HAR 6 HARINGEY HEALTH IN 1970 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. HARINGEY HEALTH IN 1970 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. Health Department, Tottenham Town Hall, The Green, High Road, Tottenham, N.15. To: The Worshipful The Mayor, Aldermen and Councillors of the London Borough of Haringey. Ladies and Gentlemen, I have the honour to present the report on the health of the Borough of Haringey for the year ended 31 December 1970. The report for 1969 described the introduction of the Directorate system and the effect of the new Social Services legislation which transferred the responsibility for Mental Health Services, Day Nursery care and Home Helps to the new Social Services Directorate, so that this report for 1970 divides the work of the Health Department into three sections - Environmental Health; Personal Health and Infectious Diseases Control; and School Health. Faced with this reorganisation the Health Department nevertheless made notable progress. The work of the Environmental Health Section increased considerably when the Council decided to accelerate the rate of inspection of premises under Part III of the 1957 Housing Act with a view to completion of the inspection area programme for the Borough by mid 1972. The improvement of houses under the Housing Act 1969 has proceeded apace. We were pleased to note that the London Boroughs Association adopted the code of fire precautions for day nurseries and child minders that was prepared by this Council's officers in consultation with the London Fire Services. Progress has been made, too, with the arrangements for midwives to work in better association with the hospitals, and with the attachment of nursing staff to general practitioners. The Chairman of the Health Committee, Councillor Mrs. Levinson, arranged a series of useful meetings between general practitioners and Health Department staff. The Council's interest in Family Planning and especially in the Domiciliary Family Planning scheme should produce long-term benefits. In a world of ever-increasing population the catch-phrase for the future may well be "every child a wanted child" or as a recipe for the successful democrat instead of "one man one vote" we may one day say "one man one child". The recent history of developing countries has shown that increasing national prosperity can be used either to increase the population or to give a better quality of life to the individual; but increasing prosperity seldom permits both. The Health Committee opened the William C. Harvey School on the Broadwater Farm Estate in September where accommodation was made available for 108 pupils. The school fills an important need because Haringey was the only authority in the former Middlesex County Council without a junior training school. The new school transferred to the Education Department on 1 April 1971. During last year the Health Department has seen the transfer of many valuable officers to the Social Services Directorate and at this stage of our history I must thank them for the loyal and conscientious service which they have given to Haringey during its first six years, probably one of the most productive periods of public health history in this part of London, and I would wish them every success in their new spheres of activity. I would like to convey my thanks, too, to the Chief Executive and Directors, to the Head of Management Services and other Heads of Service for their co-operation and assistance during the year. In conclusion I wish to record my thanks to Councillor Mrs. Levinson, Chairman of the Health Committee and the Members of the Committee for their encouragement and support. My thanks are especially due to the staff of the Health Department for their loyal and efficient service during a year made difficult by reorganisation and frequent staff changes. I have the honour to be your obedient servant, J.L. PATTON, Medical Officer of Health HEALTH COMMITTEE Councillor S.M. Ayres Mrs. J. Cooper E.V. Garwood E.C. Godfrey Mrs. C.J. Levinson (Chairman) Mrs. Brenda S. Remington, B.A. Miss J.R. Tarris (Vice Chairman) Sir Robin Williams, Bt., M.A. STAFF Medical Officer of Health and Principal School Medical Officer J.L. PATTON, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health and D.P.S.M.O. W.T. ORTON, M.B., B.Ch., B.A.O., D.P.H. Principal Medical Officers School Health Mary C. Douglas, M.B., Ch.B., D.P.H. Maternity and Child Welfare Ruth Y. Golder, M.B., Ch.B., D.R.C.O.G., D.P.H. Mental Health U.P. Seidel, M.B., B.S., D.P.H., D.P.M. Senior Medical Officers Joan F. Nicholls, M.B., B.S., D.C.H., D.P.H. Z. Zubrzycki, Med. Dipl., D.P.H. Departmental Medical Officers E.H.C. Alles, M.B., B.S., D.T.M. & H. (Ceylon), D.P.H. Manju Chakrabarti, M.B., B.S., M.Sc. (Calcutta) Kyvelie Chlouverakis, Med. Dip., M.D. (Athens), L.A.H. Avery B. Cooper, M.R.C.S., L.R.C.P. T.H. Elias, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. S.R. Lund, M.B., B.S. (Pakistan) Isobel M. Pine, M.B., B.S., D.P.H. K.V. Shah, M.B., B.S. (Bombay), D.P.H. Part Time:- Elizabeth A.S. Carrington, M.B., B.S., M.R.C.S., L.R.C.P. Margaret Kirk, M.B., B.S., D.C.H. 8 sessional Chief Dental Officer and Principal School Dental Officer G.C.H. Kramer, L.D.S., R.C.S. Dental Officers N. Ansbergs, D.D.D. Diana J. Bullock, B.D.S. Alison G. Little, L.D.S., R.C.S. A.H. Landsman, L.D.S., R.C.S. Part Time:- Mrs. M.P. Antoniewicz, B.D.S. Miss D. Saxon, L.D.S., R.C.S. R.P. Bacon, R.D.S. 6 sessional dentists Orthodontists T.J. Combes, B.D.S., D.Orth., R.C.S. Joy Maclnerney, L.D.S., D.Orth., R.C.S., B.D.S. 3 specialist dental surgery assistants 11 dental surgery assistants Public Analyst W.B. Chapman, B.Sc., F.R.I.C. Superintendent Health Visitor Mary Smith, S.R.N., S.C.M., H.V. 2 Deputy Superintendent Health Visitor Margaret J. Saywell, S.R.N., H.V. Senior Health Visitors Joan Beese, S.R.N., H.V. Edith N. Gibbon, S.R.N., S.C.M., H.V. Irene E.G. Marriott, S.R.N., S.C.M., H.V., Diploma in Social Studies Renee Boyd, S.R.N., S.R.F.N., H.V. Dulcie Carlow, S.R.N., S.R.F.N., S.C.M., H.V. Elsie T. Clarke, S.R.N., S.R.F.N., T.A., H.V. Mary A. Grimm, S.R.N., S.R.F.N., S.C.M., H.V. Ruth A.H. Jones, S.R.N., S.C.M., H.V. Jeannette Hendon, S.R.N., H.V. Betty M. Mclver, R.G.N., S.C.M., H.V. Kathleen Noolan, S.R.N., S.C.M., H.V. Doreen Witton, S.R.N., H.V. 18 health visitors; 2 student health visitors; 3 tuberculosis visitors; 12 clinic nurses. Non-Medical Supervisor of Midwives and Superintendent of Hoine Nurses Dorothy Jobling, S.R.N., R.F.N., S.C.M., M.T.T.C.Dip. (until 31.8.70) Deputy Non-Medical Supervisor of Midwives Dorothy E. Wynn-Jones, S.R.N., S.C.M. 14 midwives Deputy Superintendent of Home Nurses Berthe F. Specht, S.R.N., S.C.M., Q.N. 29 home nurses: 3 part-time home nurses: 3 bath attendants. Medical Auxiliaries Physiotherapists Nancy W. Allardice, M.C.S.P., S.R.N. Elizabeth Marcus Occupational Therapist Judith Hunt, M.A.O.T. Senior Speech Therapist Eleanor R.P. McKeown, L.C.S.T. 3 Speech Therapists Joan D. Came, L.C.S.T. Jane C. Froud, L.C.S.T. Stella E. Lyne, L.C.S.T. (until 31.3.70) Lindy V. Peacey, L.C.S.T. Ruby Sewell, L.C.S.T. Orthoptists Diana R. Kiverstein, D.B.O. Senga Conn, D.B.O. Screening Technicians Hilda M. Bristow Frances M. Jenner Philomena C. Ward Sessional Chiropodists — 20 Health Education Officer Sheila M.P. Frost, S.R.N., S.C.M., H.V., D.H.E. Chief Public Health Inspector W.J. Wilson, D.P.A., M.A.P.H.I., M.R.S.H. Deputy Chief Public Health Inspector E.S. Glegg, M.A.P.H.I, A.M.I.P.H.E. Senior Public Health Inspectors F.H. Canton, M.A.P.H.I. E.S. Gray, M.A.P.H.I. A.E. Clarke, M.A.P.H.I., A.M.I.P.H.E. J.A. Harris, M.A.P.H.I. W.E. Goodfellow, M.A.P.H.I. F. James, M.A.P.H.I. W. Shackcloth, F.A.P.H.I. 25 public health inspectors: 8 pupil public health inspectors: 6 technical assistants. Food and Drugs Officer A.J.C. Roker Meat Inspector J.K. Baker-Smith Shops Inspectors T.E. Goodwin T. Robinson (until 11.10.70) Mortuary Attendant S.J. Twinn 1 assistant 4 ADMINISTRATIVE STAFF Chief Administrative Officer D.B. Davies, D.P.A., M.R.S.H. Accounts, Wages, Supplies Building and Transport Division: N.P. Child (Divisional Head) L.E. Wells (Section Head) J.W. Bailey (Section Head) 8 clerical assistants: Prevention, Care and After Care and Mental Health Division: P.V. Ingram (Divisional Head) Hazel Gill (Section Head) Hetty L. Somers (Section Head) 9 clerical assistants: Child Health and Domiciliary Care Division: H.J. Dunham, B.A. (Divisional Head) S.E. Woodroffe (Section Head) 30 administrative and clerical assistants: 8 part-time clerical assistants: Environmental Health and Infectious Diseases Control Division: A.W. Lawrence, M.A.P.H.I. (Divisional Head) H.C.B. Wheal (Section Head) H.P. Bradford (Section Head) 12 administrative and clerical assistants: Secretariat A. Balls (Section Head) Florence Wetherall (M.O.H's Secretary) 4 administrative and clerical assistants: Mrs. S. Hogan (Acting Supervisor of Typing Section) 12 shorthand typists and copy typists 1 machine operator 5 VITAL STATISTICS 1969 1970 Area of District (in acres) 7,491 7,491 Population — Mid-year: Registrar General's estimate 242,300 238,410 Rateable Value as at 1st April £13,696,189 £13,733,152 Sum represented by penny rate £54,500 £54,750 Approximate number of separately rated dwellings in district 72,395 72,169 Registered live births: Males 2,436 2,188 Females 2,317 2,154 Total 4,753 £4,342 Birth Rate per 1,000 estimated population 19.62 (16.3)* 18.21 (16.0)* No. of live births which were illegitimate 645 611 Illegitimate live births as percentage of all live births 13.57% (8%)* 14.07% (8%)* Stillbirths: Males 41 33 Females 18 18 Total 59 51 Stillbirth rate per 1,000 total (live and still) births 12.26 (13)* 11.61 (13)* No. of stillbirths which were illegitimate 10 4 Stillbirths as a percentage of all stillbirths 16.95% 7.84% Deaths: Males 1,484 1,356 Females 1,436 1,428 Total 2,920 2,784 Death rate per 1,000 estimated population 12.05 (11.9)* 11.68 (11.7)* Maternal Mortality: Deaths from Puerperal Causes 2 4 Death rate per 1,000 total (live and still) births 0.416 0.915 Deaths of infants under 1 year of age (Infant Mortality) (a) Legitimate: Males 44 51 Females 34 33 Total 78 84 Death rate per 1,000 legitimate live births 18.99 22.51 (b) Illegitimate: Males 10 9 Females 11 8 Total 21 17 Death rate per 1,000 illegitimate live births 32.56 27.82 (c) Total: Males 54 60 Females 45 41 Total 99 101 Death rate per 1,000 total live births 20.83 (18)* 23.05 (18)* Deaths of Infants under 4 weeks (Neo-natal Mortality) 62 72 Rate per 1,000 live births 13.04 (12)* 16.58 (12)* Deaths of Infants under 1 week (Early Neo-natal Mortality) 50 58 Rate per 1,000 live-births 10.52 (10)* 13.36 (11)* Stillbirths and deaths under 1 week (Perinatal Mortality) 109 109 Rate per 1,000 live and still births 22.65 (23)* 24.81 (23)* NOTE: The figures in parenthesis marked * indicate the rates for England and Wales. 6 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 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 1970 rates for Haringey with the national rates, Haringey's figures must be multiplied by the appropriate comparability factors, which are 0.92 for births and 0.96 for deaths. The adjusted birth rate for Haringey is 16.75, and the death rate 11.51, compared with national rates of 16.0 and 11.7. Classification of Deaths The Registrar General has analysed the 1970 deaths by causes which are classified according to the International Abbreviated List of 50 causes (B. List) of the Eighth Revision of the International Classification of Diseases but with some sub-divisions, to improve comparability with the classification used before 1968. 7 8 CLASSIFIED DEATHS OF HARINGEY RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION 1970 DISEASE TOTAL Under 4 weeks 4 Weeks & under 1 year 1 - 4 5-14 15 - 24 25 - 34 35-44 45 - 54 55-64 65 - 74 75 and over M F M F M F M F M F M F M F M F M F M F M F M F B4 Enteritis and Other Diarrhoeal Diseases 4 1 - - 2 1 - - - - - - - - 1 - - - - - — - 1 - B5 TuberculdSis of Respiratory System 2 - - - - - - - - - - - - - - - — - 1 - 1 - - - B11 Meningococcal Infection 1 - - - 1 - - - - - - - - - - - - - - - - - - - B14 Measles - 1 - - - - - 1 - - - - - - - - - - - - - - - - B18 Other Infective and Parasitic Diseases 2 3 1 - - 1 - - - - - 1 - - - - - - 1 — - 1 - — B19(1) Malignant Neoplasm, Buccal Cavity etc. 1 2 - - - - - - - - - - - - - - - - - 1 - 1 - 1 B19(2) Malignant Neoplasm Oesophagus 8 9 - - - - - - - - 1 - - - - - 2 - 2 1 - 1 3 7 B19(3) Malignant Neoplasm, Stomach 28 28 - - - - - - - - - - - - - 1 1 - 10 4 9 3 8 20 B19(4) Malignant Neoplasm, Intestine 18 41 - - - - - - - - - - - - - - 2 1 7 7 3 8 6 25 B19(5) Malignant Neoplasm, Larynx 5 - - - - - - - - - - - - - - - - 1 - - 1 - 4 - B19(6) Malignant Neoplasm, Lung, Bronchus 127 33 - - - - - - - - - - - - - - 8 4 42 7 49 11 28 11 B19(7) Malignant Neoplasm, Breast 2 64 - - - - - - - - - - - - - 3 - 10 - 22 1 10 1 19 B19(8) Malignant Neoplasm, Uterus - 10 - - - - - - - - - - - - - - - 1 - 1 - 5 - 3 B19(9) Malignant Neoplasm, Prostate 15 - - - - - - - - - - - - - - - 1 - 2 - 6 - 6 - B19(10) Leukaemia 11 6 - - - - - - - - 1 - 1 2 1 1 2 - 2 1 3 2 1 - B19(11) Other Malignant Neoplasms 75 76 - - - - 1 - - - 1 - 1 1 5 1 7 12 23 17 23 19 14 26 B20 Benign and Unspecified Neoplasms 1 4 - - - - 1 - - - - - - - - - - 1 - 1 - 2 - - B21 Diabetes Mellitus 10 15 - - - - - - - - - - - - 2 1 - 1 - 2 5 6 3 5 B22 Avitaminosis, etc. - 1 - - - - - - - - - - - - - - - - - - - 1 - - B46(1) Other Endocrine etc. Diseases 5 4 - - - - - - - - - - - - - - 1 - 3 — — 1 1 3 B23 Anaemias 4 7 - - - - - - 1 - - - - — — - — — 1 — 1 - 1 7 B46(2) Other Diseases of Blood etc. 1 1 - - - - 1 - - - - - - - - - - - - - - - - 1 B46(3) Mental Disorders 1 1 - - - - - - - - - - - - - - - - - - - - 1 1 B24 Meningitis 3 - 1 - 1 - 1 - - - - - - - - - - - - - - - - - B46(4) Multiple Sclerosis 1 6 - - - - - - - - - - - 1 1 - - 3 — 2 - - — — ' B46(5) Other Diseases of Nervous System, etc. . 21 14 - - - - 1 - - - 1 — 1 - - 1 - — 3 1 7 5 8 7 B26 Chronic Rheumatic Heart Disease 11 27 - - - - - - - - - - 1 - - 2 3 5 2 6 — 5 5 9 B27 Hypertensive Disease 19 29 - - - - - - - - 1 - - - 2 - 1 - 5 1 5 5 5 23 B28 Ischaemic Heart Disease 362 260 - - - - - - - - - - - - 6 2 44 8 91 23 123 52 98 175 B29 Other forms of Heart Disease 60 93 - - - - - - - - - 1 1 - - 1 4 3 2 2 20 12 33 74 B30 Cerebrovascular Disease 98 216 - - - - - - - - - 2 1 1 2 2 6 15 13 16 37 37 39 143 B46(6) Other Diseases of Circulatory System 38 87 1 - - - - - 1 - - - - - - 1 - - 6 6 9 10 21 70 B31 Influenza 7 11 - - - - - - - - - - - - 1 - 1 1 1 1 2 4 2 5 B32 Pneumonia 104 145 4 2 7 2 - - - - - - - - - - 4 1 5 4 30 23 54 113 B33(1) Bronchitis and Emphysema 134 53 - - 1 - - - - 1 - - - - 1 - 2 1 20 5 46 12 64 34 B33(2) Asthma 1 - - - - - - - - - - - - - - - - - - - 1 - - - B46 Other Diseases of Respiratory System 18 16 - - 9 2 1 1 - - - - - - - - - 1 5 2 1 3 2 7 B34 Peptic Ulcer 16 11 - - - - - - - - - - - - - - - 1 4 2 6 1 6 7 B35 Appendicitis - 1 - - - - - - - - - - - - - - - 1 - - - - - - B36 Intestinal Obstruction and Hernia 9 13 - - - - - 1 - 1 - - - - - - 1 - 3 1 4 4 7 B37 Cirrhosis of Liver 3 4 - - - - - - - - - - - - - - - 2 2 1 - - 1 1 B46(8) Other Diseases of Digestive System 16 14 - 1 - - - - - - - - 1 - - - 2 1 4 - 5 4 4 8 B38 Nephritis and Nephrosis 4 4 - - - - - - - - - - - - - 1 1 - - - 2 1 1 2 B39 Hyperplasia of Prostate 4 - - - - - - - - - - - - - - - - - - - 1 - 3 - B46(9) Other Diseases, Genito-Urinary System 4 7 - - - - - - - - - - - - - - - 2 2 - 1 1 1 4 B40 Abortion - 2 - - - - - - - - - - - 1 - 1 - - - - - - - - B41 Other Complications of Pregnancy etc. — 2 - - - - - - - - - 1 - 1 - - - - - - - - - - B46(10) Diseases of Skin, Subcutaneous Tissue 3 - - - - - - - - - - - - - - - - - - - - - 3 - B46I11) Diseases of Musculo-Skeletal System 3 14 1 1 2 3 1 9 B42 Congenital Anomalies 12 12 6 8 2 - - - 3 1 - 1 - - 1 - - - - 1 - 1 - - B43 Birth Injury, Difficult Labour, etc. 13 9 13 9 - - - - - - - - - - - - - - - - - - - - B44 Other Causes of Perinatal Mortality 11 15 11 15 - - - - - - - - - - - - - - - - - - - - B45 Symptoms and III Defined Conditions 3 3 - - - - - - - - - - - - - - - - - - 1 — 2 3 BE47 Motor Vehicle Accidents 17 9 - - - - 1 - 2 1 4 3 1 — 2 — 1 - 1 1 — 1 5 3 BE48 All Other Accidents 22 24 - - - - - - - 2 4 1 - 1 2 ' 1 6 1 4 4 2 6 4 8 BE 49 Suicide and Self-inflicted Injuries 14 7 - - - - - - - - - 1 3 3 4 2 4 2 1 4 2 1 — 4 BE 50 All Other External Causes 4 3 - - - - - - - - 2 - 1 1 - - - - 1 - - 2 - - TOTAL ALL CAUSES 1,356 1,428 37 35 23 6 7 3 7 6 15 11 12 12 31 21 104 79 269 147 406 264 445 844 CD 10 HARINGEY STATISTICS SINCE THE CREATION OF THE LONDON BOROUGH IN 1965 Year Population (R.G. Est.) BIRTHS DEATHS COMPARABILITY FACTORS DEATH RATE OF INFANTS PER 1000 LIVE BIRTHS Still Birth Rate per 1000 live and still births Peri-Natal Mortality Rate per 1000 live and still births Percentage of Births Illegitimate No. Rate per 1000 Populationm No. Rate per 1000 Population Births Deaths Under 1 year Under 4 weeks Under 1 week 1965 256,750 5,611 21.85 2,865 11.16 .92 .97 17.82 13.01 11.76 14.06 25.65 13.75 1966 254,650 5,604 22.00 2,913 11.44 .92 .97 17.67 11.78 10.89 14.07 24.81 11.96 1967 254,120 5,337 21.00 2,805 11.04 .92 .97 18.74 13.30 11.99 10.57 22.43 12.97 11968 245,270 5,120 20.87 2,967 12.10 .92 .96 22.27 15.62 13.87 16.52 30.16 13.75 1969 242,300 4,753 19.62 2,920 12.05 .92 .96 20.83 13.04 10.52 12.26 22.65 13.57 1970 238,410 4,342 18.21 2,784 11.68 .92 .95 23.05 16.58 13.36 11.61 24.81 14.07 NOTIFICATIONS OF INFECTIOUS DISEASES DURING 1970 BY SEX AND AGE GROUPS Under 1 1 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65 + UNK 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 M F Scarlet Fever 1 - 4 1 6 4 5 3 8 5 19 28 1 3 6 3 1 2 - - - - - - - - 100 Measles 33 24 104 97 83 124 112 102 111 88 268 275 7 12 11 7 4 6 - 1 - - - - 6 9 1484 Whooping Cough 14 8 2 5 10 4 7 3 5 3 18 21 - 2 - 1 3 - 1 - - 1 108 Food Poisoning 4 1 1 - 3 1 1 - - 1 1 2 1 1 3 6 1 1 5 1 1 - - - 35 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - - A. Encephalitis Infective - - - - - - - - - - - - - - - - - - - - - - - - - - - A. Encephalitis Post Infectious - - - - - - - - - - - - - - - - - 1 - . 1 . - . . . 2 Acute Poliomyelitis Paralytic 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 Acute Poliomyelitis Non-Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Meningitis 1 3 - - 1 1 2 - 2 - 3 - 1 - 1 - - - - - 3 2 - - . . 20 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - - 1 - - 1 1 . - - . . 2 Para-Typhoid - - - - - - - - - - - - - - 1 - - - 1 - - - - 2 Dysentery 2 - 1 1 3 2 - 3 - 3 3 3 3 - 1 3 5 2 1 1 1 - - 1 39 Scabies 3 - 2 2 3 2 7 7 3 1 15 13 10 7 5 15 33 47 7 7 3 3 2 3 1 2 203 Tuberculosis Respiratory - - - 1 1 - 1 - 1 1 - - 1 - 3 2 16 12 7 5 15 6 8 4 - - 84 Tuberculosis Meninges & Central Nervous System - - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis Others - - - - - - - - - - - - - 1 - - 4 7 4 1 2 1 1 1 - 1 24 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - 1 1 - - - - - - - - 2 Infective Jaundice 1 - - - - - 1 - 2 - - 4 - - 4 - 14 10 2 3 1 3 1 - 1 47 PART 1 ENVIRONMENTAL HEALTH W.J. Wilson, Chief Public Health Inspector The scope of the work of the Environmental Health Division is solely limited by the availability of staff to meet the many diverse and pressing problems in this sphere of the Council's responsibilities. Although there was some improvement in the staffing situation in 1970 we were still three Public Health Inspectors below the establishment at the end of 1970. The build-up in the amount of work under the Housing Act 1969 has resulted in very heavy pressure upon the staff, and the added work has more than outweighed the small increase in staff. The work of inspection in environmental health is progressively more complex. Increasing use is made of scientific instruments and close-co-operation with the Scientific Branch of the G.L.C. is maintained. Drainage and Sewerage There are two systems of sewerage operative in the Borough. Surface water is collected and conveyed to water courses, rivers etc. Soil sewage is conveyed to the sewage disposal works. Occasionally it is found that the water courses are being polluted, particularly with detergent scum and soap solution. A continuous programme of investigation is carried out by a technical assistant who reports all suspected contraventions to the public health inspectors. Close co-operation with the Greater London Council (Department of Public Health Engineering) is maintained. During the year 2,289 premises were inspected in this way and drainage corrections were requested in 63 instances. The Public Health Inspectors took any necessary action to ensure that the required works were carried out and, where appropriate, formal action was taken under the Public Health Act, 1936. Water Supplies A small area on the Borough boundary containing 106 premises between Great North Road and Aylmer Road, N.2. is supplied with water by the Lee Valley Water Company and the remainder of the Borough receives its water from the Metropolitan Water Board. A full report on the water supplied by the Lee Valley Water Company was contained in the report of 1966. Dr. Windle Taylor, Director of Water Examinations, Metropolitan Water Board has kindly supplied the following information regarding water supplied by the Board to Haringey during 1970:- I refer to the Department of Health and Social Security Circular No. 1/71 and have pleasure in giving below and on the attached sheets the required information as far as it relates to the Board's direct supply to your administrative area and its several parts. You will understand that this information does not relate to private supplies or to supplies derived from or through other Water Undertakings (if any). 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1970. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) fi) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1970, was 237,786. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 12 2. (a) The supply was derived from the following works and pumping stations:- The higher ground around Muswell Hill is supplied with River Thames-derived water. The remainder of the borough is supplied with New River-derived water. During the summer months, the Northumberland Park area receives well water from Park pumping station. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. 13 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF HARINGEY FOR THE YEAR 1970 (Milligrams per litre (unless otherwise stated)) Description of the Sample No. of samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as CI Oxygen abs. from Permanganate 4 hrs. at 27° C Turbidity Units Colour (Burgess Units) Hardness (Total) Ca C03 Hardness (noncar bonate) Ca C03 pH Value Phosphate as PO4 Silicate as sio2 Sulphate as SO4 Natural Fluoride as F Magnesium as Mg. Sodium as Na Potassium as K Surface Active Material as Manoxol OT Electrical Conductivity (micromhos) New River derived 104 0.008 0.061 5.2 45 0.61 0.0 8 304 79 7.8 1.9 10 71 0.20 5 30.9 4.9 0.02 620 Thames derived 363 0.026 0.083 4.8 40 1.02 0.1 11 274 79 7.9 2.7 9 70 0.20 5 27.7 5.6 0.03 570 Park Well 3 0.135 0.025 0.4 24 0.19 0.1 2 276 68 7.5 - - - 0.65 - - - - 510 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES 1970 BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia Coli count Number of samples Agar plate count per ml. Coliform count Escherichia Coli count 20-24 hours at 37° C 3 days at 22° C Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. 20-24 hours at 370 c 3 days at 22° C Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. New River derived 1,510 46.1 - 42.91 8.1 60.79 2.2 516 10.9 - 100.0 100.0 Thames derived 8,259 31.9 - 37.91 17.3 53.58 4.7 3,710 8.0 . 99.92 99.97 Park Well 95 0.4 31 93.68 0.1 100.0 - 96 0.5 15 100.0 100.0 14 Swimming Baths and Paddling Pools Public health control of the public and privately owned pools is maintained on behalf of the Public Health Department by regular sampling of water for bacteriological and chemical examination from the swimming pools in the Borough by special chemists on the staff of the Scientific Branch of the Greater London Council. Samples are similarly taken from paddling pools in the parks when these are in use during the summer months. The filtration and chlorination equipment at the Borough Council's swimming baths is highly efficient and the analyses generally give very good results. The Baths Department is advised of the results of the tests in respect of the Council controlled establishments and these results are supplementary to the tests undertaken by the staff of that Department. Smoke Control Areas The whole of the Borough became smoke controlled on 1st December 1968. In the report for 1969 mention was made of the general concern regarding the diminishing supplies of gas coke consequent upon the rapid changeover by the gas industry to the utilisation of oil and natural gas in place of gas generated from coal. It was hoped that the production of other solid smokeless fuels would be stepped up sufficiently to off-set the loss of gas coke, but in 1970 the forecast of supplies for the winter of 1970/71 left little doubt that a shortage of solid smokeless fuel would arise that winter. After consultations with the manufacturers, distributors and the other London Boroughs it became evident that in order to avoid hardship because of the lack of suitable fuel it would be necessary temporarily to relax the smoke control orders in part of the Borough for that winter period. The Council advised the Department of the Environment that the smoke control orders relating to the north-eastern part of the borough and affecting approximately 40% of the dwellings in the borough should be suspended from the 1st December 1970 until 31 March 1971. It was fortunate that the winter weather was comparatively mild and the amount of bituminous coal which was burnt was small so that the suspension of the orders did not give rise to any marked increase in the smoke content of the atmosphere. During the year it was necessary to take informal action on two occasions in respect of the sale and delivery of unauthorised fuels in smoke control areas. Furnace Installations In accordance with Section 3 of the Clean Air Act 1956 notifications were received in respect of 34 premises where it was proposed to install new furnaces. These were examined and in 7 cases it was necessary to suggest modifications to the installation engineers. The Department was satisfied that the final proposals provided for installations which would meet the requirements of the Act that they should as far as practicable be capable of being operated continuously without emitting smoke when burning the fuel for which they were designed. Chimney Heights 10 applications were received under Section 6 of the Clean Air Act 1968. Informal discussions took place with respect of certain of these and of chimneys not requiring approval under that section. Advice was given and agreement reached in each such case by which chimney terminal heights were fixed to allow for adequate dissipation of the exhaust gases to avoid the risk of harmful local concentrations of air pollutants. Control of Atmospheric Pollution The emission of excessive amounts of smoke were noted in respect of five industrial plants. Advice was given to the management on the need to maintain adequate control measures to prevent a recurrence of the nuisance. The burning of timber on demolition sites has from time to time lead to discomfort to people in the vicinity. Whilst it is often desirable to destroy this old wood on site as it is commonly infested with woodworm it is essential to ensure that the burning is properly controlled so that it does not give rise to a nuisance to the neighbourhood. During the year a complaint was received of nuisance from the diesel exhausts of delivery vehicles at a large food depot in the borough. These vehicles were kept running on the company's vehicle park which immediately adjoins and is about three feet above a public footpath where a bus stop is situated. The vans were so parked that their exhausts discharged directly over the footpath making it almost impossible for persons to pass along the footpath or to wait at the bus stop. Discussions with the management lead to alternative parking arrangements being made and the switching off of the engines when the vans were stationary. 