. Councillor E.J J. Carter " Mrs. A.F. Remington (Chairman) " Douglas Clark Councillor J.D. Mcllwain, B.A " L.H. Collis " M.T. Morris " Mrs. D. Cunningham " M.E. Protheroe " Mrs, F.E. Haynes " J.R. Searle " F.A. Knight " Mrs. S.A. Berkery Smith " G.W. Malin, A.C.A. " 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. W. Buchanan 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 April, 1961 113,249 Mid-year Registrar General's 1961 1962 estimate 113,480 113,020 Rateable Value as at 1st April £1,976,413 £1,994,474 Sum represented by penny rate £8,060 £8,120 Approximate Number of Dwellings in District 30,998 31,166 Registered live-births Males 977 1,168 Females 942 1,065 Total 1,919 2,233 Birth-rate per 1,000 estimated population: 16.91 19.76 No. of live-births which were illegitimate 188 256 (9.8%) (11.5%) Stillbirths Males 18 17 Females 17 23 Total 35 40 Stillbirth rate per 1,000 total (live and still) births 17.91 17.60 No. of Stillbirths which were illegitimate 7 6 (20%) (15%) Deaths Males 724 716 Females 692 708 Total 1,416 1,424 Death-rate per 1,000 estimated-population 12.48 12.60 Maternal Mortality Puerperal Sepsis 0 1 Other puerperal causes 1 1 Total 1 2 Rate per 1,000 total (live and still) births 0.501 0.880 4 Deaths of Infants under 1 year of age (Infant Mortality) 1961 1962 (a) Legitimate Males 21 29 Females 26 16 Total 47 45 Death-rate per 1,000 legitimate live births 27.15 22.76 (b) Illegitimate Males 2 2 Females 2 4 Total 4 6 Death-rate per 1,000 illegitimate live births 21.28 23.44 (c) Total Males 22 31 Females 29 20 Total 51 51 Rate per 1,000 total live births 26.58 22 84 Deaths of Infants under 4 weeks (Neo-natal Mortality) 37 41 Rate per 1,000 live births 19.28 18 36 Deaths of Infants under 1 week (Early Neo-natal Mortality) 31 38 Rate per 1,000 live births 16.15 17.02 Stillbirths and deaths under 1 week (Perinatal Mortality) 66 78 Rate per 1,000 live and still births 33.78 34.32 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 in population. In 1961, although there was a natural increase in population arising from births exceeding deaths by 809, the Registrar General's estimate of population shows a reduction of 460 meaning that the outward movement of population was greater than the inward by 1,269. Classification of Deaths Deaths are classified under 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. 5 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. Birth-rate There was a further substantial increase in the birth-rate from 16.91 to 19.76 per 1,000 population, the highest figure since the peak post-war rate in 1947 of 21.57 per per 1,000. This growing upward trend which is general throughout the country means that central and local authorities are having to re-appraise their plans for the future in many different spheres of public service, For example, the hospital services are finding a greater demand for maternity beds and the local authorities health departments are meeting increased pressure for domiciliary and clinic services. Education departments in turn are required to find more places as the children reach school age. In addition there must be long term planning for housing and employment in later years, Illegitimate Births For the past seven years the percentage of illegitimate births has been steadily rising and in 1962 it reached 11.5% or one birth in every nine was illegitimate. Between the two world wars the rate never exceeded 4.6% but the following graph shows how this has risen in the post war era. Infantile Deaths The number of deaths before reaching the first birthday was 51, the same as in 1961. However, as the number of births was higher, the infantile death rate fell from 26.58 to 22.84 per thousand live births. 6 Birth-rate and Illegitimate Births in Tottenham 1939-1962 7 Lung Cancer "Several serious diseases, in particular lung cancer, affect smokers more often than non-smokers. Cigarette smokers have the greatest risk of dying from this disease, and the risk is greater for the heavier smokers. The many deaths caused by this disease present a challenge to medicine for in so far as they are due to smoking they should be preventable" (Report of the Royal College of Physicians on Smoking and Health, 1962). During 1962 this most enlightened report was published by the Royal College of Physicians on smoking in relation to cancer of the lung and other diseases, which presented extensive evidence of the hazards of cigarette smoking, and concluded that it is necessary for the health of the present population of this country, that any measures which are practicable and likely to produce beneficial changes in smoking habits should be taken promptly. In Tottenham during 1962 88 deaths were caused by lung cancer, which represents one death in every sixteen. This rate is approximately 50 per cent above the national average, and the higher figure is probably associated with the additional hazard of atmospheric pollution which is experienced in our greater cities. Chronic Bronchitis - The English Disease This crippling chest condition, which largely affects men in the 50-60 age group, is now a major public health problem It is 40 times as high in this country as it is in France, and it is much more common in towns than in the country. Atmospheric pollution and smoking must be regarded as the principal causes. 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 68 66 49 1962 86 Not available 78 Not available 00 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 3 - - 1 - 1 1 - - - - 6 4 2 Bronchitis - - - - - - - - - - - - 1 - - - - - - - - 1 1 - Haemolytic Disease of Newborn - 1 - - - - - - - - 1 - - - - - - - - - 1 - 1 Congenital malform ation 4 - 1 1 - - 2 1 - - 9 2 1 - - 1 - - - - - 13 8 5 Prematurity 7 1 1 - - - - - - - 9 - - - - - - - - - - 9 4 5 Atelectasis 5 1 3 - - - - - - - 9 - - - - - - - - - - 9 6 3 Birth Injuries 5 - 1 - - - - - - - 6 - - - - - - - - - - 6 4 2 Lack of attention at birth 1 - - - 1 - - - - - 2 - - - - - - - - - - 2 1 1 Other causes 1 - - - - - - - - 1 2 1 - 1 - - - - - - - 4 3 1 Total 23 3 7 1 1 - 3 1 1 1 41 3 2 2 - 2 1 - - - - 51 31 20 9 STATISTICS OF TOTTENHAM FOR THE LAST TWENTY YEARS Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases Cancer Deaths Whooping Cough Scarlet Fever Diphtheria Tuberculosis Respiratory Other Forms 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 1962 113,020 1,424 12.60 2,233 19.76 51 22,84 14 58 - 48 5 328 10 CLASSIFIED DEATHS OF TOTTENHAM RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION Total Under 1 year 1-4 5-14 15-24 25-44 45-64 65-74 75 DISEASE M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory 4 1 - - - - - - 1 - - 1 1 - 2 - - - Tuberculosis, other - - - - - - - - - - - - - - - - - - Syphilitic disease 1 1 - - - - - - - - - - - - 1 1 - - Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - -— Meningococcal infection - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic disease 2 - - - - - - - - - - - 1 -- 1 - - - Malignant neoplasm, stomach 17 17 - - - - - - - - - - 7 3 8 10 2 4 Malignant neoplasm, lung bronchus 75 13 - - - - - - - - 1 1 35 4 26 b 13 3 Malignant neoplasm, breast - 29 - - - - - - - - - 3 - 14 - 4 - 8 Malignant neoplasm, uterus - 12 - - - - - - - - - 2 - 6 - 3 - 1 Other malignant & lymphatic neoplasm 69 85 - - - - - - - 2 4 25 31 22 22 20 25 Leukaemia- Aleukaemia 5 6 - - - - 1 - - 1 - - 2 1 2 2 - 2 Diabetes 2 8 - - - - - - - - 1 - - 3 - 1 1 4 Vascular lesions of the nervous system 62 89 - - • - - - 1 - 1 - 12 9 20 26 28 54 Coronary disease angina 153 103 - - - - - - - - 6 1 62 15 52 36 33 51 Hypertension, with heart disease 8 5 - - - - - - - - - - 3 - 2 - 3 5 Other heart disease 38 103 - - - - - 1 - - - - 8 14 4 12 26 76 Other circulatory disease 34 52 - - - - - - - - 1 2 6 8 11 14 16 28 Influenza 2 2 - • - 1 - - 1 - - - - - 1 - - 1 Pneumonia 48 42 4 2 1 - - - 1 - - - 6 2 8 6 28 32 Bronchitis 66 31 1 - - - - - - - 1 - 17 4 26 8 21 19 Other diseases of respiratory system 7 3 - - - - 1 1 - 1 - 3 1 1 1 1 - Ulcer of stomach & duodenum 13 3 - - - - - - - - - - 1 1 5 1 7 1 Gastritis enteritis & diarrhoea 1 5 - - - - - - - - - - - - - 2 1 3 Nephritis & nephrosis 4 5 - - - - - - - - - - 1 2 2 2 1 1 Hyperplasia of prostate 3 - - - - - - - • - - - - - - - 3 - Pregnancy, childbirth & abortion - 2 - - - - - - - - - 1 - 1 - - - - Congenital malformations 10 6 8 5 1 - - - - - - - 1 1 - - - - Other defined & ill defined diseases 58 60 18 12 - - - - - 1 3 3 9 5 10 7 18 32 Motor vehicle accidents 10 6 - - - - 3 - 1 - 3 1 - - 1 3 2 2 All other accidents 17 9 - 1 1 - - - - - 6 - 3 - 2 1 5 7 Suicide 7 9 - - - - - - - - 2 3 4 4 1 1 - 1 Homicide & Operations of War - 1 - - - - - - - - - 1 - - - - - - Total 716 708 31 20 3 l 4 2 6 2 28 23 207 129 208 171 229 360 11 THE 1961 CENSUS The analysis of the Census for the County of Middlesex, published by the Registrar General, includes the following details relating to Tottenham. For comparison, where appropriate, figures for Middlesex as a whole are given in parenthesis. Population The 1961 population, 113,249, is 13,680 less than in 1951 when the last census was taken, representing a decline in population at the rate of 1.13 (0.15) per cent per annum. The density of population expressed as persons per acre is 37.6 (15.0). Age Distribution The continued trend towards a larger proportion of aged persons in the community reflects the lower birth rates in the preceeding 25 years and the improved expectation of life resulting from better living conditions and advances in preventive and curative medicine. Age Distribution of Tottenham's Population Age Groups 1921 1931 1951 1961 % % % % 0-4 years 9.2 7.3 8.0 6.9 5-14 „ 21.1 16.7 12.6 12.6 15-44 „ 47.5 49.8 43.7 39.5 45-64 „ 17.3 20.4 24.7 28.0 65 and over 4.9 5.8 11.0 13.0 Households and Dwellings: Generally The following general statistics are given:- No. of households 37,904 No. of structurally separate dwellings (a) Occupied 31,720 (b) Unoccupied 376 32,096 Proportion of persons living more than l½ persons per room (a) 1961 7.7% (5.0%) (b) 1951 11.4% Average number of persons per room .71 (.67) Average size of a household 2.9 12 Density of Occupation The following table shows the number of rooms occupied by households according to the size of the family. Possible overcrowding under the Housing Act is shown to the right of the heavy line, but as it is not possible to differentiate between children and adults nor to allow for separation of sexes, these figures should only be taken as a general indication A similar analysis following the 1951 census showed 1,324 families as possibly overcrowded compared with 764 on this occasion. Dwellings Density of Occupation No. of Persons in Family Families where No. of rooms exceeds persons by Fams. where No. of rooms equals persons Families where No. of Persons exceeds rooms by Over crowded families 6 5 4 3 2 1 1 2 3 4 5 6 1 68 295 669 928 1975 1180 558 2 56 121 1296 2416 2675 4058 1227 183 3 76 - 177 1415 2211 2173 2145 466 89 89 4 7 81 - 193 1267 1847 1375 1131 239 50 289 5 5 62 - 117 705 1010 604 357 89 17 106 6 5 47 - 80 344 432 205 98 24 2 124 7 20 - 45 156 188 68 47 7 54 8 2 21 - 25 103 86 46 12 2 60 9 4 - 7 36 30 14 8 22 10 1 16 - 8 35 47 20 20 Possibly overcrowded families 764 Tenure of Accommodation Analysis of the tenure of occupation shows the percentage of households classified by tenure as follows:- Owner-occupiers 30.6% (50.8%) Tenants by virtue of employment 1.3% (2.3%) Tenants with business premises included 1.0% (.7%) Tenants of local authorities 14.9% (13.3%) Tenants of unfurnished privately owned dwellings 46.6% (26.0%) Tenants of furnished privately owned dwellings 5.6% (6.9%) 13 Facilities available to Householders The following information is given regarding facilities available to households:- Hot water tap Shared 5.2% (4.4%) Lacking 39.4% (14.5%) Fixed Bath Shared 17.8% (13.1%) Lacking 34.7% (10.5%) Households not having exclusive use of both stove and sink 6.3% ( 3.8%) CONTROL OF DISEASE The incidence of serious notifiable diseases during during the year was very low and no cases of poliomyelitis or diphtheria occurred. Altogether 484 notifications were received compared with 1,952 in 1961, the difference being due to the normal biennial epidemic of Measles in 1961, which accounted for 1,722 notifications. Tuberculosis There were 53 notified new cases, the lowest recorded for this disease in Tottenham. Forty-eight of these (32 males and 16 females) had lung infections, and the remaining five (2 males and 3 females) had involvement of the glands in 3 cases, kidney in 1 case andgenito urinary tract in the other case. There were only five deaths from this disease. Distribution of New Tuberculosis Cases and Deaths in 1962 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 6 - - - - - - 5-9 " - - - 1 - - - - 10-14 " 1 1 - 1 - - - - 15-19 " 2 1 - - - - - - 20-24 " 1 2 - - 1 - - - 25-29 " 4 1 - - - - - - 30-34 " 1 2 - 1 - - - - 35-39 " 1 - - - - 1 - - 40-44 " 1 - - - - - - - 45-49" 6 1 1 - - - - - 50-54 " 5 1 - - 1 - - - 55-59 " 4 - 1 - - - - - 60-64 " - 1 - - - - - - 65-69 " 2 - - - 2 - - - 70-74 " 1 - - - - - - - 75 years and over 2 - - - - - - - Total 32 16 2 3 4 1 - - 14 Changes in the Tuberculosis Register During 1962 Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1962 Add 833 602 78 103 1616 New cases notified in 1961 32 16 2 3 53 Transfers into Borough 18 8 1 2 29 Restored to Register - - - - - 883 626 81 108 1698 Deduct Transfers out of Borough 27 10 1 2 40 Deaths 10 2 - - 12 Recovered Cases 22 15 - 1 38 Cases lost sight of 8 5 2 4 19 67 32 3 7 109 Number of Register at 31st December, 1962 816 594 78 101 1589 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1962 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 10,666 110 11 65 10 196 18,3 Park 10,562 68 12 63 13 156 14,7 Coleraine 11,163 73 7 53 9 142 12,7 West Green 10,560 53 - 52 9 114 10,7 Bruce Grove & Central 10,466 53 3 46 6 108 10,3 High Cross & Stoneleigh 10,461 68 11 61 9 149 14,2 Green Lanes 9,954 93 8 65 12 178 17,8 Chestnuts 10,396 69 8 47 12 136 13,4 Seven Sisters 9,459 72 7 45 4 128 13,5 Town Hall 9,793 78 6 53 10 147 15,0 Stamford Hill 9,540 79 5 44 7 135 14,2 Total 113,020 816 78 594 101 1,589 14,0 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. 15 Diphtheria No case of diphtheria occurred in the Borough in 1962. Poliomyelitis The benefits of vaccination against poliomyelitis are reflected in the greatly reduced incidence of this disease. For the third year' running there has been no notified case amongst Tottenham residents. Acute Encephalitis There were four cases of acute infective encephalitis notified in 1962 and one case of post-infectious encephalitis following whooping cough occurred in a boy aged 4 months Meningococcal Infection There was one notification of meningococcal infection which occurred in a girl aged 1 year. Smallpox No case of smallpox occurred in the Borough in 1962. Typhoid Fever The one case of typhoid fever which occurred related to a young Italian woman who was admitted to hospital five days after arrival in this country from Sicily. Scarlet Fever The incidence of scarlet fever remained about the average expected in recent years There were 58 notified cases and the disease continued to be of the mild type with few complications and no deaths. Measles The incidence of this disease continues to have its biennial cycle, 1962 being a year of low incidence. There were 296 notifications compared with 1,722 in the previous year. No deaths arose from this cause. 16 Whooping Cough This is another disease where active immunisation has resulted in a marked reduction. in its incidence and severity. Only 14 cases were notified in 1962 and no deaths resulted. Food Poisoning There were 9 notified cases of food poisoning and the agent giving rise to the illness was identified in 8 instances. The causes were salmonella typhi-murium 6, salmonella enteritidis 1 and salmonella blockley 1. Dysentery There were 32 cases of dysentery. 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 112 candidates for appointment to the Superannuation Scheme were medically examined. Seven failed to pass for the reasons below:- Pulmonary Tuberculosis 1 Diabetes 1 Thyrotoxicosis 1 Bronchitis 1 High Blood Pressure 2 Congenital Heart Condition 1 17 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1962 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 F M F M F Scarlet Fever - - 1 - - 3 3 3 5 4 14 13 2 7 1 1 1 - - - - - - - 58 Measles 5 5 19 13 17 16 13 12 22 13 69 80 3 4 1 1 2 1 - - - - - - 296 Whooping Cough 2 2 1 1 1 - - 1 1 - 3 1 1 - - - - - - - - - - - 14 Pneumonia - - - 1 - - - - - - 1 - - - - - 1 1 - - 1 1 2 2 10 Erysipelas - - - - - - - - - - - - - - - - - - - - 1 - - 2 3 Food Poisoning - - - - - 1 - - - 1 - 2 2 - 1 1 - - - - - - - 1 9 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 2 - - - - - - 2 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - -- Acute Encephalitis Infective - - - - - - - - - - 1 - 1 - - - 1 1 - - - - - - 4 Post-infectious 1 - - - - - - - - - - - - - - - - - - - - - - - 1 Acute Poliomyelitis Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Non-paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - - 1 - - - - - - - - - - - - - - - - - - - - 1 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - - - - 1 - - - - - - 1 Paratyphoid Fever - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 1 1 - 2 2 1 1 3 - - 4 3 3 2 1 2 - 1 1 1 1 1 - 1 32 Tuberculosis Respiratory - - - 2 1 1 - 2 - 1 - - 1 1 2 1 6 4 3 - 15 3 5 - 48 Meninges & C.N.S. - - - - - - - - - - - - - - - - - - - - - - - - - Other - - - - - - - - - - - 1 - 1 - - - 1 - - 2 - - - 5 Total 9 8 21 20 21 22 17 21 28 19 92 100 13 15 6 6 11 12 4 1 20 5 7 6 484 18 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. 