148 edm 20 Urban District Council of Edmonton. REPORT OF THE Medical Officer of Health FOR THE YEAR 1933. JOLLY, T.U. PRINTER, EDMONTON. Urban District Council of Edmonton. REPORT OF THE Medical Officer of Health FOR THE YEAR 1933 JOLLY, T.C. PRINTFR, EDMONTON. Edmonton Urban District Council. 19 3 3. Chairman Councillor A. R. HONE, J.P. Vice-Chairman Councillor Mrs. F. LONG. PUBLIC HEALTH COMMITTEE. Chairman Councillor H. BARRASS, J.P. Members: Councillors W. BALES, Mrs. BARRASS, A. E. COLE, T. J. DIBBENS, F. C. MOORE, J. A. WARD, Mrs. YOUNG. STAFF OF THE PUBLIC HEALTH DEPARTMENT. * H. W. Harding, M.D. (Lond.), D.P.H., M.R.C.S., and L.R.C.P., Medical Officer of Health, School Medical Officer and Supervisor for the Maternity and Child Welfare Committee. *ab J. E. Winter, Senior Sanitary Inspector, Inspector of Canal Boats, and Inspector under the Petroleum Acts (till June 30th). *ab W. Tillcock, Senior Sanitary Inspector, Inspector of Canal Boats, and Inspector under the Petroleum Acts (July 1st). *abc G. H. Huckle, Sanitary Inspector, and Inspector under the Petroleum Acts. *ab J. P. Farrar, Sanitary Inspector, and Inspector under the Petroleum Acts. *ab E. Dodsworth, Sanitary Inspector, and Inspector, under the Petroleum Acts (from Nov. 6th). a F. Beilby, Inspector for the Housing Regulations. *a Mrs. H. Fowler, Woman Sanitary Inspector. S. Clayton, Shops Acts Inspector. F. J. Nash, Senior Clerk. A. E. Clarke. J. L. A. Saunders (half-time School Medical Clerk, and half-time Public Health). * Moiety paid under Public Health Act, or by Exchequer Grants. a Certificated Sanitary Inspector. b Certificate of Meat and Food Inspector, c Certificate of Smoke Inspector. 3 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman - Mrs. E. A. YOUNG. Vice-Chairman Mrs. H. L. PORTEOUS. Members: Councillors W. BALES, H. BARRASS, J.P., Mrs. BARRASS, L. E. BERRIDGE, S. N. CHAPMAN, A. E. COLE, T. J. DIBBENS, Mrs. HEARN, Mrs. LONG, Mrs. MOSS, W. PREYE, J. A. WARD. Co-opted Members: Mesdames ALLAN, BIGGS, ELMS, GOODALL, JENNER, LEAR, PLATFORD. STAFF. a H. W. Harding, M.D. (Lond.), D.P.H., Medical Officer of Health, a Mrs. G. F. Fleetwood-Outram, M.B., Ch. B. (Glasg.), in charge of the Ante-Natal Clinic and Child Welfare Centres. a H. J. Seddon, F.R.C.S., Eng., Orthopaedic Surgeon. a E. Underhill, L.D.S., R.C.S., Dentist. abcjg Miss A. Bintcliffe, Lady Superintendent. ajg Miss A. Naylor, Health Visitor. ag Mrs. C. Boothby, Health Visitor. abeg Miss J. Anderson, Health Visitor. adeg Miss J. Paterson, Health Visitor. acg Miss M. Druce, Health Visitor. ae Miss M. F. Cozens-Walker, Chartered Masseuse (part-time). a Miss R. S. Saunders, Senior Clerk. a Miss N. A. Eyres, Junior Clerk. DAY NURSERY. aeg Matron:—Miss W. J. Vigar. a Nurses:—M. Waters, M. C. Knight, M. Brown. a Moiety of Salary paid by Exchequer Grants. b Maternity and Child Welfare Certificate. c Certificate as prescribed by the Board of Education. d Certificate as prescribed by the Ministry of Health. e Certificate of General Training. f Sanitary Inspector's Certificate. g Certificate of the Central Midwives Board. 4 To the Chairman and Members of the Edmonton Urban District Council. Ladies and Gentlemen, I have pleasure in presenting my Report for the year 1933 on the sanitary conditions of the District of Edmonton and on the vital statistics of its residents. The Report is drawn up in accordance with suggestions outlined in Circular 1346 of the Ministry of Health. Undoubtedly the outstanding feature of the year from a sanitary point of view was the work done in connection with the Clearance Areas : full reference to this is made under "Housing." There are bound to be from time to time individual houses which cannot be made properly fit for habitation without undue expenditure, and these must come under the operation of the Housing Act of 1930, but there are no blocks of houses, apart from those above, which merit treatment as "Clearance Areas." There is, of course, old property in the district, which, in process of time, will eventually end in demolition, but these houses still serve a useful purpose and the term "slum" cannot be applied to them. I am sorry to record the resignation of Mr. J. Winter, the Senior Sanitary Inspector since January, 1926, and who had been a servant of the Council for close on forty years. In Mr. Winter's retirement, the Council has lost a conscientious employee and the Staff of the Department a loyal colleague. In his place was appointed Mr. W. Tillcock, who had been in the employ of the Council for thirteen years. Mr. E. Dodsworth filled the vacant post of District Sanitary Inspector, commencing his duties on November 6th. The work of the Public Health Department continues to increase and one looks forward to the time when it will be possible to increase the clerical staff : at present it is impossible owing to lack of accommodation. There is one general office, and that houses four Sanitary Inspectors, the Shops Acts Inspector, and three clerks. A new Town Hall, with its suggestion of commodious accommodation, would prove a very great boon. I should like to take this opportunity of thanking the members of both Committees for their courtesy and help during the past year, and my colleagues for their loyal support. I am, Your obedient servant, H. W. HARDING. 5 GENERAL STATISTICS. Area (in acres) 3,895 Population. Census of 1931 77,652 Estimated by the Registrar-General for the mid-year 1933 86,540 Number of inhabited houses and tenements at the end of 1933 18,695 Rateable Value, 1st April, 1933 £469,939 Estimated product of a rate of one penny in the £ for the year ending 31st March, 1934 £1,920 Rates in the £ for the year ending March 31st, 1934 12/8 SOCIAL CONDITIONS. The District is one of London's dormitories; a few factories have been put up during the year, but the increased number of persons locally employed is more than balanced by the increase in population due to the building of new houses, and whose inhabitants are engaged elsewhere than in the District. The extent of Unemployment may be estimated by the following figures relating (1) to the municipal milk supply, (2) the number of free dinners given to school children, and (3) figures kindly given me by the Director of Public Assistance:— (1) Municipal Milk Supply:— Number of pints granted at ¼ cost during 1932 83,762 Ditto during 1933 88,725 (2) Number of Free Dinners given:— During 1931 56,752 Ditto for the year 1932 112,908 Ditto for the year 1933 120,088 (3) Figure re Out-Relief:— Cases. Amount. For the year 1931 3,010 £42,384 For the year 1932 4,249 £61,383 For the year 1933 Ordinary out-relief 1,982 £31,897 Unemployed out-relief 2,452 £29,701 Total for the year 1933 4,434 £61,598 6 All the above figures point in the same direction, namely, an absolute increase in the number of unemployed. The increase, however, is so slight that, when the increased population is taken into account, one can, I think, conclude that there is a relative decrease. VITAL STATISTICS. Live Births. Male. Female. Total. Grand Total. Legitimate 678 670 1,348 Illegitimate 18 23 41 1,389 Birth-rate per 1,000 of population 16.05 Still Births. Male. Female. Total. Legitimate 25 15 40 Illegitimate 2 2 4 Total of live and still births 1,433 Rate of still births per 1,000 total births 30.7 Deaths. Male. Female. Total. Number 451 431 882 Rate per 1,000 of population 10.2 Deaths from Puerperal Causes:— Number. Rate per 1,000 (live & still) births. From puerperal sepsis 2 1.4 Other puerperal causes 8 5.6 Total 10 7.0 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 64.0 Legitimate infants per 1,000 legitimate live births 60.8 Illegitimate infants per 1,000 illegitimate live births 170.7 Deaths from Measles (all ages) 0 „ „ Whooping Cough (all ages) 7 „ „ Diarrhœa (under 2 years of age) 7 The following list of causes of death, subdivided into males and females, has been supplied by the Registrar General. It includes non-civilians as well as civilians. 