EDM 427 Borough of Edmonton. REPORT OF THE Medical Officer of Health and School Medical Officer FOR THE YEAR 1942 BOROUGH OF EDMONTON. 1942. His Worship the Mayor Deputy Mayor Alderman A. J. Hollywood, Councillor J. A. Ward. PUBLIC HEALTH COMITTEE. Chairman Councillor L. B. Berridge. Aldermen Mrs, M.M.Barrass; G.Roid. Councilors -M.Bales; G.Euesden; Mrs. B.M. Hearn; Mrs. E.B.Newsham; C.T.N.Tott. STAT OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health, School Medical Officer and Supervisor for the Maternity and Child welfare Services:- D. REGAN, B.S., B.Sc., M.B., Ch.B., D.P.H. (L'pool). Deputy Medical Officer of Health and Deputy School Modical Officer:— Hilda R. Hay, M.B., Ch.B., D.P.H. Assistant Medical Officers and School Medical Officers:- Catherine A. Goggin, H.B., B.Ch., B.A.O., D.P.H. Kathleon M. Hart, M.D.(Lond)., M.B., B.S., D.P.II. Senior Sanitary Inspector abcd W. Tillcock, N. San.I., E.S.I.A., District Sanitar Inspectors abcc G. E. Hackle. abc J. P. Ferrar. abef E. Dodsworth. abc H.N. Grieves abc E. Beilby. a Hps. K. Eo~ lor (Woman Sanitary Inspector) (Resigned 50.9.42). Chief Cleric E. J, .Nash, Cert. a.Sen.I. J. L. A. Saunders, Infectious Diseases Clerk. A. S. Clarke, R cords Clerk (Seconded to Civil Defence duties). D. I , J. Neuman, Correspondence Clerk. H. J. Weldon, Junior Clerk (In N.H.Forces). S. Clayton, Shops Acts Inspector. T. G. Marsden, Assistant Shops Acts Inspector (Resigned, January, 1942). Miss I. . Bowie, Temporary Clerk:. J. E. Cowlard, Laboratory Assistant (Conaencod 50.5.42). S Moiety paid under Public Health Act ox by ???hocuor Grant. a Certificated Sanitary Inspector b Certificate of Moat an. Food Inspector c Inspector under the Petroleum Acts d Inspector of Canal Boats e Certificate of Smoke Inspector f R.S.I. Sanitary Science as applied to Duildinces & Public Works. PREFACE. Public Health Department, Town Hall, Edmonton, N.9, Hits Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton. Mr. Mayor, Ladies and Gentlemen, t, I have much pleasure in presenting my eighth Annual Report, for the year 1942, and the third under War-time conditions. The Report is compiled in accordance with Ministry of Health Circulars, and as requested therein, certain vital statistics have been omitted for security reasons. The BIRTH RATE shows a very great INCREASE which was unexpected on account of the National disturbance. It is to be noted with great satisfaction the DECREASE in MATERNAL MORTALITY in Edmonton, and compares very favourably with the rest of the Country. The DEATH RATE has shown likewise a very satisfactory DECREASE. It will be noted however', that there is an INCREASE in the INFANT MORTALITY RATE of approximately 3 per 1,000 live births; on analysis 59 of the total of 83 are due to Congenital Malformations and Premature Births, so that actually the result is somewhat mors satisfactory than is at first apparent. I would like however, to draw attention to the fact that there are very poor facilities in the Borough for attending to Premature Births, and none at all under the control of the Edmonton Borough Council. It will bo noted that the Tuberculosis incidence has decreased during the your 1942, this is very satisfactory during war conditions. There was an increase in the incidence in SCARLET FEVER, but the disease continued to be of a mild typo. It should be noted that Scarlet Fever as well as Diphtheria, although much milder than it used to bo, has its danger in the complications which follow, those complications are far more liable to occur under home nursing conditions than in hospital. IMMUNISATION has at last received the serious attention of the parents, but I am not yet satisfied with the number of children who have received this treatment. Every effort is being made by the staff to persuade the parents to have their children immunised against Diphtheria. It is to be regretted that the incidence of SCABIES is on the increase. a good deal of this increase is unfortunately due to the people themselves who are unwilling to seek advice, and it is with difficulty that we get cuite a number of the population to carry out our advice whom cases are detected, I am greatly concerned about the limitation of housing accommodation in the Borough and the persistent overcrowding mostly occasioned by the influx of relatives of some residents both from other areas and from evacuation. In 1942 the Civil Defence assumed more regular proportions and due to our experience in the previous year wo are inspired with great confidence and a greater sense of discipline which made administration of this difficult service more satisfactory, but I would say that much in the line of discipline is yet to bo desired before Civil Defence can be said from a casualty standpoint to be recognised as a standing force of key value. I would like however to say how much I appreciate the great efforts that are being made by some in bringing about a better understanding and dealer working order for the benefit of all concerned. Before I leave this subject I must pay tribute to the fine work carried out by Dr. R. Greville Samuel, Medical Officer, A.R.P. Services who left us to join the Royal Navy. Several changes have taken place amongst the staff during the year and I would like to record my thanks for the valuable services rend red by Mr. T.Marsden, Assistant Shops Acts Inspector who left us to take up an appointment at Coventry as District Sanitary Inspector, and also th Mrs, H.Fouler,. Woman Snnitary Inspector, who unfortunately had to retire owing to ill health after some 15 years service, I would like to offer my congratulations to Mr. E. Doasworth, District Sanitary Inspector on obtaining the Diploma of the Royal Sanitary Institute in Sanitary Science as applied to Buildings and Public Works, and to Mr. F. Roddell, formerly Motor Driver Mechanic in the Public Health Department on his appointment as Civil Ambulance Superintendent. I would like to thank the Members of the Council for their unfailing courtosy and co-operation in setting through the year which was oxceedinfily difficult in every Department. In conclusion, I would also like to thank the Members of my Staff, particularly those of the clerical department, for the sacrifice they made during the year, both in tine and effort, to moot the requirements of the unusual circumstances. I have the honour to bo, It*. Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. GENERAL STATISTICS. Area (in acros) . 3,096 Population Census of 1921 - Census of 1981 - Estimated by the Registrar-General for mid-year, 1942 Number of inhabited houses and tenements at the end of 1942 25,926 Number of inhabited houses and tenements at the end of 1941 25,819 Rateable value, April, 1942 £ 736,790 Estimated product of Id in the £ for the year ending 31.3.43. £ 2,900 Rates in tho £ for the year ending 31/5/45 14/11d. SOCIAL CONDITIONS. The extent of unemployment nay be estimated by the following figures relating to:— (1) the number of free dinners given to schoolchildren, and (2) the actual figures supplied by the Director of Public Assistance. No. 1 is given purely on economic grounds (1) Number of free dinners during 1941 (from 24/2/1) 22,626 " paid " " 1941 105,788 " " free dinners during 1942 61,483 " paid " " 1942 440,185 (2) Figures re out relief:- Persons. Amount. For the year 1941 • (a) Ordinary out-relief 2,034 £ 21,210 (b) Unemployed out-relief 51 18 2,085 £ 21,238 For the year 1942 (a) Ordinary out-relief 1.869 £ 20,187 (b) Unemployed out-relief 28 29 1,397 £ 20,216 VITAL STATISTICS. LIVE BIRTHS M F Total Grand Total Legitimate 334 799 1655 Illegitimate 55 55 68 1701 Birth rate per 1,000 of population STILLBIRTHS Legitimate 28 15 45 Illegitimate 1 5 4 47 Total of live and stillbirths 1748 Rate per 1,000 total births 26.88 DEATHS Number 484 503 987 Rate per 1,000 population - DEATHS FROM PUERPERAL CAUSES Deaths Rate per 1,000 total, (Live and stillbirths) Puerperal and post-abortive sepsis — — Other maternal causes 3 1.71 5 1.71 DEATH, RATE OF INFANTS UNDER ONE YEAR OF AGE M F Total. Number45 43 88 All-infante per-1,000 live births . 