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 to maintain 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 Preparation for retirement should ideally begin years before as it is not generally 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, so long as it is 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). Here in an unhurried atmosphere it is possible to discuss 19 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. Laundry Service for the Incontinent Aged The service is provided under section 84 of the Public Health Act, 1936, and in 1962, 950 collections were made by the Public Health Department, an increase of 107 over the 1961 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. 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. Persons in need of Care and Attention Many problems are brought to the Public Health Department particularly in the winter months where relations or neighbours find old people living in neglected circumstances and often chronically ill or suffering from malnutrition. In many instances it is possible to organise adequate care at home with the aid of the statutory and voluntary services which are available. In others, after consultation with the family doctor concerned, the consultant geriatrician at St. Ann's General Hospital agrees to visit the patient and if appropriate arranges early admission to hospital. Occasionally, however, the patient will refuse all help and twice it was necessary to enforce emergency admission to hospital with Magistrates' Orders under the National Assistance Acts, 1948 and 1951. Another old lady who was living alone was in difficulty when a burst pipe flooded her house and put the electric light out of action. The Area Welfare Officer agreed to admit her to a home temporarily whilst action was taken to restore the house to a habitable condition. 20 OLD PEOPLE'S WELFARE COMMITTEE The following is extracted from the Chairma's Annual Report Visits and General Welfare During the year 2840 office interviews were conducted and 800 domiciliary visits made In addition, 300 visits were made by voluntary workers This was augmented by visits by young people from various schools in the Borough, and during the very bitter weather they collected pensions, chopped firewood and brought in coal and shopping and, where the water was frozen, they went to the nearest stand-pipe for supplies. Meals-on-Wheels Meals are distributed on five days each week and a total of 10,453 meals were delivered during the year. 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 however if the work is to be effectively maintained and the steadily increasing demand is to be met. Chiropody Service The Chiropody Service has increased the number of full sessions each week to ten by the introduction of two evening sessions at the Lord Morrison Hall During the year 1,024 old people received foot care at clinics and 3,429 treatments were given Voluntary receptionists do much to assist the old people at the clinics, and the new evening sessions are helped by young people from Parkhurst Road School An Appointment Card system similar to one operated in hospitals is being introduced whereby a patient is booked ahead This will reduce office work and allow sufficient time for an alternative appointment if the patient notifies that the appointment cannot be kept Domiciliary Chiropody Service has provided 1,560 treatments to housebound old people. This service is continually in heavy demand and at the end of the year there was a waiting list of 22 patients, Clubs The membership of the four Clubs totals approximately 530. 6,903 Club meals were served during this year This is a drop by 1,490 on last year s figures owing to the prolonged spell of bad weather, A turkey dinner was provided to 78 Club members as a result of generous donations. All the Clubs have arrangements for summer outings 21 Holidays and Outings 54 were able to have a holiday through the Women's Holiday Fund. A home by the sea was discussed at the Annual General Meeting of the Fund, suitable for women over the age of 80 years, as women who had been going regularly for a number of years were now coming into this age group and further accommodation was necessary. Many outings were arranged for the housebound old people in the Borough through the Mayor, Ardley Brothers and various voluntary organisations. Various anonymous donations were given for this purpose to provide tea. A party of 82 people will be going to Cliftonville for a week at the end of April and the beginning of May; 30 through the Women's Holiday Fund; and 8 letters have been written arranging holidays for old people privately. Arrangements are also being made for a few elderly people to go through the British Red Cross. Harvest Festival Local schools and churches again, very kindly gave their harvest festival produce for distribution to the old people, and a total of 600 parcels were packed and delivered to the sick, housebound and club members. Christmas Parcels Approximately 1,712 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. 15 housebound people were visited Shoe Repairs 5 dockets were given to enable old people to get shoe repairs executed at a reduced rate Also 7 dockets were given for old people to get new shoes at a reduced rate Barber Service Unfortunately the hairdresser who carried out this work is unable to continue this very worthwhile service to the housebound, both men and women, and it has not yet been possible to find anyone to carry on the work. 22 Wireless The "Wireless for the Bedridden Society'' have been very helpful towards our housebound old people In addition thirty portable sets are maintained and are available from the Organiser Disposable Bed Pads There is a steady demand for these pads and they have helped families to cope during the winter months Approximately 72 pads are given per month. Coal Lack of coal has been a great source of hardship to many elderly people during the severe winter. Supplies could not get through and they were compelled to pay an excessive amount out of their small incomes for packaged solid fuel which was in the range of 16s. to 18s, cwt. With the aid of other agencies the Old People s Welfare Committee gave assistance to many needy aged persons. HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES Hospital Service - 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) BearsteadMemorial 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 are set outon the following page 23 Prince of Wales's Hospital Time-table of Out-Patient Clinics Monday Tuesday Wednesday Thursday Friday Saturday Medical a.m. a.m. p.m. p.m. a.m. - p.m. p.m. Surgical a.m. p.m. p.m. - p.m. - Varicose ulcers p.m. - - - - - Diseases of Women - p.m. - p.m. - - Children (Medical) - a.m. - a.m. - - Eye - - a.m. - - - Throat, Nose & Ear p.m. - - p.m. - - Skin - - p.m. - a.m. - Teeth - - - a.m. - a.m. Neurological p.m. - a.m. - - - Genito-Urinary - a.m. - - - - Psychiatric - p.m. - - p.m. - Physical medicine a.m. a.m. a.m. a.m. a.m. a.m. p.m. p.m. - p.m. p.m. - X-Ray 9 a.m. until 5 p.m. every day; Saturdays 9 a.m. - 12 noon Orthopaedic - a.m. - a,m. - - Fractures a.m. - - - a.m. - Allergy - - - p.m. - - Venereal Diseases Medical Officer Males 4.30 p.m. - 4.30 p.m. - 10.0 a.m. - 10.0 a.m. 7.0 p.m. 7.0 p.m. 12.30 p.m. 12.30 p.m. 4.30 p.m. 7.0 p.m. Females - 4.30 p.m. - 10.0 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 24 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). 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. Blind Welfare The welfare services for the blind and partially blind are the responsibility of the Middlesex County Council. In 1961 there were 239 blind and 85 partially sighted persons living in Tottenham. The County Council's Welfare Department provides a home teaching service which aims to enable the blind to lead as full and active lives as their handicap allows. The majority of blind persons are not capable of employment owing to age or infirmity, or may not be available for employment because they are housewives, in which case they may receive instruction in carrying out their household duties. The home teachers visit all blind and partially sighted in their own homes, hospitals and in residential homes, to advise on their welfare and to keep them in touch with the available social services. They give instruction in Braille and Moon Systems of embossed type and in handicrafts. Blind persons are eligible for the loan of wireless receivers through the British Wireless for the Blind Fund, and the County Council have a scheme for assisting blind and partially sighted persons with the maintenance of wireless sets. Other services include facilities for the placement of blind persons in employment residential rehabilitation, training courses for mothers with blind babies, supply of embossed literature, special equipment and handicraft materials, assistance in the disposal of handicrafts, and assisted holidays for those in need. Welfare of Handicapped Persons The County Council's Welfare Department provides welfare services forthe deaf and dumb and hard of hearing and other persons who are handicapped by disease, injury, or congenital deformity, All of these are administered by the Area Welfare Officer and in addition a Work Centre is in operation for Handicapped Persons also administered by the Area Welfare Officer with a Work Centre Organiser and one assistant with help from the W V S. Services to the deaf and dumb and the hard of hearing are provided by appropriate voluntary organisations, to which the County Council makes financial grants. The County Council supplies aids and appliances not otherwise provided by the National Health Service and carries out where necessary adaptations to houses to enable a handicapped person to become more mobile, provides holidays, arranges forthe disabled to take part in social activities, attend handicraft classes, etc. Advice and guidance 25 regarding personal problems are given by voluntary organisations catering for persons with particular handicaps. The Welfare Department endeavours to procure from industry appropriate assembly work and arranges for this to be carried out by handicapped persons at a work centre or in their own homes, where suitable. In 1961 there were 350 cases on Tottenham's register of handicapped persons. Mental Health The local offices of the mental health service are at the Local County Offices, Somerset Road, Tottenham, N.17. (TOTtenham 4500). Ambulance Service Ambulances are stationed at the Edmonton Fire and Ambulance Station(EDMonton 5544), 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 amd 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 73 Haemolytic Streptococci 5 Negative 68 Faeces:- Total Specimens 291 Shigella 25 Salmonella Typhi-murium 6 Negative 260 Sputum:- Total Specimens 1 Negative 1 Miscellaneous Specimens:- 17 Total Number of Specimens 382 26 SANITARY CIRCUMSTANCES OF THE AREA Water Supply Dr. E. Windle Taylor, Director ofWater Examination ofthe Metropolitan Water Board has kindly supplied the following information regarding Tottenham's water supplies "The supply to the Borough of Tottenham has been satisfactory both in quantity and quality during 1962. The Borough is supplied mainly with New River-derived water from Stoke Newington and Hornsey filtration stations with some well water at Northumberland Park from Park pumping station Details of the analytical results of the waters from these sources are set out in the tables There were no important extensions of trunk mains but a length of 8"mainwas laid in Brantwood Road, Tottenham, to improve the supply to a bottling factory. New service mains were laid to the extent of 268 yards. All new and repaired mains are disinfected with chlorine before being put into service and samples of water from them are tested bacteriologically to ensure that the quality is up to. that normally supplied. The water supplied to this area is not plumbo solvent'*. Fluoridation of Water Following years of experiment in this country and abroad, the Minister has indicated that he is prepared to approve the fluoridation of water supplies Drainage and Sewerege There are separate systems of drainage for soil and surface water. Close liaison is maintained with the Lee Conservancy Catchment Board's inspectors to detect and deal as expeditiously as possible with pollution of the surface water system arising from the incorrect discharge of soil drainage. It is expected that connection of the soil drainage to the East Middlesex Drainage System will soon be completed. At present this is pumped into the London County Council's system and the greater discharge capacity which is being provided should reduce the possibility of flooding from sewers surcharging during severe storms. 27 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OF TOTTENHAM FOR THE YEAR 1962 (Milligrams per litre (unless otherwise stated)) Description of the Sample No. of samples Ammonia Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as C1 Oxygen abs. from Permanganate 4 hrs. at 27°C Turbidity Units Colour m.m. brown 2 ft. Tube Burgess's Tintometer Hardness (Total) Hardness (noncar bonate) pH Value Phosphate as PO4 Silicate as SiO2 Sulphate as SO4 Fluoride as F Magnesium asMg. Surface Active Material as Manoxol Free CO 2 Electrical Conductivity (gemmhos) New River derived 104 0.043 0.058 5.5 38 0.58 0.1 7 302 64 7.9 0.70 11 63 0.25 6 0.10 630 Park well 1 0,086 0.030 0.3 26 0.28 0.1 4 252 47 7.3 510 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1962 BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count Escherichia coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Per cent smples negative in 100 ml. New River derived 512 7.0 - 100.0 100.0 Park well 66 0.7 36 83.36 0.5 95.45 0.2 68 0,4 6 100.0 100.0 28 Inspections Carried out by the Public Health Inspectors Appointments and Interviews 470 Cinemas and Halls 16 Complaints Investigated 2,590 Conveniences and Urinals 19 Drains Defective 71 Drains Tested 148 Entertainment Licences 36 Factories with Mechanical Power 167 Factories without Mechanical Power 13 Food Poisoning 2 Food Premises Bakehouses 24 Butchers 44 Cafes and Restaurants 94 Dairies and Milkshops 17 Factories 21 Factory Canteens 4 Fishmongers 17 Greengrocers 17 Ice Cream Premises 29 Slaughterhouses 623 Other Food Premises 135 House to House 466 Improvement Grants 81 Infectious Disease 109 Multiple Lettings 26 Noise Complaints 19 Other Visits 1,287 Rat Infestations 257 Re-Inspections 4,754 Schools 12 S.D.A A. & Housing Act Advances 207 Smoke Control Areas 7,176 Smoke Observations 78 Defects Remedied Drams reconstructed 10 Drains repaired 65 Drains cleared 27 W C. Cisterns repaired or renewed 58 W.C. Pans renewed 29 29 W.C. Pans cleansed 2 Waste pipes repaired or renewed 29 Rain water pipes repaired or renewed 56 Roofs repaired or renewed 298 Eaves gutters repaired or renewed 144 Drinking water cisterns renewed 1 Drinking water cisterns covered 2 Water service pipes repaired 33 Water supply reinstated 3 Yards repaired or reconstructed 7 Sinks renewed or provided 3 Floors repaired or renewed 95 Floors ventilated 11 Dampness remedied by insertion of damp proof courses 7 by pointing of brickwork 28 by internal rendering 62 by miscellaneous remedies 69 Window frames and sashes repaired, renewed or painted 112 Coppers repaired, renewed or provided Fireplaces, stoves & ovens repaired or renewed 25 Flues and chimney stacks repaired 28 Brickwork of walls repaired and walls rebuilt 18 Ventilated food stores provided 2 Rooms cleansed 2 Staircases, passages and landings cleansed 1 Staircases, balconies and steps repaired or renewed 26 Noxious accumulations removed 50 Nuisances arising from animals abated 6 Miscellaneous defects remedied 365 Notices Served Statutory Housing Act, 1957:- Section 9 31 31 Public Health Act, 1936: Section 39 15 Section 45 12 Section 79 2 Section 92 172 201 Tottenham Corporation Act, 1952: Section 36 23 Section 43 72 95 Total 327 Informal Notices 978 30 Work carried out in default or by agreement with the owners during 1962. Housing Act, 1957 Section 9 5 Premises £ 756 10 6 Public Health Act, 1936 Section 3 9 4 Premises £ 112 18 6 Section 4 5 1 Premises £ 8 18 2 Tottenham Corporation Act, 1952 Section 3 6 11 Premises £ 26 11 8 Section 38 4 Premises £ 19 3 2 Section 43 8 Premises £ 168 1 5 £1,092 3 5 = Abatement of Statutory Nuisances The number of complaints investigated was lower than in 1961. As in