7  Male. Female. Total. Measles 0 0 0 Scarlet Fever 1 0 1 Whooping Cough 2 5 7 Diphtheria 2 2 4 Influenza 13 25 38 Cerebro-spinal Fever 0 1 1 Tuberculosis of the Respiratory System 32 21 53 Other Tuberculous Diseases 3 2 5 Syphilis 1 0 1 General Paralysis of the Insane 3 2 5 Cancer, Malignant Disease 57 73 130 Diabetes 2 3 5 Cerebral Hæmorrhage, etc. 13 27 40 Heart Disease 109 91 200 Aneurysm 1 1 2 Other Circulatory Diseases 23 17 40 Bronchitis 11 20 31 Pneumonia (all forms) 41 37 78 Other Respiratory Diseases 7 2 9 Peptic Ulcer 6 3 9 Diarrhœa (under 2 years) 3 4 7 Appendicitis 1 0 1 Cirrhosis of Liver 1 1 2 Other Diseases of the Liver 0 3 3 Other Digestive Diseases 9 9 18 Nephritis 7 12 19 Puerperal Sepsis 0 2 2 Other Puerperal Causes 0 6 6 Congenital Debility, Premature Birth, etc. 37 14 51 Senility 3 6 9 Suicide 11 4 15 Other Violence 19 10 29 Other Defined Diseases 32 28 60 Causes, Ill-defined or Unknown 1 0 1 451 431 882 Special causes, included in the above: Polio-myelitis 1 0 1 8 The following lists of causes of death are divided into different age groups: they may vary slightly from the previous table, inasmuch as the Registrar-General is possessed of further information not known to us. MALES. Causes of Death ALL AGES Under 1 year 1 & under 2 years 2 & under 5 years 5 & under 15 years 15 & under 25 years 25 & under 35 years 35 & under 45 years 45 & under 55 years 55 & under 65 years 65 & under 75 years 75 and over 1 2 3 4 5 6 7 8 9 10 11 12 13 Measles .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. .. .. 1 .. .. .. .. .. .. .. Whooping Cough 2 1 1 .. .. .. .. .. .. .. .. .. Diphtheria 2 .. .. 2 .. .. .. .. .. .. .. .. Influenza 13 1 3 .. .. .. 2 2 3 .. .. 2 Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis, respiratory system 12 1 .. .. .. 5 12 5 6 3 .. .. Other Tubercular Diseases 3 .. 1 1 1 .. .. .. .. .. .. .. Syphilis 1 .. .. .. .. .. .. .. 1 .. .. .. General Paralysis of the Insane 3 .. .. .. .. .. .. 1 .. 1 1 .. Cancer, Malignant Disease 57 .. .. .. .. .. 4 5 6 16 18 8 Diabetes 2 .. .. .. .. .. .. .. .. .. 2 .. Cerebral Haemorrhage 13 .. .. .. .. .. .. 1 .. 2 2 8 Heart Disease 109 1 .. 1 1 1 7 3 1 23 30 41 Aneurysm 1 .. .. .. .. .. .. .. .. 1 .. .. Other Circulatory Diseases 23 .. .. .. .. .. 1 .. 2 4 6 10 Bronchitis 11 .. .. .. .. .. 1 1 1 1 1 6 Pneumonia (all forms) 41 8 4 3 2 .. .. 5 5 5 7 2 Other Respiratory Diseases 7 .. .. .. .. 1 1 2 .. 2 1 .. Peptic Ulcer 6 .. .. .. .. .. .. 3 1 .. 2 .. Diarrhoea & Enteritis (under 2 yrs.) 3 3 .. .. .. .. .. .. .. .. .. .. Appendicitis 2 .. .. .. .. 1 .. .. .. .. .. 1 Cirrhosis of Liver 1 .. .. .. .. .. .. .. .. .. 1 .. Other Diseases of the Liver .. .. .. .. .. .. .. .. .. .. .. .. Other Digestive Diseases 8 .. 2 .. .. 1 .. 1 2 .. 2 .. Nephritis 7 .. .. .. .. 1 .. .. 1 .. 3 2 Congenital Debility, etc. 17 37 .. .. .. .. .. .. .. .. .. .. Senility 3 .. .. .. .. .. .. .. .. .. .. 3 Suicide 11 .. .. .. .. .. .. 2 6 1 .. 2 Other Violence 19 .. 1 1 .. 6 2 1 4 3 .. 1 Other Defined Diseases 32 1 .. .. 5 3 3 3 1 4 8 4 Diseases Ill-defined 1 .. .. .. .. .. .. .. .. 1 .. .. Totals 451 52 13 8 10 19 33 35 40 67 84 90 9 FEMALES. Causes of Death ALL AGES Under 1 year 1 & under 2 years 2 & under 5 years 5 & under 15 years 15 & under 25 years 25 & under 35 years 35 & under 45 years 45 & under 55 years 55 & under 65 years 65 & under 75 years 75 and over I 2 3 4 5 6 7 8 9 10 11 12 13 Measles .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 5 2 .. 2 1 .. .. .. .. .. .. .. Diphtheria 2 .. .. 1 1 .. .. .. .. .. .. .. Influenza 25 3 .. .. .. .. 1 2 5 4 3 7 Cerebro-spinal Fever I 1 .. .. .. .. .. .. .. .. .. .. Tuberculosis, respiratory system 20 .. .. .. 2 5 3 2 4 2 1 1 Other Tubercular Diseases 2 .. .. .. 1 .. 1 .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane 2 .. .. .. .. .. 1 1 .. .. .. .. Cancer, Malignant Disease 73 .. .. .. .. 1 4 3 17 13 20 15 Diabetes .. .. .. .. .. .. 1 .. .. 1 1 .. Cerebral Haemorrhage, etc. 28 .. .. .. .. .. .. 1 3 7 10 7 Heart Disease 91 .. .. .. 1 .. 2 2 8 14 30 34 Aneurysm 1 .. .. .. .. .. .. .. .. 1 .. .. Other Circulatory Diseases 17 .. .. .. .. .. .. .. 2 2 6 7 Bronchitis 20 .. .. .. .. .. .. .. 2 2 5 11 Pneumonia (all forms) 37 10 6 1 .. 1 I 2 .. 5 7 4 Other Respiratory Diseases 3 .. .. .. .. .. .. .. .. 1 1 .. Peptic Ulcer .. .. .. .. .. .. .. .. 1 1 1 .. Diarrhoea & Enteritis (under 2 yrs.) 4 4 .. .. .. .. .. .. .. .. .. .. Appendicitis .. .. .. .. .. .. .. .. .. .. .. .. Cirrhosis of Liver 1 .. .. .. .. .. .. .. .. 1 .. .. Other Diseases of the Liver 3 .. .. .. .. .. 1 .. .. 2 .. .. Other Digestive Diseases 8 .. .. 1 .. 2 .. 2 1 .. 1 1 Nephritis 12 .. .. .. 1 .. .. 1 .. 4 3 .. Puerperal Sepsis 2 .. .. .. .. .. 2 .. .. .. .. .. Other Puerperal Causes 6 .. .. .. .. .. 3 2 1 .. .. .. Congenital Debility, etc. 14 14 .. .. .. .. .. .. .. .. .. .. Senility 6 .. .. .. .. .. .. .. .. .. .. 6 Suicide 4 .. .. .. .. 1 1 1 .. 1 .. .. Other Violence 10 2 .. .. .. 2 .. .. .. .. 2 1 Other Defined Diseases 28 1 .. .. 1 3 1 6 2 2 7 5 Diseases Ill-defined .. .. .. .. .. .. .. .. .. .. .. .. Totals 431 37 6 5 11 15 22 25 49 63 98 100 Deaths of Infants under one year of age:— Male. Female. Total. Grand Total. Legitimate 47 35 82 Illegitimate 5 2 7 89 Death-rate of infants under one year of age:— Legitimate infants per 1,000 legitimate live births 60.8 Illegitimate ,, ,, illegitimate ,, 170.7 All infants per 1,000 live births 64.0 10 The neo-natal causes of death— that is, those operating under the age of four weeks— together with an analysis of the causes under one year of age, are:— MALES. Under 1 week Second week Third week Fourth week Total under 1 month 1— 3 months 3— 6 months 6— 9 months 9— 12 months Total under year Whooping Cough .. .. .. .. .. .. .. .. 1 1 Influenza .. .. .. .. .. .. .. 1 .. 1 Pneumonia 1 .. 2 .. 3 .. .. 2 1 8 Diarrhoea and Enteritis 1 .. 1 .. 2 I .. .. .. 3 Congenital Malformation 1 .. .. .. 1 2 .. 2 .. 5 Congenital Debility .. 3 2 .. 5 .. .. .. .. 6 Premature Birth 7 6 2 .. 17 .. .. .. .. 17 Injury at Birth 1 1 .. .. 2 .. .. .. .. 2 Atelactasis 4 1 .. .. 5 .. .. .. .. 5 Icterus Neonatorum .. 1 .. .. 1 .. .. .. .. 1 Other Diseases of Earlv Infancy 1 .. .. .. 1 .. .. .. .. 1 Other Causes .. .. .. .. .. 1 .. .. 1 2 Totals 16 12 7 2 37 4 3 5 3 52 FEMALES. Under 1 week Second week Third week Fourth week Total under 1 month 1— 3 months 3— 6 months 6— 9 months 9— 12 months Total under 1 year Whooping Cough .. .. .. .. .. .. 