AC 439(1) TOT38 Borough of Tottenham TOTTENHAM'S HEALTH 1963 The Annual Report of the Medical Officer of Health Borough of Tottenham TOTTENHAM'S HEALTH 1963 The Annual Report of the Medical Officer of Health Public Health Department, Town Hall, Tottenham, N.15. To the Worshipful the Mayor, Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, It gives me great pleasure to submit my 28th Annual Report on Tottenham's Health in the year 1963; and to see the wheel of administration about to turn full circle within my period of service as medical officer of health. In 1948 Tottenham, with a population then of 144,000, lost much of its autonomy and wide-spread recognition as a progressive Authority, by the transfer of its personal and school health services to the County Council. The public health service was split in two, resulting in policy frustration and local difficulties of communication and co-operation with hospital and executive council services: with the new mental health, welfare and children's departments: with education and youth employment services and with many voluntary and national organisations operating locally. Further it created specialisation and mixed loyalties where none previously existed, so that to-day the majority of recruits to senior posts have had experience either in county or borough administration and rarely the necessary overall experience of the whole range of public health activities of local government. With amalgamation, as from 31st March, 1965, of Tottenham, Hornsey and Wood Green to form the London Borough of Haringey, the new Council will no longer have to conform in part to a uniform pattern; but organise and develop all public health services according to local need: co-operating with neighbouring boroughs as expediency demands. During the past year solid progress has been made in the field of environmental health: more particularly in control of infectious disease, raising standards of housing, further action under the Clean Air Act, supervision of food supplies and health education in food hygiene: a salutary reminder of the necessity for unremitting vigilance arising from the recent outbreak of typhoid in Aberdeen. Much preparatory work has been done under new legislation and surveys undertaken in relation to improvement of existing dwellings, registration and control of houses in multiple occupation and the new Shops and Offices Act. As in the environmental health services so in the personal and school health services the past year has been an extremely busy one. The shortage of health visitors, midwives and ancillary medical staff often placing a heavy burden on those required to meet the increasing public demand for the services provided. An encouraging feature, however, has been the improvement in recruitment of dental officers. The number of births was the highest since 1947 and demonstrated a continuing rise in the birth rate starting in 1961. Over 80% of confinements in the area occurred in hospital and a number of mothers had to be admitted under the Emergency Bed Service which meant that these unbooked expectant mothers did not know to which hospital they would be admitted until the last moment. It is to be hoped that the Ministry of Health's proposal to rationalise the use of maternity beds by allocating catchment areas to hospitals will do something to ease the situation, although the present and foreseeable future need would seem to be in the provision of more beds. Much has been written and said in recent times in favour of the family doctor taking over from local authorities all routine ante and post-natal care of mothers and supervision of the health of infants and pre-school children. While this seems logical in a fully integrated national health service it surely implies not only an adequacy of doctors in general practice; but the existence of more group practice premises or better still the provision of properly equipped and staffed Health Centres where the family doctor may be assisted by health visitor, home nurse, midwife or other members of a health team. The changing pattern of the school health service becomes increasingly apparent. With physical minor ailments in childhood less frequent, more emphasis is placed on the early detection and treatment of emotional difficulties. The consultant child psychiatrist, as leader of the child guidance team, yearly takes on more new cases and by particular skills is able to help in preventing breakdowns in later life. Medical officers and health visitors are becoming increasingly orientated towards early detection of emotional and behaviour disorders. Also the school medical officer and health visitor are required to-day to be more highly trained in early ascertainment of the handicapped child, with special emphasis on the "at risk" group. Congenital abnomalities as a cause of early death or later disability increase in relative importance. It was said in 1962 that "one in every thousand children surviving the neo-natal period will need special care, treatment and parental guidance for a severe handicapping condition" (Dr. Mary Sheridan). Tottenham Education Committee was an early pioneer in establishing special schools for education and treatment of the handicapped child and recognises the need for reappraisal from time to time of what is being done or should be done in the light of medical and scientific progress. Before concluding this introductory letter I wish to record the loss to the health department during the year of Dr. Wright, my deputy, who was a much esteemed colleague; and left this country to marry and take up an appointment in Sydney, Australia. We welcome Dr. Tranter to the department as his successor. I wish to acknowledge and commend to the notice of the Council the hard and unobtrusive work of the public health inspectors, medical, nursing, clerical and other staff of the Health Department. Also to express my sincere gratitude to the Chairman (Alderman R.H. Warren), the Vice-Chairman (Councillor Mrs. Haynes) and members of the Health and Housing Conmittee for their constant encouragement and support. I have the honour to be Your obedient servant G. HAMILTON HOGBEN Medical Officer of Health. August, 1964. 1 MEMBERS OF BOROUGH COUNCIL MAYOR Councillor Douglas Clark, J.P., DEPUTY MAYOR Councillor A. T. Protheroe ALDERMEN E.J. Field F.A.F. Keay, J.P. A. Reed, A.C.I. I., J.P. R.W. H. Ford H. Langer *A.F. Remington (Mrs.) L.R. Harrington (Mrs.) I.L. Peirce H.W. Turner W. S. Herbert *R.H. Warren COUNCILLORS *F.G. Bohringer E.V. Garwood Brenda S. Remington (Mrs.) B.A. *E.E. Brown (Mrs.) L.J. Goldman E.A. Remington, M.Ch.S., S.RXh. Sir Edward Brown, M.B..E, W.K. Gomm P.H. Roberts J.W.H. Brown *F.R. Haynes (Mrs.) A.B. Russell E.J.J. Carter F.A. Knight J.R. Searle A. J. Chaplin *E.G. Large R,L. Singer *L.H. Collis J.D. Mcllwain, B.A. *S.A. Berkery Smith (Mrs.) *D. Cunningham (Mrs.) G.C. Marson J. Watkins *E.W. Day *A.A, Miller (Mrs.) R.G. Wigley *G,A. DeVote *M.T. Morris J, Wolsey S.C. Morris 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: K.W. Robbins G. Hamilton Hogben, M.R.C.S., D.P.H. 2 AREA HEALTH COMMITTEE Members of Hornsey Borough Council Alderman Miss OR. Anderson Councillor C.J. Ettinger, M.Sc. (Econ.) Alderman V P Gellay, B Sc. Councillor F.C.Vo Hayward Councillor J.T. Wilkins (Chairman) Members of Tottenham Borough Council Alderman A, Reed A C 11., J.P. Councillor Mrs. D, Cunningham Alderman Mrs, A.F. Remington Councillor M.T. Morris (Vice Chairman) Alderman R.H. Warren 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, J. P. 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 M F, Bowman. OoN.C., S.R.N., S.T.D., M.S.C,?. Persons who may attend in an advisory capacity Dr. A. M. Freeman (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 I.L. Peirce „ R.W.H. Ford „ A. Reed, A.CI.I., J.P. „ F.A.F. Keay, J.P. „ Mrs. A.F. Remington '(Chairman) Councillor E.J.J. Carter Councillor J.D. Mcllwain, B.A. „ Douglas Clark, J.P, „ M.T. Morris „ L. H. Collis „ Mrs. Brenda S. Remington, B A. „ Mrs. D. Cunningham „ P.A. Roberts „ Mrs. F.E. Haynes „ J.R. Searle „ F.A. Knight „ Mrs. S.A. Berkery Smith „ J. Watkins n R„ Go Wigley Representing County Council County Councillors 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. E. Stacey Borough Education Officer - J. Power, M. A. 3 GENERAL STATISTICS Area of District (in Acres) 3,013 Population Cenus, April, 1951 126,929 April, 1961 113,249 Mid-year: Registrar General's 1962 1963 estimate 113,020 112,700 Rateable Value as at 1st April £1,994,474 £6,368,470 Sum represented by penny rate £8,120 £25,400 Approximate Number of Dwellings in District 31,166 31,163 Registered live-births Males 1,168 1,154 Females 1,065 1,094 Total 2,233 2,248 Birth-rate per 1,000 estimated population; 19.76 19.95 No. of live-births which were illegitimate 256 255 (11.5%) (11.2%) Stillbirths Males 17 19 Females 23 14 Total 40 33 Stillbirth-rate per 1,000 total (live and still) births 17.60 14.62 No. of stillbirths which were illegitimate 6 6 (15%) (18%) Deaths Males 716 743 Females 708 696 Total 1,424 1,439 Death-rate per 1,000 estimated population 12=60 12„77 Maternal Mortality Puerperal Sepsis 1 Other puerperal causes 1 4 Total 2 4 Death rate per 1,000 total (live and still) births 0.880 1.754 Deaths of Infants under 1 year of age (Infant Mortality) (a) Legitimate Males 29 29 Females 16 19 Total 45 48 Death rate per 1,000 legitimate live births 22.76 24.08 4 1962 1963 (b) Illegitimate Males 2 4 Females 4 4 Total 6 8 Death-rate per 1,000 illegitimate live-births 23.44 31.37 (c) Total Males 31 33 Females 20 23 Total 51 56 Death-rate per 1,000 total live births 22.84 24.91 Deaths of Infants under 4 weeks (Neo-natal Mortality) 41 42 Rate per 1,000 live births 18.36 18.68 Deaths of Infants under 1 week (Early Neo-natal Mortality) 38 36 Rate per 1,000 live births 17.02 16.01 Stillbirths and deaths under 1 week (Perinatal Mortality) 78 69 Rate per 1,000 live and still births 34.32 30.25 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 1963, 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 320 meaning that the outward movement of population was greater than the inward by 1,129. Classification of Deaths Deaths are classified under 36 headings barsed 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 deaths occurs in a residential home or in a chronic or mental hospital where the deceased has been a patient for six months or more. Comparability Factors To enable local vital statistics to be compared with other districts or with national figures the Registrar General issues comparability factors for correcting crude birth and death rates. These factors make allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole-. The death 'rate comparability factor has been adjusted specifically to take account of the presence of residential institutions in the area. To compare the crude birth and death rates for Tottenham with the national rates; Tottenham's figures must first be multiplied by the appropriate comparability factor 0.98 for births and 1.02 for deaths. Birth Rate The birth rate 19.95 per 1,000 population, which is fractionably higher than the 1962 rate, is approaching the immediate post war peak when in 1947 a birth-rate of 21.57 was recorded. There are many factors which may affect the birth rate and the increase does not necessarily reflect a trend toward larger families. It is probable that a basic reason is a trend toward earlier marriages resulting in a high number of marriages during the transitional stage. 5 Illegitimate Births Although the percentage of illegitimate births, 11.2%, is very slightly less than the 1962 figure, 11.5%, concern must continue to be felt than one baby in every nine is born to an unmarried mother. Apart from the moral aspects, in many cases the chances of the baby receiving a satisfactory upbringing must be reduced because of the lack of a normal home environment. Infantile Deaths 56 babies died before reaching their first birthday and of these 36 died in the first week of life. This gives an infant mortality rate of 24.91 per 1,000 births, compared with 22.84 for 1962 in Tottenham and 21.7 in England and Wales. Causes of death immediately after birth are closely related to the causes of stillbirth and these differ from causes arising later in the first year of life. For comparative purposes the early deaths are linked with stillbirths are perinatal deaths and the 1963 rate in Tottenham was 30.25 per 1,000 live and still births; for England and Wales it was 30.8 in 1962. The mortality rate between 1 week and the first birthday was 8.77 with the national rate 8.5 in 1962. Maternal Deaths There were 4 maternal deaths in 1963, which is an unusually high number. Three of the deaths occurred in hospital and the home death was the result of haemorrhage following a complicated pregnancy. Lung Cancer and Chronic Bronchitis Lung cancer and chronic bronchitis continue to be frequent causes of death; in many cases preventible. In Tottenham 44% of the deaths from cancer of the lung and over a quarter of the deaths from chronic bronchitis occurred in people under the age of 65. A survey throughout the country, under the auspices of the College of General Practitioners showed that 17% of men and 8% of women aged 40 to 64 suffered from bronchitis; also that it was the commonest reason for consulting the family doctor,, It is estimated that twenty-nine million working days are lost each year from the cause in Great Britain. 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 71 78 51 1963 99 Not available 79 Not available 6 Suicides In 1963 eighteen inhabitants of Tottenham died by their own hand. The suicide rate for the Borough over the past five years has been 15.0 per hundred thousand which compares with the national average of ll.J. However, in view of small numbers involved locally, the difference may not be regarded as statistically significant. To gain some idea of the importance of the problem, it is useful to compare the number of deaths due to this cause with other causes (1962). Tottenham England & Wales Suicide 16 5,589 Motor Vehicle Accidents 16 6,306 Diabetes 10 3,811 Tuberculosis 5 3,08 8 Cancer of the Lung 88 23,779 Suicide cases over the past 5 years broken down for age and sex. 0-24 25-44 45-64 65-74 75- Total M F M F M F M F M F M F 1959 - - 4 - 4 2 5 3 2 - 1959 15 5 1960 1 - - - 4 5 1 1 1 - 1960 7 6 1961 1 - 6 - 3 2 2 4 - - 1961 12 6 1962 - - 2 3 4 4 1 1 - 1 1962 7 9 1963 2 1 3 - 7 1 1 - 2 1 1963 15 3 4 1 15 3 22 14 10 9 5 2 56 29 These figures show that suicide is commoner amongst people over the age of 4-5. Moreover, it is commoner in males than females. (This discrepancy is still greater when it is remembered that in the general population females aged 55 to 64 exceed males by approximately 6 to 5, and over 65 by 10 to six). Two other well recognised features are of interest. Firstly, there was a reduction in the number of suicides during the war years. Secondly, for any given country the number of deaths due to suicide remain fairly stable over many years. From country to country there are considerable variations, Thus for every 100,000 of the population the following figures are examples. England & Wales 11.3 Northern Ireland 5.0 Scotland 7.9 U.S.A. 10.5 Austria 21.9 Sweden 16.9 Ireland 3.2 These figures indicate a situation locally and nationally which is far from satisfactory. In addition to the loss of life involved the occurence of suicide in a family is still the cause of considerable stigma. It is evident that many deaths as well as unsuccessful attempts of suicide are due more to a "state of mind" than to an ordinary disease process. 7 INFANTILE DEATHS IN AGES AND SEXES Causes of Death DAYS WEEKS Total under 4 weeks MONTHS Total Deaths under 1 Year Males Females 0 1 2 3 4 5 6 1 2 3 1 2 3- 6- 9- Whooping Cough - 1 1 1 Pneumonia - 1 1 2 1 1 6 3 3 Bronchitis 1 1 1 2 1 1 Gastro-enteritis 1 1 1 - Congenital Malformations 2 1 1 1 1 1 7 3 10 8 2 Injury at Birth 6 1 1 2 1 11 11 4 7 Post Natal Asphyxia and Atelectasis 5 5 5 4 1 Pneumonia of Newborn 2 2 2 1 1 Haemolytic Disease of Newborn 2 1 3 3 - 3 Immaturity 9 2 11 11 9 2 Obstruction by Inhallation or Ingestion 1 1 - 1 All Other Causes 1 1 2 1 3 2 1 Total 25 4 1 2 2 1 1 4 1 1 42 4 1 4 3 2 56 33 23 8 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 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 1963 112,700 1,439 12.71 2,248 19.95 56 24.91 92 24 - 59 15 298 9 CLASSIFIED DEATHS OF TOTTENHAM RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION DISEASE Total Under 1 year 1-4 5-14 15 - 24 25 - 44 45 - 64 65 - 74 75 M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory 3 1 - - - - - - - - 1 1 2 - - - - - Tuberculosis, other 1 - - - - - - - - - 1 - - - - - - - Syphilitic disease 2 - - - - - - - - - - - - - 2 - - - Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - 1 - 1 - - - - - - - - - - - - - - Meningococcal infection - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective and parasitic disease - 1 - - - - - - - - - - - 1 - - - - Malignant neoplasm, stomach 18 16 - - - - - - - - 2 1 4 4 8 6 4 5 Malignant neoplasm, lung bronchus 71 18 - - - - - - 1 - 1 1 28 8 25 6 16 3 Malignant neoplasm, breast - 22 - - - - - - - - - 5 - 7 - 7 - 3 Malignant neoplasm, uterus - 8 - - - - - - - - - - - 5 - 2 - 1 Other malignant and lymphatic neoplasm 69 69 - - - - - - - 1 3 2 24 24 21 15 21 27 Leukaemia, Aleukaemia 5 2 - - 1 - - 1 - - 1 - 3 - - 1 - - Diabetes 6 8 - - - - - - - - - - 2 1 2 3 2 4 Vascular lesions of the nervous system 47 85 - - - - - - 1 - 1 1 7 10 12 23 26 51 Coronary disease, angina 163 107 - - - - - - - - 3 - 60 7 45 34 55 66 Hypertension, with heart disease 8 11 - - - - - - - - - - 1 1 3 2 4 8 Other heart disease 44 79 - - - - - - - - 3 1 6 4 10 18 25 56 Other circulatory disease 32 42 - - - - - - - - 1 2 5 5 12 12 14 23 Influenza 1 - - - - - - - - - - - 1 - - - - - Pneumonia 56 85 4 4 - 1 - - - - 1 - 6 3 18 11 27 66 Bronchitis 93 19 1 1 - - - - - - 2 - 27 2 27 7 36 9 Other diseases of respiratory system 13 2 - - - - - - - - 4 - 3 2 4 - 2 - Ulcer of stomach & duodenum 8 5 - - - - - - - - - 1 2 1 1 - 5 3 Gastritis enteritis & diarrhoea 4 9 1 - - - - - - - 1 - - 3 1 2 1 4 Nephritis & nephrosis 5 3 - - - - - - - - 1 1 - 2 3 - 1 - Hyperplasia of prostate 4 - - - - - - - - - - - - - - - 4 - Pregnancy, childbirth & abortion - 4 - - - - - - - 1 - 3 - - - - - - Congenital malformations 11 3 8 2 - - - - 1 - 1 - 1 1 - - - - Other defined & ill defined diseases 50 74 19 14 - - - - - - 3 2 7 14 8 17 13 27 Motor Vehicle accidents 5 4 - - - - - - 1 - 2 - - - 1 3 1 1 All other accidents 9 15 - 1 - - 1 - 1 - 3 1 - 1 2 4 2 8 Suicide 15 3 - - - - - - 2 1 3 - 7 1 1 - 2 1 Homicide & Operations of War - - - - - - - - - - - - - - - - - - Total 743 696 33 23 1 1 1 1 7 3 38 22 196 107 206 173 261 366 10 CONTROL OF DISEASE There were 1,214 notifications compared with 4-84- in 1962, This is largely accounted for by the normal biennial epedemic of measles which accounted for 957 of the cases. There was, however, a sharp increase in the number of whooping cough cases from 14 to 92 and a baby girl died from this cause; Tuberculosis There were 74 notified new cases, an increase of 21 on the previous year, 59 of these (42 males and 17 females) .had chest infection and the remaining 15 (6 males and 9 females) had involvement of the glands in 9 cases, renal tract in 2 cases, joints in 2 cases and serous memh-ar.es in 2 cases. There were only five deaths from this disease. Distribution of New Tuberculosis Cases and Deaths in 1963 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 - - - - - - - - 5-9 „ - - - - - - - - 10 -14 „ - - - - - - - - 15 -19 „ 3 1 1 - - - - - 20 -24 „ 6 2 1 1 - - - - 25 -29 „ 1 2 1 1 - - - - 30 -34 „ 3 - - 1 - - - - 35 -39 „ 3 2 1 1 1 - 1 - 40 -44 „ 6 - 1 1 - 1 - - 45 -49 „ 4 2 - 1 1 - - - 50 -54 „ 4 1 - - 1 - - - 55 59 „ 4 5 - 1 - - - - 60 -64 „ 3 1 - - - - - - 65-69 „ 2 - - 1 - - - - 70-74 „ 2 - - 1 - - - - 75 years and over 1 1 1 - - - - - Total 42 17 6 9 3 1 1 - Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1963 816 594 78 101 1589 Add New cases notified in 1961 42 17 6 9 74 Transfer into Borough 31 23 5 5 64 Restored to Register 1 - - - 1 890 634 89 115 1728 Deduct Transfers out of Borough 20 18 1 2 41 Deaths 17 3 2 - - Recovered Cases 32 19 - 1 52 Cases lost sight of 10 3 1 - 14 79 43 4 3 129 Number of Register as 31st December, 1963 811 591 85 112 1599 11 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1963 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 10,644 104 12 67 13 196 18.4 Park 10,531 74 10 59 15 158 15.0 Coleraine 11,127 71 9 50 10 140 12.6 West Green 10,530 51 3 57 11 122 11.6 Bruce Grove & Central 10,436 48 3 42 7 100 9.6 High Cross & Stoneleigh 10,432 63 12 58 7 140 13.4 Green Lanes 9,925 94 8 65 15 182 18.3 Chestnuts 10,66 70 8 54 10 142 13.7 Seven Sisters 9,431 72 7 43 7 129 13.6 Town Hall 9,765 82 6 54 11 153 15.6 Stamford Hill 9,513 82 7 42 6 137 14.4 Total 112,700 811 85 591 112 1599 14.2 Notes: To obtain the estimated population of 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. Diphtheria No cases of diphtheria occurred in the Borough in 1963. Poliomyelitis For the fourth consecutive year there has been no notified case of poliomyelitis amongst Tottenham residents, demonstrating the efficancy of poliomyelitis immunisation. Acute Encephalitis One case of acute infective encephalitis was notified in 1963= Meningococcal Infection No notifications of meningococcal infection were received in 1963. Smallpox No case of smallpox occurred in the Borough in 1963. Typhoid Fever No case of typhoid fever occurred in the Borough in 1963. 