previous years most of these complaints related to defects in dwellings. In a majority of instances the service of informal notices was sufficient but in 172 cases abatement notices under the Public Health Act had to be served. During the year summonses were issued in 12 instances for non-compliance with abatement notices. In 6 of these the work was carried out before the hearing and proceedings were withdrawn on payment of the Corporation's costs. Orders were made in respect of 4 cases. In the remaining 2 instances the Court was unable to effect personal service of the summonses, but the work was satisfactorily carried out without recourse to legal proceedings. Cleansing and Disinfecting The cleansing and disinfection station is sited at the Refuse Disposal Works, and as well as the disinfecting apparatus itself, there are baths provided for verminous persons who need to be disinfested The disinfectors are also responsible for the collections and deliveries of laundry service for the incontinent aged. This service, which the Council is enabled to provide under its powers to cleanse articles given by the Public Health Act, is one that has earned an increasing gratitude from the public since its inception. Sheets and soiled garments are rough rinsed and disinfected by the householder and placed in string bags for collection. They are laundered at St. Ann's Hospital laundry and collected and returned. The service is twice weekly, and at any one time there may be up to two dozen elderly persons on the list. 31 Summary of Disinfection Work during 1962 Rooms disinfected after occurrence of infectious disease or death 22 Bedding Disinfected after occurrence of infectious disease or death 30 Library Books disinfected 132 Drying out wet bedding, carpets etc. caused by Burst pipes 6 Clothing for Spain Parcels 1 Baths for Verminous Persons (Males 20) (Females 6) 26 Disinfection Certificates The departmentis regularly called upon to certify that consignments of hair and rags have been sterilized. Regular visits are made by the Public Health Inspectors to the firms concerned in connection with the issue of these certificates. In the case of the hair the certificates are required for production to the public health authorities of the countries to which the hair is exported. The certificates for rags are required by firms outside the Borough who supply rags for cleaning purposes and have them sterilized by local agencies and who need the certificates either for export purposes or for submission to their customers. A fee of 5/- is charged for each certificate. Certificates Issued in 1962 Sterilisation Certificates - Hair 95 Rags 47 142 Public Baths and Laundry Establishments The Baths Superintendent supplied a full report on these services which appeared in my report for 1959. The following is a brief summary of the facilities available. (1) Bathing Pools (a) Lido Open Air Pool. (165 ft. x 75 ft.). The Total 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. 32 (2) Private Baths (a) Central 34 (b) Conway Road 18 (c) Bromley Road 14 (d) Tiverton Road 22 Total 88 (3) Public Laundries (a) Bromley Road (b) Tiverton Road (c) Markfield Laundrette 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. Insect Pests The number of bug infestations reported again declined during 1962; with 89 houses infested as against 105 the previous year. The greatest numbers of other pests dealt with were beetles - 60 infestations, and wasps - 17 nests were destroyed. 158 inspections were made of premises prior to the tenant's removal to Council houses. Disinfestation was required in 13 cases. PREMISES TREATED Houses Other Premises Ants 14 5 Bees 5 Beetles 41 19 Bluebottles 2 Bugs 89 Fleas 7 Flies 7 Leatherjackets - 2 Mites 1 1 Maggots 1 1 Red Spider Mites 4 Silver Fish 1 Wasps . 15 2 Wood Lice 1 Wood Worm 4 Total 192 30 33 Rodent Control Treatment of the sewer manholes with sodium fluoracetate four time a year was continued. Annually, in April, the treatment is now preceded by a test bait, using sausage rusk, to assess the poison bait requirements. Since commencing to use sodium fluoracetate, in 1959, there has been a steady fall in the number of "takes" of between 25% and 30% per annum. The method of assessment was changed in 1961 from direct poison "take" readings to prebait "take" readings so that sufficient information has not yet been obtained for the purpose of annual comparison. The following is a summary of premises treated in 1962:- (1) Houses 646 (2) Shops 51 (3) Factories 32 (4) School Canteens 100 (5) Miscellaneous 28 (6) Total Charge for 2-5 above £138 12s. l0d. Factories The Borough has a highly industrialised area on its eastern side, in addition to much light industry generally. The local authority is responsible for enforcing certain provisions of the Factories Act and visits are made to the factories for this purpose. Good co-operation is maintained between the Department and H.M. Factories Inspector in matters of mutual interest. Premises No. on Register Number of Inspections Written Notices Occupier Prosecuted (i) Factories in which sections 1, 2, 3, 4 & 6 are enforced by local authority 55 13 - - (ii) Factories not included in (i) in which section 7 is enforced by local authority 681 167 11 - (iii) Other premises in which section 7 is enforced by local authority (excluding outworkers premises) 12 12 - - Total 748 192 11 - 34 Summary of defects found in factories Particulars Number of cases in which defects were found Pound Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (s. 1) - - - - Overcrowding (s. 2) - - - - Unreasonable temperature (s. 3) - - - - Inadequate ventilation (s,4) - - - - Ineffective drainage of floor (s. 6) - - - - Sanitary conveniences (s. 7) (a) Insufficient 2 1 - 2 (b) Unsuitable or defective 17 16 - 13 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to outwork) 3 - 3 - Total 22 17 3 15 Outworkers Regular visits were made by the public health inspectors to the homes of persons notified to the department as outworkers in accordance with the provisions of section 133 of the Factories Act, 1961. The following is a summary of the types of work undertaken by outworkers in the Borough Wearing apparel 365 Household linen 5 Curtains & furniture 1 Upholstery work 1 Umbrellas 1 Artificial flowers 10 Paper bags 4 Cardboard boxes 44 Brushes 1 Boxing, carding of buttons 6 Christmas crackers & stockings 12 450 Although in many instances repeated reminders were necessary, no employer defaulted in making the required returns. In no case was it found that homework was being carried on in unwholesome premises. 35 Shops Inspections of shops premises have been carried out under the Shops Act, 1950, during the year; many have been made in late evenings and at week-ends to ensure that the regulations are complied with. A further increase in the "self-service" type of store has brought a "new look" to the main shopping centres. Many of the larger multiple stores have made very good provision for the comfort of the staffs in the rebuilding, but some of the smaller companies going over to self-service supply only the absolute essentials forthe staff so as to achieve the maximum sales space. The situation is often aggravated by the fact that the lesser known establishments tend to employ a staff composed mainly of young persons, many of whom would take their meals on the premises if more adequate facilities were provided. Inspections 1651 shops have been inspected, prescribed notices, records of employment, etc., have been examined and all necessary information obtained. An up-to-date register of shops within the Borough has been maintained. 1586 male assistants, 1860 female assistants, and 147 male and 327 female young persons were employed at the premises inspected. During the year the following contraventions werenoted:- Section 17(2) Assistants weekly half holiday notice not 98 exhibited Section 32(2) Record of hours of employment of young 35 persons not maintained Section 32(3) Abstract of provisions of employment 37 of young persons not exhibited Section 37(2) Notice re. use of seats by females not 79 exhibited General Closing Hours Section 2(1) Failing to close at prescribed hour 2 Weekly Half Holiday Section 1(2) Alternative closing notice not exhibited 21 Section 13(1) Exempted trade notice not exhibited 37 Section 1 Sale of unscheduled articles 1 Sunday Trading Section 22(3) Record of hours not maintained 1 Section 57 Exempted trade notices not exhibited 32 Section 47 Sale of unscheduled articles 15 36 In connection with the infringements recorded above, 65 re-inspections were made and 68 formal notices served. Middlesex County Council Act, 1944: Street Trading Twenty-three trading sites were licensed. Twenty-five warning letters were sent and sixteen prosecutions were taken for infringements of the Byelaws or unlicensed trading. Special attention has been paid to trading within the vicinity of the Spurs Ground Fabrics (Misdescription) Act, 1913 The Fabrics (Misdescription) Regulations, 1959 146 inspections were made during the year, 103 samples of cloth or clothing were examined - no infringements were noted. Some improvement in the availability of flameproof clothing was seen, but retailers are still reluctant to stock these goods as there seems to be little demand for them. Prosecutions Shops Act, 1950 and Middlesex County Council Act, 1944 Offences Section Fine Costs Total Case 1 Sale of articles not mentioned in the Fifth Schedule (Sunday trading) 47 £2 0 0 £1 1 0 £ 3 1 0 Case 2 - ditto - 47 £1 0 0 £1 1 0 £ 2 1 0 Case 3 Failing to exhibit exempted trade notice 57 £1 0 0 - £ 1 0 0 Case 4 Sale of articles not mentioned in the Fifth Schedule (Sunday Trading) 47 £1 0 0 £1 1 0 £ 2 2 0 Case 5 Failing to exhibit exempted trade notice 57 £1 0 0 - £ 1 0 0 Case 6 Sale of articles not mentioned in the Fifth Schedule 47 £1 0 0 £1 1 0 £ 2 1 0 Case 7 Failing to exhibit exempted trade notice 57 £1 0 0 • £ 1 0 0 C/Fwd. £8 0 0 £4 4 0 £12 5 0 37  Offence Section Fine Costs Total B/Fwd. £ 8 0 0 £ 4 4 0 £12 5 0 Case 8 Sale of articles not mentioned in the Fifth (Sunday trading) 47 £ 2 0 0 £ 1 1 0 £ 3 1 0 Case 9 Unlicensed Street trading 320 & £ 1 0 0 £ 10 6 £ 1 10 6 329 Case 10 Infringement of Byelaws made under section 326 of the Middlesex County Council Act, 1944 Bye law No. 5 £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 11 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 12 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 13 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 14 ditto ditto £ 2 0 0 ■£ 2 2 0 £ 4 2 0 Case 15 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 16 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 17 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 18 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 19 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 20 ditto ditto £ 2 0 0 £ 2 2 0 £ 4 2 0 Case 21 ditto (2 summonses) ditto £ 4 0 0 £ 2 2 0 £ 6 2 0 Case 22 ditto ditt (2 summonses) ditto £ 4 0 0 £ 2 2 0 £ 6 2 0 Case 23 Unlicensed street trading 320 & 329 £ 1 0 0 10 6 £ 1 10 6 Case 24 ditto 320 & 329 £ 1 0 0 10 6 £ 1 10 6 £43 0 0 £34 2 6 £77 3 6 The Oil Heaters Regulations, 1962 Regulations made by the Secretary of State came into force on the 1st June, 1962. They prescribe standards of construction, design and performance for unflued domestic oil heaters, including pressure types, and are based on the British Standard for Kerosine Unflued Space Heaters. 38 In addition heaters are required to bear a warning against the following practices:- 1. Using petrol as a fuel; 2. Carrying heater when alight; 3. Usingheater in unventilated place; 4. Exposing heater to draughts; and 5. Placing heater where it may be knocked over. The regulations do not apply to appliances manufactured before the 1st June, 1962, Rag Flock & Other Filling Materials Act. 1951 There are no establishments licensed for the manufacture of rag flock, At 31st December, 1962 there were 19 premises registered for the use of filling materials. Pet Animals Act 1951 At 31st December, 1962, 10 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, 1962. Burials 10 burials were carried out under section 50 of the National Assistance Act, 1948, where no suitable arrangements would otherwise have been made. DOWNHILLS/BRUCE GROVE SMOKE CONTROL AREA 39 CLEAN AIR ACT Smoke Control Areas The third smoke control order which came into operation on the 1st November 1962, extended smoke control to the western sector of the borough. A fourth order affecting 515 acres was made by the Council on the 8th November and received confirmation of the Minister of Housing and Local Government on the 30th January 1963. When this comes into operation on the 1st November 1963 smoke control will be extended to a further 7,321 dwellings. The area also includes 104 factories, 322 commercial premises and 37 other buildings. Furnace Installations Six notifications under section 3 of the Clean Air Act, 1956 were received and examined of proposals to install industrial furnaces. Investigation of Atmospheric Pollution Tottenham is a participating authority in the national survey into atmospheric pollution which is being conducted by the Department of Scientific and Industrial Research. Three sulphur dioxide and smoke recorders are now established in the borough, the third station at Markfield Secondary Modern School coming into operation in October, 1962. 40 ATMOSPHERIC POLUTION RECORD, 1962 (Microgrammes per cubic metre) Month North Site (Devonshire Hill Library Central Site (Technical College) South Site (Markfield School) Smoke Sulphur Dioxide Smoke Sulphur Dioxide Smoke Sulphur Dioxide Average Highest Average Highest Average Highest Average Highest Average Highest Average Highest January 54 95 181 234 166 370 125 279 February 145 391 219 490 117 276 214 400 March 169 364 224 473 183 431 261 542 April 53 146 101 477 56 112 158 301 May 46 117 90 201 45 133 111 247 June 18 26 62 163 21 49 98 224 July 26 57 71 120 28 54 77 134 August 36 80 51 160 40 84 69 168 September 43 70 56 172 82 195 133 384 October 76 302 94 170 115 310 125 419 90 104 314 518 November 221 1,107 207 332 215 978 186 448 133 342 138 219 December 752 2,226 674 2,518 564 1,730 529 3,055 344 624 472 3,174 LOVE LANE AREA 41 HOUSING The greater part of the work required in dealing with "unfit" houses was carried out by owners after service of informal notices, but in some instances it was necessary to serve statutory notices and to carry out work in owners' default in a small minority of these The Housing Act, 1961, gave powers to local authorities to require additional facilities in houses in multiple occupation and in order to implement these provisions and to abate and control overcrowding, detailed inspections were immediately made by a preliminary survey of such premises. In many cases several visits had to be made before full particulars became available, because although notice was given prior to the Inspector's visit it was seldom found that all tenants had made arrangements for him to have access to their rooms. Only rarely was it possible for Inspectors to be able to obtain all essential information on their initial inspection, and in some cases evening visits were necessary. This work has become a routine duty: the movement of tenants and changing conditions require that a constant check be kept on all houses in multiple occupation . Overcrowding Cases of overcrowding have arisen from time to time, particularly in houses let off to several tenants. Informal action was taken in most instances but in one case where the landlord had let a house in three parts and in each case so as to cause statutory overcrowding, legal proceedings were taken under section 78 of the Housing Act, 1957. The landlord was fined a total of £15 and ordered to pay £5.5 0 costs to the Corporation. Clearance Areas and Individual Unfit Houses During the year representation was made of the area comprising the houses in Willow Walk and Milton Road 72 houses in all. In October, 1962, the Minister confirmed the Council's Whitehall Street/Stanley Grove and Church Road/Kings Road Nos. 1, 2, 3, 4 and 5 Clearance Orders The redevelopment of these areas will form the second phase of the White Hart Lane Scheme. Four unfit houses were dealt with by individual closing and demolition orders' in one case a closing order was made in respect of one room in a house. 31 houses were repaired following the service of notices under Section 9. Work was carried out in owners default in 5 houses at a cost of £756.10.6 which was recoverable from the owners. 42 Certificates of Disrepair The applications for certificates continued to decline. While part of this decline may be attributed to apathy on the part of some tenants it is true that many repairs are carried out by owners more readily than was the case a few years ago. Applications for Certificates of Disrepair Number of applications for certificates 10 Number of decisions not to issue certificates 1 Number of decisions to issue certificates (a) in respect of some but not all defects 6 (b) in respect of all defects 3 Number of undertakings given by landlords under paragraph 5 of the First Schedule 6 Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil Number of Certificates issued 3 Applications for Cancellation of Certificates Applications by landlords to Local Authority for cancellation of certificates 3 Objections by tenants to cancellation of certificates Nil Certificates cancelled by Local Authority 3 43 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 4. 