Urban District Council Of Edmonton. REPORT OF THE Medical Officer of Health FOR THE YEAR 1935 CruSha & Son, Ltd., Tottenham, Enfield, Palmers Green and Wood Green. urban District Council Of Edmonton. REPORT OF THE Medical Officer of Health FOR THE YEAR 1935 3 Edmonton Urban District Council. 1935. Chairman Councillor H. Gatward, J.P. Vice-Chairman ,, Mrs. E. A. Young. PUBLIC HEALTH COMMITTEE. Chairman-. Councillor J. A. Ward. Councillors W. Bales, Mrs. Barrass, L. E. Berridge, Mrs. F. Long, Mrs. Moss, Mrs. Porteous, S. W. Creasey. STAFF OF THE PUBLIC HEALTH DEPARTMENT. * D. Regan, B.A., B.Sc., M.B., Ch.B., D.P.H. (L'pool.), Medical Officer of Health, School Medical Officer, and Supervisor for the Maternity and Child Welfare Services. *ab W. Tillcock, Senior Sanitary Inspector, Inspector of Canal Boats, and Inspector under the Petroleum Acts. *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. a F. Beilby, Inspector for the Housing Regulations. *a Mrs. H. Fowler, Woman Sanitary Inspector. F. J. Nash, Senior Clerk, Cert.R.San.I. J. L. A. Saunders, Clerk. A. E. Clarke, Junior Clerk. S. Clayton, Shops Acts Inspector. * 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. 4 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor S. N. Chapman. Councillors W. Bales, Mrs. M. M. Barrass, L. E. Berridge, S. W. Creasey, W. A. Edmunds, T. J. Harington, Mrs. E. M. Hearn, Mrs. F. Long, Mrs. E. M. Moss, Mrs. H. L. Porteous, W. Prete, J. W. Shaw, J. A. Ward. Ex-officio Members : Councillors H. Gatward, Mrs. E. A. Young. Co-opted Members, not being Councillors: Mesdames M. Allan, E. Elms, E. Hasemore, M. Jenner, A. Lear, H. Nicholson, S. Sweeney. STAFF. D. Regan, B.A., B.Sc., M.B., Ch.B., D.P.H. (L'pool.). Mrs. G. F. Fleetwood-Outram, M.B., Ch.B. (Glas.), in charge of Ante- Natal and Child Welfare Centres. H. J. Seddon, F.R.C.S. (Eng.), Orthopaedic Surgeon. E. Underhill, L.D.S., R.C.S., Dentist. abde Miss A. Bintcliffe, Lady Superintendent. de Miss A. Naylor, Health Visitor. d Mrs. C. Boothby, ,, ,, acd Miss J. Anderson, ,, ,, bed Miss J. Paterson, ,, ,, bd Miss M. Druce, ,, ,, bed Miss R. Bullock, ,, ,, (Commenced 29th July, 1935.) c Miss M. F. Cozens-Walker, Chartered Masseuse, Orthopaedic Clinic (part-time). Miss R. S. Saunders, Senior Clerk. Miss N. A. Eyres, Clerk. Miss C. Churchley, Junior Clerk. (Commenced 1st July, 1935.) DAY NURSERY. cd Miss W. J. Vigar. † Miss M. Knight, Miss E. A. Weller, Miss P. Williams. a Maternity and Child Welfare Certificate. b New Health Visitor's Certificate, c State Registered Nurse. d State Registered Midwife. e Sanitary Inspector's Certificate. f Certificate of Day Nursery Training. 5 To the Chairman and Members of the Edmonton Urban District Council. Ladies and Gentlemen, I have much pleasure in presenting my Report for the year 1935 on the sanitary circumstances, the sanitary administration and vital statistics of the Urban District of Edmonton, containing in addition some aspects of future re-organisation already adopted by this Council. The contents are compiled in accordance with Circular 1492 issued by the Ministry of Health. Doctor H. W. Harding relinquished office on 31st May and I commenced duties on 1st June, 1935. I wish every happiness to Dr. Harding in his retirement. A Special Report was presented to the Council on 19th December, 1935, embodying some fundamental points for re-organisation and for increasing the scope of the Medical Services. Judging by the eager manner in which Members of the Council debated this Report it must be said that they gave evidence of their anxiety to do everything in their power for the youth of their district. It is true that the Report was clear cut and concise and therefore gave little cause for comment. At this juncture I would like to emphasise the very valuable assistance which I received from individual members of the Ministry of Health. I was further influenced by a Report issued by the Ministry of Health, dated 11th September, 1935, relative to a survey of the district. In compliance with a suggestion contained therein, amalgamation of the Maternity and Child Welfare and School Medical Staff was proceeded with. This necessitated training two of the School Nurses, Miss Hazelton and Miss Garrett, as Health Visitors, and so far this work has proceeded smoothly. The Nurses themselves are delighted with the work and it should prove of much value for Health Visitors into the district. During my first few weeks of office I could not help being struck by the scattered arrangements of the various offices serving the public health of the district, thereby making administration almost an impossibility. Realising this anomaly, the Council sought to centralise the various sub-offices in one, and as a result of the Special Report decided to house the Public Health, School Medical and Maternity and Child Welfare Departments temporarily at Pymmes House in Pymmes Park. It was further decided to establish a number of sub-clinics to facilitate mothers in their own districts. 6 The establishment of an additional post for an Assistant Medical Officer of Health and School Medical Officer will give both these services an impetus which is sadly needed. In order to cope with the increased work of all departments the clerical staff will have to be augmented. In order to co-ordinate the work of the various departments it will be necessary, in the case of multiple officers, to arrange appointments according to schedule. This may appear at first to be somewhat irksome to some of the senior members of the staff, who for so long have been accustomed to perform their duties with little regard for time. An attempt is being made also to make group appointments so that mothers will be kept in the Clinic for the shortest possible time. The success of this arrangement is entirely dependent on the promptitude with which the patients are dealt with by the officers concerned. The housing problem is in a considerably better position in this district than in most others similarly placed. There is, however, one matter that has not received sufficient attention, namely, the large family. In order to meet • this necessity a larger type of house of the four-bedroomed type should be permitted to be built. At the time of going to press the Housing Survey under the 1935 Act has been completed, and the percentage of 1.69 is a very creditable result, thanks to the continued efforts of the Council. There is still some old property left which really would be better demolished, although it has been kept in a reasonable state of repair by the application of Sections 17 and 19 of the Housing Act, 1930. It appears that these Sections have been too often invoked instead of clearance. Edmonton is becoming more and more of a dormitory for Industrial London, and it is imperative therefore that the matter of housing should always occupy the front page of the Council's programme. The population is, however, rapidly approaching saturation point, and an endeavour should be made to develop the derelict spaces in the vicinity of the sewage purification plant into playing fields and parks, with perhaps, a small housing scheme interspersed. In order to accomplish this it will be necessary to remove the present sewage plant and the antiquated Enfield Sewage Farm situated in the Edmonton area, by conveying the sewage of those respective areas to Barking Creek to be dealt with there in the same manner as the Southern Essex area. 7 The non-notifiable infectious diseases, Whooping Cough, Mumps and Chicken Pox, were much in evidence during the year. Scarlet Fever, though not so virulent as in former years, occurred fairly frequently. In the latter part of the year, Diphtheria almost disappeared from the district. Towards the end of the year septic sore throat appeared to harass a considerable number of the population of all ages. Sporadic cases of Enteric Fever kept on recurring almost at regular intervals. The source of infection was not discovered in any one case. This was complicated by the fact that B. Typhosus occurred in one district while Bacillus Paratyphosus B. appeared in another. During the summer and autumn months matters were further complicated by an outbreak of Enteritis amongst the juvenile population. It is to be regretted that this latter disease caused a number of deaths. Dr. W. Vernon Shaw, of the Ministry of Health, visited the district and gave to the Department the benefit of his valuable advice. The Birth Rate is high as one would expect in a developing area like Edmonton, inasmuch that the number of young married couples is relatively high in such areas. The Death Rate is low due principally to the decline in mortality amongst the juvenile population. The Death Rate from T.B. remains constant but the incidence shows a slight tendency to increase. The Infantile Mortality rate remains low at 52.8 in relationship to that in England and Wales. The Maternal Mortality figure 1.8 is very creditable. This is a very remarkable result, even though it must be regarded as incidental when one considers that Edmonton has no official hospital accommodation other than the ordinary use of the local hospitals for the primary treatment of Midwifery cases. The incidence of Puerperal Fever and Puerperal Pyrexia however occurs moderately frequent, and the Council have wisely made arrangements with the Queen Charlotte's Hospital, Ravenscourt Square, for the treatment of such cases. The results achieved in this institution are very satisfactory, and it is to be hoped that such facilities offered by this Council will be more frequently utilised by Medical Practitioners attending Edmonton mothers. 