1llo Mr. HALLETT. Urban District Council of Edmonton. REPORT OF THE Medical Officer of Health for the year 1936. Jully T.u PRINTER EDMONTON Urban district Council of Edmonton. REPORT OF THE Medical Officer of Health for the year 1 936. |C)I.LY, T.U. PRINTER, EDMONTON. J 77197 Cdmonton Urban District conncil. 1 936. Chairman Councillor Mrs. E. A. Young, J.P. Vice-Chairman Councillor G. E. Albon. PUBLIC HEALTH COMMITTEE Chairman : Councillor J. A. Ward. Councillors W. Bales, Mrs. Barrass, L. E. Berridge, H. Gatward, T. J. Harington, Mrs. Moss, Mrs. Nicholson. 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. I. G. MacIntyre, B.A., M.B., B.Ch., B.A.O., D.P.H., Assistant Medical Officer of Health, and Assistant School Medical Officer (commenced November 16th, 1936). *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. *ab H. W. Grieves, Sanitary Inspector, and Inspector under the Petroleum Acts. (Commenced August 1st, 1936.) a F. Beilby, Inspector for the Housing Regulations. *a Mrs. H. Fowler, Woman Sanitary Inspector. F. J. Nash, Chief Clerk, Cert.R.San.I. J. L. A. Saunders, Infectious Diseases Clerk. A. E. Clarke, Records Clerk. D. H. J. Newman, Correspondence Clerk. (Commenced June 22nd, 1936.) H. J. Weldon, Junior Clerk. (Commenced July 20th, 1936.) 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. 3 To the Chairman and Members of the Edmonton Urban District Council. Ladies and Gentlemen, I have much pleasure in presenting my Second Annual Report for the year 1936 on the sanitary circumstances, the sanitary administration and vital statistics of the Urban District of Edmonton. The contents are compiled in accordance with Circular 1561 issued by the Ministry of Health. As the result of a Special Report presented to the Council in 1935 certain alterations were made by that body, and these have since borne fruit. The expansion of the work thus entailed has led to larger numbers of the general public availing themselves of the facilities offered by the Council; this in turn has increased the amount of work to be performed by the professional and clerical staff. As was stated in my last report the members of the Council showed great anxiety to do everything in their power for the youth of the district, and already this year it is apparent that the youth of the district is equally anxious to respond. The amalgamation of the Maternity and Child Welfare and School Medical Staff is now completed and the officers concerned are settling down to their extensive duties with the determination that has always characterised them in the performance of their duties. We would like to express our congratulations to Miss Hazelton and Miss Garrett, who have now obtained the new Health Visitors' Certificate, and in turn express our gratitude to the New Health Society for the facilities offered us for training these nurses. It is to be regretted that the Office accommodation at the disposal of the Staff is so very inadequate, as thereby the output of work remains restricted because of the lack of facilities. The resolution adopted by the Council to centralise the services in Pymmes Park House has not yet been accomplished owing to the high expenditure of the Council in establishing schools and other departmental buildings. It is to be hoped, however, that some similar procedure will be adopted soon, so that the officers can cope with the increasing demands upon their services. The additional position for an Assistant Medical Officer of Health and School Medical Officer established in the year 1935 has now been filled, 4 and the services of Dr. Ivan Gordon MacIntyre have been obtained. It is too early yet to estimate the increase in benefit of this additional Officer. Also an additional Sanitary Inspector, together with two Clerks, were appointed during the year in order to cope with the increased work of the Public Health Department, and the efficiency of the persons concerned has fully justified their appointment. The co-ordination of work in the various departments is now proceeding satisfactorily, and the benefits derived are beginning to become apparent; no longer does the Health Visitor work independently of the Sanitary Inspector, nor the Maternity and Child Welfare Department of the School Medical Department. It will take some time, however, before the officers concerned will settle down to the automatic accomplishment of such duties. The work of the various clinics is being speeded up in order to facilitate the mothers' return to their domestic duties as quickly as possible. This is bearing good fruit, because the numbers attending the clinics are showing steady increase. During the year the provisions of the Housing Act, 1935, were applied to the district and the Overcrow cling Survey of the whole district was put into operation. A Temporary Sanitary Inspector, a clerk and six enumerators were employed to carry out this duty. From this it was discovered that there are 401 cases of overcrowding in Edmonton and the percentage for the district is 1.69, which, in my opinion, is very pleasing and satisfactory; the Ward with the highest percentage is Angel Road, the figure being 3.33. Although Edmonton as a whole is relatively free from overcrowding, the standard of houses in some parts of the area is old, the brickwork and woodwork in many instances show signs of wear and tear, and the sanitary accommodation although not defective is not ideal, and in a large number of houses there is not sufficient accommodation for cleansing of the person and clothing; these requirements some years ago were not looked upon as entirely essential, but with a better outlook on life offered to the greater number of the population these requirements are no longer looked upon as a luxury, consequently serious consideration will have to be given to some of these areas within the near future. With the exception of measles we were happily relatively free from infectious diseases during the year. Measles seemed to have made up for the lack of this, at one time the incidence in the schools was very high and 5 a few very serious cases resulted; there were nine deaths recorded as the result. Enteric Fever continued to appear in sporadic fashion, but we arc happy to say that there were no fatal cases. The Birth Rate (16.1) continues to be high for reasons stated in my previous report. The Death Rate (8.99) although low in past years is lower still this year. Since the population of the district increases by some 3,000 persons per aanum the above figure is really more creditable than it appears to be. The Death Rate from Tuberculosis is still constant and the number on the register is slightly higher than last year. The Infantile Mortality Rate is again reduced, and now stands at the very commendable figure of 43.9. The Maternal Mortality Rate (3.0) has increased compared with last year, but this is due to the remarkably low figure of 1.8 then obtained. However, it has remained fairly constant for Edmonton over the last five years. The incidence of Puerperal Fever and Puerperal Pyrexia, though lower than 1935, had a higher mortality. In conclusion I should like to record my deep appreciation of the loyal service and co-operation which I have received from the members of the Staff throughout what proved to be 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 1936 98,910 6 Number of inhabited houses and tenements at the end of 1936 23,772 Number of inhabited houses and tenements at the end of 1935 22,566 Rateable Value, April, 1936 £624,723 Estimated product of one penny in the £ for the year ending March 31st, 1937 £2,600 Rates in the £ for the year ending March 31st, 1937 12s. 6d. 