51.73 Legitimate infants per 1,000 legitimate live births 50.82 Illegitimate-infants per 1,000 illegitimate live births 73.53 Deaths from Cancer (all ages) 166 " " Measles( -"- ) - " " Whooping Cough (all ages), 3 Diarrhoea (under 2 years of age) 14 The following causes o£ death-are supplied by the Registrar General and refer to deaths which were registered during the calendar year:- Cause of Death M F Total Typhoid and Para-typhoid fevers — 1 1 Cerebrospinal fever 1 1 2 Scarlet Fever — — — Whooping Cough — 3 3 Diphtheria — 1 1 Tuberculosis of the respiratory system 27 19 46 Other forms of tuberculosis 7 3 10 Syphilitic diseases 1 3 4 Influenza — 5 5 Measles — — — Acute Poliomyelitis and Polio-encephalitis — — — Acute infective encephalitis — 1 1 Cancer of buccal cavity and' oesophagus (M) Uterus (F) 3 5 8 Cancer of stomach and duodonum 13 20 33 Cancer of breast — 21 21 Cancer of all other sites 50 54 104 Diabetes 2 3 5 Intra-cranial vascular lesions 41 42 83 Heart disease 96 112 200 Other diseases of the circulatory system 21 18 39 Bronchitis 47 26 73 Pneumonia 35 38 73 Other respiratory diseases 10 8 18 Ulcer of stomach or duodenum 13 2 15 Diarrhoea (under 2 years) 7 7 14 Appendicitis 1 2 3 Other digestive diseases 14 16 30 Nephritis 8 10 18 Puerperal and post-abortive sepsis. — — — Other maternal causers — 3 3 Premature birth 16 11 27 Congenital malformations, birth, injuries, infant diseases 15 17 32 Suicide _ 3 4 7 Road traffic,accidents 9 3 12 Other violet causes 9 8 17 All other causes 35 36 71 484 503 987 The two tables overleaf give the deaths of those registered during the 53 weeks ended 2nd. January , 1943. The slight difference between the tables overleaf in respect of the causes of death and the one supplied by the Registrar General is that the Registrar General is in possession of additional information on the matter. MALE S. Causes of death AIL AGES – to 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 & over Typhoid and para-typhoid fever – – – – – – – – – – – – Cerebro-spinal Fever 1 1 – – – – – – – – – – Whooping Cough – – – – – – – – – – – – Tuberculosis of the respiratory system 30 – – – – 6 5 3 4 6 1 – Other forms of tuberculosis 7 1 1 – 2 2 – 1 – – – – Syphilitic diseases 1 – – – – – – – – 1 – – Influenza – – – – – – – – – – – – Acute encephalitis lethargica – – – – – – – – – – – – Cancer of buccal cavity oesophagus 3 – – – – – – – – 1 2 – Cancer of stomach and duodenum 13 – – – – – – 1 2 4 4 2 Cancer of all other sites 55 – – – – – 1 – 6 11 23 14 Diabetes 3 – – – – 1 – – – – 1 1 Intra-cranial vascular lesions 40 – – – – – – – 2 6 16 16 Heart disease 97 – – – 1 2 2 5 12 16 28 31 Other circulatory diseases 20 – – – – – – – – 5 6 9 Bronchitis 47 — – – – – 2 – 7 10 14 14 Pneumonia 35 2 3 1 – – – 2 6 4 11 6 Other respiratory diseases 10 1 – – – – – 2 2 2 1 2 Ulcer of stomach or duodenum 13 – – – – – – 4 3 5 1 – Diarrhoea (under 2 years) 7 5 2 – – – – – – – – – Appendicitis 1 – – – – – – – 1 – – – Other digestive diseases 14 3 – – – 1 – 1 2 – 4 3 Nephritis 8 – – – 1 – – 1 – 2 1 3 Premature birth 16 16 – – – – – – – – – – Cong.mal., birth injuries, infant dis. 15 14 1 – – – – – – – – – Suicide 5 – – – – – 1 1 3 – – Road traffic accidents 9 – – 1 1 – – 1 1 1 2 2 Other violence 9 1 – – 2 1 5 1 – – 2 2 All other causes 39 1 – – 1 1 1 2 7 2 12 12 498 45 7 2 8 14 12 30 55 79 129 117 FEMALES. Typhoid and para-typhoid fever 1 – – – – – – 1 – – – – Cerebro-spinal fever – – – – – – – – – 1 – – Whooping Cough 3 1 2 – – – – – – – – – Diphtheria 1 – – 1 – – – – – – – – Tuberculosis of the respiratory system 18 – – – – 7 9 – 2 – – – Other forms of tuberculosis 3 – – – 2 – – – 1 – – – Syphilitic diseases 4 – – – – – – – – 1 – 3 Influenza 5 – – – – – 1 – – 1 2 1 Acute encephalitis lethargica 1 – – – – – – – 1 – – – Cancer of uterus 6 – – – – – – 1 3 1 1 – Cancer of stomach and duodenum 17 – – – – – – – 2 4 4 7 Cancer of breast 24 – – – – – – 3 4 5 7 5 Cancer of all other sites 56 – – – – 1 6 5 6 8 17 13 Diabetes 4 – – – – 1 – – – 1 2 – Intra-cranial vascular lesions 42 – – – – – – – 5 13 9 15 Heart disease 113 – – – 2 2 4 4 4 14 27 56 Other circulatory diseases 18 – – – – – – – – 5 5 8 Bronchitis 28 – – – – 1 – 1 1 1 10 14 Pneumonia 39 3 1 – 1 1 1 3 3 2 6 18 Other respiratory diseases 8 – – – – – 1 1 – 1 3 2 Ulcer of stomach and duodenum 2 – – – – – 1 – – – – 1 Diarrhoea (under 2 years) 7 7 – – – – – – – – – – Appendicitis 1 – – – 1 – – – – – – – Other digestive diseases 16 2 – – – 1 2 2 1 2 1 5 Nephritis 9 – – – – – 1 2 2 2 2 – Puerperal and post-abortive sepsis – – – – – – – – – – – – Other maternal causes 4 – – – – – 2 2 – – – – Premature birth 11 11 – – – – – – – – – – Cong.mal., birth injuries, inf.dis. 18 18 – – – – – – – – – – Suicide 4 – – – – – 1 1 – 1 – 1 Road traffic accidents 3 – – – – – – – – 2 – 1 Other violence 8 1 – – 1 – 1 – – 1 1 3 All other causes 33 1 1 – – 1 2 3 5 4 12 9 513 44 4 1 7 15 32 29 40 70 109 362 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:- M F Total Legitimate 41 42 83 Illegitimate 4 1 5 ' 45 43 88 The death rate of all infants per 1,000 live births was 51.73. A detailed subdivision of the causes, etc. of these DEATHS is as follows:- MALES. Causes of death Under 1 week 2nd week 3rd week 4th week Total under 1 mth 1- 3 mths 3- 6 mths 6- 9 mths 9- 12 mths. Total under 1 year Gerebro-spinal Fever – – – – – – – 1 – 1 Other forms T.B. – – – – – – – 1 – 1 Diarrhoea – – 1 – 1 2 2 – – 5 Pneumonia – – – – – – 2 – – 2 Violence – – – – – 1 – – – 1 Premature birth 13 1 1 – 15 1 – – – 16 At???lactasis 2 1 1 – 4 – – – – 4 Asphyxia neonatorum 1 – – – 1 – – – – 1 Congenital malformations 5 2 – – 7 2 – – – 9 Other causes – 1 – 2 3 1 1 - – 5 Totals 21 5 3 2 31 7 5 2 – 45 FEMALES Whooping Cough – – – – – – – 1 – 1 Diarrhoea – – – – – – 3 4 – 7 Pneumonia – – – – – – 1 1 1 3 Congenital malformations 1 – – – 1 3 3 – – 7 Congenital debility – – – – – – 1 – – 1 Premature birth 10 1 – – 11 – – – – 11 Injury at birth 1 – – – 1 – – – – 1 Atelactasis 5 – – – 5 – – – – 5 Other causes 2 – – – 2 1 – 2 1 6 Ashpyxia noonatorum 1 – – – 1 – – – – 1 Violence – – – – – – – – 1 1 20 1 – – 21 4 8 8 3 44 COMPARATIVE STATISTICS. The Registrar-General has. forwarded provisional figures relating to the country as a whole and to London, enabling comparisons to be made as follows:- Birth rate per 1,000 population Death rate per 1,000 births From diarrhoea, etc. under 2 years . Total deaths under 1 year Live Still. England and Wales 15.8 0.54 5.2 49 London 14.0 0.48 8.6 60 EDMONTON – – 8.23 51.73 ANNUAL DEATH RATE PER 1,000 of POPULATION All causes Measles Scarlet Fever Whooping Cough Diphtheria Influenza England and Wales 11.6 0.01 0.00 0.02 0.05 0.09 London 13.9 0.01 0.00 0.04 0.02 0.07 EDMONTON - - - - - - The following table gives the number of births and deaths (registered) subdivided into the four Wards of the Borough, It should be remembered that births are only those which occurred in Edmonton of Edmonton residents; those are registered in Edmonton. Births which take place outside the Borough are not included; this fact accounts for the difference between these figures and those supplied by the Registrar-General. The deaths include thoso taking place outside the Borough, the information being given quarterly by the Registrar-General. Ward BIRTHS DEATHS INFANT- DEATHS Male Female Male Female Male Female Bury Street 227 195 161 146 20 22 Church Street 128 134 38 136 9 2 Angel Road 141 127 113 118 8 13 Silver Street 179 181 129 113 8 7 Vagrants - - 2 - - - 575. 657 493 513 45 44 LABORATORY. FACILITIES. \ The activities of the Council's Laboratory have in the past been limited in the main to examination of swab's from suspected cases of Diphtheria and contacts of actual cases, and Sputa for the presence of tubercule bacillus. It had been desired for some time to establish a bacteriological department on a practical basis and a much higher standard", I therefore submitted a full report on the matter to the Public Health Committee and I am happy to report that I was given authority to proceed with the scheme. Unfortunately, owing to war-time restrictions, it was not possible to carry out certain structural work to extend the existing laboratory, but it is hoped that this may be done after the war. Certain alterations have been carried out in the existing laboratory and now equipment obtained end a full-time laboratory Assistant appointed. From the report -set out below some idea can be obtained as to the work carried out during the year. There are still some; specimens which will h.ave to be sent out, including those requiring animal inoculation. This Department has been of great asistance in School Medical work, particularly the Open Air School by giving the Medical. Department first hand knowledge ox what they are dealing with in the vast majority of oases. The Maternity and Child Welfare Department, particularly the Ante-Natal and Post-Natal Clinics, have profited Very materially by the information supplied to them, and I have -no doubt that in future the work of the Laboratory will prove a groat factor in reducing Maternal Mortality. Many cases found in the Borough have also profited by the immediate results obtained which assisted my Department as well as the Medical Practitioners; it is to be