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 1 955 25 28. 9.54 25. 5.55 13. 1.56 12.57 1.58 Plevna Crescent Nos. 1, 2 & 3 26 29.11.55 11.10.56 Not Confirmed St Ann's Road 5 29.11.55 11.10.56 14. 2.57 3.59 Hartington Road 15 29.11.55 11.10.56 14. 2.57 10.59 12.59 Northumberland Park (No 1) 26 28. 2.56 19.12.56 26. 4.57 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 and 15, 3 60 8. 7.60 - - Tewkesbury No.7 3 14.10 58 - 27.10.59 22.1.62 - Markfield Redevelopment 1958 50 18.11.58 5. 7 60 4.10.60 - - Tewkesbury No 8 6 3 0. 6.59 Inspector's visit 7. 9.60 - - 17. 6 60 - - Northumberland Park Nos 2, 3, 4, 5 & 6 58 12.1.60 17. 1.61 30 5.61 - - Durnford Street/ Gourley Street 74 12. 1.60 (56 Purchased by Agreement) - - Redevelopment - - Whitehall Street/ Stanley Grove 86 23. 1.61 20. 3.62 18.10.62 - - Church Road Kings Road Nos. 1 2, 3, 4 & 5 76 23.1.61 20. 3.62 18.10.62 - - Milton Road/ Willow Walk 72 29.5.62 - - - - Tewkesbury Road and Seven Sisters Road Redevelopment 43 • 13.2.62 12. 2.63 - - - 44 Premises the subject of Demolition Orders not demolished as at 31st December, 1962 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 Braemar 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 8 Markfield Road 29.11.62 * These premises were still occupied at 31st December, 1962 HOUSING ACTS 1936 & 1957 SECTIONS 9 & 10 WORK IN DEFAULT Year Number of Houses Cost £ s. d. 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. 1962 5 756 10. 6. 45 Provision of Rent Books The Landlord and Tenant Act, 1962 which came into force on the 1st November, 1962 places a duty on landlords to provide rent books or similar documents but this requirement applies in the case of weekly tenants only. Before this new legislation became operative legal proceedings were taken under section 12 of the Rent Act in one case of failure to provide a rent book for the tenant of furnished accommodation. The landlord was fined £1 and ordered to pay £1.1.0 costs to the Corporation and £3.3 0 for an interpreter. 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 107 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 7 2. Refer to Committee 52 3. Allow medical points 22 4. Recommend transfer to more suitable accommodation 3 5. To be reviewed at a later date 3 6. Unable to support 19 7. Circumstances changed making further action unnecessary 1 46 FOOD CONTROL 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 but also to keep before food handlers the need for a high standard of personal hygiene. The total number of food shops as at 31st December, 1962 was 1050, 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, 1962 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 428 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 eel's 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:- 47 Articles No. of Hawkers Registered No. of Storage Premises Registered Fruit and vegetables 100 87 Shellfish 18 7 Fish 8 4 Ice-cream 5 - Light refreshments 9 1 Peanuts 3 1 Eggs 1 - Groceries 1 1 Condemned Food A large amount of food is dealt with by the Public Health Inspectors. Most of this is surrendered by the local wholesalers, with some from retailers. A certificate from the Public Health Department that articles or consignments are unsound, due perhaps to decomposition, is a document necessary to tradesmen in dealing with their suppliers. The following articles were dealt with':- Condemned Food Tinned Articles Baby Foods 645 Pease Pudding 4 Bacon 3 Pie Filling 3 Beans Baked 401 Potato Salad 3 Beans Curried 2 Preserves 7 Beans Butter 4 Rice Creamed 83 Beans & Sausages 1 Soup 861 Beef Pie 1 Beverages 38 Spaghetti 42 Bolognaise 27 Sponge Pudding 6 Coco Cola 1 Steak Pies 8 Fish 458 Steak Stewed 17 Fruit Juice 16 Stew Irish 15 Fruit Mixed 396 Sultana Pudding 1 Fruit Puree 38 Tomatoes 119 Lemon Bitter 1 Tomato Juice 65 Meat Processed 783 Tomato Paste 101 Meat Puddings 3 Tomato Puree 6 Milk & Cream 337 Vegetable's Mixed 246 Mint Sauce 1 Vegetable Salad 13 48 Other Articles of Food Condemned Bacon 771½ lbs. Lard 8 Packets Bacon & Vegetables 24 Jars Macaroni 120 Packets Beverages 60 Jars Mayonnaise 2 Jars 24 Packets Meat 1019 lbs Blancmange 5 Packets Meat Paste 3 Jars Butter 1 Packet Meat Processed 12 Jars Cheese 39 lbs. Milk & Cream 12 Jars 32 Packets Mint 12 Jars Chickens 24 Pickles 63 Jars Chocolate Spread 12 Cartons Preserves 142 Jars Cornflour 16 Packets Rice 4 Packets Custard Powder 10 Drums 84 lbs 8 Cartons Rice Pudding 24 Packets Currants 29 Packets Salad Cream 41 Jars Dates 6 Boxes Sandwich Spread 8 Jars Eggs Chilled 5 Cases Sausages 1 Jar Fish 19 Stones 4 lbs. Soup 7 Packets 2 Jars Stuffing 82 Packets Frozen Foods 510 Packets Suet 36 Packets Fruit Mixed 55 J ars Sweet Mix 3 Packets Gherkins 1 Jar Tapioca 4 Packets Honey 2 Jars Tomato Sauce 24 Bottles Horseradish 49 Jars Vegetables 1 Jar Instant Whip 18 Packets Vermicelli 5 Packets J ellies 24 Packets Yeast 49 lbs. Legal Proceedings Food and Drugs Act 1955 (a) Chocolate containing mould and larvae: plea of Guilty, fined £5. (b) Black grease in loaf of bread - "not of substance"; plea of Guilty, fined £5 with £5.5.0 costs. (c) Sale of mouldy cake; plea of Guilty, fined £10 with £5.5.0 costs. (d) Sale of bread roll containing wood screw; plea of Guilty fined £5 with £2.2.0 costs. Food Hygiene (General) Regulations 1960 - 5 summonses (e) Found Guilty on one summons and fined £2. No costs were awarded. Four other summonses dismissed. 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 1962:- 49 Article No. of samples procured Unsatisfactory Milk (various) 43 - Milk (evaporated) 1 - Butter 31 2 Bread and Cakes 6 - Cheese 15 - Coffee 5 - Cream 19 - Drugs 26 - Pish and Pish Products 21 - fruit (fresh and canned) 14 2 Fruit (dried) 2 - Ice Cream 13 - Liver 17 - Margarine 18 - Meat and Meat Products 134 2 Preserves 4 - Sauces and Pickles 4 - Sausages 11 - Soft Drinks and Fruit Juices 10 - Spirits 6 - Vinegar 23 - Miscellaneous 28 1 Totals 451 7 Commenting upon the unsatisfactory samples, the Public Control Officer makes the following observations "Butter. Two samples of butter which were procured in your borough were found to contain percentages of water slightly in excess of that permitted. Because the excess of water was small follow-up samples were obtained and in each case the result of analysis was satisfactory. Fruit. A greengrocer in your borough was prosecuted for selling Rennett Walder apples which were not of the nature of the food demanded, namely Granny Smith apples He was also prosecuted for falsely describing Rambour Frank apples as Red Delicious apples. In respect of these offences the greengrocer was fined a total of £15 and ordered to pay 3 guineas towards the costs. Meat, A butcher in your borough was prosecuted for selling minced steak containing 1,587 parts per million of sulphur dioxide. Sulphur dioxide is a preservative which is not permitted in minced steak The manager of this butcher's shop was also prosecuted for the same offence because he personally added the preservative knowing it to be wrong The butcher was fined £5 and the manager £10, and each of them was ordered to pay £6.17.6d towards the costs. 50 Miscellaneous A sample of "Milk Ring" biscuits which was procured for analysis was found not to contain whole milk but skimmed milk. Subsequent enquiries showed that the biscuits were old stock and the manufacturers informed me that in fact current production of these biscuits was made with whole milk. In the circumstances a letter of caution was sent to the biscuit manufacturer*. Milk and Dairies Regulations During the year 8 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 8 new registrations, 6 were for new premises and the other 2 were in respect of the change of proprietorship of previously registered premises The number of premises and distributors registered at 31st December, 1962 was as follows':- No. of distributors 164 No. of Dairies 8 Imported bulked frozen whole egg and egg whites Consignments of frozen whole egg or egg whites are frequently imported from Commonwealth and foreign countries direct to warehouses in the borough where they are held until import examination is carried out by this authority. Certain consignments are pasteurised and these are released without further examination. Ten per cent sampling methods are used for the untreated consignments In some cases this is done by Guy's Hospital Laboratory on behalf of the importers and in other cases the samples are collected by the public health inspector and submitted to the Public Health Laboratory Service for bacteriological examination. Where adverse reports are received the distribution of the batch affected is stopped until the importer can arrange for its pasteurisation. During 1962 520 tons were imported (of which 213 tons were pasteurised) and of 317 samples taken 19 showed bacterial contamination as follows:- Salmonella typhi-murium 8 ,, thompson 3 ,, potsdam 1 ,, jerusalem 1 ,, hessarek 3 pullorum 3 Slaughterhouses There are two licensed slaughterhouses in the borough., one of which deals principally with horses. Following confirmation of the Council's Slaughterhouse Report in 1960 the 1st July 1962 was fixed as the appointed day for the application to existing slaughterhouses 51 of the Slaughter of Animals (Prevention of Cruelty) Regulations 1958 and the Slaughterhouses (Hygiene) Regulations 1958. The slaughterhouse in Philip Lane ceased the slaughter of bovine animals except calves owing to lack of space and the requirement of the Slaughter of Animals (Prevention of Cruelty) Regulations that a stunning pen must be provided for these animals This slaughterhouse underwent considerable alteration and improvement in order to meet the requirements of the above-mentioned Regulations Meat Inspection Although the number of Public Health Inspectors were not up to establishment meat inspection was fully maintained. This entails evening work as well as work on Saturdays and public holidays the inspectors taking these sessions in a duty rota Fewer cows were slaughtered during the year than previously and the number of horses slaughtered showed a progressive decline, reflecting the constantly diminishing numbers of horses used for transport generally. SUMMARY OF CARCASES INSPECTED 1962 Horses Cows Calves Sheep & Lambs Pigs exclud. Sows Sows Goats Number killed 312 21 1445 2855 14494 1716 115 Number inspected 312 21 1395 2839 14494 1716 115 All Diseases except Tuberculosis Whole carcases condemned - - - 21 11 1 - Carcases of which some part or organ was condemned 9 7 2 284 1621 106 13 Percentage of number inspected affected with disease other than tuberculosis 2.88 33 33 .14 10.74 11.26 6.24 11.30 Tuberculosis Only Whole carcases condemned - - - - - - - Carcases of which some part or organ was condemned - - - 1 105 31 - Percentage of number inspected affected with tuberculosis - - - .04 .72 1.81 - Note: No case of cysticercosis was reported during the year 52 PERSONAL AND SCHOOL HEALTH SERVICES TOTTENHAM AND HORNSEY (Joint Population 210 740) 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 6%. 1962 1961 1960 Live Births (a) Domiciliary 943 853 799 (b) Hospital or Nursing Home 3636 3219 3084 Still Births (a) Domiciliary 4 7 3 (b) Hospital or Nursing Home 67 52 55 4650 4131 3941 Ante-natal Clinics The routine care of expectant mothers has continued at all the centres showing a a slight increase over last year's figures, The relatively larger number of mothers receiving care in Hornsey compared with Tottenham reflects the fact that all patients confined in the Alexandra Maternity Home attend local authority clinics for their ante natal care. Duringthe year an important report was made under the auspices of the Royal College of Obstetricians and Gynaecologists by the National Birthday Trust following a nation wide survey they made into Per: natal Mortality This survey was an investigation into all births occurring in one week in 1960 throughout England, Wales and Scotland, and all perinatal deaths occurring in three months. Detailed reports of all these births have thrown light on the standard of obstetric care that was being provided at that time. Argument is still going on about the interpretation of the findings but it is clear that standards are still far from ideal and that some infant deaths could be prevented if a little more skill and care were available. Mothers who come off worst are those who are "unbooked", i.e. no one doctor is responsible for the care throughout the pregnancy. This is not a local problem, it is a national one and the remedy will have to be partly national as well. At local liaison committees representatives of the hospital boards, general practitioners and this health department continue to try to ensure that local facilities are used to the best advantage All 'the obstetric units that accept 53 patients from Tottenham and Hornsey are constantly working to the limit of their capacity , as are the domiciliary midwives. While we wait hopefully for an increase in the numberof maternity beds in the area, the only way there seems to be any hope of increasing the number of mothers who have the advantages of a booked hospital bed is to foster schemes for early discharge from hospital after the birth to adequate care at home, This would bring increased turnover in the labour wards and new work for midwifery staff on the district and the staffing position in these two spheres has to be kept constantly under review. No one likes the system whereby patients are admitted on the Emergency Bed Service; not the family doctors disturbed during the night, nor the hospital staff receiving patients they do not know, nor the clinic staff trying ceaselessly by letters and telephone calls to find an alternative, nor least of all the patient who is anxious and in suspense until the last moment. We all work for and look forward to the day when we are in a position to abandon it. But as the situation is, the Emergency Bed Service is an extremely efficient and well run organisation the absence of which would cause greater hardships and possible risks to mother and child. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 52.0% in 1962 compared with 61.2% the previous year. The following table gives details of attendances at all clinics in the Area:- Number of sessions held Number of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Burgoyne Road 90 252 104 1831 108 21.5 Highgate 56 150 52 1043 54 19.6 Portis Green 100 246 126 2078 130 22.1 Hornsey Town Hall 154 424 75 3314 80 22.0 Mildura Court 64 214 77 1494 79 24.6 Stroud Green 52 155 74 983 76 20.4 The Chestnuts 163 464 226 2643 231 17.6 Lordship Lane 153 247 103 1559 109 11.0 Park Lane 102 266 157 1326 160 14 8 Totals 1962 934 2418 994 16271 1027 18.5 Totals 1961 936 2527 982 15334 1050 17.5 Totals 1960 923 2416 1082 16151 1094 18.7 54 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 27 176 6.5 Highgate 4 19 4.8 Portis Green 12 81 6.8 Hornsey Town Hall 24 303 12.6 Mildura Court 21 136 6.5 Stroud Green 22 197 9.0 Chestnuts 51 818 16.0 Park Lane 90 377 4.2 Lordship Lane 51 91 1.8 Total 302 2198 7.3 Mothercraft and Relaxation Classes The following table shows attendances at Mothercraft Clinics during the year- Clinics Number of sessions held Number of new cases Total number of attendances Average attendance per session Burgoyne Road 43 46 319 7.4 Highgate 30 43 155 5.2 Portis Green 48 75 364 7.6 Hornsey Town Hall 51 102 556 10.9 Mildura Court 45 54 271 6.0 The Chestnuts 51 102 563 11.0 Lordship Lane 51 76 407 8.0 Park Lane 51 59 292 5.7 Total 370 557 2927 7.9 An average attendance of 7.9 per session is reasonable because every mother during relaxation instruction requires individual attention if she is to obtain the maximum benefit. The health visitor aims to achieve an informal atmosphere, encouraging group participation, where fears and misapprehensions can be dispelled. Infant Welfare Clinics The increase of first attendances of babies under one year is consistent with the increased number of births. Immigrant mothers particularly appreciate the services available, as shown by their continued and regular visits. It is inevitable, because of 55 the language difficulty, that some of the sessions extend beyond the usual hours at clinics where a number of immigrants live in the vicinity Evidence of extensive dry rot at the Church Road Clinic resulted in these premises being closed on the 23rd February. At first, emergency arrangements were made for a weekly ante natal and infant welfare session to be held at the Fortis Green clinic and a toddler session a Weston Park, Mothers with their own cars were most helpful in offering lifts and making special journeys in order to assist other mothers. Such help willingly given was much appreciated. Alternative accommodation was later obtained at the Congregational Church Hall, Swain's Lane, Highgate Even though accommodation here was not ideal, it has been possible to provide a reasonable service as a temporary measure. The number of children attending the centres is as follows".