8 Mr. Fredk. J. Nash, Senior Clerk in the Public Health Department, has obtained the Certificate of the Royal Sanitary Institute. This will prove of much value in the discharge of his duties as Senior Clerk. Mr. J. L. A. Saunders who has been part-time clerk in the Public Health and School Medical Departments, has now been transferred entirely to the Public Health Department. The Inspectoral Staff is still insufficient for the carrying out satisfactorily of the many and varied duties placed upon them by the various Acts and Orders which are ever increasing, but an effort is being made to appoint an additional District Sanitary Inspector as soon as possible. An additional Health Visitor, and a Junior Clerk were appointed to the Maternity and Child Welfare Department during the year. These appointments were long overdue, as in the latter instance a good deal of the work in clinics fell to the lot of the clerks in the Maternity and Child Welfare Department owing to the absence of organised help. At this juncture I should like to extend my very best thanks to the Members of the Council and the various Committees for their kindness and courtesy extended to me during my first year of office. I would also like to thank the Staff for their loyal co-operation throughout a very strenuous year. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, D. REGAN, Medical Officer of Health. Section A. GENERAL STATISTICS. Area (in acres) 3,896 Population— Census of 1921 66,809 Census of 1931 77,652 Estimated by the Registrar-General for the mid-year 1935 96,320 Number of inhabited houses and tenements at the end of 1935 22,566 Number of inhabited houses and tenements at the end of 1934 21,271 9 Rateable Value, April, 1935 £587,057 Estimated product of one penny in the £ for the year ending March 31st, 1936 £2,425 Rates in the £ for the year ending March 31st, 1936 lls. 8d. SOCIAL CONDITIONS. The extent of unemployment may be estimated by the following figures, relating to:— (1) the municipal milk supply to nursing mothers and young children, (2) the number of free dinners given to school children, and (3) the actual figures supplied by the Director of Public Assistance. Both (1) and (2) are given on purely economic grounds. (1) Municipal Milk Supply:— Number of pints granted at¼ cost during 1933 88,725 „ „ „ „ „ 1934 77,350 „ „ „ „ „ 1935 31,297 ,, ,, ,, Free during 1935 53,006 (2) Number of free dinners during 1933 120,088 1934 103,368 1935 89,076 (3) Figures re out-relief— Cases. Amount. £ For the year 1933 4,434 61,598 For the year 1934:— (a) Ordinary out-relief 1,554 30,640 (b) Unemployed out-relief 1,609 23,696 Total 3,163 £54,336 10 For the year 1935:— Cases. Amount. £ (a) Ordinary out-relief 3,335 37,008 (6) Unemployed out-relief 3,383 18,832 Total 6,718 £55,840 It will be noticed that the number of cases is far greater than in previous years. This is due to the fact that the individual units were given in the past, whereas the actual individuals are shown this year. VITAL STATISTICS. Live Births. M. F. Total. Grand Total. Legitimate 790 765 1,555 1,610 Illegitimate 26 29 55 Birth-rate per 1,000 of population 16.71 Still -births. M. F. Total. Grand Total. Legitimate 30 25 55 56 Illegitimate 1 — 1 Total of live and still births .. .. .. 1,666 Rate per 1,000 total births .. .. .. 33.6 Deaths. M. F. Total. Number 447 422 869 Rate per 1,000 population .. .. .. 9.02 Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis .. 2 1.2 Other puerperal causes .. 1 0.6 Total .. 3 1.8 11 Death-rate of infants under one year of age. M. F. Total. Number 54 31 85 All infants per 1,000 live births .. .. .. 52.8 Legitimate infants per 1,000 legitimate live births .. ths .. .. 49.5 Illegitimate infants per 1,000 illegitimate live births .. births .. 145.45 Deaths from measles (all ages) .. .. — ,, whooping cough (all ages) .. .. 3 ,, diarrhoea (under 2 years of age) .. .. 22 GENERAL INVALIDITY. With the increased facilities at our disposal there is no excuse why conditions of occupation or environment should have a detrimental effect on the health of citizens. It will be necessary, however, to keep a watchful eye on the conditions that govern Juvenile Employment for some years to come. The children who attend our feeding centres look very well, and as free dinners are given on financial grounds, I think that one may safely assume that these children come from homes where the father is either unemployed or is earning poor wages in proportion to the number of children in the family. There are, however, several cases of malnutrition occurring amongst the children of those whose economic conditions are above that usually allowed by the Ministry of Health. Mere food alone will not rectify the error in children of this class. They will need careful investigation and diet prescribed to suit the needs of individual cases. In future more attention will have to be given to patients who have suffered from infectious diseases. Such children should be clinically examined once or twice a year as they are particularly prone to chest diseases. As regards influenza, the year was very quiet; there were only two deaths registered as occurring from this disease. The number of notified cases of pneumonia was lower—63 compared with 77 last year. 12 The following causes of death are supplied by the Registrar-General and refer to deaths which were registered during the calendar year:— M. F. Total. Typhoid and Para-typhoid Fevers — 3 3 Measles — — — Scarlet Fever 1 — 1 Whooping Cough 2 1 3 Diphtheria 3 1 4 Influenza — 2 2 Encephalitis Lethargica 1 — 1 Cerebro-spinal Fever 1 — 1 Tuberculosis of the Respiratory System 45 28 73 Other Tuberculous Diseases 4 5 9 Syphilis 1 1 2 General Paralysis of the Insane, Tabes Dorsalis 5 3 8 Cancer, Malignant Disease 52 63 115 Diabetes 4 7 11 Cerebral Haemorrhage, etc. 17 25 42 Heart Disease 93 99 192 Aneurysm 5 1 6 Other Circulatory Diseases 14 15 29 Bronchitis 11 13 24 Pneumonia (all forms) 39 24 63 Other Respiratory Diseases 6 1 7 Peptic Ulcer 12 2 14 Diarrhoea, etc. (under 2 years) 13 9 22 Appendicitis 3 4 7 Cirrhosis of Liver 1 — 1 Other Diseases of Liver, etc. — 4 4 Other Digestive Diseases 6 9 15 Acute and Chronic Nephritis 12 18 30 Puerperal Sepsis — 2 2 Other Puerperal Causes — 1 1 Congenital Debility, Premature Birth, Malformations, etc. 25 15 40 Senility 3 15 18 Suicide 5 5 10 Other Violence 21 12 33 13 M. F. Total. Other Defined Diseases 42 33 75 Causes Ill-defined or Unknown - 1 1 Special Causes (included in "Other Defined Diseases"):— Smallpox — — — Poliomyelitis — — - Polio-Encephalitis — — — Total Deaths 447 422 869 The following tables give the deaths of those registered during the 52 weeks ended 28th December, 1935, sub-divided as to age groups:— 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 years & over. Typhoid Fever - - - - - - - - - - - - Measles - - - - - - - - - - - - Scarlet Fever.. 1 1 - - - - - - - - - - Whooping Cough 2 - 1 1 - - - - - - - - Diphtheria 3 1 - - 2 - - - - - - - Encephalitis Lethargica 1 - - - - - - - - - - - Cerebro-spinal Fever 1 1 - - - - - - - - - - Tuberculosis of the Respiratory System 44 - - - - 2, 16 10 8 2 1 - Other T. B. Diseases 4 - - - - 1 - 1 1 1 - - Syphilis 1 - - - - - - - - - - - General Paralysis of the Insane 5 - - - - - - 2 2 - 1 - Cancer 51 - - - - - - 4 11 9 16 1 1 Diabetes 4 - - - - 1 - - - 1 - 2 Cerebral Haemorrhage 18 - - - - 1 - - 1 5 6 - Heart Disease 90 - - — 1 1 2 2 8 23 23 30 Aneurysm 5 - - - — - - - 1 2 2 - Other Circulatory Diseases 14 - - - - - - - - 3 5 6 Bronchitis 11 - - - - - - - 3 3 2 3 Pneumonia 88 12 - 2 - 1 1 9 5 7 5 1 Other Respiratory Diseases 6 - - - - - - 1 - 3 - 2 Peptic Ulcer 12 - - - - - - - 6 4 2 - Diarrhoea, etc. (under 2 years of age) 13 13 - - - - - - - - - - Appendicitis 3 - - - - - 1 - - - - - Cirrhosis of Liver 1 - - - - - - - - 1 - - Other Digestive Diseases .. 