12 Scarlet Fever There were 24 notified cases of scarlet fever in 1963. This was the lowest recorded figures and was less than half the number for 1962, the previous lowest. Measles The incidence of this disease has a biennial cycle, and 1963 was a year of high incidence. There were 957 notifications compared with 296 in the previous year. No deaths arose from this cause. Whooping Cough There were 92 notifications of this disease in 1963, which was a sharp increase on the previous year when only 14 cases occurred. Oie death resulted in a baby girl aged six months who had not been immunised. This increased incidence emphasises the need for continued vigilance and active immunisation at an early age. Food Poisoning 12 cases of food poisoning were notified and the organism was isolated in six of these as follows:- s. typhimurium 2 s. heidelberg 2 s. give 1 staphlococcus 1 An outbreak of food poisoning occurred in a factory in September where the causal organism was identified as CI. welchii. It was thought that the food giving rise to the illness was chicken voi-au-vent which were prepared from trimmings of carcases cooked the day previously and reheated and after the addition of a white sauce, put into the pastry cases. It appeared that the canteen staff did not fully understand the precautions required in handling pre-cooked and reheated foods. There was also an outbreak of food poisoning amongst the Council's staff following their Annual Dinner, where the cause was traced to CI. welchii. The Dinner took place in an adjoining Borough where the outbreak was investigated and the Department co-operated in obtaining specimens and case histories from those affected. Dysentry There were 27 notified cases of dysentry. The illness was generally of a mild character. Staff Medical Examinations Eight of the 105 candidates medically examined during the year before appointment to the staff, failed to pass the examination. Ghe case was reported upon because of liability of an undue amount of sickness and the other seven were failed for the following reasons:- Hypertension 3 Bronchitis 1 Tuberculosis 1 Heart disease 1 Psychoneurosis 1 13 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1963 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 - - 2 - - 1 3 1 3 2 3 5 - 1 - - 1 1 - - 1 - - - 24 Measles 24 26 74 52 69 71 84 56 68 76 172 151 9 10 2 5 2 5 - 1 - - - - 957 Whooping Cough 5 6 12 8 6 5 8 6 3 4 11 14 1 3 - - - - - - - - - - 92 Pneumonia - - - - - - 1 - - - 3 - 1 - - - 1 - 2 3 1 1 1 - 14 Erysipelas - 1 - - - - - - - - - - - - - - - - - - - 2 1 - 4 Food Poisoning 1 - - - - - - - - - - 1 - - 1 - 1 2 - 2 3 - - 1 12 Puerperal Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infective - - - - - - - - - - - - 1 - - - - - - - - - - - 1 Post-infectious - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Non-paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Scabies - 1 - - - - - - - - 1 2 1 1 - - 1 1 1 - - - - - 9 Typhoid Fever - - - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid Fever - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 3 1 2 1 3 - - - 1 2 - 2 1 1 - - 2 3 - 2 1 1 1 - 27 Tuberculosis Respiratory - - - - - - - - - - - - - - 3 1 10 4 9 2 15 9 5 1 59 Meninges & C.N.S. - - - - - - - - - - - - - - - - - - - - - - - - - Other - - - - - - - - - - - - - - 1 - 2 3 2 2 - 2 1 2 15 Total 33 35 90 61 78 77 96 63 75 84 190 175 14 16 7 6 20 19 14 12 21 15 9 4 1214 14 CARE OF OLD PEOPLE With the increasing percentage of older people in the population the problem of their care has continued to occupy much time and thought. The basic aim must always be to keep old persons where they are happiest, in general, in fact, in their own homes and it is to this end that the majority of the services are directed. By means of the services outlined below, it is often possible for the old people's to continue to live with their friends and in the surroundings that they have known since childhood. In some cases, however, when the old people have been looked after in their own homes for some years their disabilities slowly increase so that they slip beyond the ambit of the services provided. This occurs much less commonly in old people with their mental faculties unimpaired. At this stage, however, a difficulty not infrequently arises in that some old people are unable to appreciate the fact that they are no longer able to manage. No dramatic change may have taken place and no change in the home environment may have occurred, but the basic requirement is merely an increase in simple care. Considerable tact and time may be required to persuade the old person to take advantage of the other types of facilities available to them. It is unfortunate that some old people have to leave their homes prematurely, because their physical disabilities are such that with the homes designed as they are, they are unable to cope with their domestic problems. Where possible the Council try to help by rehousing in suitable alternative accommodation. Laundry Service for the Incontinent Aged This service is provided under Section 84 of the Public Health Act, 1936, and in 1963, 689 collections were made by the Public Health Departmento 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 a unit for the chronic sick which comprises 100 beds (60 females and 40 males) Problems may arise in the discharge of elderly patients who live alone and have no close relatives or friends to whom they may look for assistance In an endeavour to ensure smooth transfer from hospital to domiciliary care, a meeting was arranged between those concerned on hospital and local authority staffs and agreement reached on the procedure to be followed before the discharge of this type of patient. Persons in need of Care and Attention Reports reach the Public Health department from time to time but more particularly during this winter months, of old people who are no longer able to care for themselves , and who are unwilling or unable to obtain help from relatives or neighbours. All such cases are sympathetically investigated and it is often possible to arrange domiciliary services to meet their problems. In some instances adequate provision cannot be made at home and after consultations with the family doctor,, the hospital consultant geriatrician may visit and if appropriate arrange early admission to hospital. 15 In exceptional cases the patient refuses all assistance or admission to a suitable home or hospital and action may be necessary to secure a Magistrates Order under the National Assistance Act in order to ensure proper care and attention. One such case arose in 1963. A man aged 85 years living alone was incapable of looking after himself and there was a fire risk to others living nearby. An order was made for his admission to a County home, and subsequently he continued happily there on a voluntary basis. (XX) PEOPLE' S WELFARE COMMITTEE The following is extracted from the Chairman's Annual Report. Visits and General Welfare A regular visiting service is maintained to the needy giving such assistance as is available. In addition to 960 visits by the Committee's staff, voluntary workers visited in 210 instances. The Inner Wheel members assist very much in visiting the sick and housebound, and supplying nourishment, help and service to the elderly people. School children are also very interested in visiting, and it is good for both the old and young to get to know each other. 2,500 office interviews took place during the year when advice and information was given as to the services available. There are many old people who are still reluctant to apply for supplementary help from the National Assistance Board. Meals-on-Wheels Service Meals are distributed on five days each week and a total of 11,638 meals were delivered during the year. Although the meals are prepared in the Council's Catering Department their delivery is largely dependant upon the voluntary workers, who so tirelessly give of their time to this service. More helpers would be welcome so as to ensure that the work can be effectively maintained. Chiropody Service Ten clinic sessions are held each week which were attended by a total of 1,064 old people who received 4,3 82 treatments during the year. The appointments are at present spaced as far apart as twelve weeks and this is too long a period for many of the old people to wait. For this reason it is hoped that it will be possible to arrange additional clinics in the future. 1,704 treatments were given to old people in their homes and during the year the number of weekly visits was increased from 30 to 36, although there are still 28 people on the waiting list of this service. Optical Service 20 housebound patients were visited by the Optician. Shoe Repairs Efforts to get more shoe repairers interested in this service have not yet met with success, and there is only one repairer in the Borough operating the Scheme. 16 Radio and Television A wireless for the bedridden society have been very helpful towards the housebound elderly., 23 sets are in circulation and depending upon the old people's circumstances they are supplied free of charge and the licence is paid. 6 television receivers which were given by a generous donor are in circulation in the Borough and are issued to people who are very lonely and unable to pay for this service themselves. The sets were supplied through the National Council of Social Service to whom a full report is sent with each application. Clubs Four clubs are operating in conjunction with the local welfare committee and 6,709 meals were served at the clubs during the year. The Council's Entertainment Manager arranges for shows to be put on by the Council throughout the year. Parcels for the Sick and Elderly Many schools and churches throughout the Borough kindly gave their harvest festival offerings to the Committee which enabled the 600 parcels of food and vegetables etc. to be given to the sick. Much of the tinned food was stored and distributed to the sick and needy during the winter months. At Christmas time 2,000 pre-packed parcels were distributed by voluntary staff to the sick and elderly. 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) Bearsted Memorial Maternity Hospital with Annexe at Hampton Court, (2) St, Ann's General Hospital. (3) Prince of Wales's General Hospital with Annexe at Nazeing (Princess Louise Convalescent Home, (4) Tottenham Chest Clinic. Out patient clinics provided at the Prince of Wales's General Hospital are set out on the following page. Personal Health The personal health services for the area are administered from the Area Health Officer at the Local County Offices, Somerset Road, Tottenham, N. 17. (TOTtenham 4500). Welfare The welfare service is administered in Tottenham by the Area Welfare Officer8 Local County Offices, Somerset Road, Tottenham, N. 17, (TDTtenham 4500). Mental Health The local offices at the mental health service are at the Local County Offices, Somerset Road Tottenham N. 17. (TOTtenham 4500). 17 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. Alt. weeks Surgical a.m. p.m. p.m. - p.m. - Varicose ulcers p.m. - p.m. - - - Diseases of Women - p.m. - p.m. - - Children (Medical) - a.m. - a.m. - - Eye - - a.m. - - - Throat. Nose & Ear p.m. - - p.m. - - Skin - - p.m. - a.m. - Teeth - - - a.m. - a.m. Neurological p.m. - 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. - a.m. a.m. a.m. p m p.m. - p.m. p.m. p.m. Allergy - - - p.m. - - Venereal Diseases Medical Officer Males 4.30 p.m. 7.0p.m. - 4.30 p.m. 7.0 p.m. 10.0 a.m. 12.30 p.m. 4.30 p.m. 7.0 P.m. 10.0 a.m. 12.30 p.m. 4.30 p.m. 7.0 p.m. Females - 4.30 p.m.7.0p.m. - 10.0 a.m. 12.30 P.m. 2. 0 P.m.7. 0 p.m. 10.0 a.m.12.30 P.m. Intermediate Treatment 9.0 a.m.- 7.0 p.m. 9.0 a.m.- 7.0 p.m. 9.0 a.m.- 7.0 p.m. 9.0 a.m.- 7.0 p.m. 9.0 a.m.- 7.0 p.m. 9.0 a.m.- 12.30 p.m. Doctors' Letters required All Patients seen by appointment The Casualty Department is always open for medical and surgical emergencies 18 Ambulances Ambulances are stationed at the Education 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 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 bya special messenger for examination at the Hornsey Branch Laboratory, Coppett's Road, No. 10. Collecting times are 3.00 p.m. Monday to Friday and 10,00 a.m. Saturday. A twenty-four hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of work carried out for Tottenham by the Laboratory Services:- RECORD OF EXAMINATIONS Throatj Nose and Hand Swabsi- Total Specimens 35 Haemolytic Streptococci 2 Negative 33 Faeces;- Total Specimens 262 Shigella 24 Salmonella paratyphi 2 Salmonella heidelberg 5 Cl. welchii 5 Negative 226 Sputum; - Total Specimens 1 Negative 1 Water Samples;Total Specimens 4 Negative 4 Frozen Egg Samples?- Total Specimens 146 Salmonella hessarek 6 Salmonella pullorum 2 Salmonella typhi-murium 1 Negative 137 Ice -cream Samples' Total Specimens 18 Provisional Grade 1 - 15 • 2-2 3-1 18 Other Food Samples;- Total Specimens 5 Negative 5 Miscellaneous Specimens;- 10 Total Number of Specimens 481 19 SANITARY CIRCUMSTANCES FOR THE AREA Water Supplies Dr. Windle Taylor, Director of Water Examination, 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 1963. The Borough is supplied with New River - derived water from Stoke Newington and Hornsey filtration stations with additional well water fromthe Board's Park well during the summer months. Summaries of the analytical results of the waters from these sources are set out on the following page. There were no changes in the general scheme of supply to the Borough of Tottenham during 1963. No trunk mains were laid, but new service mains were laid to the extent of 507 yards. All repaired and new mains are disinfected with chlorine before being restored or passed into service and samples of water from them are tested in these laboratories to ensure that its quality is up to that normally supplied. The water in this area is not plumbo solvent. Drainage and Sewerage There are separate systems of drainage for soil and surface water. Incorrect connections to the surface water system may give rise to pollution of streams and close liaison is maintained with the Lee Conservancy Catchment Board's Inspectors so that action may be taken as soon as possible to deal with any contraventions. The final transfer of the sewage outfall from the London sewerage system to the East Middlesex Drainage System was completed on the 10th January, 1964. Good progress is being made on the Council's flood relief schemes. The improvement of the Hebourne Ditch has been completed, the Stonebridge Brook Scheme has reached its last phase, and major work is in hand to enlarge the overflow system from the old Moselle Brook. Inspections Carried out by the Public Health Inspectors Appointments and Interviews 598 Certificates of Disrepair 6 Cinemas and Halls 16 Complaints Investigated 2,844 Conveniences and Urinals 49 Drains Defective 66 Drains Tested 212 Factories with Mechanical Power 143 Factories without Mechanical Power 2 Food Poisoning 15 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) Chlop= ides as Cl Oxygen abs, from Permanganate 4 brs, at 27°C Turbidity Units Colour m.m brown 2 ft Tube Burgess s Tintometer Hardness (Total) Hardness (noncar bonate) pH Value Phosphate as PO. 4 Silicate as lo2 Sulphate as SO. 4 Fluoride as F Magnesium as Mg. Surface Active Material as Manoxol Sodium as NA Potassium as K Electrical Conductivity (micromhos)       New River derived 104 0.86 0.1 5.2 38 0.2 0. 6 306 70 7.8 1.0 11 58 0,25 5 0,07 29 4.9 620 Park well 2 0.110 0.020 0.3 2.6 0.8 0.2 5 264 56 7.4 18.0 4.1 630 BACTERIOLOGICAL RESULTS- YEARLY AVERAGES, 1962 BEFORE TREATMENT AFTER TREATMENT Agar plate couni per ml. Collfofm count Escherichia coll count Agar plate count per ml, Coliform count Escherichia coli count Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Count per 100ml Pe' 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 samples negative in 100 ml.       New River derived 512 4.5 - 100.0 100.0 Park well 65 0.4 22 95.38 0.1 98.46 - 69 0.1 4 100.0 100.0 20 21 Inspections Carried out by the Public Health Inspectors (Cont'd.) Food Premises Bakehouses 27 Butchers 51 Cafes and Restaurants 123 Dairies and Milkshops 11 Facto ries 4 Factory Canteens 8 Fishmongers 24 Greengrocers 30 Ice cream Premises 48 Slaughterhouses 687 Other Food Premises 131 House to House 256 Improvement Grants 96 Infectious Disease 128 Multiple Lettings 424 Noise Complaints 16 Other Visits 1,746 Outworkers 23 Rat Infestations .179 Re-Inspections 5,151 Schools 6 S.D.AA. & Housing Act Advances 228 Smoke Control Areas 6,357 Smoke Observations 55 Workplaces 1 Defects Remedied Drains reconstructed 5 Drains repaired 44 Drains cleared 26 W.C. Cisterns repaired or renewed 93 W Cc Pans renewed 56 W.C Pans cleansed 4 Waste pipes repaired or renewed 28 Rain water pipes repaired or renewed 58 Roofs repaired or renewed 240 Eaves gutters repaired or renewed 170 Drinking water cisterns renewed 1 Drinking water cisterns covered 1 Water service pipes repaired 40 Water supply reinstated 9 Yards repaired or reconstructed 21 Sinks renewed or provided 12 Floors repaired or renewed 78 Floors ventilated 13 22 Defects Remedied (Coat'd.) Dampness remedied by insertion of damp proof courses 3 by pointing of brickwork 33 by internal rendering 59 by miscellaneous remedies 75 Window frames and sashes repaired, renewed or painted 119 Coppers repaired, renewed or provided 1 Fireplaces, stoves & ovens repaired or renewed 22 Flues and chimney stacks repaired 16 Brickwork of walls repaired and walls rebuilt 17 Ventilated food stores provided 4 Rooms cleansed 1 Staircases, passages and landings cleansed 2 Staircases, balconies and steps repaired or renewed 19 Noxious accumulations removed 35 Nuisances arising from animals abated 3 Miscellaneous defects remedied 282 Notices Served Statutory:- Housing Act, 1957: 43 Section 9 39 Section 90 4 Housing Act, 1961: Section 15 10 14 Section 16 2 Section 19 2 Public Health Act, 1936: Section 3 9 27 284 Section 45 9 Section 79 2 Section 92 246 Tottenham Corporation Act, 1952: Section 36 46 Section 43 116 162 Informal Notices 1,348 503 23 Work carried out in default or by agreement with owners during 1963 Housing Act, 1957 Section 9 9 Premises £169. 12. 6. Public Health Act, 1936 £ 58. 1. 1. Section 39 4 Premises Section 45 1 Premises £ 1. 13. 3. Section 79 1 Premises 18. 9. Public Health Act, 1961 Section 22 1 Premises £ 12. 6. 0. Tottenham Corporation Act, 1952 Section 36 32 Premises £192. 14. 5. Section 38 11 Premises £ 51. 3. 11. Section 43 24 Premises £210. 1. 6. £696. 11. 5. Abatement of Statutory Nuisances There was a small rise in the number of complaints investigated during 1963. The majority of these complaints related to defects in dwellings and in most instances it was possible to secure remedial steps by informal action. In 246 instances, however, it was necessary to take action under Part III of the Public Health Act, 1936, for the abatement of nuisances. Legal proceedings were instituted in 17 cases and abatement orders were made in 4 of these. In the remaining cases the work was completed before the matter reached the Court. In one instance a fine of £5 was imposed and altogether 31 guineas costs were awarded. 