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 at ½ cost during 1934 77,350 „ „ „ „ „ 1935 31,297 „ „ „ Free „ 1935 53,006 „ „ „ Free „ 1936 82,929 „ „ „ at ½ cost ,, 1936 6,454 (2) Number of free dinners durinj 1934 103,368 „ „ „ 1935 89,076 „ „ „ 1936 68,227 (3) Figures re out-relief— Cases. Amount. For the year 1934 3,163 £ 54,336 For the year 1935:— (a) Ordinary out-relief 3,335 37,008 (b) Unemployed out-relief 3,383 18,832 6,718 £55,840 For the year 1936:— Cases. Amount. £ (a) Ordinary out-relief 3,918 42,238 (6) Unemployed out-relief 3,443 13,970 7,361 £56,208 The number of cases shown for 1934 is in respect of individual units, but those for the years 1935 and 1936 relate to the actual number of individuals. 7 VITAL STATISTICS. Live Births. Grand Total. M. F. Total. Legitimate 771 780 1,551 Illegitimate 20 22 42 1,593 Birth-rate per 1,000 of population ... ... ... 16.1 Still-births. Grand Total. M. F. Total. Legitimate 32 23 55 Illegitimate — 1 1 56 Total of live and still births ... ... ... 1,649 Rate per 1,000 total births ... ... ... 33.9 Deaths. M. F. Total. Number 441 449 890 Rate per 1,000 population ... ... ... 8.99 Deaths from Puerperal Causes. Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 3 1.8 Other puerperal causes 2 1.2 5 3.0 Death-rate of infants under one year of age. M. F. Total. Number 43 27 70 All infants per 1,000 live births 43.9 Legitimate infants per 1,000 legitimate live births 43.8 Illegitimate infants per 1,000 illegitimate live births 47.6 Deaths from cancer (all ages) 110 ,, measles (all ages) 9 ,, whooping cough (all ages) 6 ,, diarrhoea (under 2 years of age) 10 GENERAL INVALIDITY. The children attending our feeding centres are not so great in number as in previous years, this is to a great extent due to the desire on the part of the parents to feed them at home, and not at the feeding centres; also to the fact that the malnourished child is becoming more speedily attended to, and thereby becoming less in number. 8 Cases of malnutrition, however, occurring among the better class families, though similar in number, do not show the same tendency to decrease. The partaking of milk in schools, especially by the younger child, seems to be more favoured than formerly. The number of persons dying from cancer remains constant, but it must be noticed that the greater proportion of the deaths from this disease are from 55 years of age and upwards. Amongst the males the greater number of fatal cases seems to be associated with the alimentary tract, whereas the breast and uterus seem to be the predominating causes amongst the females. 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 .. .. .. Measles 5 4 9 Scarlet Fever .. .. .. Whooping Cough. 1 5 6 Diphtheria 2 .. 2 Influenza 2 1 3 Encephalitis Lethargica .. .. .. Cerebro-spinal Fever .. 1 1 Tuberculosis of the Respiratory System 32 26 58 Other Tuberculous Diseases 6 5 11 Syphilis 2 .. 2 General Paralysis of the Insane, Tabes Dorsalis .. .. .. Cancer, Malignant Disease 43 67 110 Diabetes 3 5 8 Cerebral Haemorrhage, etc. 15 29 44 Heart Disease 104 113 217 Aneurysm 3 2 5 Other Circulatory Diseases 21 25 46 Bronchitis 13 18 31 Pneumonia (all forms) 54 35 89 Other Respiratory Diseases 4 3 7 Peptic Ulcer 4 .. 4 Diarrhoea, etc (under 2 yrs.) 7 3 10 Appendicitis 2 2 4 Cirrhosis of Liver 1 1 2 Other Diseases of Liver, etc. 1 6 7 Other Digestive Diseases 12 12 24 Acute and Chronic Nephritis 14 10 24 Puerperal Sepsis 3 3 Other Puerperal Causes 2 2 Congenital Debility, Premature Birth, Malformations, etc. 21 11 32 Senility 2 10 12 Suicide 10 4 14 Other Violence 20 15 35 Other Defined Diseases 35 31 66 Causes Ill-defined or Unknown 2 .. 2 Special Causes (included in " Other Defined Diseases"):— .. .. .. Smallpox .. .. .. Poliomyelitis .. ... .. Polio-Encephalitis .. .. .. Total Deaths 441 449 890 9 The following tables give the deaths of those registered during the 53 weeks ended 2nd January, 1937, 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 and over Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. Measles 5 .. 3 1 1 .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 1 .. .. .. .. .. .. .. .. .. .. Diphtheria 2 .. .. 1 1 .. .. .. .. .. .. .. Influenza 2 .. .. .. .. .. .. .. .. .. 2 .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of the respiratory system 34 .. .. .. .. 6 7 8 3 7 2 1 Other T. B. Diseases 6 .. 2 1 1 1 .. 1 .. .. .. .. Syphilis 1 .. .. .. .. 1 .. .. .. .. .. .. General Paralysis of the Insane .. .. .. .. .. .. .. .. .. .. .. .. Cancer 45 .. .. .. .. 2 .. 4 6 11 16 6 Diabetes 3 .. .. .. .. .. .. .. 1 .. 2 .. Cerebral Haemorrhage 15 .. .. .. .. .. 1 .. 2 4 4 .. Heart Disease 107 .. .. 1 1 3 .. 2 4 22 33 41 Aneurysm 3 .. .. .. .. .. 1 .. .. 1 1 .. Other Circulatory Diseases 21 .. .. .. .. .. .. .. 2 .. 6 9 Bronchitis 11 1 .. .. .. .. 1 .. .. 1 8 2 Pneumonia 56 10 7 1 2 .. 6 4 3 5 7 11 Other Respiratory Diseases 3 .. .. .. .. 1 .. .. .. 1 1 .. Peptic Ulcer 3 .. .. .. .. .. .. 1 .. 1 1 .. Diarrhoea (under 2 years of age) 7 7 .. .. .. .. .. .. .. .. .. .. Appendicitis 2 .. .. .. .. 1 .. .. .. 1 .. .. Cirrhosis of Liver 1 .. .. .. .. .. .. .. .. .. 1 .. Other Diseases of the Liver 1 .. .. .. .. .. .. .. .. .. .. 1 Other Digestive Diseases 13 1 .. 1 1 .. 4 .. 2 .. 3 1 Acute and Chronic Nephritis 15 .. .. .. 2 1 2 1 4 1 3 1 Congenital Debility, etc. 21 21 .. .. .. .. .. .. .. .. .. .. Senility 3 .. .. .. .. .. .. .. .. .. .. 3 Suicide 10 .. .. .. .. .. 2 2 .. .. 2 2 Other Violence 20 1 .. .. 1 1 .. 4 1 1 2 4 Other Defined Diseases 35 1 2 1 2 4 4 1 2 .. 6 7 Causes ill-defined or unknown 2 .. 1 .. .. .. .. .. .. 1 .. .. Totals 450 43 15 7 12 21 33 28 30 68 100 93 18 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 Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 .. 2 2 .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 5 3 .. 1 1 .. .. .. .. .. .. .. Diphtheria .. .. .. .. .. .. .. .. .. .. .. .. Influenza 2 .. .. 1 .. .. .. 1 .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever 1 .. 1 .. .. .. .. .. .. .. .. .. Tuberculosis of the respiratory system 27 .. .. .. .. 9 9 5 2 1 .. 1 Other T. B. Diseases 4 1 .. .. .. .. 2 1 .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane .. .. .. .. .. .. .. .. .. .. .. .. Cancer 65 .. .. .. .. 1 2 9 7 19 11 16 Diabetes 5 .. .. .. .. .. .. .. 2 .. 2 1 Cerebral Haemorrhage 29 .. .. .. .. .. .. 1 1 7 11 9 Heart Disease 121 .. .. .. .. 2 2 2 9 16 30 60 Aneurysm 2 .. .. .. .. .. 1 .. .. 1 .. .. Other Circulatory Diseases 26 .. .. .. .. .. .. .. 1 3 10 12 Bronchitis 18 .. 1 .. .. 1 .. 1 .. .. 4 11 Pneumonia .. 9 .. 1 .. 1 1 2 2 4 3 7 Other Respiratory Diseases 3 .. .. .. .. .. .. .. .. 1 1 1 Peptic Ulcer .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea,etc. (under 2 years of age) 3 3 .. .. .. .. .. .. .. .. .. .. Appendicitis 2 .. .. .. .. .. .. 1 .. .. 1 .. Cirrhosis of Liver 1 .. .. .. .. .. .. .. 1 .. .. .. Other Diseases of the Liver 6 .. .. .. .. .. .. .. .. 2 2 2 Other Digestive Diseases 12 .. .. .. .. .. 1 1 1 3 3 3 Acute and Chronic Nephritis 10 .. .. .. .. .. .. .. 1 4 4 1 Puerperal Sepsis 3 .. .. .. .. .. 1 2 .. .. .. .. Other Puerperal Causes 2 .. .. .. .. .. .. 2 .. .. .. .. Congenital Debility 11 10 .. .. .. .. 1 .. .. .. .. .. Senility 11 .. .. .. .. .. .. .. .. .. .. 11 Suicide 5 .. .. .. .. .. 2 1 .. 2 .. .. Other Violence 15 1 .. .. .. 1 3 1 2 4 3 .. Other Defined Diseases 33 .. 2 .. 1 1 6 4 5 5 6 3 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. Totals 462 27 9 5 5 16 31 34 34 72 91 138 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. 11 INFANTILE MORTALITY, The deaths of infants under one year of age were as follows:— M. F. Total Legitimate 42 26 68 Illegitimate 1 1 2 43 27 70 The death-rate of all infants per 1,000 live births was 43 9. A detailed sub-division of the causes, etc., of these infant deaths is as follows:— MALES. Causes of Death Under 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 Bronchitis .. .. .. 