1 .. 1 2 Influenza .. .. .. .. 1 .. 1 .. I 3 Cerebro-Spinal Fever .. .. .. .. .. .. .. .. 1 1 Pneumonia I 1 .. I 3 2 2 1 2 10 Diarrhoea, etc. .. .. 1 1 2 .. 2 .. .. 4 Congenital Malformation I .. .. .. 1 .. 1 .. .. 2 Atelactasis 1 .. .. .. 1 .. .. .. .. 1 Prematurity 4 1 2 .. 7 .. .. .. .. 7 Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Inattention at Birth 2 .. .. .. 2 .. .. .. .. 2 Congenital Debility I 1 .. .. 2 .. .. .. .. 2 Other Causes .. 1 .. .. 1 1 .. .. .. 2 Totals 11 4 4 2 21 3 7 I 5 37 COMPARATIVE STATISTICS. The above figures relating to the Vital Statistics are more valuable when they can be compared with similar figures for London and for England and Wales as a whole. 11 Provisional figures for 1933 have been forwarded by the RegistrarGeneral and the following comparisons can be made:— Birth-rate per 1.ooo population Death-rate per 1,000 births. From diarrhoea, etc., under 2 years Total deaths under 1 year Live Still England and Wales 14.4 0.62 7.1 64 London .. .. .. .. 13.2 0.45 11.6 59 Edmonton .. .. • • 16.05 0.51 5.04 64 Annual Death Rate per 1,000 of Population. All Causes Typhoid Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence England and Wales 12.3 .01 .00 .05 .02 .05 .06 .57 .54 London 12.2 .00 .00 .02 .02 .08 .08 .51 .58 Edmonton I0.2 .00 .00 .00 .01 .02 .02 .15 .51 GENERAL INVALIDITY. It is possible to gauge the general invalidity prevailing in the district from the reports made weekly by the Health Visitors and the returns made to the Education Committee by the Attendance Department. In addition, I see weekly the medical certificates of the Council's workmen who are on the sick list, and in the case of those on the list longer than a fortnight, I pay a visit to make enquiries—the result of my visit being reported to the appropriate Committee. The causes of general invalidity might be grouped under two main headings:—(1) an infection spreading through the community and (2) personal illness. With regard to the former, I noted that there was much influenza and pneumonia in the third week in January, and that in Edmonton the deaths exceeded the births. This condition prevailed for a month and I noted that in the third week in February the influenza and bronchitis was not so bad, and that there were not so many workmen on the sick list. The infection gradually abated and for the first week in April I noted : " Warm week : sunny : illness died down." 12 Towards the end of the year, a few cases of chicken pox and whooping cough appeared in the younger population, forerunners, unfortunately, of a more widespread outbreak which developed in 1934. Regarding invalidity due to the second heading, "personal illness," many of the causes are associated with septic infection, such as gastric and duodenal ulcers, lumbago and other forms of muscular rheumatism, etc. These illnesses are common amongst the Council's workmen and are responsible for much sick leave. Regarding the effect of environment on the health of the population, there is no evidence to show that any section is exposed to adverse conditions. A similar remark may be made with regard to occupation, with one exception, and that was a case of tar acne arising in a man working with tar. Has unemployment affected the health of the individual? The only evidence bearing on the question is furnished by the school children attending the free school dinners; judging by their appearance, one would say that their health is not affected. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Laboratory Facilities. These are the same as described in the Report for 1932. The Medical Officer of Health carried out the following examinations during 1933:— Swabs for Diphtheria: Positive. Negative. Total. From suspected cases 38 720 758 From contacts 13 235 248 From carriers and old cases 16 21 37 Total 67 976 1,043 Sputa for the Presence of the Tubercle Bacillus: Positive. Negative. Total. 6 28 34 Hairs for the Presence of Ringworm Organism : Positive. Negative. Total. 2 1 3 Other material for bacteriological examination is sent to the Clinical Research Association, including virulency tests for the Diphtheria bacillus. These examinations included:— One Diphtheria swab for virulency— positive result. One specimen of Cerebro-spinal fluid— negative result. Three specimens of blood for the Typhoid test—two were negative to all the varieties of the typhoid organism, one was positive to the para-B form. Designated milks—such as Grade A, etc.—are sent for bacteriological examination to the Counties Public Health Laboratories. The results of these examinations were:— Passed. Failed. Total. Grade A (T.T) 24 6 30 Pasteurised 5 1 6 Grade A (pasteurised) 1 0 1 Certified 1 0 1 The Middlesex County Council is the Authority under the Sale of Food & Drugs Acts. Ambulance Facilities. These are the same as described in the Report for 1932. The Superintendent of the Fire Brigade has kindly furnished the following figures giving some idea of the work carried out during the past year :— Private cases 2,134 Accident cases 380 Maternity cases 189 Clinic cases 201 Isolation Hospital Visitors 1 2,905 The Council's small 'bus—housed in the Town Hall Yard—picks up the partially blind children morning and afternoon, taking them to and from school: it also picks up a few feeble-minded children in the morning, conveying them to a spot to meet the guide. Nursing in the Home. The arrangement made between the Council and the Edmonton Nursing Association has been working satisfactorily during the past year. Poorer residents in the district are supplied with a trained nurse at the Council's expense. The cost to the Council during 1933 was £85 2s. Od. The "Queen's" Nursing Association for Edmonton has just published the Third Annual Report for the nine months ending December 31st, 1933. 14 The results are extremely encouraging and the thanks of the District are certainly due to the Nurses and the energetic Honorary Secretary of the Association. The Report for the nine months shows that there are five Nurses in the District; that the number of patients nursed was 510; and that the Nurses paid a total of 11,738 visits. Finances are in a flourishing condition, and at a recent meeting it was decided to go forward with a scheme for building a suitable house to accommodate a greater number of nurses. Clinics and Treatment Centres. These have been fully described in previous Reports; no amendments to these are necessary for the 1933 Report. The work carried out by the Maternity and Child Welfare Clinic is described later on. Hospitals. A similar remark applies to Hospitals. Cases of infectious disease are admitted to the Enfield and Edmonton Joint Hospital. Arrangements are made with the North Middlesex County Hospital for the operative treatment of tonsils and adenoids by both the Education and the Maternity and Child Welfare Committees; for the treatment of mastoid cases and of ringworm of the scalp by X-ray measures by the Education Committee; and treatment of children under the age of 5 years by ultra-violet radiation by the Maternity and Child Welfare Committee. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The district is supplied by the Metropolitan Water Board. Rivers and Streams. The supervision of Pymmes Brook is undertaken by the River Lea Catchment Board, and Salmon's Brook by the Middlesex County Council. Public Cleansing. This was fully described in the Report for 1932. Bi-weekly collection of household refuse would be a boon to the district, and an incinerator is long overdue. The dumping of refuse in close proximity to Montagu Road during the course of the year had to be abandoned: the nuisance from flies in moderately-near dwellings was intolerable. 15 The Engineer and Surveyor has kindly given a summary of the work undertaken by his Department to improve the sanitation and social amenities of the district. Sewerage, Sewage Disposal and Drainage. A commencement was made with the extension of the Sewage Disposal Works by the Contractors in October last. The works consist of two. additional filter beds, four humus tanks, additional sludge drying beds, offices, laboratory, etc., the contract figures being ,£34,290 19s. l0d. The main sewer in Church Street has been extended to pick up new estates in course of development. Improvements have been carried out on surface water culverts in the Hertford Main Road, and other culverts have been cleansed. Road and Footpath Works. Work was commenced on the Hertford Main Road reconstruction from the Town Hall to Tramway Avenue. The whole of the haunches to be repaved and footpaths relaid. Also the paving of the second section of the paths on the Council's Hyde Housing Estate was put in hand, and this will complete the footpath paving on this Estate. Paving improvement works were carried out in Town Road, Montagu Road, Bounces Road, Victoria Road, and The Broadway. Tarspraying and surface treatment of the roads throughout the district was systematically maintained during the year, thereby minimising dust and improving the life and surface of the roads. Trees and Shrubberies. 1,283 new trees were planted in the district, and from time to time new shrubberies were laid out. Buildings. A new public convenience was erected at the corner of the Cambridge Arterial Road and Church Street. The number of houses erected by the Council during the year by State assistance was 103. Open Spaces. Bury Lodge and grounds, 4£ acres in extent, have been acquired by the Council for a permanent public open space. Improvements have been carried out in Pymmes Park, the old rustic bridges over the lake have been replaced by two reinforced ornamental concrete bridges. 16 SANITARY INSPECTION OF THE AREA. The District is divided into three areas, having its own Sanitary Inspector who also acts as Inspector under the Petroleum Acts. A fourth Inspector carries out house-to-house inspection. The Woman Sanitary Inspector looks after out-workers' premises, the sanitary condition of factories where women are employed, supervision of the premises where ice-cream is made or sold, women's lavatories, the supervision of home-nursed cases of the notifiable infectious complaints and the investigation of these latter diseases, including tuberculosis. The Senior Sanitary Inspector supervises the work of the District and is also Inspector under the Canal Boats Acts. The following tabular statement gives the number and the nature of the inspections made during the year :— Complaints1,094 Infectious Diseases 492 Tuberculosis 243 House-to-house 156 Factories 149 Workshops 53 Workplaces - Outworkers 110 Schools 27 Offensive Trades 81 Smoke Observations 127 Sanitary Conveniences, Urinals 502 Stables 39 Piggeries 67 Gipsies 63 Petroleum 141 General Inspections 432 Reinspections 5,223 Sundry Visits 1,875 Cinemas and Halls 24 Visits to Canal 24 17 Inspection of Places where Food is Prepared, etc. Dairies and Milkshops 120 Shops and Stalls 284 Butchers 178 Fish Shops 62 Coffee Shops 12 Ice-Cream Shops 127 Slaughter Houses 183 Bakehouses 51 The number of notices served were :— Preliminary or informal notices 1,103 Statutory notices 206 Whilst the work carried out as the result of these notices was:— Houses repaired, cleansed, etc. 552 Drinking water cisterns repaired, covered, etc. 23 Water fittings repaired 61 Water taken off main 1 Drains examined, tested, etc. 229 Drains cleared, traps repaired, etc. 258 Drains reconstructed 24 Chambers inserted 21 Chambers sealed down 26 Soil and vent pipes repaired 31 W.C.'s repaired, cleansed, etc. 255 Flushing cisterns repaired 136 Waste pipes repaired, etc. 74 Sinks repaired 23 Roofs repaired 241 Gutters and rain water pipes repaired 250 Yards paved or repaired 129 Scullery floors repaired 54 Spaces under floors ventilated 56 Dampness remedied 151 Floors repaired 75 Coppers and stoves repaired, etc. 271 New dustbins supplied 243 Accumulation of refuse removed 60 Nuisance from animals abated 8 Gipsies removed 50 Other nuisances abated 456 Rooms cleansed after infectious disease 38 18 Van Dwellers. The number of these is gradually diminishing year bv year; at the present time practically all available land has been taken over for building purposes. Offensive Trades. There are 30 such businesses, comprising one gut scraper, one fat boiler and 28 fish fryers and fish curers in the district. One person was fined 40s. and five guineas costs for carrying on the trade of a "fish curer" contrarv to the provisions of the Public Health Acts. Pig-Keeping. There are now very few pig-keepers; there is a certain number of pigs on the Council's allotments at Weir Hall, but they are well beyond the statutory distance from occupied houses. The other small piggeries are dotted about the area and are periodically visited by the District Inspectors. Rats and Mice Destruction Act, 1919. This matter was fully commented upon in the report for 1932. The Act throws the responsibility on the occupier of the premises infested, but they do not always realise this. The Inspectors are always ready to investigate the matter by testing drains, etc.; also to give advice and barium biscuits. The work of the Inspectors of rat destruction, appointed by the Middlesex County Council, is to a large extent advisory and to coordinate the action of householders and land-owners when necessary. Smoke Abatement. During the year 127 smoke observations were made. On three occasions, contravention of the bye-laws occurred on the part of three separate factories; cautionary letters were written, and there has been no subsequent offence. Overcrowding. Thirty-three cases of overcrowding in houses or flats were reported to the Committee during the course of the year; these cases were referred to the Housing Committee for their information. With the advent of cheaper houses in the neighbourhood, overcrowding should be diminished. For instance, on one estate in Edmonton, freehold houses can be had for ,£23, and repayments 13s. 6d. weekly; 19 on another estate, the figures respectively are £25 and 17s. 4d.; another, £25 and 14s. 8d. Disinfection. Disinfection of the patient's room, bedding and clothing is carried out as a routine measure. The following figures give details :— Number of journeys to collect bedding 258 ,, ,, return bedding 243 Rooms disinfected after infectious disease 487 ,, ,, ,, phthisis 96 ,, ,, ,, cancer 19 ,, ,, ,, vermin 96 Bedding, clothing, etc., disinfected, after infectious disease; number of articles 3,042 Bedding, clothing, etc., disinfected, after phthisis; number of articles 400 Bedding, clothing, etc., disinfected, after other cases ... 