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. Theyare laundered at St. Ann's Hospital laundry and collected and returned. The service in twice weekly, and at any one time there may be up to two dozen elderly persons on the list. Summary of Disinfection Work during 1963 Rooms disinfected after occurrence of infectious disease or death 13 Bedding disinfected after occurrence of infectious disease or death 23 Library Books disinfected 121 Drying out wet bedding, carpets etc. caused by burst pipes 20 Second hand clothing sent abroad Parcels 2 Baths for Verminous Persons (Males 16) (Females 6) (Children 2) Total number of baths 56 24 Disinfection Certificates The Department is 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 1963 Sterilisation Certificates Hair 75 Rags 15 90 Radioactive Substances Act, 1960 An order made in 1963 appointed 1st December, 1963, as the date when this Act came into operation. The Act is concerned with the accumulation and disposal of radioactive wastes. As from the appointed day persons who keep or use radioactive material, unless exempted, are required to register with the Ministry of Housing and Local Government, and to obtain authorisation from them for the accumulation and disposal of radioactive wastes. Control of the substances is exercised directly by the central government and is not a local government responsibility. In certain circumstances the local authority must be consulted before the Ministry issue authorisation for the disposal of radioactive wastes in respect of major nuclear establishments, or where the disposal is likely to involve the need for special precautions by the authority, The Government policy contemplates the use, in suitable cases of low concentration,, of local conventional methods of disposing of wastes, e, g, discharge into sewer or disposal on refuse tip. The Ministry consider it desirable that such methods should be used wherever practicable, since by them, the harmless dispersal can most often be achieved and the increased exposure caused by multiple handling avoided, Section 9 (5) places a duty on the local authority to accept and to deal with radioactive wastes sent to their refuse tip in accordance with the authorisation issued by the Minister. Swimming Pools The Council have two covered pools at the Central Baths and an open air pool at Lordship Lane. Details are as follows:- (a) Lido Open Air Pools (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. 25 The General Manager, Baths Department (Mr, P.E. Lusher) has provided the following report upon modernisation work which has recently been undertaken at the Central Baths; The small swinming pool and entrance foyer have undergone a complete transformation at a cost of approximately £15,000. Last year the first stage of this scheme was completed by the removal of dressing cubicles from the poolside and constructing separate dressing and clothes storage rooms. The most notable feature of the scheme is the new suspended ceiling works which entirely conceal the unsightly roof trusses and windows. In the centre and running the full length of the pool are louvred panels which serve to admit natural lighting, conceal the fluorescent lighting and floodlights and to afford a foul air exit to atmosphere. Acoustic tiles form the rest of the ceiling to effect noise absorption and reduce condensation. The side walls are tiled in light blue relieved by dark blue piers and the end walls feature abstract designs. A scum channel replaces the former hand rail and also serves to draw off surface pollution for return to the filtration plant. The entire pool surround has been re-laid with non-slip buff tiles. The floor of the large pool is also being retiled, replacing glazed brick tiles which had become chipped and dangerous to bathers feet. The last stage was the modernisation of the entrance to the swimming pools. A former private baths suite was removed and replaced witha kitchen and buffet. Vending machines provide refreshments at all times of the day. Private Baths Private baths are available at four establishments in the Borough as follows1: - (a) Central 34 (b) Conway Road 18 (c) Bromley Road 14 (d) Tiverton Road 22 88 Public Laundries Laundry facilities are available at three Corporation establishments in the Borough at Bromley Road, Tiverton and Mark field Laundrette, Broad Lane. General Manager of the Baths Department, Mr. P.E. Lusher, has supplied the following information on the developments in this service during 1963. Markfield Laundrette The scheme consists of 12 x 12 lb. dry weight Lister "Atlantic" washing machines fitted with "Newbery" three formulae process control. Each machine is fitted for coin and automatic soap solution operation. There are four Broadbent 16" Hydro Extractors also fitted for coin operation. A full dry service is available by four Lister "Airflo" gas heated, coin operated Drying Tumblers. The novel feature of the scheme is the Autobar where vending machines supply a variety of beverages and refrigerated drinks. 26 Paintwork is completely absent. Contemporary ceramic tiles line the walls, thermoplastic tiles cover the floor and acoustic stove enamelled tiles are employed to form the suspended ceiling. Flush fitted fluorescent light fittings line up with plastic louvres giving a foul air exit through variable speed extract fans. Two doors marked "In" and "Out" ensure a clockwise flow of the public using the laundrette. The "backroom" plant consists of a Permutit automatic water softener through which the mains water is softened to zero hardness and elevated to a 2,000 gallon storage tank on the roof. A common supply from this tank, through a centrifugal pump induces an artificial head of SO feet to give equal pressures on the hot and cold services. The 300 gallon hot water storage cylinder is inter-connected with two 200,000 B.T.U's per hour Potterton gas fired boilers which are also fully automatic and time-clock controlled. Two 80 gallon soap solution tanks fitted with immersion heaters ensure a full days supply. Two female supervisors are the only staff employed and share a 72 hour operational week. The complete installation receives only a routine daily visit from a maintenance engineer. The charges are 2/- for a hot, warm or woollen washes, 1d. for the use of hydro extractors and 6d, for the use of drying tumblers. A liquid bleach machine vends four fluid ounces for 3d. Tiverton Road Baths and Laundry This establishment is situated in the southern part of the Borough and until 1962, like Bromley Road, it operated for 30 years as a "Public Wash-house". Upon redevelopment of the surrounding area under the Slum Clearance programme, the Council decided to retain and preserve this establishment as a site amenity after modernisation. The modernisation scheme provided for the entire gutting of all plant and machinery within the laundry and boiler house and its replacement. A person may present up to but not exceeding a maximum of 25 lbs. dry weight of any classification for processing. After loading the machine, she may select her own washing formulae, insert the requisite coins in the coin mechanism and press the start button. The washing machine will carry out the complete selected washing cycle in 20 minutes for white work, 17 minutes for coloureds and 13 minutes for woollens. Soap and soda is automatically introduced so that the customer is relieved of even this small task. At the end of this process the work is removed to the hydro extractor for further high speed water extraction before being transferred to the steam drying tumbler. The drying tumbler is pre-set for a five minute run, after which period the customer removes work required for ironing and at this stage is still slightly damp. She may retain the use of the tumbler for any work requiring to be fully dried. A further five minute run will ensure this. The ironing machine is of adequate dimensions to enable two persons to work at the same time. This machine will iron all flat articles and the customer will have completed the washing, drying and ironing of her load within 45 minutes for an inclusive charge of 4/- per load. Attendances prior to modernisation averaged only 400 per week, but today attendances are to the order of 800 per week and steadily increasing. 27 Steam Generating Plant The establishment is within a Smoke Control Area and the problem of grit and smoke emission even from a tall stack presented difficulties in view of the close proximity of four storey blocks of flats. Once again the pioneering spirit is exhibited when the Council approved the recommendation to install a Steam Generator as opposed to conventional boiler plant to serve all heating requirements of the establishment. The generator burning 35 second gas oil, required only a short stack which cannot be observed from street level. The advantages of the Steam Generator are considerable and initially they outweigh those of conventional boiler plant. Prime factors being a high efficiency, space saving and low capital cost. Particular regard has also been given to the unsightly emission of flash steam from vent pipes which also represents a considerable loss of heat and operational costs. To overcome this, the Baths Department incorporated a condensate cooling battery through which all condensate passes to give up the excess heat to a calorifier to assist in the production of hot water. The installation, together with the ancillary services was installed and commissioned by the Baths Department maintenance staff under the direction of the General Manager and was the first generator in England to be installed in the Baths Service. Insect Pests The number of bug infestations reported again declined during 1963; with 61 houses infested as against 89 the previous year. The greatest numbers of other pests dealt with were beetles - 28 infestations, and wasps- 19 nests were destroyed. 242 inspections were made of premises prior to the tenant's removal to Council houses, Disinfestation was required in 16 cases. PREMISES TREATED Houses Other Premises Ants 8 5 Bees 1 - Beetles 20 8 Bluebottles 3 2 Bugs 61 - Fleas 6 - Lice 1 - Maggots 1 - Moths 1 - Golden Spider Beetles 3 - Silver Fish 2 - Slugs 1 - Wasps 18 1 Total 126 16 28 Rodent Control Three sewer treatments were carried out during the year. Two were direct poison treatments using pin-head oatmeal and sodium fluoracetate, Prior to the third treatment test bait with sausage rusk was laid at 940 points. Sodium fluoracetate and pin-head oatmeal was subsequently laid as follows:- For complete prebait "takes" 8 ozs; Good "Takes"- 4 ozs; Small "Takes"- 2 ozs; and No."takes" - 2 oz, The following is a summary of premises treated in 196.1 (1) Houses 702 (2) Shops 32 (3) Factories 45 (4) School Canteens 86 (5) Miscellaneous 45 (6) Total Charge for 2-5 above £135. 3, 1d. 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 provision 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 No of Inspections Written Notices Occupier Prosecuted (i) Factories in which section 1.2,3,4 & 6 are enforced by local authority 50 22 1 - (ii) Factories not included in (i) in which section 7 is enforced by local authority 665 143 7 - (iii) Other premises In which section 7 is enforced by local authority (excluding outworkers premises) 34 24 - - Total 749 169 8 Summary of defects found in factories Particulars Number of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (S.l) 1 1 - 1 Overcrowding (S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) - - - - Ineffective drainage of floor (S.6) - - - Sanitary converiences (S.7) - (a) Insufficent - - - - (b) Unsuitable or defective 11 10 - 2 (c) Not separate for sexes 1 1 - 1 Other offences against the Act (not including offences relating to outworkers) 4 - 4 - Total 17 12 4 4 29 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 3 24 Household linen 7 Curtains & Furniture hangings 1 Upholstery work 1 Umbrellas 1 Artificial flowers 9 Paper bags 2 Cardboard boxes 18 Boxing, carding of buttons 8 Christmas crackers & stockings 15 Lampshades 2 388 Shops Inspections of shop premises have been carried out under the Shops Act, 1950, during the year; late evening and week-end inspections have been made to ensure that the regulations have been complied with. Despite the growth of the large self-service and multiple stores, the number of small shops in the Borough does not show any appreciable decrease, but a more rapid change of ownership of these small businesses does, perhaps, indicate a greater difficulty to make a living in the face of the competition. Inspections 1699 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. 1882 male assistants, 2178 female assistants and 189 male and 261 female young persons were employed at the premises inspected. During the year the following contraventions were noted:- Section 17(2) Assistants weekly half holiday 68 notice not exhibted Section 32(2) Record of hours of employment of young persons not maintained 13 Section 32(3) Abstract of provision of employment of young persons not exhibited 12 Section 37(2) Notice re. use of seats by females not exhibited 5 8 General Closing Hours Section 2(1) Failure to close at prescribed hour 1 30 Weekly Half Holiday Section 1 (2) Alternative closing notice not 11 exhibited Section 13(1) Exempted trade notice not exhibited 33 Section 1 Sale of unscheduled articles 7 Sunday Trading Section 22(3) Record of hours worked not maintained 4 Section 57 Exempted trade notice not exhibited 27 Section 47 Sale of unscheduled articles 15 Jewish Sabbath Section 53 Trading on the Jewish Sabbath 2 In connection with the infringements recorded above, 46 reinspections were made and 14 warning letters sent. Fabrics (Misdescription) Act, 1913 The Fabrics (Misdescription) Regulations, 1959 122 inspections were made during the year, 83 samples of cloth or clothing were examined- no infringements were noted. Middlesex County Council Act, 1944 Street Trading 22 trading sites were licensed. 9 warning letters were sent and 3 prosecutions were taken for unlicensed street trading. Special attention has been paid to ice cream vehicles near parks and schools. Prosecutions Shops Act, 1959 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 £1. 0. 0. £1. 1. 0 £2 1. 0 Case 2 - ditto - 47 £1 0. 0. £1, 1. 0 £2. 1. 0 Case 3 - ditto - 47 £1 0. 0. £1, 1. 0 £2. 1. 0 Case 4 Sale of articles not mentioned in the First Schedule (weekly half holiday) 1 £2 0. 0. £2 2 0 £4 2. 0 Case 5 Failing to exhibit exempted trade notice 57 £1. 0. 0. 10 6 £1.10. 6. Case 6 Failing to keep records of Sunday employment 22(3) £2 0. 0. £1. 1. 0 £3. 1. 0. Case 7 - ditto - 22(3) £6 0. 0. £5. 5. 0 £11. 5. 0. Case 8 Unlicensed street trading 320 & 329 £4. 0. 0. £2 2. 0 £6. 2, 0. Case 9 -itto - 320 & 329 £2. 0. 0. £5 5. 0 £7. 5. 0. Case 10 - ditto - 320 & 329 £10 0. 0. £2. 2. 0 £12. 2. 0. Total £30. 0. 0. £21. 10 6 £51. 10. 6 31 Rag Flock and Other Filling Materials Act, 1951 There are no establishments licensed for the manufacture of rag flock. At 31st December, 1963 there were eighteen premises registered for the use of filling materials. Pet Animals, 1951 At 31st December, 1963 nine premises were licensed as pet shops in accordance with the Pet Animals Act, 1951. Middlesex County Council Act, 1944 Par XII Eight establishments were registered for chiropody and special treatment at 31st December, 1963. Animal Boarding Establishments Act, 1963 The Council have licensed one establishment under this act, which came into force on the 1st January, 1964. The licensing conditions were based on a model form prepared by the Royal Society for the Prevention of Cruelty to Animals. Burials 5 Burials were carried out under section 5 0 of the National Assistance Act, 1948, where no suitable arrangement would otherwise have been made. 32 CLEAN AIR ACT Smoke Control Areas A preliminary survey was completed of the fifth area in the Smoke Control Programme but the Council decided to defer making the Order until they are assured that sufficient fuel would be available to meet the resulting increased demand. The area covers 603 acres and includes 1,429 Corporation dwellings, and 2,300 L.C.C. dwellings, as well as 3,595 privately owned houses. As smoke control progresses the improvement in the atmosphere during the winter months becomes more apparent and the "smogs" experienced in earlier years are now rare and much less bituminous. It would be unfortunate if, following fundamental changes in methods of gas production, national uncertainty as to fuel supplies should lead to any loss of momentum in the campaign to control smoke emission. It is hoped that following publication of the Government's Command Paper on Domestic Fuel Supplies in December, 1963, adequate supplies of smokeless fuel at reasonable prices can be planned so that there will continue to be public support for the extension of Smoke Control Areas. Much has been said of the harm caused by cigarette smoking but it must be remembered that polluted air also gives rise to chest diseases and anything that can be done to promote clean air is a matter of primary public health. Furnace Installations Two 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, and has three sulphur dioxide and smoke recorders operating in the Borough, BELMONT/WHITE HART LANE SMOKE CONTROL AREA 33 ATMOSPHERIC POLLUTION RECORD, 1963 (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 268 644 431 743 410 1576 397 1052 Insufficieit Readings February 205 486 334 527 216 576 326 626 154 224 352 565 March 85 156 134 348 66 196 213 518 Insufficient Reading April 71 120 132 232 65 128 171 301 62 116 94 155 May 39 72 70 109 39 123 133 424 49 76 60 115 June 25 91 67 169 26 70 81 191 27 49 84 287 July 25 50 70 162 22 67 83 204 24 83 50 272 August 21 61 57 257 27 65 123 348 23 60 89 213 September 43 75 90 217 50 163 119 262 37 92 123 266 October 96 228 141 287 116 240 180 284 101 168 166 294 November 156 484 178 603 160 468 175 429 120 484 165 521 December 176 300 292 417 171 376 232 514 158 268 279 452 34 HOUSING It is usual when dealing with unfit houses to serve informal notices in the first instance. In most cases the work required is carried out as a result of these notices but in some instances it is necessary to serve a statutory notice. In a small percentage of these, work has to be carried out in owners default. The complaints received during the year were some 250 more than in the previous year and the majority of these related to housing defects. This increase and the fact that the filling of staff vacancies enabled more systematic inspection of houses known or thought to be in multiple occupation resulted in an increase of 3 70 in the number of informal notices served. Clearance of Unfit Houses In the latter part of the year the Park Lane/Waverley Road Area was represented. The total number of houses in the compulsory purchase area is 152 of which 33 have already been accquired by the Council and of the remainder, 76 are considered to be unfit. Confirmation was received, with minor modifications, of the Willow Walk/Milton Road Area and the Tewkesbury Road/Seven Sisters Road Redevelopment Area. Improvement of Houses A pilot survey was undertaken in April, 1963, in order to assess the interest of owners and occupiers in the grants which are available to improve existing houses by providing the modern amenities, A typical road comprising 89 houses was visited, but in 23 cases it was not possible to gain access or to interview the occupiers. The remaining 66 houses were inspected and the improvement grant schemes explained to the householders. 