5 - - 1 - - - - - 4 - - Acute and Chronic Nephritis 12 - - - - - - - - 5 3 4 Congenital Debility, etc. 25 25 - - - - - - - - - - Senility 3 - - - - - - - - - - 3 Suicide 5 - - - - - - - - 1 1 1 Other Violence 21 - - - 3 2 2 4 2 1 1 6 Other Defined Diseases 41 1 - 1 1 4 5 4 3 5 10 7 Causes ill-defined or unknown - - - - - - - - - - - - 440 54 3 5 7 15 27 30 51 89 78 81 11 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 years & over. Typhoid Fever 3 - - - - 1 1 - 1 - - - Measles - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - Whooping Cough 1 1 - - - - - - - - - - Diphtheria 1 — - 1 — — — - — — — — Influenza 1 - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - Tuberculosis of the Respiratory System 28 1 - - - 4 7 10 1 4 1 - Other T. B. Diseases 6 1 2 1 1 1 - - - - - - Svphilis 1 - - - - - - - - - - - General Paralysis of the Insane 3 - - - - - - - 2 - 1 - Cancer 63 - - - - - - 5 9 17 24 8 Diabetes 7 - - - - — 2 - — 9 9 1 Cerebral Haemorrhage 25 - - - - - - 1 1 5 10 8 Heart Disease 96 - - - - 4 — 3 7 9 30 43 Aneurysm 1 - - - - - - - - - 1 - Other Circulatory Diseases 15 - - - - - - - - 5 4 6 Bronchitis 15 2 - - 1 — - - — 3 4 5 Pneumonia 24 2 1 2 — 1 — 1 1 5 5 6 Other Respiratory Diseases 1 - - - - - - - 1 - - - 1 - - - - - - - - - 1 — Diarrhoea, etc. (under 2 years of age) 9 9 - - - - - - - - - - Appendicitis 4 — - — 1 1 — - 1 1 - -— Cirrhosis of Liver - - - - - - - - - - - - Other Diseases of Liver 3 1 - — — 1 — - — — - 1 Other Digestive Diseases 9 — - — — 1 1 1 1 2 1 2 Acute and Chronic Nephritis 18 - - - 1 1 1 4 - 3 4 2 Puerperal Sepsis - - - - - 1 1 - - - - - Other Puerperal Causes 1 - - - - - 1 - - - - - Congenital Debility 15 14 - 1 - - - - - - - - Senility 15 - - - - - - - - - 1 14 Suicide 4 - - - - - - 2 - - 1 1 Other Violence 12 1 1 1 1 - 1 1 - - 1 5 Other Defined Diseases 29 - - - 1 4 4 1 6 8 4 1 Causes Ill-defined or Unknown 1 - - - - - - - - - - 1 414 32 4 6 6 20 19 29 34 65 95 104 There is a slight difference in respect of the causes of death between these last two tables and the one supplied by the Registrar-General, who is probably in possession of additional information on the matter. 15 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M. F. Total. Legitimate 49 28 77 Illegitimate 5 3 8 54 31 85 The death-rate of all infants per 1,000 live births was 52.8 A detailed sub-division of the causes, etc., of these infant deaths is as follows:— MALES. Causes of Death. Under 1 week. Second week. Third week. Fourth week. Total 1 month. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Diphtheria - - - - - 1 - - - 1 Scarlet Fever - - - - - - - - 1 1 Cerebro-Spinal Meningitis — — — — — — 1 — - 1 Bronchitis - - — — - - - - - - Pneumonia 2 — 1 2 5 2 4 1 - 12 Diarrhoea 1 1 1 2 5 4 2 2 1 13 Congenital Malformation 1 2 — — 3 1 — — 1 4 Congenital Debility 2 — — — 2 1 1 — 1 4 Premature Birth 8 2 2 — 12 1 - — - 13 Injury at Birth — 1 — — 1 — - — - 1 Atelectasis 2 — — — 2 — - — - 2 Other Causes .. - - - - - 1 - 1 - 2 16 6 4 4 30 11 7 4 2 54 FEMALES. Causes of Death. Under 1 week. Second week. Third week. Fourth week. Total 1 month. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under I year. Whooping Cough - - - - - 1 - - - 1 Bronchitis - - - - — 1 — 1 - 2 Pneumonia - - - - - - - 1 - 2 Pulmonary Tuberculosis - - - - - - - - 1 1 Other T.B. Diseases - - - - - - - - - 1 Diarrhoea - - 3 1 4 2 - 1 1 9 Congenital Malformation 2 - - - 2 - - - 1 3 Congenital Debility - - 1 - 1 - 1 - - 2 Premature Birth 6 - 1 - 7 - - - - 7 Injury at Birth 1 - - - 1 - - - - 1 Atelectasis 1 - - - 1 - - - - 1 Other Causes 1 - - - 1 1 - - - 2 11 - 5 1 17 5 4 3 3 32 16 COMPARATIVE STATISTICS. The Registrar-General has forwarded provisional figures relating to the country as a whole, and to London, enabling the following comparisons to be made:— Birth-rate per 1,000 population. Death-rate per 1,000 births. From diarrhoea, &c., under 2 years. Total deaths under 1 year. Live. Still. England and Wales 14.7 0.62 5.7 57 London 13.3 0.52 11.2 58 Edmonton 16.7 0.58 13.6 52.8 Annual Death Rate per 1,000 of Population. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. England & Wales 11.7 .00 .00 .03 .01 .04 .08 .18 .52 London 11.4 .00 .00 .00 .01 .04 .06 .11 .61 Edmonton 9.02 .03 .00 .00 .01 .03 .04 .02 .44 The following table gives the number of births and deaths (registered) subdivided into the four wards of the district. It should be remembered that the births are only of those which occurred in Edmonton and of course of Edmonton addresses: these are the ones registered in Edmonton. Births which take place outside the district are not included; this fact accounts for the difference between these figures and those supplied by the Registrar-General. The deaths include those taking place outside the District, the information being given us quarterly by the Registrar-General. Ward. Births. Infant Deaths. Deaths. M. F. M. F. M. F. Bury Street 284 (298) 245 (255) 133 108 23 10 Church Street 99 (121) 100 (134) 65 88 7 4 Angel Road 163 (173) 170 (183) 126 100 8 8 Silver Street 164 (199) 176(203) 112 117 16 9 Vagrants — — 4 1 — 1 710 (791) 691(775) 440 414 54 32 The figures in brackets include births registered in other districts, information regarding which is forwarded by the Medical Officer of Health of the district concerned. The total is 1,566, whilst the Registrar-General's total is 1,610. 17 Section B. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Laboratory Facilities. These are as described in previous reports. The Medical Officer of Health has carried out the following examinations during 1935:— Swabs for diphtheria:— Positive. Negative. Total. From suspected cases.. 89 1,041 1,130 ,, contacts 37 374 411 ,, carriers and old cases 21 62 83 Total 147 1,477 1,624 Sputa for the presence of tubercle bacillus:— Present 3 Not found 33 Total 36 Hairs for the presence of the parasite of ringworm:— Present 1 Not found 5 Smears from the eyelids for the presence of the gonococcus was made in five cases, all with negative results. During the year the following material was sent to the Clini Association for bacteriological examination:— cal Eesearch Positive. Negative. Swabs for virulence of diphtheria organisms 7 20 Blood for presence of typhoid organisms 7 12 Faeces for presence of typhoid organisms 1 7 Swabs for presence of haemolytic streptococci 4 8 Designated milks are sent to the Counties Public Health Laboratories. The results of these examinations were:— Passed. Failed. Grade A (T.T.) Milk 26 7 Pasteurised 12 0 The Middlesex County Council is the Authority under the Sale of Food and Drugs Acts. 18 Ambulance Facilities. The Council possess two ambulances housed at the Fire Brigade Station, and the following figures kindly supplied by the Superintendent, give some idea of the work carried out:— Private cases 4,255 Accident cases 526 Maternity cases 92 Clinic (tonsil cases) 145 Special services 140 Total 5,158 First aid was rendered on 163 occasions, whilst the resuscitating apparatus was in use 18 times. The bedside apparatus for the supply of oxygen was requisitioned for 11 patients by local practitioners. With the increase in size of the population, these two ambulances are in requisition to a greater extent—the corresponding figure for 1934 was 3,239. The total mileage of the vehicles was 27,403 miles. The Council's small bus conveys the deaf and dumb children 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. It is to be hoped that improved facilities for conveying such children to and from their destination will soon be available. Nursing in the Home. This is as described in previous reports. The arrangements made between the Council and the Edmonton Nursing Association has been terminated, as it is undesirable that an institution which is primarily meant for the care of mothers in their confinement should be even indirectly associated with possible sources of infection. The risk of carrying infection is much greater in general nursing than is usually supposed and the danger is considerable in the case of midwifery more particularly because the "carrier" never suspects that he or she is the cause. Nor is it sufficient proof that because the patient does not die one is innocent of being the cause. Many of our mothers are walking the streets of our cities and towns suffering extreme discomfort from infection brought to them by others. 19 The "Queen's Nursing Association" (Edmonton Branch) is increasing in scope and popularity each year. It is to be hoped that those people who need home nursing will make full use of this Institution and that no person, no matter how poor, will ever be refused by them, as they are primarily a charitable Institution. Clinics and Treatment Centres. These are as described in previous reports and may be briefly summarised:— School Clinics. Minor Ailments:— (1) Pymmes Park, Upper Edmonton. (2) Croyland Road, Lower Edmonton. Dental Clinic:— (1) Pymmes Park and (2) Croyland Road. Ophthalmic Clinic:— Pymmes Park. Orthopaedic Clinic :— Methodist Central Hall, Fore Street. Maternity and Child Welfare Clinics. Child Welfare:— (1) Brookfield House, adjoining the Town Hall. (2) St. Stephen's Church Hall, Bush Hill Park. Ante-Natal Clinic:— Brookfield House. Dental Clinics:— Pymmes Park and Croyland Road School Clinics. Orthopaedic Clinic:— Methodist Central Hall, Fore Street. HOSPITALS. Infectious fevers are admitted into the joint Enfield and Edmonton Isolation Hospital situated in Enfield. Arrangements for the treatment of ear, nose and throat disorders, ringworm and treatment by ultra-violet rays are made with the North Middlesex County Hospital which is situate in Edmonton. 