15 Investigation of Atmospheric Pollution Haringey continued to co-operate with the Department of Trade and Industry to which the Warren Spring Laboratory is attached by operating four instruments at suitable sites in the Borough for recording the daily level of smoke and sulphur dioxide in the atmosphere. In addition to giving information on local trends, the data forms part of information collected by the Laboratory to show national distribution and trends in atmospheric pollution. The readings obtained depend to some extent on varying local meteorological conditions which at times may give rise to deviations from the general trend. TABLE A Average Daily Readings of Smoke and Sulphur Dioxide in the Atmosphere 1969/70 (Microgrammes per cubic metre) Hornsey Town Hall, N.8. (1) Burghley Road N.8. (2) Tottenham Town Hall, N.15. (3) Civic Centre N.22. (4) Classification A.3 A.1 A.2 D.2 (a) Smoke July 1969 23 21 21 16 August 28 28 28 33 September 33 27 33 32 October 62 62 73 67 November 59 58 92 62 December 73 78 88 81 January 1970 63 69 76 67 February 34 36 38 36 March 43 41 48 37 April 31 28 N 25 May 31 24 25 N June 18 17 23 N (b) Sulphur Dioxide July 1969 89 83 95 95 August 99 92 101 86 September 87 82 99 80 October 171 138 181 158 November 165 149 115 53 December 247 224 263 236 January 1970 264 239 266 232 February 172 173 187 164 March 198 176 204 148 April N 125 N 105 May 76 77 68 N June 79 73 85 N NOTE: "N" indicates that number of readings insufficient to give accurate average. 16 Classification of Sites The following classification of sites indicates the neighbourhood in which the instruments are located as follows:- A.1. — residential area with high density housing or with medium density housing in multiple occupation, in either case surrounded by other built-up areas. A.2. — predominantly A.1 but interspersed with some industrial undertakings. A.3. — residential area with high density housing or medium density housing in multiple occupation surrounded by, or interspersed with open spaces. D.2. - small town centre; limited commercial area mixed with old residential housing and possibly industry. TABLE B Monthly Deposit Gauge Readings 1970 MONTH Hornsey Town Hall Site Hampden Road, N.8. Site Rainfall (litres) Deposits-mgs. per m2 Rainfall (litres) Deposits-mgs. per m2 Dissolved Undissolved Total Dissolved Undissolved Total January 5.0 70 118 188 5.4 72 130 202 February 3.6 67 67 134 3.7 112 38 150 March 4.1 58 118 176 3.8 59 67 126 April 7.2 111 149 260 6.9 112 133 245 May N N N N N N N N June 1.3 32 55 87 1.4 35 72 107 July 4.6 54 92 146 4.4 37 70 107 August 4.2 28 14 42 4.1 32 14 46 September 4.4 56 145 201 4.4 52 137 189 October 2.2 42 76 118 2.3 67 47 114 November 11.0 365 119 484 10.8 259 72 331 December 2.6 58 64 122 2.2 67 62 129 TOTAL (11 months) 50.2 941 1,017 1,958 49.4 904 842 1,746 Rodent Control Details of the rodent control measures employed in the sewers in Haringey are set out on the following page. In addition to the routine sewer baiting programme, various measures to control the number of rats and mice are carried out wherever they are found. An aspect of this work which has increased during the past year arises from the spread of strains of rats and mice resistant to the poisons which have previously been effective. People no longer keep cats in anything like the numbers previously experienced and this has made other control measures more necessary. Close liaison is maintained with the Pest Control Unit, Ministry of Agriculture, Fisheries and Food and with the Pest Control Officers in adjoining boroughs. The services of the Council's rodent operatives are provided free of charge for the treatment of infestations in domestic premises. A charge to cover the cost of the operator's time and the materials used is made for the treatment of other premises. The following is a summary of dwelling houses and business premises etc., treated during 1970. 1. Dwelling houses — 2065 2. Factory premises — 69 3. Shops and Cafes — 83 4. Schools — 18 5. Miscellaneous — 40 6. Total charge for 2 - 5 above — £589.00 17 18 RODENT CONTROL - SEWER BAITING 1970 AREA Total manholes WARFARIN SODIUM FLUORACETAMIDE Baited manholes 1st revisit after 7 days 2nd revisit after further 7 days 1 st treatment 2nd treatment No take Part take Complete take No take Part take Complete take West 2141 2141 2059 78 4 2106 30 5 2141 2141 East 1256 1256 1136 106 14 1199 52 5 1256 *Not completed in 1970 TOTAL 3397 3397 3198 184 1 8 3305 82 10 3397 2141 PERCENTAGE 100.0 94.2 5.3 0.5 97.3 2.4 0.3 100 63.0 *NOTE: This treatment was completed February 1971. 1256 manholes were treated. Cleansing and Disinfecting Station The treatment of affected materials by cleansing, disinfection and/or disinfestation was carried out at the Department's Depot in Hornsey High Street, N.8. In addition to routine disinfection work to infected bedding or soft furnishings, bundles of articles were disinfected prior to despatch abroad. Supervised bathing and treatment of verminous persons and scabies patients was also carried out at the Station. The reorganisation of the Depots, as mentioned in the Annual Report for 1969, took place during the year and the Health Department Depot was moved to Wightman Road, N.4. on 1st April 1970. Laundry Service for the Incontinent During the year 2,467 bundles of soiled articles were cleaned and laundered. With the co-operation of the Tottenham Group Hospital Management Committee, the laundering of these articles was undertaken by the St. Anns Hospital laundry until a fire destroyed the hospital laundry on 21 October 1970. Alternative arrangements were made for the work to be carried on at the Council's laundry in the Hamilton Hogben Training Centre. Care is taken to ensure that the laundry is treated separately from the normal work undertaken at the Centre. Collections and deliveries are made twice weekly by the Department's general assistants. The names of persons requiring this service are normally referred to the Department by general medical practitioners, home nurses or home help organising staff. Fifty-nine people were helped by this service in 1970, the average number on the "active list" at any one time is about thirty. Insect Pests Free assistance is given to householders to eradicate insect pests, DDT continuing to be the most effective insecticide in dealing with the majority of these insects. PREMISES TREATED IN 1970 Insect Pest Houses Other Premises Ants 71 12 Beetles and Cockroaches 128 26 Bugs 131 - Fleas 134 3 Flies, Bluebottles and Maggots 38 1 Wasps and Bees 444 24 Other pests or precautionary treatment 108 4 TOTAL 1054 70 Where requests for assistance are received in respect of non-domestic premises a charge is made to cover the cost of the service. During 1970 £70.00 was received in this connection. Mortuary The Public Mortuary is situated in Myddleton Road, Hornsey, N.8. and is used for the reception of bodies from the whole of the Borough. During 1970, 392 bodies were received into Hornsey mortuary and a post-mortem examination was carried out in every case. 19 Inspections and Re-inspections carried out by Public Health Inspectors and Technical Assistants Statutory Nuisances 7,459 Drainage 1,403 Drain Tests 19 Surface Water Pollution 2,289 Vermin and Pests 483 Rodents 478 Accumulation of Refuse 698 Smoke Observations 201 Smoke Control 1,410 Noise 484 Disrepair Certificates 12 Housing Surveys 1,025 Multiple Occupation 9,438 Overcrowding 110 Other inspections under Housing Acts 961 Mortgage Advance 7 Improvements Grants 2,895 Infectious Disease (Not food borne) 382 Food Poisoning and food borne disease 197 Factories with Mechanical Power 371 Factories without Mechanical Power 9 Outworkers 79 Offices etc.: General Inspection 248 Offices etc.: Other visits 442 Shops Act 3,158 Employment of Young Persons 575 Bakehouses 113 Bakers and Flour Confectioners 204 Butchers 507 Canteens and Kitchens 178 Confectioners - Sugar 248 Fishmongers 90 Fried Fish Shops 135 Greengrocers and Fruiterers 482 Grocers 929 Hawkers of Food 53 Prepared Food Premises 28 Public Houses and Off Licences 212 Restaurants and Cafes 930 Slaughterhouses 310 Other Food Premises 218 Street Traders 2,091 Food and Drugs Sampling 868 Ice Cream Sampling 87 Milk Sampling 63 Surrender of Unsound Food 292 Investigation of Food Complaints 322 Bacteriological examination of Food 141 Hairdressers 54 Old People's Welfare 44 Pet Animals Act 66 Other visits 3,965 No access 4,265 20 Defects remedied as a result of action by District Public Health Inspectors Drains repaired 62 premises W.C. cisterns repaired or renewed 80 " W.C. pans renewed or cleansed 24 ,, Flush pipes repaired 15 " Waste pipes repaired or renewed 66 ,, Rain water pipes repaired or renewed 88 ,, Roofs repaired or renewed 451 ,, Eaves gutters repaired or renewed 166 ,, Drinking water cisterns renewed or covered 2 ,, Water service pipes repaired 19 ,, Yards repaired or reconstructed 17 ,, Floors repaired or renewed 132 ,, Dampness remedied 420 ,, Window frames and sashes repaired, renewed or painted 323 ,, Fire places, stoves and ovens repaired or renewed 6 ,, Flues and chimney stacks repaired 3 ,, Brickwork of walls repaired and walls rebuilt 79 ,, Wallplaster repaired 307 ,, Ceiling plaster repaired 185 ,, Rooms cleansed 12 ,, Staircases, balconies and steps repaired or renewed 34 ,, Noxious accumulations removed 79 ,, Nuisances from animals abated 4 ,, Miscellaneous defects remedied 300 ,, Statutory Notices Served Housing Act 1957 Section 78 (Overcrowding) 17 (A summary of the statutory provisions with regard to overcrowding is shown on page 30) Housing Act 1961 (Houses in Multiple Occupation) Section 12 (Management Orders) 2 Section 14 (Neglect of Management) 2 Section 15 (Amenities) 15 Section 16 (Means of Escape in case of Fire) 20 Section 19 (Limitation of number of occupants) 4 Public Health Act 1936 Section 39 (Drainage) 49 Section 45 (Repairs of W.C.'s) 16 Section 79 (Accumulations of refuse) 2 Section 83 (Cleansing premises) 1 Part III (Statutory nuisances) 238 Public Health Act 1961 Section 17 (Drainage) 27 Tottenham Corporation Act 1952 Section 43 (Urgent Repairs) 109 21 Work Executed by the Council;— Work carried out in default of or by agreement with the owners during 1970 Public Health Act 1936 Section 39 (Drainage) 1 premises Section 45 (Water Closets) 1 ,, Part II MStatutory Nuisances) 3 " Public Health Act 1961 Section 17 (Drainage Clearance) 15 ,, Section 18 (Drainage repair) 1 " Tottenham Corporation Act 1952 Section 43 (Emergency Repairs) 37 ,, Housing Act 1961 Section 14 (Houses in Multiple Occupation: Management) 1 " Section 15 and 16 (Houses in Multiple Occupation: Amenities and Fire Precautions) 4 ,, G.L.C. (General Powers) Act 1967 Section 23 (Defective water fittings or pipes) 1 " Rag Flock and Other Filling Materials Act 1951 No rag flock is manufactured in any premises in the Borough. 18 premises are registered for the use of filling materials in upholstery work or the stuffing of bedding, toys etc., but the use of rag flock as a filler is not now very common. Abatement of Statutory Nuisances The wide scope of the work tackled by the district public health inspectors means that their services are always in demand by the public. Primarily the work involves the inspection of premises which have been reported to be in any way prejudicial to health or a nuisance. Investigations are also made following observations by the inspectors during the normal course of their duties. Where defects are found the attention of the persons responsible is drawn to the matter informally, and frequently this suffices to secure the abatement of the nuisances, but, if not, a statutory notice is served specifying the works necessary. If this too fails to achieve the desired result then the matter is referred to the magistrates' court. During 1970 7,459 visits were made to investigate complaints and 842 informal notices were sent requesting action to remedy unsatisfactory conditions. In 238 instances it was necessary for this informal approach to be followed by the service of statutory abatement notices. Legal proceedings were taken against defaulters on 12 occasions resulting in fines totalling £75.00 and costs £70.00. In 109 cases where the normal procedure for securing the abatement of statutory nuisances would have been unduly lengthy having regard to the defective conditions arising, urgent notices were served under the provisions of section 43 of the Tottenham Corporation Act 1952 and repairs were carried out by the Council in the owner's default at 37 premises. Noise 484 visits were made in connection with complaints of noise. Usually the noise comes into two categories. Firstly noise emanating from business premises where an informal approach to the management usually achieves the desired co-operation. Frequently a good deal of technical research and experiment is necessary to decide the best and most economical method by which the legal requirement that the "best practicable means shall be used to minimise the effect of the noise or vibration", can be achieved. The second category involves noise which is generated by people working in private houses as outworkers 22 to the clothing trade where noise arises from the use of such machinery as sewing machines. Practical measures are recommended with the object of reducing the transmission of noise and vibration and if necessary the opinion of the town planning department is sought to ascertain whether the use is permissible in certain domestic premises. Sometimes complainants must be advised that the proper course of action would be to seek legal advice with a view to taking a civil action in the Courts Local bye-laws concerning noisy loudspeakers and also noisy animals are a great help in dealing with appropriate cases. Drain Stoppages Where complaints are received of obstructed drains the Public Health Department first investigates to see if the obstruction can be cleared by some simple action such as plunging. If so, this is carried out by the Public Health general assistants free of charge. In the event of the stoppage being more resistant, the owner is notified that immediate action is necessary to clear the drain and is invited to sign a form requesting the Borough Engineer's staff which has the use of heavier equipment to deal with the matter. In these cases the person responsible must undertake to meet the Council's charge. If agreement cannot be reached statutory action is taken under Section 17 of the Public Health Act 1961 whereby the Council does any necessary works and recovers the cost thereof from the owner of the premises. During the year 980 drains were cleared by the Public Health Department and 383 jobs were passed to the Borough Engineer's Department. It was also necessary to serve 27 notices under Section 17, Public Health Act, 1961 and in 15 of these cases to carry out the clearance in the owners' default. House Drying Assistance is given when premises have been saturated, caused possibly by burst water pipes or tanks or major roof defects. Powerful hot air blowers and dehumidifiers are taken to the premises and greatly speed up the drying out process. Accummulations of Refuse An unfortunate trend towards indiscriminate dumping of rubbish on any available site has continued throughout the year. The practice is conducive to the harbourage of vermin and causes a great deal of inspection and administrative work for the department. Diseases of Animals Act 1950 The Council is the responsible local authority under this Act, but no local emergency arose during the year which required special action in this respect. Pet Shops and Animal Boarding Establishments 19 premises are licensed as pet shops and there are two licensed animal boarding establishments in the Borough. Regular inspections are made by the public health inspectors to ensure compliance with the Council's licensing conditions, and arrangements have been made for veterinary supervision of the premises and animals to be carried out by Mr. F.G. Buxton, F.R.C.V.S. HOUSING Unfit Houses Progress continued, but because of the limitations on the Council's resources, at a reduced pace, in the representation of areas of houses considered to be unfit for human habitation and in the confirmation for clearance of such areas. Areas of houses listed in the Council's Inspection Area Programme for 1970 were examined in detail and reports and recommendations were made appropriate to the conditions found upon examination. Targets for the year as to number of areas inspected and the anticipated dates of reports on the areas were not fully achieved, partly due to staff shortages and also in some measure due to the pressure of activity under the Housing Act 1969 in relation to sounder houses and to a lowering of emphasis upon the urgency of dealing with houses already unfit for habitation. Observations were made during the year of progress in the clearing of sites of confirmed clearance areas. At five confirmed areas clearance of the site was completed and work proceeded at seven other confirmed areas. 23 Four areas were confirmed for clearance during the year. These comprise a total of 222 houses which were occupied by 291 families. Two areas which were represented during 1969 still await confirmation. These comprise a total of 340 houses which are occupied by 394 families. Eight areas were represented for clearance during 1970. These covered 190 houses and 298 families. Public Local Inquiries were held in respect of three areas for clearance under Part III Compulsory Purchase Orders. Contrary to the expectation that the increased compensation in respect of unfit houses under the Housing Act, 1969, would tend to reduce the number of objections, many objections were made to the classification of houses in the clearance areas. These objections were accompanied by claims for good maintenance and much time of the Minister's Inspectors were taken up in dealing with these claims. The figures above relate to houses within clearance areas. Numbers set out in the tables below show houses and families in clearance areas and also the total numbers of houses and families in the related Compulsory Purchase Orders. 1. Areas Demolished and Sites Cleared during 1970 Suffolk Road/Sutton Road/St. Ann's Road, N.15. Langham Road/West Green Road, N.15. Clyde Road/Lawrence Road, N.15. Western Road, N.22. Station Road/Brograve Road, N.17. 2. Areas confirmed before 1970 and not yet cleared The Grove, N.8. Brunswick Road, N.15. West Green Road/Stanley Road, N.15. Upper Tollington Park, N.4. Park Lane, N.17. Chesnut Road/Welbourne Road/Colsterworth Road, N.15. & N.17. High Cross Court, N.17. 3. Areas Confirmed during 1970 In Clearance Areas In Compulsory Purchase Orders Houses Families Houses Families Paxton Road, N.17 11 12 15 14 Kings Road, N.22 21 24 28 31 Birkbeck Road/St. Joseph's Road, N.8 185 250 249 299 Craven Park Road, N.15 5 5 5 5 222 291 297 349 4. Areas Represented before 1970 and not yet confirmed Russell Road/Victoria Crescent, N.15 186 240 196 250 Beaufoy Road/Tenterden Road, N.17 154 154 202 200 340 394 398 450 24 5 Areas Represented during 1970 In Clearance Areas In Compulsory Purchase Areas Houses Families Houses Families Eade Road/Vale Road, N.4 39 88 40 88 Boyton Road/Eastfield Road, N.8 44 62 48 66 Tebworth Road, N.17 9 8 10 9 Philip Lane, N.15 13 15 16 18 Summerhill Road, N.15 18 20 21 24 Clarendon Road, N.15 36 54 60 84 Lealand Road, N.15 11 24 11 24 Westerfield Road, N.15 20 27 28 35 190 298 234 348 The Compulsory Purchase Orders which were confirmed during the year were confirmed without modification except for 4 "Grey" houses where the sites were held to be unnecessary for the proper redevelopment of the area. Four houses were re-classified as "not unfit", three of these being owner occupied. The considerations upon which the fitness or unfitness for habitation of a house is assessed remains as indicated in Section 4(1) of the Housing Act, 1957 with the amendment of the Housing Act, 1969 concerning the internal arrangement added. There is some evidence however that, for various reasons, the general expectation in regard to quality of dwelling accommodation is at a higher level than heretofore. Rising incomes, the widespread publicity relating to the housing stock, the example of new building projects both public and private where houses are in good condition, dry and with modern and convenient facilities all influence the outlook of people presently obliged to live in poor housing conditions and tends to make them less tolerant of sub-standard accommodation with the attendant inconvenience and frustrations. It is clear that, for example, disrepair which might have been tolerated by the occupants of houses years ago is now regarded as unreasonable and its continuance a matter of resentment. A further example is the outside water closet which 10 years ago might have been considered readily accessible, now it is not. The "twilight" house, that is, the sub-standard house which is structurally of poor quality or is of unsuitable design for rehabilitation and not yet so unsound as to warrant immediate Part III clearance, remains a problem not discernably diminished as the years pass. The constant deterioration of buildings, the lack of adequate maintenance and a heightening expectation in regard to quality of accommodation give rise to the continued existence of a large body of unsatisfactory dwellings in which people must live for many years with a doubt as to a successful outcome of remedial efforts within the foreseeable future. Many dwelling units of long term good quality are urgently required and with the strengthening interpretation of Section 4(1) of the Housing Act, 1957 on the one hand and the provisions for rehabilitation outlined in the Housing Act, 1969 on the other, the way is indicated leading to a reduction of the "Twilight" band of houses and to a line of demarcation between buildings suitable for clearance and those for early repair and improvement. The following dwellings were the subjects of closing orders or demolition orders made during the year. These were houses or parts of houses which were unfit for human habitation which could not be made fit at reasonable expense: — 157 Hornsey Park Road N.8 16 Ennis Road N.4 140 Cornwall Road N.15 48 Endymion Road N.4 67 Lothair Road N.4 88 Upper Tollington Park N.4 1 & 2 Francis Place N.6 4 Northwood Road N.6 587 Seven Sisters Road N.15 81 West Green Road N.15 As adequate repair works had been executed, the closing order relating to part of the under-noted house was determined during the year: — 28 Avenue Road N.15 25 Improvements and Rents The Housing Act 1969 has linked the improvement of properties with the decontrol of controlled tenancies and the re-assessment for rent purposes of "regulated" tenancies and this is an additional incentive to owners to modernise their properties. If, when the Act came into operation on 25th August 1969, a dwelling let at a controlled rent, was provided with all the standard amenities and these amenities continue to be available, the owner can apply to the Council for a Qualification Certificate to enable him to request the Rent Officer to fix and register a fair rent for the dwelling and this rent can be brought into operation, the increase being phased over a period of five years. Before issuing the Qualification Certificate the Council must be satisfied that, in addition to having all the standard amenities, the dwelling is fit for human habitation and is in good repair having regard to its age, character and locality. 437 applications for Certificates were received in 1970. Applications for Qualification Certificates Dwellings having amenities at 25th August 1969 No. of Applications received since 25th August 1969 701 No. of Qualification Certificates Granted 21 No. of Qualification Certificates Refused 112 No. of Applications withdrawn 6 No. of Applications where owners notified of repairs needed 326 No. of Applications under investigation at 31st December 1970 236 Where a controlled dwelling lacked some of the standard amenities in August 1969, the owner may submit proposals for installing these amenities, with or without the aid of a grant from the Council and apply for a Certificate of Provisional Approval. This will enable him to request the Rent Officer to indicate the fair rent for the improved dwelling if and when the improvements and repairs have been completed. When the fair rent has been fixed and the tenant advised, the owner must then request the tenant to consent to the improvements being carried out: and only if this consent is given can the owner be entitled to a Qualification Certificate upon the satisfactory completion of the work. This enables him to request the Rent Officer to register the fair rent. 122 applications were received in 1969. Applications for Qualification Certificates Missing Amenities to be provided No. of Applications received since 25th August 1969 136 No. of Certificates of Provisional Approval issued 50 No. of Qualification Certificates issued 4 No. of Applications withdrawn 9 No. of Applications under investigation or negotiation at 31st December 1970 77 General Improvement Areas Under the Housing Act 1969 the Council may declare general improvement areas where it is considered that special efforts are warranted to secure the improvement of dwellings in the areas supplemented by general environmental improvements to the area to make it a more pleasant area in which to live. Consultation and collaboration with the residents and owners is an essential feature of any scheme of this nature as its success must rest wholly upon their co-operation and active participation. The house condition surveys of two prospective areas were completed in 1970 and these were declared General Improvement Areas on the dates shown: Durban Road, G.I.A. (115 Dwellings) 6th July 1970 Clonmell Road, G.I.A. (289 Dwellings) 30th November 1970 26 General Imornvement Area Survevs 1970 Conditions Found Durban Road Area Clonmell Road Area TOTAL No. of Premises (Building/S/C dwellings) 110(115) 289 399(404) Tenure: Owner-occupied sole 28 146 174 " part 1 18 19 Controlled tenants 43 94 137 Regulated " 36 83 119 Service — 2 2 Total: Households 108 343 451 Occupation: Single household 96 230 326 Two 6 46 52 Three " 7 7 Vacant " 8(13) 6 14(19) Part Vacant - 2 2 Type: Terraced 108 289 397 Semi-detached 2 — 2 Of above Part-Shop (or business) 3 10 13 Self-contained flats 5(10) - 5(10) External Condition: Structure Poor 2 2 4 Fair 35 88 123 Good 68 199 267 Repair Poor 17 6 23 Fair 64 157 221 Good 24 126 150 Decoration Poor 35 10 45 Fair 43 142 185 Good 27 137 164 Internal Condition: Structure Poor 3 3 6 Fair 35 86 121 Good 67 200 267 Repair Poor 12 4 16 Fair 65 145 210 Good 28 140 168 Decoration Poor 22 12 34 Fair 44 135 179 Good 39 142 181 Existing Facilities: Bath 43 243 286 Hot water 40 218 258 Cold water 42 243 285 Wash Hand basin 32 158 190 Hot water 29 146 175 Cold water 32 158 190 Sink 106 336 442 Hot water 58 224 282 Cold water 106 336 442 Internal W.C. 44 233 277 No. improvement required 22 117 139 Cars: Number 27 102 129 Parking facilities 1 - 1 Garages — 1 1 Repair Costs (Estimated) (£) 36,050 46,280 82,330 Improvement Costs (Estimated) (£) 52,930 83,740 136,670 Total Costs (Estimated) (£) 88,980 130,020 219,000 Repairs needed to already improved houses (£) 1,470 5,270 6,740 Attitude of residents to proposals For 54 108 162 Against 27 59 86 Overspill (Units/Persons) 3(6) 24(59) 27(65) Housing Gain (Units) 1 - 1 Council owned — Improved 7 2 9 — Improvement in hand 3 — 3 " " — Not improved 5 — 5 Improvement Grants During the year applications for improvement and standard grants under the Housing Act 1969 were lodged at a continually increasing rate so that by 31st December applications had been received in respect of 550 dwellings, as follows: — Standard Grant 213 Improvement Grant 194 Conversion Grant 140 TOTAL 550 27 Grants approved during the year amounted to £148,297 in respect of 331 dwellings and details are set out in the accompanying Table and graphs. To provide a complete picture since the inception of the Housing Act 1969, the months of September to December 1969 have been included in the two graphs. As public awareness and understanding of the availability and scope of grants has become more widespread, so has a trend of increasing complexity become apparent in the applications received in respect of conversions and works of improvement. This has placed an ever increasing burden upon both the technical and administrative staff. By the end of the year there appeared to be indications of a near-deluge of enquiries and applications. Very limited office accommodation is a hampering factor in dealing with the intricaces of improvement grant work plus the fact that the technical and administrative sections are physically separated from one another in different buildings. LONDON BOROUGH OF HARINGEY HOUSING ACT 1969 DETAILS OF GRANTS 1970 Month CONVE RSIONS IMPROVEMENT GRANTS STANDARD GRANTS No. Received No. Approved Amount of Grants £ No. Paid Amount Paid £ No. Received No. Approved Amount of Grants £ No. Paid Amount Paid £ No. Received No. Approved Amount of Grants £ No. Paid Amount Paid £ JAN - 6 3,139 2 346 6 6 2,936 5 1,790 14 10 1,215 7 909 FEB 5 7 3,020 - - 15 4 2,559 - - 20 11 1,925 2 470 MAR 11 - - 2 488 13 2 1,250 4 1,352 22 12 1,467 6 688 APR 7 7 3,489 - - 12 10 4,680 4 983 22 8 800 13 1,636 MAY 15 3 999 2 941 14 15 5,174 4 2,169 29 9 2,225 6 820 JUN 15 31 27,550 3 1,786 18 2 479 6 1,758 16 15 3,217 9 1,000 JULY 11 3 2,015 1 288 21 10 2,953 6 2,323 11 11 1,280 1 185 AUG 7 3 1,859 - - 24 11 4,112 7 2,738 8 8 1,442 7 1,921 SEP 24 8 6,109 3 1,081 23 8 3,142 7 3,441 26 6 1,045 3 305 OCT 17 8 4,244 - — 19 11 4,719 5 1,421 17 4 963 5 882 NOV 14 15 8,841 3 1,464 17 16 5,132 8 3,376 17 14 1,649 5 928 DEC 14 28 17,922 6 4,152 