16 houses had all the amenities present although in 8 cases the W.C. was readily accessible outside. With one exception these were owned by the occupiers and 5 had received improvement grants. The following is a summary of the facilities lacking in the remaining 53 houses:- Fixed bath in a bathroom 3 9 Wash hand basin 44 Hot water supply 40 Ventilated food store 18 Internal W.C. 46 14 tenants and 5 owner occupiers expressed a qualified interest in the possibility of improvements being carried out with the aid of grant. Some of the reasons advanced by householders who did not want improvements carried out were; - Unwillingness to pay extra rent Inability to spare room for conversion into bathroom Pensioners who did not want to bother Possibility of moving to other accommodation 35 Apart from this pilot survey approaches have been made to two companies which are each responsible for the management of a considerable number of rented properties within the Borough which would rank for improvement grants. In one case there was a plain statement that the return on expenditure was insufficient and nothing further has been heard. In the second case, the owner of some of the properties expressed some interest but is still considering the matter and to date nothing concrete has been decided. Houses in Multiple Occupation A considerable amount of time has been given by the Department to problems arising from the implementation of the provisions of the Housing Act, 1961. Some results have been achieved but, owing to the circumstances mentioned below these are comparatively snail in relation to the effort involved. Initial visits by the Public Health Inspectors arise in the following ways (a) on a systematic house to house basis in certain selected areas, (b) as a result of complaints by occupiers, (c) because of information coming to the knowledge of the Department during the course of visits to houses for other purposes and (d) following up information obtained by other Departments. Full details of these inspections are recorded and the premises registered so that appropriate action can be taken to remedy any adverse conditions found and visits can be paid from time to time to ensure that improvements are maintained. A number of calls are often necessary to interview all occupiers and inspect their accommodation. It is sometimes difficult to obtain information from tenants who are apparently content with their accommodation although it may not comply with the requirements of the Act, and who fear that they may be evicted if action is taken by the Council. Information given in these circumstances by tenants may be suspected as being untrue by the inspector but is almost impossible to refute. This, together with the fact that in some houses the occupants change so frequently, makes it difficult to obtain a record which can be relied upon as accurate. At present 24 hours notice has to be given of intention to enter premises, but the Housing Bill now before Parliament will provide powers of entry without notice after obtaining a warrant. Action under section 15, to require the provision of amenities, has resulted in a number of cases in the eviction of some of the tenants. Before the service of a notice under section 16 for means of escape in case of fire the advice of the Chief Officer of the Fire Brigade is required to be sought and a visit is normally paid by an officer of the Fire Brigade in company with the Public Health Inspector. Secondary access is not required where there is nobody living above the first floor and some cases have arisen where, in order to obviate the need for providing a fire escape to attic rooms, the tenants have been evicted. Conditions for the gradual reduction in the number of occupants, using the provisions of section 19 vary considerably throughout the Borough. In some cases the tenants have been in occupation for a long time and do not intend to move, and the application of section 19 gives no practical assistance. On the contrary it not only appears to condone the overcrowding but precludes the service of notice under section 15 to secure amenities. The Housing Bill will enable both sections to be operated simultaneously. 36 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 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 9.3055 5.56 8. 56 White Hart Lane No.l 4 1.6.54 22.2.55 9.7.55 11,57 8.60 No. 2 123 1.6.54 22.2.55 9.7.55 2, 60 8 60 Tewkesbury No,2 71 29.6.54 28.3.55 27.10.55 5,60 9 60 No, 3 2 30.8.55 Purchased by agreement 8 57 10 57 Markfield Redevelopment 1955 25 28.9.54 25.5.55 13.1.56 12,57 1. 58 Plevna Crescent Nos.l, 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, 12 3 & 4 200 4.6.57 30.9.58 13.5.59 9.63 3.64 and 2.12.58 Tewkesbury No.5 4 1.4.58 17.12.58 Demolition Orders 5.63 8.63 No 6 88 14.10.58 1st 8.7.60 3.63 5.63 2.6.59 and 15.3.60 - - No. 7 3 14.10.58 - 27.10.59 22.1.62 8.63 Markfield Redevelopment 1958 50 18.11.58 5.7.60 4.10.60 9.63 12.63 Tewkesbury No 8 6 30.6.59 Inspector's visit - - - 17.6.60 7.9.60 4.64 - Northumberland Park Nos. 2,3„4,5 & 6 58 12.1.60 17.1.61 30.5.61 - - Durnford Street/ Gourley Street Redevelopment 74 12.1.60 (56 Purchased by Agreement - - - - Whitehall Street/ Stanley Grove 86 23.1.61 20.3.62 18.10.62 - - Church Road King's Road Nos.l 2, 3t 4 & 5 76 23.1.61 20.3.62 18.10.62 - - Milton Road/ Willow Walk 72 29.5.62 11.6.63 18.9.63 - - Tewkesbury Road & Seven Sisters Road Redevelopment 43 13.2.62 12.2.63 18.11.63 - - Park Lane/Waverley Road Nos 1,2.3 & 4 76 15.10.63 - - - - 37 Housing Act, 1957, section 18 A basement room, the subject of a Closing Order, was found being used for human habitation. Legal proceedings were taken against the person responsible and the Court imposed a fine of £10 and costs totalling 5 guineas awarded to the Corporation in respect of this and three further summonses against the same person. Premises the subject of Demolition Orders not demolished as at 31st December, 1963 Premises Date of Order 5-8 Union Row 11. 8.63 33 Waverley Road 4.11.57 28 Avenue Road 23.10.59 15 Braemar Road 28.6.60 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 8 Markfield Road 29.11.62 4 Markfield Road *17.1.63 6 Markfield Road 17.1.63 * These premises were still occupied at 31st December, 1963 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. 1963 9 169 12. 6. 38 Landlord and Tenant Act, 1962: Provision of Rent Books For failing to provide his tenant with a rent book, a landlord was fined £10 and costs of 2 guineas were awarded to the Corporation. 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 warrant special consideration by the Housing Lettings Sub-Committee. To meet this need arrangements exist for the Housing Manager to forward to the Medical Officer of Health details of housing applications where medical evidence has been submitted supporting the need for rehousing. These cases are then visited and an assessment made of the medical grounds and the amount of priority which could be recommended. 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. When any doubt exists and it is not possible to give unqualified support for medical prioritys the facts are placed before the Sub-Committee for their consideration and decision. It will be appreciated that a comparatively large proportion of recommendations for rehousing on medical grounds are made for older persons suffering from a disability caused or exacerbated by their age. They usually need one bedroom accommodation either on the ground floor or in premises with a lift. Some cases were seen who would have been eminently suitable for the proposed Old People's accommodation with the attendance of a Warden. Assessments of 106 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 5 2. Refer to Committee 33 3. Allow medical points 33 4. Recommend transfer to more suitable acconmodation 3 5. To be reviewed at a later date 6 6. Unable to support 2J 7. Circumstance changed making further action unnecessary 1 Certificates of Disrepair Very little use is now made of the Rent Act provisions for an abatement in rent of controlled tenancies where the landlord has failed to keep the property in good repair. This is shewn by the following summary of applications dealt with in 1963. 39 Applications for Certificates of Disrepair Number of applications for certificates 10 Number of decisions not to issue certificates Number of decision to issue certificates (a) in respect of some but not all defects 5 (b) in respect of all defects 5 Number of undertakings given by landlords under paragraph 5 of the First Schedule 5 Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Number of Certificates issued 5 Applications for Cancellation of Certificates Applications by landlords to Local Authority for cancellation of certificates 3 Objections by tenants to cancellation of certificates Certificates cancelled by Local Authority 3 FOOD CONTROL Supervision of all food premises in the Borough is exercised by the Public Health Inspectors, in order to ensure that the equipment and premises are properly maintained and that hygienic handling of food stuffs is observed. Most businesses engaged in the handling of food stuffs are well aware of the need for constant vigilance and in the majority of cases visits by the Public Health Inspectors are appreciated even though criticism may be the result of a visit. The need for constant reiteration of even elementary principles is unfortunately still apparent in a very small minority of cases. There have been instances of small Cafes being opened without proper facilities, without prior notification to the Department, only to close once more when pressure has been applied to enforce the Food Hygiene Regulations. Most people who intend to open a food business are sufficiently prudent to consult the Department before acting. Advice and criticism, constructive if possible, are given, and the staff find this work rewarding in that their counsel is valued by the public who consult them, and they are saved the task of having to require alterations to a newly opened establishment on which a considerable sum may have been spent. There is still a very small number of people, however, often immigrants who try to establish a food business in conditions which cannot be tolerated. The case for compulsory licensing of food premises before their inauguration is strongly argued by these, happily few, defaulters. 40 The total number of food shops as at 31st December, 1963 was 1049, made up as follows:- Bakers 50 Butchers 91 Cafes & dining rooms 118 Confectioners 334 Dairymen 33 Damestic stores 128 Fishmongers 49 Fruiterers & greengrocers 119 Grocers & provisions 290 Ham & Beef Dealers 4 Off Licences 82 Public Houses 58 Registered Food Premises At 31st December, 1963 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 435 Manufacture and sale of ice-cream 1 Storage of ice-cream 1 Cooking of hams and other meat 35 Fish frying 40 Fish curing (smoking) 1 Sausage manufacture 59 Preparation of sausages ( Hot Dogs) 1 Preparation of jellied eels 3 Shellfish 1 In addition the following classes of food hawkers and their storage premises are registered under section 11 of the Middlesex County Council Act, 1950s- Articles No of Hawkers Registered No of Storage Premises Registered Fruit and vegetables 103 85 Shellfish etc. 17 7 Fish 6 4 Ice-cream 6 1 Light Refreshments 9 1 Peanuts 2 1 Eggs 1 - Groceries 1 1 41 Liquid Egg (Pasteurisation) Regulations 1963 These Regulations were made jointly by the Ministry of Agriculture, Fisheries and Food and the Ministry of Health and came into force on the 1st January, 1964. They require that liquid whole egg must be pasteurised before use as an ingredient in the preparation of food and only pasteurised liquid egg may be imported. Tests are prescribed with which pasteurised liquid egg must comply. The Regulations do not deal with liquid egg albumen as at present it is difficult to prescribe a test which will show whether satisfactory pasteurisation has been carried out. Considerable quantities of imported liquid egg come direct to a cold store in the Borough and sampling is carried out by the Public Health Department. 1,191 tons passed through Tottenham during 1963, and of this 471 tons was accompanied by certificates of pasteurisation issued by the country of origin. 146 samples were taken for bacteriological examination, of which 9 were positive as follows:- s. hessarek 6 s. pullorum 2 s. typhi-murium 1 Distribution of the batches from which the positive samples were taken were held up until the consignor could arrange for pasteurisation at an approved establishment under the supervision of the health authority. 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 257 Bacon 3 Baking Powder 9 Beans Baked 260 Beans Curried Beans & Frankfurters 2 Broth Scotch 3 Cheese 2 Cheese Flaps 9 Chicken & Mushroom 1 Coco Cola 1 Cornflour 8 Crab 9 Custard Powder 7 Fish 206 Fruit Juice 81 Fruit Mixed 1,229 Fruit Pulp 27 Kidneys 1 Lamby Liver 3 Lemon Tango 3 Macaroni Creamed 1 Meat Processed 705 Milk & Cream 2 84 Mustard 1 Pease Pudding 21 Pepsi Cola 5 Pie Filling 1 Preserves 13 Rice Creamed 13 9 Sausages 3 Shrimps 1 Soup 914 Spaghetti 100 Steak Pie 2 Steak Pudding 10 Stew Irish 9 Suet 2 Tomatoes 5 63 Tomato Juice 34 Tomato Paste 37 Tomato Puree 24 Tomato Sauce 39 Unlabelled Tins 3 0 Vegetable Juice 1 Vegetables Mixed 774 Vegetable Salad 3 42 Other Articles of Food Condemned Bacon 449¾ lbs. Meat 892 lbs. Cheese 58 lbs. Milk & Cream 1 Crate 71 Packets Nuts Flaked 1 Box 34 Portions Paste 137 Jars Chickens 3 Pickle 1 Jar Christmas Puddings 3 Preserves 48 Jars Confectionery 210 Packets Rice 2 Packets Cornflakes 36 Packets Ryvita 96 Packets Cornflour l6 Packets Salmon Spread 12 Jars Crackers 135 Packets Salt 1 Drum Fish 11½ Stone 135 Packets Frozen Foods 2,399 Packets Sandwich Spread 26 Jars Fruit Dried 30 lbs. Sausages 21 lbs. Fruit Mixed 35 Trays Sponge Pudding 12 Packets 5 Cartons Steak Pies 8 1 Ton Suet 13 Packets Hams 13 Tapioca 6 Packets 5 0 lbs. 1 oz. Tea 45 lbs. Horseradish 1 Jar Tomato Juice 1 Jar Ice cream 315 Portions Tomato Ketchup 12 Jars Ice lollies 255 27 Bottles Jellies 1,152 Vegetables 7 Packets Kidneys 42 lbs. Vinegar 1 Bottle Lambs' Livers 30 lbs. Wafers 30 Packets Lard 2 Portions Legal Proceedings Food and Drugs Act, 1955 (a) Piece of wire in loaf of bread; plea of Guilty, fined £10 with £2.2=0. costs (b) Sale of mouldy steak and kidney pies; plea of Not Gilty but offence proved, fined £10 with £5,5.0. costs. (c) Sale of decomposing chicken; plea of Not Guilty but offence proved, fined £10 with £5.5.0. costs. A subsequent appeal by the defendant was dismissed and costs of £26 5 0. awarded to the Corporation. (d) Sale of chocolate infested with maggots, and mouldy; plea of Guilty, fined £5. (e) Sale of mouldy steak and kidney pies; plea of Guilty, fined £15 with £5.5,0. costs. (f) Sale of mouldy pork pie; plea of Guilty, fined £10 with £5.5.0. costs. Food Hygiene (General) Regulations, I960 - 6 summonses (g) Smoking in food premises; fined £10 with £2,2.0. costs. (h) Smoking in Food premises; fined £2 with £1.1.0. costs. (i) Smoking in food premises; fined £2 with £1.1,0. costs. (j) Smoking in food premises; fined £1 with £1.1.0. costs. (k) Food business being carried on in insanitary premises; fined £10. (1) Absence of accommodation for clothing not worn during the handling of food on food premises; fined £2. Costs of £5.5.0 were awarded in respect of these and two further summonses. 43 Milk and Dairies Regulations During the year 5 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 5 new registrations, 4 were for new premises and the other 1 was in respect of the change of proprietorship of previously registered premises. The number of premises and distributors registered at 31st December", 1963 was as follows; - No. of distributors 168 No. of Dairies 8 Slaughterhouses There are two licensed slaughterhouses in the Borough, and one knackers yard. One slaughterhouse is used mainly for the slaughter of horses; the other is restricted to smaller animals as it has no stunning pen. Slaughtermen There were eleven licensed slaughtermen. Meat Inspection Regulations These Regulations (which replace the Public Health (Meat) Regulations 1924 and Memorandum 3/Meat) came into operation on the 1st October, 1963. They give statutory effect to the code of inspection previously detailed in the memorandum and require local authorities to ensure that all carcases are properly inspected. Each carcase must be marked with an official stamp showing where it was inspected and coded so that the inspecting officer may be identified. Subject to certain exceptions during the first two years of operation meat may not be removed until it has been inspected and marked. The Minister was unable to meet the request of local authorities for powers to control the hours of slaughter as he considered that to do so would be an unjustifiable disturbance in the accepted pattern of trade. Instead of the existing three hours notice of slaughter, 24 hours notice is now required and notice of regular slaughtering maybe given only with the local authority's approval. The Regulations enable the authority to make charges for inspection and it was decided by the Tottenham Council that the maximum fees should be levied, namely, 2s. 6d. per horse or bovine animal, 9d. per calf or pig and 6d. per sheep, lamb or goat. 100% post-mortem examination of all animals slaughtered in Tottenham was continued in 1963 by operatinga rota-system of inspection by the Public Health Inspectors at the slaughterhouses. SUMMARY OF CARCASES INSPECTED 1963 Horses Cows Calves Sheep & Lambs Pigs exclud. Sows Sows Goats Number killed 171 38 841 2661 12162 2084 15 Number inspected 171 38 841 2661 12162 2084 15 All Diseases except Tuberculosis Whole carcases condemned 2 6 2 4 9 _ Carcases of which some part or organ was condemned 59 16 3 249 1782 114 - Percentage of number inspected affected with disease other than tuberculosis 35.67 57.89 .59 9.51 14.73 5.47 - Tuberculosis only Whole carcases condemned _ _ _ _ - - - Carcases of which some part or organ was condemned Percentage of number inspected - - - - 119 38 - affected with tuberculosis - - - - .98 1.82 - Note: No case of cysticercosis was reported during the year 4-4 PERSONAL AND SCHOOL HEALTH SERVICES TOTTENHAM AND HORNSEY (Joint Population 210890) 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 80,8%. 