1 1 .. .. .. .. 1 Pneumonia 1 .. 2 1 4 2 1 2 1 10 Inflammation of the Stomach .. .. .. 1 1 .. .. .. .. 1 Diarrhœa .. .. .. .. .. 1 4 1 1 7 Congenital Malformation 1 1 .. .. 2 .. 1 1 .. 4 Congenital Debility .. .. 1 .. 1 .. .. .. .. 1 Premature Birth 10 .. .. .. 10 .. .. .. .. 10 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 Atelactasis 1 .. .. .. 1 .. .. .. .. 1 Other Diseases of Early Infancy 1 1 .. .. 2 .. .. .. .. 2 Other Causes .. .. .. .. .. .. .. 1 1 2 Totals 17 2 3 3 25 4 6 5 3 43 FEMALES. Causes of Death Under 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 .. 3 Pneumonia 2 i .. 1 4 2 1 .. 2 9 Other T. B. Diseases .. .. .. .. .. .. .. .. 1 1 Diarrhœa .. .. .. .. .. 2 .. 1 .. 3 Congenital Malformation .. .. .. .. .. 1 .. .. .. 1 Premature Birth 2 .. 1 .. 3 1 .. .. .. 4 Injury at Birth I .. .. .. 1 .. .. .. .. 1 Atelactasis 2 .. .. .. 2 1 .. .. .. 3 Icterus Neonatorum .. 1 .. .. 1 .. .. .. .. 1 Inattention at Birth 1 .. .. .. 1 .. .. .. .. 1 Totals 8 2 2 1 13 7 1 3 3 27 12 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 diarrhœa, etc., under 2 years Total deaths under 1 year Live Still England and Wales 14.8 0.61 5.9 59 London 13.6 0.53 14.4 66 Edmonton 16.1 0.56 6.2 43.9 Annual Death Rate per 1,000 of Population. All Causes Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence England and Wales 12.1 .01 .00 .07 .01 .05 .07 .14 .52 London 12.5 .01 .00 .14 .01 .06 .05 .14 .52 Edmonton 8.99 .00 .00 .09 .00 .06 .04 .03 .49 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 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 Deaths Infant Deaths M F M F M F Bury Street 233 246 126 129 18 6 Church Street 107 127 87 91 7 2 Angel Road 176 171 127 126 9 9 Silver Street 201 191 100 113 9 9 Vagrants .. .. 10 3 .. 1 717 735 450 462 43 27 13 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 1936:— Swabs for diphtheria:— Positive. Negative. Total From suspected cases 41 852 893 „ contacts 9 205 214 „ carriers and old cases 5 3 8 55 1,060 1,115 Not Present. found. Total. Sputa for the presence of tubercle baccillus nil 43 43 Hairs for the presence of the parasite of ringworm nil 1 1 Smears from the eyelids for the presence of the gonococcus was made in two cases, with negative results. During the year the following material was sent to the Clinical Research Association for bateriological examination:— Positive. Negative. Total. Swabs for virulence of diphtheria organisms 2 — 2 Blood for presence of typhoid organisms 5 6 11 Faeces for presence of typhoid organisms 1 2 3 Swabs for presence of haemolytic streptococci 2 7 9 Designated milks are sent to the Counties' Public Health Laboratories. The results of these examinations were:— Passed. Failed. Total. Grade A (T.T.) Milk 24 9 33 Pasteurised 18 nil 18 The Middlesex County Council is the Authority under the Sale of Food and Drugs Acts. 14 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 during the year:— Private cases 4,902 Accident cases 640 Maternity cases 127 Clinic (tonsil cases) 145 Special services 149 False alarms 5 Total 5,968 First aid was rendered on 219 occasions, whilst the resuscitating apparatus was in use 7 times. The bedside apparatus for the supply of oxygen was requested by 34 patients. With the increase in the population, these two ambulances are in requisition to a greater extent—the corresponding figure for 1935 was 5,158. The total mileage of the vehicles was 26,089 miles. The Council's small bus conveys the deaf and dumb children to and from school; it also picks up a few other children in the morning, taking them to a spot to meet the guide. It is the intention of the Council to provide proper motor vehicles for the conveyance of children to the open-air and special schools in the near future. Nursing in the Home. This has been fully described in previous reports. 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 15 Middlesex County Hospital, which is situate in Edmonton. Arrangements for the treatment of tonsils and adenoids have been made With the Prince of Wales's Hospital, Tottenham. 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 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 was received during 1936. Section C. SANITARY CIRCUMSTANCES OF THE AREA. The information re water supply, rivers and streams has been given in previous Reports. The refuse and salvage incineration plant has been completed and put into operation during the year and, as the result, large quantities of refuse which were dumped on the old sewage farm are now being disposed of in the new Works. There still remains, however, a tremendous amount of dumping in the gravel pits in Montagu Road, and the destruction of some of the waste material is causing a good deal of nuisance from time to time, but one can never hope for anything less from dumping. The extension of the Sewage Disposal Works has had to a certain extent a setback on account of the inability of the old sewers in the NorthEastern area of the District proving insufficient for the flow of sewage consequent on the heavy rainfall during the year. The Open-air Bath is now being fully appreciated by large numbers of the juvenile population, and the facilities offered for swimming and sunbathing are being eagerly sought. It is to be regretted that the swimming baths in Knight's Lane are closed for swimming purposes during the winter months. If one of the Baths was kept open I am sure it would prove popular. For some years to come the sewerage of Edmonton will present a grievous and expensive problem, due to the age and construction of the sewers on the one hand, and the increase in sewage, consequent on the increase in population, on the other. 16 The Council are busily engaged in constructing open spaces and children's playing fields. Bury Lodge Garden, although far from being completed, is proving to be very attractive already, especially to the juvenile population. The children's Boundary Playing Field and the Tatem Recreation Ground will prove to be a haven for the youth of the District from the large amount of traffic which speeds along the Cambridge Arterial Road. The Southern Flood Relief Scheme, which was begun last year, is now on its way to completion; this has proved to be a difficult problem. Commencement has been made on the Council's Galliard Road Estate with the erection of 128 houses, and a similar effort is contemplated with regard to 114 houses on the Slipes Estate; the latter houses for the relief of overcrowded families under the Housing Survey. I am indebted to the Engineer and Surveyor for the information which he has supplied me. SANITARY INSPECTION IN THE AREA. Since my last report another Sanitary Inspector has been engaged, with the result that the district is now divided into four areas, corresponding roughly to the four Wards. Each Sanitary Inspector is also the Petroleum Acts Inspector in his own district. The Housing Inspector is constantly engaged for house-to-house inspection and for making special investigations in the houses concerning which complaints have been made in the Public Health Department. The Woman Sanitary Inspector looks after out-workers' premises, the sanitary condition of factories where women are employed, the supervision of home-nursed cases of the notifiable infectious illnesses, and the investigation of these latter diseases, including tuberculosis. She also assists the Senior Sanitary Inspector in the supervision of the women's public conveniences. The Senior Sanitary Inspector supervises the work of the district and is Inspector under the Canal Boats Acts. 17 The following tabular statement gives the number and the nature