hoped that this service in this direction will increase to a greater extent. From a Public Health standpoint the immediate information obtained from the prompt examination of milk samples obtained in the Borough proved in many instances gratifying, but I note that towards the summer months a groat falling off in the purity of milk is noticed every year in Edmonton. This will have to receive serious attention. During the early part of the year, prior to facilities being available in the Council's Laboratory, the following material was sent to the Clinical Research Association for bacteriological examination:- Positive Negative Total. Blood for the presence of typhoid agglutinins 0 5 5 Faeces for the presence of typhoid organisms 0 1 1 Faeces for the presence of dysentery 1 2 3 Swabs for the virulence of K.L.Br 1 1 2 Swabs for the presence of haemolytic streptococci 0 3 3 Urine for the presence of bacillus coli 1 0 1 The following examinations wore carried out in the Council's Bacteriological Laboratory:- Positive Negative Total. Swabs for the presence of K.L.B. (a) from suspects 21 560 581 (b) from contacts 9 163 172 (c) from old cases 17 70 87 Total number of swabs for presence of K.L.B. 47 793 840 Swabs for presence of Haemolytic Streptococci – 7 7 Sputa for presence of Tubercle bacilli 1 20 21 Blood - full count - - 7 Urine - chemical examinations - - 152 Urine.- Microscopical examinations - - 36 Urine - bacteriological examinations - - 15 Urine for presence of Tubercle bacilli - 1 1 Faeces - microscopical examinations - - 5 Faeces - bacteriological examinations - - 6 Smears for presence of Gonceocci - 5 5 Rectal swabs for presence of Dysentery Orgs. - 5 5 1,100 : Prior to the facilities being available in the Council's Laboratory, 21 samples of designated milks were sent to the Counties Public Health Laboratories for examination. The Designations of the samples wore as follows:- 8 Tuberculin Tested, 1 Accredited, 9 Pastourised, 3 Tuberculin Tested (Pasteurised). The following are the results of the examinations:- Nature of test. Tuberculin Tested. Accredited. Passed. Failed. Passed. Failed. Methylene Blue & Coliform Bacilli 8 - 1 — Methylene Blue 8 - 1 — Coliform bacilli 8 - 1 — Tuberculin Tested (Pasteurised) Pasteurised Phosphatase 8z Bacterial Count 9 - 3 - Phosphatase 9 — 3 — Bacterial Count 9 — 3 — 74 samples of Designated milks were examined in the Council's Laboratory. Those samples wore mode up as follows:- 20 Tuberculin Tested, 4 Accredited, 33 Pasteurised, 8 Tuberculin Tested (Pasteurised). The following are the results of the examinations: - Nature of test Tuberculin Tested. Ac credited. Passed. Failed. Passed. Failed. Methylene Blue & Coliform bacilli 17 5 3 - Methylene Blue 21 8 4 - Coliform bacilli 20 9 3 1 Tuberculin Tested. (Pasteurised) Pasteurised. Phosphatase & Bacterial Count 30 1 7 0 Phosphatase 51 2 8 0 Bacterial Count 31 2 7 1 The Middlesex County Council is the authority under the Food and Drugs Act as regards adulteration. AMBULANCE FACILITES. Duo to the establishment of the National Fire Service, the Council's three ambulances were transferred. from the Fire Brigade to the Medical Officer of Health. The ambulances are at present housed at Will is Garage, Weir Hell, Edmonton. Mr. F. Roddell, formerly Motor Driver Mechanic in the Public Health Department, was appointed Ambulance Superintendent, and I acknowledge with thanks the information supplied by him and set out below, giving some idea of the work carried out during the year Private Cases 5,169 Accident cases 622 Maternity cases 134 School Medical Dept (Tonsils) 519 Maternity & Child Welfare (Tonsils) 86 B odside Apparatus 17 Analgesia 12 Not required 79 False calls 10 Social services 146 6,594 First Aid was rendered on 215 occasions , The resuscitating apparatus was in use on 18 occasions. The total mileage of the vehicles was 54,977. A 2 ton Bodford Coach cenveys tho deaf and dumb and partially blind children to and from school, picks up a few other children in the morning, taking them to a spot to moot the guide; also conveys children to and from London railway termini -in connection with convalescent home treatment. NURSING IN This has been described in previous reports. HOSPITALS infectious disease's arc admitted into the Enfield, Edmonton and Potters Bar Joint Isolation Hospital, situated in Enfield. Arrangements for the treatment of car, nose and throat disorders amongst school children arc made with the Prince of Wales* Hospital, Tottenham; ringworm is treated at the North Middlesex County Hospital, Edmonton. and ultra-violet light treatment given at the 'Council's Clinic NURSING HOMES REGISTRATION There 'is one Nursing Home registered by the Council. This is kept under supervision by the Medical Officer of Health* No new applications to bo placed on the registered were received during 1942,. SANITARY INSPECTION IN THE AREA. . . Five District Sanitary Inspectors are ongagod in the sanitary supervision of the Borough, working under the Supervision vision on the Senior Sanitary Inspector. The Woman Sanitary Inspector looks after outworkers premises, the sanitary condition of factories where women are employed and the investigation of notifiable inectious disease, including tuberculosis, She also assists in the supervision of the woman's public conveniences, The Senior Sanitary Inspector supervises the work of the Borough and. is Inspector under the Canal Boats Acts. At the outbreak of hostilities the Senior Sanitary Inspector was appointed Controlling Officer for Emergency ? ??? Supplies and also the Authorised Officer for the Decontamination of Food (Food De contamination Officer). The District Sanitary Inspectors are acting as Billeting Officers and in addition one as War Mortuary Superintendent, SANITARY CONVENIENCES, There are seven Public Conveniences in the Borough which are kept under constant supervision by the Public Health Department, RATS AND NICE (DESTRUOTlON) ACT. 193 9 The Middlesex County Council is the authority for this Borough under the Act which places the responsibility upon the occupier of the of the premises infested, but the Rat Destruction Officer of th County' Council is always willing to give advice. The- Inspectors of the Public Health Department often examine' the drainage of. premises where it might be possible that the info station is due to a defect in the house drainage system. MIDDLESEX: COUNTY COUNCIL (GENERAL POWERS) ACT, 1958: SECTION 71 HANKERS, ETC. The Act came into operation on the 1st January, 1959, the Council together with other Local Authorities considered the adoptive sections and put the necessary resolutions and action into being regarding Sections 70 and 71, No now applications were received during 1942. • DISINFECTION AND DISINFESTATION. The Council's now Disinfecting Station was opened in November, 1942. During the year the work has been carried out it the Enfield Disinfecting Station and I Would like to take this. opportunity of expressing ray 'thanks for the co-operation received from the Enfield Authorities in this matter. The following table gives some idea of the work carried out:- Number of journeys to collect bedding 279 " " " " return bedding 279 Rooms disinfected after infectious disease 779 Rooms disinfected after phthisis 97 Disinfestation carried out after vermin 187 Bedding, clothing etc. disinfected after infectious disease 4,974 articles " " " " " phthisis 598 " " " " " " other eases 2,500 " The Council distribute a disinfecting, powder and fluid to residents who apply for the sane at the Town Hi11 Yard. During the year, the applicants numbered 16,548. 