20 Arrangements have also been made with the Prince of Wales's Hospital, Tottenham, for the treatment of tonsils and adenoids. The children are received into the Hospital for a period of two days, while the operation is being performed. NURSING HOMES REGISTRATION ACT. One maternity and two other nursing homes are registered by the Authority, the Edmonton Council, and are kept under supervision by the Medical Officer of Health. No new application to be placed on the Register has been received during 1935. Section C. SANITARY CIRCUMSTANCES OF THE AREA. Information re water supply, rivers and streams, has been given in previous reports. A Cleansing Department will be set up in accordance with the recommendation of the Ministry of Health to deal with public cleansing, and as the result of the proposal to erect a Refuse Disposal Works, a Cleansing Superintendent appointed, who will report to a Committee and the Council's Engineer and Surveyor. This is a much felt need and should result in the abolition of the dumping of all kinds of rubbish on vacant plots of land in the various parts of the district, as well as clearing up the very undesirable dump at present at the Sewage Farm. The extension of the Sewage Disposal Works has been completed at a cost of £32,500, and preliminary plans are in course of preparation for a further extension necessitated by the continued development of this district and the Borough of Southgate. Extensions at the Open-air Bath have been completed and include a filtration plant. A similar plant has been installed at the Knights Lane Baths. The Council, during the year, erected 25 houses in the Hertford Road (Byron Terrace) and a further 44 houses on the Cambridge Road (Kipling Terrace), while a commencement has been made with the Galliard Road Housing Scheme (128 houses) where, for the first time, the roads are being constructed in concrete. 21 A commencement has been made in the preparation of plans, etc., for the reconstruction of the main sewers in the district. The reconstruction of the Southern Outfall Sewer is being proceeded with first. The construction of an up-to-date Refuse Salvage Incineration Plant was placed in hand and is proceeding satisfactorily. The above information has been given me by the Engineer and Surveyor, to whom I am indebted. SANITARY INSPECTION IN THE AREA. The district is divided into three areas, each having a sanitary inspector, who also acts as Inspector under the Petroleum Acts. A fourth inspector carries out house-to-house inspection. The Lady Sanitary Inspector looks after out-workers' premises, the sanitary condition of factories where women are employed, supervision of premises where ice-cream is made or sold, the women's lavatories belonging to the Council, the supervision of home-nursed cases of the notifiable infectious illnesses, and the investigation of these latter diseases, including tuberculosis. The Senior Sanitary Inspector supervises the work of the district and is Inspector under the Canal Boats Acts. The following tabular statement gives the number and the nature of the Inspections made during the year:— Complaints 1,485 Infectious Disease 488 Tuberculosis 258 House-to-House 102 Factories 145 Workshops 26 Workplaces 6 Outworkers 186 Schools 7 Dairies and Milkshops 96 Offensive trades 81 Shops Act (Primary) 6 ,, (Re-inspections) 7 Shops and stalls 175 22 Smoke observations 21 Sanitary conveniences, urinals 801 Stables 7 Piggeries 29 Gipsies 31 Petroleum 175 General inspections 242 Re-inspections 6,213 Sundry visits 1,655 Cinemas and halls 43 Visits to canal 25 Inspections of Places where Food is Prepared. Butchers 157 Fish shops 83 Coffee shops 8 Ice cream shops 143 Dairies and milkshops 96 Slaughterhouses 134 Bakehouses 36 Number of Notices served were :— Preliminary or informal notices 1,547 Statutory notices 327 Defects Remedied. Houses repaired, cleansed, etc. 734 D. W. cisterns repaired, covered 17 Water fittings repaired 65 Water taken off main 3 Drains examined, tested, etc. 204 Drains cleared, trapped, repaired 206 Drains reconstructed 96 Chambers inserted 42 Chambers sealed down 23 Soil and vent pipes repaired 58 W.C.'s repaired, cleansed, etc. 452 Flushing cisterns repaired 144 Waste pipes repaired, etc. 101 Sinks repaired or renewed 41 Roofs repaired 470 Gutters and rain water pipes repaired 347 23 Yards paved or repaired 190 Scullery floors repaired 53 Spaces under floors ventilated 99 Dampness remedied 240 Floors repaired 140 Coppers and stoves repaired, etc. 349 New dustbins supplied 155 Accumulation of refuse removed 21 Nuisances from animals abated 3 Gipsies removed 29 Other nuisances abated 955 Rooms cleansed after infectious disease 22 Sanitary Conveniences. The three conveniences belonging to the Council are kept under constant supervision. The enlargement of the convenience on The Green is nearing completion. Sites for other conveniences have been obtained at Weir Hall, Hertford Road and Bush Hill Park, and it is to be hoped that they will be erected with all haste as they are long overdue. The urinal in Pymmes Park at Victoria Road is about to be rebuilt to form a convenience in that area. Van Dwellers. As mentioned in previous reports these have practically become eliminated owing to the fact that most of the spare ground of the past has been developed for building purposes. Offensive Trades. The businesses under this heading comprise 35 fish fryers and curers, one fat boiler, and one gut scraper, making a total of 37. Regarding the Gut Scraping Factory an interview was accorded representatives of the Edmonton Ratepayers' Alliance for them to submit their case against the continuance of this business, and as the result the Council obtained legal advice, and decided to take action against Messrs. Aupers. The required signatures and affidavits of ten inhabitants were forthcoming. Proceedings were instituted against Messrs. F. Berndes, Ltd., of No. 42, Silver Street, Edmonton, for carrying on the trade of Fish Frying without the 24 consent of the Council, and after consultation with Counsel two summonses were issued having regard to the fact that a Restaurant had been opened where Fish Frying was in the main the business of that Restaurant. The cases came before the Tottenham Petty Sessions, and fines of 40s. were imposed on each count and 25 guineas costs allowed. Pig-keeping. Fewer pigs are now kept in the district—extensive building operations have brought these within the operation of the byelaws. Rat and Mice Destruction Act, 1919. The County Council are the authority for this district under the Act which throws the responsibility upon the occupier of the premises infested, but the Rat Destruction Officer of the Middlesex County Council is always willing to give advice. The report from the Chief Officer, Public Control Department, County Council of Middlesex, is as follows:— "During the year, the Council's Inspector of Rat Destruction paid 148 visits to rat infested premises in Edmonton, and the work of rat destruction was continued by the County rat-catchers throughout the year at your Council's (Edmonton) Sewage farm and refuse dump." The Inspectors of the Public Health Department often examine the drainage of premises where it might be possible that the infestation is due to a defect in the house drainage system. Smoke Abatement. Considering the large number of factories in this district it is rarely necessary— taking them on the whole— to employ any legal pressure as to smoke nuisances. Twenty-one observations were made during the year and on two occasions contraventions of the Byelaw occurred and notification sent to the firms concerned, resulting in no repetition of the offence. Overcrowding. There is still a certain amount of overcrowding in the district, despite the efforts of the Council. A good deal of the difficulty lies in the fact that, when 25 the Authority houses an overcrowded family, another family comes in from outside the district and repeats the trouble which had just been attended to. As previously mentioned, the overcrowding survey under the Housing Act, 1935, shows the number of cases of overcrowding in the district, but the alternate remedy cannot take effect for some time yet, as after the submission of the proposals by Local Authorities, the Ministry will then approve the number and type of houses to be built for the rehousing of overcrowded families concerned. Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 276 ,, return ,, 270 Rooms disinfected after infectious disease 646 ,, ,, ,, phthisis 204 ,, ,, ,,cancer 77 Disinfestation carried out for vermin.. 