of the Inspections made during the year:— Complaints 1,600 Infectious Disease 349 Tuberculosis 281 House-to-House 19 Factories 232 Workshops 21 Workplaces 4 Outworkers 288 Schools 7 Offensive Trades 81 Shops Act (Primary) 43 ,, (Re-inspections) 2 Shops and Stalls 197 Smoke Observations 26 Sanitary Conveniences, urinals 472 Stables 13 Piggeries 28 Gipsies 15 Petroleum 192 General Inspections 996 Re-inspections 5,231 Sundry visits 2,514 Cinemas and halls 45 Visits to canal 23 Inspections of Places where Food is Prepared. Butchers 176 Fish shops 75 Coffee shops 2 Ice cream shops 149 Dairies and milkshops 127 Slaughterhouses 125 Bakehouses 40 Number of Notices served were:— Preliminary or informal notices 1,271 Statutory notices 335 Defects Remedied. Houses repaired, cleansed, etc. 642 D.W. cisterns repaired, covered 14 18 Water fittings repaired 57 Water taken off main 2 Drains examined, tested, etc. 162 Drains cleared, trapped, repaired 285 Drains reconstructed 38 Chambers inserted 51 Chambers sealed down 14 Soil and vent pipes repaired 28 W.C.s repaired, cleansed, etc. 334 Flushing cisterns repaired 101 Waste pipes repaired, etc. 109 Sinks repaired or renewed 70 Roofs repaired 456 Gutters and rainwater pipes repaired 357 Yards paved or repaired 138 Scullery floors repaired 54 Spaces under floors ventilated 30 Dampness remedied 190 Floors repaired 116 Coppers and stoves repaired, etc. 240 New dustbins supplied 175 Accumulations of refuse removed 23 Nuisances from animals abated 6 Gipsies removed 12 Other nuisances abated 807 Rooms cleansed after infectious disease 23 Sanitary Conveniences. The following Conveniences come under the supervision of the Public Health Department:— The Green Convenience.—Has been enlarged during the year. Church Street Convenience.—Continues to serve the district in its immediate vicinity, but there does not seem to be the demand here that one would expect in such an area. Angel Road Convenience.—Has been removed from the centre of the road and is being rebuilt on the side walk just removed from the corner. The erection of two additional Conveniences was commenced during the year at Victoria Road and the Sunken Gardens, Bush Hill Park. 19 Van Dwellers. Very few have been seen during the year, owing to the fact that practically the whole of the spare ground in the district has been built upon. Offensive Trades. There are 38 businesses under this heading in the district, comprising 1 gut scraper, 1 fat boiler, and 36 fish fryers and curers. As the result of representation made to the Council by the Edmonton Ratepayers' Association, consideration has been given to the position of Messrs. Aupers' gut scraping factory, and at the time of going to press the matter is still under review. Pig Keeping. This business is rapidly disappearing in Edmonton, due to the absence of suitable sites. Rat and Mice Destruction Act, 1919. The County Council is 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 192 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 the defective house drainage system. Smoke Abatement. Despite the large number of factories in the district, it is rarely necessary to employ any legal pressure as to smoke nuisance. 20 Twenty-six observations were made during the year, and on three occasions contraventions of the Byelaw occurred and notification sent to the firms concerned ; the offences were not repeated. Overcrowding. We are hoping that the Housing Act, 1936, will be regarded as a step forward in the establishment of better housing for the working classes, and that the superficial space allowed per person will in years to come, be increased. It is to be regretted that kitchens and day rooms are included in the calculation when arriving at the "permitted number." The Act appears to suit the later type of house, but leaves the dweller in the older houses still wanting. Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 272 „ „ „ return „ 260 Rooms disinfected after infectious disease 437 „ „ „ phthisis 141 „ „ „ cancer 32 Disinfestation carried out for vermin 240 Number of articles (bedding, clothing, etc.) disinfected after infectious disease 1,884 Ditto after phthisis 433 Ditto after other illnesses 348 Articles of bedding, etc., destroyed 176 The Council distribute a disinfectant powder and a disinfectant fluid to residents who apply for same at the Town Hall Yard. During the year the applicants numbered 32,798, an increase of over 3,000 for 1935. One hour daily is allowed for such distribution, with the exception of Fridays and Saturdays. 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 656; other articles, 48. In September the Council agreed to the supply of Izal in ½-pint tins to those applicants who desired it in lieu of the disinfectant referred to above. Instructions were given for a report to be submitted on this matter at a later date. 21 There was a slight decrease in the number of cases of disinfestation for vermin, and it is to be hoped that the decrease will be maintained. Petroleum (Regulations) Acts, 1928 and 1936. During the year, 14 new licences and 119 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences:— Petroleum spirit 344,818 gallons. Petroleum mixtures 5,074 ,, Carbide of calcium 4 tons 47 lbs. These figures show an increase over those of last year and are noteworthy. Mortuary. During the year 59 bodies were deposited in the mortuary, 48 by order of the Coroner, and 11 for sanitary reasons. Canal Boats Acts. During the year 23 visits were paid to the canal and 20 boats were seen, but none of these were fitted or used as dwellings or registered under the Acts. Places of Public Entertainment. Forty-five 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. Nuisances. Three summonses Were taken out against persons failing to comply with Notices served under Section 94 of the Public Health Act, 1875, and resulted, in two instances, of Orders being made for the abatement of the nuisances within fourteen days, with three guineas costs; whereas, in the other case, the offender vacated the premises—leaving for an unknown destination— before the summons could be served. 22 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) 237 29 .. Workshops (including Workshop Laundries).. 21 1 .. Workplaces (other than Outworkers Premises) 4 1 .. Totals 262 31 .. 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 13 13 .. .. Want of ventilation .. .. .. .. Overcrowding .. .. .. .. Want of drainage of floors .. .. .. .. Other Nuisances 27 25 .. .. Sanitary Accommodation Insufficient 1 1 .. .. Unsuitable or defective 64 64 .. .. Not separate for sexes .. .. .. .. Offences under the F. & W. Arts— Illegal occupation of underground bakehouses .. .. .. .. Other Offences 4 4 .. .. Total 109 107 .. .. 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Served. Notices Prosecution. Wearing Apparel Nil. Nil. Nil. Umbrellas Artificial Flowers Brushmaking 23 Schools. On account of the high incidence of measles in the early part of the year it was found necessary to disinfect some of the schools. This appeared to curtail the incidence of the epidemic. It was, therefore, not found necessary to close any of the schools during the year. Section D. HOUSING. Housing Act, 1935. The results of the Overcrowding Survey under Section I of the above Act are now available, and are submitted below:— The Survey was commenced on the 9th January, 1936, and the enumerators completed their work on the 22nd April, 1936. The total number of houses dealt with was 23,648, and the percentage of overcrowding 1.69, the number of overcrowding cases being 401. The number of houses found to be overcrowded was 371, giving a percentage of overcrowded houses of 1.56. 