- Name of Centre Number of sessions held Number of first attendances under 1 year Number of attendances Total attendances Number of cases seen by M.O. Average attendance per session Under 1 year Over 1 but under 2 Over 2 but under 5 Burgoyne Road 153 418 5803 687 230 6720 1542 43.9 Highgate 91 255 2269 302 158 2729 1323 30.9 Fortis Green 185 385 4643 756 207 5606 2152 33.3 Hornsey Town Hall 155 678 5704 561 170 6435 2509 41.5 Mildura Court 100 286 3240 625 25 3890 1385 38.9 Stroud Green 103 352 3499 395 112 4006 1324 38.9 The Chestnuts 202 759 6897 810 294 8001 2266 39.6 Lordship Lane 255 408 4983 1028 281 6292 1727 24.7 Park Lane 205 379 4937 614 320 5871 1701 28.7 Somerset Road 151 352 3855 621 410 4886 1485 32.4 Totals 1962 1600 4272 45830 6399 2207 54436 17414 34.0 Totals 1961 1770 3936 47547 6934 2046 56527 17584 31.9 Totals 1960 1729 3782 45230 7489 1879 54598 17853 31.6 Toddlers Clinics A friendly and informal atmosphere is created during these sessions and the children are encouraged to mix and play together. Attendances remain rather low in spite of encouragement, reminders and letters of appointment to the parents. After the first attendance, the majority of mothers continue to bring their children at six-monthly intervals or more frequently when necessary until the child enters school The following table gives details of attendances at the individual clinics:- 56 Name of Centre Number of sessions held Total attendances Number of cases seen by M.O. Average attendance per session Burgoyne Road 27 488 488 18.1 Highgate 24 218 212 9.1 Fortis Green 27 460 460 17.0 Hornsey Town Hall 60 503 503 8.4 Mildura Court 51 738 732 14.5 Stroud Green 20 294 294 14.7 The Chestnuts 50 734 733 14.7 Lordship Lane 52 638 638 12.3 Park Lane 24 328 328 13.7 Somerset Road 39 518 486 13.3 Totals 1962 374 4919 4874 13.2 Totals 1961 365 5301 5139 14.5 Totals 1960 373 5186 5065 13.9 Daily Guardian Scheme As indicated by the following table this scheme continues to serve a very useful purpose for the care of children whose mothers for various reasons, seek employment outside the home. The arrangements, as in previous years, continued to work smoothly parents taking advantage of the service are very appreciative. 1962 1961 1960 Number of Daily Guardians on register 266 263 197 Number of Daily Guardians minding children 96 103 111 Number of children being minded 118 114 141 Total number of children minded during the year 230 252 297 Total number of days minded 26,309 30,420 29,128 Day Nurseries The demand for day nursery admission is often greater than the number of places available. At the end of the year 42 were on the waiting list, The largest number of applicants awaiting admission is usually in the 0 2 years age group because of the limited number of places in this category and the demand from unmarried or unsupported mothers. Many would-be applicants are discouraged from making application because they do not come within the eligible categories. It is often possible to help these parents through the daily guardian scheme. During the year 197 admissions were arranged, whilst 84 of these children were still attending at the end of the year, a large percentage were temporary admissions ranging from one to twelve weeks only. 57 Handicapped Children Eight handicapped children were admitted to Stonecroft Day Nursery, Hornsey during the year. Two were partially deaf, three whose parents were deaf, one with post polio paralysis, one mentally handicapped and the eighth was both blind and mentally handi capped. Plevna Day Nursery It is anticipated that this nursery will be closed early in 1963 for demolition and building of a new nursery on the existing site. In this event the Cornwall Road School Clinic would be adapted as a temporary day nursery. These premises being smaller means a reduction in the number of available places and it would not be possible to accommodate any child under two years of age. Inevitably, the reduction of places must extend the period of waiting for priority admissions and throw a heavier burden on the other two nurseries, especially Park Lane Day Nursery, making it necessary that the establishment of staff be kept at the highest level. It is expected that 32 places will be available, with a slight increase for emergency admissions On this assumption, the number of staff on the present ratio of staff to the number of places would only allow four staff including the matron. This would be an impossible and even a dangerous situation, especially during staff absenteeism because of sickness and annual leave. Training of Nursery Nurses Six student nursery nurses were accepted for training In addition, two students were accepted for one year s practical training under a pilot scheme organised through the aegis of the Tottenham Technical College. The second year of training w.ill be undertaken in a nursery school before qualifying for the examination of the Nursery Nurses Examination Board. Attendances 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 Average daily attendances Under 2 2-5 Under 2 2 - 5 Under 2 2 - 5 Total Stonecroft 15 43 17 42 3585 8547 12132 47.8 Park Lane 20 30 13 27 3112 5356 8468 33.3 Plevna 20 30 15 34 2828 7339 10167 40.0 Totals 1962 55 103 45 103 9525 21242 30767 121.1 Totals 1961 55 103 47 119 9502 22881 32383 127 5 Totals 1960 55 103 52 112 10890 21273 32163 126.1 58 Private Day Nurseries and Registered Child Minders Regular inspections are made of private day nurseries and of registered child minders in the Area. The latter are persons who mind three or more children in their homes for part of the day. There are several different types of arrangement for those registered in the Area 1. Day nurseries taking children all day Greygates Nursery, 39 children 182 Muswell Hill Road, N.10 Fortis Green Nursery, 24 children 68 Fortis Green, N.2. 2 Day nurseries taking children in mornings only Woodlands Nursery School, 48 children 38 Wood Lane, N.6. West Drive Nursery Group, 18 children Moravian Church Hall, N.8. 3. Child Minders taking children all day Miss Hermitage, 22 children 28 Bedford Road N 15. Mrs. Kruger, 8 children 38 Crouch Hall Road, N.8. 4 Child Minders taking children in mornings only Mrs. Blit, 9 children 57 Collingwood Avenue, N 10. Mrs. Summers, 9 children 53 Mount View Road, N.4. Mrs. Atkinson, 11 children 26 Dukes Avenue, N.10. Mrs. A. Watson, 10 children 7 Jackson's Lane, N.6. Mrs. Stringer, 12 children 101 Crouch Hill, N.8 59 Distribution of Welfare Foods The full effect of the introduction of economic prices for orange juice, cod liver oil and vitamin tablets in June 1961 is reflected in the following tablet- Year National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tabs (packets) 1962 31489 42976 5429 5593 1961 30801 67012 10038 9428 1960 32910 99584 12790 12213 1959 36350 98855 11676 11048 Priority Dental Service for Mothers and Young Children 9% of the dental officers' time was devoted to the priority classes. Although the number of expectant and nursing mothers inspected and treated remained constant, there was an increase of 143 fillings and a decrease of 157 extractions, and in consequence, eleven fewer dentures were fitted. The ratio of 2.5 fillings to one extraction was achieved. 563 children under five were inspected, including 59 examinations at day nurseries. The number of fillings inserted was 1,206, the highest since 1955, but, unfortunately, the number of extractions remained unaltered. For every child treated there were 3.6 conservations (fillings and silver nitrate treatments) and 0.6 extractions. This means that the ratio of conservations to extractions was 6:1. In spite of this high proportion, it was found necessary to supply four partial dentures. It is in the early years that a child can derive most benefit from Dental Health Education. The dental auxiliary who was appointed in September has been trained in this field of work, and has made a start in giving group talks at welfare centres, so far at ante-natal clinics, and to the mothers of toddlers. Of course, advice has always been given to individual mothers, when they and their children attend the dental clinics. The following table gives details of attendances made:- 60  1962 1961 1960 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 160 563 158 492 162 539 Number referred for treatment 158 461 156 402 160 459 New cases commenced treatment 166 473 187 359 149 351 Cases made dentally fit 70 385 66 227 46 176 Forms of dental treatment Provided:- Teeth extracted 183 279 340 276 243 334 General Anaesthetics 23 169 33 142 81 179 Number of fillings 471 1206 328 911 249 628 Number of inlays 1 - 2 - 2 - Scalings and gum treatment 131 - 130 - 133 - Silver nitrate treatment - 518 - 285 - 440 Other operations 402 651 500 476 240 151 Number of radiographs 8 3 10 1 21 1 Denture dressings - - - - - - Dentures fitted:(a) Pull 14 - 20 - 24 - (b) Partial 37 4 42 10 28 5 Number of attendances 796 1694 884 1159 736 1061 Number of appointments not kept 270 454 279 325 208 216 Number of half-days devoted to treatment 322 244 194½ MIDWIFERY SERVICE (Section 23) The establishment of midwives was increased from twelve to fourteen towards the end of 1962. The actual number varied between nine and eleven during the year. Two pupil midwives were accommodated throughout the year for periods of three months each, whilst undertaking the district part of their training. The amount of work continued to outstrip the number of midwives available and it is a matter for regret that it was not found possible to implement a day and night shift system. 61 Deliveries The most significant increase was in the number of confinements conducted by the midwives 939 women were delivered in 1962, a rise of 300 cases in the past three years. These women received a total of 16,206 visits. It is not possible to estimate the amount of time spent with a woman in labour. This can vary from a few hours to 48 hours or more. The same can be said of visits during the early days following confinement. Although it is usual to allow 40 minutes for these visits, this must often be exceeded as feeding and other problems arise. In this connection the very young mother is an increasing factor to be considered. These immature young women require a great deal of support and encouragement before, during and after their confinements. Early Discharge from Hospital 175 women were discharged from hospital at the third day or earlier following their confinements. The majority of these were patients sent into hospital by the midwives because of some deviation from the normal. There is at present no scheme for planned early discharges. It is anticipated that arrangements for this will have to be made in 1963. Shortage of Hospital Beds The shortage of hospital beds remains acute and this, together with the high number of women admitted to hospital via the Emergency Bed Service, is an unsatisfactory aspect of the midwifery service. Many of these patients are ultimately delivered at home without adequate preparation or facilities. Ante natal Clinics Each midwife attends a local authority clinic and in addition four midwives attend ante natal sessions at the surgeries of general practitioners. It has been found that this makes for excellent liaison between patients, doctors and midwives. A table is given below showing the work for the past three years:- 1962 1961 1960 Number of deliveries attended 939 842 792 Number of visits made 16206 14795 15223 Number of hospital confinements discharged before 10th day 175 160 143 Number of visits made 830 1439 1288 Number of cases in which medical aid was summoned 248 265 282 Number of cases in which gas and air analgesia was administered 407 402 508 Number of cases in which pethidine was administered 515 510 481 Number of cases in which trichloroethylene was administered 424 380 189 Number of cases in which gas and air and trichloroethylene were administered 12 11 32 62 HEALTH VISITING SERVICE (Sections 24 and 28) The function of the health visitor is to promote good health, not only to individuals in a family, but to all members of a family. She needs to be aware of the social, environmental and psychological aspects as well as the physical. Because her work of necessity brings her into contact with the whole range of Local Authority services and other allied agencies, the health visitor is the liaison officer of the Local Authority. General practitioners are becoming more aware of her professional training and avail themselves of the support and help she can offer to their patients, either by her own efforts or through liaison with other social agencies. The actual number of visits made by the health visitors this year was as shown in the following tablet- Number of visits paid by Health Visitors working in the Area 1962 1961 Expectant Mothers First Visits 1617 1796 Total Visits 2471 3120 Children under 1 year of age First Visits 5399 4737 Total Visits 13134 12997 Children aged 1-2 years First Visits 5707 6704 Children aged 2-5 years Total Visits 8652 10524 Other cases - Total Visits as Health Visitor 6459 6102 Total Visits as School Nurse 673 978 Visiting the Aged Much of the work of the health visitor gets less recognition than it should but her services are in constant demand. Requests for visits to the elderly are an everyday feature, mostly from general practitioners or hospital almoners. Many of the elderly are unable to care for themselves, are sometimes without relatives and so require a number of the social services available. The health visitor is very much aware of the valuable work undertaken by the Old People's Welfare Associations of Hornsey and Tottenham and she frequently seeks their help. It is sometimes difficult to persuade some elderly people to accept help and only after several visits is their co-operation achieved Once help has been accepted, further deterioration is frequently prevented and perhaps the necessity of admission to hospital averted. Health Education Instruction in health practices is only part of the health education programmes. Whether given individually in the home or in organised groups, it seeks to develop sound attitudes To be successful, the health visitor has to create relationships with parents and parents-to-be, to gain the interest of the apathetic and the disinterested and ??? be aware of the psychological aspects She also needs to understand the metabolic turmoil of pregnancy, with accompanying social and economic stresses. Increase in the 63 preparation of both parents will increase the knowledge of health in the community and lead to improved child care In giving anticipating guidance to parents and prospective parents the health visitor will enable them to be prepared against possible future stresses and difficulties Health education in welfare clinics is a regular procedure and is considered to be a much more important function than the weighing of babies Discussion of the child's progress advice on general care behaviour and feeding problems is routine Health education in schools has been undertaken by health visitors and one school nurse for a number of years Two hundred and forty four classes were held in schools during 1962. The classes are kept on an easy and informal basis, the pupils being encouraged to ask questions and take part in the discussions. Many of the pupils who in the past have had the opportunity of participating in these classes, now have children of their own, and frequently seek the help of the health visitor who has seen them through their school life. Talks to Local Organisations by health visitors have been requested from time to time as well as a series of lectures to the British Red Cross Society. Also ParentTeacher Associations extend invitations to health visitors to speak on open discussions. Lectures on Social Aspects of Disease were given each term by the Superintendent Health Visitor and the Deputy Superintendent to student nurses at the Prince of Wales's General Hospital and the Preliminary Training School, Special Services Health Visitors Families with acute problems requiring immediate and time consuming attention are referred by the district health visitors to the special services health visitors who, in return, hand back to their colleagues some of the old-standing "problem" families who, although still in need of fairly close supervision, are on the whole managing their affairs better, as the children grow up and cause less strain on the parents. Mental illness, low intelligence in parents with families too large for them still remain the chief cause of parents being unable to manage their problems During 1962 the reasons for referral of new cases included mental illness in one or other parent, marital