1,008 Articles of bedding, etc., destroyed 162 The Council distribute a disinfectant powder and a disinfectant fluid to residents who apply for these; the total number of applicants was 29,037—a huge number. As the Town Hall Yard is open only on five afternoons a week, the average daily number of applicants was over 110! In addition there is a Formalin chamber for books, leather goods, etc. —articles damaged by steam. The number of books disinfected was 460, and other articles, 11. Petroleum (Consolidated) Act, 1928. During the year 13 new licences and 78 renewals were granted by the Council, whilst three applications were refused. Recent investigations show that the material and quantities affected by these licences are :— Petroleum spirit 255,198 gallons. Petroleum mixtures 1,810 ,, Carbide of Calcium 3 tons 15 cwt. 261b. Mortuary. During the year 72 bodies were deposited in the Mortuary, 60 by order of the Coroner and 12 for sanitary reasons. Canal Boats Act. During the year 24 visits have been paid to the Canal, and 91 boats were seen, but of this number none were fitted or used as dwellings or registered under the Act. 20 Public Convenience. A new convenience at the junction of Church Street and the Cambridge arterial road was opened on April 4th. Provision is being made to have another one at Weir Hall, and it is hoped that it will be possible to provide a third in the vicinity of Tramway Avenue in the northern part of the district. Fouling of Footpaths by Dogs. This is a nuisance which has increased largely of late, due to the large number of greyhounds kept by folk living in the area. The highly nitrogenised diet which these dogs have creates a most abominable state of affairs, and a suitable bye-law to deal with the nuisance is urgently required. FACTORY AND WORKSHOP ACTS. The following work has been carried out under these Acts:— 1.—Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 149 5 .. Workshops (including Workshop Laundries) 53 i .. Workplaces (other than Outworkers' Premises) .. .. •• Totals 202 6 •• 2.—Defects found in the above. Particulars Number of Defects No. of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of cleanliness 6 6 .. .. Want of vantilation 1 2 .. .. Overcrowding .. .. .. .. Want of drainage of floors .. .. .. .. Other Nuisances 13 14 .. .. Sanitary Accommodation Insufficient 2 3 .. .. Unsuitable or defective 26 26 .. .. Not separate for sexes 1 .. .. .. Offences under the F. & W. Acts— Illegal occupation of underground bakehouses .. .. .. .. Other Offences .. .. .. .. Total 49 51 .. .. 21 3.—Outwork iii Unwholesome Premises. Notices ProsecuNature of Work. Instances. Served. tions. Wearing Apparel Umbrellas Artificial Flowers Nil Nil Nil Brushmaking The details of the defects remedied, as given above in Section 2,. were :— W.C.'s and Urinals cleansed or repaired 11 Additional W.C.'s and Urinals provided 1 "Elsan" Closet provided 1 Sanitary accommodation provided 2 Flushing cisterns repaired or renewed 9 W.C.'s cleared 5 New Sparge pipes fixed 1 Water fittings repaired 3 Waste pipes repaired or cleared 3 Accumulations of refuse removed 5 New sinks fixed 3 W.C. seats repaired 3 Sanitary accommodation improved 3 Workshop roof repaired 1 SCHOOLS. As one would naturally expect, some of the older Schools in the district are not so well off as the more modern Schools in respect of arrangement of the rooms and corridors, the provision of staff rooms,, cloak room accommodation and W.C. accommodation. It may be of interest to the Committee to know that All Saints'' National School was opened in 1822, and St. James's National in 1872, and Brettenham Road Council School in 1882. These are the three oldest, and the remarks made above regarding arrangement of rooms certainly apply to them. Unfortunately, even in some of the Schools erected in the 'eighties and since, the type of water-closet erected was the " trough " form. One is glad to see that these are being converted to separate flushing pedestal closets. During 1933 this conversion was made in respect of Raynham Road School; during 1932 a similar conversion was made at Croyland Road Schools. In addition, sanitary paper and the requisite fittings have been provided at all Schools. 22 The Cleveland Road entrance to Houndsfield Road School—an eyesore for many years—has now been made up. This was made possible by the development of the land in the immediate neighbourhood. The playgrounds at Raynham Road and the Lower Latymer Schools have been re-conditioned, and provision made for a playing-field for the former school. , Internal work includes decoration at Eldon Road and Brettenham Road Schools, and the re-lighting of Eldon Road School. All the Schools have lavatory accommodation and a separate tap off the main for drinking purposes. The Education Committee introduced paper towels into the Schools nearly three years ago, to be used by children suffering from impetigo and other varieties of septic skin trouble. There is not a large demand for them, but they are found useful, not only for the original purpose, but for others, in addition. The Memorandum on Closure and Exclusion from School has been adopted by the Committee, and individual children have been excluded from School in accordance with the recommendations therein. The question of the exclusion of chicken-pox contacts was brought up for discussion by the Committee, because it was found that some other Authorities were not excluding these—apart from whether they had chicken-pox or not—but it was decided to adhere to the recommendations of the Memorandum. There has been no School closures during the year. HOUSING. 1.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) ... 1,626 (b) Number of inspections made for the purpose ... ... 6,802 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 156 (b) Number of inspections made for the purpose 1,066 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 {4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,046 23 2. REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERYICE OF FORMAL NOTICES Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 850 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners 3 (b) By Local Authority in default of Owners — (b) Proceedings under Public Health Acts : — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 129 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By Owners 122 (b) By Local Authority in default of Owners — (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or rooms having been rendered fit — 24 CLEARANCE AREAS. Ten clearance areas, as apart from individual unfit houses, were scheduled over three years ago, and one is now in the happy position of saying that Ministerial Enquiries have been made and Demolition Orders confirmed. These clearance areas—two of which embraced only two houses each— involved 59 houses, with 250 occupants, and 60 houses will be required for dispossessed families. The enquiry regarding