15 27 12,404 2 809 11 47 1,342 3 399 TOTALS 140 119 79,187 22 10,546 197 122 49,540 58 22,160 213 155 19,570 67 10,143 28 29 HOUSES IN MULTIPLE OCCUPATION Staff shortage has continued to restrict the work of this section of the Department, and the position was further aggravated during the year by prolonged periods of sickness amongst some of the staff. The problem arising when houses in multiple occupation were deprived of gas or electricity supplies, due to the statutory undertakers withdrawing their services because of non-payment of accounts by owners, continued. The legal complications are that there is no simple, effective and expeditious way of dealing with this matter. If it could be proved that the manager of a house in multiple occupation had "unreasonably caused a supply of gas or electricity to be withdrawn" then the power given to the Council under existing legislation is to prosecute for an infringement of the regulations covering houses in multiple occupation. This process obviously takes several weeks; and, in any case, would merely secure a penalty in the Court, and not necessarily obtain restoration of the gas or electricity supply. A Control Order or Compulsory Purchase Order would not achieve a quicker solution and may not be reasonable in all the circumstances. A Control Order, in particular, is a very complex procedure involving many of the Council's departments and a Compulsory Purchase Order is, of course, subject to the delays inherent in the procedure laid down. However, these problems were somewhat relieved by the acquisition during the year of 3 calor gas operated hot plates, with grills fitted, together with appropriate gas storage cylinders. This apparatus was in fact required by the Welfare Department, at the instigation of the Public Health Department, and it has been arranged that its loan is controlled by the Public Health Inspectorate. The use of this apparatus was kept to a minimum by the persistence and tenacity of the Public Health Inspectors in persuading the owners to take the necessary action, generally by paying outstanding accounts, sometimes with the addition of a deposit, in order to restore supplies. However, it has been invaluable to have the use of this form of emergency cooking available to assist in the very difficult situation that does arise when a family no longer has facility for the cooking of food. This does not, of course, solve the problem of either space heating or of artificial lighting when these are affected by the withdrawal of supplies; so, during the year, consideration was given as to what other effective action could be taken in these situations. The result was the inclusion in the Haringey Corporation Bill, to be laid before Parliament, of a clause to empower the Council to pay the outstanding account in cases of this type and so secure the speedy reinstatement of supplies. It was intended that the amount expended would then be recoverable from the owner or person letting the premises and become a charge upon the property until this had been done. If and when this bill becomes law, it will form an extremely useful addition to the legislation concerning houses in multiple occupation in Haringey, which, it is believed, would be the first local authority to obtain such powers. Consideration was also given during the year to the question of a scheme of registration for houses in multiple occupation under the amended powers created by the Housing Act 1969. The Social Services Committee, however, were satisfied that the Public Health Inspectors were sufficiently informed as to the amount of, and location of, multiple occupation in the Borough without introducing a registration scheme, and were of the opinion that there would be no point in the Council deciding to introduce a registration scheme at the present. It is considered that advice received from the Ministry of Housing and Local Government some time ago, when schemes of registration of houses in multiple occupation were being considered, is very pertinent. "There is no point in devoting time to a comprehensive scheme unless the information it reveals can be quickly followed up by inspection and remedial action when necessary." This is certainly considered essential with a scheme of this nature and, for the scheme to be effective, a considerably increased staff of widely experienced Public Health Inspectors, expressly to deal with multiple occupation, would be required. Overcrowding The following is a summary of the statutory provisions with regard to overcrowding: — 1. Overcrowding is illegal The Housing Act 1957 provides that it is an offence for any occupier of a dwelling-house or the landlord thereof to cause or permit the house to be over-crowded. 2. Definitions (a) "DWELLING-HOUSE" means "any premises used as a separate dwelling". (b) "LANDLORD" means "the immediate landlord of an occupier'" 30 3. Minimum standard of accommodation (a) A dwelling-house is deemed to be over-crowded if the accommodation is such that any two persons, being ten years old or more, of opposite sexes and not being persons living together as husband and wife, are obliged to sleep in the same room. (b) The maximum number of persons, irrespective of sex, who may be permitted to sleep in a dwellinghouse at one time is fixed in relation to the number and sizes of the rooms in the house. The maximum permitted number may be ascertained by reference to the Public Health Department. 4. Duties of landlords It is the duty of the landlord to prevent his dwelling-house from becoming overcrowded, and the landlord will be deemed to have caused or permitted a dwelling-house to be overcrowded if, after the Council has notified him or his agent in writing that the house is overcrowded, he fails to take all reasonable steps to secure the abatement of such overcrowding, by the removal of a tenant or tenants, including legal proceedings for the recovery of possession of the house. Every rent book or other similar document used in relation to a dwelling-house must contain the following summary of the provisions of the Act relating to overcrowding, including a statement of the number of persons permitted to sleep in the house. (i) An occupier who causes or permits his dwelling to be over-crowded is liable to prosecution for an offence under the Housing Act 1957, and, if convicted, to a fine not exceeding five pounds. Any part of a house which is occupied by a separate family is a "dwelling". (ii) A dwelling is overcrowded if the number of persons sleeping in it is more than the "permitted number", or is such that two or more of those persons, being ten years old or over, of opposite sexes (not being persons living together as husband and wife) must sleep in the same room. (iii) The "permitted number" for the dwelling to which this (Rent Book) (description of other document) relates is persons. In counting the number of persons each child under ten years of age counts as half a person, and a child of less than one year is not counted at all. Failure to insert this summary is punishable on conviction by a fine not exceeding ten pounds. 5. Duties of occupier It is the duty of an occupier to prevent overcrowding in his dwelling-house. To enable the Borough Council to discharge its duties under the Act, the occupier of a house is required to furnish to the Council a statement in writing of the number, ages, and sexes of the persons sleeping in the house, within fourteen days of receiving notice from the Council to that effect. 6. Enforcement of the Act It is the duty of the Council to enforce the provisions outlined above, and to take all proceedings for offences committed under the Act. 7. Penalties (a) An occupier or landlord of a dwelling-house who causes or permits it to be over-crowded is liable on conviction to a fine not exceeding five pounds and to a further fine not exceeding two pounds in respect of every day on which the offence continues subsequent to the date of conviction. (b) The Council may serve on the occupier of a house, which is over-crowded in such circumstances as to render him guilty of an offence, notice in writing requiring him to abate the over-crowding within fourteen days, and if at any time within three months from the expiration of that period, the house is still occupied by the person on whom the notice was served or by a member of his family, and is still over-crowded, in such circumstances as to render the occupier guilty of an offence, the Council may take legal proceedings to compel the occupier to vacate the house, and recover from the landlord the costs incidental to such proceedings. (c) If a landlord of a dwelling-house or his agent fails to notify the Borough Council within seven days after it has come to his knowledge that the house has become over-crowded, the landlord or his agent as the case may be is liable on conviction to a fine not exceeding two pounds. (d) An occupier must, on request by an authorised officer of the Council, produce for his inspection any rent book or similar document in his custody. In default an occupier is liable on conviction to a fine not exceeding two pounds. (e) If an occupier having been duly requested by the Council fails to furnish in writing a statement or knowingly makes a false statement of the number of and sexes of persons sleeping in the house within fourteen days of such request he is liable on summary conviction to a fine not exceeding two pounds. 31 HOUSES IN MULTIPLE OCCUPATION Summary of action taken in 1970 No. of separately occupied parts of houses visited for first time 951 No. of revisits to above 8,487 No. of inspections where multiple occupation would exist upon completion of mortgage advances being contempleted by this Council 87 No. of houses completely inspected 301 No. of houses where informal notices sent relative to S.15 (Amenities) 208 No. of houses where informal notices sent relative to S. 16 (Fire Precautions) 198 No. of houses where items of inadequate management notified to owners 135 No. of cases of penal overcrowding 76 No. of cases of penal overcrowding abated „ 38 No. of cases of non-penal overcrowding 25 No. of cases of non-penal overcrowding abated 19 No. of formal S.14 Notices (Management) 6 No. of formal S.15 Notices (Amenities) 15 No. of formal S.16 Notices (Fire Precautions) 20 No. of formal S.78 Notices (Overcrowding) 17 No. of houses where S.19 Directions made 4 No. of houses where S.12 Management Orders made 2 Other Notices served 241 Other visits including discussions with owners, builders etc. at premises 1,268 Completed work W.C.'s provided 11 Baths/Showers provided 12 Sinks/lavatory basins provided 19 Water heaters provided 73 Space heating provided 4 Fire precautions work 78 Repairs: External 138 Internal 217 FOOD HYGIENE In the past, it was common to note that in food premises, the parts observable by the public were often brought to a reasonable standard, whereas the rooms at the rear and not seen by the public were frequently neglected. However, the standard of hygiene generally has steadily improved and the different standards of care, order and hygiene between the front and rear of such premises is now much less marked. On the other hand, there is a greater contrast between the highest and lowest standard in any particular area, in other words, it appears that because of the general improvement, the isolated cases where the conditions fall below the standard required by the Regulations are more conspicuous. These unsatisfactory premises are found to be mainly the result of lack of knowledge and experience in the particular trade, undue emphasis being put on the profit motive, or occasionally to people obtaining a business with limited capital which has been expended in opening the premises leaving nothing for work required to achieve satisfactory arrangements and working conditions. 32 If the premises for any reason are not brought to a standard indicated by the Food Hygiene (General) Regulations, formal proceedings are the only answer and during the year under review, several such cases have been taken to the Courts by the Department, a procedure which was very rarely necessary in the past. A more encouraging fact is that more persons who intend taking control of food premises are asking for advice from the department whilst the work required to adapt the premises is in the planning stage. Others seek advice when alterations are contemplated with the result that many such premises are brought to a standard higher than could be enforced by the Regulations. Generally, the number of persons from overseas in control of food shops and restaurants has continued to increase during the year and it is also noted that there is a tendency for these people to set up in certain areas. Some of these shops tend to stock a very large variety of foods which range from paraffin to vegetables or butchers meat, resulting in overstocking in a limited space with its inevitable difficulties of stock rotation and cleansing procedures. The education in food hygiene of such persons is an uphill job which can only be achieved after many visits by the Public Health Inspectors attached to the Food Section. The total number of food shops at the end of the year was as follows: — Trade No. of Shops No. of Inspections Bakers and Flour Confectioners 98 204 Butchers 114 507 Cafes and restaurants 241 930 Confectioners, Sugar 375 248 Fishmongers 34 90 Fruiterers and greengrocers 171 482 Grocers 429 929 Off licences and public houses 200 212 Registered Food Premises At the end of the year the following premises were registered under Section 16 of the Food and Drugs Act 1955. Sale of ice cream 820 Manufacture and sale of ice cream 11 Storage of ice cream 1 Cooking of hams and other meat 65 Fish frying 56 Fish curing (smoking) 3 Sausage manufacturer 101 Preparation of "Hot Dogs" 1 Preparation of jellied eels 3 Shell fish 2 Prepared foods 23 Pickling meat 3 Total 1,089 In addition the following classes of food hawkers and their storage premises are registered under Section 11 Trade No. of Hawkers registered No. of storage premises Fruit and vegetables 129 93 Shellfish 14 5 Fish 13 4 Ice cream 31 5 Light refreshments 21 6 Peanuts 4 2 Eggs 3 — Groceries 10 3 Confectionery 1 1 Total 226 119 33 Milk and Dairies Regulations The number of distributors registered at the end of 1970 was 285. There are no dairies in the Borough where loose milk is bottled. Milk (Special Designation) Regulations At the end of the year the following licences to use special designations were valid for premises in the Borough: — Pasteurised Milk 233 Sterilised Milk 221 Untreated Milk 28 Ultra Heat Treated Milk 60 Imported Food Regulations 1968 Consignments of frozen liquid whole egg and egg whites have been imported direct to cold stores for some years, but since the advent of the above-mentioned Regulations and particularly during the year under review, the amount of food imported in sealed containers direct to the warehouses in the Borough without prior examination by the Port Health Authority has considerably increased. In addition to the eggs already mentioned, such 'container' consignments include meat, bacon, cheese, tinned milk, fruit juices and confectionery. Consignments of Imported Food examined under Imported Food Regulations Type of Food No. of consignments Egg, Frozen or dried 20 Cheese 21 Confectionery, Sugar 3 Meat and offal 32 Tinned milk or Fruit Juices 6 Total 82 Food Sampling A large number of samples over a wide range of foodstuffs was submitted to Mr. W.B. Chapman, The Council's Public Analyst, who gave invaluable advice regarding all aspects of the Food and Drugs Act and the Regulations made thereunder. In no case where dificiencies or minor irregularities were revealed was it necessary to take formal action as the manufacturers concerned were in each case anxious to comply with the law on the subject and in some cases, appreciated the advice we were able to offer. A number of articles of food were submitted to the Analyst as the result of complaints made by members of the public with regard to apparently unsatisfactory food purchased within the Borough and legal proceedings were instituted where the facts justified such action. In these cases, the Certificates issued by the Council's Analyst were of material assistance and in every case, proceedings were successful. Monthly samples of all designations of milk were submitted to the Analyst for chemical and bacteriological examination. It was frequently found that the percentage of milk fat or percentage of solids not fat were lower than the presumptive standard, but there was no evidence of added water. These results were sent to the dairy company concerned and also to the Chief Public Health Inspectors of the Boroughs in which the milk was bottled for their information and any action they considered necessary. Food samples were also collected regularly for submission to the Central Public Health Laboratory at Colindale. These are bacteriological investigations of food stuff which are normally intended for consumption without further cooking (cooked meat, meat pies, etc.) 34 FOOD SAMPLES Articles No. of Samples provided Unsatisfactory Analysis Labelling Alcoholic Beverages 3 2 Cereal and Starch Products 3 - - Cheese and Cheese preparations 13 - 1 Confectionery (Flour) 4 - - Drugs 89 3 1 Fish and fish products 5 - - Flour and flour products 8 - - Foods — miscellaneous 1 - - Herbs and herb preparations 7 - - Jam and preserves 3 - - Meat and meat preparations 57 3 - Milk 177 34 - Milk, Dried and condensed 1 - - Milk preparations 7 1 - Oils, fats and fatty foods 1 1 - Soft Drinks 27 3 1 Soup and soup mixes 15 - - Spices and condiments 4 - 1 Sugar confectionery 40 - 465 45 6 Details of unsatisfactory samples Sample Irregularity Comments and Action Taken Beef casserole Total meat content — 25 per cent deficient of legal minimum of 35 per cent Old stock, thought to have been withdrawn by manufacturer Kidney Rissotto Total meat content deficient A letter was sent to manufacturer who gave their assurance that this line has been discontinued. This explanation was accepted Beef casserole Sample contained approximately 9 small hairs + 2 small fragments of skin Identified as calf hairs or similar and reported to the manufacturer Cherry Yoghourt Contained benzoic acid, the addition of which is not permitted Manufacturer informed. No further action pending clarification of legal position Lemon drink tablets Sample contained cyclamic acid A letter was sent to the food importers, who gave their assurance that they have no more of this product in stock and that this situation will not recur. Remainder of stock surrendered Lemon squash Sample contained cyclamic acid Old stock — remainder uplifted by manufacturer Drugs (a) Contained light green S.F., unsuitable for internal use Manufacture discontinued (b) Contained colour ponceau SX Manufacturer's attention drawn to the matter (c) Deficient in Vitamin A Manufacturer's attention drawn — Further samples satisfactory — No further action taken 35 Sample Irregularity Comments and Action Taken Almond flavoured drink The sample was in an active state of fermentation Warning letters to manufacturer and shop-keeper. Appropriate Local Authorities informed Cotton seed oil Consisted of ground nut oil Miscalled by Staff of Factory. Both cotton seed oil and ground nut oil referred to by staff as ground nut oil 34 Samples of Milk Samples were deficient of the presumptive minimum standard of 3 per cent milk-fat laid down by the Saleof Milk Regulations. Deficiency due to natural causes Letters were sent to the dairies concerned and Local Authorities where bottling took place informing them Labelling The following labelling irregularities, noted in respect of 6 samples, were brought to the attention of the manufacturers or distributors responsible. Misleading Description — 1 case Insufficient information — lease No list of ingredients — 1 case Incorrect list of ingredients — 4 cases Food Complaints 87 complaints of unsound foodstuffs were investigated and, where appropriate, legal proceedings were instituted or warning letters sent. Details are shown in the following tablet- Commodity No. of Complaints Action Taken Formal action not justified Foreign bodies found Other Reasons Official warning letter Prosecution Baby Food 2 - 1 1 - Bacon 2 - 1 1 - Biscuits 1 1 1 1 — Bread 10 9 13 5 1 Cereal 2 1 1 1 1 Cheese — 1 1 — — Chicken — 2 — — 2 Confectionery (Flour) 5 1 2 4 - Confectionery (Sugar) 3 2 3 1 1 Corned Beef 2 1 3 1 - Cream 1 - 1 - Crispbread 1 - 1 Fish 3 1 1 - 3 Fruit (Fresh) - 1 1 - - Fruit (Tinned) 1 1 1 1 - Honey 1 — — 1 — Meat (Cooked) 5 1 3 3 Meat Pies 1 5 2 3 1 Milk 3 5 1 1 6 Oil — 1 — 1 - Peanuts 1 - - - 1 Prepared Food 3 2 — 5 — Vegetables (Tinned and Frozen) 1 2 1 - 2 Yoghourt - 2 1 1 - 47 40 37 29 22 36 Prosecutions were instituted in 29 cases where it was judged that the circumstances warranted such action. In two cases, although found guilty, the defendants were granted absolute discharges. In the remaining 27 cases the offences were found to be proved and fines totally £625 were imposed with £212.25p costs. Seizure of Unsound Food Whilst conducting a routine food hygiene inspection of a self-service grocers shop the Public Health Inspector observed a quantity of groceries contaminated with mouse droppings. The contaminated foodstuff was seized and taken before a Magistrate who condemned it as unfit for human consumption. Proceedings were taken against the shopkeeper in respect of contraventions of the Food Hygiene Regulations and for having unsound food deposited for sale. He was found guilty on all six charges and fined a total of £115 and £8 costs. Surrender of Unsound Food 1,212 Certificates were issued in 1970 in respect of unsound foodstuffs which were surrendered by wholesale and retail distributors. Meat Inspection The abattoir in the Markfield Road, N.15, constructed in 1969 increased its throughput during 1970, and in September 1970, an authorised meat inspector was appointed by the Council to assist in the inspection services which the Public Health Inspector is statutorily required to provide. The abattoir is constructed to deal with many types of animals where the flesh is intended for human consumption but the bulk of the work covers bovines and horses, the flesh of some of which is intended for export. The Company is licensed by the Ministry of Agriculture, Fisheries and Food to export to countries within the European Economic Community and such a licence is only granted to an abattoir which complies with the stringent requirements of the E.E.C. The whore or parts of carcases which are rejected as unsuitable for human consumption are passed directly for processing, sterilization and manufacture into pet food within a separate building in the same complex. This arrangement is regarded by the Public Health Department as eminently satisfactory since the rejected meat is not removed from the direct supervision and control of this department. SUMMARY OF CARCASES INSPECTED 1970 Goats Donkeys Bovines Horses Calves Sheep and Lambs Cows Number killed 5 3 210 467 172 29 2,043 Number inspected 5 3 210 467 172 29 2,043 All diseases except Tuberculosis Whole carcases condemned - - 16 5 3 3 98 Carcases of which some part or organ was condemned - 2 109 338 47 14 1,631 Percentage of number inspected affected with disease other than tuberculosis - 66.6 59.5 73.4 29.0 58.6 84.6 Cysticercosis only Whole carcases condemned - - - - - — 7 Carcases of which some part or organ was condemned — - - 1 - - - 3 Percentage of number inspected affected with cysticercosis - - 0.5 - - - 0.5 Note: There were no cases of tuberculosis reported during the year The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 The Middlesex County Council Act 1950 — Section 11 On the Tottenham Hotspur Football Club match days, regular visits were paid by members of the Department to the streets in the vicinity of the ground to check whether the vendors of "hot dogs" and other foodstuffs were complying with the above-mentioned Regulations. Although the standard has appreciably risen over the years and the vast majority of vendors offer no threat to public health, satisfactory standards are difficult to enforce, especially in regard to the itinerant vendors who appear at the important matches for the first and sometimes the only time. 37 Offices, Shops and Railway Premises Act 1963 Special attention has been paid to the inspection of lifts under the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968. The advice of the Deputy Superintending Factory Inspector was sought with regard to hand-operated lifts, especially those used in public houses. These present many problems, including practicability of complying with the regulations and the question is still being considered by central government and technical and legal officers. Class of Premises No. of Premises Registered during 1969 No. of Registered premises at end of year No. of Registered premises receiving a general inspection 1969 Offices 17 475 224 Retail Shops 23 1,098 488 Catering establishments and canteens 2 153 38 Wholesale shops and warehouses 2 69 2 Fuel Storage Depots - 3 - 44 1,798 752 Analysis of Contraventions Found Section Type of contravention No. found Section Type of contravention No. found 4 Cleanliness 10 12 Clothing accommodation 2 5 Overcrowding - 15 Easing Facilities - 6 Temperature 48 16 Floors, Passages, Stairs 49 7 Ventilation 1 17 Fencing machines 13 8 Lighting 4 23 Heavy work - 9 Sanitary conveniences 13 24 First Aid 35 10 Washing facilities 14 50 Abstract 41 11 Supply of drinking water - Persons employed in registered premises Class of workplace No. Offices 6,965 Retail Shops 6,571 Wholesale Shops, Warehouses 1,477 Catering establishments 1,088 Canteens 238 Fuel Storage Depots 35 Total 16,374 Males 7,330 Females 9,044 38 Reported Accidents Workplace No. Reported Total No. investigated Prosecution Formal warning Informal warning No Action Offices 5 2 - - - 2 Shops, Retail 52 31 — — 9 22 Wholesale Shops 5 2 — - - 2 Catering establishments 2 2 — 1 1 — Fuel Storage depots 2 2 - - - 2 Total 66 39 - 1 10 28 Analysis of Reported Accidents Offices Retail Shops Wholesale Warehouses Catering Establishments Canteens Fuel Storage depots Machinery - 6 1 - - Transport — 4 — — — Falls of persons 3 16 2 2 - Stepping on or striking against object or person - 4 - - - Handling goods 2 13 - 1 - Struck by falling objects - 2 2 - - Fires and explosions - 1 - - - Electricity - 1 - - - Use of hand tools — 2 — — - Not otherwise specified - 3 - 1 - Hairdressers Section 21 of the Greater London Council (General Powers) Act 1967 was applied to Haringey with effect from 1st January 1968. This requires all persons carrying on business as hairdressers or barbers at premises in the Borough to be registered with the Council. New byelaws in respect of such establishments in Haringey were approved and came into force on 1st October 1968. These prescribed standards of hygiene in relation to the premises, equipment and persons working on the premises. 