1963 1962 1961 Live Births (a) Domiciliary 911 943 853 (b) Hospital or Nursing Home 3798 3636 3219 Still bitths (a) Domiciliary 5 4 7 (b) Hospital or Nursing Home 63 67 52 4777 4650 4131 Ante-natal Clinics These sessions for the care of mothers who are either booked for hospital delivery or for home but have no general practitioner giving ante-natal care, continue to be very busy. For the hospital-booked cases, attending their local clinics saves them long journeys to the hospital and also relieves the pressure on the overcrowded hospital ante-natal clinics. It is interesting that in many parts of the country including Middlesex, local authority ante-natal clinics are becoming smaller as general practitioners take over the ante-natal care of their own patients. This has not occurred in Tottenham and Hornsey. Four of the medical officers attend clinics at hospital as well as in the clinic buildings. Two go to the North Middlesex Hospital and two to the Bearsted Memorial Hospital. This is a valuable link between the two services as personal meetings make co-operation immeasurably easier. The following table gives details of attendances at all clinics in the Area:- Number of sessions held Total Attendances Average Attendance per session A N. P.N. Burgoyne Road 100 1659 137 18.0 High gate 66 1110 60 17.7 Port is Green 100 1837 99 19.4 Hornsey Town Hall 156 2928 118 19.5 Mildura Court 65 1664 86 26.9 Stroud Green 61 1212 65 20,9 The Chestnuts 164 2677 193 17.5 Lordship Lane 154 1731 109 11 9 Park Lane 102 1402 145 15.2 Totals 1963 968 16220 1012 17.8 Totals 1962 934 16271 1027 18.5 Totals 1961 936 15334 1050 17.5 45 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 attendance per session Burgoyne Road 25 77 3.1 Fort is Green 25 167 6.7 Hornsey Town Hall 23 200 8.7 Mildura Court 13 100 7.7 Stroud Green 23 157 6.8 Chestnuts 53 375 7.1 Park Lane 92 412 4.5 Lordship Lane 43 19 0.4 Total 297 1507 5.0 Mothercraft and Relaxation Classes An additional class was commenced early in the year at Stroud Green Clinic, Hornsey. This type of valuable instruction is now available for expectant mothers at all the clinics. An in-service training course, at which some health visiting and midwifery staff attended, was again arranged as in previous years. The course, under the direction of Mrs. Williams, Physiotherapist, was considered by the staff attending to be of great value. It is hoped that in the future similar courses will be arranged, to give all members of the staff an opportunity of receiving up-to-date instruction. The following table of attendances at Mothercraft clinics during the year is the highest over the last four years: - Clinics Number of sessions held Total number of attendances Average attendance per session Burgoyne Road 31 134 4.3 Highgate 44 259 5.9 Fort is Green 44 316 7.2 Hornsey Town Hall 47 432 9.2 Mildura Court 43 261 6.1 Stroud Green W 35 331 9.5 The Chestnuts 50 434 8.7 Lordship Lane 52 488 9.4 Park Lane 51 412 8.1 Total 397 3067 7.7 46 Infant Welfare Clinics Appreciation of the services available to the mother with her new baby is shown by the reasonably high attendantat the infant welfare clinics. The reassuring advice and support given to the mother during the early weeks help her to gain the necessary confidence in the handling of her baby. Once the confidence has been achieved, visits to the clinic are quite naturally less frequent. Attendances at the Swains Lane Clinic show a marked improvement over the previous year, indicating that a clinic is necessary in this district. This clinic is a temporary one and gives an adequate service, but (1) it is outside our area and hence is inconveniently situated for the majority of the public it is intended to serve; (2) the large hall which is used for a great deal of the clinic activities is also constantly in use during the evenings by various organisations connected with the Congregational Church; (3) all clinic equipment has to be set out before and stored away at the end of each clinic session, This results in some of the health visitors8 time and energy being expended on work which is too heavy and outside her professional skills. A new clinic is scheduled, but it is a matter of the greatest urgency that adequate accommodation be found to house this clinic during the interim period. The following table shows attendances at the various clinics Name of Centre Number of sessions held Total attendances Average attendance per session Number of cases seen by M, 0. Number of cases referred elsewhere Burgoyne Road 156 6984 44.8 1313 - High gate 103 3715 36 1 1727 9 Port is Green 184 5021 27.3 1882 18 Hornsey Town Hall 151 6771 44 8 2564 9 Mildura Court 102 4218 41 4 1252 8 Stroud Green 101 4814 47.7 1366 16 The Chestnuts 201 8095 40 3 2238 - Lordship Lane 253 5629 22.2 1364 6 Park Lane 207 5591 27.0 1527 23 Somerset Road 152 4054 26.7 1124 1 Totals for 1963 1610 54892 34.1 16357 90 Totals for 1962 1600 54436 34.0 17414 - Totals for 1961 1770 56527 31.9 17584 - 47 Toddlers Clinics Attendances at these clinics are normally arranged by appointment, usually at six-monthly intervals, but more frequently in certain instances. Early detection of minor defects with referral when necessary for specialist opinion is one of the functions of this type of clinic. For example, regular attendance frequently results in the early detection of dental caries. If the parents are willing to accept the necessary treatment, routine dental inspection throughout life is more likely to be achieved when parents take advantage of the treatment offered in these early years of the child's life. The following table gives details of attendances at the individual clinics-. - Name of Centre Number of sessions held Total attendances Number of cases seen by M.O. Average attendance per session Burgoyne Road 28 511 495 18.3 Highgate 24 251 240 10.5 Port is Green 31 473 473 15.2 Hornsey Town Hall 59 612 612 10.4 Mildura Court 48 669 565 13.9 Stroud Green 23 251 250 10.9 The Chestnuts 49 482 481 9.8 Lordship Lane 51 650 648 12.7 Park Lane 24 365 350 15.2 Somerset Road 39 428 428 11.0 Totals for 1963 376 4692 4542 12.5 Totals for 1962 374 4919 4874 13.2 Totals for 1961 365 5301 5139 14 5 Daily Guardian Scheme This service continued to be extensively used by working mothers. It enables them to make satisfactory arrangements for the daily care of their children. In some instances, mothers make use of this service whilst waiting for a suitable day nursery vacancy. Many children are daily minded by guardians who do not seek registration. Most of these give satisfactory care. Mothers are advised to make alternative arrangements when it is considered that adequate care is not given. 1963 1962 1961 Number of Daily Guardians on register 239 266 263 Number of Daily Guardians minding children 78 96 103 Number of Children being minded 98 118 114 Total number of children minded during the year 207 230 252 Total number of days minded 18935 26309 30420 4-8 Day Nurseries Applications for day nursery admissions far exceeded available places, even in the priority categories. At the end of the year, 70 in the accepted categories were on the waiting list, a high proportion of these being in the 0-2 age group. The closure of Plevna Day Nursery and transfer to limited and smaller premises where it was only possible to cater for children over two years of age, was only partially responsible for the increased waiting list. The greatest demand is from mothers solely supporting their children and immigrants. In some instances, because of financial pressure mothers have placed their children with unsuitable daily minders. These arrangements not infrequently break down, which must inevitably have repercussions on the children. Other mothers, in spite of financial hardships, prefer to wait until a vacancy occurs, because they consider that day nursery care more adequately meets the need of their children. 186 admissions were arranged during the year and approximately one third of these admissions were children of immigrants. Of the 186 admissions, a high proportion, because of the different needs, stayed in the nursery for varying lengths of time, from a few days to several months. This continual change-over requires patience and understanding on the part of the staff helping the children to settle in their new surroundings. Plevna Day Nursery This nursery was closed in the middle of February and the majority of the children under two years of age were transferred to Park Lane Nursery. It was necessary for transport arrangements to be made for these children because of the increased distance of travelling involved. Parents were given adequate warning of the new arrangements which went forward without difficulty. The remainder of the children were transferred to the Cornwall Road premises which had been adapted to accommodate 32 children over two years of age. Due to the admirable efforts on the part of the nursery staff, only one week elapsed between the closing of Plevna Nursery and the admission of the children to the Cornwall Road Nursery. To avoid any unnecessary hardship as much warning as possible was given to the parents to enable them to make alternative arrangements. i Training of Nursery Nurses The six students who completed their two-year training in September were successful in obtaining the certificate of the Nursery Nurses Examination Board. Due to the limited facilities at Cornwall Road Nursery, only four students were accepted for training as against six in previous years. Once again, two students were accepted for one year's practical training under the pilot scheme organised by the Tottenham Technical College. Attendances The following table shows the attendances at individual nurseries during the years - 49 Name of Day Nursery Number of approved places at end of year Number of children on register at end of year Total number of attendances Total Average daily attendances Under 2 2 - 5 Under 2 2 - 5 Under 2 2 - 5 Stonecroft 15 43 18 45 3897 8503 12400 48 8 Park Lane 20 30 19 34 3541 6145 9686 38 1 Plevna (Closed 13.2.63) 20 30 - - 163 965 1128 35.3 Cornwall Road (Opened 18.2.63) - 32 - 30 - 5427 5427 24 7 Totals for 1963 35 105 37 109 7601 21040 28641 113.0 Totals for 1962 55 103 45 103 9525 21242 30767 121.1 Totals for 1961 55 103 47 119 9502 22881 32383 127 5 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 182 Muswell Hill Road, N. 10 39 children Fortis Green Nursery 68 Fortis Green, N.2 24 children 2. Day nurseries taking children in mornings only Woodlands Nursery School 38 Wood Lane, N.6 48 children West Drive Nursery Group Moravian Church Hall, N,8 18 children 3. Child Minders taking children all day Miss Hermitage 28 Bedford Road, N.15 22 children Mrs. Kruger 38 Crouch Hall Road, N.8 8 children Mrs. Henry 25 Glebe Road, N.8 10 children 4. Child Minders taking children in mornings only Mrs. Blit 57 Collingwood Avenue, N. 10 9 children Mrs. Summers 53 Mount View Road, N. 4 9 children Mrs. A. Watson 7 Jackson's Lane, N.6 10 children Mrs. Stringer @ 101, Crouch Hill, N. 8 12 children Hornsey Housebound Wives Church Crescent, N. 10 23 children 50 Distribution of Welfare Foods There were no changes in the arrangements for the distribution of these foods during the year:- Year National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tabs (packets) 1963 31158 48453 5798 5420 1962 31489 42976 5429 5593 1961 30801 67012 10038 9428 1960 32910 99584 12790 12213 Priority Dental Service for Mothers and Young Children This service shows little change, and the dental officers devoted 8% of their time to the inspection and treatment of expectant and nursing mothers, and children under five. The number of mothers who were examined and treated remainded constant, also the conservative pattern of the treatment. There was a slight increase in the number of fillings and extractions performed and dentures provided. Each mother treated had an average of 3.3 fillings and 1,3 extractions, i.e. the same ratio of 2,5 fillings to 1 extraction, as recorded last year, and made an average of five attendances. 637 children were examined, including 62 at day nurseries, an increase of 74. 510 (80%) were found to be defective and 479 of these (90%) received treatment. For each child treated, an average of 2.5 fillings and 0.6 extractions were carried out, and 3,5 attendances made. The ratio of conservations (fillings and silver nitrate treatments) was 6.6 to 1 extraction. It is interesting to compare the above with the statistics for the year 1953 and note the changes that have taken place. 15% of the dental officers' time was then required and 100% more mothers and over 50% more children were treated. At that time it was very difficult to obtain appointments with a practitioner in the National Health Service and there were long waiting lists. The ratio of fillings to extractions was 1.3 : 1 for mothers and 2.1 : 1 for the children. Pressure of work and, to a certain extent, the lack of appreciation for conservative treatment were responsible for this state of affairs. Nowadays it is not surprising that many mothers will choose to have continuous treatment which is readily available in the General Dental Service, and to receive the privilege later extended to them, when expectant and nursing. Also it is easy to take the young children with them when attending for treatment, and one gets the impression that the better types may be lost to our service. The Dental Auxiliary carries out certain treatment for the under-fives, and has had the opportunity of talking to groups of mothers at mothercraft, ante-natal and toddlers' clinics, devoting 10% of her time to the priority classes. The need for dental health education is still great, as the incidence of dental disease is much too high. The simple lesson of caries control learnt by wartime conditions is forgotter. or disregarded, and prosperity has contributed to the daily over-indulgence in harmful foods. Our aim is to promote "tooth consciousness ", particularly in the preventive field of diet and oral hygiene and to encourage the early and regular inspection of young children by dental surgeons, so that individual advice can be given, and where necessary, defects remedied before they have deteriorated to cause pain and loss of function. SI It is hoped that the fluoridation of water supplies will not be long delayed, such a measure being of proven value in the fight against dental caries, and the benefit therefrom being first apparent in the young child. The following tables give details of treatment: - 1963 1962 1961 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 Expect ant and Nursing Mothers ren under 5 Number examined by dental officer 154 637 160 563 158 492 Number referred for treatment 152 510 158 461 156 402 New cases commenced treatment 156 479 166 473 187 359 Cases made dentally fit 97 385 70 385 66 227 Forms of dental treatment provided:- Teeth extracted 204 296 183 279 340 276 General Anaesthetics 23 148 23 169 33 142 Number of fillings 515 1197 471 1206 328 911 Number of Inlays 1 - 1 - 2 - Scalings and gum treatment 102 - 131 - 130 - Silver nitrate treatment - 773 - 518 - 285 Other operations 391 643 402 651 500 476 Number of radiographs 22 4 8 3 10 1 Dentures fitted: - (a) Pull 22 - 14 - 20 - (b) Partial 36 3 37 4 42 10 Number of attendances 794 1794 796 1694 884 1159 Number of appointments not kept Number of half days devoted to treatment 193 390 270 454 279 325 291 322 244 MIDWIFERY SERVICE (Section 23) The number of deliveries conducted by the midwives was 909 in 1963, for the first time in many years showing no increase since the previous year. The number of early discharges from hospital after confinement was 1J5. Schemes for planned discharges were approved with the North Middlesex Hospital and the Whittington Hospital, but owing to staff shortages these had only made a tentative beginning by the end of the year0 With the complinients of the Medical officer of Health Health Department, Fowm Heoll Fottenham,N.15. 52 A table is given below showing the work for the past three years. 1963 1962 1961 Number of deliveries attended 909 939 842 Number of visits made 16223 16206 14795 Number of hospital confinements discharged before 10th day 155 175 160 Number of visits made 641 830 1439 Number of cases in which medical aid was summoned 220 248 265 Number of cases in which gas and air analgesia was administered 362 407 402 Number of cases in which pethidine was administered 508 515 510 Number of cases in which trichloroethylene was administered 284 424 380 Number of cases in which gas and air and trichloroethylene were administered 25 12 11 HEALTH VISITING SERVICE (Sections 24 and 28) Health Visiting A disturbing feature of the health visiting service has been the difficulty experienced in filling existing staff vacancies. This appears to be an experience of many local authorities and not merely a local problem. The establishment of health visitors at the end of the year was the lowest that it has been for a number of years. Inevitably the health visitors have far larger districts than can be adequately covered. Routine visiting with its wide aspects of preventive ill-health is therefore seriously undermined. The follow-up of the newly born after their discharge from hospital with their mothers cannot be omitted. Experience has shown that the first and subsequent visits in the early weeks of life of the baby is regarded as essential in nearly every case. The rising birth rate naturally brings a higher proportion of this type of visiting. Another factor which brings many problems is the constantly shifting population especially among the immigrants. These people are anxious to make use of the social services, but for a variety of reasons they do not acquire of permanent or stable homes They do not stay long enough in any locality to gain sufficient supportive guidance which is often necessary. They move on, and another family with its attendant problems moves in. This means much of the health visitor's work does not produce the maximum result she achieves under more stable circumstances. For the past few years, one health visitor has been allocated to attend a local group medical practice twice weekly. It was regretted that, because of shortage of staff, attendance had to be reduced to once weekly at the latter part of the year. As soon as the staff position is improved, it is anticipated the previous arrangements will be reinstated. 53 The actual number of visits made by the health visitors this year was as shown in the following table - Number of visits paid by Health Visitors working in the Area 1963 1962 1961 Expectant Mothers First Visits 1594 1617 1796 Total Visits 2268 2471 3120 Children under 1 year of age First Visits 5101 5399 4737 Total Visits 9602 13134 12997 Children aged 1-2 years Total Visits 7220 5707 6704 Children aged 2-5 years Total Visits 10841 8652 10524 Other cases - Total Visits as Health Visitor 2223 6459 6102 - Total Visits as School Nurse - 339 673 978 Student Health Visitors The two sponsored student health visitors who completed their training in July were successful in obtaining the health visitors certificate. As in previous years students sponsored by other local authorities have received practical experience and training. Special Services Health Visitors The intensive case work with problem families continued during the year along the same lines as in previous years. Some families, because of the concentrated visiting and support it has been possible to give over varying periods, were in a better position to manage their own affairs and therefore were referred back to the district health visitor. Several other families are growing toward stability and will, it is expected, soon be able to manage without the special services. Others continue to require constant attention and will do so for a very long time. General mismanagement, too many children born too quickly, heavy debts, frequently resulting in the threat of eviction, and the probability of the children requiring residential care, continue to be the main problems. Work with the mentally sick, especially those parents who refuse to accept psychiatric treatment, are a particular source of anxiety, because of their inability to co-operate and make use of available help. One family, the father being an alcoholic, is constantly being turned out of different lodgings because of his behaviour. This family move in and out of the district, make a great deal of works and there seems very little hope of improvement. For the first timef a family of West Indians was referred to one of the special services health visitors. The father, who was in regular employment, deeply resented and refused to pay rates. Consequently this resulted in the accumulation of arrears The mother of a family of six children died suddenly at the latter part of the year. Three school girls are under supervision of the probation officer because of truancy, another child attends a residential school for maladjusted children, the fifth child, because of post poliomyelitis paralysis, attends the school for physically handicapped children, whilst the sixth child attends the local day nursery. 54 It is regretted that the vacancy caused by the resignation of Miss Spooner, who worked in Tottenham, had not been filled at the end of the year. The district health visitor, because of the many demands on her time, is not able to give the constant supervision required by the families. Of considerable importance is the help given by local and national voluntary agencies. This help, in the form of clothes, money, holidays, Christmas gifts and parties, is of great assistance in the rehabilitation of problem families. Once again we wish to record our appreciation for all the help we have received during the year. HOME NURSING SERVICE (Section 25) The treatment of cases during the year may be classified as follows:- Injections 857 General Nursing care 485 Blanket baths 296 Enemas 118 Dressings 309 Preparation for diagnostic investigation 118 Pessaries changed 3 9 Wash-outs, douches, etc. 3 9 Other treatments 107 The sex and age of patients at the time of the nurse's first visit may be classified as follows: - Age Males Females 0-4 32 22 5 - 15 20 23 16 - 39 49 128 40 - 64 208 333 65 and over 441 954 750 1460 Cases attended during the year were referred from the following sources: - General practitioners 1535 Ifcspitals 648 Chest Physicians 10 Public Health Department 2 Direct 15 The following table shows the work of the home nurses during the year:- New cases attended 1603 Number of cases on register at end of year 579 Number of visits made 64417 55 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox was 13.6% compared with 54.1% in 1962. This fall is accounted for by two factors, the first being a change in vaccination policy whereby children are not now vaccinated until the second year of life, and the second being a fall from the high level of 1962 which was due to anxiety occasioned by the smallpox outbreaks in Yorkshire and South Wales. The modest success of previous years in vaccinating even 4-0% of the child population under one year of age is unlikely to be repeated in the 1-2 age group. Successful maintenance of a high rate of infant vaccination depends on fitting the procedure into a planned immunisation schedule in the first year of life, when the mother is most likely to attend an infant welfare clinic with her baby. As doubt has been cast upon the efficacy of vaccination of infants as a means of controlling smallpox in the general population, perhaps the low rate of infant vaccination is not the reason for alarm. Nevertheless, great efforts are being directed towards increasing the acceptance rate in the 1-2 years age group. 