291 Number of articles (bedding, clothing, etc.) disinfected after infectious disease 2,971 Ditto after phthisis 642 Ditto after other illnesses 1,183 Articles of bedding, etc., destroyed 37 It would be a great economy in time and labour if the Disinfecting Station were situated in a more central position, such as the Town Hall Yard. The Council distribute a disinfectant powder and a disinfectant fluid to residents who apply for these at the Town Hall Yard. During the year the applicants numbered 29,298. A formalin chamber is used for the disinfection of books, leather goods, etc.—articles that would be damaged by steam. The number of books disinfected was 650, other articles, 20. There is still an increase in the number of cases of disinfestation for vermin, and this may be accounted for by the fact that people are becoming to some extent, "bug" minded. The buying of old bedding and furniture, lack of perseverance on the part of certain tenants, and that in some cases persons do not like it known that they have such vermin in their houses, all tend to make this problem more difficult to deal with. 26 Petroleum (Consolidation) Act, 1928. During the year, 23 new licences and 91 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences :— Petroleum spirit 336,748 gallons. Petroleum mixtures 4,654 ,, Carbide of calcium 4 tons 47 lbs. These figures show an increase over those of last year and are noteworthy. Mortuary. During the year 74 bodies were deposited in the mortuary, 61 by order of the Coroner, and 13 for sanitary reasons. Canal Boats Acts. During the year 25 visits were paid to the canal and 28 boats were seen, but none of these were fitted or used as dwellings or registered under the Acts. Places of Public Entertainment. Forty-three inspections of cinemas and of other places of entertainment were made in accordance with the circular of the Ministry of Health, of August, 1920. Conditions were found to be generally satisfactory. FACTORY AND WORKSHOP ACTS. The following work has been carried out under the Factory and Workshop Act:— 1.—Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 145 5 - Workshops (including Workshop Laundries) 26 - - Workplaces (other than Outworkers' Premises) 6 1 — Total 177 6 — 27 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 16 14 - - Want of ventilation 1 1 - - Overcrowding — — — — Want of drainage of floors — - — — Other Nuisances 9 9 — — Sanitary Accommodation Insufficient 1 1 — Unsuitable or defective 18 20 — - Not separate for sexes - - - - Offences under the F. & W. Acts— Illegal occupation of underground bakehouses - - - - Other offences — — — — Total 45 45 — — 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Notices Served. Prosecutions. Wearing Apparel Nil. Nil. Nil. Umbrellas Artificial Flowers Brushmaking Details of defects remedied, as given above in Section 2, were:— W.C. 's and urinals cleansed 14 W. C. cisterns repaired 2 W. C. seats repaired 9 New W.C. pans and traps fixed 4 W.C. putty joint repaired 1 W.C. cleared 1 Surface drains cleared 1 Waste pipes cleared 2 Sanitary accommodation extended 1 Urinal drain trapped 1 New sparge pipe fixed 1 W. C. window frame repaired 1 Ventilated space provided 1 28 Curbs fixed to surface water gullies 1 Ventilating pipe repaired 1 Yard paving repaired 1 New surface drain laid 1 Accumulations of refuse removed 2 Outworkers. During 1935, there were added to the register the names of 59 new outworkers; the total number on the register is 146. Schools. The exclusion of children suffering from infectious diseases, and their contacts, is dealt with in accordance with the memorandum issued jointly by the Ministry of Health and the Board of Education. No schools were closed during the year on account of infectious diseases. Section D. HOUSING. Housing Act, 1935. The Overcrowding Survey in accordance with Section 1 of this Act was commenced, and the Reports, etc., will be submitted at a later date. It must be noted that the rehousing of overcrowded families discovered as the result of such survey cannot take place for some considerable time. Housing Act, 1930. There were no clearance areas dealt with during the year under review. Individual Unfit Houses. During the year 14 houses have been represented to the Council as coming within the category of Section 19 of the 1930 Act, and up to the end of the year 4 had been demolished— the Council rehoused the affected families, and in one case an undertaking given to execute certain works to the Council's satisfaction and such undertaking accepted by the Council. The following details regarding the inspection of houses, etc., have been drawn up in accordance with instructions received from the Ministry:— 29 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) 1,539 (b) Number of inspections made for the purpose 7,155 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 102 (b) Number of inspections made for the purpose 1,680 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 14 (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 1,092 2.—Remedy or Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority of their officers 868 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 69 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners 74 (б) By local authority in default of owners 2 30 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 122 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 107 (б) By local authority in default of owners 5 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 5 (2) Number of dwelling-houses demolished in pursuance of demolition orders 4 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 room having been rendered fit — Section 17 of the 1930 Act. Sixty-nine Notices were served under this Section during the year and only in two cases were the Council called upon to execute the work owing to the default of the persons having control of the premises, although such authority was asked for in a number of instances. One can say with pride that a rather large amount of work has been done in premises as the result of the service of Notices under this Section—which are accompanied by a Schedule of Defects itemised. 31 Section E. 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 59, of which 6 were added during the year. A total of 96 visits were paid to these during the course of the year. No contravention of the Milk and Dairies Order, 1926, has come to the knowledge of the Staff. With respect to the Milk (Special Designations) Order, 1923, samples of designated milks are sent to the Counties' Public Health Laboratories for bacteriological examination; the results are tabulated previously under "laboratory facilities." Various licences were granted as under :— Primary. Supplementary. Pasteurised 10 7 Grade A (T.T.) 14 5 Grade A, pasteurised 1 1 Certified 2 1 Grade A — 1 27 15 Four of the above retailers bottle Grade A (T.T.) milk and two firms pasteurise and bottle the milk on their premises. Supplementary licences are granted to milk retailers who live outside the district but who sell milk in the district; the primary licence is granted them by the Authority of the district in which they reside. No examinations for the tubercle bacillus were made. 32 Meat and other Foods. The inspectors paid the following visits during the course of the year:— Butchers' shops 157 Fish shops 83 Coffee shops 8 Shops and stalls 175 Slaughterhouses 133 Bakehouses 36 Ice cream shops 143 The following carcases were examined during or shortly after slaughter :— Oxen 53 Sheep and lambs 426 Pigs 183 There are three slaughterhouses in the district (2 licensed and 1 registered) and visits are made when slaughtering is carried on, although the figures are not very large consequent upon the fact that the majority of meat sold in this district is bought from the London markets. Slaughter of Animals Act, 1933. During the year two applications were received for "licence as a slaughterman"; these were granted by the Council, thus making the total number of slaughtermen on the register ten. The following is a list of the surrendered food for examination and retained as unfit for human consumption :— 38 boxes of peaches. 211 tins of cherries. 1 box of apples. 1 rabbit. 7 lambs' livers. 3 tins lambs' livers. 1 box of pears. 18 tins of pears. 5 bags of pears. 4 tins of jellied veal. 1 box of conger eel. 11 New Zealand lambs. 33 1 chilled hind quarter beef. 2 loins of beef. 2 rumps of beef. 32 legs and shoulders of lamb. 4 whole loins of pork. 3 forequarters of lamb. 2 top pieces beef. 4 chines of mutton, steak and chops. 3 chickens. 15 tins of pineapple. 77 tins of French hams (cooked). 3,727 tins of crab-spread. 135 oranges. 8 tins of cooked ham. 5 tins of "apricot puff" biscuits. 2 tins of "raspberry puff " biscuits. Our thanks are due to Mr. J. E. Hill, J.P., who has always given willingly his assistance when orders of condemnation and destruction of foodstuffs have been sought. Ice Cream. Premises used for the sale or manufacure of ice-cream must be registered in accordance with the provisions of the Council's Act of 1929. Sale of Food and Drugs Act. The Middlesex County Council is the Authority for the administration of this Act, and I am indebted to the Chief Officer of the Public Control Department for the following information which relates to foodstuffs purchased in Edmonton:— List of samples taken during 1935 :— Taken. Adulterated. Milk 250 1 Milk, new 4 — Milk, sterilized 7 — Arrowroot 3 — Brandy 2 — Butter 13 — 34 Coffee. 