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 and other articles thus disinfected was 411. Three Council houses and 97 other houses were found to be infested and the total number of rooms disinfected was 187. The whole of the work is carried out by the Department, the materials used being Block Disinfestators combined with the Use of Insecticides such as Pyagra, etc. PETROLEUM (REGULATIONS) ACTS, 1928 & 1956. During the year 4 now licences and 103 renewals v. ere granted by the Council. The following is list of particulars of quantities, etc., affected by these licences:- Petroleum spirit - gallons Petroleum mixtures - " Carbide of calcium - tons MORTUARY. During, the year 77 bodies wore deposited in the Mortuary, 74 by order of the Coroner nd 5 for sanitary reasons. The following tabular statement gives the number and nature of the inspections made during the year:- Complaints 1,817 Infectious disease 402 Tuberculosis 165 Factories with mechanical power 128 Factories without " " • 17 Other premises under the Factories Act - Outworkers 185 Schools 2 Offensive trades 7 Shops and Stalls 276 Shops Act (Primary) - Shops Act (Re-inspections) - Sanitary conveniences and urinals 328 Number and nature of inspections contd:- Stables 6 Piggeries 14 Petroleum 20 General Inspections 821 Sundry visits 1,620 Cinemas end balls 6 Visits to canal 6 A.R.P. Shelters 193 Billects 1,065 Re-inspections 5,615 INSPECTIONS OF PLACES WHERE FOOD IS PREPARED. Butchers 163 Fish Shops 55 Coffee Shops 52 Ice Cream Shops 42 Dairies and milkshops 159 Slaughterhouses 71 Bakehouses 18 NUMBER OF NOTICES SERIVED. Preliminary or Informal notices , 1,127 Statutory notices 405 DEFECTS REMEDIED Houses repaired, cleansed, etc. 542 D. W. cisterns repaired, covered 5 Water fittings repaired 155 Drains examined tested etc. 464 Drains cleared, trapped, repaired 316 Drains reconstructed 36 Chambers inserted 57 Chambers sealed down 22 Soil and vent pipes repaired 28 W. C's repairod, cleansed, etc. 216 Flushing cisterns repaired 126 Waste pipes repaired, etc. 63 Sinks repaired or renewed 15 Roofs repaired 250 Glitters and R.W. P's repaired 135 Yards paved or repaved 45 Scullery floors repaired 23 Spaces under floors ventilated 27 Dampness remedied 54 Floors repaired 50 Coppers and stoves repaired etc. 95 New dustbins supplied 113 Accumulation of refuse removed 9 Nuisances from animals abated 6 Other nuisances abated 206 CANAL BOATS ACTS. During, the year 6 visits wore paid to the Canal and 4 boats wore soon, but of this number none 7 as fitted or used as a duelling or registered under the Acts. PLACES OF PUBLIC ENTERTAINMENT. Six inspections of cinemas and other places of entertainment wore made in accordance with the Circular of the Ministry of Health of 1920. Conditions were found to bo generally satisfactory. FACTORIES ACT, 1957. The following, work has been carried out under the above Act:- 1. INSPECTIONS FOR THE PURPOSE OF PROVISIONS AS TO HEALTH Promises Inspections Written Notices Occupiers prosecuted Factories with mechanical power 128 5 - Factories without mechanical power 17 - - Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) - - - Totals 145 5 - 2. DEFECTS FOUND Particulars No. of defects No. of defects in respect of which prosecutions. were instituted. Found Remedied Referred to H.M. Inspector Want of cleanliness 14 12 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 1 1 - - Sanitary Conveniences: Insufficient 5 5 - - Unsuitable or defective 18 17 - - Not separate for sexes - - - - Other offences 2 2 - - (not including offences relating to Home work or offences under Sections mentioned in the schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921 and re-enacted in the Third Schedule to the Factories Act, 1957). ■4 Totals 40 57 - - 3. OUT WORK IN UNWHOLESOME REMISES. Nature of Work. Instances Notices served Prosecutions Wearing Apparel Making, etc. - - - Cleaning and washing - - - FACTORIES AND WORKSHOPS , ETC . DEFECTS REMEDIED W, C, Walls cleansed 12 W. C. Cisterns repaired 2 W. C. Seats repaired or renewed 8 W. C. Flush pipes repaired 2 W. C. Doors repaired 1 W. C. Pans replaced 5 Roofs repaired 1 Workrooms cleansed 1 Sanitary accommodation improved 4 Inadequate ventilation 1 HOUSING - HOUSING ACT, 1936. 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) 1,469 (b) Number of inspections made for the purpose 4,568 (2) (a) Number of dwelling Louses (including under sub-head (l) above)-which were inspected and recorded Under the Housing Consolidated Regulations, 1925 & 1932. (b) Number of inspections-made for the purpose - (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of duelling houses (exclusive of those referred to above under the preceding sub-head) found not to be in all respects reasonably fit for human habitation. 1,229 2. REMEDY OF DIFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES:- Number of defective dwelling houses rendered lit in consequence of informal actionly the Local Authority or their officers 840 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR. A - Proceedings under Sections 9, 10 & 16 of the Housing Act, 1956 (1) Number of dwelling houses in respect of which notices were served requiring repairs 116 (2) Number of dwelling houses which wore rendered fit after service of formal notices:- (a) by Owners 76 (b) by Local Authority in default of owners 4 B - Proceedings under Public Health Acts:- (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 63 (2)..Nuiaber of houses in which defects were remedied after service of formal notices:- (a) by owners 37 (b) by Local Authority in default of owners 7 C - Proceedings under Sections 11 & 15 of the Housing Act, 1936:- (1) Number of dwelling houses in respect of which demolition orders were made (2) Number of dwelling houses demolished in pursuance of demolition orders - D - Proceedings under Section 12 of the Housing Act, 1936:(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 tenements or rooms having been rend rod fit SLAUGHTER HOUSES Soventy visits were paid and the carcases and organs of 569 pigs were inspected during or shortly after slaughter, permission for slaughter having been obtained from the _Area Moat and Livestock Officer, and the .following surrendered 3 Carcases (Weight 676 lbs). 61 Plucks 4 Hoads 2 Logs 4 sots of Lungs INSPECTION AND SUPURVISION OF FOOD. MILK SUP-PLY Various licences were granted as under:- Primary Supplementary Pasteurised 11 7 Tuberculin tested 8 5 Accredited - 1 19 13 One of the above retailors is licensed to bottle Tuberculin tested milk raid one firm is licensed to pasteurise and bottle milk on the promises; one firm is licensed to bottle pasteurised milk on the premises. Supplementary licenses are granted to retailers who live outside the Borough but who. sell milk in the Borough; the primary licence is granted by the Authority in which they reside. ' UNSOUND FOOD The following is a list of the food surrendered for examination end retained as'Unfit for human consumption:- 3,935 tins of Evaporated Milk 87 Fish Cakes (various brands) 34 Sponge rolls 548 tins beans 7 Shocolate rolls 375 tins peas 40 lbs apples 1,101 tins canned fruit 1 Case of rabbits 772 tins canned meat 1. sack sultanas 284 tins canned fish 1 doz. chocolate cakes 104 tins tomatoes 2 lbs chocolate 504 boxes of choose spread 1 Turkey 265 Australian eggs 1 Chicken 105 meat pies 7 boxes Fish (various) 48 lbs cocca. together with various small consignments of Bacon; Cheese; Pickles; Carrots etc. The above items do not include the food dealt with at shops subjected to damage on account of "enemy action." The Shops. Acts Inspector submits a monthly report to the Public Health Committee, and the following is a Sirort summary:- Visits to shops, licensed street traders, etc. 3,996 Contraventions - CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The only examinations carried out by the Council are those for designated milks. The matter has been discussed previously. PREVALENCE OF INFECTIOUS DISEASE MEASLES AND WHOOPING COUCH These diseases were made compulsorily notifiable in October, 1939. 1,0:4 cases of Measles and 174 cases of ' hooping Cough were notified during the year. There were 3 deaths from hooping Cough and no deaths from Measles. DIPHTHERIA I am happy to report the continued low incidence of this disease. , 22 cases were notified during the year compared with 18 in 1941, There was one death. SCARLET FEVER This disease continued to occur throughout the year in a mild. form; there were 330 cases compared. with .143. in 1941; there were no deaths. Return' cases numbered 12 allowing for an interval of 28 days between d patient returning home from the Isolation Hospital and the onset of tho disease in another inmate of the house, SMALLPOX No cases of smallpox were notified during the year. POLIOMYSITIS No cases of this disease were notified during the year. DYSENTERY 5 cases of this disease were notified during the year. 2 were of the Sonne type. Investigation failed to reveal the source of infection. One death occurred outside the Borough. CEREBRO-SPINAL FIVER 11 cases wore notified during the year. The eases were carefully investigated and precautions taken to prevent the spread of infection. 2 deaths took place. PUERPERAL PYREXIA AND OPHTAIMlA NEONATORUM These are referred to later on under the heading of Maternity & Child Welfare. FOOD POISONING 1 case was reported., but there were no deaths. pneumonia The number of cases of primary and influenzal pneumonia notified showed a decrease. The number of deaths from all forms of pneumonia remains about the same. DIARRHOEA AND ENTERITIS UNDER 2 YEARS OF AGE The death rate per 1,000 live births for London was 8.6 whilst that for Edmonton was 8.23 as compared with 6.8 and 2,45 respectively last year. IMMUNISATION. DIPHTHERIA, During the year 3,000 children completed treatment under the Council's arrangements; of these 1,520 were under 5 years of age. 55 children were Schick tested. In 1941 3,102 children completed immunisation treatment. MEASLES * Measles Immune Globulin was issued to general practitioners in accordance with the Council's resolution quoted in my report for 1940. 