Areas Nos. 1 and 5 was held on September 28th, and the confirmation was dated December 5th; with regard to the other areas, the corresponding dates were respectively November 14th and January 23rd, 1934. Suitable houses are being built on the Council's Woolmer Road Estate for re-housing, and at the time of writing some of these are approaching completion. Practically all these houses were unsuitable for human occupation, due to faulty building in the first instance, such as absence of damp-proof course, floors laid on the earth, and want of ventilation under the floors. In addition, the brickwork becomes porous, roof-timbers give way, roofs and ceilings sag, and the house is permanently damp; in a few the bad arrangement of the houses, crowded state, etc., were partly responsible for the condemnation. At the enquiries there were objectors, but it is gratifying to note that the opinion of the Council, namely, that these houses could not be made fit for human occupation, was upheld, as stated previously. It is probable, as time goes along, that individual houses will be met with which cannot be made fit at a reasonable sum, and which will be brought to the notice of the Council for demolition, but there are no blocks of houses known to the Department which can be treated as clearance areas. It is unfortunate that the term "Slum Clearance" is associated with the Act of 1930, dealing with clearance areas, for the property dealt with cannot fairly be classed as such, accepting the usual connotation of that term. 25 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There are no cow-keepers in the district. The number of milk retailers on the register at the end of the year was 61, including 15 new names added during the course of the year; among this latter number were five retailers who sold milk in unopened bottles or containers only. The premises are inspected periodically by the District Sanitary Inspectors, the total number of visits made being 120. No contravention of the Milk and Dairies Order, 1926, has come to the knowledge of the staff during the year. Regarding the Milk (Special Designations) Order, 1923, samples of the designated milks are sent from time to time to the Counties Public Health Laboratories for bacteriological examinations; the results are recorded previously under "laboratory facilities." There are four retailers who bottle their own Grade A (T.T.) Milk; others purchase it already bottled. There is also one firm who pasteurise and bottle their own milk. There were altogether 25 dealers who were granted licences to sell designated milk during 1933; as some of these dealers had multiple shops, the figure 25 is actually the number of premises from which these milks are sold. Meat and Other Foods. The following visits by the District Inspectors were made during the year :— Butchers' shops 178 Fish shops 62 Coffee shops 12 Ice-cream shops 127 Shops and stalls 284 Slaughter-houses 183 Bakehouses 51 There are one "registered" and two "licensed" slaughter-houses in the district; these are kept under regular supervision. The Slaughter of Animals Act, 1933, came into force on January 1st, 1934, and the Council have so far issued seven licences to persons to act as slaughtermen. 26 The Council have by resolution included sheep, ewes, wethers, rams and lambs under Section 2 of the Act to come within the purview of the Act. There has been a real difficulty in obtaining "captive bolt" pistols, so the Council have adopted the lead given in the House of Commons over this matter, namely, agreed to abstain from taking proceedings on condition that a mechanically-operated instrument had been ordered. The following carcases were examined during or shortly after slaughter :— Oxen 14 Heifers 2 Sheep and Lambs 226 Pigs 264 Ice Cream. Premises used for the manufacture or sale of ice-cream have to be registered in accordance with the provisions of the Edmonton Urban District Act of 1929. This is a very useful provision, for though the large majority of manufacturers realise the hygienic requirements of this commodity, there are others who are not so careful. By some, more particularly in the past, ice-cream making and selling has been looked upon as a side-line, useful when other means of a livelihood are diminishing; these are the folk who require very careful inspection—the conditions under which they make and store their product are not always what they should be ! Unsound Food. The following is a list of food brought by the retailer to the Town Hall on account of dubious quality. After examination by the staff of the Department, the articles are retained as unfit for food :— 5 stone of plaice. 1 chicken. 4 ,, catfish. 1 pig's pluck. 3 ,, cod fillets. 1 box of oranges. 14 lbs. cod roes. 3 cwt. of peas. 13£ stone of sprats. 80 boxes of tomatoes. 1 tin of lambs' livers. 2 forequarters of Australian 2 cooked hams. lamb. Mr. J. E. Hill, J.P., as in the past, has always willingly given his assistance when orders of condemnation and destruction of the foodstuffs have been sought. 27 Sale of Food and Drugs Act. The Middlesex County Council is the Authority under the above Arts; The following particulars given me by the Chief Officer of the Public Control Department relate to goods purchased in Edmonton during 1933 :— Article. Number taker Number found to be adulterated. Milk 176 3 Milk (Sterilised) 16 — Butter 7 — Gin 1 — Hake 4 2 Lard 1 — Lemon Sole 1 — Minced Beef 2 — Vinegar 1 — Whisky 3 — There was one prosecution ana one conviction. Shops Acts. The Shops Acts Inspector presents his monthly report to the Public Health Committee, and the following is a short summary of these reports :— Visits to shops, licensed street traders, etc. 2,878 Number of contraventions 32 Proceedings were taken against five traders, and fines were inflicted as follows:—One of two guineas, two of one pound each, and two of ten shillings each. PREVALENCE OF INFECTIOUS DISEASE. Measles was conspicuous by its absence during 1933; to the best of my knowledge, there were no cases occurring. Whooping Cough existed in sporadic fashion during the year, showing an increased incidence towards the latter end. The disease was responsible for seven deaths. Typhoid Fever. Three cases were notified, two of these being the para-B form. It was not possible to trace the source of the infection in any of these. 