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 642 382 107 87 142 1360 Number of re-vaccinations - 3 29 80 334 445 Immunisation against Diphtheria, Tetanus and Whooping Cough The following table shows the number of children receiving primary and re-inforcing doses against these diseases. An interesting feature emerging for the first time is the use of quadruple vaccine, which incorporates poliomyelitis vaccine. Quadruple vaccine became commercially available during the year and a number of general practitioners are using it although the Ministry of Health has not yet approved its use by local health authorities. There is little doubt that when quadruple vaccine comes into general use the percentage of infants immunised against all four diseases will increase by reason of reducing the number of visits necessary to obtain complete protection and consequently reducing the number of parents who default before the course is finished. 56 Age at Date of Immunisation Number of Children who completed a full course of Primary Immunisation Diphtheria only Whooping Cough Only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphtheria Tetanus and Whooping Cough Combined Diphtheria Tetanus Whooping Cough and Polio Under One 5 3 - 3 7 1707 21 One 33 14 4 34 18 1872 18 Two to Pour 11 2 6 9 13 144 - Five to Fourteen 57 1 102 23 86 29 1 Total 106 20 112 69 124 3752 40 Number of Children who received a Secondary (Re-inforcing) Injection Diphtheria only Whooping Cough Only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphtheria Tetanus and Whooping Cough Combined Diphtheria Tetanus Whooping Cough and Polio Under One _ 3 . 7 _ One 2 - 1 4 9 1036 2 Two to Four 26 - 3 3 29 1049 - Five to Fourteen 373 - 36 9 429 218 4 Total 401 40 19 467 2274 6 Poliomyelitis Vaccination Oral poliomyelitis vaccine was used mainly during the year and the table below shows the number of persons vaccinated;- Completed course of two injections using Salk vaccine Completed course of three doses of oral vaccine Children born in 1963 12 220 Children born in 1962 64 1747 Children born in 1961 32 288 Children and young persons born in 1943 to I960 66 497 Young persons born in 1933 to 1942 76 345 Other persons 43 189 Total 293 3286 Re inforcing doses were given as follows: 3rd Salk Injections 546 4th Salk injections to children between the ages of five and twelve years 67 Oral vaccine after two Salk injections 655 Oral vaccine after three Salk injections 751 Total 2019 57 PREVENTION OF ILLNESS, CARE AND AFTER CARE (Section 28) Recuperative Holidays The Area Health Staff continued to be responsible for dealing with applications for recuperative holidays and during 1963 151 applications were received compared with 170 the previous year. Of these, 98 were approved. Chiropody Service At the beginning of the year two chiropodists were employed on a sessional basis for a total of eight sessions a week. Early in 1963 two more chiropodists were appointed for an additional three (sometimes four) sessions a week, and in December another chiropodist was appointed for a further one session a week. Thus at the end of 1963 there were five sessional chiropodists working in the Area, carrying out 12% sessions a week (81/ for elderly persons and 4- for children and expectant mothers). The following table shows the treatment carried out at clinics during the year;- Category New cases First attendance during year of old cases Reattendances Total Elderly persons 93 179 1295 1567 Physically handicapped persons 4 1 20 25 Expectant and nursing mothers 4 - 7 11 Others 2 - 4 6 School children 238 61 1309 1608 Total 341 241 2635 3217 In addition, in March a chiropodist was appointed to carry out treatment for elderly persons in their homes, where by reason of frailty or ill-health it was inadvisable for them to attend a clinic. The following table shows the domiciliary treatment carried out during the year: - Category New cases Re attendances Total Elderly persons 55 180 235 Physically Handicapped persons 1 5 6 Total 56 185 241 5 8 Retirement Advice Clinic This clinic continued to operate during 1963, and with the co-operation of the local office 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 29 Number of new cases attended 41 Number of re-attendances 25 DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 2100, which was again a record. The number of new cases remains about the same 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 six cases. The total number of home visits made by the Home Help Organiser and her assistants during the year was 6320 and of this number, 1221 were in respect of new applications. The neighbourly help service continued to operate satisfactorily, but it is not easy to expand the service owing to the difficulty in obtaining suitable good neighbours. The following table shows details of the cases served during the year:- Cases provided with help Number of new cases provided with help Number of old cases for which help was continued from 1962 Total number of cases provided with help during the year Total number of cases still being provided with help at end of year Aged 65 or over at first visit 582 1218 1800 1220 Aged under 65 at first visit: Chronic sick and tuberculosis 48 30 78 91 Mentally disordered 1 - 1 - Maternity 96 3 99 7 Others 96 26 122 35 Total 823 1277 2100 1353 59 INSPECTION OF PRIVATE NURSING HOMES There are three private nursing homes 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 108, Colney Hatch Lane, N10 17 patients Kenwood Annexe Nursing Home 4 Princes Avenue, N.10 15 patients Strathlene Nursing Home, 79 Creighton Avenue, N.10 20 patients SCHOOL HEALTH SERVICE Area School Population The school population for the Area in 26419, as shown in the following table:- Kornsey Tottenham Primary Schools and Nursery Classes 5870 7916 Nursery Schools - 205 Secondary Modern Schools 2877 4873 Grammar and Technical Schools 1819 2654 Special Schools- Physically Handicapped - 99 Blanche Nevile School for the Deaf (including classes for the partically deaf) 107 10565 15854 Periodic Medical Inspections The following table shows the number of children inspected by years of birth and the classification of their physical condition:- Year of Birth Number of pupils inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory Number % Number % 1959 & later 145 145 100.0 - - 1958 782 775 991 7 0. 9 1957 699 689 98 6 10 1.4 1956 520 518 99 6 2 0.4 1955 1293 1286 99 5 7 0.5 1954 832 828 99 5 4 0.5 1953 188 188 100,0 - - 1952 1255 1245 99,2 10 0.8 1951 1407 1397 99 3 10 0.7 1950 507 504 99.4 3 0.6 1949 249 248 99.6 1 0.4 1948 & earlier 2886 2872 99.5 14 0.5 Total 10763 10695 99 4 68 0.6 60 Once again over ten thousand children had a periodic medical inspection during the year. This represents over one-third of the school population of the Area. 2697 pupils were found to require treatment, and this number does not include those requiring treatment for vermin infestation and dental disease. In the appendix to this report will be found an analysis of the conditions requiring treatment and it will be seen that by far the greatest number of these is vision at 1684. This is not to say that this defect hadnot been discovered previously; in fact, a large proportion of visual defects had already been detected at previous examination, but it was still necessary to record the defects as requiring treatment. The same principle applies to other defects listed. Undoubtedly a number of new defects are discovered at each examination and the proper treatment instituted, but it is inescapable that a large part of the time of school medical officers is concerned with checking the progress of established defects. In this Area, periodic medical inspections are carried out four times during the pupils' school life. Some consider this to be unproductive work and maintain that the school medical officer's time could be used to better advantage. In certain parts of the country interesting experiments are taking place with selective medical inspections. The details of the system vary from place to place but in the main depend on a full medical inspection of all entrants followed up from time to time by inspection of those children selected by medical officers as a result of answers to questionnaires sent to the parents and as a result of referral by head teachers and others. The system demands very close co-operation between teachers and school medical officers, requiring frequent visits to schools and it takes into account the results of hygiene surveys by school nurses. It is believed that selective medical examinations will eventually replace periodic medical inspections, and the results of the experiments in other authorities will be received with interest. B.C.G. Vaccination The following table shows details of B.C.G. vaccinations during the year:- School Children Students Total Number % Number % Number % Parents approached 2909 3 2912 Parents accepting 2153 74 0 3 100,0 2156 74 0 Number tested 1985 3 1988 Number found to be Mantoux positive 137 6 9 - - 137 6. 9 Number found to be Mantoux negative 1724 86 9 3 100 0 1727 86,9 Number failed to attend for Mantoux reading 124 6 2 - - 124 6 2 Number vaccinated (% of those approached) 1724 59.3 3 100.0 1727 59 3 61 School Dental Service The service was maintained during the year, though there were some changes in personnel. Two full-time dental officers resigned, one for reason of retirement and the other to take up a similar appointment nearer to his home; also two part-time dental officers left, all vacancies being filled with little delay. The resulting staff position remains unaltered, comprising the area dental officer, five full-time and 16/11 equivalent in part-time dental officers, and one dental auxiliary. The orthodontist's sessions were reduced for a period of three months and later restored to six per week. The total number of sessions worked was 320%, an increase of 116% over those for last year. This constituted 89% of the dental officer's time. At 175% inspection sessions 20198 children, i.e. 75% of school roll were inspected; 11767 (587°) were found to require treatment, and of these, 6560 (587°) were treated S-t the clinics. There is evidence that many children receive regular treatment through the National Health Service; a small number make only occasional attendances, and treatment is offered in these cases. Treatment sessions amounted to 3 094. The output of work remained steady, and continued to be mostly conservative in nature. 1414-7 fillings were inserted in 12359 permanent teeth, and the number of permanent extractions again decreased, by 116 to 701. As 174 of this total were extracted for orthodontic purposes, it follows that just over 23 permanent teeth were conserved for one permanent tooth lost by disease. 1245 more temporary teeth were saved than in 1962. A reduction in the number of teeth extracted in both primary and permanent dentitions showed a corresponding decrease in the number of general anaesthetics administered, and dentures fitted. 147 evening sessions were held for the treatment of school children, and were well attended by selected cases, the output of work being greater, with fewer broken appointments than at average day sessions. In general, the number of appointments not kept continues to cause concern, 21.3% children failing to attend without excuse, or the notice given being too short to offer the appointment to another patient. The Dental Auxiliary has worked her first full year as part of the experimental scheme to assess the value of such persons in the Local Authority Service. 90% of her time has been devoted to the School Dental Service, and for 13% of this she has been engaged on Dental Health Education in schools, concentrating her efforts on children aged seven to eleven years. These classes were mostly in the Hornsey part of the Area where her clinical duties were carried out. She was well received in the schools, and we feel she is making a good contribution in the field of preventive dentistry. It is worthy of mention that the dental auxiliary is held against the establishment of dental officers, although the number of clinical sessions undertaken, and the output of work (partly because she is not allowed surgery assistance) are not the equivalent of a dental officer. The supervision required also occupies time that would normally be spent on patients. Thus it will be seen that both the dental auxiliary and the supervisory dental officer tend to lower the average level of work done in the Area. 62 Orthodontic Inspection and Treatment This part of the service remains in great need of expansion and we have not been successful in appointing additional staff to enable us to deal with the very long waiting list. In fact, as has already been stated, the orthodontic sessions were reduced for one quarter of the year resulting in 358% sessions being undertaken compared with 431 last year. The number of pupils inspected and found to require treatment did not vary, but the number actually treated and most of the items of treatment carried out, showed a corresponding decrease. 243 sessions were worked by the orthodontist and 115%by dental officers, consisting of 60% day and 55 evening sessions, the latter continuing to be very popular. All the surgeries in the clinics have now been modernised and are well equipped, with the exception of two which are to be replaced by new premises. The opening of the High Cross Dental Clinic, Tottenham is imminent, and the second surgery should have a beneficial effect on the service, allowing for expansion, long overdue, but until now prevented by shortage of accommodation. It is hoped that building in Hornsey at Fortis Green and Burgoyne Road will be started in 1964. The following tables show the work undertaken during tne year. DENTAL INSPECTIONS AND TREATMENT Number inspected 20198 Number found to require treatment 11769 Number offered treatment at the County Council's Dental Clinics 11767 Number of pupils treatment commenced 6560 Number of pupils treatment completed 5247 Number of attendances made by pupils for treatment 22475 Number of appointments notkept 6071 Number of half-days devoted to:- (a) Inspection 175 (b) Treatment 3 094 Fillingss- Permanent Teeth 14147 Temporary Teeth 7377 Number of teeth filled:- Permanent Teeth 12359 Temporary Teeth 6620 Extractions:- Permanent Teeth 527 Permanent Teeth for Orthodontia 174 Temporary Teeth 2952 General Anaesthetics 1350 Other operations:- (a) Permanent Teeth 3915 (b) Temporary Teeth 4887 Number of pupils supplied with dentures 35 Number of crowns and inlays 52 Number of radiographs 508 63 ORTHODONTIC INSPECTIONS AND TREATMENT Number of pupils inspected 204 Number of pupils found to require treatment 155 Number of pupils corimenced treatment (first attendance) 92 Number of cases carried forward from previous year 123 Number of cases discontinued during the year 12 Number of attendances for all purposes 3057 Number of appointments not kept 558 Number of impressions, adjustments and other alterations 3252 Number of pupils treated with appliances 185 Number of fixed appliances fitted 19 Number of removable appliances fitted 229 Number of radiographs 1044 Number of pupils treatment completed 74 Number of orthodontic sessions (Half-days) 358 Ophthalmic Clinics Dr. R. Welch, consulting ophthalmologist at the Hornsey Ophthalmic Clinic, reports:- "During the year 1963 attendances at Hornsey Eye Clinic have continued to be very good. The patients examined ranged from infants to adolescents of school leaving age. The commonest symptoms complained of were defective vision and headaches or eyes aching after close work. A less common symptom was diplopia. On examination most of these cases were found to have errors of refraction or ocuular muscle imbalance. In a few cases symptoms were functional and attributable to an anxiety state. A very important group of cases were referred to the clinic on account of convergent squints, constant or intermittent. Fortunately these are being recognised at an early stage when treatment can be most effective. They are refracted under atropine to ensure complete relaxation of accommodation. As these cases almost invariably have hypermetropia (long sight) with or without astigmatism, glasses are prescribed for constant wear. Subsequent treatment, where there is uni-ocular amblyopia, is carried out under the supervision of the orthoptist and consists of occlusion of the fixing eye for a variable period followed by orthoptic training to restore and strengthen binocular vision. If this treatment fails to cure the squint surgical treatment is indicated. Apropos the need for early detection of squint, some cases rightly referred to the clinic as they present the appearance of a convergent squint, are in reality cases of pseudo-squint caused by epicanthic folds of skin covering the inner canthus of the eye. It is sometimes difficult to exclude the possibility of a real convergent strabismus in a few of these cases. It is now the practice of refracting many of the older children suspected of myopia without using a mydriatic. This obviates the need for a second visit to the clinic and causes the minimum of interruption of their school work. Minor eye complaints treated during the year were cases of acute conjunctivitis, blepharitis and dacryocystitis". 64 Dr. Teviot G. Kletz, consulting ophthalmologist at Lordship Lane Clinic reports that, as in previous years, most of his work was concerned with refractions and the treatment of squints. 1258 new cases were seen, of whom 93 were under five years of age. There were 165 cases (of whom 79 were new) treated in the Orthoptic Department. 75 cases were recorded as "complete success" after treatment. There were no blind registrations during the year. Dr. Kletz comments also that the number of children attending the clinic on their own is a matter for concern. Orthopaedic Clinics Dr. E.M. Palser, consultant in physical medicine to the Hornsey Orthopaedic Clinic, reports;- "During this year 131 new patients have been seen - 62 of pre-school age and 69 over five years. Total attendances were 625, of which 212 were of pre-school age and 413 over five years. From mid-April to mid-September a physiotherapist was in attendance, and on the 14th October our previous physiotherapist, Mrs. Allardyce, returned to this clinic, and is now building up the treatment sessions. There have been 496 attendances so far, and a considerably larger number is expected during 1964. The usual small number of cases requiring surgical or other hospital treatment have been seen and duly transferred. Of the remaining it is becoming apparent that the number of teenage children with foot trouble is decreasing, presumably because they have already been seen and treated in their earlier school and pre-school years. The number of pre-school age children whose principal abnormality is knock-knees is proportionately increasing". Mr. E„H, Hambly, consulting orthopaedic surgeon to Lordship Lane Clinic, reports:- "As this is the last year in which the Area will operate in its present form, and as I have been conducting the schools' Orthopaedic Clinic for the Area for seventeen years, I would like to say how much I have enjoyed taking these clinics. This centre is well known as a very attractive one to work in, both from the point of view of the consultant and from the patient's point of view. We have been especially helped by our relations with the Vale Road Physically Handicapped School, thanks to Dr. Dunham and Mr. Ives and his staff, and Mrs. Hurrell, school nurse. Their patients include a great number of muscular dystrophy cases and they have been particularly helped by the work of Miss Marcus, at Vale Road. I would also like to say how splendid the patients and their parents have been over the years. On the whole they have carried out my instructions implicitly and I am always surprised by the way the parents and children are turned out, when they visit my clinics. Fathers take an increasing interest in the work of the clinic and frequently both parents attend. I have always considered that the Tottenham Area had a medical service which is second to none in the world and I do think those living in the Area appreciate the fact. It is all the more amazing as it comprises of an increasing number of different races who rapidly adapt themselves to the local way of living and carry out instructions splendidly. 