24 Details of defects remedied, as given above in Section 2, were:— W.C.'s and urinals cleansed 41 W.C. cisterns repaired 18 W.C. seats repaired 28 W.C.'s overhauled 4 Drains cleared 14 Drains relayed 2 Waste pipes cleared or repaired 1 Sanitary accommodation extended 1 W.C. window frame repaired 1 Ventilating pipe repaired 1 Ventilated space provided 1 New roofs provided 1 Limewashing 8 Accumulations of refuse removed 2 Outworkers. During 1936 there were added to the register the names of 75 new outworkers; the total number on the register is 185. Given hereunder are the facts and figures concerned in each Ward— excluding the Council's Housing Estates and the Tottenham Estate (Rehousing), which are given separately:— Angel Road Ward. Houses dealt with 4,646 Found to be overcrowded 161 Percentage of overcrowding 3.46 Bury Street Ward. Houses dealt with 6,642 Found to be overcrowded 120 Percentage of overcrowding 1.8 Church Street Ward. Houses dealt with 5,035 Found to be overcrowded 17 Percentage of overcrowding 0.33 Silver Street Ward. Houses dealt with 5,609 Found to be overcrowded 48 Percentage of overcrowding 0.85 Council's Housing Estates. Houses dealt with 1,672 Found to be overcrowded 55 Percentage of overcrowding 3.28 Tottenham Council Estate. Houses dealt with 44 Found to be overcrowded Nil Percentage of overcrowding Nil The Council's Housing Estates are separated out in the different Schemes showing the individual cases of overcrowding, and in each Ward the particulars of the cases of overcrowding are given in each street or road. The overcrowding percentages of the various Wards, without the separation of any Housing Estates, are as follows:— Angel Road Ward 3.33 Bury Street Ward 1.79 Church Street Ward 0.33 Silver Street Ward 1.36 It may be mentioned that, out of the total premises dealt with, it was only necessary to despatch 185 Notices in accordance with Section 10 (3) of the Act, requiring the necessary information to be supplied by the occupier, 25 and in the majority of cases it was found due, either to the fact that the persons concerned were out most part of the day and to some where there was a misunderstanding or objection to the "doorstep" survey. Having regard to the fact that the percentage of overcrowding for this district is under 2 per cent., the appointed day was fixed as the 1st of January, 1937, in accordance with Circular 1539, issued by the Ministry. Under Section 6 (2) it is the duty of the Local Authority, upon the application of the landlord or of the occupier, to inform the applicant in writing of the number of persons constituting the permitted number in relation to the house. As numerous applications for such information were received, the services of the temporary clerk have had to be retained. PERCENTAGES OF OVERCROWDING IN EACH WARD AND FOR THE WHOLE DISTRICT. Total No. Overcrowded Percentage ANQEL ROAD WARD (Inclusive of Housing Estate) 5165 172 3.33 (Exclusive of Housing Estate) 4646 161 3.46 BURY STREET WARD (Inclusive of Housing Estate) 6667 120 1.79 (Exclusive of Housing Estate) 6642 120 1.8 CHURCH STREET WARD (Inclusive of Housing Estate) 5055 17 .33 (Exclusive of Housing Estate) 5035 17 .33 SILVER STREET WARD (Inclusive of Housing Estate) 6761 92 1.36 (Exclusive of Housing Estate) 5609 48 .85 PERCENTAGE FOR WHOLE DISTRICT (Inclusive of Housing Estates) 23648 401 169 (Exclusive of Housing Estatej .. 21976 346 i'57 Housing Act, 1930. There were no clearance areas dealt with during the year under review. Individual Unfit Houses. During the year Demolition Orders have been made in respect of 12 houses, and 7 have been demolished. The Council re-housed the affected families in 3 cases, the remainder not accepting the Council's offer of accommodation, and 5 undertakings were given to execute certain works to the Council's satisfaction. The undertakings were accepted by the Council and the works carried out. 26 The following details regarding the inspection of houses, etc., have been drawn up in accordance with instructions received from the Ministry:— 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) 1,511 (b) Number of inspections made for the purpose 6,641 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 12 (b) Number of inspections made for the purpose 176 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 16 (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 1,085 2.—Remedy of 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 848 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 92 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 71 (b) By local authority in default of owners 5 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 80 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 75 (b) By local authority in default of owners 2 27 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 12 (2) Number of dwelling-houses demolished in pursuance of demolition orders 7 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. Ninety-two Notices were served under this Section during the year, and only in five 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. 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 9 were added during the year. A total of 127 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) Orders, 1923 and 1936, 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 14 7 Grade A (T.T.) 14 4 Tuberculin Tested 1 Grade A, pasteurised 1 1 Certified 2 2 Grade A — 1 32 15 28 three 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. Seven samples of new milk were examined for the presence of the tubercle bacillus, but were not found in any of the samples. The following carcases were examined during or shortly after slaughter:— Oxen 58 Sheep and lambs 358 Pigs 198 There are two slaughterhouses in the district (both licensed) and visits are made when slaughtering is carried on, although the figures are not verylarge consequent upon the fact that the majority of meat sold in this district is bought from the London markets. The registered slaughterhouse was closed during the year, the premises being given up. Slaughter of Animals Act, 1933. During the year seven applications were received for renewal of "Licence as Slaughterman"; these were granted by the Council for a period of three years. Unsound Food. A seizure of a cow-carcase (in joints) took place and a Magistrate's Order obtained for condemnation. Proceedings were subsequently taken against the offender resulting in a fine of £5 and 2½ guineas costs. 29 Meat and other Foods. The inspectors paid the following visits during the course of the year:— Butchers' shops 176 Fish shops 75 Coffee shops ... 2 Shops and stalls 197 Slaughterhouses 125 Bakehouses 40 Ice cream shops 149 Dairies and milkshops 127 The following is a list of the surrendered food for examination and retained as unfit for human consumption:— 22 tins of apricots. 4 tins of cooked hams. 2 boxes of apples. 3 boxes of fillets. 2 boxes of roe. 31 boats of blackcurrants. 1 tin of lunch tongue. 35 rabbits. 3 tins of milk. 5 tins of red plums. 16 tins of beans. 1 tin of oranges. 1 tin of fruit salad. Mr. J. E. Hill, J.P., has, as in past years, willingly given his assistance to the department when Orders of Condemnation and destruction of foodstuffs have been sought. Ice Cream. Premises used for the sale or manufacture of ice-cream must be registered in accordance with the provisions of the Council's Act of 1929, and such premises are visited periodically. 