6x2 c. cs were issued during the year. WHOOPING COUGH Edmonton children are immunised against Whooping Cough,. The material-used is 'Vaccine A', and during the year 841 appointments were made for this treatment. The treatment i3 carried out at the Council's Clinics. The following table gives the age, incidence, etc. of those suffering from notifiable diseases, excluding tuberculosis which is dealt with separately. It must be noted that the figures in the second column ('No. removed to hospital') includes these 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 includes puerperal pyrexia and ophthalmia neonatorum. Disease Total No. of cases. Number removed to Hosp. Deaths to 1 1 to 2 2 to 3 3 to 4 4 5 to to 5 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 & over Scarlet Fever 330 319 — — 9 16 28 45 368 40 10 9 5 — — Diphtheria 22 22 1 - 1 1 2 2 7 6 2 1 - - - Puerperal Pyrexia 122 120 - - - - - - - - 5 95 22 - - Pneumonia 63 . 23 73 3 2 4 2 1 9 2 2 9 10 11 8 Erysipelas 32 6 - - - - - 1 1 6 5 12 7 Ophthalmia Neonatorum 14 8 - 14 - - . - - - - - - - - Food poisoning 1 1 - - 1 - - - - — - - - - - Whooping Cough 174 9 3 19 21 19 23 28 56 2 - 5 - 1 MoasleB 1034 15 - 22 79 82 98362373 8 4 5 - 1 - Cerebro-spinal fever 11 11 2 2 1 1 2 1 - 2 1 1 - - Dysentery 5 1 1 1 - - - - - 1 - 3 - i Encephalitis lethargica 1 1 - - - - - - - 1 - - - Distribution of infectious disease 1942. Disease Bury Street Ward Church Street Ward Angel Road Ward Silver Street Ward North Mddsx C.Hosp. Other Inst' ns. Total Scarlet Fever 170 33 64 61 2 – 330 Diphtheria 3 1 8 10 – – 22 Puerperal Pyrexia 11 10 9 13 79 – 122 Pneumonia 21 5 19 16 – 2 63 Erysipelas 8 5 6 11 2 – 32 Ophthalmia Neonatorum 1 2 3 4 4 – 14 Food poisoning – 1 – – – – 1 Whooping Cough 84 33 25 34 – – 174 Measles 227 235 188 336 – – 1034 Cerebro-spinal fever 3 – 2 5 1 – 11 Dysentery 2 5 – – – – 5 Encephalitis lethargica 1 – – – – – 1 CANCER. The incidence of Cancer relative to the various organs of the body is given as under:- Males. Females. Breast – 24 Uterus – 6 Buccal cavity and oesophagus 3 – Stomach and duodenum 13 17 All other sites 55 56 71 103 PREVENTION OF BLINDNESS Casta of ophthalmia neonatorum are Promptly visited and, if thought necessary, are removed to hospital for treatment. No oases of blindness have arisen during the year due to this cases. As provided by Section 176 (1) of the Public Health Act, 1956, arrangements exist with' the Middlesex County Council for the treatment at the school clinics of adolesconts who are ascertained at school to be suffering from defective vision.' ORTHOPAEDIC TREATMENT. Details ox this scheme were set out in my Report for 1959. Financial assistance was rendered for the supply of surgical appliances in 2 cases during the year'. ESTABLISHMENTS. FOR. MASSAGE OR SPECIAL TREATMNT. - In 1941 the Council resolved that Pert 7 of the Middlesex County Council Act, 1954 be put into operation in th . Borough. 1 not: licenco ,was'granted during the year. L0USE BORNE TYPHUS FEVER A full report on Ministry ex Health Circular 2515 was submitted to the Council and I set out below main details of the scheme to deal with cases of LouseBorne Typhus Fever .which may occur in .this Borough. The Middlesex County Council to act as the Central Co-ordinating body for the County. The Middlesex County Council to make arrangements for hospital accommodation and ambulance facilities for Edmonton cases, and to make a general County charge to the Local Authorities concerned of the cost involved in making the two hospitals (Hornsey and Uxbridge) suitable for the reception of Typhus cases. The cost to bo equally distributed among the authorities concerned. The Edmonton Borough Council would be willing to paythe cost of maintenance of Edmonton residents whilst in hospital suffering from Typhus Fever, and admitted from the Borough of Edmonton, The Edmonton Borough Council is willing, subject to the approval of the Enfield Edmaonton and Pottres B r Joint Hospital Board, to admit other infectious disposes from other areas-,'into their Isolation Hospital if the two hospitals mentioned above bcome full of Typhus cases, and that a-reciprocal chargo be made for their-maintenance. The Edmonton Borough Council to be responsible for disinfection of premises after removal of Edmonton casus and the disinfestation of the Edmonton contacts of such cases. The Edrjonton Borough Council to co-operato with Enfield and bouthgate and Potters Bar into the establishmeat and maintenance of one common centre for dealing with Typhus contacts from their respective areas The IliudldsEn Covihty Council subsequently approved tho necessary expenditure in respect of structural alterations required1to he carried out at the Hornsey end .fchridgo Isolation" Hospitals in connection with the reception therein of any cases of- typhus occurring within the County, Further, they ogrcod that all stops would be Jjokon to assist Local Authorities on the lines indicated by the Edmonton Boreu h Council. A conference was hold bet eon officers of Edmonton, Enfiold, Potters Bar and Southgate Councils when the- fallowing proposals wore drawn up:Cleansing Station Ecuipment and Cost - The conversion of an existing building in Southgatc ^suitably equipped as a cleansing station. The cost of conversion to bo borne by tho four Authorities participating on the basis of their 1933. census population. Staffing or_ Cleansing Station - Sanitary Inspectors and Health Visitors of Edaonton and Enfield to undertake the actaa_ work of bathing and disinfecting typhus contacts. Tho operatives to wear protective clothing ant. gloves. Transport - Each Local ...uthority to use its own transport for contacts to end from the Cleansing- Station and for delivery oi infested clothing to the disinfecting station at the Joint Isolation Hospital and return sane after disinfestation to tho Cleansing Station. Disinfestation of Contacts Clothing - The Enfield Edmonton and Potters Bar Joint -'Isolation Hospital have placed their disinfecting plant at the Isolation Hospital at tjho disposal of the four Authorities concerned, subject to certain conditions. Each futhority to provide its own disinfecting stall. The proposals ???re agreed to by the Edmonton Borough Council. The necessary teams for dealing with contacts have been established and protective clothing provided. Age periods. , m New Cases Deaths Respiratory Non-respiratory Respiratory Non-respiratory Male Female Male Female Male Female Male Feamle Under 1 year – – 1 – – – 1 – 1-5 years – – 1 – – – 1 – 5-15 „ 3 1 6 5 – – – 2 15-25 „ 15 25 2 1 6 7 2 – 25-35 „ 10 15 4 5 5 9 2 – 35-45 „ 15 7 2 – 8 – – – 45-55 „ 8 4 – 1 4 2 1 1 55-65 „ 2 2 – – 6 – – – 65 years upwards – – – – 1 – – – 53 54 16 12 30 18 7 3 In addition 13 c sos of pulmonary tuberculosis and 2 cases of non—pulmonary tuberculosis previously notified in other areas, moved into Edmonton. The total number of names added to the Register, for the first time during the year, occluding of course, non-notified deaths was:- i  Males. Females New cases (respiratory) 53 54 (non-respiratory) 16 12 Transferred cases (respiratory) 5 8 (nen-respiratory) 1 1 75 75 Tlie cases dying of Tuberculosis and not previously notified were:- Males females Rospiratory 4 – Non-respiratory – 2 There were thus 6 noi-notified deaths out of a total of 56 persons registered as dying of tuberculosis (Registrar's figuros). Regarding the non-notification of the-above cases, there was no suggestion of wilful neglect or of refusal to notify. The non-respiratory forms oi tuberculosis notified were:- males Females Genito-urinary tract 2 5 Other bones and joints 1 2 Meningeal 1 – Glands 4 4 Abdomen 2 1 Kidney 1 1 Miliary 4 – Slcin 1 1 Tho Public Health (Prevention of Tuberculosis) Regulations, 1925, relate to tuberculous employees in the milk trade; whilst Sioction 172 of tho Public Health Act, 1936 gives power to the Local Authority to remove to hospital certain cases of tuberculosis which are dangerous to other people. No occasion during the year had occurred in which it has boon necessary to invoke those powers. PUBLIC HEALTH (Tuberculosis) Regulation 1930. Tho number of cases of tuberculosis on the Register at the end of 1942 was:- Males. Females Total. Pulmonary