28 Respiratory Infections were prevalent in the early months of the year. I have referred to this subject earlier under "General Invalidity." Diarrhoea in young children. In spite of the hot, dry summer, only seven deaths of children under the age of two years occurred during the year. As mentioned previously, flies were extremely prevalent in the Montagu Road area, and one anticipated unusual infection from that source. Fortunately, it did not occur. The incidence of deaths from this complaint was less than half of that which occurred in London, as shown earlier under comparative statistics. Smallpox. No cases of this complaint were notified during 1933. Scarlet Fever. This disease continued to be prevalent during the year, and, like the cases occurring during 1932, were of a more serious type. Complications were frequent, and, as happens in scarlet fever, were of a serious nature. Fortunately, only one death occurred, whereas seven occurred in the previous year. Diphtheria was not very prevalent during the year: 72 cases were notified and there were four deaths from the disease. Nasal cases and carriers were very few. Puerperal Fever, puerperal pyrexia and ophthalmia are referred to later on, under the portion dealing with maternity and child welfare. Disinfection, etc., is referred to in an earlier portion of this report. The following table gives the age incidence of those suffering from the notifiable infectious complaints, excluding tuberculosis, which is dealt with separately. Disease Total No. ol Cases No. Kemoved to Hospital Deaths Under i year 1—2 years 2—3 years 3—4 years 4—5 years 5—10 years 10—15 years 15—20 years 20—35 years 35—45 years 45—65 years 65 and upwards Erysipelas 5o 20 3 1 1 .. .. .. 3 .. 1 9 11 l6 5 Scarlet Fever 368 316 1 5 9 18 25 28 155 85 16 17 9 1 .. Diphtheria.. 72 71 4 .. 3 5 7 10 28 16 .. 2 . 1 .. Pneumonia 101 .. .. 2 5 .. 2 3 7 4 5 24 10 20 10 Puerperal Fever 13 11 2 .. .. .. .. .. .. .. 1 11 1 .. .. Puerperal pyrexia 18 15 .. .. .. .. .. .. ... .. 3 9 6 .. .. Enteric Fever 3 2 .. .. .. .. .. .. .. .. .. 3 .. .. .. Oph. Neonatorum 5 .. •• 5 .. .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Fever 1 1 1 1 .. .. .. .. .. .. .. .. .. .. .. 29 Of the total of 78 deaths from pneumonia and broncho-pneumonia, 45 took place in hospitals. On the other hand, a number of deaths from lobar pneumonia taking place in hospitals were not notified during the life of the individual. One can only assume that the individual was admitted to hospital before a diagnosis was made and hence not notified, whilst the resident doctor in the hospital assumed that such a notification had been made prior to admission. TUBERCULOSIS. The following table gives details as to age and sex of new cases ol tuberculosis, also the deaths from the disease, these latter figures including the non-notified cases. Age Periods. New Cases Deaths Respiratory Non-respiratory Respiratory Nou-respiratory M F M F M F M F Under i year .. .. .. .. .. .. .. .. 1— 5 years .. .. 3 .. 1 .. 2 .. 5—15 3 5 1 1 .. 2 1 .. 15—25 11 8 3 3 5 5 .. 1 25—35 13 13 .. 1 12 3 .. 1 35—45 11 8 .. .. 5 4 .. .. 45—55 5 4 1 .. 6 3 .. .. 55—65 3 2 .. .. 3 2 .. .. 65 years upwards 2 * * .. • • .. 2 .. • • Totals 48 40 8 5 32 21 3 2 In addition, seventeen cases of tuberculosis previously notified in another district, moved into Edmonton. Excluding non-notified deaths, the 118 cases added to the Register during 1933 were made up as follows:— Males. Females. New Cases—respiratory 48 40 ,, ,, non-respiratory 8 5 Transferred Cases—respiratory 6 10 ,, ,, non-respiratory 1 — 63 55 30 The cases dying of tuberculosis and not previously notified were.:— Male. Female. Respiratory 2 4 Non-respiratory 1 1 There were thus eight non-notified deaths out of a total of 58 persons :registered as dying from tuberculosis. Regarding the non-notification of these cases, there was no suggestion of wilful neglect or refusal to notify. The non-respiratory forms of tuberculosis notified were :— Male. Female. Peripheral Glands2 1 Abdominal— 2 Of the Spine 1 1 Other Joints 3 — Meningeal 2 — Of the Eye — 1 The Public Health (Prevention of Tuberculosis) Regulations, 1925, relate to tuberculous employees in the milk trade; whilst Section 62 of the Public Health Act of 1925 gives power to the Local Authority to remove to hospital certain cases of consumption who are dangerous to other people. There has been no occasion during the year to take action under these powers. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. The number of cases of tuberculosis on the register at the end of year was :— Male. Female. Total. Pulmonary forms 245 208 453 Non-Pulmonary forms 75 73 148 320 281 601 Corresponding figures for previous years were :— Male. Female. Total. 1932 363 284 647 1931 382 311 693 1930 381 311 692 1929 1928 421 426 352 354 773 780 31 The notifications during the same five years were :— Male. Female. Total. 1932 71 43 114 1931 68 53 121 1930 61 40 101 1929 66 60 126 1928 73 59 132 For last year, 1933 63 55 118 It will be seen that there is not a great variation in the number of cases added to the register every year. The drop in the number is due to three causes—deaths, leaving the district, and arrest of the disease or recovery. Constant revision of the register is necessary to cope with the first two causes, for it is not uncommon for persons suffering from tuberculosis to die of some other cause. For instance, five persons on the register died last year of causes other than tuberculosis. Valuable help is obtained from the Tuberculosis Dispensary, but the medical officer in charge is not in contact with all the cases notified. COUNCIL'S EMPLOYEES. During the course of the year your Medical Officer of Health has. examined 24 men prior to their appointment to permanent posts. It was necessary to make further examinations in two cases on account of functional albumineria. He has also visited employees who have been on the sick list more than a fortnight, and fortnightly afterwards whilst on the list. Altogether 51 men were visited and 132 visits were made. It is difficult to say whether any benefit accrues to the Council as a result of these visits; on the other hand, they tend to induce a certain type of individual to return to work probably earlier than is beneficial for him. MATERNITY AND CHILD WELFARE WORK. Mirths. The number of births notified during 1033 were in respect of the following :— Live births, notified by midwives 1,822 ,, „ ,, doctors and parents 368 Still-births, ,, midwives 93 ,, ,, ,, doctors and parents 4 32 Excluding births taking place in the North Middlesex County Hospital of mothers who are resident in other districts, the above figures are reduced to :— Live births 1,325 Still-births 36 Visits to the Homes made by the Health Visitors. These can be conveniently tabulated as follows :— To expectant mothers— (1) First visits 191 (2) Total visits 281 To children under 1 year— (1) First visits 1,384 (2) Total visits 9,398 To children aged 1 to 5 years 6,991 To children aged 5 to 9 years under the Children's Acts 88 Total 16,758 CLINICS. These are as follows :— (1) Ante-natal Clinic at Brookfield House, Fore Street. (2) For Child Welfare : (a) at Brookfield House; (b) at St. Stephen's Church Hall, Bush Hill Park. (3) Dental Clinic at Pymmes Park. (4) Orthopaedic Clinic at Brookfield House. Ante-Natal Clinic. This is held once weekly, thus making 44 sessions during the course of the year. The total number of prospective mothers attending was 224, of whom 200 attended for the first time during the year; the total attendances were 972, thus giving an average of 22 per session. Actual consultations numbered 523. 