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 30 purchased in Edmonton :— List of samples taken durintr 1936:— Taken. Adulterated. Milk 181 5 Milk, sterilised 3 1 Biscuits 1 — Brandy 2 - Cinnamon 1 - Coffee, essence 1 - Cream pastry 1 - Fish paste 3 — Gin 1 — Hake 1 — Lard 3 — Lemon Sole 1 — Marmalade 1 — Whisky 2 — 202 6 No prosecutions were instituted during the year. Shops Act, 1934. The three items (1) ventilation, (2) temperature and (3) sanitary conveniences, in connection with the shops which come within the sphere of a Sanitary Inspector's duties, have been dealt with, but it is pleasing to note that, so far, the premises dealt with have made the provisions, or are prepared to carry out the requirements as set out by the Act. Shops Acts. 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. 3,065 Number of contraventions 12 Proceedings were taken against four traders and fines of 20s. and three of 10s. respectively were inflicted. 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. It was hoped to make a general survey of the malnourished pupils in the schools, but the work of the Department has increased so rapidly as to make it well nigh impossible. The newly appointed Assistant Medical Officer seemed to have all his time taken up in the additional duties which have to be performed. There is no doubt that the people of Edmonton desire, and ultimately will get, a full clinical service for their children. It will therefore necessitate the appointment of another Medical Officer to meet these extra duties which are still so needed. 31 Section F. PREVALENCE OF INFECTIOUS DISEASE. The non-notifiable infectious diseases still give a lot of trouble, particularly to the young children attending school for the first time, but an attempt is being made to provide convalescent treatment at various convalescent Homes at the seaside for such children; this work is very encouraging and gives very good results. Doctor Latham Brown, Medical Superintendent of the Isolation Hospital, continues to favour us with the kindness and courtesy which is characteristic of him in dealing with the cases of infection, and some of the non-notifiable diseases are treated in the Isolation Hospital. There is a fall in the incidence of Diphtheria, and were it not for a slight outbreak immediately after Easter the result would have been even better. Scarlet Fever is still in evidence in a mild form throughout the district. As some of these cases exhibit no greater symptoms than a mild sore throat, it is extremely difficult to detect until subsequent peeling indicates the cause of the previous indisposition. "Return" cases numbered 13, allowing for an interval of 28 days between a patient coming home from the Isolation 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 the disease continued to appear in sporadic fashion, but we are happy to say with less incidence than last year. We are still unable to trace the source of infection. Immunisation against Diphtheria. As mentioned in my last report there is again an increased demand for immunisation against diphtheria, and the sense of co-operation of the parents in the matter is greatly appreciated. Practically all the children brought for immunisation are under 10 years of age, and it is not considered necessary in the first instance to Schick Test these children. So far no immunised child in Edmonton has developed the disease. The preparation used is T.A.F. and three injections are given at weekly intervals. Puerperal Fever, puerperal pyrexia and ophthalmia neonatorum are referred to later on, under the heading of Maternity and Child Welfare. 32 Food Poisoning. This disease is notifiable in Edmonton, but no cases have been reported during the year. Rheumatism. The relatively large number of children incapacitated by heart trouble caused by Acute Rheumatism is a matter of deep concern, and the Education Committee have decided to establish a clinic for the treatment of such cases, with arrangements at the local Prince of Wales's Hospital for in-patients if necessary. Pneumonia. The number of cases of primary pneumonia was slightly higher compared with last year, but secondary cases following influenza were extremely small owing to the absence of this complaint. Infantile Diarrhœa. The death-rate per 1,000 live births for London as a whole was 14.4, whilst that for Edmonton was 6.2 as compared with 11.2 and 13.6 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 Total No. of Cases No. Removed to Hospital Deaths Under 1 year of age 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 over Scarlet Fever 216 201 .. .. 3 5 17 8 108 31 16 21 4 2 1 Diphtheria 68 68 2 1 1 4 6 6 32 8 4 3 2 1 .. Enteric Fever 14 14 .. .. .. .. .. 3 2 2 3 2 2 .. .. Puerperal Fever 14 13 3 .. .. .. .. .. .. .. .. 12 2 .. .. Puerperal Pyrexia 30 29 .. .. .. .. .. .. .. 1 1 25 2 1 .. Pneumonia 71 31 89 6 3 2 1 7 7 3 3 11 14 12 1 Erysipelas 45 26 .. .. .. 1 .. 1 .. 2 4 9 8 l6 4 Cerebro-Spinal Fever 1 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 15 9 .. 15 .. .. .. .. .. .. .. .. .. .. .. Acute Polio-myelitis 7 7 .. .. .. 3 .. .. 2 1 1 .. .. .. .. Encephalitis Lethargica 1 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. 33 The following table indicates the wards from which the various cases were notified:— Disease Bury Street Ward Church Street Ward Angel Road Ward Silver Street Ward North Middlesex County Hospital Other Institutions Total Scarlet Fever 63 20 53 63 15 2 216 Diphtheria 16 11 20 10 9 2 68 Enteric Fever 5 5 2 2 - - 14 Puerperal Fever - 2 6 3 3 - 14 Puerperal Pyrexia 5 8 2 2 12 1 30 Pneumonia 22 18 15 15 - - 70 Erysipelas 15 6 9 7 7 1 45 Cerebro-spinal Fever - 1 - - - - 1 Anthrax - 1 - - - - 1 Ophthalmia Neonatorum 6 1 2 1 5 - 15 Encephalitis Lethargica - - - 1 - - 1 Acute Polio-myelitis 4 1 2 - - - 7 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. 34 CANCER The incidence of cancer relative to the various organs of the body is given as under:— Males. Females. Lung 3 2 (Esophagus 3 1 Stomach 11 7 Large intestine 11 13 Genito-urinary 6 4 Breast — 14 Liver 2 3 Uterus — 11 Other organs 9 10 45 65 TUBERCULOSIS. The following table gives details as to age and sex of new cases of tuberculosis, also deaths from the disease, this latter figure including the deaths of non-notified cases. Age Periods. New Cases Deaths Respiratory Non-respiratory Respiratory Non-respiratory M F M F M F M F Under 1 year .. 1 .. 1 .. .. .. 1 1—5 years 1 .. 3 .. .. .. 3 .. 5—15 „ 5 3 1 6 .4 .. 1 .. 15—25 „ 16 15 4 2 6 9 1 .. 25—35 „ 10 10 1 .. 7 9 .. 2 35—45 „ 12 5 .. 2 8 5 1 1 45—55 „ 6 4 .. .. 3 2 .. .. 55-65 „ 6 1 1 .. 7 1 .. .. 65 years upwards 2 1 .. .. 3 1 .. .. Totals 58 40 10 11 34 27 6 4 In addition, 16 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 58 40 „ „ Non-respiratory 10 11 Transferred cases—Respiratory 4 12 „ „ Non-respiratory 1 2 Totals 73 65 The cases dying of tuberculosis and not previously notified were:— Males. Females. Respiratory 4 2 Non-respiratory 4 1 There were thus 11 non-notified deaths out of a total of 69 persons registered as dying of tuberculosis. (Registrar's figures.) 35 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. Miliary - 1 Spine - 1 Other bones and joints 3 - Meningeal 1 - Glands 2 3 Abdomen - 6 Kidney 1 - Genito Urinary 3 - 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 number of cases of tuberculosis on the register at the end of 1936 was:- Males. Females. Total. Pulmonary forms 247 191 438 Non-pulmonary forms 68 61 129 Totals 315 252 567 The corresponding figures for the end of 1935 Were:— Males. Females. Total. Pulmonary forms 257 196 453 Non-pulmonary forms 73 69 142 Totals 330 265 595 36 COUNCIL'S EMPLOYEES. During the course of 1936 the Medical Officer of Health examined 52 persons prior to their appointment to permanent posts. He also visited employees of the Council who have been on the sick list longer than a fortnight and, when necessary, at fornightly intervals. The total number of visits paid during the year to the employees in their own homes was 280, of these 41 were "not at home," and 6 had already resumed to work. 37 Corresponding figures for previous years were:— Males. Females. Total. 