forms 271 226 497 Non-pulmonary forms 77 78 155 348 304 652 The corresponding figures at the end of 1941 were:- Males Females Total Pulmonary forms 276 214 490 Non-pulmonary forms 79 79 158 _ 355 293 648 Corresponding figures for previous years were:- Males Females Totals 1940 349 313 662 1939 357 301 658 1938 363 297 660 1937 336 260 596 1936 315 252 567 1935 330 265 595 1934 339 281 620 1933 320 281 601 1932 363 284 647 1931 382 311 693 COUNCIL'S Employsees During 1942 the Medical Officer of Health paid a total of 224 visits to those employees who had been on tho sick list for longer than a fortnight and, when necessary, at fortnightly intervals Of thaso 65 wore 'not at hone' end 4 had already resumed duty. Also, during tho year 10 persons vjero examined prior to their appointiiont to porinanont posts. MATERNITY MID CHILD WELFARE COhLIITTZE. Chairman: Cr. Ltcs® A. M. Glover. Councillors A. J. H ollywood (Mayor); Cr. J. Ward (Deputy Mayor) and Alderman Mrs. M. M. Barrass. Councillors: J.A.G.Boattie; L.'ABerridge; Mrs. E.II.Heam; Mrs. E.M.Moss; Mrs, E.B.N cwshnn; Mrs. A .E.Shinglea. STMT. D. Regan, B.A., B.Sc., M.3., Ch.B., B.A.O., D.P.H(L'pool). H. R. Hay, M.B., Cii.3 (Edin)., D.P.E., Deputy Medical Officer. C. A. Goscini M.B., B .Ch., B.A.O., D.P.H., Assistant Medical Officer. K. M. H art, H.B., B.S (Lond)., M.D., D.P.H., Asistant Medical Officer. J. A. Choli'ieley, F.R.C.S. (Eng)., Orthopaodic Surgeon. R. Leslie Dodds, F.R.C.S., Consulting Accoucheur, E. Underhill, L.D.S., R.C.S,, Dentist. II EALTK VIS If OR SCHOOL NURSES (Combined Service). abdo Miss A. Bintcliffe - Lady Superintendent, Health Visitor School Nurses. do Miss A. Naylor bed Miss M. R. Hazelton acd Miss J'. M. Anderson bed Miss V. Garrett bed Miss J. Paterson. bd Miss M. Druce. bed Miss R. Bullock, bed Miss B. F. Lis or. bed Miss M. V. Hugh s. c Miss A. Faiiy (School vork only). Mrs* C. Tonkin (School work only). MASSEUSE. Miss M, F. Colons-Walker, Chart ..rod Mnaaouso, Orthopaedic Clinic (Part-time). JUNI3IPAL MIDI,'IVES. cdfg Mrs. R.K.M. Wingrove – Non-Medical Supervisor of Midwives. edg Miss J. A. Weeks - Sailor Midwife (Corxionccd July, 1942). edg Mrs. D.S.C. Gazzard dg Mrs. A. J. Griffiths edg Miss A.G. Walker edg Miss IC.M. James edg Miss D. M. Lewis. edg Miss V. Uraen. edg Mrs. A.M. Burton (temporary). dg Miss D.Chaplin (temporary). cd Misn S.Simpson (temporary, com. Jan, 1942). a Maternity and Child Welfare Certificate, b New Health Visitors' Certificate. c State Registered Nurse. d State Certified Midwife, e Sanitary Inspector's Certificate, f Teacher's Certificate of Midwifery. Z Ccrtific to for Gas and Air. h Nursery Nurses Diploma. CLERICAL. Miss R. S. Saunders Senior Clerk. Miss N. A. Eyres 1st Assistant. Miss H. P. Turton 2nd Assistant. Miss W. S. Beattie 3rd Assistant. Miss J. Blatter 4th Assistant. MATRONS - NURSERIES. Harponden - c Miss E. Cadmn. Fore Street - h Miss M. r. Betteridge. Hertford Road - c Mrs. I. Drunuond. Tke following information gives details of tke Maternity and Ckild Welfare Clinics at tke end of 1942:- (1) Ante-Natal Clinic at Brookfiold House, Fore Street (Adjoining tho Tovai Hall)» Five sessions weekly. (2) Ckild Welfare Centres:- (a) Brookfield House. Four Sessions weekly. (b) Methodist Ckurch Hall, Busk Hill Park. Ono session weekly, (c) St. Alpkege Ckurck Hall. Tvro sessions weekly. (d) Uoir Hall. Tim sessions weekly. (3) Post-Niatal and Advisory Clinic at Brookfield House. One session weekly. (4) Dcntrl Clinic at Croyland Road Sckool Clinic. Two sessions weekly. (5) Ortkopaodic Clinic at Methodist Central Hall, Fore Street. Two sessions weekly. (6) Obstetric Surgeon attends once a fortnight at Brookfield Houco. FOREWORD. 1942 has proved a h-ghly satisfactory year for all activities appertaining to this Department and it will be of interest to note the services in which an increase in demand has been experienced as against the year 1941. Ante-Natal Clinics - the increase in the attendances is very great, viz 10,123 in 1942 against 6,527 in 1941; an increase of 3,796. The entire work of this Clinic is undertaken by the midwives, and an increase of 203 cases were dealt with under the midwifery service. Infant Welfare Sessions and Post Natal Clinics have been patronised more than in 1941. The Government evacuation scheme for expectant mothers has prpved oven more popular during 1942. A groator number cf mothers havo taken the opportunity of obtaining dentures at reasonable prices at tho Dental Clinic. The arrangements made with the Education Committee for (a) Sunlight and (b) Ophthalmic treatment, have been very satisfactory and have more than justified their inception: many children under five years of ago have been able to obtain treatment. 607 sterilised maternity outfits wore issued during the year against 392 in tho previous year. Tho Harpcndon evacuated nursery continued to operate during tho year, having accomodation for 28 childr n under five years of age, but the problem with regard to the staffing of Lho promises remained very serious, Tho Fore Street War-time nursery was open during the whole year and gave very satisfactory service for the war-workers in the district. The accomodation was increased from 40 to 66 places for children under five years of ago by enlarging and adapting thu exisiting promises and building a hut extension.in the garden. Hertford Read War-time Nursery with accomodation for 55 children was openeo on 19th October, and Florence Road War-time Nursery with accommodation for another 55 children will bo ready for opening in January, 1943. Plans for other War-tine nurseries in the district are also under consideratioru I should like to express my appreciation to the Members of the Maternity and Child Welfare ,CoiJiittoe and to the He.ibors of the Staff for thoir co-operation during tie year* The following infc motion will give some indication of the work carried out by the D^partront' during the year 194.1. b??? The total number of births notified during 1942 was as follows:- LIve births notified by midwives 2,209 „ „ doctors and parents 129 Stillbirrths „ „ midwives 97 „ „ „ doctors 3 2,438 BIRTHS Contd. 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 rosidnnts aro:- LIve births notified by midwives 1,169 „ „ doctors and parents 126 still „ „ midwives 39 „ „ „ doctors 3 1,337 Number of live Edmonton babies born in outlying institutions 143 „ „ stillborn „ 1 144 The following table includes births of Edmonton residents and these born and registered in other districts:- Male Female Total Live births 746 709 1,455 Stillbirths 27 12 39 773 721 1,494 VISITS PAID BY THE HEALTH VISITORS. Hie following table gives details as to the visits paid by the Health Visitors To expectant mothers:- First visits 134 Totrl visits 134 To childron under 1 year of age:- First visits 1,382 Total visits 8,654 To childron between 1 ana 5 years:- 12,143 Infant Protection visits to children 5-9 yoars. 37 20,968 Ante-Natal CLINIC. This Clinic was hold five tiraos wookly, and tho following arc the figures for tho year:- Total number of sessions in the year 253 Number of prospective mothers 1,807 (X) Total number of attendances 10,123 Nunbor of consultations 8,544 Average number of attendances:- (a) Per session 40.11 (b) For consultations 33.33 (X) Included in this total are 374 referred from the North Middlesex County Hospital under the scheme of co-operation with that hospital. POST-NATAL CLINIC. Number of sessions 46 Actual number of mothers who attended 419 Number of consultations 927 Average attendance oer session 20.52 Total attendances at clinic 944 SPECIALIST' CLINIC The consulting Specialist made 25 visits during the year and saw 247 cases, making an average of 9.88 per session. child clinics. The figuros relating to attendances are:- • Brookfield House St. Stephens St.Alphage Weir Hall. No. of sessions. 201 50 102 99 New Cases:(a) Under 1 year 564 176 248 303 (b) 1-5 years 130 42 41 57 Attendances:(a) Under 1 year 9,868 3,090 3,921 5,845 (b) 1-5 years 5,931 1,623 2,929 3,900 15,799 4,713 6,850 9,745 Doctor's consultations 4,835 1,024 2,312 2,200 Average attendances 78.90 94.26 67.15 98.43 ORTHOPEDIC CLINIC. The Clinic is hold twice weekly and tho following are the figures for the year:* NUmber of sessions 85 New cases referred during tho year 76 Attendances:- Su???'s days 271 Treatment days 638 Total attendances 885 In-patient treatment. Eleven children were admitted to Stanmore during 1942, the average length of stay being 10 weeks 1 day. One child was still in hospital from 1941 and one was still in hospital at the end of Decenbcr, 1942. DENTAL CLINIC. Details of the work carried out are:- Mothers. Children. No. of sessions 101 80 Number of attendances. 