33 Child Welfare. There are five afternoon sessions at Brookfield House (adjoining the Town Hall), and one morning session at St. Stephen's Hall. Attendances, etc., were as follows:— Brookfield House. St. Stephen's Hall. Number of sessions 217 42 New cases : (a) under 1 year 581 54 (b) 1—5 years 339 15 Attendances : (a) under 1 year 8,716 719 (b) 1—5 years 12,319 629 Actual Consultations 3,522 435 Average Attendance 96.9 32 Brookfield House, adjoining the Town Hall, is the main Welfare Centre, but is inadequate for the work required to be carried on there. At the present time a movement is on foot to secure a more desirable Town Hall, with a properly built and equipped centre occupying a portion of the ground floor. This cannot come too quickly, for the work is steadily increasing. At the same time, owing to a very large increase in the number of houses being built on the outskirts of the district, it is hoped that Branch Centres will be established in the Northern and in the South-Western areas. It is a wonder to me that so many mothers do conscientiously attend this Clinic, especially in the summer months, when the afternoon sun beats down on the building making it intolerably hot, in addition to a very heavy tram and motor traffic immediately outside. It will be realised that the attendances, in order to make an average of 97, must on some days reach well above 100; on some occasions they rise to over 120, and it is not difficult to imagine the strenuous time which occurs at these particular sessions. My own experience is that 80 is the maximum number for a session ; above that number, it becomes unwieldy. Dental Clinic. This is held once weekly at Pymmes Park School Clinic. 34 Details regarding the work carried out there are :— Mothers. Children Number of attendances 480 284 Total number treated 415 244 Fillings (cases) 26 23 Scalings 18 0 Extractions (number of teeth)— Under gas 751 490 Local anaesthetic 21 0 Number of gas cases 216 195 Dressings 9 27 Dentures— Impressions 27 Bites 28 Try-ins 28 Fitted 27 Alterations and repairs 10 Easements 12 Of the 27 dentures, 11 were assisted by the Committee. The total cost of these was ,£.116 8s. 6d., towards which the Committee assisted by the sum of ;£29 15s. 6d. The gas—nitrous oxide—is given by the Medical Officer of Health. Orthopedic Clinic. The Clinic is held twice weekly and the surgeon visits bi-monthly. Here, again, one is dependent on figures to give some idea of the work carried on at this Clinic :— Number of sessions 89 New cases seen 91 Number of Consultations 240 Average number per Surgeon's visit 40 All other attendances 615 One child was sent into Stanmore, the county branch of the Royal National Orthopjedic Hospital, for treatment, regarding whom Mr. Seddon has kindly given the following summary as to the method of treatment :— 35 "Boy, aged 3½, was admitted on 17.3.33. with severe right club-foot. Two operations were performed and good correction of the deformity was obtained. The second operation is of some interest. A strip of tissue was taken from the thigh and passed beneath the skin on the outer side of the ankle so as to sling the outer border of the foot to the bone above the ankle joint in such a manner as to prevent a relapse of the deformity. For many years silk has been used for this operation, but has not given uniformly satisfactory results. This is the third occasion on which we have used the patients' own tissues in place of the strand of silk, and we feel that this operation marks a definite advance in our treatment of this troublesome deformity. The boy was discharged on 4.8.33." MIDWIFERY AND MATERNITY SERVICES. The Committee have no arrangements for a maternity service; they have neither hospital beds, nor do they subsidise midwives. The Council are the supervising authority under the Midwives Acts, and during the past year the following notifications to practise in the district were received :— From midwives residing in the area 10 From midwives residing in the North Middlesex County Hospital 15 From midwives residing in the surrounding districts 6 Total 31 The number of claims made by doctors on account of medical aid was 115; these claims are due to the fact that midwives have to call to their aid medical assistance under certain conditions. The Committee have laid down a scale below which medical aid is granted free. The number falling within this category was 72; two were partly assisted and the remainder had to pay in full. The total sum involved was £129 14s., of which the Committee paid i,80 6s. TONSILS AND ADENOIDS. Arrangements are made with the County Hospital for the removal of tonsils and adenoids. 36 Thirty-four children were operated on; 17 cases were free, being below the scale mentioned above, the remainder contributed 5s. each. The cost to the Committee is 10s. 6d. per child. MUNICIPAL MILK SUPPLY. The arrangements recorded in the report for 1932 still holds. Details are as follows :— Number of applications 2,341 Number of recipients 2,292 Number of pints granted at quarter cost 88,725 Actual number of applicants 429 CONVALESCENT HOMES. Two mothers and one child have been sent for convalescent treatment •during the year, the expenses being paid wholly by the Committee for the two mothers, but part cost for the child under a contract with the I.C.A.A. ARTIFICIAL SUNLIGHT. During the year only 16 children were sent to the County Hospital to receive this form of treatment. There was an average gain in weight of 1 lb. 11 oz. Ten of these children were improved, four were discharged as absentees and two improved, but attendance was cancelled on account of infectious disease. HOME HELPS. There is not an extensive demand for these; during the year only six mothers applied for their services. INFECTIOUS ILLNESSES. Cases Cases notified, visited. Ophthalmia Neonatorum 5 5 Puerperal Fever 13 7 Puerperal Pyrexia 18 10 Measles (non-notifiable) 13 Whooping Cough ( ,, ) 64 Diarrhoea ( ,, ) 34 37 Of the above, 11 cases of puerperal fever were removed to, or were already in, hospital, and a similar remark applies to 15 cases of pyrexia. Two of these cases were removed to Queen Charlotte's Hospital, Ravenscourt Square, and the Committee were responsible for the whole of the expenses. None of the cases of ophthalmia were removed to hospital, and there was neither impairment of vision nor any death. CHILDREN ACTS. Applicants during the year to be placed on the Register of Foster Mothers numbered 41. At the end of the year there were 54 foster mothers on the Register and 61 children. The Lady Superintendent visits the homes of all applicants and reports in detail to the Committee; once registered, the homes are visited regularly by the Health Visitor for that particular district. DAY NURSERY. The Day Nursery, with the exception of three weeks during August,, has been open the whole year and was well patronised : children had to be refused at times owing to the accommodation being full. Attendances for the year were :— For the whole day 6,438 For the half-day (Saturday) 326 Fifteen children were admitted into residence during the course of the year. Dr. Outram pays fortnightly visits to the Nursery to supervise the health of the children. NURSING HOMES REGISTRATION ACT. The Council is the authority for the purposes of this Act. One Nursing Home has applied and been placed on the Register during the year. There are now three Nursing Homes and one Maternity Home in the district, and these are visited periodically by the Medical Officer of Health. 38