4 — Cream pastry 3 2 Gin 3 — Hake 3 1 Lemon sole 1 1 Mustard 2 — Pepper 2 — Sausages 5 — Tea 1 — Vinegar 4 3 Whisky 3 — 310 8 Number of prosecutions 1 Number of convictions 1 Shops Act, 1934. This Act came into force at the end of 1934 and contains provisions regarding (1) ventilation, (2) temperature and (3) sanitary conveniences of shops, and entails additional work for the district inspectors. Shops Act. The Shops Acts Inspector submits a monthly report to the Public Health Committee, and the following is a short summary :— Visits to shops, licensed street traders, etc. 2,747 Number of contraventions 18 Proceedings were taken against two traders, and the fines of 20s. were inflicted in each case. Chemical and Bacteriological Examination of Food. The only examinations carried out by the Council are those for designated milks; these are sent to the Counties' Public Health Laboratories. The matter is discussed previously. Nutrition. An effort has been made in this direction to sort out the mal-nourished in the Schools and School Clinics, and to ascertain the cases of such, but no 35 definite advance has as yet been made to make a comprehensive survey of the whole district. With the appointment of a new Assistant Medical Officer of Health, investigations can be more thoroughly made to cope with what is now recognised as a very important function in Public Health administration. Section F. PREVALENCE OF INFECTIOUS DISEASE. The non-notifiable illnesses were not much in evidence during the year. It is well known that children who suffer from these diseases are very prone to antemia and chest troubles with a tendency to tuberculosis, and it will be a great boon to such when the open-air school will have begun to function in Edmonton. Severe cases of measles or of whooping cough, and more particularly when the environment is unsatisfactory, are received into the Isolation Hospital. The incidence of diphtheria was somewhat higher than last year, although following a localised outbreak associated with a Tottenham school, which proved to be rather virulent, very few notifications were received during the l.ast six months of 1935. Scarlet Fever was in evidence in a mild form throughout the whole of the year, and in many instances the disease was so slight as to render it difficult to diagnose. Return cases numbered eleven, allowing an interval of 28 days between a child coming home from the Hospital and an inmate of the house going down with scarlet fever. Smallpox. No cases of smallpox were notified during the year. Enteric Fever. As previously mentioned there was a sporadic outbreak of this disease in various parts of the district during the year. The separate occurrence of this disease did not appear to have any common factor, which made investigation exceedingly difficult. In a few instances the serum of the patients was agglutinated with B.Abortus, and gave a positive result in a fairly slight dilution. 36 Immunisation against Diphtheria. There has been a continued demand for this, and in all cases the demand has been met. The preparation used is T.A.M. and three injections at weekly intervals are given. The parents have been invited to bring the children three months later for the Schick test. In those, however, who had the test performed, the results have given a uniform negative. The age of the child to be preferred is from 6 months upwards. This service is now officially available to all Edmonton residents, but no effort has been made to bring it to the notice of any of the parents, nor has any special clinic been formed for the purpose. The number of children who received the three injections was 42, and the number who were "Schicked" was 23; all these were negative. Puerperal Fever, puerperal pyrexia and ophthalmia neonatorum are referred to later on, under the heading of Maternity and Child Welfare. Food Poisoning. Food poisoning is notifiable in the district but no cases have been reported. Rheumatism. The frequent discovery of heart trouble following Scarlet Fever gives evidence that this disease is very frequently associated with Acute Rheumatism, and this latter appears to occur far more frequently than is generally believed. Quite a number of children have been excluded from school suffering from Chorea and it is to be regretted that there are a number of heart cases in the district who cannot attend school. Much harm is done in cases which have suffered from rheumatic infection and no diagnosis is made until a serious lesion of the heart gives evidence of what has already occurred. Pneumonia. The number of cases of primary pneumonia notified was slightly lower compared with last year, but secondary cases following influenza were extremely small owing to the absence of this complaint. 37 Infantile Diarrhoea. The increased incidence of this disease had, unfortunately, a fatal termination in a number of cases, and the resulting debility in those who survived pointed out how serious the infection was. The death-rate per 1,000 live births for London as a whole was 11.2 whilst that for Edmonton was 13.6, as compared with 12.6 and 0.6 respectively last year. The following table gives the age incidence, etc., of those suffering from notifiable diseases, excluding tuberculosis, which is dealt with separately. Disease. Number ot Cases. No. Removed to Hospital. Deaths. Under 1 yr. of age. 1—2 yrs. 2—3 yrs. 3—4 yrs. 4—5 yrs. 5—10 yrs. 10—15 yrs. 15—20 yrs. 20—35 yrs. 35—45 yrs. 45—65 yrs. 65 and over. Scarlet Fever 334 300 1 1 7 21 21 35 133 46 15 40 9 5 1 Diphtheria 127 123 4 3 6 7 12 9 52 28 2 8 — — — Enteric Fever 23 21 3 — — — 1 1 2 1 6 6 2 4 — Puerperal Fever 18 18 2 - - - - - - - 2 15 1 — — Puerperal Pyrexia 30 29 - - - - - - - - 3 25 2 — — Pneumonia 61 27 63 3 2 2 3 2 3 2 6 13 9 14 2 Erysipelas 36 14 — 2 — — — — 2 1 1 6 6 15 3 Cerebro-spinal Fever 2 2 1 1 - - - - 1 - - - - - - Ophthalmia Neonatorum 17 10 — 17 - - - - - - - - - - - Polio-Encephalitis 2 1 — — — — — 1 1 — — — — — — Dysentry 1 - - - - - - - - - - - - 1 — Anthrax 1 1 - - - - - - - - - 1 - - - It must be noted that the figures in the second column as being removed to hospital includes those already under treatment at a hospital— for instance, the North Middlesex County Hospital. This remark applies more particularly to the infections associated with parturition and include puerperal fever, puerperal pyrexia and ophthalmia neonatorum. 38 The following table indicates the wards from which the various cases were notified:— Bury Street Ward. Church Street Ward. Angel Road Ward. Silver Street Ward. North Middlesex County Hospital. Other Institutions. Total. Scarlet Fever 76 46 86 107 18 1 334 Diphtheria 31 11 47 33 5 — 127 Enteric Fever 4 8 9 2 2 3 23 Puerperal Fever 4 2 1 1 10 — 18 Puerperal Pyrexia 3 3 4 4 16 — 30 Pneumonia 13 7 22 18 — 1 61 Erysipelas 12 3 6 11 4 — 36 Cerebro-spinal Fever 2 - - - - - 2 Anthrax — — — — 1 — 1 Ophthalmia Neonatorum 5 5 1 4 2 — 17 Dysentery — — — 1 — — 1 Polio Encephalitis 1 - 1 — — — 2 CANCER. The incidence of cancer relative to the various organs of the body is gi as under:— Males. Females. Lip 2 — Oesophagus 5 1 Stomach 19 18 Large intestine 5 8 Bladder and prostate 5 2 Breast — 20 Liver 5 3 Uterus — 7 Other organs 10 4 51 63 39 PREVENTION OF BLINDNESS. Cases of ophthalmia neonatorum are promptly visited and if thought necessary are removed to St. Margaret's Hospital for treatment. No cases of blindness have arisen during the year due to this cause. TUBERCULOSIS. The following table gives details as to age and sex of new cases of tuberculosis, also the deaths from the disease, this latter figure including the deaths of non-notified cases. Age Periods. New Cases. Deaths. Respiratory. Non-resp'ry. Respiratory. Non-resp'ry. M. F. M. F. M. F. M. F. Under 1 year — 2 — — — 1 — 1 1— 5 years — 1 — 2 — — — 3 5—16 ,, 8 4 8 1 — — — 1 15—25 ,, 11 12 1 1 2 4 1 1 35—35 „ 19 14 1 — 16 7 — — 35—45 ,, 11 5 — 1 10 10 1 — 45—55 ,, 6 1 — — 8 1 1 — 55—65 ,, 5 2 — 1 7 4 1 — 85 and upwards 1 — — 1 1 — — Totals 60 42 11 6 44 28 4 6 In addition, 25 cases of pulmonary tuberculosis and 3 cases of nonpulmonary tuberculosis previously notified in other districts, moved into Edmonton. The total number of names thus added to the register during the year excluding, of course, non-notified deaths—was :— Males. Females. New cases— Respiratory 60 42 ,, ,, Non-respiratory 11 6 Transferred cases—Respiratory 13 12 ,, ,, Non-respiratory 1 2 Totals 85 62 40 The cases dying of tuberculosis and not previously notified were :— Males. Females. Respiratory 5 2 Non-respiratory 3 1 There were thus eleven non-notified deaths out of a