disharmony, debts and rent arrears In one case the mother had an obsessional neurosis and has had to have in-patient psychiatric treatment three times during the year. She has eight children living and for medical and psychiatric reasons wars sterilised after the birth of her last baby, born in November. In another case a Pakistan lawyer with a legal wife in his own country bigamously married a high grade mentally defective Irish girl by whom he had two children. He recently returned to his legal wife who has meanwhile become very wealthy This has made it necessary to get the two children aged nine and five years happily placed for adoption. The mother has been helped to find satisfactory residential work in hospital. Two mothers, whose husbands are incurable psychopaths have started to take the contraceptive pill under careful supervision as the usual family planning methods have proved unacceptable. The consultant and family doctor only recommended this after a very thorough investigation and it has resulted in an ease of tension in the families concerned 64 In the debt cases, the family comes to feel that the whole situation is hopeless, they become apathetic and family relationships are very strained, each partner blaming the other for their circumstances. Generous help has been provided in the form of clothing furniture, bedding etc. from the W.V.S , Red Cross, Shaftesbury Society. One family with a multitude of debts was helped by the Glasspool Trust after some effort had been made of their own. This helped them to feel the situation was improving a little more rapidly and they have continued with regular weekly payments since, in spite of added expenditure on coal, etc. which has made budgeting for these families increasingly difficult this winter. Both special services health visitors wish to acknowledge gratefully help they have received from local societies The Round Table of Hornsey arranged a holiday for two families and gave constructive and personal help to twelve families at Christmas. N.A.L.G.O. arranged a Christmas party which was very much enjoyed by all the children between three and eleven years In Tottenham the Rotary Club and Round Table made it possible for four boys at attend Highgate camp in August. Bertram Mills Circus and the Wembley Stadium were again generous in issuing free tickets enabling some of the mothers to have an outing with their children during the Christmas season. Miss Howse, in Hornsey, has accepted invitations to speak at various Guilds, Youth Clubs, Parent-Teacher Associations etc. and keeps in close contact with the excellent work done by the Churches in Hornsey. Intenseive family case work continues to help keep families together and is not only of benefit to the families and the children concerned, but in view of the expense of residential care is an enormous saving of public money HOME NURSING SERVICE (Section 25) The treatment of cases during the year may be classified as follows:- Injections 887 General nursing care 574 Blanket baths 302 Enemas 141 Dressings 316 Preparation for diagnostic investigation 77 Pessaries changed 60 Wash-outs, douches etc 28 Other treatments 32 The sex and age of patients at the time of the nurses's first visit may be classified as follows:- 65 Age Males Females 0-4 23 13 5-15 24 23 16-39 49 114 40-64 188 300 65 and over 439 995 723 1445 Cases attended during the year were referred from the following sources:- General practitioners 1571 Hospitals 575 Chest Physicians 9 Public Health Department 4 Direct 9 The following table shows the work of the home nurses during the year.- Type of Case Number of new cases attended by home nurses during year Number of cases on register at end of year Number of visits paid by home nurses during year M F Total M F Total Medical 489 837 1326 120 388 508 59936 Surgical 83 152 235 17 60 77 11230 Infectious Diseases 1 5 6 - - - 35 Tuberculosis 21 14 35 8 2 10 3010 Maternal Complications - 12 12 - - - 94 Totals 1962 594 1020 1614 145 450 595 74305 Totals 1961 609 1105 1714 129 425 554 73570 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox during the year was 54 1% compared with 49 6% for 1961. 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 vaccinations 2479 464 854 2184 4457 10438 Number of re-vaccinations 56 29 344 2679 11230 14338 66 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 1962 It has called for very careful programming to fit in with other prophylactic measures and the parents of all children in the Area have been offered appointments as soon as their children have reached the age of two months. There is provision for follow-up of defaulters to achieve maximum acceptance rates. doctors for immunisation or attending at the clinics, and the following tables show the results - 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:- Age at date of immunisation Number of Children who completed a full course of Primary Immunisation Diphtheria only Whooping Cough only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphtheria Tetanus and Whooping Cougn Under One 22 10 - 9 7 1712 One 45 21 3 27 18 1636 Two to Four 31 1 26 6 25 150 Five to Fourteen 110 - 83 8 186 40 Total 208 32 112 50 236 3538 Number of Children who received a Secondary (Re-inforcing) injection Diphtheria only Whooping Cough only Tetanus only Combined Diphtheria and Whooping Cougn Combined Diphtheria and Tetenus Combined Diphtheria Tetanus and Whooping Cough Under One - - - - - - One 6 3 - 15 2 1567 Two to Four 93 1 - 7 31 773 Five to Fourteen 1168 1 13 21 128 78 Total 1267 5 13 43 161 2418 Poliomyelitis Vaccination On the 2nd February 1962, Ministry of Health Circular 3/62 was issued, in which the use of oral vaccine for routine vaccination against poliomyelitis was authorised, As with the Salk vaccine, it is available to all between the ages of six months and forty years, but may be administered by nurses, thus releasing the medical officers for other work Salk vaccine continued to be available for use by those general practitioners who preferred it for their patients. 67 The following table shows the work carried out both by general practitioners and at the clinics:- Completed course of two injections using salk vaccine Completed course of three doses of oral vaccine Children born in 1962 33 163 Children born in 1961 526 762 Children and young persons born in 1943 to 1960 870 438 Young persons born in 1933 to 1942 581 248 Other persons 552 230 Total 2562 1841 Re-inforcing doses were given as follows: 3rd Salk injections 3496 4th Salk injections to children between the ages of five and twelve years 232 Oral vaccine after two Salk injections 2943 Oral vaccine after three Salk injections 1798 Total 8469 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 1962 170 applications were received compared with 180 the previous year. Of these, 159 were approved. Chiropody Service At the beginning of the year three chiropodists were employed on a sessional basis for a total of eleven sessions a week In August one chiropodist resigned and the sessions were reduced to eight a week. This was the position at the end of 1962, although two chiropodists were appointed early in 1963 for a further four sessions a week The following table shows the treatment carried out at clinics during the year 68 Category New cases First attendance during year of old cases Reattendances Total Elderly persons 169 85 1282 1536 Physically handicapped persons 1 - 1 2 Expectant and nursing mothers 12 1 9 22 Others - 1 - 1 School children 240 71 1339 1650 Total 422 158 2631 3211 Retirement AdviceClinic This clinic continued to operate during 1962, and with the co operation of the local offices of the Ministry of Pensions and National Insurance, men approaching 65 years of age were invited to attend for medical examination and advice as to how they might best enjoy their retirement. Sessions and attendances were as follows - Number of sessions held 28 Number of new cases attended 40 Number of re-attendances 32 DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 2028, which was again a record. The number of new cases is tending to decline slightly and the bulk of the work continues to be with old people who need permanent help A free service for mothers suffering from toxaemia in pregnancy was given in four cases. The total number of home visits made by the Home Help Organiser and her assistants during the year was 4710. This was less than the previous year owing to sickness and shortage of staff. A neighbourly help service was started during the year and potential good neighbours have been interviewed. Generally speaking, however, it has been found that neighbours who are already carrying out small duties for an infirm person prefer to continue on a neighbourly basis rather than being formally employed and paid for their services. The following table shows details of the cases served during the year:- 69 Cases provided with help Number of new cases provided with help Number of old cases for which help was continued from 1961 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) 119 5 124 3 Tuberculosis 12 28 40 30 Chronic sick (including aged and infirm) 544 1168 1712 1218 Others 119 33 152 26 Total 794 1234 2028 1277 INSPECTION OF PRIVATE NURSING HOMES There are three private nursinghomes in the Area registered with the County Council and regularly visited by the Senior Assistant Medical Officer. All these homes accommodate mainly chronically ill elderly patients, and particulars of the homes are as follows.- Claremont Nursing Home, 17 patients 108 Colney Hatch Lane, N.10. Kenwood Annexe Nursing Home, 15 patients 4 Princes Avenue, N.10 Strathlene Nursing Home, 20 patients 79 Creighton Avenue, N.10, SCHOOL HEALTH SERVICE Area School Population The school population for the Area is 26 731, as shewn in the following table- Hornsey Tottenham Primary Schools and Nursery Classes 5797 7886 Nursery Schools - 205 Secondary Modern Schools 2940 5248 Grammar and Technical Schools 1848 2603 Special Schools Physically Handicapped 97 Blanche Nevile School for the Deaf (including Classes for the Partially Deaf) - 107 10585 16146 70 Introduction The work of the School Health Service was again aided in 1962 by the continued co-operation of the Borough Education Officers of Tottenham and Hornsey and by Head Teachers, to whom I am grateful. During the past few years the earlier maturation of children has brought its own problems, not least of which is the occasional occurrence of pregnancy in older school girls. The handling of the situation requires an understanding approach to the girl and her parents and involves the co-operation of teachers, school medical officers and others concerned. Physical maturity by no means implies mental or emotional maturity and the decision whether the child is to be adopted or kept by the young mother requires a degree of heart-searching which no girl of 14 or 15 should be required to face. The problem of prevention of the conditions leading to these undesirable pregnancies is complex and is partly due to improved economic circumstances leading to earlier maturation but other more tangible factors play a part. The instance I have just quoted illustrates the fact that to remain a viable and useful institution, the School Health Service must be prepared to adapt to changing conditions. First conceived over 50 years ago to combat the appalling ill-health prevalent in the school population, today the service is more concerned with maintenance and promotion of health - physical and mental The reports of our consultant child psychiatrists given later in this section pay eloquent tribute to the importance now attached to the prevention and early treatment of emotional difficulties in children of all ages. Health education also becomes increasingly important as a contribution to healthy living and is best given in confidential surroundings to individuals or to small groups of children. In this way the results are more lasting and valuable than those obtained by impersonal campaigns. Periodic Medical Jirspectioirs The following table shows the number of children inspected by years of birth and the classification of their physical conditions ■ 71 Year of Birth Number of pupils inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory Number % Number % 1958 & later 350 346 98.9 4 1.1 1957 1209 1195 98.8 14 1.2 1956 712 709 99.6 3 0.4 1955 352 346 98.3 6 1.7 1954 1072 1066 99.4 6 0.6 1953 624 624 100.0 - - 1952 189 187 98.9 2 1.1 1951 486 483 99.4 3 0.6 1950 1465 1457 99.5 8 0.5 1949 620 615 99.2 5 0.8 1948 760 755 99.3 5 0.7 1947 & earlier 2924 2903 99.3 21 0.7 Total 10763 10686 99.3 77 0.7 There was a fall in the number of children examined and a slight fall in the number of children of unsatisfactory general condition (0 7%). A child deemed to be of unsatisfactory general condition is closely observed and any necessary ameliorative measures taken It is interesting to note that during 1961 the percentage of "unsatisfactory" children in the country as a whole ranged between 0% and 4+%. With a percentage of 0 7% this brings Tottenham and Hornsey into the same category as, for example, Hastings and Leeds, and less than either Norwich or Bristol, The assessment of unsatisfactory physical conditions must always be the final estimate of the examining doctors who may differ to such an extent that it would not be surprising if a change in the medical staff resulted in a different percentage of classified "unsatisfactory children from year to year The important point to bear in mind, however is that when a child is deemed to be unsatisfactory, the whole extent of the medical services is used tobring him to "satisfactory" physical condition. Infectious Diseases in School Children 1962 An epidemic of rubella (German measles) affected the Area during the first three quarters of 1962. This was part of an epidemic which affected the whole country. Rubella is not a notifiable disease and the magnitude of the epidemic came to light because of the unprecedented demand for gamma-globulin. This is a blood product which is usedfor protecting the foetus from the congenital abnormalities frequently caused when the expectant mother contracts the disease during the first three months of pregnancy. 72 Dysentery There were 35 cases of dysentery, all of the Sonne variety in the Area during the year. This is an increase on the previous year's figures but does not give cause for alarm. Tuberculosis Three cases of pulmonary and two cases of non-pulmonary tuberculosis were notified during 1962. In one case of pulmonary disease the source of infection was not clear and epidemiological investigations were conducted at the school. 37 pupils in the child's class were skin tested and the class teacher was X-rayed, and it was ascertained thatthe source of the infection did not lie in the school, nor had any other children in the class contracted the disease. Poliomyelitis and Diphtheria No cases of these diseases occurred in 1962, a matter for encouragement and no doubt mainly due to vigorous immunisation programmes carried out in the past and continued equally energetically each year. B..C.G. Vaccination Close co-operation was maintained with the Directors of the Chest Clinics at Tottenham and at Hornsey. It is interesting to note that the acceptance rate of 75.7% compares very favourably with the overall acceptance rate for the country which, in 1961, was 68%. Similarly in the country as a whole the percentage positive to the prevaccination tuberculin test was 14 3 (in 1961), in the Area this figure was 7.7%. School Children Students Total Number % Number % Number % Parents approached 3102 5 3107 Parents accepting 2349 75.7 5 100.0 2354 75.8 Number tested 2096 5 2101 Number found to be Mantoux positive 162 7.7 1 20.0 163 7.8 Number found to be Mantoux negative 1867 89.1 4 80.0 1871 89.0 Number failed to attend for Mantoux reading 67 3 2 - - 67 3.2 Number vaccinated (% of those approached) 1862 60.0 4 80.0 1866 60.1 73 School Dental Service The overall picture is one of modest expansion. The staffing position remained steady for the five full-time dental officers; and the area dental officer, but was very fluid in respect of the part-time officers. They varied in number from four to six, working between fifteen and twenty six sessions per week. In September a dental auxiliary was appointed. The orthodontist is shared with an adjoining area, and continued to work six to seven sessions weekly. Since the 21st March an additional evening orthodontic session has been undertaken. The dental auxiliary is employed in the Experimental Scheme of the General Dental Council. Her clinical duties, in accordance with the regulations, are carried out under supervision at the two-surgery clinic at Weston Park, Hornsey. Her training in health education has enabled her to give talks in schools and clinics. The total number of sessions worked was 3,153, which was 337 more than in 1961. At 163 inspection sessions 19,284 children were inspected, i.e. 68% of school roll. 11,621 (60%) were found to require treatment, and of these 6,353 (54.7%) were treated at the clinics. At school inspections, it was noticeable that many children were receiving regular treatment through the National Health Service. Treatment sessions amounted to 2,990 and the output of work per session also showed a slight increase. The pattern was of a markedly conservative nature, and 13,836 fillings were inserted in 11,875 permanent teeth. The number of permanent extractions fell by 210 to 817 Allowing for the fact that 200 of these teeth were extracted for othodontic purposes, 19 permanent teeth were saved for each permanent tooth lost by disease Fillings in temporary teeth also increased by 2,210, but the number of temporary teeth extracted remained constant. 