1934 339 281 620 1933 320 281 601 1932 363 284 647 1931 382 311 693 1930 381 311 692 1929 421 352 773 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. M. Hearn. Councillors: W. Bales, Mrs. M. M. Barrass, L. E. Berridge, W. A. Edmunds, T. H. Joyce, C. G. Lacey, Mrs. F. Long, Mrs. E. M. Moss, Mrs. H. Nicholson, Mrs. H. L. Porteous, J. W. Shaw, W. Preye, J. A. Ward. Ex-officio Members : Councillors Mrs. E. A. Young and G. Albon. Co-opted Members, not being Councillors: Mesdames M. Allan, F. E. Clarke, E. Elms, E. Hasemore, M. Jenner, A. M. Lear, S. E. Sweeney. STAFF. D. Regan, B.A., B.Sc., M.B., Ch.B., D.P.H. (L'pool). I. McIntyre, B.A., M.B., B.Ch., B.A.O., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. Mrs. G. F. Fleetwood-Outram, M.B., Ch.B. (Glas.), Medical Officer, Maternity and Child Welfare. 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, „ „ bcd Miss R. Bullock, „ „ Miss M. F. Cozens-Walker, Chartered Masseuse, Orthopædic Clinic (part-time). Miss R. Saunders, Senior Clerk. Miss N. A. Eyres, Clerk. Miss C. Churchley, Junior Clerk. 38 DAY NURSERY. cd Miss W. J. Vigar. / Miss E. A. Weller, Miss P. Williams, Miss E. Martin. a Maternity and Child Welfare Certificate. b New Health Visitors' Certificate. c State Registered Nurse. d State Registered Midwife. e Sanitary Inspector's Certificate. f Certificate of Day Nursery Training. I have much pleasure in presenting my second Report on the work of the Maternity and Child Welfare Department for the year 1936. During the latter part of the year we made arrangements for the establishment of two additional Clinics, namely, at St. Alphege and St. John's Church Halls, and these will be open early in the New Year. We shall then have nine weekly sessions, in comparison to our former seven. It is our intention to establish further Clinics in the course of the ensuing year, in order to facilitate the mothers, and thereby entice them to attend the Clinics more regularly and more often. With the establishment of a greater number of Clinics, and better attendance, we have no doubt that the Toddler question, which at the present time seems to be so much in abeyance, will automatically solve itself. A great deal of propaganda amongst the mothers will be necessary before this problem will be solved. The idea is far too prevalent in Edmonton that, once a child is able to walk, he needs no further attention, because the growing child, and especially the child of developmental errors, needs far more care at this stage in its life than during the school period. The resolution of the Council to employ paid workers instead of voluntary workers has borne good fruit. The regularity of attendance and the specialisation of duties, has assisted the Staff to interview the mothers more rapidly so that the latter can depart from the Clinic to attend to their domestic duties earlier. Three Ante-Natal Sessions have now been established, due to the increase in the numbers attending the Clinics. It will be remembered that I commented last year on the meagre attendances and the few visits paid by individual mothers. This year not only has the number of mothers increased, 39 but the number of visits paid by each, individual mother is greater. I would like to remind the Committee, however, that we are very far from real advance in this direction. On account of the difficulties of providing premises for Clinics, the establishment of a Consultant Service had to be delayed, but at the time of going to Press the Surgeon visits a Special Clinic fortnightly for the benefit of all who wish to make use of it. The Medical Officer, in charge of the Ante-Natal Clinic, has now a source of appeal, convenient to the mother and himself alike. When this service becomes properly known it will prove of much value. In respect to Ante-Natal mothers a system of co-operation with the North Middlesex County Hospital has been arranged, whereby mothers who intend to enter that Institution for their confinements can continue their Ante-Natal supervision in the Council's Clinic. This will keep our Officers in touch on the one hand, and on the other to relieve the immense congestion which existed at the Hospital, to the mutual benefit of all concerned. It is the intention of the Middlesex County Council to proceed with the establishment of a new Maternity Unit at this Hospital as soon as possible, and it can only be stated at the present time that such facilities will come none too soon. It is to be regretted that a Post-Natal Clinic has not yet been established, although the Council have given their assent to do so, but the delay is due to the lack of suitable premises. The effort made to have the Ante-Natal and Infant Welfare Services continuous throughout the year has borne good fruit. Contrary to expectations the numbers in attendance during the holiday period were at least equal to any time during the year. The two Education Nurses whom the Council permitted to take the New Health Visitors' Certificate have been successful, and I would like to personally congratulate Miss Hazelton and Miss Garrett on their success. Their success is characteristic of the steady effort that these young ladies, together with their colleagues, have given to the services of the Edmonton Council and Education Committee in the past. The amalgamation of the Health Visitors and School Nurses have now been completed, and the inauguration of a continuous Service has commenced. The good results of such a Service will take some time to be appreciated, and cannot be perceived for the first few years. 40 The Midwives Act, 1936, was played on the Statute Book on the 31st July, 1936, and the Maternity and Child Welfare Committee proceeded to hold the initial interviews in November and December. A Scheme has been formulated which embodies, amongst other points, the employment of seven Midwives (five permanent and two temporary), and later such further number as the Council may require, to enable the service of one Midwife to be available for approximately every 80 cases. This Service should, in the first instance, be a great benefit to the Midwives, and ultimately tend to produce a more uniform domiciliary midwifery service for the patients. Births. The number of births notified during 1936 were as follows:— Live births (by midwives) 2,300 „ (by doctors and parents) 359 Stillbirths (by midwives) 107 „ (by doctors) 9 2,775 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 (by midwives) 1,114 „ (by doctors and parents) 345 Stillbirths (by midwives) 39 „ (by doctors) 8 1,506 Number of Edmonton babies born in outlying Institutions 172 The following table includes births of Edmonton residents registered in other districts:— Male. Female. Total. Live births 809 808 1,617 Stillbirths 31 24 55 Total ... 840 832 1,672 41 It will be noted that the number of Ante-Natal visits have decreased markedly since last year. This was on account of the fact that an effort was made to economise the Health Visitors' work as much as possible, as their services were required for Education duties in the place of the two Education Nurses mentioned above. It may be stated that most of the houses in the district are known to our Health Visitors or to the Sanitary Inspectors and, consequently, such visits were cut out, as we already knew the accommodation. The other Ante-Natal visits left out were those of mothers who failed to attend our Clinics, as we realised that they had made other arrangements. Clinics and Treatment Centres. These are as described in previous reports and may be briefly summarised. Maternity and Child Welfare Clinics. These are as follows, and include the Church Halls which are sanctioned by the Council, and will be started early in 1937. (1) Ante-Natal Clinic at Brookfield House, Fore Street, adjoining the Town Hall. (2) Child Welfare:— (a) At Brookfield House. (b) At St. Stephen's Church Hall, Bush Hill Park. (c) At St. Alphege Church Hall, Tramway Avenue. (d) At St. John's Church Hall, Dysons Road. (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.) 