total of 82 persons registered as dying of tuberculosis. (Registrar's figures.) Regarding the non-notification of the above cases, there was no suggestion of wilful neglect or of refusal to notify. The non-respiratory forms of tuberculosis notified were :— Males. Females. Spine — — Other bones and joints 1 2 Meningeal — 2 Glands 7 1 Abdomen 3 — Kidney — 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 gives power to the Local Authority to remove to hospital certain cases of tuberculosis who are dangerous to other people. No occasion during the year has occurred in which it has been necessary to invoke these powers. Public Health (Tuberculosis) Regulations, 1930. The corresponding figures for the end of 1934 were:— Males. Females. Total. Pulmonary forms 266 213 479 Non-pulmonary forms 73 68 141 Totals 339 281 620 The number of cases of tuberculosis on the register at the end of 1935 was :— Males. Females. Total. Pulmonary forms 257 196 453 Non-pulmonary forms 73 69 142 Totals 330 265 595 41 Corresponding figures for previous years were :— Males. Females. Total 1933 320 281 601 1932 363 284 647 1931 382 311 693 1930 381 311 692 1929 421 352 773 COUNCIL'S EMPLOYEES. During the course of 1935 the Medical Officer of Health examined C2 persons prior to their appointment to permanent posts. He has also visited employees of the Council who have been on the sick list longer than a fortnight and, when necessary, at fortnightly intervals. This is a rather interesting departure from my usual duties as Medical Officer of Health, and gives a unique opportunity to the Chief of the Public Health Department to form an opinion of the home circumstances of his people. It is to be regretted, however, that a good number of visits made are futile, owing to the absence of the individuals concerned either at convalescent homes or simply " not at home." MATERNITY AND CHILD WELFARE WORK. I have much pleasure in presenting my Report for the year 1935 on the circumstances appertaining to the Maternity and Child Welfare Department. At present the district is served by two Clinics and it is already proposed by the Council to increase these to eight in order to facilitate mothers attending. Each Clinic will be situated as near as possible to the centre of the district which it is intended to serve. It is intended to employ a full-time Assistant Medical Officer of Health and School Medical Officer in order to speed up the service already rendered by the Medical Officer and to relieve her of some of the work which is becoming entirely too heavy for one Doctor. With the addition of another Dentist in the School Medical Department it is to be hoped that more attention will be paid to dentition amongst the very young of the Maternity and Child Welfare, although this does not primarily call for dental attention so much as preventive medication and diet. On account of the very poor attendances put in by voluntary workers for the past year, it has been decided to employ paid workers to assist in the duties of the Clinics. 42 There are two Ante-Natal Sessions held weekly, but it is to be regretted that the attendances at these Centres is rather meagre, and the majority of the mothers only attend for a few sessions and then towards the end of their pregnancy leave off. This is, of course, the most important time for AnteNatal care, and a great deal of propaganda will have to be adopted before the mothers will fully realise the importance to themselves of regular Ante-Natal treatment. The Medical Officer in charge of the Ante-Natal Clinic at the present time has no appeal in difficult cases, except to send them to the local Hospital. This fact accounts for a good deal of the lack of and irregular attendances. It is intended to appoint a Consultant Surgeon in the near future, who will be attached to one of the London Maternity Hospitals, in order to facilitate treatment of difficult cases. The Surgeon is to attend fortnightly at a Special Clinic to which all the abnormal cases found by Practitioners, Midwives and at the Council's Ante-Natal Clinic can be referred. Every effort must be made to encourage mothers to attend regularly at the Ante-Natal Clinic, particularly towards the end of the carrying period. It is to be hoped that every branch associated with the Maternity Service may be welded into one common cause for a common effort, in order to reduce Maternal Mortality. In this direction promptitude in reporting abnormalities during the puerperium will greatly help because delay gives no chance for Hospital or Specialist Service. I refer particularly to Midwives in practice and general Practitioners. The North Middlesex Hospital contains 66 beds for Maternity purposes and, in my opinion, this number is entirely inadequate to deal with the large population which this Hospital serves. It is the intention of the Middlesex County Council to increase the number of beds at some future date, but it is necessary for the Edmonton Authority to make some provision in the meantime. An effort is being made to render the Ante-Natal and Infant Welfare Services continuous throughout the year, instead of closing down for a period of time at Christmas, Easter and the Summer. For this reason it is necessary to employ a locum tenens in lieu of the permanent Officers whilst on holiday. An effort is also being made to establish a Post-Natal Centre. It will be accomplished in a very few months. Two of the Education Nurses are being trained at the National Health Society, with the permission of the Ministry of Health, to obtain the New Health Visitors' Certificate, and further to amalgamate the existing Health 43 Visitors and School Nurses for the combined Maternity and Child Welfare and School Medical Services. It must be definitely understood that it is only those nurses who will come up to the standards required by both the Ministry and the Board, who will be amalgamated. Births. The number of births notified during 1935 were as follows :— Live births, nptified by midwives 2,101 ,, ,, doctors and parents 359 Stillbirths ,, midwives 98 ,, ,, doctors 10 Total 2,568 These figures include births which have taken place in the North Middlesex County Hospital, both of Edmonton and non-Edmonton residents; excluding these latter, the notified births of Edmonton residents are :— Live births, notified by midwives 1,051 ,, ,, doctors and parents 355 Stillbirths ,, midwives 42 ,, ,, doctors 10 Total 1,458 It must be remembered that births have to be notified to the Medical Officer of Health within 36 hours; registration of the birth must be made within, fortv-two davs. The registered births, as given previously, were :— Male. Female. Total. Live births 791 775 1,566 Stillbirths 30 22 52 Total 821 797 1,618 The registered births include those which take place outside the district. 44 Visits to the Homes by the Health Visitors. These can be tabulated as follows:— To expectant mothers:— (1) First-visits 216 (2) Total visits 320 Visits to children under 1 year:— (1) First visits 1,725 (2) Total visits 10,194 Visits to children, 1 to 5 years 6,343 Infant protection visits to children aged 5 to 9 years 135 Grand total 16,992 It can be seen that the birth rate in Edmonton is still rising as evidenced from the above figures. This is primarily due to the fact that Edmonton is becoming more and more a residential area. CLINICS. These are as follows:— (1) Ante-Natal Clinic at Brookfield House, Fore Street, adjoining the Town Hall. (2) For Child Welfare:— (a) At Brookfield House. (b) At St. Stephen's Church Hall, Bush Hill Park. (3) Dental Clinic at Pymmes Park School Clinic. (1 session per week.) (4) Orthopaedic Clinic at Methodist Central Hall, Fore Street. (2 sessions per week.) 45 Ante-Natal Clinic. This is held twice weekly, and there were 73 sessions during the course of the year. Attendances, etc., were:— Number of prospective mothers 264 (including 42 who made their first attendance in the latter part of 1934) Total number of attendances 1,176 Number of consultations 719 Average number of attendances— (1) Per session 16.1 (2) For consultation 10 (approx.) An additional Ante-Natal Session was started since 1934 in order to speed up the work in this direction. The work here, however, is far from perfect, and will need a great deal of attention and effort in order to bring it up to a satisfactory standard. When one considers that out of a Birth Rate of 1,458 only 264 mothers attended during the whole year, the service must be regarded as poor. That is, only 18.1 of the mothers attended an official Ante-Natal Clinic. Child Welfare Clinics. There are five afternoon sessions at Brookfield House, and one morning session at St. Stephen's Church Hall, Bush Hill Park. The figures relating to attendances, etc., are:— Brookfield House. St. Stephen's Hall. Number of sessions 247 43 New cases:— (a) Under one year 735 84 (b) 1 to 5 years 337 28 Attendances:— (a) Under one year 12,031 1,144 (b) 1 to 5 years 13,510 787 Doctor's Consultations 4,239 503 Average Attendance 103.4 44.9 The average attendances were 4.3 and 9.4 respectively above those obtaining during the previous year. 46 Dental Clinic. This is held once weekly in the school dental clinic at Pymmes Park. Details of the work carried out there are:— Mothers. Children. Number of attendances 435 198 Total number treated 415 182 Fillings 30 39 Dressings 1 51 Scalings 13 — Extractions (number of teeth) Under gas 1,049 396 Local anaesthetic 10 — Number of gas cases 241 141 Dentures:— Impressions .. 