184 premises were registered at the end of the year. All are inspected from time to time based on an assessment of conditions found at the times of previous inspections. Shops Act 1950- 1966 A total of 3,158 shops inspections were made during the year. The following contraventions were noted: — General Section 17(2) Assistants weekly half holiday notice not displayed 302 Section 32(2) Notice of hours of employment of young persons not displayed 61 Section 32(2) Abstract of provisions of employment of young persons not displayed 56 Closing Hours Section 2(1) Failed to close at prescribed hour 9 Section 1(1) Failed to close at 1pm on early closing day 7 Section 1 (2) Failed to exhibit early closing day notice 124 Section 13(1) Failed to exhibit exempted trade notice 177 Sunday Trading Section 22(3) Failed to keep record of hours of employment 3 Section 57 Failed to exhibit Sunday Trading Notice 38 Section 53 Persons observing Jewish Sabbath: Contraventions Nil 39 Street Trading Although there is no street market in the Borough, 27 sites on the public highway are licensed for street trading. The majority of these are in side roads off the Tottenham and Wood Green High Roads and off West Green Road, N.15. The Council also license 19 small sites on the public footpath for trading. These are occupied mainly by newsvendors and are situated in the vicinity of British Rail and Underground Stations. FACTORIES The local authority has responsibilities to inspect the sanitary accommodation and water supplies, in all factories and business premises. In factories where no mechanical power is used, the other welfare provisions of the Factories Acts are also the responsibility of the local authority. Frequent visits are made to factories for a variety of reasons and it is the usual practice to check all the conditions whilst on the premises. Premises No. on Register No. of Inspections Written Notices Prosecutions (1) Factories in which sections 1, 2,3,4 and 6 are enforced by the local authority 58 9 - - (2) Factories not included in (1) in which section 7 is enforced by local authority 1,014 • 361 11 - (3) Other premises in which section 7 is enforced by local authority excluding outworkers 17 - - - Total 1,089 370 11 - Summary of defects found in factories Particulars No. of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Sanitary conveniences (S7) (a) want of cleanliness 19 8 - - (b) unsuitable or defective 21 6 - - (c) not seperate for sexes 1 - - 1 (d) no intevening lobby 6 2 - - (e) w.c's not labelled 2 - - - Abstract 6 - 6 - 55 16 8 1 Outworkers Employers of outworkers in certain specified trades are required to make half-yearly returns showing the home addresses of such workers and the class of work upon which they are engaged so that any necessary steps can be taken to prevent work being undertaken in unwholesome premises, or to stop the spread of infectious disease. Outworkers Trades No. employed Making of wearing apparel 183 Making of curtains and furniture hangings 4 Making of handbags 1 Making of Sacks 1 Umbrellas 4 40 Outworkers Trades No. employed Artificial flowers 7 Cardboard boxes 10 Brushes 4 Fancy Goods 1 Christmas crackers 9 Total 224 174 visits were made to outworkers premises. RADIOACTIVE SUBSTANCES ACT 1960 Only one additional notification of the holding of radioactive material at premises within the Borough was received during the year. This related to the use of tritium in a gaseous form for the purpose of carrying out tests in connection with the manufacture of fluorescent lamps. Premises using radioactive materials are visited by one of the senior Public Health Inspectors so that the department can be kept informed of the levels and use of these materials within the Borough. STUDENT PUBLIC HEALTH INSPECTORS The Department has an establishment of eight student public health inspectors, with two pupils on each year of the four-year course. They attend the Education Board Diploma day-release course at the Tottenham Technical College. The in-service training is directly supervised by a Senior Public Health Inspector who has steadily expanded and developed their programme of practical work, to ensure that, when qualified, the officer has had a very full experience of the best methods of dealing with the problems he is likely to meet with as a public health inspector. 41 PART II PERSONAL HEALTH SERVICES AND INFECTIOUS DISEASE CONTROL Co-ordination and Co-operation with Hospital and Family Doctor The Health Service now moves towards the unification of the tripartite organisation with the anticipated establishment of the Area Health Authorities in 1974. We must work towards this evolution in an attempt to visualise the new concept of community physician. The Health Departments of the Local Authorities have over many years evolved a very highly efficient approach to epidemiology and it is to be hoped that some of these practices can be adapted to the needs of the new Area Health Authorities. In Haringey we have been particularly fortunate in a long and useful association with the hospital services in the specialties of chest disease, paediatrics, infectious and venereal diseases. Elsewhere in the report reference is made to our more recent involvement with the dermatologist to establish a warts clinic, with a haematologist to ensure safer dental anaesthesia in children with sickle cell anaemia, and with a surgeon in a long-term research project into the problem of breast cancer. In our links with general practice the outward sign of growth and co-operation can be seen in the Health Centre at Stuart Crescent where staff of both share the same roof to develop together a more comprehensive service to the communities in which they work. The Health Department's weekly bulletin has been a useful vehicle of communication with general practitioners. Primarily a communication for information on infectious disease it has developed into a many-sided publication dealing with a variety of problems, and a useful section about medical meetings and hospitals has helped to give an effective boost to the attendance at academic centres and so improve the links between general practitioner and consultant. Appreciation of the bulletin would appear to be indicated in that requests are made for it from many authorities from the Elephant and Castle downwards. Indeed, publications of this kind may have a vital part to play in the improvement of the services provided by future Area Health Authorities. During the year arrangements were made for different groups of general practitioners to meet up with their associated nursing teams together with other staff of the Health Department and at these meetings a variety of problems were considered. CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Live Births (a) Domiciliary 332 (b) Hospital or Nursing Home 4,056 Still Births (a) Domiciliary 3 (b) Hospital or Nursing Home 47 Total 4,438 Family Planning From August 1970 the Borough agreed to pay the consultation and advice fee for all clients. Per capita fees were agreed with the Family Planning Association for two types of case — priority cases in certain medical and social categories, the Council paying consultation and advice fee and necessary supplies of contraceptives; and non-priority, the Council paying consultation and advice fee only. The number of cases for whom responsibility was accepted under these arrangements to the end of the year were — priority cases 131; non-priority cases 1,101. The number of priority cases dealt with under previous arrangements, up to July 1970, was 184. The domiciliary scheme continued to function as previously and 203 cases were dealt with by this service in 1970. In October the Family Planning Association opened an additional I.U.D. Clinic at Hornsey Central Hospital, and there are now 11 % weekly family planning clinic sessions held in the Borough. 42 Family Planning — for Unmarried Girls I am indebted to Dr. Christopher for her statistics on the work of the Family Planning Clinic for unmarried girls and below is an extract from her comments:- "We have very few West Indian patients and those that are seem to come from the nearby Home for unmarried mothers. A point of note is the 'problems'. They are not necessarily having treatment for them or even admit that they have them; this is an assessment by the clinic doctor. It would seem that Fortis Green is largely a clinic for 'middle-class' girls and there are quite a number of unplanned pregnancies among them, though they tend to seek termination of the pregnancy, whereas the girls from poorer homes tend to have the babies and may get them adopted or may keep them". Fortis Green Clinic for Young People Total No. of cases December 1968 — October 1970 500 Regular Attenders 314 Transfers 66 Non-attenders 120 (58 of these attended once only) Ages of Girls Nationalities 15 years 5 England 449 16 23 Europe 16 17 48 West Indian 16 18 42 Australia, New Zealand, S. Africa 9 19 56 Eire 5 20 86 India 2 21-25 204 Chinese (Hong Kong) 1 26+ 36 U.S.A. 1 Greek Cypriot 1 Referring Agent Occupation Friend 161 Clerical (secretaries, typists) 190 Reading about it 127 Students 94 G.P. 88 Teacher 40 F.P.A. Transfer 62 Schoolgirl 21 Beacon Lodge 30 Nurse 12 Social Worker 17 Unemployed 20 Hospital 15 Factory Hairdresser Shop Assistant Musician Other 123 Artist Librarian Dental Nurse Lab. Assistant Total No. Unplanned Pregnancies 116 Termination 37 Abortions Spontaneous 3 Criminal 3 43 Illegitimate Adopted 38 Children Kept Baby 31 73 (4 children died) 43 Girls from Beacon Lodge accounted for 38 of the above children and 3 abortions. 14 of 16 West Indian girls had illegitimate children. They came from Beacon Lodge. Methods chosen:- Oral Contraceptive 401 Cap 66 I.U.D. 5 Nil 28 Methods used before attending clinic:- Withdrawal Safe period Sheath Nil Problems: Sexual 33 Relationship (and Sexual in some cases) 121 (of these 64 had had unplanned pregnancy) Ante-Natal Clinics The attendances during the year are shown in the following table:- Clinic Total Attendances Sessions held Ante-natal Post-natal Average attendance per session Burgoyne Road 48 480 41 10.8 Chestnuts 93 809 60 9.3 Church Road 44 158 5 3.7 Fortis Green 50 676 33 14.1 Gordon Road 52 589 51 12.3 Lordship Lane 50 468 44 10.2 Mildura Court 52 672 32 13.5 Park Lane 52 658 68 14 Stroud Green 51 413 21 8.5 Weston Park 102 916 50 9.5 Stuart Crescent 51 231 25 5.0 TOTAL 645 6,070 430 10 A Midwives' Ante-Natal Clinic was held at Park Lane Centre on 34 occasions. 50 attendances were made for ante-natal consultations. There were no post-natal attendances. Cervical Cytology Clinics continued to be held at centres, as part of the routine ante-natal clinic sessions. One weekly evening session solely for cervical cytology continued at Mildure Court Centre, Hornsey, where 36 sessions were held. 6 evening sessions were held at Burgoyne Road Centre in connection with a special campaign. 44 Attendances at clinic sessions were as follows:- Clinic Attendances Burgoyne Road 106 Chestnuts 218 Church Road 24 Fortis Green 84 Gordon Road 109 Lordship Lane 141 Mildura Court 287 Park Lane 167 Stroud Green 44 Stuart Crescent 82 Weston Park 151 TOTAL 1,413 Nine sessions were held at four local factories, 2 for staff at a local hospital, and 10 at a local telephone exchange. At these sessions 296 smears were taken. In all, 4 "positive" cases requiring further investigation were found, of whom 2 were subsequently diagnosed as cancer, and 2 are still under investigation. I should once more like to express my gratitude to the Haringey Cancer Control Committee for their continued help, by public meetings and publicity displays. Child Health Clinics The following table of attendances during the year indicates the continuing need and use of the service Clinic Sessions Attendances Average attendance per session Number of cases seen by M.O. Number of cases referred elsewhere Alexandra Park Road 53 1,877 35.4 531 39 Burgoyne Road 153 5,188 33.4 996 2 Chestnuts 198 4,960 25 1,923 47 Church Road 153 2,568 16.8 1,054 10 Fortis Green 105 3,616 34.4 1,609 17 Gordon Road 104 2,621 25.2 994 79 Lordship Lane 204 4,784 23.4 1,614 13 Mildura Court 100 3,242 32.4 1,215 46 Park Lane 155 5,035 32.5 2,177 44 Somerset Road 148 2,010 13.6 969 76 Stroud Green 103 4,381 42.5 1,213 20 Weston Park 152 5,559 36.6 2,080 33 Stuart Crescent 154 5,201 33.8 1,629 31 TOTAL 1,782 51,042 29.2 18,004 457 Mothercraft and Relaxation Classes These classes are considered to be one of the important branches of health education, health visitors and midwives co-operating together in the weekly courses of instruction and discussion. 45 Clinic Sessions Attendances Average attendance per session Burgoyne Road 37 149 4 Chestnuts 40 192 4.8 Church Road 16 84 5.2 Fortis Green 43 228 5.3 Gordon Road 35 170 4.8 Lordship Lane 48 248 5.1 Mildura Court 28 71 2.5 Park Lane 46 305 6.6 Somerset Road 10 20 2 Stroud Green 36 211 5.8 Weston Park 41 181 4.4 Stuart Crescent 10 24 2.4 TOTAL 390 1,883 4.8 Toddlers' Clinics — (2-5 years age group) Children attending toddlers sessions do so by special appointment at six to twelve month intervals. Because of the difficulty of meeting the need additional weekly sessions were introduced during the year at the Chestnuts, Lordship Lane and Park Lane clinics and twice monthly additional sessions at Weston Park These additional sessions proved worth while, there being an increased attendance of 1,228 over the previous year. The following table gives details of attendance:- Clinic Sessions Attendances Average Attendance per session No. of Cases seen by M.O. No. of cases referred elsewhere Burgoyne Road 51 710 14 709 19 Chestnuts 89 769 8.6 769 66 Church Road 23 281 12.2 269 2 Fortis Green 51 585 11.5 585 16 Gordon Road 50 455 9.1 452 55 Lordship Lane 102 923 9 923 22 Mildura Court 50 738 14.8 603 44 Park Lane 98 1,088 11.1 1,088 43 Somerset Road 52 449 8.6 448 63 Stroud Green 52 610 11.7 604 34 Weston Park 94 971 10.3 969 51 Stuart Crescent 49 541 11 541 25 TOTAL 761 8,120 10.6 7,960 440 Congenital Malformations Details of children born with a congenital abnormality continued to be passed to the Registrar General. During the year 91 cases were notified, suffering from abnormalities as detailed below:- 46 Details of children born with a congenital abnormality continued to be passed to the Registrar General. During the year 91 cases were notified, suffering from abnormalities as detailed below:- Diagnostic Group Congenital Malformation Number 0.1 Anencephalus 8 0.8 Spina Bifida 8 0.4 Hydrocephalus 8 0.6 Other specified malformations of brain or spinal cord 1 1.1 Anophthalmos and microphthalmos 1 1.0 Unspecified malformations of eye 1 2.1 Cleft lip 5 2.2 Cleft palate 4 2.6 Malformations of tongue 1 2.7 Rectal and oral atresia and stenosis 2 2.9 Other unspecified malformations of alimentary system 1 3.0 Unspecified malformations of heart and circulatory system 1 5.7 Hypospadias, epispadias 6 5.4 Malformations of male external genitalia 1 5.3 Hydrocele 1 5.5 Malformations of female vagina and external genitalia 2 5.0 Unspecified malformations of urino-genital organs (including pseudo hermaphroditism) 1 6.0 Polydactyly 4 6.1 Syndactyly 2 6.4 Unspecified reduction deformity of limbs 1 6.5 Talipes 25 6.6 Congenital dislocation of hips 3 6.8 Other unspecified malformations of leg or pelvis 3 6.9 Unspecified limb malformations 2 7.1 Malformations of skull or face bones 1 7.5 Chondrodystrophy 1 7.0 Other malformations of musculoskeletal system (including congenital hernias except hiatus hernia) 1 8.3 Pigmented naevus 5 8.6 Unspecified malformations of hair, nails or teeth 1 9.0 Other and unspecified congenital malformations 2 9.6 Down's syndrome (mongolism) 3 Total 106 Analysis of Pre-School Children on Observation Register at 31st December 1970 Categories of Observations Deafness of genetic origin in parents or siblings 46 History of maternal rubella in first four months of pregnancy 15 Gestation 36 weeks or less 272 Birthweight under 4lbs 24 Moderate or severe birth asphyxia 322 Difficulty in sucking or swallowing 6 Failure to thrive not explained by simple feeding problem 74 Convulsions 7 Cyanotic attacks or severe apnoeic spells 29 Abnormal neurological signs in neo-natal period 35 Haemolytic disease of the newborn 169 Congenital abnormalities 211 Late or late intake 202 Mother in care of mental health service 26 Total 1,438 47 Number of children born during year 4,438 Number placed on observation register (16% approx.) 708 Where there is a particular risk of deafness children are examined at the audiology unit as well as at the normal child health sessions. 134 children were seen at the unit during the year. Analysis of Pre-School Children on Handicapped Register at 31st December 1970 Categories of Handicap Partially sighted 1 Physically handicapped 35 Deaf 1 Mental handicap 59 Partially hearing 4 Miscellaneous 18 Epileptic 1 Total 119 Health Visiting Service Students The four sponsored student health visitors, on completion of their training in September, were successful in obtaining the health visitors' certificate. Two students commenced the academic year's training in September 1970. However, in spite of these four additional health visitors and the recruitment of a fifth health visitor, stafl shortage persists (6.4 out of an establishment of 36). It is depressing to note that the number of health visitor; at present working in the Borough is the same number in employment before the amalgamation with Wood Green. We are therefore grateful to the three health visitors who are able and willing to continue in service although they have reached retirement age. The number of visits made by health visitors are: — Number of visits paid by Health Visitors working in the Borough Expectant mothers — First visits 1,195 Total visits 1,824 Children under 1 year of age — First visit 4,872 Total visits 10,346 Children aged 1—2 years 9,718 Children aged 2—5 years 16,102 Other cases 2,654 Total effective visits as Health Visitors 40,644 Total No. Ineffective visits 10,676 Distribution of Welfare Foods The following table gives details of the distribution of these foods during the year- National Dried Milk (packets) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tabs. (packets) 8,419 55,801 4,578 3,407 48 Dental Care for the Priority Classes Mr. G.C.H. Kramer, Chief Dental Officer, reports as follows:- The number of sessions employed in the priority service was lower by 69 than in the previous year and the numbers of patients seen and the items of treatment provided correspondingly fell. As we have continued to accord real priority to this class of patient and have not sought to reduce the demand, it seems that the many dental practitioners in the borough providing treatment under National Health Service arrangements are at last finding it possible to accept more of these patients in their practices. This changing pattern of supply and demand is being reported in many authorities and, particularly for the expectant and nursing mothers, is to be welcomed as indicating continuing regular dental care with a "family dentist" instead of a temporary arrangement with one of our clinics, which must cease as soon as the eligibility for treatment expires. When a parent is a regular patient, a likely natural consequence is for children in the family also to receive their treatment from the same practitioner, thus giving regular and continuing attention for a highly •vulnerable section of the community. We are, however, concerned for the pre-school children who do not receive treatment from any source and whose dentition is seriously affected when we have the opportunity of seeing them after they have first entered school. All too frequently, if the dental defects of the child have not caused pain to a degree which has resulted in loss of sleep or family upsets affecting the parents, treatment is not sought. It is particularly for such families that we must pin our hopes for future fluoridation of the water supplies, to bring protection and benefits in better dental health without any effort on the part of those concerned. The statistics are as follows:- Expectant and nursing mothers Pre-school children Number examined 120 789 Requiring treatment 117 567 Attendances for treatment 433 1815 Treatment completed 68 430 Number of fillings 263 1625 Teeth filled 239 1444 Number of extractions 47 385 General anaesthetics 7 149 Number of prophylaxes 91 77 Teeth otherwise conserved - 87 Other operations 194 551 Number of radiographs 62 17 Crowns and inlays 4 - Total number of dentures 15 Number of treatment sessions 311 Midwifery Service There were 15 full-time midwives on the establishment at the commencement of the year 1970. The number has decreased to 13 midwives and 1 acting supervisor from 1st September, 1970. A scheme for attaching midwives to General Practitioner Obstetricians was introduced during the year and 11 midwives are attached. The scheme is working satisfactorily. The Health Services and Public Health Act, 1968, makes it legal for midwives employed by the local authority to go into hospitals to deliver patients, and from 1st February, 1970 a pilot scheme has been working whereby domiciliary midwives go into hospital with their own booked planned early discharge patients, deliver them and accompany them home by ambulance. 51 patients have been delivered successfully by domiciliary midwives. 49 The number of domiciliary bookings during the year was 508. 324 were actually delivered at home. 48 were transferred to hospital for varying reasons and 136 moved out of the area. 51 patients were delivered by domiciliary midwives in North Middlesex Hospital and transferred home for nursing within 6 hours making a total of 375 deliveries by domiciliary midwives during the year. Source of request Number of requests received 1967 1968 1969 1970 Requested by hospitals in North West Metropolitan Region 187 267 233 268 Requested by hospitals in North East Metropolitan Region 143 137 201 254 Requested by London Teaching Hospitals 39 44 50 63 TOTAL 369 448 484 585 Number accepted 491 Unplanned 136 Actual number discharged and attended 762 Self discharges 151 The number of visits, i.e. Ante-natal, labour calls, post natal visits and guthrie re-tests from various hospitals during the year was 16,645. This figure is less than for 1969 owing to the reduced number of deliveries during the first six months. However there was an increase during the last half-year and the trend as the year closed was upwards. Self discharges rose to 151 compared with 116 in 1969. Student Midwives Training 61 students were in training during the year, 12 from the Alexandra Maternity Home, 19 from the North Middlesex Hospital, and 30 from the Whittington Hospital. Obstetric Nurse Training There were 40 students from the City of London Hospital and 26 students from the Whittington Hospital who spent a day on the district and were given an insight into the work of the district midwife. HOME NURSING SERVICE The work load for district nurses continued to increase, especially after the introduction of group and general practitioner attachment on 1st May 1970. Nurses visit the doctors to whom they are attached at least once weekly, one nurse attends an afternoon clinic weekly, one a morning session twice weekly and another attends a group practice each morning, treating an average of six patients at each visit. Four nurses obtained the National Certificate for District Nurses. Two attended the course at Chiswick Polytechnic and two the course at the North Western Polytechnic. These are day release courses over a period of thirteen weeks, including a two week block. Five nurses attended Practical Work Instructors' Courses, two attended refresher courses and one attended an administration course. The Marie Curie Memorial Foundation gave full night nursing for eleven patients suffering from terminal carcinoma and gave financial aid for extra nutrition to one patient. During the year the Prince of Wales's Hospital sent thirty student nurses for instruction on community nursing and the Middlesex Hospital sent nine. Number of old patients carried forward from 1969 to 1970 1,113 Number of new patients started during 1970 2,364 These new cases were referred from the following sources:- 50 Source 1970 General Practitioners 1,467 Hospitals 748 Chest Physicians 8 Health and Welfare Departments 113 Old Peoples Welfare 28 Total 2,364 The following tables show the work of nurses during the year:- 1968 1969 1970 New cases attended 2,004 2,280 2,364 Total visits 88,112 92,053 104,286 Number of visits of over one hour's duration 2,844 2,371 1,781 The work load may be broken down as follows:- Injections 28,418 Dressings 22,192 General Nursing Care 22,755 Enemata 1,085 Diagnostic preparations 33 Bladder washouts 147 Blanket baths 14,942 Scabies 220 Maternity complications 86 Supervisory 5,802 Other treatments 4,724 Surgeries and miscellaneous 3,882 Total 104,286 Age of patients at time of nurses first visit of the year:- 1968 1969 1970 0-4 35 108 54 5-64 971 211 1,205 65 and over 1,885 3,416 2,218 GERIATRIC SERVICES Primary Prevention Primary prevention is concerned with elderly who are still active and in good general health. It is designed to lower the incidence of new cases of illness and disability. It aims to further the concept of positive health, an active enjoyment of good health, not merely the absence of disease. Retirement Advice Clinics in Haringey are intended to further these objects, and this they have continued to do, though to a limited extent. Figures of attendances closely resemble those of previous years, and expansion will not be possible until there is an increase in the community nursing staff, i.e. in the provision of geriatric visitors, so that an adequate domiciliary service can be run in parallel with the clinic sessions. Advice is given on health and diet and general guidance on making the best of retirement. Two aspects of the life of older people attracted attention. One was the fact that many older men moved to new flats found themselves in difficulty over hobbies, since they no longer had their gardens or a shed in which to do work like carpentry. The other was the rather depressing assumption by many retired people that because they had reached their sixties they must therefore be past all sexual activity. They were told that this was a fallacy and reminded that retirement was an excellent opportunity of making the most of their married lives. 51 Secondary and Tertiary Prevention Secondary prevention aims to reduce the duration of existing illness, and tertiary prevention to limit the severity of any existing disease or defect which cannot be eliminated. In undertaking these aspects of the care of older people the Health Department works in close co-operation with general practitioners, hospitals and social services. The Department is represented on the North West Metropolitan Regional Geriatric Liaison Committee in which the above meet to discuss the care of the elderly. The Liaison Committee's first annual report, which was issued during the year, makes some interesting comparisons between the domiciliary services provided by the three local authorities represented on the committee: Camden, Islington and Haringey. The two former have greater financial resources than this borough and this is generally reflected in the figures. While Haringey had in June, 1970, 0.60 home helps per 1,000 population, Islington had 0.68 and Camden 0.80. Haringey, however, had a target of 0.85 for 1975 while Islington's was 0.80; but Camden aimed for 1.36. Where home nurses were concerned, Haringey had 0.14 per 1,000 population compared with 0.18 in Islington and 0.19 in Camden. Neither Haringey nor Islington is proposing to alter the ratio of home nurses, but Camden intends to increase it to 0.25 by 1975. As for health visitors, Haringey had 0.11 per 1,000 population in May, 1970, while Islington had 0.16 and Camden 0.17. Haringey plans to increase its ratio to 0.17 in 1975 and Camden to 0.19, but Islington's will reduce slightly to 0.15. The most striking difference between the boroughs is with regard to geriatric visitors. Islington had 8 in September 1969, and Camden 21. Haringey had none, a situation which still exists. There is an urgent need for geriatric visitors in Haringey. A very high proportion of the problems of the elderly are concerned with their health. Social workers do not have the background and training to deal with many of these, while the skills of the state registered nurse are eminently suited to them. It is to be hoped that it will become possible to make appointments of this kind in the near future as the need is considerable. Not to be confused with the Geriatric Liaison Committee is the Geriatric Co-ordinating Committee, which is a small group of specialised officers in the Health and Social Services Departments formed to exercise surveillance and a degree of control over elderly people in the borough who are in a state of crisis or are likely to become so. Although compulsory removal to a hospital or an old people's home was considered in a number of cases it fortunately did not prove necessary, and the Committee was able to co-ordinate the services so that the old people retained the maximum freedom of action while receiving as much support as was acceptable to them. The Co-ordinating Committee has with time developed a good deal of experience in this field. It meets monthly and has been deliberately kept small in number to facilitate prompt action. After long deliberation it was decided this year to enlarge it by one, giving a total of six, by including a Medical Social Worker from St. Ann's Hospital who has since made a valuable contribution to its work. The principal quality required of a member of the Co-ordinating Committee is expertise. Geographical factors are of no importance. Any worker in the field may inform a member of a problem, which is then dealt with by the whole committee. The Chairman is the Deputy Medical Officer of Health, who takes responsibility for compulsory removal under Section 47 of the National Assistance Act, 1948. A senior Mental Welfare Officer advises on mental health questions, and the remaining four are the Deputy Superintendent Health Visitor, the Supervisor of Home Nurses, a Senior Welfare Officer with considerable knowledge of old people in the community and also of the residential and other services available to them, plus the Medical Social Worker. Thirty new cases were referred during the year and 28 old cases were kept under review. Nine went into old people's homes, 7 died and 18 were removed from the list with the proviso that they could be returned at any time. 52 Retirement Advice Clinics No. of Sessions New Patients Re-attendances Total Attendances Hornsey 13 6 42 48 Wood Green 9 7 31 38 Tottenham 43 23 223 246 Totals 65 36 296 332 North West Metropolitan Regional Hospital Board - Geriatric Liaison Committee The Committee, on which Haringey is represented, has made its first report for the year ended 31st March 1970. It was set up in 1968 by the North West Metropolitan Regional Hospital Board in accordance with the conditions of the Memorandum on "The Care of the Elderly in Hospitals and Residential Homes" and covers a large area of north/north west London including the eastern third of Haringey. The members include senior officers from the Health and Welfare Departments of the London Boroughs of Camden, Islington and Haringey, consultants, general practitioners, administrators and medical social workers from the Teaching and Regional Board hospitals and delegates from the Middlesex and Inner London Medical Executive Councils. The meetings are held at approximately two-monthly intervals. The Liaison Committee has no executive powers but from time to time it makes recommendations which are transmitted to the constituent authorities for consideration. The Committee use existing administrative channels to promote arrangements for dealing with problems as they arise in the operation of the health and welfare services for the elderly and aims to foster co-operation between the various authorities. The central role which the family doctor plays in the care of elderly is well recognised. General practitionersservices and their inter-relation with local authority and hospital services are being discussed at present. The Committee strongly support the setting up of psychogeriatric assessment units, and was pleased to learn that a small eight-bedded unit is being set up in St. Pancras Hospital. It is hoped that this kind of unit will be developed in the Haringey area. The Committee also study the provision of health services by the three local authorities concerned. Generally, Haringey's services were smaller than those of the other two. To take, for example, home helps in post on 30th June 1970, Haringey had 0.60 per 1,000 population while Islington had 0.68 and Camden 0.80. Regarding the target for home help services in 1975, Haringey aimed for 0.85 and Islington for 0.80, but Camden expected to have 1.36. Where home nurses were concerned Haringey had 0.14 per 1,000 population in June 1970 and Islington had 0.18. There were no plans to increase these by 1975, but Camden proposed to enlarge the service from 0.19 to 0.25. In health visitor provision Haringey was certainly the lowest, having 0.11 per 1,000 in June 1970. Islington had 0.16 and Camden had 0.17. Haringey proposes to reach the Camden figure by 1975 while Camden itself aims even higher, for 0.19. Islington, on the other hand, proposes to reduce its health visitor strength to 0.15 by this time. It is on the provision of geriatric visitors that the contrast in services is most marked. At 30th September 1969 Camden had 21, i.e. 0.09 per 1,000 population, and Islington had 8, i.e. 0.03 per 1,000. Haringey had none. Chiropody The pressure on this service continued to grow. Its capacity to deal with the increased volume of work was largely made possible in 1969 by the institution of the assessment of applicants for domiciliary chiropody by medical officers and the use of chiropodists' own surgeries. Domiciliary chiropody was thereby restricted to patients in real need of it while chiropody treatment became more widely available throughout the borough. However, demand for clinic, surgery and domiciliary treatment, increased further in 1970, the numbers of the latter being swelled by some whose health or circumstances had deteriorated with time, and it is becoming evident that further resources will have to be devoted to chiropody if the service is to be able to satisfy the requirements of its patients. 