42 VISITS PAID BY THE HEALTH VISITORS. During the year these total 15,833, being made up as follows:— To expectant mothers:— (1) First visits 5 (2) Total visits 14 Visits to children under 1 year:— (1) First visits 1,673 (2) Total visits 10,426 Visits to children 1 to 5 years 5,224 Infant protection visits, 5 to 9 years 169 15,833 School Clinics. Minor Ailments:— (1) Pymmes Park, Upper Edmonton. (2) Croyland Road, Lower Edmonton. Dental Clinics:— (1) Pymmes Park. (2) Croyland Road. (3) Hazelbury Road. Ophthalmic Clinic :— Pymmes Park. Orthopaedic Clinic:— Methodist Central Hall, Fore Street. Ante-Natal Clinic. This is held twice weekly, and there were 99 sessions during the course of the year. Attendances, etc., were:— Number of prospective mothers 346 (including 41 who made their first attendance in the latter part of 1935) Total number of attendances 1,382 Number of consultations 1,088 Average number of attendances:— (1) Per session 13.9 (2) For consultation 11 A third Ante-Natal Clinic is being started early in 1937. Child Welfare Clinics. There are five afternoon and one morning 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 305 49 New cases:— (a) Under 1 year 842 93 (b) 1 to 5 years 353 40 43 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 98 New cases seen 144 Attendances:— Surgeon's days 480 Treatment days 704 Total attendances 1,184 In-patient Treatment. Seven children were admitted to the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, during the year, and there were three still away from the previous year. The length of stay for the seven children admitted during 1936 was as follows:— 1st Child.—Was admitted for two periods, the first time for 2 weeks and the second for 4 weeks and 5 days. 2nd Child.—4 weeks and 3 days. 3rd Child.—7 weeks. 4th Child.—9 weeks and 2 days during 1936, and was still away at the end of the year. 5th Child.—5 weeks and 4 days, and was still away at the end of the year. 6th Child.—5 weeks and 2 days, and was still away at the end of the year. 7th Child.—5 weeks and 2 days, and was still away at the end of the year. 44 Attendances:— (a) Under 1 year 14,905 1,554 (b) 1 to 5 years 14,942 921 Doctor's consultations 5,854 657 Average attendance 97.8 50.5 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 443 288 Total number treated 420 272 Fillings 41 38 Dressings 16 143 Scalings 10 - Extractions (number of teeth) Under gas 780 588 Local anaesthetic 22 — Number of gas cases 197 195 Dentures. There were 37 dentures supplied, and of these 13 were assisted by the Committee. Municipal Milk Supply. Towards the end of the year the Committee extended the scope of the Milk Scheme by allowing dried milks, such as Trufood and Lactogen, to be supplied in place of cow's milk, when recommended by the doctor in charge of the Infant Welfare Clinics. This arrangement is of great advantage to the mothers, and the full extent of the added facility will be revealed during 1937. Actual number of people who applied for milk during 1936, 452. Of this number 75 were expectant mothers. FREE SUPPLIES OF COD LIVER OIL AND MALT, FERROFAX, NUMOL, HALYCALCYNE, AND PURE COD LIVER OIL. The following free supplies were granted during 1936:— Cod Liver Oil and Malt 2,504 cartons, 45 Details regarding the supply of milk to the recipients are:— Number of applications 2,214 „ recipients 2,101 „ pints granted at quarter cost 6,454 „ „ „ free 82,929 Trufood, number of Tins 48 Lactogen, „ Pkts. 6 Ferrofax 4 bottle Numol 800 cartons. Halycalcyne 17 bottles. Pure Cod Liver Oil 119 bottles. 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. Seven mothers, five with their babies, were sent for convalescent treatment during the year for an average period of three weeks two and a half days. Nine children were sent away under an arrangement with the Invalid Children's Aid Association, for an average period of five weeks, four and a half days per child. Of these nine children, three, who were away in 1935, carried their convalescence into 1936, and three who were sent away in 1936 were still away at the beginning of 1937. Artificial Sunlight. This treatment is carried out at the North Middlesex County Hospital, and during the course of the year nine children received treatment, and the report submitted by the Hospital Authorities was as follows:— 4 children improved and were discharged. 1 child improved and was then sent to a Convalescent Home. 3 children improved, but were finally discharged as absentees before the treatment was completed. 1 child improved, but the treatment had to be suspended. The average gain in weight was 14 ozs. Home Helps. This service is gradually becoming more popular with the mothers; 18 applications were made and granted during the year, as against 9 applications in 1935. Midwifery and Maternity Services. Edmonton Council are the Local Supervising Authority under the Midwives Acts for their area. 46 The following notifications to practise within the area were received during 1936:— Notifications from Midwives residing in area 12 „ „ „ „ in Hospital 20 „ „ „ „ in surrounding areas but practising in Edmonton 6 38 The number of claims made by doctors for medical aid was 170, and of these 77 came under the scale for financial help from the Council. The total amount involved was £202 0s. 6d., of which the Council paid £88 11s. 6d. INFECTIOUS ILLNESSES. Ophthalmia Neonatorum. Fifteen cases of Ophthalmia Neonatorum were notified during the year, and of this number 10 cases were in the North Middlesex County Hospital. Puerperal Fever and Pyrexia. Forty-four cases of Puerperal Fever and Pyrexia were notified during the year. Of this number 31 cases were in the North Middlesex County Hospital, and 6 cases were sent by the Council to Queen Charlotte's Hospital. The patients admitted to Queen Charlotte's Hospital were inmates for the following periods:— 1st Mother.—4 weeks and 3 days. 2nd Mother.—5 weeks and 3 days. 3rd Mother.—1 Week and 3 days. 4th Mother.—4 weeks and 1 day. 5th Mother.—3 weeks and 2 days. 6th Mother was admitted on the last day of the year. The five mothers who were discharged during the year made a complete recovery, and the Council have good reason to be pleased with the arrangement which enables Edmonton women to receive such prompt and skilled treatment at Queen Charlotte's Hospital. This has on so many occasions saved the lives of our mothers. 47 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 1936 was 52, and the number of children 56. DAY NURSERY. The Day Nursery was open for the whole of the year, with the exception of Bank Holidays, and three weeks during August. During the latter period the necessary repairs and alterations to the Nursery were carried out. Dr. Outram now pays weekly visits to the Day Nursery to advise the dietary of the children. The attendances of children for the year were as follows:— Whole day 6,490 Half-day (Saturdays) 484 Resident children admitted during the year 13 INSPECTION OF MIDWIVES AND NURSING HOMES. The 12 midwives resident in the Edmonton area were inspected quarterly, and on each occasion everything was found to be in order. The three 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 21 such patients were sent, and of these 9 had free advice, and the remainder were in a position to pay for their own expenses. 48