28 Bites .. 28 Try-ins .. 28 Fitted .. 28 Alterations and repairs to dentures .. 1 Easements .. 3 There were 28 dentures supplied and of these, 17 were assisted by the Committee. Orthopaedic Clinic. The clinic is held at the Methodist Central Hall, Fore Street, twice a week, and the surgeon visits monthly. That this clinic serves a useful purpose is shown by the following figures which deal with the year's work:— Number of Sessions 95 New cases seen 154 Attendances:— Surgeon's days 444 Treatment days 696 Total attendances 1,140 Three children were treated as in-patients at Stanmore, the country branch of the Royal National Orthopredic Hospital, and were in residence for the following periods:— 47 1st child.— 6 weeks during 1935, and was still away at the end of the year. 2nd child.— 14 weeks during 1935, and was still away at the end of the year. 3rd child.— 30 weeks during 1935, and was still away at the end of the year. It is to be regretted that the necessity for orthopaedic treatment is increasing, and this is out of proportion to the increase of the population. This, together with the increased necessity for dental treatment, forms the acid test for an efficient Maternity and Child Welfare Service. It is to be noted, therefore, that increased attention must be given to the Maternity and Child Welfare Service all round. Tonsils and Adenoids. Arrangements are made with the Prince of Wales's Hospital, Tottenham, for the operative treatment of tonsils and adenoids. Three children received this form of treatment; of these, the Committee paid the whole cost of one, and the other two were above scale for assistance. Convalescent Homes. One mother, with her baby, was sent for convalescent treatment during the year for a period of 3 weeks. Seven children were sent away under an arrangement with the Invalid Children's Aid Association, for an average period of 12 weeks and 6 days per child. Of these 7 children, 2 who were away in 1934 carried their convalescence into 1935, and 2 who were sent away in 1935 were still away at the beginning of 1936. Artificial Sunlight. This treatment is carried out at the North Middlesex County Hospital. This has proved invaluable to those who partake of it, and the tendency should be to increase this Service. Only ten children were sent during the course of the year and the reports regarding these children were:— 4 children improved. 4 improved but discharged as absentees. 2 discharged as absentees. 48 There was an average gain in weight on 8 cases of lib. 5oz., but in the two other cases the discharge weight was not recorded. There is great need amongst some of the Ante-Natal mothers, and toddlers, for Ultra-Violet Light treatment. At present this is being done at the North Middlesex County Hospital, but on account of the large numbers treated there, it would be far more satisfactory if a centre was established in association with our Orthopaedic Clinic and under the direction of the Orthopaedic Surgeon. Home Helps. There has not been a great demand for these services; nine applications were made and granted during the year. Municipal Milk. Details regarding the supply of milk to the recipients are :— Number of applications 2,104 Number of recipients 2,027 Number of pints granted at ¼ cost 31,297 ,, ,, ,, Free 53,006 Actual number of people who applied for milk during 1935 404 Of this number 48 were expectant mothers. Free Supplies of Cod Liver Oil and Malt, Numol, Hepa, Halycalcyne and Ferrofax. The following free supplies were granted during 1935:— Cod Liver Oil and Malt 2,304 cartons. Hepa 91 bottles. Ferrofax 24 bottles. Numol 1,068 cartons. Halycalcyne 60 bottles. With the addition of another Doctor to the Service it is desirable to bring the granting of other amenities under the control of a committee, and it is to be hoped that steps in that direction will be taken during the ensuing year. MIDWIFERY AND MATERNITY SERVICES. Edmonton Council are the Local Supervising Authority under the Midwives Acts for their area. Dr. Outram acts as Inspector of Midwives and Nursing Homes. 49 So far the Council have made no arrangements for Maternity services, but it is to be hoped that arrangements will be made with some of the general hospitals to help in difficult cases. The following notices to practise within the area were received during 1935:— Notifications from Midwives residing in area 12 ,, ,, ,, ,, in Hospital 21 ,, ,, ,, ,, in surrounding areas but tising in Edmonton 7 40 In so far as this service goes it is a good one, and the Midwives appear to be young and enthusiastic about their work, and as a result the year's work is satisfactory and should be fostered. With the advent of the new Midwives Act it may be necessary for the Council to consider establishing a Midwives' Service, and if so, Edmonton is rather well placed because of the superiority of its Midwives. The number of claims made by doctors for medical aid was 155, and of these, 66 came under the scale for financial help from the Council. The total amount involved was £191 17s. Od., of which the Council paid £75 16s. 6d. INFECTIOUS ILLNESSES. Ophthalmia Neonatorum. Seventeen cases were notified during the year; of these, 7 were in the North Middlesex County Hospital. Three were sent by the Council to St. Margaret's Hospital, the length of stay being 3 weeks, 7 weeks and 1 day, and 10 weeks respectively. All made a good recovery. Puerperal Fever. Eighteen cases of this complaint were notified during the year. Of these, 10 were Edmonton residents. Three cases were sent into the Isolation Branch of Queen Charlotte's Hospital, their length of stay being as follows:— 1st case.— 3 weeks and 4 days. 2nd case.— 2 weeks and 2 days. 3rd case.— 4 weeks. 50 Puerperal Pyrexia. Thirty cases were notified; of these, 14 were Edmonton residents. Out of the total 48 cases of Puerperal Fever and Pyrexia, 42 cases were in the North Middlesex County Hospital. An effort has been made to induce all mothers coming within the scope of Puerperal Fever and Puerperal Pyrexia to be removed to Queen Charlotte's Hospital, Ravenscourt Square. There is an objection by the relatives to remove the patients to Queen Charlotte's Hospital because of the distance, and it is to be hoped that a full service for such cases will be established at our own Isolation Hospital shortly. Measles, Whooping Cough and epidemic diarrhoea are non-notifiable diseases in this area. The Health Visitors paid 3 visits to cases of Measles and 62 to Whooping Cough. INFANT LIFE PROTECTION. Each of the Health Visitors employed by the Council is an Officer for Infant Life Protection, and great care is taken by them in supervising this part of the work. A considerable amount of time and trouble is frequently taken in order to be satisfied about some of the more difficult cases, especially those who migrate from district to district. The number of persons on the register at the end of 1935 was 58, and the number of children 62. DAY NURSERY. The Day Nursery was open for the whole of the year, with the exception of Bank Holidays and three weeks during August, the latter because there is no one suitable to take the place of the Matron amongst the Staff. As most of the mothers are on holiday, there is not the same demand as there would be throughout the rest of the year. On account of the frequent departure of members of the staff, an attempt is being made to reduce the work done per unit, and if possible to reduce the hours. 51 Dr. Outram now pays weekly visits to the Day Nursery to advise the dietary of the children. The attendances for the year were as follows :— Whole day 5,769 Half-day (Saturdays) 348 Resident children admitted during the year 22 INSPECTION OF MIDWIVES AND NURSING HOMES. The 12 midwives resident in Edmonton area were inspected quarterly, and it is a matter of solace to know that these were found to be in order. The 3 Nursing Homes in the district were similarly found to be conducted in a satisfactory manner. BIRTH CONTROL. There is no Birth Control Clinic in Edmonton, but an arrangement has been made to send Edmonton women to the Royal Free Hospital, London, at a cost to the Council of 7s. 6d. for two consultations. Only women coming within the meaning of the Ministry of Health's Circular 1408 may be referred by the Medical Officer to the Hospital. During the year 7 such patients were sent, and of these, 4 had free advice and the remainder were in a position to pay for their own expenses.