53 Chiropody No. of Applications received 1968 1969 1970 Clinic New Cases 742 802 990 Domiciliary New Cases 262 419 474 Transfer from clinics 97 43 80 Waiting for assessment - 28 12 Number of Assessments made for Domiciliary treatment during 1969 1970 Domiciliary treatment all the year New cases 217 291 Transferred from clinics 17 12 Domiciliary treatment winter months months New cases 35 16 Transferred from clinics 3 7 Referred to Home Nursing Department for nail cutting New cases 70 45 Transferred from clinics 11 2 Clinic treatment only New cases 24 55 Old Cases 4 - Cases that could be dealt with by relatives or friends New cases 24 • Cases no action taken 57 21 Total 462 449 1,719 clinic sessions were held during the year, including sessions for school children. Patients receiving treatment at end of the year at 1969 1970 1969 1970 Clinics 1,768 1,782 Private Surgeries 941 1,278 Domiciliary treatment 1,116 1,231 Waiting for clinic appointments 235 52 New patients on waiting list - Clinic 61 69 New patients on waiting list - Domiciliary 15 - Old patients on waiting list - transfer from Clinic 12 2 1969 1970 Number of patients treated including school children 3,995 4,461 Number of treatments given at Clinics 10,841 10,651 At private surgeries 4,230 6,747 Domiciliary 5,345 5,568 School Children 1,330 1,651 Total Treatments 21,746 24,618 54 1969 1970 New patients treated at clinics 272 648 at private surgeries 469 272 at domiciliary 190 247 school children 282 269 Totals 1,213 1,436 CHIROPODISTS 22 Part-Time Chiropodists 12 at Clinic Sessions 3 of whom treat patients at their private surgeries 9 Private Surgeries 3 of whom attend clinic sessions 10 Domiciliary 5 of whom attend clinic sessions 1 clinic chiropodist resigned in 1970 Staff Medical Assessments There was a further increase in the total number of medical assessments during 1970. In that year 2,409 cases were dealt with as compared with 2,095 in 1969. The increase was partly due to the Borough's Statutory Resolution of 1969 to admit manual employees to the Superannuation Scheme subject to medical assessment. Medical Assessment of New Applicants without Medical Examination: Shown by Departments Architect's 11 Cemeteries 1 Chief Executive's 62 Childrens 69 Cleansing and Transport 1 Education 951 Engineer and Surveyor's 28 Health 151 Housing 32 Libraries 33 Town Planning 19 Comptroller and Treasurer's 21 Welfare 39 Tottenham Technical College 59 Hornsey College of Art 46 1,523 Medical Examination of New Applicants Education 6 Health 4 Housing 1 Libraries 1 Welfare 1 Tottenham Technical College 1 14 Medical Examination of: — 1st Appointment Teachers 111 Teacher Trainees 240 Hornsey College of Art End of Term Teachers 64 415 55 Medical Assessment of Employees for Admission to Superannuation Scheme: Shown by Departments Baths 2 Catering 7 Cemeteries 1 Cleansing and Transport 73 Engineer and Surveyor's 66 Parks 35 184 Medical Examination of Employees for Admission to Superanuation Scheme Cleansing and Transport 3 Engineer and Surveyor's 3 Parks 3 9 Total number of Medical Assessments 1,730 Reports on Sick Pay Cases without medical examination 86 Reports on Sick Pay Cases with medical examination 46 Special assessments of employees without medical examination 51 Special assessments of employees with medical examination 31 Medical examination of staff over 70 years of age 9 Employee returned to work or resigned before report completed 41 Total number of Medical Examinations 524 Total number of cases dealt with 2,409 The Changing Vista of Community Mental Health: by Dr. U.P. Seidel The year 1970 saw the implementation of the Local Authority Social Service Act which based on the Seebohm Committee Recommendations, divorced mental health social work from health, and therefore, from the medical side of community psychiatric care. This in my view was a mistake and I hope the Hospital Boards will not have to pay dearly for it both in man power and in In and Out Patient facilities. My reasons for saying this are quite simple. Over the past few years we have tried and to a certain extent succeeded in building up a community psychiatric service whereby mentally disordered persons could remain in the community more often and longer and, if required to enter hospital, earlier discharges were made possible. This was in accord with the true spirit of the Mental Health Act of 1959 which envisaged an expanding community based psychiatric service. That such a service cannot function without the close participation of medical people trained and experienced in psychological medicine and stationed in the community must have been obvious to anyone who knows anything at all about mental disorders. The Mental Welfare Officers let alone the new generic social workers will be unable either by qualification, training or experience to carry out this task adequately and efficiently on their own without obvious dangers to the patient. In this highly specialised field of psychiatric community care, ties between social workers and community psychiatrists should have become closer and not severed altogether as appears to be the case under the new Act. Furthermore, instead of having a generic social worker deal with psychiatric cases, I would have suggested the very opposite, namely to raise the qualifications, training and experience of all social workers working in mental health to that of the psychiatric social worker we are accustomed to deal with in the hospital setting. Are we turning back the clock to the time of the Duly Authorised Officer whose main function consisted of compulsory disposal of psychiatric patients to mental institutions ? 56 There are two particular aspects of community mental health which might be mentioned in this context. About 5,000 people succeed in killing themselves by suicide every year in England and Wales. Almost six times as many again make some suicidal attempt on their own lives. The comparative yearly figures for Haringey are 41, 30 males and 11 females. The considerable burden thrown on the many agencies trying to deal with this problem and the unnecessary wastage of human life could be curbed if appropriate community facilities under medical direction were in existence to recognise, supervise and treat mental illnesses as these appear in the community, for mental disorders are the main cause of consummated suicide and suicidal attempts. Unfortunately, the breakaway of mental health social work from health departments will make the establishment of such a preventive scheme impossible. The other point to consider is that of drug dependants which as I see it, can be tackled more successfully by a community-based approach. There were 123 out-patient and 19 in-patient notifications to us of Haringey residents being "hard" drug addicts during the year which may even constitute an under-estimate as not all drug dependant persons are known to the various official bodies and therefore are lost to all census. The overall yearly figure for England and Wales amounted to over 5,000 drug addicts with a known death rate of 30, 19 males and 11 females. The dangers of even experimenting with habit-forming drugs should be brought home forcefully to everyone especially young people and school children and advice clinics geared to recognise, advise and suggest management to those likely to fall prey to the temptation of drugs and to those who have already succumbed to them. Additionally, the staff should be experienced enough to spot an underlying personality defect whenever this is the causative factor responsible for the drug dependence. Their management requires a high degree of expert knowledge which must embody medical, psychiatric and social work expertise and should be available right where it is required, namely in the community, as very few of these people once spotted are willing to be sent to any other clinic or department. In spite of my gloomy forebodings one hopes that a true interest in the welfare of the mentally afflicted will prevail and future approaches shaped in the light of the real needs of the patient. Vaccination against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis and Measles The following tables record the number of persons under the age of 16 known to have received a primary course, or reinforcing dose during the year by general practitioners or clinic staff. The number who completed a full course of primary immunisation Age at date of Immunisation Triple Dip/WC Dip/Tet Dip WC Tet Sabin Measles Rubella Total 0—1 years 76 - 1 - — - 76 - - 153 1 —2 years 2,100 - 200 1 - 1 2,302 1,051 - 5,655 2—4 years 836 - 103 1 - 2 951 1,571 - 3,464 4—6 years 38 - 134 2 - 22 220 402 1 819 6—16 years 8 - 64 129 91 83 26 401 Total 3,058 502 4 - 154 3,640 3,107 27 10,492 The number who received a reinforcing dose Age at date of Immunisation Triple Dip/WC Dip/Tet Dip WC Tet Sabin Total 0—1 year _ _ _ _ _ — _ 1—2 years 61 - - - - 1 60 122 2—4 years 327 - 222 2 - 2 599 1,152 4—6 years 106 1 1,624 23 - 50 1,793 3,597 6—16 years 12 - 117 1 - 349 857 1,336 Total 506 1 1,963 26 - 402 3,309 6,207 57 Vaccination against Smallpox The following table records the number of persons under the age of 16, 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 5-15 Total Number of Primary Vaccinations 65 1,354 849 218 2,486 Number of Re-vaccinations - 1 210 929 1,140 HEALTH EDUCATION Tempting though it may be to think of Health Education as a form of advertising, it has at least one difference: the product is not always as attractive at first sight as its commercial equivalent — and we certainly do not have the resources to display it so temptingly before the public. And since what we propose often means giving up some habit to which people are irrationally, albeit dangerously, addicted, it is not surprising that we do not have as much success. The Health Educationalist must resign himself to many years, even decades, of ;apparently fruitless effort before he begins to see any result; and it is too easily forgotten how long it took and how many setbacks were experienced before such measures as clean water, adequate sewerage and pasteurisation of milk came to be generally accepted. Perhaps the greatest problem facing Health Education at the present time is that of cigarette smoking. What we have to deal with here is literally the refusal of a large proportion of the general public to face the facts, a silent opposition based on almost pure irrationality. If reason is to have hope of success against this, it will have to have many years in which to work its effect. Probably a change in fashion would achieve more, but there seems to be no prospect of this at the present time; and we are forced to rely increasingly on the force of personal example — which seems feeble enough at the best of times. We can never know how much harm has been done by a parent, a teacher, a doctor or a borough councillor who smokes. The forces opposed to health education have been known sometimes to assume the forms of pseudo-rationality, and the anti-fluoridation movement is a good example. It is quite futile to point out to many of the general public that the claims of toxicity from fluoridation of water supplies have been shown to be based on faulty experiment and bad reasoning. Sensational claims always have the edge on plain truth where impact on many of the public is concerned, though there remains a longterm solution to this: that all the people can't be fooled for all of the time. But the success of the anti-fluoridation cause so far depends on something much more subtle: their claim that fluoridation of water is an interference with the rights of the individual. Sex Education is also a controversial subject nowadays, but there is no doubt that it plays an increasing part in school curricula, and we are frequently approached by teachers for information, display materials, films, slides etc. We are sometimes asked to provide expert speakers on subjects like the birth process or venereal disease, and are pleased to find that marriage guidance counsellors are increasingly in demand and sooner or later we must give young people all the information they need on birth prevention. While it is often claimed that parents should be giving this kind of information it tends to be forgotten that many are too embarrassed to talk it over with their children, or feel that they do not know enough. The matter is discussed first of all at parent-teacher meetings, and the parents frequently see the same films etc. which are later shown to their children. The operative word is "education" not "instruction"; and the subject of sex has a natural place in much wider programmes. Girls tend to receive more, as it often forms a part of their home economics or biology courses. The preference for physics and chemistry in boys' schools has made it harder to fit in, but it is encouraging to find that it is appearing more frequently in mixed classes on social studies or humanities courses. As a department we have no doubt about the value of sex education. There is no evidence that it is a cause of promiscuity in young people; indeed the national increase in illegitimacy and sexually transmitted diseases was already evident in 1958, before a significant proportion of school children were having sex education. Only too often we have found that promiscuity is associated with abysmal ignorance on sexual matters. The courses that have been evolved over the years are directed towards helping the child towards a more mature understanding of the place of sex in the whole pattern of life, not exaggerating or diminishing its role, but showing that, important as it is to the human being, love matters more. 58 Another subject on which we are increasingly asked to provide information is the drug problem in young people. Since it is already so much discussed by children we have no hesitation in supplying carefully selected information which gives a balanced view of the whole drug situation. Health Education is a subject which receives much lip-service nowadays, but even though many people acknowledge the great benefits that it could bring to individuals and the community in general, and the subsequent easing of the strain on the country's health services, surprisingly little of these resources are devoted to this purpose. Health Education in Schools Talks and short courses on a variety of health topics continue to be given in schools by the Health Education Officer. It is encouraging that many more teachers ask advice and use the audio-visual aids available from the Health Education section. Pupils increasingly use the service for their health education projects and it is a measure of their interest in the subject. Health topics are being programmed into biology, home economics and social studies courses and vary from human biology, venereal diseases, smoking, drugs, child development, parentcraft to world population. Health Education sessions by school doctors, were discontinued in 1970 due to frequent changes in staff establishment, and only in isolated cases did the doctors participate in health education talks. It is hoped that these sessions will recommence at a later date. Stimulated by the B.B.C. radio-vision and television series on primary sex education, talks on menstruation and "growing up" were requested by six primary schools. Parents were very co-operative. Some schools held parent/ teachers meetings prior to the talks in schools. In all cases parents were notified by letter of the nature of the talks, and had the option of withdrawing their child. Withdrawals varied from one or two to four in one school. A short series of talks for school leavers has been initiated in one comprehensive school for separate groups of girls and boys. Topics on development, reproduction, ante-natal care, childbirth, smoking and venereal disease were included in the series. The amount of health education given in schools by the Health Department is limited by the small percentage of health personnel who are available to give talks in schools compared with the numbers of schools and pupils. The objectives of the Health Education section are therefore aimed at providing audio-visual aids, advising and assisting teachers to introduce health education into the syllabus. With these aims in mind the Health Department in co-operation with the Education Service, are providing a series of lectures at the Teachers' Centre during the Spring Term of 1971. During the year a total of 65 talks was given in six primary and six comprehensive schools, to a total of 1,170 school children. The Inter-Services Standing Committee on Youth and Working Party This Committee consisting of representatives of the education, health and social services and various voluntary organisations concerned with youth, continues to meet at periodic intervals. The Health Education section plays an active part in the working party. The section was responsible for arranging two symposiums — "The Adolescent in Society" in March 1970 with Dr. Wendy Greengross, from Marriage Guidance, and Mr. Alec Dickson, C.B.E. of Community Service Overseas as Speakers. At the second symposium, "Youth and the Social Services in the 70's" held in November 1970, Mr. John Ewer, M.A. of the Youth Service Information Centre, Leicester, was the Speaker, followed by a panel of experts from Education, Health and the Juvenile Bureau, Both symposiums were excellently chaired by His I Honour, Judge H.B. Grant. Following the success of these two meetings, it is proposed to hold a similar venture in 1971. 59 Detection of Hearing Defects in the Infant and Pre-School Child — A two-day Course for Health Visitors This was the second course organised by the Section, under the direction of Dr. L. Fisch, the Consultant Otologist, at the Audiology Unit, Tottenham The course is designed to give health visitors an insight into the detection of hearing loss in infants and young children. Forty-two Health Visitors attended from Local Authorities in and near London, in addition three visitors from Holland, a doctor, nurse, and psychologist, who hope to run a similar course, also participated. Dr. Fisch, Health Department staff and two peripatetic teachers gave lectures and demonstrations. These were held in Tottenham Town Hall, the Audiology Unit and Blanche Nevile School for the Deaf. The booklet "Talking to the Elderly Deaf" produced by Dr. Fisch in co-operation with the section in 1970, has had wide distribution throughout the country. "Notes on High Frequency Hearing Loss in Children" has been reprinted. Food Hygiene Courses Following the talks on personal and food hygiene at the Prince of Wales's Hospital last year, the Health Education Officer was requested to run a similar course for domestic staff at St. Ann's Hospital. The talks were run in co-operation with the domestic supervisor and pathologist who appreciated that hygiene standards had improved following the previous talks. It is hoped that this programme will be an ongoing series. Cervical Cytology Publicity Campaign — April—August One of the functions of the Health Education section is to publicise the local authorities' health services. Cervical cytology tests at local authority clinics had declined as shown in table 1. In the first quarter of 1969, tests were 365, and dropped to 254 in the same quarter of 1970. At the beginning of the year it was decided to concentrate publicity in a limited geographical area to see whether results could be improved. The area chosen was that served by Burgoyne Road Clinic, consisting of four roads, bounded on one side by Green Lanes and on the other by Wightman Road. The Haringey Women's Cancer Control Committee were approached and this small active group of six women agreed to distribute application forms and literature. The roads were divided into three groups (see table II). The 1970 electoral register was used so that the women received a personally addressed envelope containing an application form and explanatory leaflet in English and Greek. A large proportion of women in this area are of Greek-Cypriot origin. Publicity was given in the local papers on the women's pages. Advertisements were placed in three local papers. A Greek-Cypriot newspaper printed an article written by a Greek doctor on the Department's staff and these papers were distributed in the Burgoyne Road Clinic and to the women in Group 3. Summary Results are shown in Tables II and III. Considering the number of leaflets and application forms distributed a greater response might have been expected but if the number of 47 tests of 1968-69 (Table I) is compared with the 154 tests taken during the three months of the campaign, one can consider it a reasonable increase. Fortunately groups most at risk responded to the campaign, 59% were over 35 years of age, and 95.3% of the total number were married (Table III). No positive smears were obtained but many other disorders were discovered (Table IV) and these women were referred to their own doctors. During the sessions, advice and appointments for family planning were made. It is proposed to carry out a publicity campaign in 1971 involving the women patients in one particular doctor's practice. 60 TABLE 1 Tests in Haringey Clinics Year Number of Tests in Haringey Tests in Burgoyne Road Clinic 1968 1,412 12 1969 1,126 35 Total 2,538 47 TABLE II Distribution of leaflets and applications forms by groups Groups Number of Roads Number of Application Forms Distributed Appointments Requested Attendances 1 7 669 52 41 2 7 1,247 77 66 3 7 1,270 50 47 Total 21 3,186 179 154 TABLE III Persons tested: by age groups Age Groups Number Tested Percentage of Totals 20-35 59 41 36-45 34 46-74 61 59 Total 154 100 TABLE IV Disorders discovered Disorder Number Cervix-erosion 18 Polypus 6 Inflammatory changes 18 Vaginal discharge 38 Trichomonas vaginitis 6 Monilia 1 Cystitis 2 Mastitis 1 Post menopausal haemorrhage 4 Table V Social Class 1. Higher professional and managerial 1 2. Lower professional and managerial 7 3. Skilled manual, supervisory and routine clerical 41 4. Partly skilled 33 5. Unskilled 38 6. Unknown (including retired persons) 34 61 Health Education to Organisations and Establishments Talks were given to various organisations usually outside normal working hours, to such groups as parent teachers' associations, a teacher training college and voluntary organisations on such topics as general health, statutory services, child development, sex education, drugs,~smoking and first aid. Health propaganda and displays in Council premises and on public notice boards is part of the day-to-day activity of the section. The section has a wide variety of limited supply of teaching aids which it loans to schools and organisations. An audio-visual aid catalogue is widely distributed and is in the process of being revised and brought up-to-date for 1971. INFECTIOUS DISEASES - W.T. Orton, Deputy Medical Officer of Health Diphtheria There were no cases in Haringey, but there was some anxiety about an outbreak in another part of London, especially since it was known that about a third of the children in this borough who were entitled to immunisation had not been brought to their doctors or clinics to receive it. There is still a widely held misconception that diphtheria no longer exists, and newspaper reports of outbreaks in other boroughs or other parts of the country have so far largely failed to shake it. But possibly warnings may be reinforced by evidence that the danger can arise from yet another source, the Continent of Europe. In many countries there the infection has not been brought under the same degree of control as it has in the British Isles. For example Italy had 1,724 cases in 1967. In the face of this, parents might wish to check whether their children have been immunised before taking them on their next continental holiday. Although there have been no examples of infection from Europe recently, who wants to be the first ? Cholera The possibility of this disease occurring in a British tourist has been hinted in this Annual Report a number of times. The first case occurred this year and involved a man from Wales, who was fortunantely not seriously ill. But with tourism extending increasingly in developing countries, others may follow, and travel agents and their customers would do well to be on their guard. In September of this year, because of the international spread of this disease, the Department of Health introduced regulations which required people arriving in this country from cholera endemic areas to be kept under surveillance for five days, unless they had valid certificates stating that they had been vaccinated against it. Six people were followed up in Haringey. Poliomyelitis There were no notifications of this illness in Haringey residents. The one case that appears in our records was a child resident in a Middle Eastern country who took ill and was flown here for treatment. Smallpox The Health Department undertook the surveillance of 36 people coming into this country from smallpoxendemic areas without valid vaccination certificates. Consultant advice was sought with regard to two patients suffering from illnesses resembling smallpox, but the diagnosis was excluded in both cases. Smallpox will continue to be a menace in this country as long as it exists in other parts of the world. The low incidence of the infection has in recent years been due largely to the control exercised by our port health authorities. The World Health Organisation Report on smallpox in Europe between January, 1961, and September, 1970, underlines the need for continual vigilance. There were 391 cases of smallpox in Europe during this ten year period arising from the introduction of the disease on 28 occasions. The United Kingdom experienced the