65 Another interesting point is the enormous variety of jobs that the older boys and girls, who visit my clinic, take on. Some of the jobs are of the highest quality in professions. They also have worked extremely well in carrying out their exercises and do appreciate the value of them in their future jobs and lifes. We are delighted to have Mrs. Allardyce back as our physiotherapist and would like to thank Miss Claydon for the way she has run and organised the clinic". Audiometry The tables below gives the numbers and results of audiometry tests during 1963. It is now arranged that children due to have periodic medical inspections at the ages of five, eight and eleven, first have an audiogram. Those children failing audiometry have a full audiograph prepared and this is available for the school medical officer when the inspection is made. In this way the school medical officer is able to discuss with the head teacher the child's progress in school, to arrange a seating position in Class favourable for hearing and to follow up with any other investigations necessary. The standards for passing audiometry are set purposely high, and of the 614 children failing first tests in 1963, a very large proportion were found to respond to simple measures or not to need treatment. As would be expected, the percentage failing retests was high because these children had either been referred specially because deafness was suspected or were already under treatment. Maintained Primary and Secondary School Population of the Area 26419 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 2044 117 145 22 44 206 10 1 Intermediate 5556 270 230 62 93 395 7.1 Leavers 194 4 2 7 13 6 7 Totals 7794 390 379 86 144 614 7.9 Audiometer Tests - Specials Age First tests Re-Tests Failures both ears One ear Total % of Column 1 right left (1) (2) (3) (4) (5) (6) (7) Under 5 17 6 7 4 2 13 76.5 5 22 19 11 1 4 16 72.7 6 31 38 10 5 6 21 67 7 7 33 45 9 4 5 18 54.5 8 18 37 8 3 3 14 77.8 9 12 38 5 3 1 9 75.0 10 8 23 2 - 3 5 62.5 11 35 25 12 5 6 23 65.7 12 28 26 7 6 5 18 64,3 13 9 21 2 2 1 5 55.6 14 5 13 4 - 1 5 100.0 Over 14 19 25 9 2 3 14 73.7 Totals 237 316 86 35 40 161 67.9 66 Audiology Unit Dr. L. Fisch, Consultant Otheogist Continued to devote two sessions each week to seeing children at the audiology unit, at times assisted by Dr. G. S. udall, senior Lecturer in Child Health at St. Batholomew's Hospital Medical College and at Other times by the Deputy Area Medical Officer, The table Below shows the number and type of Cases seen. The opening of a new audiology unit at Neasden made it possible to transfer a number of Cases there and so lighten the load on the Tottenham unit. Miss Evans, one of the peripatetic teachers, now works from Neasden and the case load of miss Abbott, the remaining teacher, has become so large that she is unable to devote as much time as is necessary to each case. It is hoped that an additional peripatetic teacher will be appointed. A two-day course for health visitors on the early detection of deafness was held during the year. Number of cases seen: Age in years 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 4- 15- 164- Total New cases 130 19 5 12 15 15 11 20 5 14 12 9 7 14 6 5 3 302 Re-examinations - 10 8 11 21 12 15 26 23 24 17 9 10 14 9 11 4 224 Total 526 Pre-school children 218 Attending Infant and Junior Schools 188 Attending Senior Schools 99 Over five but not at school 21 Reasons for referrals among new children were as follows: For diagnosis 131 Auditory training 14 At risk of deafness 128 Immigrants to Area known to be deaf 1 Partially deaf children, advice as to placement 9 Children known to be deaf- application for admission to Blanche Nevile School or partially deaf units 2 Transfer from hospital out patient departments 5 Advice as to placement where deafness might be the cause of backwardness 12 Source of referrals: Tottenham and Hornsey 196 Other boroughs in Middlesex 92 London - neighbouring boroughs 3 Essex 5 Hertfordshire 6 67 Handicapped Pupils Distribution as at 31st December, 1963 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 - 4 1 - - - 1 . - 5 2 Partially Sighted Pupils 4 3 1 1 2 - - - - - 7 4 Deaf Pupils 4 4 3 1 - - - - - - 7 5 Partially Deaf Pupils 11 8 1 2 - - - - - 1 12 11 Educationally Subnormal Pupils 68 49 9 6 3 1 - - - 1 80 57 Epileptic Pupils 1 - 1 - - - - - - 1 2 1 Maladjusted Pupils 1 - 21 7 10 4 15 9 6 - 53 20 Physically Handicapped Pupils 21 16 1 2 2 1 1 3 2 28 21 Pupils with Speech Defects - - 1 1 214 106 5 3 7 3 227 113 Delicate Pupils 1 8 10 3 3 1 - - - - 14 12 Pupils with Multiple Defects 3 2 2 2 2 - - - - - 7 4 Totals 115 90 54 26 236 Ill 21 14 16 9 442 250 Grand Totals 205 80 347 35 25 692 The return of handicapped pupils shown about displays the fact that the three largest categories are children with speech defects, educationally sub-normal and maladjusted. In contrast, the number of pupils with what may be termed physical defects has shown a fall over the years and, indeed, the number of delicate pupils is remarkably low. The reason for the difference between the "physical" and the "emotional" groups of handicaps is not hard to discover. Over the past twenty years advances in medical science have been tremendous and it is possible to treat conditions that a few years ago would have been untreatable; advances in prevention have also been great and imporved ante-natal care avoids the production of a large number of damaged babies each year. We are left, then, with two groups of handicaps which present a continuing problem. The first of these is that group of children born with an inherent continuing defect the origin of which is unknown; this group includes those with such conditions as congenital perceptive deafness, congenital blindness, and low mental ability. Much research is going on to establish the basis of such handicaps and in mental deficiency, particularly, biochemical and chromosome studies continue to reveal fresh information. The second group in the continuing problem of handicapped pupils is what may be termed the "emotional' group, that is to say the maladjusted pupil. Over the years the number of children in this group has risen, reflecting the rise in mental disorder in the adult community. This grave problem shows no signs of diminishing and is dealt with in the reports of the consultant child psychiatrists later in this report. 68 Vale Road School for Physically Handicapped Children I am grateful to Mr. A.J. Ives, headmaster of the school, and to his staff, for their continued co operation during the year. It is no easy task to reconcile the educational needs of the children with their need for physical treatment, but the Cordial relationship between teaching and medical staff has made it possible for both to flourish to the detriment of neither. The gymnasium at the school is inadequate to accommodate both a physiotherapist and an occupational therapist, and it is to be hoped that the building of the proposed extension to the school will not be long delayed. Cerebral Palsy Unit Dr. William Dunham, the consultant in charge of the unit, continued to attend for one session a week, and the work of the unit proceeded on lines previously reported. Five children seen as new patients at the clinic were recommended for admission to Vale Road School. Rheumatism Supervisory Centre Of the children under supervision, twenty made 30 attendances at Dr. I.M. Anderson's Clinic at the Prince of Wales's Hospital, Six of these were new cases, five girls and one boy, and in them the following diagnoses were established: - Total In Tottenham In Other Areas Rheumatic Fever Streptococcal Allergy (state) 4 2 1 1 3 I There were four removals during 1963 leaving 207 children on the register of the Supervisory Centre at the end of the year. These 207 have been classified as follows:- Total In Tottenham In Other Areas Rheumatic Fever 72 45 27 Rheumatic Carditis 37 25 12 Rheumatic Carditis with Chorea 4 4 - Chorea alone 6 5 1 Rheumatic Arthritis 5 1 4 Congenital Cardiac Lesions 54 34 20 Streptococcal Allergy (state) 6 4 2 Other cases 23 19 4 207 137 70 Males 97 Females 110 69 Ear, Nose and Throat Clinics Mr. F.P.M. Clarke, Consultant Ear, Nose and Throat Surgeon to the Hornsey E.N.T. Clinic, reports: - "The work of the ear, nose and throat clinic has been carried on during the year 1963 along similar lines to those of previous years. Average attendances have been good and the majority of the patients seen were those with abnormal and unhealthy conditions of the nose and its normal functions, its various spaces and sinuses; rhinitis, sinusitis,"allergy", occasionally structural deformities, nasal obstruction, mouth breathing, epistaxis, etc. These nasal abnormalities are primary and usually the focal point from which many serious secondary defects develop later in related regions - the eyes, ears, throat, lungs, etc. A number of children have been referred with hearing defects, including those of a suitable age for audiometric testing who have "failed" to past the test, and younger children whose hearing can be tested only by clinical methods. Also a small number with otitis media, acute or sub-acute, with or without discharge, and others with external otitis. Some were seen who had one or more attacks of mild tonsillitis or hypertrophied cervical glands, as well as some with speech defects queried as to any relation with abnormal nasal function or defective hearing. Longstanding chronic ear discharge has shown a marked decline in recent years. After years of treatment elsewhere which had apparently failed, these cases respond to the special method of zinc ionisation treatment, adopted at this clinic for many years Methods of treatment so successfully employed include aural suction for acute and sub-acute otorrhoeawith Chloromycetin mainly; zinc ionisation for chronic otorrhoea, always with concurrent correction of any nasal factors causing or complicating the condition. For sinusitis, except acute, in children, Proetz "displacement method" using, after initial weak ephedrine solution, albucid, or argyrol or lipiodol (French) as indicated. The results, in selected cases, after lipiodol therapeutically, have been very good. In certain cases of rhinitis, a course of Dowling's nasal argyrol packs. Gautier's nasal diastolisation is perhaps the most frequently employed and is an excellent method of treatment in suitable cases, with lasting results in clearing the nasal passages and re-establishing a free nasal airway and normal respiration as well as relieving the objectionable mouth breathing enforced by nasal obstruction. Also in those frequent instances of defective hearing in young children, chiefly due to unnoticed, untreated or incorrectly treated otitis, or nasal complications; defective hearing is a very common sequel in nasal obstruction. Diastolisation in the majority of cases through its effect in clearing the nasal respiratory airway, etc. has produced the most remarkable results in the restoration of the affected hearing. Even in deafness of long standing, due no doubt to the absence of suitable treatment, where full normal restoration is not now possible, diastolisation can, properly used,produce a very marked improvement. Its good results have been long established by such authorities as A.G, Wells and A R„ Friel in this country, and numerous leading specialists in France who first devised the method and technique and have practised it extensively. We have found nasal zinc ionisation very effective in rapidly and completely suppressing the distressing symptoms in the few cases of allergic rhinitis treated. The method was first devised by Leduc in France, and later used frequently and successfully here by Friel and others. 70 Finally, I would emphasise the very great importance of a few points in connection with the scope and aims of these E.N.T. clinics. 1. The prevention and relief of impaired hearing in children at earliest possible stage. Thus it is of the utmost importance in the preservation of the normal hearing to detect as soon as possible any impairment however slight and to investigate in detail and diagnose correctly the cause and give immediate and appropriate treatment. Also to remove any potential causes and continue treatment until the hearing is restored to normal. Any neglect here will certainly allow the condition to progress to chronicity and risk of permanent deafness later on. 2. The early detection, exact cause of and suitable treatment to relieve nasal respiratory insufficiency. This condition is quite common among children of school age and very of ten earlier, and prompt remediation is urgent because of widely dispersed effects and possible later permanent disabilities far removed from the site of origin, 3. Exact diagnosis is imperative. Every care must be taken not to mistake "effect" for "cause", which so frequently happens, or what is "secondary" for "primary". In the matter of treatment it is, of course, essential to employ the appropriate remedy if success is to be obtained, otherwise it is waste of time and energy. It is equally true that the correct technique, with strict adherence to its essential details, must be used in the application of treatment". Mr. W, McKenzies Consultant to the Park Lane Clinic, reports;- "The work is quite steady and I think it is likely to remain so for three or four years at least, if not longer. The audiology service in the schools is a great help and I hope that this will expand in future because many of these deaf children can be helped by the removal of the adenoids, Hie striking feature of my clinic in the last twelve months has been the absence of chronic otorrhoea and this is not due to specialised treatment but to the improved health of the children". Child Guidance Centres Dr. K.,A. Graf, Medical Director of the Hornsey Child Guidance Centre, reports "This was my third year as the Medical Director of the Child Guidance Centre, and workingasan unchanged teamwewere again fully occupiedwith the problems of diagnosing and treating emotional maladjustment among the over 13000 children in the Authority's and private schools in Hornsey. On paper our establishment may appear adequate,, but there was so much additional work that we were stretched to the limit. New problems were created by immigrant children and their parents, who in an increasing numbe' required our support. Many of these children had only recently been reunited with their parents in this country after years of separation during the most impressionable years of their lifes, and they reacted to the strange new environment and completely different cultural pattern by considerable aggressiveness in school, and caused their parents frequent concern by their wayward behaviour. The children who had been used to a considerable amount of corporal punishment in homes and schools overseas cannot understand our less punitive methods of disciplining here, mistaking our more kindly verbal approach and reluctance to use the cane, for tolerance or even condoning then behaviour, with the result that they are very bewildered when ultimately more energetic measures do appear necessary. 71 Our conventional casework approach and playtherapy techniques require considerable modification and new thinking on our part. The parents' hours of work, the language barrier, and above all the completely different pattern of intra-familial relationships, which is based on the concept of an extended family circle where the grandmother assumes the maternal role and other relatives may take over near-parental responsibilities, make traditional methods of treatment and concepts of theory invalid. Many of the problems are fundamentally caused by the difficulties the child has in coping in the changed physical and social environment, and his frustration in making himself understood. The result is that often very little can be done for these cases at the child guidance clinic, apart from explaining the position to everybody concerned and stressing the need for the child to have time to adjust. This year we had a fair number of referrals from private schools, and the co-operation with the staff and attention given to parents and children was in no way different to the schools administered by the Local Authority. The child psychiatrist can probably observe certain side effects on the community due to the Mental Health Act 1959 better than his colleagues in the mental hospital,as he observes at close range the disturbing effect in the home on the emotional stability of the children who are living with mentally unbalanced adults, who often suffer from florid delusions or severe agitated depressions. This is a comparatively new development of Community Mental Health Therapy and remains an unsolved problem in an otherwise progressive and most welcome approach to mental illness. It appears to me that the concept of the modern Community Mental Health Service could break down if more support for families with mentally unbalanced members, by increasing the number of trained caseworkers, is not forthcoming. An interim solution would seem to be, as has been shown in other areas, to base the Community Mental Health Service on a greatly extended local child guidance clinic, which would have the advantage of its considerable experience in working within families and co-ordinating different social agencies. The fact that child psychiatry provides treatment for the family could be extended to the community. The number of cases of school phobia, a complaint more fully explained in the previous report, remained at a high level, and many children presented themselves with severe psychosomatic symptoms, particularly vomiting, diarrhoea and abdominal pain, which at first conceded the underlying problem of separation anxiety which required psychiatric attention. In a few cases there has been a tendency to mental and physical collapse and in one case even a suicidal attempt was made. The circumstances and symptoms allow a sharp distinction from truancy, and intensive psychotherapy is called for in all cases, even if this means more absence from school, since research has shown that such children without the expert treatment are liable to remain misfits in society with severe personal and social disturbances in later life. The cases at this clinic were roughly divided equally between boys and girls, and the age range spread from six years to sixteen years, with at least half being of secondary school age. This corresponds with the general observation that school phobia can occur independently of sex at any age during the child's scholastic career. Intelligence levels ranged from very low average to one very superior. On the whole, school phobia tends to occur in more intelligent children and seems fairly independent from failure or success in school, while truancy is more frequent in backward children who find the requirements of the school difficult. In almost every case of school phobia we found parental problems of an emotional nature involving the child. More than half thechildren were thought to be over-indulged or lacking 72 firm control at home. Many were overweight. In