1,232 202 Number of new cases 369 140 Total number treated 781 (x) 188 Fillings 175 5 Drossings 38 174 Sealings 48 - Extractions (No. of teeth) Under gas 1,936 283 (b) Local anaesthetic 38 - Number of gas cases 483 116 (x) This figure does not include mothers attending for dentures. Dentures. NtantT supplied - 99, of whon 22 were assisted by the Committee. ADVISORY CLINIC This Clinic is held for women from -i0 - 50 years of age, in conjunction with the Post-Natal Clinic, v,ho are needing advice, and the following attendances were made:- No. of attendances 25 No. of new cases 17 SUNLIGHT CLINIC. 375 children were referred during the year for sunlight treatment and 1,640 treatments were given. OPHTHALMIC CLINIC. 103 children under 5 years of age attended this clinic during the year. 74 attended for Refraction and 125 for re-examination. BIRTH CONTROL CLINIC. 10 women were referred to this clinic during the year. SPEECH CLINIC. Arrangements are made with the Education Comittee for children under fivo to attend the Speech Clinic and 8 children were referred during the year. DETAILS OF DISTRIBUTION OF MILK, COD LIVER OIL etc., distributed by the Maternity and Child Welfare Department apart from any scheme of the Ministry of Food. Liquid Milk 252 pints. Trufood 225 tins. Cow end Gate 619 packets. Osterrailk 288 tins. Cod Liver Oil & Malt 310 cartons. Bomax 17 cartons. Pure Cod Livor Oil 6 bottles. Halycalcyno 216 bottles. Ferrofax 10 bottles. Glucose 24 packets. Fersolato 5 packets. NATIONAL DRIED MILK. This was distributed through the Infant Wolfaro Clinics up to the end of June, when 2,010 had been sold and 469 issued free of chargo. In addition 30 tins were paid for by tho Council. FREE HEALS. During the year 42 applications were received, 31 of whom were granted the supply of freo moals at the British Restaurants. 13 people had their applications renewed. CONVALESCENT CASES. 12 children were sent away under the contract with the Invalid Children's Aid Association, and 4 children were still away at the beginning of the year who had boon sent away in 1941. TONSILS AND ADENOIDS. 57 children were admitted to hospital for the removal of Tonsils and Adenoids; of these 33 paid tho full cost, 10 were freo and 14 were through the H.S.A. INFECTIOUS DISEASES. Ophthalmia Neonatorum. 15 cases wero notified during the year, and of these 8 cases occurrod in North Middlesex County Hospital, 4 of which were Edmonton cases. INFECTIOUS DISEASES Contd. Puorperal Pyrexia. 127 cases were notified during the year and of this number 120 cases occurred in tho North Middlesex County Hospital, of which 36 were Edmonton cases. Four of the seven casos which occurred on the district wore admitted to the Isolation Hospital. Pemphigus Neonatorum. 1 notification was roceived fluring the year vdiich was an Edmonton case. Midwiferey SERVICE. Medical Aid. Tho number of claims made by doctors for Modical Aid during the year 1942 was 159, of this number 41 cases were granted free of charge, 14 at half cost and the remainder paid the full fee. MidwiferyThe following gives information as to the actual bookings for 1942:- Numbor of women who booked during 1942 1,069. Of this number 853 paid tho full cost, 70 paid half the fee and 146 wore granted the services of the midwife free of charge, in addition 54 re-applications were reviewed during the year, these latter mothers being relieved from further payment. Analysis of work Acturl confinements attended by midwives 812 (Of this number 728 as midwivos & 84 as maternity nurses). Attended by midwivos, but women admitted to hospital for actual confinement 126 Loft district before confinement or mothers evacuated through L.G.C. schomc etc, 68 (Attention and Supervision given by Municipal midwives during Ante-Natal period). Gas and Air Analgesia. 18 applications were received during the year, 17 paid the full cost, and 1 granted froe of cost, 10 casos had tho Gas and Air administered and 8 wore cancelled for various reasons. Evacuation of Expectant Mothers under the Government Schema at tho eighth month of pregnancy. The department is responsible for the arrangements in connection with the evacuation of expectant mothers under tho Government Scheme, and in 1942 283 mothers applied to be sent away and by December 31st, 182 women had been sent to reception areas for their confinement and 93 cancelled the arrangements. Home Helps. 113 women had the services of a Home Help during 1942, 63 paid the full cost, 21 half cost and 29 had tho services free of charge. Ante-Natal scheme of co-operation between the Council and North Middlesex County Hospital. Under an arrangement with the Middlesex County Council tho Health Visitors visited 136 homes during the year where women applied to the North Middlesex County Hospital for admission and the Authorities desired to have c report on the hone circumstances. Sterilised Maternity Outfits. 607 Sterilised Maternity Outfits were issued during the year; 414 wore paid for; 45 paid half cost and 148 were granted free. X-Rays. 18 mothers were referred to the hospital for X-Rays during the year, 14 of whori paid the full cost, 2 half cost and 2 were free of chargo. Children undor 5 years of ago discharged from tho North Middlesex County Hospital. 54 visits wore paid to children under 5 years of ogo who had been discharged fton the hospital and it was nocoscary for then to remain under supervision. infant life protection. Each Health Visitor employed by tho Council is an Officor for ln:ant Life Protection and great care is taken by them in supervising this part of the work. The number of persons on tho register at tho ond of 1942 was 20 and the number of children 22„ War-time Nurserties. Attendances for the whole year were:Forc Street - 13,604. Hertford Road - 1,475 (Opened Octobcr, 1942). The evacuated nursery at Harpenden had places for 28 children. » BorOugh Of ADMONTOM Education commitee : 1 9 4 2. Chairman; Ald. Mrs. E. A. Young. Vice-Chairman: Cr.W.H.Coleman. His worship the Mayor: Ald. Mr. A. j . Hollywood. alderman W Preye, J. ???eid, W. F. Midaleton, W. A. Edmunds. CO???: Mrs. F ??/ ,Mrs. h. Nicholson; Mrs.e. M. Hearn; W. B???, T. H. Joyce,, H. Gatvard; W.Green and G. r. w. Tott. whole time medical staff D. e.j, n, B.a., B.Sc. k.B„? Ch.B., L.a.O., D.P.E. (L'pool), School Medical Oixicer, Medic;i Oixicer of Health ana Supervisor of Maternity Services. Ho a. Hay, M.B., Ch.B., L.P.H. , Deputy 3 chool Medical Officer and Deputy Medical' Oificer oi He-.lth. C. .■ . Gobbin; M.B., Ch.B., D.P.H., Assistant School Medical Officer and Assistant Medical Oflicer oi Health. * K. Hart, 1,'l.B., B.Sc. (Lone .), M.L. , D.P.H., Assistant School Mecical Gffi.er nd ..ssistcait Medical Officer of Health. Whole-time Dental Suru>ons. J- F. Ardouin, Jj.d.s. , u.C.S., Senior ,, arbeon Dentist. L. Underbill, jj.l.s., u.C.S., Assistant Surgeon Dentist. . F.H.S. Weiss, L.L.o. , u.C.b, ;J j-i.ssistc.nt Surgeon Dentist (now serving with His Majesty's forces). S. Williams, L.D.o., Pi.C.S., Temporary Assistant Surgeon Dentist (Left tho Council's employ August, 1942). Consultants. J. A. Choline! ey, . .u.C.b. (hng.), Orthopaedic Surgeon Miss L. M. Stith-Olark, u.B., Ch.B., Ophthalmic Surgeon. J. Browning-Alexander, F.tt.C.P., uheunatic Specialist. Viz. Ibbotson, i.u.C.b., Aur-.l Specialist. Part-time St -i. hiss M. F. Cosens-iaiker, Chartered Masseuse. Miss B. ii. Oldrey, M.S-b.T., Speech Therapist. School riurses anu Health Visitors , Miss A. Bintciiiie (Lady Superintendent) Miss V, Garrett Miss A. iiaylor * Miss J. Paterson Mrs. C. Tonkin hiss M. Druce Miss h, il. Haz. el ton Miss K. Bullock Miss A. Fahy Miss B. Lister Miss J. Anderson Miss V„ Hughes. Dental Attendants Miss 0. Brooks ' Miss J. Collyer. « ' n -± — ClericalStaff B. R. Allen, School Medical Clerk (now serving with H.M. Fcrcos) H. A. Carloss, acting School Medical Clork. S. J. Woodroife, Clerk (no;; serving v/ith H. M. Forces) . Miss A. Savill, Clerk/shorthand.