42 children were supplied with dentures, compared with 57 in 1961. Evening sessions, three per week, continued to be well attended at Park Lane Clinic. The orthodontic service was responsible for 431 sessions, 289 of which were worked by the orthodontist and 142 by dental officers. 34 evening sessions were carried out at Weston Park Clinic, Hornsey, and were much appreciated by patients and parents. There is a long waiting list for treatment and we continued to be well under our establishment, although every effort was made to recruit additional staff. During the year, the plan to modernise and re-equip surgeries proceeded. Good working conditions are necessary to attract and retain dental officers. Three air turbine machines were supplied, bringing the number in the Area to five. An X-ray machine and dark room were provided at Weston Park Clinic, to extend the radiography service to the schools in Hornsey. Previously children had to make the considerable journey to Park Lane, Tottenham, for this facility. 74 A Dental Health Week was held in May, in which two junior schools combined to share the exhibition. This proved very popular. Mr J.O. Legg was seconded for one year as part-time demonstrator in the Children's Department of the London Hospital, and has expressed his satisfaction with this appointment. At High Cross, Tottenham, the foundations of the new dental clinic were laid in December, and its completion is eagerly awaited. Further projects related to comprehensive clinics, for a single surgery clinic at Burgoyne Road and a two-surgery clinic at Fortis Green, are included in the 1963-64 programme The following tables show the work undertaken during the year- DENTAL INSPECTIONS AND TREATMENT Number inspected 19284 Number found to require treatment 11621 Number offered treatment at the County Council s Dental Clinics 11606 Number of pupils treatment commenced 6353 Number of pupils treatment completed 5336 Number of attendances made by pupils for treatment 20533 Number of appointments not kept 5751 Number of half-days devoted to: (a) Inspection 163 (b) Treatment 2990 Fillings:- Permanent Teeth 13836 Temporary Teeth 6106 Number of teeth filled:- Permanent Teeth 11878 Temporary Teeth 5375 Extractions:- Permanent Teeth 617 Permanent Teeth for Orthodontia 200 Temporary Teeth 3349 General Anaesthetics 1717 Other operations. (a) Permant nt Teeth 4288 (b) Temporary 3561 Number of pupils supplied with dentures 42 Number of crowns and inlays 25 Number of radiographs 381 75 ORTHODONTIC INSPECTIONS AND TREATMENT Number of pupils inspected 204 Number of pupils found to require treatment 156 Number of pupils commenced treatment (first attendance) 100 Number of cases carried forward from previous year 223 Number of cases discontinued during the year 19 Number of attendances for all purposes 3276 Number of appointments not kept 735 Number of impressions, adjustments and other alterations 3507 Number of pupils treated with appliances 273 Number of fixed appliances fitted 8 Number of removable appliances fitted 266 Number of radiographs 726 Number of pupils treatment completed 79 Number of orthodontic sessions (half-days) 431 Ophthalmic Clinics Dr. T.G. Kletz, consulting ophthalmologist at Lordship Lane Clinic reports:- "As in previous years, the work of this clinic was mainly concerned with refractions and the investigation and treatment of squints and phorias. A number of non-refractive medical and surgical cases were also seen. The cases of squints and phorias having orthoptic treatment are showing very encouraging results. Of 140 cases who received treatment, 74 were completely successful, whilst a further 53 cases are improving. During the year five cases were referred to hospital for surgical treatment of squints, one case for surgical treatment of congenita' cataracts. Two children were registered as partially sighted, The number of young children and new cases attending unaccompanied by a responsible person is a matter of increasing concern". Dr. R. Welch, consulting ophthalmologist atthe Hornsey Ophthalmic Clinic, reports':- "During the past year the work at Hornsey Eye Clinic has proceeded on much the same lines as in previous years. Most of the cases referred were for defects of vision due to errors of refraction. One noticeable trend among these cases was the increase in simple myopia occurring in older school children who were approaching the school leaving age. 76 There would appear to be no very definite explanation for this increasing incidence of simple myopia at this age (13-16 years), but it is significant that these are years of rapid growth. There is no other treatment than prescription of glasses for constant wear. Other cases seen and treated were a few for minor injuries, dacryocystitis in infants with the usual history of watering and discharge from the eye since birth and one very unusual case with Megalo Cornea with opacification, which was referred to Moorfields Hospital for further investigation. It is worth recording that there is a greater awareness of the necessity of treating cases of squint, even if it is only transient, at the earliest possible age As unilateral squint is invariably associated with amblyopia, treatment cannot be commenced too soon, and where such is possible, results of treatment are very favourable, Any opportunity that may present itself of examining the vision of children of pre school age where there is a family history of squint or "lazy eye* should be taken advantage of, as it often means earlier detection of an amblyopic eye. In testing these young children who have notyetlearnt the alphabet, the Beale-Collins picture test types is most helpful". Orthopaedic Clinics Inability to obtain the services of a physiotherapist for most of the year hampered the work of the clinics Mr. E. Hambly, F R.C S of the Lordship Lane Orthopaedic Clinic comments that lasy year was extremely busy and he continued to be impressed by the very high standard of intelligence with which both children and their parents carry out instructions. Both parents frequently attend with their children and their combined interest is a great help. Dr. E.G.M. Palser of the Hornsey Orthopaedia Clinic comments on the absence of a physiotherapist and notes that there were only 57 attendances for the physiotherapist instead of a possible 3,000 A few children were treated in hospital physiotherapy departments but most were instructed in home exercises which they carried out with the ready assistance of their parents, who continued to take a keen interest in these matters. Audiometry The increasing importance paid to early detection of hearing defects in children is shown by the table below, which gives the number and results of audiometry tests during 1962. The aim is to test each child's hearing three times during school life, the first test being not later than the age of seven years. Special cases such as children with cerebral palsy, children who fail to develop proper speech and those who fail without apparent reason to make proper progress at school are seen as "specials". The per 77 centage of those failing routine audiometry may seem rather high, but a large proportion are cured by relatively simple measures such as removal of wax from the ears. Those who require further inestigation are seen by Dr. L Fischr the consultant otologist at the Audiology Unit. Maintained Primary and Secondary School Population of the Area - 2 6731 Audiometer Tests - Routine Age Groups 1st Tests sweep or gramophone Re-Tests Failures Both Ears One Ear Total % of Column 1 Right Left (1) (2) (3) (4) (5) (6) (7) Up to 7 years 2262 32 103 34 29 166 7.3 Intermediate 3819 68 110 31 39 180 4.7 Leavers - - - - - - - Totals 6081 100 213 65 68 346 5.7 Audiometer Tests - Specials Age 1st Tests Re-Tests Failures Both Ears One Ear Total % of Column 1 Right Left (1) (2) (3) (4) (5) (6) (7) Under 5 25 6 9 4 6 19 76.0 5 22 16 17 - 3 20 90.9 6 19 22 7 4 1 12 63.2 7 16 33 10 2 2 14 87.5 8 17 25 8 - 3 11 64.7 9 14 26 10 - 2 12 85.7 10 11 18 3 - 1 4 36.4 11 9 18 3 - 2 5 55.6 12 10 15 4 - - 4 40 0 13 16 15 8 3 1 12 75.0 14 15 11 7 3 1 11 73.3 Over 14 9 8 5 1 2 8 88.9 Totals 183 213 91 17 24 132 72.1 78 Audiology Unit The number and type of children seen at the Audiology Unit are shown in the table following. It will be seen that 246 new cases and 143 re-examination cases were examined during 1962. an increase of 68 and 78 respectively on the previous year. This increase is due to the extra weekly session Dr. Fisch has been able to give to the unit. AUDIOLOGY UNIT 1962 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 25 7 13 22 21 16 24 24 13 14 14 14 17 9 7 3 2 1 246 Re-examination - 2 1 4 9 11 20 19 20 8 8 11 12 2 7 6 2 1 143 Total 389 Pre-school children 97 Attending Infant and Junior Schools 214 Attending Senior Schools 74 Over five but not at school 4 Reasons for referrals among new children were as follows For Diagnosis 202 Auditory training 1 Immigrants to Area known to be deaf 1 Partially deaf children, advice as to placement 4 Children known to be deaf - application for admission to Blanche Nevile School or partially deaf units 2 Transfer from hospital out patient departments or E.N,T. clinics 26 Advice as to placement where deafness might be the cause of backwardness 10 Source of referrals: Tottenham and Hornsey 145 Other boroughs in Middlesex 99 Hertfordshire 2 79 The work taking place at the Audiology Unit is a co- operative venture and involves the participation of the consultant otologist the medical officers, the headmaster of Blanche Nevile School for the Deaf, two peripatetic teachers of the deaf the educational psychologist and two audiometricians Patients are seen by Dr Fisch, who is assisted by a medical officer from the Area Medical Officer s staff The headmaster of the School for the Deaf adds the weight of his experience in educational placement of deaf and partially hearing children and is also responsible for administrative matters connected with the peripatetic teachers These teachers are responsible, under Dr. Fisch's supervision, for auditory training of pre-school children and for visiting partially hearing children in ordinary schools. The audiometricians attend the clinic to carry out new and repeat audiograms on patients in attendance. During the year a second peripatetic teacher and a second audio metrician were appointed This enables the team on the one hand to detect hearing loss earlier and on the other hand to give better training and closer supervision of progress of the children who have hearing difficulties but are not in special classes or the special day school The equipment of the clinic has been completed now by the addition of an amplifying testing unit which enables the use of new and specialised tests for hearing in the very young as well as the older children. This unit comprises a very high quality record player and tape recorder, and the amplified sound is replayed into two loudspeakers placed in two corners of the room The sound can be played into the left or right speaker or both together. Test sounds are recorded and then played back at known levels of intensity, so as to estimate the true level of hearing much earlier than previously Speech tests can be carried out and the effectiveness of hearing aids can be tested with this equipment. A number of visitors (doctors, health visitors teachers) attended at the clinic throughout the year and in this way a considerable amount of teaching has been carried out. Also medical students from Guy s Hospital attended a session of clinical demonstration. For some time it has been hoped that the old air raid shelter which adjoins the clinic would be available for the extension of the clinic This has now been agreed in principle and detailed plans have been prepared for the conversion of the shelter There will be a room for the the psychologist which will also be used by the teachers, an audiometric room and a room for the technicians for making impressions from the ears issuing hearing aids, etc The availability of these rooms will be a great improvement in every aspect to the work of the clinic Vale Road School for Physically Handicapped Children Cerebral Palsy Unit Dr. William Dunham, the consultant in charge of the Unit, continued to attend for one session a week and the work proceeded on the same lines as previously reported. The following table analyses the cases seen at the Unit during 1962 80  Male Female Total Under Five years 6 4 10 Five to Ten years 2 1 3 Ten to Fifteen years - - - Over Fifteen years - - - Total 8 5 13 Diagnosis Male Female Total Cerebral Palsy 2 2 4 Mental Retardation 3 2 5 Paraplegia 1 - 1 Hemiplegia 1 1 2 Hydrocephalus 1 - 1 Total 8 5 13 4 CONFIRMED CASES OF CEREBRAL PALSY ACTION TAKEN Recommended for admission to Vale Road Physically Handicapped School 2 For supervision at Cerebral Palsy Unit 2 2 CASES OF HEMIPLEGIA ACTION TAKEN Recommended for admission to Vale Road Physically Handicapped School 1 For supervision at Cerebral Palsy Unit 1 1 CASE OF PARAPLEGIA AND 1 CASE OF HYDROCEPHALUS Both recommended for admission to Vale Road Physically Handicapped School 5 CASES OF MENTAL RETARDATION ACTION TAKEN For report to Local health authority as unsuitable for education in school 3 Under supervision at Cerebral Palsy Unit 1 No special treatment required (child at day educationally sub-normal school) 1 81 Child Guidance Centres In Tottenham, the Medical Director, Dr. William Craike continued to see an increasing number of cases and he stresses the importance of case conferences involving all the members of the Child Guidance Team During the year such a conference was held on a special case, in which the mother was psychotic and had been discharged from mental hospital. There were two young children and the head mistress was concerned about their safety. Arrangements were made to call together the Headmistress, the Psychiatric Team, Mental Welfare Officer, School Welfare Officers and the Child Care Officer, in an endeavour to find a satisfactory method of helping this family. It is to be anticipated that more cases of this type will arise with the policy of early discharge of psychotic patients to their homes, where they still live in the community, having home treatment from their general practitioners though still under hospital supervision. It is likely that stresses and strains will be thrown on the child, which may be reflected in school and general behavour. From past experience it would seem that the adolescents are more likely to be disturbed than the younger children; but this is one of the side effects of the Mental Health Act which was not anticipated and which may cause considerable concern in future years. Dr. Craike has proposed an evening clinic for the Consultant Psychiatrist to meet working parents and adolescents who cannot miss time from school or employment Dr. Nina Meyer, writing about her work with the under-fives, comments that the work has grown markedly in the last year Most have been cases of severe disturbance of sleeping in the under-twos In many it emerged that it was a problem of the inability of the mother to let the young child separate from her. For many mothers it is a difficult problem to make the transition from infancy to the toddler phase, and this can be one in which disturbed patterns of behaviour and personality are laid down. At many of the diagnostic interviews, the health visitor concerned with the child came with the mother; this was most helpful to the psychiatrist and Dr. Meyer hopes that it will be increasingly so to the health visitor. Suggestions were made of the sort of information the health visitor can look for which may be helpful in psychiatric consultation. Dr. Meyer suggests the health visitor will be able to act increasingly as a liaison between psychiatrist and family. The under-five clinic has no psychiatric social worker and this is an aspect where the unique knowledge and experience of the health visitor is so valuable in her helpfulness to the mother., A further innovation was a monthly discussion group comprising medical officers in infant welfare and toddler clinics and the Consultant Psychiatrist Here problems and points of view in relation to disturbances of the under fives were freely discussed with great benefit to the psychiatrist and the medical officers. The under-five clinic is now firmly established what is most encouraging is the interest of fathers