greatest number of these, 9, and the Federal Republic of Germany came second with 7. Twenty originated in Asia, 5 in Africa. Almost all the importations were by air — 23 of the 26 for which the 62 mode of travel was known. Nationals of the country concerned were usually responsible for introducing the disease to their own countries. Since smallpox is extremely rare among people successfully vaccinated in the last preceding three years. It is reasonable to conclude that more than half the outbreaks in Europe could have been prevented if travellers had been adequately vaccinated before going to endemic areas. Enteric Fever Both the cases of typhoid which occurred this year originated abroad. We were also involved in the follow-up of contacts of cases in other boroughs. During one of these the family of the case, including a relative who as a carrier of the disease was the source of the infection, moved into Haringey. Measures were taken to prevent further spread. One paratyphoid case occurred just after the patient had arrived in this country from overseas and certainly had its origins there. The source of the other infection was in this country and remains unknown. Measles The withdrawal of one of the measles vaccines in March, 1969, was a serious interruption of a nationwide campaign to reduce the infection to the status of a less common infectious disease. Vaccination was largely suspended for several months until alternative supplies became available. Although an intensive campaign was undertaken to complete vaccination before the autumn of 1970 and the expected biennial measles epidemic, the public response was very disappointing, only about a third of what had been expected. Contrary to the usual experience, measles notifications, which usually are greatest in the wintertime, climbed to a peak of over 60 a week in July then dropped to less than 10 in September. Subsequently the old pattern re-established itself and 60 had again been passed by Christmas. There can be no doubt that vaccination gives considerable protection, but what appears to have happened is that many children who were not vaccinated during the first campaign did not catch the disease because those who had been vaccinated prevented the easy spread of the disease in the child population. However, since not enough children received the vaccine, the disease then recrudesced and the unvaccinated ones who had previously escaped fell victims to it. Measles will therefore continue to be a common unpleasant and sometimes dangerous disease until the great majority of parents decide to do something about it. Whooping Cough This is a disease with wide variations in annual incidence. Vaccination may not prevent it, but does much to reduce its frequency and severity. In 1967 there were 131 cases notified, 58 in 1968, while in 1969 there were only 17. This year there were 108. Such wide swings are hard to account for, but some factors have been recognised. A few years ago a part of the vaccine had to be modified because a strain of the bacterium had developed which was not susceptible to it More recently there has been evidence that some viruses may cause an illness closely resembling whooping cough, and information from general practitioners in Haringey suggests that a small proportion of the cases notified may have been of this kind. Psittacosis A local veterinary surgeon informed us of his suspicions that an Amazon parrot bought from a local pet shop had died of psittacosis. This virus infection of birds can cause a severe form of pneumonia in humans. The diagnosis was subsequently confirmed. The stock of birds in the shop was destroyed and the premises were thoroughly cleaned and disinfected. It was found that members of the staff of the shop had had a mild respiratory infection a week or so before. Blood samples were taken. These showed no evidence of recent attacks of psittacosis, but a low blood titre of antibodies to organisms of the psittacosis group showed that they had been exposed to this kind of infection not sooner than two months before. This had probably occurred in the course of their work. 63 Tuberculosis A member of the nursing staff of a maternity unit in the borough was found to be suffering from open pulmonary tuberculosis. On the advice of a chest physician all the mothers who were confined there during the period of infectivity were followed up and given chest X-rays, while their babies were tested for evidence of tuberculosis. No further cases of infection were found. Rubella (German Measles) This disease has been found to be a significant cause of congenital abnormalities in babies when the mothers are infected during early pregnancy. During the year the Department of Health announced that rubella vaccine would become available for girls aged eleven to thirteen years to prevent the disease occurring when they become mothers later in life. The Haringey Council was reluctant to accept the advice of the Department of Health and decided not to implement this policy on the grounds that it was not known if the immunity would persist into the childbearing years. The Council reversed this decision in July, 1971, and rubella vaccination will begin in Haringey schools in the autumn of 1971. Contact Tracing and Health Education in the Control of Venereal Diseases The tables supplied by the Consultant Venereologist at the Prince of Wales's Clinic show that venereal disease is increasing. As the disease is not notifiable we cannot be sure that this increase is due to the number of Haringey patients or to patients who have attended from elsewhere. The venereal diseases are not notifiable in order to ensure the confidential nature of their treatment and, indeed, anonymity is part of the technical expertise of a successful V.D. Clinic.. During 1970 prior to the passing of the Social Services Act, the Health Department shared with Enfield a social worker who devoted part of her time to the care of unmarried mothers and in the remainder of her time she helped to trace women contacts who were alleged to have infected men patients and who could therefore be advised on the need for treatment for their disease. It is an accepted fact that when contact tracing is functioning well there is a decline in the male : female ratio and the table below shows how this has been achieved. New Cases of Gonorrhoea Gonorrhoea Female Male Ratio 1965 56 226 1 : 4 1966 51 224 1 : 4.4 1967 116 298 1 : 2.6 1968 149 388 1 : 2.6 1969 159 387 1 : 2.3 1970 167 430 1 : 2.5 In 1971 the Health Department will have the part-time (0.6) services of a separately appointed contact tracer which will be shared with the Borough of Enfield. When talks are given in schools, children are advised on the risks of venereal diseases and pregnancy. Housing Applications - Assessment on Medical Grounds During 1970 requests were received for 715 cases to be investigated and recommendations to be made on their priority for re-housing as a result of illness or disability. This number was approximately the same as in 1969. All these cases were considered by Senior Medical Officers of the Health Department. 64 Of the total 715 assessed, 98 were put into a category of "Special medical cases", which are referred to the Housing Tenancy Selection Panel outside the Housing Points Scheme. These may be urgent cases of very severe illness, or those with severe disability that is aggravated by unsuitable accommodation, and with little prospect of being rehoused under the Points Scheme. For example, a person with severe heart disease living in a large, roomy flat at the top of several flights of stairs. Provision of housing on the ground floor, or with a lift, not only makes life more tolerable but will often delay deterioration in health. The Housing Tenancy Selection Panel was able to allocate top priority to 88 of these disabled applicants in 1970. So far, 19 have actually been rehoused during the year. There were 58 cases given priority in 1969, and 36 of these have so far been rehoused. Many of these people are elderly, as well as infirm, and any delay in rehousing them is usually due to lack of suitable accommodation on the ground floor being available. Some are also waiting for more specially adapted housing such as warden-assisted accommodation. These examples illustrate the need for such housing in the Borough. REHOUSING Housing Assessment on Medical Grounds Month No. of cases Source of Request Housing Department Hospital, G.P. or Clinic Tenant, H.V. P.H.I, etc. January 65 36 9 20 February 71 50 7 14 March 31 21 3 7 April 67 56 3 8 May 58 36 13 9 June 60 40 14 6 July 82 63 4 15 August 39 26 7 6 September 63 48 8 7 October 67 38 14 15 November 70 48 9 13 December 42 30 6 6 Total 715 492 97 126 "These figures include second investigations carried out during the yera. Medical Priorities Recommended during 1970 No. of cases Special refer to Panel 98 1st degree 191 2nd degree 167 3rd degree 144 Recommend for transfer 37 Recommend for hostel accommodation 2 Recommend for accommodation to be shared 6 Recommend for priority when Clearance Area is being rehoused 6 Recommend to be referred to other sections 5 32 cases were investigated where no medical recommendation was made. These figures include second assessments made during the year. 65 PART III SCHOOL HEALTH SERVICE REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1970 EDUCATION COMMITTEE 1970/71 Councillor G. Murphy (Chairman) Councillor P.E. Hitchens MSc Alderman A.J.F. Doulton (Vice-Chairman) OBE TD MA Councillor Miss C.D. Jackson Alderman C.C.H. Chalker Councillor V.N. Jary Alderman V.P. Gel lay BSc AlnstP ARIC Councillor Miss S.A. Jones Councillor Mrs. L.A. Angell Councillor A.C. Perry BA Councillor S.R. Gaubert BA Councillor Peter P. Rigby JP Councillor Miss A. Harris TD Councillor Mrs. P.A. Spratt Co-opted Members Rev. R.J. Avent Mr. R.E. Grout Mr. J.G. Elkington BA Mrs. J. Sondheimer MA PhD Schools Sub-Committee Councillor Miss A. HarrisTD (Chairman) Councillor Mrs. L.A. Angell Councillor A.C. Perry BA (Vice-Chairman) Councillor Mrs. E.M. Donno Alderman C.C.H. Chalker Councillor Miss C.D. Jackson Alderman V.P. Gellay, BSc AlnstP ARIC Councillor D.J. Patrick Co-opted Members Mrs. J. MacGregor Mr. P.A.Moon PRINCIPAL SCHOOL HEALTH STAFF J.L. Patton MB ChB DPH Medical Officer of Health and Principal School Medical Officer W.T. Orton MB BCh BAO DPH Deputy Medical Officer of Health and Deputy Principal School Medical Officer Mary Douglas MB ChB DPH Principal Medical Officer (School Health) G.C.H. Kramer LDS RCS Chief Dental Officer and Principal School Dental Officer 67 To The Worshipful the Mayor, Aldermen and Councillors of Haringey I have the honour to present for your consideration the report on the work of the School Health Service for the year ended December 1970. The Annual Report of the Principal School Medical Officer is not an exercise in public relations but a survey of the work done in the School Health Service and where criticism is expressed by officers and consultants I hope that it will be seen to be constructive. The Consultative Document on the National Health Service reorganisation states that "future arrangements for the School Health Service will require special consideration" and with that in mind we can look back on the recent years of the School Health Service and realise that the present administrative machine is one which in spite of a shared responsibility between the Health Committee and the Education Committee has nevertheless allowed for adaptation to changing circumstances, although such a machine calls for the continued interest of all concerned. During recent years the problem of the correct assessment of intelligence has stimulated much thought and we all realise that the well-tried I.Q. test is not so much a measure of competence to succeed in a wide variety of careers as an attempt to measure academic potential. The I.Q. test may not reveal all the combination of qualities that make for future happiness and success, and most of us would agree that there is scope for an improved test. The school doctor plays an important part in this assessment to ensure that no child who appears to be backward is so because of a failure to receive treatment for a defect of hearing or vision or general health. In Haringey the School Health Service has been particularly fortunate in the inspiration and advice which we have received from our consultant colleagues in the hospital service not only those whose services have been available to us on a sessional basis but from others who are not employed directly by the School Health Service. I refer with appreciation to the advice we have had from Dr. Napier Thorne, consultant dermatologist, on the establishment of a warts clinic and to the assistance from Dr. Jeanne Reeve, consultant haematologist, in connection with the Chief Dental Officer's pioneer investigations into sickle cell anaemia as a hazard in dental anaesthesia. Once again I am pleased to record thanks to all those who have contributed to the work of the School Health Service, the Chairman and Members of the Education Committee, the Director of Educational Services, the Chief Education Officer and the staff of the Education Department, and the teachers who have always given their support in the interest of their pupils. J.L. PATTON Principal School Medical Officer. 68 SCHOOL HEALTH SERVICE Dr. Mary Douglas, Principal Medical Officer School Population . The School population of the Borough on 21 January 1971 was 38,064 as shown in the following table: — Primary Schools and Nursery Classes 23,519 Nursery Schools 385 Secondary Comprehensive Schools 12,636 Other Secondary Schools 1,125 Special Schools — The Vale School (for Physically Handicapped) 97 Blanche Nevile School (for the Deaf) (including classes for partially-hearing) 152 The Moselle School (for Educationally Subnormal) 47 Suntrap Residential Open-Air School 103 TOTAL 38,064 Medical Examinations in School The medical examination of the school child is directed to eliciting signs of deviation from the normal which may handicap a pupil's learning ability. Therefore very special attention is given to assessing the hearing acuity and the visual acuity of each child, independent of the doctor's visit to a school. Special importance is attached to the child's first medical examination in school, when the maximum number sent for at each session does not exceed 15, and when a very detailed examination is carried out. During the final statutory year of school life, each pupil has a leaving interview with the school doctor when the pupil is given the opportunity to discuss his or her own health problems with the doctor and ask advice relevant to health about a future career. Medical examination at other stages in a child's school life is carried out by selection, either by request of the parents or the Head Teacher, or to supervise a child known to have a handicap which could add to his difficulty in making normal school progress. Endeavours are made to have the school doctor visit his or her primary schools each month, particularly to meet the needs of new entrants. During 1970 efforts were made to increase the visits to secondary schools, at least two of which the doctor visits weekly, so that the medical officer is available for consultation with the Head Teacher and the pastoral heads of the school. The Blanche Nevile School, including the partially, hearing units, is visited by a medical officer once a month and the Vale School for physically handicapped children has bi-weekly visits from a medical officer. In September 1970 the Moselle School for educationally subnormal pupils opened in temporary premises and classes are held for children aged 10-12. It is hoped that these children also will have a monthly visit from the school medical officer. The William C. Harvey School for severely subnormal children was opened in September 1970. There are 108 pupils in the school including 36 children with dual handicaps in the special care unit. Although this school will not officially come under the control of the Education Department until April 1971, medical services equivalent to those in other schools are already being provided and the school has a weekly visit from a senior medical officer of the Child Health Service. During 1970 children with handicaps either attending Haringey Schools or placed by Haringey in schools outside the Borough were offered an annual medical review. Signifies Selective Medical Examinations 69 Periodic Medical Inspection The following table shows the number of children inspected by years of birth and the classification of their physical condition: — Year of Birth Number of Pupils inspected Physical Condition of Pupils inspected Satisfactory Unsatisfactory Number % Number % 1966 & later 194 192 98.9 2 1.1 1965 1,035 1,028 99.3 7 0.7 1964 2,386 2,370 99.3 16 0.7 1963 656 649 98.9 7 1.1 1962 316 312 98.7 4 1.3 1961 237 234 98.7 3 1.3 1960 413 412 99.8 1 0.2 1959 613 611 99.7 2 0.3 1958 425 423 99.5 2 0.5 1957 215 213 99.1 2 0.9 1956 1,388 1,384 99.7 4 0.3 1955 & earlier 1,627 1,624 99.8 3 0.2 TOTALS 9,505 9,452 99.4 53 0.6 In the Appendix to this report will be found an analysis of the defects found at periodic medical inspections to require treatment or observation. Other Medical Inspections The following are the numbers of special inspections and re-inspections carried out during 1970. A special inspection is one which is carried out at the special request of a parent, doctor, nurse or a teacher, usually at a school clinic. Number of special inspections 3,566 Number of re-inspections 1,548 TOTAL 5,114 An analysis of the defects found at special inspections to require treatment or observation will be found in the Appendix. Medical Treatment Details are given in the Appendix of treatment (excluding uncleanliness and dental defects) of pupils attending maintained primary and secondary schools (including nursery and special schools), whether provided directly by the Council or arranged through other agencies. Handicapped Pupils The Education Act 1944 places upon local Education Authorities the duty of ascertaining handicapped pupils in their areas and of providing special educational treatment for such children. Although it is the duty of the local Authority to ascertain these children from the age of 2 years, it is often desirable, especially in the case of blind, deaf or cerebral palsied children, that the defects be discovered before this age so that steps may be taken to help the child to develop as normally as possible despite his handicap. The School Health Service and Handicapped Pupils Regulations 1953 defined the various categories of handicapped pupils as follows: — (a) Blind — pupils who have no sight or whose sight is or is likely to become so defective that they require education by methods not involving the use of sight. (b) Partially sighted — pupils who by reason of defective vision cannot follow the normal regime of ordinary schools without detriment to their sight or to their educational development, but can be educated by special methods involving the use of sight. (c) Deaf — pupils who have no hearing or whose hearing is so defective that they require education by methods used by deaf pupils without naturally acquired speech or language. (d) Partially hearing — pupils who have some naturally acquired speech and language but whose hearing is so defective that they require for their education special arrangements or facilities though not necessarily all the educational methods used for deaf pupils. (e) Educationally subnormal — pupils who by reason of limited ability or other conditions resulting in educational retardation require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. (f) Epileptic — pupils who by reason of epilepsy cannot be educated under the normal regime of ordinary schools without detriment to themselves or other pupils. (g) Maladjusted — pupils who show evidence of emotional instability or psychological disturbance and require special educational treatment in order to effect their personal, social or educational readjustment. (h) Physically handicapped — pupils not suffering solely from a defect of sight or hearing who by reason of disease or crippling defect cannot, without detriment to their health or educational development, be satisfactorily educated under the normal regime of ordinary schools. (i) Pupils suffering from speech defect — who on account of defect or lack of speech, not due to deafness, require special educational treatment. (j) Delicate — pupils not falling under any other category who by reason of impaired physical condition need a change of environment or cannot without risk to their health or educational development be educated under the normal regime of ordinary schools. Pupils handicapped by severe blindness or deafness are normally educated in special schools. Children with handicaps in other categories may attend ordinary schools with special consideration where necessary. The vast majority of children with speech defects are educated in ordinary schools and there is no Haringey child at present with a speech defect so severe that attendance at a special school is required. Most children suffering from epilepsy or diabetes are able to be educated in ordinary schools. One epileptic child is at present placed in a special school, but there is no diabetic child at present needing special school placement. Where appropriate arrangements cannot be made for handicapped children in ordinary schools, or where the child fails to maintain reasonable progress, or is unhappy because of his disability, arrangements are made for education in day or residential special schools. 70 As the number of children with more than one disability who do not fall clearly in one category is increasing, there is special need for facilities to assess each child's total handicap and to provide the appropriate special educational treatment. Home tuition may be arranged on a temporary or permanent basis for children who are unfit for education at school. Children who are in hospital for prolonged periods are given help from the hospital school. I should like to make particular comments on two types of handicapped children: — (a) Maladjusted Children It follows from the definition given in (g) above that the term 'maladjusted' covers a wide variation of behavioural abnormalities from the very shy, withdrawn child to the very boisterous, aggressive, not easily controlled child. Autistic children are for the purposes of treatment and placement therefore ascertained as maladjusted but are given special treatment according to their needs. In December 1970 there were 14 autistic children in the borough. (b) Diabetic children In 1945 these children were classified as handicapped and given a separate category of their own. There were found to be 150 diabetic children in the country who needed residential care, and 3 residential schools were provided. On review in 1951 it seemed there were roughly the same number of diabetic children and the number of schools provided seemed adequate. It was therefore decided by the Ministry of Education to remove diabetes as a special category and for the future to ascertain these children under the heading "delicate". The position is roughly the same today. The majority of diabetic children are able to have education in a normal day school. There are 24 diabetic children in Haringey. The age range is wide and provision of special classes would not be practical, but there is a case for providing them with special tuition about diet and self-administration of insulin. The table on the next page, for which I am indebted to the Chief Education Officer, shows the number of pupils newly ascertained as handicapped, and newly placed in special schools during the year; and the distribution of ascertained handicapped children and the number awaiting placement on 21 January 1971. 71 RETURN OF ASCERTAINED HANDICAPPED PUPILS REQUIRING SPECIAL EDUCATIONAL FACILITIES IN THE CALENDAR YEAR DISTRIBUTION ON 21 JANUARY 1971 CATEGORY Number newly ascertained as requiring education in a Special School (other than hospital Special Schools) Number newly placed in Special Schools (other than hospital Special Schools) Number on register of — Independent Schools Number placed in Boarding Homes Number requiring places in Special Schools Number on register of hospital Special Schools Number being educated at home. under arrangements made under Sec.56 Education Totals Maintained Special Schools Non-Maintained Special Schools Day Boarding Day Boarding Day Boarding Boys Girls Boys Girls B G B G B G B G B G B G B G B G B G B G B G Blind Pupils 2 - 2 - - - 3 1 - - 3 1 - - - - - - - - - - - - 6 2 Partially Sighted Pupils 1 - 5 2 9 5 - . - _ - 2 - - - - - - - - - - - - 9 7 Deaf Pupils 2 - 2 3 13 12 1 2 - - 3 2 - - - - - - - - - - - - 17 16 Partially Hearing Pupils 2 1 10 13 1 - - - - - - - - - 1 1 - - - - - - 12 14 Physicplly Handicapped Pupils 9 3 1 1 34 26 1 _ _ 4 3 1 2 1 - - - - - - 42 30 Delicate Pupils 24 14 21 18 26 22 12 14 - - - - - - - - 6 4 1 - - - - - 45 40 Maladjusted Pupils 29 9 26 7 5 3 9 - - - 25 6 13 9 7 - 3 - 14 5 - - - - 76 23 Educationally Subnormal Pupils 47 22 41 15 130 94 13 2 5 6 3 3 1 2 1 21 9 2 - - - - - 176 116 Epileptic Pupils 2 - - - - - - - - - 1 - - - - - - - - - - - - - 1 - Pupils with Speech Defects 4 1 1 - - - - - - - - - 2 1 - - 2 1 - - - - - - 4 2 TOTALS 122 50 99 46 227 175 40 19 5 6 39 17 17 12 8 - 35 16 17 5 - - - - 388 250 GRAND TOTALS 172 145 402 59 11 56 29 8 51 22 - - - - 638 72 Special School Provision (a) Day Special Schools The following are the day special schools in Haringey — Name of School Category of handicapped pupil Numbers on roll Totals Haringey children Out-Borough children The Vale School Physically 59 38 97 handicapped Blanche Nevile School (includes units at Risley Avenue Infant and Junior and Drayton Comprehensive Schools for partially-hearing children) Deaf and partially-hearing 45 107 152 The Moselle School Educationally subnormal 47 — 47 The children attending the partially-hearing units require special teaching because of their hearing difficulty, but are otherwise fully integrated with ordinary school life. The opening of the Moselle School in October 1970 facilitated the placement of educationally subnormal children. At the end of the year, however, there were still 177 children in this category attending day special schools out of the Borough, mainly at Durants School, Enfield (29), Oak Tree School, Enfield (23) and Oak Lodge School, Barnet (97). On 21 January 1971 there were 30 educationally subnormal children in the Borough awaiting placement in day special schools. There is still a particular need for the placement of such children under seven years of age. Partially-sighted pupils requiring day special schooling are placed mainly in the Joseph Clarke School, Walthamstow, or New River School, Islington, and delicate pupils mainly at Hazelbury Open-Air School, Enfield. (b) Residential Special Schools The Borough's residential special school — Suntrap Open-Air School, Hayling Island, Hampshire accepts delicate and physically nandicapped children — boys of primary school age, i.e. 5 to 11, and girls of all ages. The resident staff includes a night nurse, and a medical practitioner attends twice a week and a dental officer once a week. I am sorry to have to record that Dr. A.J. May, who retired in September 1969 from his appointment as part-time medical officer to the school, died in January 1971. The number of children placed at Suntrap at the end of 1970 was 103, of whom 21 were Haringey children and 82 from other Boroughs. The following were the defects for which the Haringey children required placement — Asthma 7; Chronic bronchitis 4; Nervous debility 2; Hirschsprung's Disease 1; Recurrent respiratory infection 1; Lead poisoning 1; Emotional disturbance 3; Epilepsy 1; Hydronephrosis 1. Blind children are educated in residential special schools, mainly at Dorton House, Sevenoaks and at Linden Lodge School, Wimbledon. Children in other handicapped categories who require residential schooling are placed in schools administered by other local authorities or independent bodies, apart from children suffering from severe epilepsy, who are placed in hospital special schools. The only large number of such children are those in the maladjusted category. Hospital Classes I am indebted to the Chief Education Officer for the following report: — "Tuition has continued to be provided by two teachers to children who have been in-patients at St. Ann's and the Prince of Wales's Hospitals. The ages of the children concerned range from 5 to 15 years. By dose liaison with the day school, every effort is made to ensure that each child follows his own curriculum as far as his condition allows. The teachers greatly appreciate the co-operation of the hospital staffs, which ensures the smooth running of the classes, and also the help provided by the Haringey Library Service. The average number of children receiving tuition at any one time was 32." 