-typist. Mrs. E. ii. Taylor, Clerk. Mrs. P. il. Thorley, Clork. Miss V. D. Bruton, Clerk ( commenced 26th February, 1942.). To the Chairman end Members 'of tho Education Committee. Ladies ..rid Gentlemen., I beg to submit my eighth annual report, for the year 1942, on tho work of the School Medical Department. As in previous reports tho report will be brief, t o comply with the Bou.re oi education's wishes, in that it only aeals v/ith salient fc.cts and changes in the Department' s :.erviceS. During t he e....rly part of the year, the Ultra-Violet Light Clinic was opened. This is held at the Orthopaedic Clinic, Central Hall, and Miss Walker, the Masseuse, is in charge. Soon after tho Clinic started, the sessions hue. to be increased in order to cope with tho waiting lists. Until other suitable premises are available, this service v/ill fill a very great need amongst the children of dm on ton. All other services ..re running normally insofar as the limitations of staff will aliow, but I might add that the demands on each item of this Department are no;, Very Oroat. I would like to mention here how 0 rat „ful I am for the loyal co-operation of the staff; the iiling efforts of the Head Teachers and their staff, and the assist-.nee they have given to me through a very difficult administrative year. I also extend my grateful thanks to the Chairman and the members of the Education Committee for their courtesy and interest shown in the work of the Department. I have the honour to remain. Ladies and Gentlemen, Your obedient Servant, D. regal. School iiedical Officer. 1. STAFF Mr. S. Williams, Dentist, left the employ of the Council in August, 1942. He had been actin??? temporary Dentist during the absence of Mr. Underbill, o .ing to illriess. 2. CO-OuDIMATIQM. Tho co-ordination between the various Departments, general practitioners, education Oific-S, and teaching staff continued to run smoothly as in previous years. 5. SCHOOL HYGUE I might mention here that the setting up of shelters and bafflewalls have interfered with the proper Ventilation of the class rooms ana corridors. -2- 4. Mediacal inspection — The number of children fully examined in the routine inspection „ of eceh group during the yocr 1942 was 435&> and the analysis of the age groups Vvere c..s follows Entrants: 1896; Second Age Group: 1351; Third Age Group: 1131. 5. ??? (a) Malnut??? The folic .ing table gives the classification of the nutrition of the Children inspected during the year 1942 in the routine age groups:- Wo. Inspectea A 3 C D 4553 538 3164 571 35 (b) Cleanliness. The cleansing of heads ana the treatment of scabies continued to be carried out at the Town hall Inspection Clinic. (c) Minor Ailments na Diseases of the Skin. Tho only clinic in this aistrict for the treatment of Minor Ailments is at Croyland Roaa. The attendances for 1942 vera 20,139- (d) Visual Defects and external eye Diseases. The clinic for the treatment of visual defects was held, as usual, at the Central Hail, Do re Street, N.9 Statistics are given at the ???ck of this report. (e) Nose did Throat Delects na (f) Ear diseases and Defective Hearing. Mr. I.illiam Ibbotson attended the aural Clinic at the Croyland iload Clinic tvice a month. The attendances for the year were:, 351 Mew CaSeS; 238 Old Cases. Total 569 Children -recommended for the removal of their tonsils and/or adenoids \ ^re remittee- 00 tno j»iin3« Hospita.^ <..c parley Lane, Goodmayes. The number oi cailaren receiving operative treatment during 1942 a/as Arrangements are J. so urn do for children to see the Specialist at the ilorth MiaaleSe,, County Hospital, when parents prefer this, and the number of operations carried out there during 1942 was 65. Cases of speech c.efects were aealt v/ith by Miss Oldrey, the Speech Therapist. (g) Dental Defects. The treatment of dental c.exects w,.s carried out at the Croyland uoad r.ne Hazelbury aoad Dental Clinics. Particulars of attendances, etc., are given at the ena oi this report. Orthodontic CaSeS aero treated ??? the above two clinics, anri thetotal number of cases on the registers up to tho end oi 1942 was 333° (h) Orthopaedic ana Postural Defects. Orthopaedic delects vere, c s in previous years, treated at the Special Clinic held at the Dehtral Hall, Fore Street, N.9. Mr. J. A. Cholmeley, the Orthopaedic Specialist, attended the t Clinic monthly una Miss walker, the Masseuse, attendea on Monaay, Wednesday, Thursaay na Friaay mornings. The number ox attenaances during the year was 2461. The Surgeon saw 85 new cases and 215 old cases total 298 2 (i) Heart Diseases ana Rheumatism. Dr. J. L. Alexanaer, P.R.C.P., attended the.Clinic, held once monthly, for the purpose of examining children suffering from rheumatism ana diseases of the heart. i.here neccessary, arrangements were made for chilaren to be admitted to Heart-Homes. The attendances for 1942 were 110 NLw CASeS; 128 OLD CASDS TOlALs 238. (j) Tuberculosis: I must extend my most grateful thanks to Dr. H. Evans, the Tuberculosis Officer, for the co-operation he. has given to this Department in dealing with cases referred to him. The number of notified cases and the mortality of children of school age during 1942, taken from tne records ox the Public Health D e p artmen t was:- Notified Deaths ??? F M F Pulmonary 4 - - Non-pulmonary 5 4 2 2 (k) Other Defects and Diseases These cases were dealt with as in previous years. 6. FOLLowing-UP . The same arrangements were in effect as in previous years. A R ??? The arrangements for treatment at the various Clinics were as follows Croyland Rd. Minor Ailment Clinic: A doctor was in attendance each morning to aavise parents Rheumatic Clinic: Held the third Thursday in each month - by appointment only. Aural Clinic: Held the second and fourth ary in each month - by appointment only. Ophthalmic Clinic: Held every Monday, with ional extra sessions. New Cases by appointment only. Orthopaedic Clinic: Held the first Friday in each month. By appointment only. Dental Clinics; Held at Iiaselbury Rd. and land Rd. Clinics. By appointmenc only. Orthodontic Clinic: Held once a month at each Dental Clinic. By appointment. Speech Clinic: Four sessions held each week. Luring the early part of the year at Brettenhan fid. School & later at Haselbury Road School. By appointment only. Ultra-Violet Light Clinic: Held At Central Hall, N.9° By appointment only. 8. INFECTIOUS Diseases. Those children who suffereu from infectious diseases were dealt with in the same manner as in previous y. ars. -4- BOARD OF EDUCATION Medical Inspection aid Treatment fie turns Year Ended 31st December, 1942. C li-JEsLE I. Medical Inspections of children attending x'ublic Elementary Schools. . • . A - tiOUTIi1.. ivieblCAii IMbPHCxiuub, (1) No. of Inspections in the Prescribed Age Groups: Entrants; I696. S conc. Age Group: ljjl. Third Age Group: 1151. Total: 4358. (2) No. of oth^r Routine Inspections: Nil Grand Tnt^ l 4.^8 B - OTHER INSPECTIONS ♦ No. of Special Inspections unci He-Inspections 787 TABLE II Classification of the Nutrition of Children Inspected During the Yec r in the Routine Age Groups. Number of Children Insp. A B C D Mo. % N 0. % No. /° No. % 4353 - « 588 . 13.49 3164 72.58 571 13.10 55 1 K\ 1 OO 1 • I . TaBLE' III. Treatment of Minor Ailments (Excluding Uncleanliness) (I) Total No. of Defects treated or under treatment during the year under the Authority's Scheme: 7001. (2) Treatment oi D„fe\&ye Vision and Squint, Under the Authority's Scheme. Errors ol Refraction (including squint) 952 Other defect or disease of the eyes (excluding those recorded in Group 1) 1 TOTAL. 955 No. of children for whom spectacles were (a) Prescribed 911 (b) Obtained 910 (3) Treatment 01 Defects of Nose and Throat Received Operative Treatment: 2 77 Received oth^r forms of treatment 247 Total Number treated 524 TABLE IV Dental Inspection and Treatment. (1) Number of children inspected by the Dentist fa) Routine Age Groups 0 10080 (b) Specials 1727 (c) Total (Routine & Specials 11807 -5- TABLE IV (Cont.) (2) Number found to require treatment: 7179 (3) Number actually treated 3544 (4) Attendances m^de by children for treatment: 6355 (5) Half-days devated to:- Inspection: 54 Treatment 804 Total 858 (6) Fillings:- Permanent Teeth: 2513 Temporary Teeth: 89 Total: 2602 (7) Ext pactions:- Permanent Teeth: 956 Temporary Teeth: 4628 Total: 5534 (8) Administrations of general anaesthetics for extractions 2126 (9) Other Operations: Permanent Teeth: 367 Temporary Teeth: 4133 Total: 4500 table V. Verminous Conditions. (1) Average number of visits per school made during the year by tho School Nurses or other authorised persons: 19 (2) Total number of examinations of children in the Schools by School Nurses or other authorised persons: 37105 (3)' Number of individual children found unclean: 1139 (4) Number oi individual children cleansed under Section 87 (2) and (37 of the Education Act, 1921: 1057 (5) Number of cases in which lug -1 proceedings wore taken:- (a) Under the Eouc. tion Act, 1921. (b) Under School Attendance Byelaws 1 TABLE VI. 'Blind and Deaf Children. Number of totally or almost totally blind and deaf children who are hot at the present time receiving education suitable lor their special needs. At a Public Elementary School At an institution other than a Sp-ciai School. At no School or Institution. Blind Children 1 - - Deaf Children - - - -6-