who often accompany their wives with the children. It seems that young children arouse and hold fathering instincts more easily than when they are beginning to become independent. This fostering of fathering is of benefit to the family's 82 whole life; relationships between parents also seem to improve in the sharing and understanding of the problems of the young child Dr. K.A. Graf, Consultant Psychiatrist in Hornseyj also comments on the importance of teamwork. Mr. Walbridge, the educational psychologist, dealt with 233 children of which 75 were seen by Dr. Graf. The majority of these cases again reached the clinic through head teachers (24) and assistant medical officers (16) Direct approach to the clinic was made by 11 parents, and Dr. Graf was particularly pleased that more children were sent to the clinic from hospital specialists and general practitioners (7 each) The relation ship with Dr. Yudkin, Consultant Paediatrician at the Whittington Hospital, proved particularly cordial and professionally useful, and Dr. Graf only regretted that the limited time he had did not allow him to visit the wards as frequently as Dr. Yudkin and he would have welcomed, since close co-operation with the local children's hospital is one of the most important trends in modern child psychiatry Other referrals to the clinic were by the Magistrates of Juvenile Courts, and the Children's Officer. Analysis of the age groups referred showed a fairly even spread and, while the youngest clients were only three years old, there was a shift towards older age groups than last year, the peak ages being early adolescence, twelve and thirteen years The number of child guidance sessions held during the year was 74 and a total of 123 new and old patients attended. The waiting list at the end of the year amounted to 27 cases. The analysis of the diagnostic entities of child guidance cases, which is based on a scheme Dr. Graf drew up a few years ago and which was favourably commented upon in the most recent report of the Chief Medical Officer of the Ministry of Education shows as would be expected, that behaviour problems due to environmental factors (including parental problems and maternal deprivation) were most nun.erous but more striking perhaps was the high incidence of school phobias, a neurotically determined inability to attend school, which must be distinguished from truancy The low number of sex problems and psychotic disturbance is perhaps interesting in view of public interest in these difficulties. Dr. Graf also records research carried out largely as a result of the enthusiasm of the educational psychologist, with a team from the National Hospital for Nervous Diseases, investigated the incidence of Finget Agnosia amongst poor readers in Hornsey, and also amongst a control group of normal children. Dr. Nuttal Home of the Ministry of Education examined a number of children with most severe reading difficulties. A weekly evening session was held at the Town Hall, and was always fully booked Speech Therapy During 1962 cases continued to be referred to speech therapists by head teachers, school medical officers and specialists. 83 Miss Joan Came, the senior speech therapist, comments that the principles underlying present day speech therapy reflect current thought in associated professional fields. Stammering and other emotionally-activated speech disorders are examples of conditions in which preventive medicine may play a part, in that they are frequently found where there is a disturbed mother/child relationship. Miss Came stresses that the therapist is responsible for diagnosis, assessment, and planning of treatment which in each case is specific for the patient. The Handicapped Child Distribution as at 31st December 1962 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 1 - 5 1 - - - 1 - - 6 2 Partially Sighted Pupils 3 4 1 - 2 - - - - 1 6 5 Deaf Pupils 5 5 2 2 - - - - - - 7 7 Partially Deaf Pupils 9 9 2 2 - - - - - - 11 11 Educationally normal Pupils 69 47 8 3 5 5 - - - - 82 55 Epileptic Pupils - 1 1 - - - - - - 1 1 Maladjusted Pupils - - 24 6 10 1 9 5 - - 43 12 Physically capped Pupils 22 16 4 2 1 - - 1 3 - 30 19 Pupils with Speech Defects - - - 1 233 125 6 3 4 1 243 130 Delicate Pupils 1 6 7 6 1 - - - - - 9 12 Pupils with Multiple Defects 4 2 2 2 2 - - - 1 - 9 4 Totals 114 89 56 26 254 131 15 10 8 2 447 258 Grand Totals V 203 V 82 V 385 25 10 705 Details are given in the Appendix of the special schools attended by children shown in the above table. 84 Hospital School I am indebted to Mr. J. Power, M.A., Borough Education Officer Tottenham, for the following report:- "The tuition of the children in St Ann s Hospital and at the Prince of Wales's Hospital has continued smoothly over the past year Those children (ages ranging from 4½ to 15 years) who are well enough attend for lessons in a classroom on one of the wards Individual teaching has been extended to other wards, when requested by the Consultant concerned The work has been comprehensive, catering for pupils from primary, secondary and grammar schools, and when possible a close contacthas been maintained with each child's school. The older pupils particularly express gratitude, as many are long-term patients, and parents are most appreciative. Lessons are surprisingly popular with the children who really like to have an ordered day. Their hobbies and interests are pursued whenever possible. Often the children find delight in planning a decorative scheme for the ward, participating in painting pictures on windows and making models, etc. Former pupils often revisit or write. As in thepast, theTottenham Library Servicehas been most helpful. The progress of the school has been due, to a great extent, to the co-operation of the Sisters and hospital staff concerned". SCHOOL HEALTH SERVICE STATISTICS 1962 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 1958 & later 3 38 38 1957 21 167 170 1956 16 126 125 1955 29 49 63 1954 113 132 209 1953 66 51 105 1952 12 30 38 1951 88 60 131 1950 220 160 339 1949 104 67 152 1948 137 102 211 1947 & earlier 655 321 872 Total 1464 1303 2453 85 DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. Defect or Disease Periodic Inspections Special Inspect ions Entrants Leavers Total including all other age groups inspected T 0 T 0 T 0 T 0 4 Skin 31 54 82 142 223 350 822 7 5 Eyes (a) Vision 37 29 591 70 1464 303 233 83 (b) Squint 51 10 42 5 175 32 11 1 (c) Other 13 3 31 12 101 39 65 3 6 Ears (a) Hearing 4 50 10 32 35 174 157 23 (b) Otitis Media 8 71 11 47 38 244 10 1 (c) Other 4 2 1 1 15 18 102 7 7 Nose and Throat 47 214 24 102 109 637 76 23 8 Speech 18 42 8 5 56 77 52 3 9 Lymphatic Glands - 81 - 5 - 160 - - 10 Heart 5 23 1 56 13 151 10 11 11 Lungs 27 74 10 69 65 277 20 14 12 Developmental: (a) Hernia 6 12 - 4 11 25 1 1 (b) Other 4 38 11 18 22 179 8 14 13 Orthopaedic: (a) Posture 2 14 22 93 42 202 9 8 (b) Feet 42 89 65 106 245 394 46 38 (c) Other 15 33 31 52 75 234 73 7 14 Nervous System: (a) Epilepsy 5 3 8 9 24 21 3 1 (b) Other 2 7 1 17 12 70 17 3 15 Psychological: (a) Development 2 18 1 14 7 74 47 5 (b) Stability 5 125 5 81 39 489 59 25 16 Abdomen - 20 2 29 9 90 17 2 17 Other 4 9 - 12 13 59 525 67 T - Requiring Treatment 0 - Requiring Observation 86 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) Number of cases Known to have been treated Group 1. Eye Diseases (e.g. blepharitis, conjunctivitis) Defective Vision ana Squint (a) External and other, excluding errors of refraction and squint 94 (b) Errors of refraction, including squint 1656 Total 1750 (c) Number of pupils for whom spectacles were prescribed 897 Group 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for. (a) Diseases of the ear _ (b) Adenoids and Chronic Tonsillitis 138 (c) Other nose and throat conditions - Received other forms of treatment 463 Total 601 Total number of pupils in schools known to have been provided with hearing aids: (a) During the current year 10 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 42 Group 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 890 Group 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp (ii) Body 2 Scabies Impetigo 13 Other skin diseases 804 Total 819 Group 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and otner hospital clinics) 137 Group 6. Speech Therapy Number of pupils treated by speech therapists 247 Group 7. Other treatment given (a) Number of miscellaneous minor ailments treated by the County Council 352 (b) Treatment other than (a) above and excluding convalescent treatment 156 87 EDUCATION ACT 1944 SECTION 57 Cases dealt with under Section 57, Education Act 1944 3 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as for fitness for appointment 20 (b) Number of Students examined as to fitness for first appointment 56 (c) Number of Students examined as to fitness to undertake training course 124 HANDICAPPED PUPILS IN SPECIAL SCHOOLS AS AT 31st DECEMBER 1962 Category Name of School Day School Residen tial School Blind Hampstead Child Therapy Clinic 1 - Dorton House, Seal. Kent - 3 Chorley Wood College, Herts - 1 Royal Normal College, Shrewsbury - 1 North House, Wimbledon - 1 Condover Hall, Shrewsbury - 1 1 7 Partially Harborough School, N.19. 3 - Sighted Joseph Clark School, Walthamstow 3 - John Aird School, Willesden 1 - Exhall Grange, Coventry - 1 7 1 88 Category Name of School Day School Residential School Deaf Blanche Nevile School, Tottenham. 10 - Jewish Deaf School, Wandsworth - 1 Royal School for Deaf and Dumb, Margate - 1 St. John's, Boston Spa, Yorks. - 2 10 4 Partially Tottenham Partially Hearing Units 14 - Hearing Blanche Nevile School, Tottenham 4 - Rayner's School, Penn, Bucks. - l Hurtwood School, Peaslake, Surrey - l Mary Hare Grammar School, Newbury - 2 18 4 Educationally Durants School, Enfield 81 - Sub-normal Oak Lodge School, Finchley 34 - Swaylands, Penshurst, Kent - 9 Wavendon House, nr. Bletchley - 3 115 12 Epileptic Lingfield Hospital School, Surrey - 2 Maladjusted Junior House, Saffron Walden - 1 Roxburgh House., Cranbrook, Kent - 4 St, Thomas More, East Allington, Devon - 1 Tylney Hall, Hook, Hants. - 1 Muntham House Horsham, Sussex - 2 Woodlands, Fairwarp, Sussex - 1 Whatcombe House, North Cheriton, Somerset - 2 Potterspury Lodge, Towcester, Northants. - 2 Horncastle, East Grinstead, Sussex - 5 Red House, Tadworth, Surrey - 3 East Quinton Seaford, Sussex - 5 Midhurst Grammar School, Sussex - 1 Kingsmuir, Stonelands, Sussex - 1 Cotswold Chine, Box, Glos. - 2 St. Joseph's, East Finchley - 2 By lands, Stratfield Turgis, Herts. - 1 Gaveston Hall, Nurthurst, Sussex - 1 Carried forward - 35 89 Category Name of School Day School Residential School Brought forward - 35 Maladjusted Breckenborough, Thirsk, Yorks. - 1 contd. King's, Sherbourne Park. Northleach, Glos - 1 Farney Close, Bolney, Sussex - 3 St. Catherine's, Almondsbury, nr. Bristol - 1 Midland Road Preparatory, Gloucester - 1 St. Michael's Convent, Uckfield, Sussex. - 1 - 43 Physically Vale Road P H. School Tottenham 39 - Handicapped Tylney Hall, Hook Hants. - 1 Valence School Westerham Kent. - 1 Irton Hall, Holmbrook Cumberland - 1 Halliwick, Winchmore Hill - 1 Winifred House Hospital School, Barnet - 1 39 5 Speech Defects Moor House, Oxted, Surrey - 1 Delicate Hazelbury Open Air, Edmonton 7 - Park Place Hen ey onThames - 3 Suntrap, Hayling Island, Hants. - 5 St. Vincents, St. Leonards, Sussex. - 1 Elmers Court, Lymington, Hants. - 4 7 13 Multiple Vale Road P.H School, Tottenham 3 - Defects Durants School, Enfield 2 - Hazelbury Open Air, Edmonton 1 - Lingfield Hospital School, Surrey - 2 Condover Hall, Shrewsbury - 2 6 4 90 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. (Dec'd. 9. 8.62) E.S. Glegg, M.A.P.H.I. (App'd. 20 11.62) 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 10 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 Area Health Staff (Tottenham and TCornsey) Deputy Area Medical Officer Senior Assistant Medical Officer Area Dental Officer Superintendent Health Visitor Non-medical Supervisor of Midwives and Home Nursing Superintendent G.S. Udall M B., B.Chir., D.P.H., D.C.H. (Resigned 1.7.62) A. Shaw, M B., B.S., D.P.H. (Appointed 16.7.62) Ruth Golder M.B., Ch B., D.R.C 0 G , D P H. Miss W.M. Hunt, L.D.S , R.F.P.S. Miss H Townsendf S.R.N., S.C.M., H.V. (Retired 29 9,62) Miss M. Smith, S.R.N , S.C.M., H.V. (Appointed 1.10.62) Miss F.E. Curtis, S.R.N., S.C.M., H.V., M.T.D. 91 Home Help Organiser Assistant Home Help Organisers Miss D. Williams, S.R.N., M.I.H.H.O. Miss J.E. Caplin, M.I.H.H.O. Mrs. A. Orchard, M.I.H.H.O. Mrs M. Rudrum (Appointed 2.7.62) Area Administrative Officer Deputy Area Administrative Officer W.L.N. Relleen, T.D., D.P.A. H.J. Dunham, B,A. Administrative Officers (Section Heads) A. Balls N.P. Child S,E. Woodroffe Classification of Staff Part-time Medical Officers 10 5 Dental Officers 6 5 Dental Hygienist 1 - Supervisory Nursing Staff 2 - Administrative and Clerical Staff 37 6 Health Visitors/School Nurses 25 1 Student Health Visitors - 2 Clinic Nurses 8 - Midwives 11 2 Home Nurses 22 4 Speech Therapists 2 2 Physiotherapists 1 - Occupational Therapists 1 - Chiropodists - 2 Audiometer Operators 2 - Orthoptists - 2 Dental Surgery Assistants 10 - Day Nursery Staff 34 3 Home Help Service 4 163 Manual Workers, Domestic Grades, etc. 10 22 186 219 Full-time 92 INDEX Page Abatement Notices 30 Aged) Wei fare of 18 Ambulance Service 25 Ante Natal Clinics 52 Area Health Committee 2 Area Health Service 24 Are a Health Staff 90,91 Area Welfare Service 24 Atmospheric Pollution 39 Audiology Unit 78 Audiometry 76 Baths and Laundry Services 31 B.C.G. Vaccination 72 Births and Deaths 3 Births, Notification of 52 Blind Welfare 24 Borough Council, Members 1 Bronchitis 7 Cerebral Palsy Unit 79 Certificates of Disrepair 42 Child Guidance Centres 81 Chiropody & Special Treatment Establishments- Licensing 38 Chiropody Service 20, 67 Clean Air 39 Cleansing and Disinfecting Station 30 Clearance Areas 41,4 Comparability Factors 5 Council, Members of 1 Daily Guardian Scheme 56 Day Nurseries, Local Authority 56, 57 Private 58 93 Page Deaths, Classification of 4, 10 Defects, Sanitary; Remedied 28, 29 Demol11ion Orders 41, 44 Dental Service, Priority 59 School 73 Diphtheria 15,72 Diphtheria Immunisation 66 Disinfection 30, 31 Disinfestation 32 Domestic Help Service 68 Drainage and Sewerage 26 Dysentery 16, 72 Education Committee 2 Egg. Frozen Imported 50 Encephalitis 15 Fabrics (Misdescription) Regulations 1959 36 Factories 33 Fluoridation of Water Supply 26 Food Condemned 47, 48 Contro1 46 Hawkers 46, 47 Hygiene 46 Imported Frozen Eggs 50 Poisoning 16 Prosecutions 48 Registered Premises 46 Sarnpling 48, 49 Shops 46 Furnace Installations 39 Handicapped Child, The 57, 83 Handicapped Persons, Welfare 24 Hawkers of Food 46, 47 Health and Housing Committee 1 94 Page Health Services provided by other Authorities 22 Health Visiting Service 62 Home Nursing Service 64 Hospital Services, Old People 19 Hospitals 22 Hospital School 84 Houses Unfit 41, 43, 4.4. Houses in Multiple Occupation 41 Housing 41 Housing Act 41, 44 Illegitimate Births 5,6 Infantile Deaths 5,8 Infant Welfare Clinics 54 Infectious Diseases in School Children 71 Infectious Diseases, Table of Cases 17 InsectPests 32 Inspections carried out by Public Health Inspectors 28 Knackers Yard 50 Laboratory Service 25 Laundries, Public 31,32 Laundry Service for the Incontinent Aged 19 Lunacy and Mental Treatment Acts 25 Lung Cancer 7 Maternal Deaths 3 Meals on Wheels 20 Measles 15 Meat 1nspection 51 Medical Grounds for Rehousing 45 Members of Borough Council 1 Meningococcal Infection 15 Mental Health 25 Midwifery Service 60 95 Page Midwives' Ante-Natal Clinics 54 Milk and Dairies 50 Mothercraft and Relaxation Classes 54 Notices Served 29 Oil Heaters 37 Old People's Welfare 18 Ophthalmic Clinics 75 Orthopaedic Clinics 76 Out-Patient Clinics at Prince of Wales's Hospital 23 Outworkers 34 Overcrowding 12, 41 Periodic Medical Inspections 70, 71 Personal Health Service 24 Pet Animals Act, 1951 38 Poliomyelitis 15, 72 Vaccination 66 Population, Movement of 4 Preserved Poods 46 Prince of Wales's Hospital, Out-Patient Clinics 23 Public Health Department, Staff 90 Public Health Act, 1936 Legal Proceedings 30 Rag Flock and Other Filling Materials Act, 1951 38 Recuperative Holidays 67 Rehousing on Medical Grounds 45 Rent Act, 1957 42 Rent Books, Provision 45 Repairs in Default 30, 44 Retirement Advice Clinic 18 Rodent Control 33 Sanitary Circumstances of the Area 26 Scarlet Fever 15 96 Page School Health Service 69 Sewerage and Drainage 26 Shops 35 Prosecutions 36 Slaughterhouses 50, 51 Slaughtermen 51 Slum Clearance 41, 43 Smallpox 15 Smallpox Vaccination 65 Smoke Control Areas 39 Speech Therapy 82,83 Staff Medical Examinations 16 Statistics 3 Stillbirths 3 Street Trading 36 Superannuation Medical Examinations 16 Swimming Baths 31 Tetanus Immunisation 66 Toddlers' Clinics 55 Tuberculosis 13 In Schools 72 Typhoid Fever 15 Unfit Houses 41,43, 44 Vale Road School for Physically Handicapped Children 79 Water Supply 26 Welfare Foods Distribution 59 Welfare Service, Area 24 Whooping Cough 16 Innunisation 66 Work in Default 30, 44