73 Special Classes attached to Ordinary Schools In addition to the units for partially-hearing children, there are seven remedial classes in schools throughout the Borough for children with a normal range of ability, but with learning difficulties. Placement in these classes is temporary. At the end of 1970, the number of children attending such 'Opportunity' classes was 61. Remedial help by peripatetic teachers is available for children who have a specific reading difficulty. Home Tuition During the year 6 children received home tuition for varying periods under Section 56 of the Education Act 1944, when they were not well enough to attend school for a considerable period. Day Nurseries — Admission of Handicapped Children During 1970 the Council's day nursery scheme continued as in previous years. Children in the following categories were admitted on a medical recommendation, without charge to the parents:— (i) Deaf, partially-hearing, partially-sighted, physically handicapped, maladjusted. (ii) Mentally handicapped children under five years of age. (iii) Children over one year old of deaf or deaf/mute mothers. The cost of attendance was borne either by the Education Committee under Section 56 of the Education Act 1944, or by the local health authority under Section 22 of the National Health Service Act 1946. Admission may be for the whole or part of the day. During 1970 12 Haringey children and 1 child from another borough were in attendance at day nurseries under these arrangements. At the end of the year, 3 Haringey children were still in attendance, but the child from the other borough left before the end of the year. In addition, 4 handicapped children were placed in private play groups, without cost to the parents. None of these children was still in attendance at the end of the year. Recuperative Holidays During 1970 10 boys and 13 girls were recommended for recuperative holidays in order to assist their recovery after illness. 5 boys and 6 girls were placed in suitable homes for periods of varying length. THE SCHOOL CLINIC Medical Officer Sessions Sessions staffed by school medical officers are held to deal with minor medical problems which occur from day to day, the follow-up of defects found at periodic and other medical examinations, and particular problems brought by parents. The medical examination which is offered to all school children who are new entrants to the country, including any child who has been out of the country for a year or more and has returned, is proving of great value. It provides an opportunity to have these children's immunisation and vaccination programmes brought into line with other children in the Borough, and also enables parents to meet the school doctor and discuss their child's welfare with him. 357 children who were new entrants to the country were examined during the year under these arrangements. School clinic sessions also afford opportunity for special work to be carried out by school medical officers, including the weight-watching and warts clinics. Weight-Watching Clinic During 1969, the weight-watching clinic session at Somerset Road Clinic had to be discontinued because the medical officer who had been conducting it left the department. In May 1970, the appointment of a new medical officer enabled sessions to be resumed, and later in the year the clinic was transferred to Burgoyne Road Clinic. The weight-watching clinic at Fortis Green Clinic continued to be held throughout the year. Plantar Warts Two clinic sessions continued to be held each week, at Weston Park and Lordship Lane Clinics, to deal with plantar warts. Dr. K. Shah reports as follows on the year's work at these clinics: — "The work at the wart clinics has progressed well during the year 1970. Cases are referred to these clinics by the medical officers, school nurses and the general practitioners of the Borough. The treatment of warts and verrucae by electrocautery gives quite satisfactory results, and most of the parents whose children are treated by this method are very pleased with it, because their children do not have to miss school very much and attend the clinic too often. The children are also happy, particularly the swimmers, because they are able to take part in all the school activities in about a week or ten days. 74 Warts that are not suitable for electrocautery and those of small children or where the consent for local anaesthesia is not given, are treated by the usual method of paring the warts after application of Chlorosal paste or Collodion salicylic acid. The attendances at the two clinics during the past year were as follows:— Clinic Number of Sessions Total Attendances New cases Number treated with electrocautery Lordship Lane 48 770 265 94 Weston Park 50 541 206 81 TOTALS 98 1311 471 175 Consultant Sessions Orthopaedic Clinics Dr. E.G.M. Palser, Consultant in Orthopaedic and Traumatic Surgery to the Weston Park Clinic, retired at the end of March 1970 and I should like to express my gratitude to Dr. Palser for the valuable work he accomplished at the Hornsey School Orthopaedic Clinic over a period of more than ten years. After Dr. Palser's retirement, children with serious orthopaedic problems were referred to the Whittington Hospital, a school medical officer dealing with minor orthopaedic problems and advising the Physiotherapist on their treatment. It is hoped that early in 1971 a special hospital session staffed by a registrar will be arranged at the Whittington Hospital, for children from the Hornsey part of the Borough. Details of the attendances at the Weston Park Clinic during the year are as follows:— Consultant sessions (up to 31 March) Under 5 years Over 5 years Totals New Cases 64 110 174 Total Attendances 66 113 179 Medical Officer sessions (from 1 April) Under 5 years Over 5 years Totals New Cases 37 52 89 Total Attendances 65 99 164 Physiotherapy sessions Under 5 years Over 5 years Totals New Cases 18 94 112 Total Attendances 49 310 359 Mr. E. Hambly, FRCS, consulting Orthopaedic Surgeon to the Lordship Lane Clinic, Tottenham, retired because of ill-health towards the end of 1969, after a prolonged absence. I wish to express the appreciation of the department for the excellent work which Mr. Hambly carried out at the Clinic over the past twenty years. Mr. Hambly's successor is Mr. J.P.S. England, FRCS., who commenced sessions at Lordship Lane in January 1970. Details of attendances at the Lordship Lane Clinic during the year are as follows:— Consultant sessions Under 5 years Over 5 years Totals New Cases 115 238 353 Total Attendances 136 258 394 Physiotherapy Sessions Under 5 years Over 5 years Totals New Cases 23 107 130 Total Attendances 44 345 389 Ear, Nose & Throat Clinic The last Ear, Nose & Throat clinic session at Park Lane Medical Centre, Tottenham, was held in April 1970, and Tottenham children with ear, nose and throat defects are now seen by Mr. William McKenzie, the Consultant, at his clinic at the Prince of Wales's Hospital. 75 Ophthalmic Clinics There are three ophthalmic clinics in the Borough, at which seven sessions are held each week. Towards the end of 1969 Stuart Crescent Health Centre was opened, and the ophthalmic clinic sessions for Wood Green children, which had been held temporarily at Lordship Lane Medical Centre, were transferred to the new Health Centre. Two full-time orthoptists work at the school ophthalmic clinics in conjunction with and under the direction of the consultant ophthalmologists. Dr. T.G. Kletz, consultant ophthalmologist to the Lordship Lane Clinic, Tottenham, reports as follows on the year's work at the clinic:— "The ophthalmic clinic at Lordship Lane, as in previous years, sees mainly children referred on account of visual or ocular muscle defects. There are three ophthalmic sessions weekly, and a full-time orthoptist is in attendance. Continuation of the ethnic survey took place during the year, with the following results — 1. Children attending the clinic — 44.9% were native — 55.1% were immigrant or of immigrant origin. 2. Of the children attending for the first time, the comparative figures are — 36% native; 64% immigrant. The immigrant section consisted of — 47.9% West Indian 17.9% Cypriot 16.3% Irish 7.1% Indian 10.8% Others. 3. The figures for myopia were — Native — 24.5% of cases seen were myopic West Indian — 47% of cases seen were myopic Immigrants as a whole — 31.5% of cases seen were myopic. 4. The incidence of high myopia in young children was again almost totally in the West Indians, with 16 cases out of 54 myopes being over 10 dioptres and up to 18 dioptres. There were 2 cases amongst the Cypriots and 1 case in the native children. During the year an exceptionally high number of cases were referred as squints or strabismus, and of these 40 cases had neither squint nor refractive error needing correction. A further 10 cases were found to have refractive errors but no squint. These were out of a total of 370 new cases referred for all reasons." Mr. E.M.G. Galton, Consulting Ophthalmologist to the Stuart Crescent Clinic, retired in November 1970 and was replaced by Dr. A.Z. Abdeen who started sessions at Stuart Crescent in December 1970. Mr. Galton has kindly furnished the following report on the work at the clinic during 1970:— "Work at the new Clinic started at the beginning of 1970. It made an immediate appeal to both parents and staff. A ttendances have increased considerably. The new system in which the Orthoptist, Mrs. Conn, visits the schools to assist in sight-testing has had considerable success. Infants with low degrees of squint have been detected and referred to the Clinic for treatment. In the past these cases have tended to slip through the net with disastrous results to the vision in the affected eye. Mrs. Conn has used the Sheridan-Gardiner vision test, which has been found to be quite accurate from about 3 to 3% years. I feel this test and orthoptic screening should be more widely used." Dr. Peswani, Consultant Ophthalmologist for the Weston Park Clinic, Hornsey, reports as follows:— "The clinic was continued with 2 weekly sessions. During the year the attendances were as under:— Under5 year Over 5 years Totals Total Attendances 129 1159 1288 New Cases 61 380 441 Error of refraction (including squints) 26 668 694 , There were 44 amongst the new cases who needed orthoptic investigations and treatment." 76 Medical Services at the Vale School for Physically Handicapped Children This school offers day education to physically handicapped children in the borough and also from the London boroughs of Enfield and part of Barnet. I am again most grateful to Mr. A.J. Ives, Headmaster of the school and his staff for their continued co-operation with the medical staff. Dr. Z. Zubryzcki, Medical Officer to the school, reports as follows:— Children attending the Vale School present a wide range of physical disabilities. The largest group, forming one-third of the total, are the cerebral palsied children, sometimes called spastics. This group is under the supervision of Dr. William Dunham, the visiting consultant in Physical Medicine, who holds a weekly session jointly with the school medical officer. The remaining children include cases of spina bifida, muscular dystrophy, bone and joint abnormalities, heart defects, blood disorders, etc. Nearly every child attends periodically one or sometimes more hospitals where the initial investigation of the handicap had been made before the child started school. In these cases the specialist's recommendations for treatment such as physiotherapy or drugs are carried out by the school medical team, consisting of the school medical officer who visits the school twice a week, a full-time nurse and two full-time therapists. In addition, speech therapy and auditory training by the peripatetic teacher of the deaf are also provided in the school. Every child has a general medical examination by the school medical officer at least once a year, when the parent is invited to be present. Various complaints and ailments, from which no day in the school is free, are dealt with by the school nurse or medical officer. Swimming sessions in the municipal baths once a week are of great benefit to these children, and are greatly enjoyed by them. Unfortunately, in some cases, particularly of heart defects, the coldness of the water in the pool is quite prohibitive. It is hoped that when the school gets its own swimming pool as has been planned, more children will benefit from this very useful form of physical exercise." The cerebral palsy unit associated with the school is a Centre to which mothers are referred for advice and children for treatment as soon as cerebral palsy is diagnosed. Dr. William Dunham, Consultant in physical medicine to the Unit, attends weekly and a full time cerebral palsy therapist gives treatment to the children under his direction. A speech therapist and an educational psychologist are available to give advice and treatment in suitable cases. Of the nine new cases seen at the Unit during 1970, five were Haringey children and four from outside the borough. Four of these children were under 5 years of age and five over 5. The recommendations made for the new cases were as follows:— Recommended admission to the Vale Special School — 6 Recommended for later re-assessment — 3 Audiology Unit The Audiology Unit is within the curtilage of Blanche Nevile School and there is excellent co-operation between the medical and teaching staff. Three sessions are held each week. There is regular supervision of pre-school children with hearing defects and school children with hearing loss who attend ordinary schools. Pre-school children with hearing loss are admitted where possible to day nurseries, playgroups and where necessary to the nursery class at the Blanche Nevile School. Many of these children wear hearing aids and those not attending Blanche Nevile School are supervised by two full-time peripatetic teachers of the deaf who work in close co-operation with Dr. L. Fisch, the Consultant Otologist. Dr. Fisch reports as follows upon the year's work at the Unit:— "The work of the Audiology Clinic proceeded satisfactorily during the past year. By strenuous efforts we managed to reduce the waiting time and no child who needs urgent examination because of a suspicion of deafness has to wait very long. The greatest difficulty still was the lack of a third peripatetic teacher. In spite of efforts by the education authorities no suitable applicant for the post has been found as yet. The two peripatetic teachers on the staff of the clinic worked very hard in order to cover the urgent cases of children. Special attention is paid to the pre-school group. Unfortunately occasional visits to schools, where there are children with hearing impairment, have had to be curtailed. There was an improvement as regards placing children in classes for partially hearing children. The pressure for places has been, to a certain extent, relieved by the establishment of two classes for partially hearing children in the Borough of Brent. We still feel that one of the most important deficiencies is the provision of a nursery for partially-hearing children. The clinic is well equipped. Fortunately more funds were available for purchasing additional equipment, such as an improved model of a free field audiometer which helps with the testing of small children. Contacts were established with the Hornsey College of Art. Their Industrial Design Section is keen to work on various projects for deaf children and a promising situation is developing in this respect. Several projects are planned, such as the production of a new series of test cards and the construction of new types of equipment for testing. 77 Unfortunately one deficiency must still be reported. This concerns accommodation. As we have already mentioned in last year's report, the most urgent need as far as accommodation is concerned is for an adequate waiting room, toilet provision, and for a one-way observation room. Dr. Douglas and the audiometricians carried out an investigation into the possibilities of pre-school audiometry and possibility of pre-school screening for speech difficulties. The results of this investigation will be published in a paper which is being prepared. An improvement can be reported concerning the taking of impressions from the ears of children who need a hearing aid. Our audiometricians have been trained to take the impressions and this has proved to be very successful. Very satisfactory co-operation can be reported between the clinic and Blanche Nevile School and the Headmaster Mr. Stanway. Children who attend at the school or at one of the classes for partially hearing children are regularly re-assessed. Almost invariably the class teacher of the child attends with the child so that the re-assessment of the child can be carried out jointly. This proved to be very beneficial. The electronic engineer of the Blanche Nevile School gives us valuable help with some of our technical problems. His work concerns the supervision and repair of hearing aids of all children who attend the Audiology Unit. This is most useful and ensures the effective use of hearing aids. A successful course for Health Visitors was held. Organisation of this course was in the hands of Miss Frost, the Health Education Officer. Three doctors from Holland attended this course. They had been especially sent to this country for this purpose. The clinic was frequently visited by various visitors and we provided facilities for observing clinical work to student teachers of the deaf and to student Health Visitors. The booklet on High Frequency loss, which was published last year, proved to be very successful and contributed significantly to better understanding of this particular type of hearing difficulty and, consequently, to better management of these children. A similar booklet on unilateral deafness was prepared and is ready for printing." The following is an analysis of the cases seen during 1970:— Age -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Total New cases in year 117 24 34 33 26 26 31 23 6 11 9 8 8 5 3 - - 364 Cases brought forward from previous year 3 7 17 38 22 27 32 40 30 20 22 23 17 30 21 17 8 374 Re-examinations of old and new cases 7 10 17 21 6 15 11 15 7 8 8 6 4 1 7 4 1 148 Total Attendances 886 Pre-School Children 402 Attending Infant and Junior Schools 339 Attending Senior Schools 145 Total 886 Reason for referral of new cases:— For diagnosis 197 Known to be deaf, examination before admission to Blanche Nevile School 5 Immigrants to Borough known to be deaf 9 Partially hearing, advice as to placement 3 Auditory training 10 "At risk" 122 Transfer from hospital out-patients departments 15 Advice as to placement where deafness might be the cause of backwardness 3 Total 364 58 of the above referrals were from other boroughs. Audiometric and Vision Screening Routine audiometric and vision screening is carried out by three full-time trained audiometrician/vision testers. Vision screening in schools by the Keystone apparatus is combined with audiometric screening in junior and secondary schools, and an additional vision screening test alone is given in the last year at school. Combined testing has not been found to be practicable or time saving in infants' schools. 78 Audiometry Audiometric screening is carried out twice in infants' schools — in the first and last year; once in junior schools and once in secondary schools — in the first year. The standard for passing screening tests is set purposely high, and a high proportion of those who fail are found to respond to simple corrective measures. The percentage of children who failed in "special" tests continued to be high because these children had either been referred especially because deafness was suspected or were already under treatment. We are attempting to co-operate closely with family doctors in the investigation of hearing loss following acute ear infection. Audiometry will be carried out for any child referred by his family doctor, and the result will be sent to the doctor, so that he may carry out any further investigations which he considers necessary, unless he specifically asks for these investigations to be carried out at the Audiology Unit. The tables below give the numbers and results of audiometry tests during 1970:— Audiometer Tests — Routine Age Group 1st Tests sweep Re-test Failures both ears one ear Total %of Column 1 right left (1) (2) (3) (4) (5) (6) (7) Up to 7 years 6,360 87 277 99 103 479 7.5% Intermediate 3,832 141 111 48 65 224 5.8% Leavers 3,129 72 69 39 43 151 4.8% TOTALS 13,321 300 457 186 211 854 6.4% Audiometer Tests — Specials Age 1st Tests Re-Tests Failures both ears one ear Total % of Column 1 right left (1) (2) (3) (4) (5) (6) (7) Under 5 21 2 11 - 1 12 57.1% 5 40 7 16 4 7 27 67.5% 6 43 22 16 9 6 31 72.1% 7 38 16 18 7 6 31 81.5% 8 23 8 9 3 2 14 60.8% 9 16 12 6 2 3 11 68.7% 10 20 8 11 4 1 16 80% 11 28 10 5 9 4 18 64.3% 12 17 6 9 3 1 13 76.5% 13 10 3 4 1 2 7 70% 14 11 2 2 1 - 3 27.3% Over 14 24 5 3 2 2 7 29.2% TOTALS 291 101 110 45 35 190 65.3% Vision Screening Vision screening by the Keystone apparatus continues to be carried out in junior and secondary schools. In infants' schools, vision testing is carried out by the school nurse at periodic medical inspections, while the orthoptists carry out screening procedures for the discovery of latent squints. We have not yet been able to achieve our ideal of vision testing every second year of school life. The following report has been supplied jointly by a senior technician and an orthoptist: — "Screening of vision is carried out on a machine called a Keystone, by means of which a very quick and accurate test can be conducted in a confined space — a great advantage in the schools. The test consists of Depth and Perception, Distant and Near Vision, Distant and Near Muscle Balance, and Colour Blindness. The age groups tested on the machine are 9 — 10 years, 11 — 12 years, and 15 — 16 years. The method was tried out on children in the younger age groups, but was found not to be practical or time saving for the orthoptist. The children who fail are referred to the orthoptist, who recommends further investigation or sees the children concerned again at a later date. 79 The system whereby the technician using the Keystone and the orthoptist visit senior schools together was extended during 1970. This method avoids disrupting a class twice, and the children can give information there and then, as to whether they are undergoing or have had treatment. 1360 children were Keystone tested in senior schools under these arrangements. Of these, 420 (30.8%) were referred to the orthoptist as Keystone 'failures'. 285 of these children (68%) were confirmed as failures by the orthoptist. The orthoptist referred 49 of these (17.2%) for investigation at the ophthalmic clinic; 150 (52.6%) were found to be already under treatment; and 86 (30.2%) had defects in a minor degree which did not require further action. This type of vision testing is repetitious and could become very monotonous for the technician to do con tinuously. However, by alternating these tests with those of hearing, this disadvantage is obviated to some extent." Speech Therapy Mrs. E.R.P. McKeown, Senior Speech Therapist, reports as follows:— "At the end of the year, one full-time and four part-time speech therapists were providing, in all, 31 sessions per week at eight school health clinics, the Vale School and the William C. Harvey Junior Training School, which was opened in September 1970. For six of these sessions student therapists have visited our clinics and received practical training under the supervision of the speech therapist. Number of attendances made by children in 1970: Under five years — 682 Over five years — 2,999 Total 3,681 In 1970, a senior speech therapist was appointed to concentrate on the co-ordination of the speech therapy service and, in particular, to expedite the counselling service which was established in 1969. Under this service parents are receiving initial advice more quickly with the result that waiting lists have been reduced. Therapists have established regular visiting of schools, and teachers have been most helpful in referring for screening those pupils who appear to need treatment. Therapists aim to see all reception class pupils during the year. There is an encouraging awareness in this cosmopolitan borough of the importance of speech and language development. But, even so, in certain areas there are ethnic groupings which present diagnostic difficulties for the Speech Therapist because when the children from these groups start school some of them neither understand nor speak English." Child Guidance Service The Borough has two Child Guidance Centres — at Lordship Lane, Tottenham, where Dr. Nina Meyer is Medical Director, and at Tetherdown, Hornsey, where the Medical Director is Dr. K. Graf. The administrative director of the child guidance and school psychological service is Mr. B.J. Watkins, Senior Educational Psychologist. Dr. Meyer reports on the year's work at Lordship Lane — "Referrals to this Clinic for the years 1968/71, have been broken down into age groups; interesting findings have emerged. The largest number of referrals is in the age group 0 — 5: in the other two groups, 5 — 10 and 10 — 15, the numbers are roughly equal. It is now eight years since we started seeing pre school children: many of these infants and toddlers are now at school. Their school reports often describe these children as basically normal, functioning well and happily; teachers constantly express surprise that they were ever referred to the Clinic. The number of re-referrals is in the region of 3%. One feels the future of Child Guidance must increasingly le in the treatment of the early disturbances of childhood and in the cementing of the first mother/child relationship. In the last two years Nurseries have been able to contain and help many severely disturbed children. The appointment of an Occupational Therapist working in the Nurseries, with whom the Psychiatrist maintains dose weekly contact, has contributed to this. Discussion of children in Nurseries has resulted in greater ability to integrate children who would otherwise be regarded as impossible to help. The work of the Occupational Therapist has now branched out to include Students; the period of their stay in the Nurseries has been raised from four to six weeks — an indication that the Institute of Occupational Therapists regards this part of their training as important and worthwhile. The Hornsey Art College is also contributing by providing creative toys for the children, and we have a voluntary helper, who wishes to become an art therapist. The Educational Psychologists attached to this Clinic eighteen months ago, have developed increasing skill in helping with the management of disturbances of children at school. This has followed regular weekly discussion at the Clinic with the Psychiatrist, aimed to delineate disturbances of childhood into definite syndromes. These skills have resulted in rewarding counselling of school teaching staff, and in the allocating of resources of Opportunity Classes. 