fact, more cases of school phobia seem to develop from a family problem rather than a difficulty in the school situation. Many children come from culturally superior homes and had ambitious but anxious parents who were most disturbed and helpless in coping with the failure to attend school. In contrast we found that the ordinary truant more often comes from a family which does not appreciate the advantages of education. While the truant spends his time roaming about the streets frequently making a nuisance of himself in the company of similarly minded boys and enjoying his absence from school, we found that the victim of school phobia either remains at home or wanders aimlessly and alone in a most unhappy mood, frequently amounting to severe depression. These cases are time consuming for the child guidance staff and often immediate attention is essential. Treatment consists of intensive individual therapy on analytic lines by a trained psychotherapist, and more recently the educational psychologist has experimented, under psychiatric guidance, with a new approach based on Behaviour Therapy and Learning Theory which showed promise. "Crisis of Adolescence" has become a common reason for referral and appears to occur now at a younger age, as many of the children were this year only about twelve years old. This somewhat earlier incidence may reflect the earlier onset of adolescence in the population. I introduced the term Adolescent Crisis some years ago to describe adolescents who were referred witha variety of most disturbing symptoms, which at any other age would have indicated serious mental disorder, but seemed to respond to a minimum of treatment with a complete remission or cure. Our evening clinic continues to prove its usefulness by facilitating the attendance of adolescents and working parents, especially fathers. While this weekly session had been always fully booked, we are less happy that in spite of repeated efforts by the Child Guidance Team, some twenty cases that had been referred by head teachers or school medical officers during the year, either failed to attend after having accepted appointments, or did not respond at all. In many cases the parents had agreed initially to the referral but had apparently no intension of following this up. As we have a timetable of appointments which must allow up to one hour for every interview, such failure to attend without fair notice is most uneconomical and unfair to others on our long waiting list. Even more time consuming were a number of parents who having accepted appointments failed to keep them and then required appointments at another time. The building of the new Neurophysiology Department at the Whittington Hospital has enabled us to obtain Electro-Encephalograms locally when required, but we remain appreciative to Dr. Sakula who until recently provided this service at the Central Middlesex Hospital. We are particularly pleased with the excellent co-operation we enjoy from Dr. Yudkin and the Paediatric Department at the Whittington Hospital. It is very important that the Child Guidance Clinic co-operates with the local children's hospital to ensure consultation and investigation of doubtful cases, and bladder and bowel disturbance can be observed in hospital to exclude organic factors before psychotherapy is commenced. ATurkish Cypriot boy, referred for most aggressive behaviour in school, turned out to be a most complex case of brain damage, and he required five different specialist examinations to enable an adequate diagnosis. The most interesting and unusual referral of two autistic brothers aroused widespread interest and they had the benefit of the advice from specialists in three different hospitals before appropriate treatment was arranged by this clinic. 73 A very happy and promising development was the monthly attendance at the Child Guidance Clinic of school medical officers. They joined individually the psychiatrist in his diagnostic session and took part in the Case Conference. They have expressed their appreciation of the value of this contact, and we in turn learned much from their presence. Child Guidance reaches out from the profession to the community, particularly to teachers and parents. Explanations of the purpose and function of the service to laymen or colleagues in related disciplines, forms part of our work. During the year the educational psycholoeist has given talks to groups of young wives, to two training colleges for teachers, and to medical officers attending a course for the D.P H. The child psychiatrist conducted courses under the auspices of the Extra-Mural Department of the London University which were attended by many trainees and active workers in the field of Mental Health, and he read during the summer papers relating to his speciality at International Medical Congresses in Rome and Paris. Hie internal reconstruction of the Child Guidance Centre at Tetherdown is nearing completion. The remaining part of the building will be dealt with later. I hope, therefore, to be able to report next year that a Child Guidance Centre reasonably adapted for its use exists for the first time in this Borough. Mr. Walbridge was dealingwith 221 referrals to the Child Guidance Centre of which 75 were seen by me. The majority of these cases reached us again through head teachers (25) and assistant medical officers (23). Direct approach to the clinic was made a; 14 parents, and general practitioners referred eight cases. Three cases came through the Juvenile Court and two from hospitals. Twenty cases had to be removed from the waiting list because of not replying to offers of appointment or refusing to attend. Analysis of the age groups referred showed a range from three years to seventeen years with peaks at six years and twelve years* Pre school children referred formed 16% of the total. The number of Child Guidance sessions held during the year was 73 and a total of 128 new and old patients attended,, The waiting list at the end of the year amounted to 23 cases. The analysis of diagnostic entities of Child Guidance referrals based on my classification, which has been acknowledged by the Ministry of Education, showed again that behaviour problems due to environmental factors (including parental problems and maternal deprivation) easily top the list, while school phobia remains in second position with Emotional Crisis of Adolescence a close third. Chronic Anxiety States and referrals due to bedwetting were quite numerous. Specific sexual problems and more serious pyschotic disturbances were again very infrequent". Dr. Nina Meyer, Consultant Child Psychiatrist at the Tottenham Child Guidance Centre, reports;- "The work of the clinics has this year extended far beyond what it has been in previous years. Referrals have increased from 92 in 1961 to 150 this year. This is largely due to the greater contact maintained with auxiliary child workers, such as child care workers, health visitors, and probation officers. General practitioners are using the service to a greater degree, and we have even had parents coming on their own initiative for help} this indicates that the clinic is becoming recognised as an essential part of the community services. 74 The increase in its usefulness owes much to the enthusiasm of the staff, which has resulted in many home visits by the psychiatric social worker, innumerable contacts by telephone, visiting to the clinic, and conference with auxiliary child workers. All this, of course, entails greatly added work, but its results have been its potential reward. It is very regrettable that Dr. Craike, Senior Consultant Psychiatrist, resigned in October; he has been much missed. The vacancy has not yet been filled, but it is hoped that a new appointment will be made very shortly. We are also hoping to increase the number of psychiatric social workers, and this, in turn, will entail larger premises." Speech Therapy Miss Joan Came, Senior Speech Therapist, reports - "Delays in staff replacement chiefly affecting Hornsey caused difficulties in 1963. Many children need help with language acquisition in addition to articulation improvement. Among other aetiological factors associated with delayed onset of speech and language are cerebral palsy, minimal neurological abnormality and cleft palate. Recent work in linguistics and studies of the emotional origins of communication offer valuable insight into language development. Pre-school referral provides optimum conditions for preventive treatment and research in such cases. Treatment of two children at the partially-hearing unit, Devonshire Hill, has given a much-appreciated opportunity to co-operate with the teachers of the deaf, under their headmaster, Mr. Brown. Type of speech disorder Number of children treated Number discharged Remaining Under observation for review ø Boys Girls Boys Girls Boys Girls Stammering 21 3 20 5 41 14 Dyslalia 27 16 13 20 42 15 Dyslalia (sigmatism) 7 5 8 9 9 12 Delayed speech development 10 3 1 1 11 6 Development dysarthria 2 - 2 - - - Dysarthria associated with cerebral palsy 1 2 1 - - - Developmental dysphasia 2 1 2 - - - Traumatic aphasia - 1 - - - - Dysphonia 1 - - 1 - 1 Indistinct speech 6 3 1 2 5 1 Cleft-palate speech1 1 1 1 - 2 1 Speech disorder associated with high-frequency deafness 1 - - - - - 79 35 49 38 110 50 Totals 114 87 160 0 Most cases are kept for a period of Observation after treatment, before final discharge Number of pre-school children referred 20 Number of attendances for treatment 2461 75 Hospital Classes I am indebted to Mr. J. Power, M.A., Borough Education Officer, for the following report: - "The tuition of children in the St. Ann's and Prince of Wales's Hospitals has continued progressively over the past year. Some children attend the classroom provided in one of the wards, while others receive lessons in bed. Outside wards are visited and here children are taught in cubicles. The age range being from 4'A years to 15 years, Nursery teaching is included with Primary, Secondary and Grammar. Both long and short term patients have lessons. Practically all the teaching is individual, but often those children of the same age, who are well enough to attend the classroom, can be grouped for nature, history and geography lessons. Here the radio, record player, and television can be used, when convenient to hospital routine. The children are keen to have lessons, not only because children like, to some extent, to be organised, but because then they do not feel set apart through being in hospital. Individual work helps the child tremendously. He is able to work at his own pace and the nervous child in particular gains confidence. Pupils' interests and hobbies are encouraged. For long term patients close liaison is maintained with the school. Often long term children have been transferred from other hospitals (where there is no teaching) in order to benefit from lessons. After being discharged children often return to visit the hospital classes, which shows that the experience of lessons in hospital has not been forgotten. Parents also gratefully acknowledge the benefit gained by their children. The help given by the Tottenham Library service during the year has been greatly appreciated, and also the co-operation of the hospital staff". Statistical Information Certain statistics relating to the work of the school health service not included in the body of the report are contained in the appendix. 76 SCHOOL HEALTH SERVICE STATISTICS 19 63 PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION Number of Individual Pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestations with vermin) Year of Birth For defective vision (excluding squint) For any of the other conditions recorded Total Individual Pupils 1959 & Later - 20 15 1958 19 117 115 1957 31 114 128 1956 44 67 98 1955 142 180 274 1954 95 111 170 1953 23 24 43 1952 214 182 342 1951 261 210 404 1950 82 63 128 1949 52 34 72 1948 & earlier 721 292 908 Total 1684 1414 2697 Defect Code No. Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Total including all other age groups inspected T o T o T o T o 4 Skin 26 78 60 151 321 557 662 9 5 Eyes (a) Vision 37 19 455 48 1684 360 185 54 (b) Squint 25 14 23 1 205 42 12 2 (c) Other 13 6 6 1 57 35 53 1 6 Ears (a) Hearing 4 35 1 35 45 265 133 49 (b) Otitis Media 5 42 6 34 40 229 7 - (c) Other 2 3 2 3 14 18 130 8 7 Nose and Throat 39 134 12 82 118 606 76 18 8 Speech 9 36 1 5 45 89 43 5 9 Lymphatic Glands 90 1 17 5 309 2 2 10 Heart 1 23 2 41 13 144 12 4 11 Lungs 16 64 3 38 51 289 11 19 12 Developmental: (a) Hernia 4 6 - 1 14 18 4 3 (b) Other 3 13 3 17 38 168 29 12 13 Orthopaedic: (a) Posture 2 12 11 73 38 273 7 6 (b) Feet 36 119 47 113 247 703 33 20 (c) Other 11 27 8 52 63 248 53 7 14 Nervous System (a) Epilepsy 3 - 1 3 12 21 1 1 (b) Other 1 4 1 14 5 65 23 1 15 Psychological (a) Development - 26 2 15 3 147 33 2 (b) Stability 4 112 2 63 46 519 64 26 16 Abdomen 3 15 2 20 13 108 5 3 17 Other 4 2 2 11 19 48 399 65 T - Requiring Treatment 0 Requiring Observation 77 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 and Squint (a) External and other, excluding errors of refraction and squint 41 (b) Errors of refraction, including squint 1443 Total 1484 (c) Number of pupils for whom spectacles were prescribed 771 Group 2 Disease; and Defects of Ear, Nose and Throat Received operative treatment for- (a) Diseases of the ear 1 (b) Adenoids and Chronic Tonsillitis 164 (c) Other nose and throat conditions 37 Received other forms of treatment 259 Total 461 Total number of pupils in school known to have been provided with hearing aids: (a) During the current year 8 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 139 Group 3 Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 704 Group 4 Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 1 (ii) Body - Scabies 2 Impetigo 11 Other skin disease 425 Total 439 Group 5 Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 123 Group 6 Speech Therapy Number of pupils treated by speech therapists 171 Group 7 Other treatment given (a) Number of miscellaneous minor ailments treated by the County Council 124 (b) Treatment other than (a) above and excluding convalescent treatment 217 78 EDUCATION ACT 1944 - SECTION 5 7 Cases dealt with under Section 57, Education Act 1944 8 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 - MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 10 (b) Number of Students examined as to fitness for first appointment 62 (c) Number of Students examined as to fitness to undertake training course 71 STAFF Borough Health Department Medical Officer of Health, School and Area Medical Officer G- Hamilton Hogben, M.R.C. S., D.P.H, Deputy Medical Officer of Health and Assistant County Medical Officer P.A.C. Wright, M.B., B.S., D.P.H. (Left 30,4,63) A. W. Tranter, M. B., B. S., D,C.H., D.P.H. (Appointed 13.8.63) Chief Public Health Inspector E, S. Glegg, M. A.P.H„I. Deputy Chief Public Health Inspector A.E. Clarke, M.A.P.H. I. Chief Administrative Assistant A.W. Lawrence, M.AP.H. I. Senior Administrative Assistant 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 79 Area Health Staff (Tottenham and Hornsey) Deputy Area Medical Officer Senior Assistant Medical Officer Area Dental Officer Superintendent Health Visitor Non-medical Supervisor of Midwives and Home Nursing Superintendent Home Help Organiser Assistant Home Help Organisers Area Administrative Officer Deputy Area Administrative Officer Administrative Officers (Section Heads) A. Shaw, M.B., B.S., D.P.H. Ruth Golder, M.B., Ch. B., D.R.C.O.G., D.P.H. Miss W.M. Hunt, L.D.S., R.F.P.S. Miss M. Smith, S.R.N., S.C.M., H. V. Miss F.E. Curtis, S.R.N., S.C.M., H.V., M.T.D. (Retired 28.6. 63) Miss D. Williams, S.R.N., M.I.H.H.Q Miss J.E. Caplin, M. I.H.H.O. Miss A. Orchard, M. I.H.H.O Mrs. M Rudrum W.L.N. Relleen, T.D., D.P.A. H.J. Dunham, B.A. A. Balls N.P. Child S.E. Woodroffe Classification of staff Full-time Part-time Medical Officers 10 6 Dental Officers 6 5 Dental Auxiliary 1 - Supervisory Nursing Staff 2 - Administrative and Clerical Staff 37 6 Health Visitors/School Nurses 22 2 Clinic Nurses 8 - Midwives 12 3 Home Nurses 22 4 Speech Therapists - 3 Physiotherapists 2 - Occupational Therapists 1 - Chiropodists - 5 Audiology Assistants 2 - Orthoptists - 2 Dental Surgery Assistants 9 - Day Nursery Staff 32 3 Home Help Service 8 171 Manual Workers, Domestic Grades, etc. 8 26 182 236 80 INDEX Page Abatement Notices 23 Aged, Welfare of 15 Ambulance Service 18 Animal Boarding Establishments Act, 1963 31 Ante Natal Clinics 44 Area Health Committee 2 Area Health Service 16 Area Health Staff 79 Area Welfare Service 16 Atmospheric Pollution 32 Audiology Unit 66 Audiometry 65 Baths and Laundry Services 25 B.C.G. Vaccina11 on 60 Births and Deaths 4 Births, Notification of 44 Borough Council, Members 1 Bronchitis 5 Burlals 31 Cerebral Palsy Unit 68 Certificates of Disrepair 38 Child Guidance Centres 70 Child Minders, Registered 4-9 Chiropody & Special Treatment Establishments: Licensing 31 Chiropody Service 15,57 Clean Air 32 Cleansing and Disinfecting Station 23 Clearance Areas 36 Closing Orders 37 Comparability Factors 4 Council, Members of 1 Daily Guardian Scheme 4-7 Day Nurseries, Local Authority 48 Private 49 81 Page Deaths, Classification of 4, 9 Defects, Sanitary Remedied 22 Demolition Orders 37 Dental Service, Priority 50 School 61 Diphtheria 11 Diphtheria Immunisation 55 Disinfection 23 Disinfestation 27 Domestic Help Service 5 8 Drainage and Sewerage 19 Dysentery 12 2ar, Hose & Throat Clinics 69 Education Committee 2 Egg, Frozen Imported 41 En cephalitis 11 Fabrics (Misdescription) Regulations 1959 30 Factories 28 Food — Condemned 4-1, 4-2 Control 39 Hawlcers 30 Hygiene 42 Imported Frozen Eggs 41 Poisoning 12 Prosecutions 42 Registered Premises 4-0 Shops 29 Furnace Installations 32 Handicapped Pupils 67 Hawkers of Food 40 Health and Housing Committee 1 Health Services provided by other Authorities 16 Health Visiting Service 52 Home Nursing Service 54 Hospital Services, Old People 14 82 Page Hospitals 16 hospital classes 75 Houses Unfit 34 Houses in Multiple Occupation 35 Housing 4 Illegitimate Births Improvement of Houses 4 Infantile Deaths , 7 Infant Welfare Clinics 6 Infectious Diseases, Table of Cases 3 Insect Pests 7 Inspections carried out by Public Health Inspectors 9 Knackers Yard 3 Laboratory Service 8 Leiundris, Public 25 Laundry Service for the Incontinent Aged 4 Lung Cancer Materna1 Deaths Meals on Wheels 5 Measles 12 Meat Inspection 43 Medical Grounds for Rehousing 38 Members of Borough Council 1 Meningococcal Infection 11 Mental Health 16 Midwifery Service 51 Midwives' Ante-Natal Clinics 45 Milk and Dairies 43 Mothercraft and Relaxation Classes 45 Notices Served 22 Nursing Homes, Private 59 83 Page Old People's Welfare 15 Ophthalmic Clinics 63 Orthopaedic Clinics 64* Out-Patient Clinics at Prince of Wales's Hospital 17 Outworkers 29 Periodic Medical Inspections 59 Personal Health Service 16 Persons in need of Care and Attention 14 Pet Anima1s Act, 1951 31 Poliomyelitis 11 Vaccination 56 Population, Movement of 4 Preserved Foods 40 Prince of Wales's Hospital, Out-Patient Clinics 17 Public Health Department, Staff 78 Public Health Act, 1936 Legal Proceedings 23 Radioactive Substances Act, 1960 24 Rag Flock and Other Filling Materials Act, 1951 31 Recuperative Holidays 57 Rehousing on Medical Grounds 38 Rent Act,1957 38 Rent Books, Provision 38 Repairs in Default 23,37 Retirement Advice Clinic 5 8 Rheumatism Supervisory Service 68 Rodent Control 28 Sanitary Circumstances of the Area 19 Scarlet Fever 12 School Health Service 59 Sewerage and Drainage 19 Shops 29 Prosecutions 30 Slaughterhouses 43 Slaughtermen ... ... ... ... ... ... 43 84 Page Smallpox ll Smallpox Vaccination 55 Smoke Control Areas 32 Speech Therapy 74 Staff Medical Examinations 12 Statistics 3 Stillbirths 3 Street Trading 30 Superannuation Medical Examinations 12 Swimming Pools 24 Tetanus Immunisa11ons 55 Toddlers' Cinics 47 Tuberculosis 10 Typhoid Fever 11 Unfit Houses 34 Vale Road School for Physically Handicapped Children 68 Water Supply 19 Welfare Foods Distribution 50 We1fare Service Area 16 Whooping Cough 12 Immunisation 55 Work in De fault 23, 37 Published by the Tttenham Corporation, Town Hall, N. 15. and Printed by their Public Libraries Department.