80 Conferences and discussion with colleagues in the field of child care, teachers, social workers and probation officers, have also aimed at defining social and individual pathology. These colleagues, like members of the team, have increasing awareness and thus greater potential for helping cases which otherwise might need the more specialised care of the psychiatric team. It is only by increasing such awareness that the very small available resources of a part-time psychiatric service can hope to cover the vast extent of disturbance in the child population. Tottenham is a microcosm of all the problems affecting the country as a whole. The need for special provision for disturbed children is the first and paramount priority. The absence of a Day Maladjusted School for the disturbed who cannot be contained in school, of a group for the school phobics who break down under the stress of their lives into depression and withdrawal, is one which must be met, if constructive therapeutic approach is to continue. Research has indicated one in fifteen of women and one in twenty men need to be in institutional or hospital care, because of mental illness. Of these a very great proportion present in early childhood and adolescence as school phobics and refusers. It remains only to say that the year has been a fruitful one: the numbers indicate the extent of our labours. In this year, 163 children have been referred. The parents of 197 were seen by the Psychiatric Social Workers, many of them regularly over a long period of time. 109 children were seen for diagnostic interview and assessment by the Psychiatrist. Of these the psychotherapist has treated 38 children intensively, by weekly sessions in the first instance, and later fortnightly or monthly. We have dosed 155 cases, of which 78 improved with help; of 20 the Health Visitor or Mother reported improvement, 10 moved away, 10 were non-co-operative, and to 14 we received no response for offered appointments; 2 were dosed under Educational Psychologist supervision in the last year. In the present year it appears this last number will be far higher." Dr. K. Graf reports on the year's work at Tetherdown — "This is my sixth annual report as Medical Director of Tetherdown Child Guidance Clinic. The establishment and the demands made on the sessions of this clinic have progressively increased, but the psychiatric sessions have remained unaltered for the past 20 years. It is now to be hoped that in the near future the North West Metropolitan Regional Hospital Board will agree to an additional appointment of a part-time Senior Psychiatric Registrar. The number of children referred for child guidance investigation in 1970 was 231. The majority were referred from schools through teachers (with parental consent), the Chief Education Officer and Educational Psychologists (87); the Principal School Medical Officer has sent us 68 children, while we were particularly pleased that 39 children reached us through their parents and 15 from General Practitioners. Other sources of referrals were from hospital specialists, Probation Officers, Children's Officers and the N.S.P.C.C., (including reports for the Court). Our advice, with a view to treatment, was sought for a multiplicity of complaints including emotional disturbance (69); behaviour disorders (67); School phobia, school refusal and truancy (14); delinquency (13); physical complaints explainable by emotional factors, including bed-wetting (11) and learning problems (27). The remaining 30 referrals were mostly cases of minor psychiatric significance. Boys predominated over girls and the peak age for referrals was 11 years (28), the youngest children being 2 years (7) and the oldest 16(3). The majority of cases required only counselling and advice to the parents or child (71), change of school or educational modification (22), while specialised treatment by one of our highly qualified and experienced child psychotherapists, often more than once weekly and extending over very prolonged periods, was arranged for 27 referrals. There were many other forms of help we were able to provide for the distressed parents and exasperated teachers, but 46 children improved spontaneously, left the district or were prevented by their parents or other circumstances from accepting help we had offered. 18 of the children sent for investigation were still on our diagnostic waiting list at the end of the year. Not every child who was referred required to be seen by all members of the team. The length of the investigations necessary in dealing with disturbed children is responsible for the long waiting lists for diagnosis and treatment which are common in all Child Guidance Clinics in the country. Nevertheless, we have been able to reduce our diagnostic waiting list to really negligible proportions but unfortunately, owing to the shortage of available psychotherapists and the limited time at the disposal of the psychiatrist for treatment, our treatment waiting list remains quite formidable. We continued to employ the well tried out team approach to our clients' problems, and nearly every child is seen by the Psychiatrist, who investigates his emotional stability, and the Educational Psychologist who is particularly interested in his intellectual endowment and his special needs in school, while the Psychiatric Social Worker explores the situation within the family where she tries to contact the parents and to improve the domestic situation, when necessary, by skilled casework. We are in dose co-operation with the school psychological service which is predominantly responsible for educationally subnormal children and educational problems of pupils which are not explainable by emotional disturbance." 81 Tuberculosis Prevention of tuberculosis by B.C.G. vaccination B.C.G. vaccination is offered to all school children over 13 years of age. No students of Further Education took advantage of the opportunity to have B.C.G. vaccination during 1970. The following table gives details of B.C.G. vaccinations carried out by the Council during the year- School children Number % Parents approached 3464 - Parents accepted 2864 82.7 Number skin tested 2804 — Number found positive 109 3.9 Number found negative 2449 87.3 Number failed to attend for Mantoux reading 246 8.8 Number vaccinated (% of those approached) 2418 69.8 Cases of Tuberculosis occurring in Teachers or Pupils Investigations were carried out on the advice of the Chest Physician at two comprehensive schools where cases of pulmonary tuberculosis had occurred amongst the pupils, and at a primary school where a case occurred amongst the non-teaching staff. The details were as follows — (a) Comprehensive School — pupils who had not previously been B.C.G. vaccinated were skin tested; pupils already vaccinated, and the staff, were mass x-rayed. Number of pupils skin tested 114 Number with negative results subsequently given B.C.G. vaccination 106 Severe positives referred to Chest Clinic 1 Mild positives 7 Number of pupils x-rayed 412 Number of staff x-rayed 50 Referred to Chest Clinic for further investigation 2 (b) Comprehensive School — the case was in the age group due to be offered B.C.G. vaccination in 1971, and vaccination of this group was therefore brought forward one year. Number of pupils skin tested 85 Number with negative results subsequently given B.C.G. vaccination 82 Severe positives referred to Chest Clinic for further investigation 1 Mild positives 2 (c) Primary School — all pupils in the junior and infant age groups were skin tested. Number of pupils skin tested 581 Number referred to Chest Clinic for further investigation 38 No additional case was discovered at any of the schools concerned. Co-operation with the Prince of Wales's Hospital The department continues to maintain a close link with the Prince of Wales's Hospital. The Rheumatism Supervisory Clinic continues to be held at the Hospital under the direction of Dr. Ian M. Anderson, Consultant Paediatrician. A weekly session is held at which a senior medical officer from the department attends; and another senior medical officer attends at a weekly general paediatric session. I am grateful to Dr. Anderson for the following report on the work of the rheumatism clinic during 1970:— "During 1970 only one case of Rheumatic Fever was admitted to the Paediatric Unit at St. Ann's Hospital. This was in fact a relapse. Previous admissions were to the North Middlesex Hospital with Rheumatic Fever in 1964/5. There were 38 new cases of Congenital Cardiac Lesions seen by Dr. I.M. Anderson during 1970 in his Paediatric Clinics at the Prince of Wales's General Hospital. Total number of new cases in 1970—39 (Male 20 Female 19) In Haringey Borough 32. From other boroughs 7. 50% were referred from child health clinics. 82 Cases classified as follows:— Total In Haringey From other areas Male Female Rheumatic Fever 1 1 — 1 Congenital Cardiac Lesions 38 31 7 19 19 Innocent murmur 24 20 4 12 12 Aortic Stenosis 1 1 — 1 - A trial Septal Defect 2 2 — 1 1 Ventricular Septal Defect 6 4 2 4 2 Fallot's Tetralogy with dextro cardia 1 1 - 1 - Wolff/Parkinson/White Syndrome 1 - 1 — 1 Pulmonary Stenosis 1 1 - - 1 Mitral Stenosis 1 1 - - 1 Endocardial Fibroelastosis 1 1 — — 1 Six of the new cases have been transferred to the Westminster Hospital to attend Dr. I.M. Anderson's Cardiac Clinic there for further investigations and follow-up." Mr. William McKenzie no longer holds consultant sessions at Park Lane Clinic, but a medical officer from the department attends Mr. McKenzie's weekly ear, nose and throat clinic at the hospital, acting as registrar. Uncleanliness and Verminous Conditions School nurses continued to carry out regular hygiene inspections in the schools, although a verminous head is now the exception rather than the rule. Careful watch still needs to be kept to prevent the spread of infection. The following are details of the hygiene inspections carried out during 1970:— Number of individual examinations of pupils in schools 51,926 Number of individual pupils found to be infested 278 Ringworm of the Scalp During the year 8 cases of ringworm of the scalp occurred in 7 schools throughout the Borough. We continue to be grateful to St. John's Hospital for Diseases of the Skin, who carried out screening procedure in six schools involved. No evidence of spread of infection was discovered. Screening at the remaining school was unnecessary as the source of infection was identified outside the school. As in previous years, all doubtful cases were referred to the Consultant Dermatologist at the Prince of Wales's Hospital for further investigation. The great majority of cases continues to occur in immigrant children. Deaths of School children It is with regret that I include the following details of local school children who died during 1970: — Sex Age Cause of Death Years Month F 13 3 Home accident F 7 7 Purulent bronchitis; hydrocephalus M 7 2 Myocardial insufficiency M 9 9 Accidental M 10 5 Hypertrophic cardiac myopathy M 11 2 Intestinal obstruction; Hirschsprung's disease F 11 1 Intestinal obstruction in a diaphragmatic hernia M 7 7 Broncho-pneumonia; dyshaemopoietic anaemia F 13 11 Road accident F 12 4 Accidental carbon monoxide poisoning M 11 - Pulmonary embolus; sickle cell disease F 14 11 Broncho-pneumonia; severe subnormality F 15 5 Cerebral haemorrhage F 11 - Acute tracheo-bronchitis; Down's Syndrome F 15 2 Subacute myocarditis 83 Road accidents to School Children I am indebted to the Accident Prevention Officer for the following details of road accidents involving school children during 1970:— Fatal Serious Slight Total Pedestrians 1 40 194 235 Cyclists 1 1 32 34 TOTALS 2 41 226 269 LIST OF SCHOOL HEALTH CLINICS AS AT 31 DECEMBER 1970 a - School Advice e - Orthopaedic j - Audiology Unit b - Dental f - Physiotherapy k - Child Guidance c — Ophthalmic g — Cerebral Palsy Unit I — Chiropody d — Orthoptic h — Speech a All Saints' Church Hall, 11 Church Road N6 j Blanche Nevile School for the Deaf, Philip Lane N15 abh Burgoyne Road Clinic, 58 Burgoyne Road N4 b Chestnuts Clinic, 268 St. Ann's Road N15 k Child Guidance Centre, Tetherdown N10 abh School Clinic, 128 Cornwall Road N15 abh Medical Centre, 150 Fortis Green N10 ah Gordon Road Clinic, 1a Gordon Road N11 b Dental Clinic, 334 High Road N15 abcdefhkl Medical Centre, 239 Lordship Lane N17 abh Medical Centre, 131 Park Lane N17 a Somerset Road Clinic, 370 High Road N17 abcdh Health Centre, 8 Stuart Crescent N22 abcdfhl Medical Centre, rear of Hornsey Town Hall, 23a Weston Park N8 dfgh The Vale School for Physically Handicapped Children N4 SCHOOL DENTAL SERVICE Mr. G.C.H. Kramer, Principal School Dental Officer, reports as follows: — Inspection and Treatment "The number of pupils on the school rolls as at 21 January 1971, was 38,064, this being a further increase of 2,219 as compared with the previous year. We were at last able to reverse the declining percentage of the total seen at routine dental inspections in the schools, which had been a disappointing feature of the past two years and, although even the present level is far from satisfactory, the future seems more hopeful if the staffing position can at least be maintained. The number of sessions devoted to school inspections was 185, an increase of 41 over the previous year, at which 16,741 children were examined for the first time in the year, while a further 3,878 were first examined in the clinics. Thus we were able to see a total of 20,619 which represents 54.1% of the school population, as compared with 45.3% in the previous year. Although it has not yet been possible to return to, let alone exceed, the 64% average over the first few years of our dental service, the target now looks again to be within reach. It is perhaps worthy of mention that since the first report of 1965, the number of children in the schools has risen by no less than 4,908, so that the inspection of even the same number each year produces a declining figure when expressed as a percentage. Unless we were able to increase where they are most needed both the numbers of dental officers and surgeries much above any we have ever had, while the need and demand for treatment continues at the same high level as always, / cannot foresee us ever achieving our real aim of inspecting every child at least once in each year. Again as in the past two years, as we have been unable to cover the whole school population with inspections, we have concentrated first on the most vulnerable age groups in the primary schools. A further 2,477 children were re-inspected in the year, and of the total of first or re-inspections numbering altogether 23,096, treatment was needed for 14,404 or 62.2%. Treatment sessions totalled 3,901, fewer by 76 than in 1969, and of these 734 were for our orthodontic service. The output per session was well maintained and reflects the efforts made by all members of the dental staff to make such inroads as are possible into the large demand for our services. 84 As would be expected from the lesser number of sessions, there was a small (but only a small) decrease in the number of fillings and of individual teeth filled, and / am delighted to report that there was a reduction in the number of teeth extracted. The fact that we are able to offer a predominantly conservative service is highlighted by the ratios of teeth extracted to teeth restored. For deciduous teeth this is 1 to 2.4, against a national average of 1 to 0.9, and for permanent teeth 1 to 15.3 as compared with the national 1 to 6.4. Indeed, if the sound teeth necessarily removed as an essential part of orthodontic treatment for certain patients were disregarded, the ratio would be 1 to 26.8. / derive additional encouragement from the fact that the total of extractions reduced by 101 below the 1969 figure required 152 more general anaesthetics, thus showing that, on average, each individual child needing to suffer this procedure required fewer extractions than in the previous year. / shall never cease to be appalled when tiny children require the extraction of up to a dozen teeth, yet this is by no means exceptional, and filling of others not yet beyond hope of restoration. Staffing The staffing position in the dental services throughout the country is recorded as on 31 December each year, for the annual returns required by the Department of Education and Science. In fact, to a degree which varies in different Authorities, part of the total is attributable to treatment of the priority classes and not to the school service. In the year under review, 93% of our service is for the schools although the figures which follow relate to the two services together. On the date mentioned above, in addition to the Chief Dental Officer/Principal School Dental Officer, we had two orthodontists giving service equivalent to 1.7 full-time and eleven dental officers equivalent to 7.4 full-time. These officers work with two specialists and 10 other dental surgery assistants. Comparing one year with another during the six years that our Borough has been in existence, the bare figure on the last day of each calendar year suggests that the staffing position remains fairly stable. In fact, the figure tends to conceal many changes and shortages at other times throughout the year, when dental officers particularly may leave for one reason or another and cannot be replaced before some time has elapsed. There is, however, no reduction in the unrelenting demand for treatment. It is deserving of comment that the increase of 4,908 in the school population referred to in the earlier part of this report, would alone require more than the equivalent of another full-time dental officer to meet the extra demand which it has created. Premises The dental clinic in the new Stuart Crescent Health Centre in Wood Green could not be brought into use until March, three months after other services there were operating, because of delays in the supply and installation of some items of essential equipment. However, after an interval of over two years, the Wood Green schools were at last returned to a clinic more conveniently placed for them than the various temporary arrangements which had obtained during the building of the new premises. It is a cause for regret that only one of the two surgeries is fully equipped. If it was financially possible and we could be certain to recruit another dental officer, there is pressing need to have an additional surgery, proper recovery room and separate dental waiting room at Weston Park. The present premises are in no way satisfactory or adequate in this centrally situated and very busy clinic, where there continues to be an enormous demand for our services much in excess of our ability to meet the need. As financial considerations would make it unrealistic at present to consider any large-scale replacement of major items of equipment, we have succeeded only in maintaining what we have in good order and with minor additions or replacements from time to time. We do meet the reasonable needs of the dental officers, but it must be recognised that obsolete or obsolescent equipment cannot be maintained indefinitely and will require replacement in the not far distant future, and that recruitment of scarce categories of staff is very much influenced by the premises and equipment where they would be working. Blood Testing of Certain Ethnic Groups Last year / reported that we had been able in March 1969 to introduce a system for the greater safety of children needing a general anaesthetic for dental treatment, by blood tests to ensure that proper account could be taken if genetic abnormalities were present. An additional benefit deriving from these tests was that information helpful to the medical services could result, even if the information was not relevant to provision of dental treatment. In the first incomplete year during which the new system was operating, / reported that from a total of 448 tests we had found 98 cases in which the procedure had proved valuable in one way or another. During the full year 1970, a further 514 tests were done from which useful information was obtained in 106 cases, and it now seems appropriate to comment in a little more detail on the results over the whole 21-month period since testing was started. 85 From the total of 962, there were findings directly of concern to us when general anaethetics were involved for 52 children. All but two of these required only the knowledge of the condition to ensure a modified anaesthetic technique, and it was thus possible to avoid a risk which otherwise could have obtained. The other two, however, would have been put at very serious risk indeed if we had not known of their conditions, and if the avoidance of this had been the only result of 962 tests over the whole period, / should still judge all the work and effort involved to have been fully justified. The first and less serious of these was a six year old little boy due to have all eight deciduous molars extracted three days after the blood test report showed that he was suffering from a serious iron deficiency anaemia with a haemoglobin level of only 43%. The extraction appointment was cancelled and the condition notified to our medical service who acted immediately. The child needed to be admitted to hospital for blood transfusions and was put onto suitable iron supplements, and was discharged fit three weeks later. The necessary extractions vxre done when we had reliable information that no risk remained. The second case was a seven year old boy who, surprisingly, was a hitherto undiagnosed true sickle-cell anemia — although subsequently we discovered that two siblings had died of this condition before the family came to England — and it was possible to avoid the child being put at risk of the most dire consequences. In my report last year on this subject / wrote "It is not, of course, possible to know or even theorise as to whether or not any serious difficulties with general anaethesia have been avoided by possession of knowledge gained....That was true when it was written, but / have no doubts that the reverse is now the case. In addition to the foregoing findings, results of a further 153 tests have been the concern of the medical service in smaller degree, while not being in any way of significance for dental treatment. As far as / am aware, we have been the first local authority in the country to have such an established system of precautionary testing before dental anaesthetics, although it has been usual for some time in the hospital services if members of these ethnic groups need an anaethetic for surgical procedures. We have now had a number of interested enquiries from various public services as to our methods and the results being obtained and / have recently been told that what / believe to be our pioneering work in Haringey is to be followed in some other places. Fluoridation The widespread problems arising from dental decay, either of itself or from its consequences, continue to cause me deep concern. The average standard of dental health in our Borough is, to put it no higher, poor: yet it would require combined resources of our service and the general dental practitioners far in excess of any possible to envisage, if all necessary treatment were to be provided. Although some people sincerely feel that there are good reasons why fluoridation of the piped water supplies is not acceptable, in the capacity in which / serve the Borough / must continue to view the matter from a purely professional angle and fervently hope that this measure will be brought into effect. My own feelings are expressed admirably by some words written in the annual report of the Chief Dental Officer of Sheffield 1969 "Failing to fluoridate the water supplies does not add to our difficulties, it neglects the opportunity of halving them." Dental Inspection and Treatment Pupils first inspected at school 16,741 Pupils first inspected at clinics 3,878 Pupils re-inspected 2,477 Number found to require treatment 14,404 Number of fillings: Permanent teeth 12,460 Temporary teeth 8,582 Number of teeth filled: Permanent teeth 10,539 Temporary teeth 8,278 Extractions: Permanent teeth unsavable 393 Permanent teeth orthodontia 297 Temporary teeth 3,476 General anaesthetics administered: Total 1,343 By dental officers 858 Number of dentures supplied 15 86 Number of crowns and inlays 20 Number of teeth root filled 26 Number of prophylaxes 1,320 Number of teeth otherwise conserved 617 Other operations 4,175 Orthodontic Treatment Cases remaining from previous year 194 New cases commenced during year 128 Number of appliances fitted: Removable 305 Fixed 47 Number of impressions, adjustments etc. 3,928 Number of radiographs 3,194 87 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1970 SCHOOL HEALTH SERVICE STATISTICS 1970 Pupils found to require treatment at Medical Inspections Number of Individual Pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestation with vermin) Year of Birth For defective vision (excluding squint) For any of the other conditions recorded Total individual Pupils 1966 & later 6 51 56 1964 59 290 328 159 608 698 1963 52 187 219 1962 33 107 125 1961 28 83 95 1960* 56* 137* 174* 1959* 104* 206* 274* 1958* 63* 138* 174* 1957 33 58 81 1956 229 312 463 1955 & earlier 349 383 631 TOTALS 1171 2560 3318 *Signifies "Selective" medical examinations Defect Code No. Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Total including all other age groups inspected T O T O T 0 T O 4 Skin 99 230 144 188 341 557 440 94 5 Eyes (a) Vision 235 237 550 148 1171 544 249 115 (b) Squint 100 41 30 10 197 81 23 11 (c) Other 31 30 9 36 56 93 52 30 6 Ears (a) Hearing 51 53 35 27 156 191 59 70 (b) Otitis Media 18 41 7 26 36 87 7 2 (c) Other 77 51 46 17 183 102 167 54 7 Nose and Throat 117 403 43 93 237 705 75 92 8 Speech 46 103 5 15 75 210 30 16 9 Lymphatic Glands 5 115 1 20 8 187 3 24 10 Heart 23 123 16 25 63 206 55 42 11 Lungs 80 144 33 59 163 302 76 66 12 Developmental: (a) Hernia 9 52 — 5 13 80 5 10 (b) Other 69 127 133 80 346 336 162 222 13 Orthopaedic: (a) Posture 15 29 47 74 134 149 13 26 (b) Feet 207 243 94 134 468 529 82 76 (c) Other 48 80 30 45 154 176 101 68 14 Nervous System: (a) Epilepsy 9 11 7 4 29 27 14 6 (b) Other 10 17 7 14 35 47 11 50 15 Psychological: (a) Development 8 33 2 23 28 108 119 55 (b) Stability 133 249 24 80 268 520 162 105 16 Abdomen 26 16 15 17 58 59 30 22 17 Other 51 30 45 21 136 77 198 100 T — Requiring Treatment O — Requiring Observation 89 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 137 (b) Errors of refraction, including squint 3,171 TOTAL 3,308 (c) Number of pupils for whom spectacles were prescribed 1,022 GROUP 2 Diseases and Defects of Ear, Nose and Throat Received operative treatment for: — (a) Diseases of the ear 3 (b) Adenoids and Chronic Tonsilitis 46 (c) Other nose and throat conditions - Received other forms of treatment 201 TOTAL 250 Total number of pupils still on the register of schools at 31 December 1970 provided with hearing aids: (a) During the current year 15 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 70 GROUP 3 Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 904 GROUP 4 Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 8 (ii) Body 1 Scabies - Impetigo 12 Other skin diseases 593 TOTAL 614 GROUP 5 Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 616 GROUP 6 Speech Therapy Number of pupils treated by speech therapists 309 GROUP 7 Other Treatment given (a) Number of miscellaneous minor ailments treated by the Council 136 (b) Pupils who received convalescent treatment under School Health Service arrangements 11 (c) Pupils who received BCG vaccination 2,418 (d) Treatment other than (a) (b) and (c) above 368 90 EDUCATION ACT 1944 - Section 57 Cases dealt with under Section 57, Education Act 1944 — Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 — MEDICAL EXAMINATION OF TEACHERS (a) Number of teachers examined as to fitness for first appointment 111 (b) Number of Students examined as to fitness to undertake training course 240 (c) Number of Students examined on completion of training course at Hornsey College of Art 64 91 INDEX Page No. Advice Clinics for the Elderly 51 Ante-natal Clinics 44 Atmospheric Pollution 15 Audiology Unit 77 Audiometry 78 Births, Notification of 42 Care of Mothers and Young Children 42 Cervical Cytology 44 Publicity Campaign 60 Child Guidance Service 80 Child Health Clinics 45 Chimney Heights 15 Chiropody Services 53 Cleansing and Disinfection 19 Clearance Areas 23 Comparability Factors 7 Congenital malformations 46 Deaths of Haringey Residents 8 Deaths of School Children 83 Defects remedied 21 Dental Care: Priority Classes 49 School 84 Disease of Animals Act 1950 23 Drainage and Sewerage 12 Ear, Nose and Throat Clinics 75 Education Committee 67 Factories 40 Family Doctor, co-operation with 42 Family Planning 42 for unmarried girls 43 Food Complaints 36 Food Hygiene 82 Food Premises 33 Food Sampling 34 Furnace Installations 15 Geriatric Services 51 Hairdressers 39 Handicapped Pupils 70 Requiring special educational facilities 72 Handicapped Register, Children on 48 Health Committee 1 Health Education 68 Health Visiting Service 48 Page No. Home Nursing Service 50 Hospital Services, co-operation with 42 House Drying 33 Houses in Multiple Occupation 21 Housing applications, assessment on medical grounds 64 Improvement Areas 26 Grants 27 of dwellings 26 Infectious Diseases 62 Infectious Diseases, Notification of 11 Insect Pests 19 Inspections carried out by Public Health Inspectors 20 Laundry services for the incontinent 19 Measles 63 Meat Inspection 37 Medical examination of staff 55 Medical examinations in schools 69 Mental Health 56 Midwifery Service 49 Mortuary 19 Mothercraft and Relaxation Classes 45 Multiple occupation. Houses in 30 Noise 22 Observation Register, Children on 47 Offices, Shops and Railway Premises Act 1963 38 Ophthalmic Clinics 76 Orthopaedic Clinics 75 Outworkers 40 Pet Shops and Animal Boarding Establishments 23 Physically Handicapped Children, Medical Services at The Vale School 77 Qualification Certificates 26 Radioactive Substances Act 1960 41 Refuse, Accumulation of 23 Ringworm 83 Road accidents to School Children 84 Rodent Control 17 Rubella 64 School Clinic, The 74 School Dental Service 84 School Health Clinics, list of 84 School Health Service 69 School Health Service Statistics 88 Page No. School Population 69 Shops Act 1950-1966 39 Smallpox 62 Smoke Control Areas 15 Special Schools Provision 73 Speech Therapy 80 Staff 2,67 Staff Medical Assessments 55 Statistics, Dental 86 Statistics, School Health 88 Statistics, Vital 6 Statutory Notices Served 21 Statutory Nuisances, Abatement of 22 Street Trading 40 Swimming Baths and Paddling Pools 15 Toddler's Clinics 46 Tuberculosis in Schools 82 Tuberculosis 64 Tuberculosis, Prevention by B.C.G. vaccination 82 Unfit houses 23 Unmarried firls, family planning for 43 Vaccination against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis and Measles 57 Vaccination against Smallpox 58 Venereal Disease 64 Vision Screening 78 Vital Statistics 6 since 1965 10 Water Supplies 12 Weight Watching Clinics 74 Welfare Foods, Distribution of 48