34/6/3 821 AC 439 (1) EDM 33 Borough of Edmonton REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1948 Jolly the Printer Ltd., (T.U.) 238 Fore St., N.18 Borough of Edmonton REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1948 Borough of Edmonton 1948 His Worship the Mayor - - Councillor S. W. Creasey, J.P. Deputy Mayor - - - - - - Councillor C. G. Lacey PUBLIC HEALTH COMMITTEE. Chairman: Councillor Mrs. A. M. Glover. Members: Councillor S. W. Creasey, J.P. (Ex-Officio) „ C. G. Lacey (Ex-Officio) Alderman W. Preye Councillor L. E. Berridge C. W. A. Conway „ Mrs. S. J. Halliday „ Mrs. V. E. Hindell Miss. E. J. Mattocks „ E. S. Taylor 3 PREFACE Public Health Department, Town Hall, Edmonton, N.9. His Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton. Your Worship, Ladies and Gentlemen, I have much pleasure in presenting my Annual Report for the year 1948. It contains only a brief outline of the health circumstances relating to the Borough, and is compiled in accordance with Ministry of Health Circular 3/49. The Annual Report this year differs markedly from those Reports presented in previous years, inasmuch as the introduction of the National Health Service Act 1946 on the 5th July 1948, divides the School Health and Maternity 6? Child Welfare Section into two parts—i.e., that carried on in the beginning of the year by the Local Council and that carried on during the latter half of the year by the Middlesex County Council. The Public Health section still remains intact, and is a somewhat similar Report to those of preceding years. The sanitary circumstances of the District are greatly improved to what they used to be, but we still have quite a formidable task before we reach our goal. A number of houses are becoming rapidly more and more unfit, and the two areas in Bridport Road and Fore Street should by now have been dealt with as Clearance Areas were it not for the restrictions on building. Housing continues to focus the main amount of attention in the Health section. Mainly due to the tremendous difficulty in obtaining housing acconv modation, young married couples are finding themselves accommodated in one and two rooms, oft times to the social detriment of family relations. It is in fact becoming frequent to have a husband living with his relatives and the wife with her relatives. The prospect of housing is not at all bright. I regret to have to mention that there is an increase in the incidence of Tuberculosis. The number of beds available in Sanatoria is still too few to cope with the number of cases. Happily, however, in many instances the patient can be attended to at home where the housing accommodation is suitable, but even this is becoming strained by the tendency of the number of cases to increase. 4 We did not have the Mass X-Ray Unit this year because of the need for accommodation to operate it. Indeed the need for accommodation is becoming more and more acute as regards Public Health matters. IMMUNISATION AGAINST DIPHTHERIA is having its effect. There were no deaths, and the incidence has been reduced to the unit measure. We have immunisation also against Whooping Cough, and it may be said that the children so immunised do not seem to develop the disease and epidemics in Edmonton are very mild compared with those in the past ; no control experiments, however, have been used in order to prove the scheme to be effective. BIRTH RATE has fallen somewhat abruptly—very probably due to the influence of the economic outlook. DEATH RATE is comparatively low, and again the major feature of this is the number of old people who have passed on. INFANTILE MORTALITY RATE is lower than last year and leaves us in favourable comparison with England and Wales. MATERNAL MORTALITY—there have been no maternal deaths during this year either in hospital or district midwifery. It is now, I am pleased to say, a considerable time since we had a death in district midwifery, but we must however not in any sense relax our efforts. POLIOMYELITIS has decreased, but we are still having the after effects of the epidemic of 1947. FOOT CLINIC was transferred to the administration of the Middlesex County Council on 5th July 1948. It is, however, a matter of regret that this very popular service in no way equals the demand made by the public. Finally, the difficulties of transfer under the National Health Service Act 1946 are. still with us, but they are slowly being ironed out, and in time will be satisfactorily overcome. As Medical Officer of Health I feel some regret for the administration that has passed on, although I am looking to the future for a greater and better Service yet. The acceptance or otherwise of the service rendered in the future will be a matter for decision by the general public in comparison with the service that had been rendered. 5 I would like to record by thanks to my staff for the able and efficient manner in which they have carried out their duties throughout the year. To the members of the Council and the Public Health Committee in particular, I wish to acknowledge their help and advice accorded to me during the year. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient Servant, D. REGAN, Medical Officer of Health. 6 GENERAL STATISTICS. Area (in acres) 3,896 Population— Census of 1921 66,809 Census of 1931 77,652 Estimated by the Registrar-General for mid-year 1948 105,800 Number of inhabited houses and tenements at the end of 1948 28,200 Number of inhabited houses and tenements at the end of 1947 28,063 Rateable value, April, 1948 £762,754 Estimated product of 1d. in the £ for the year ending March 31st, 1949 £3,025 Rates in the £ for the year ending March 31st, 1949 18s. 6d. SOCIAL CONDITIONS. (1) the number of free dinners given to schoolchildren, and (2) the actual figures supplied by the Divisional Finance Officer. No. 1 is given purely on economic grounds. (1) Number of free dinners during 1947 71,101 „ „ paid „ „ 1947 1,136,253 „ „ free „ „ 1948 69,249 „ „ paid „ „ 1948 1,307,634 The average number of children receiving meals daily was 6,259 (48.7% of the children in school). Under the Milk in Schools Scheme an average of 11,863 children (96.6% of the children in Junior and Infants' Departments and 77.2% in Secondary Schools), had milk daily. (2) Figures re out relief:— Amount. For the year 1947— (a) Ordinary out-relief £26,801 (b) Unemployed out-relief Nil £26,801 (a) Ordinary out-relief for year ended 31-3-1948 £23,400 „ „ 1-4-1948 - 5-7.48 5,800 (b) Unemployed out-relief Nil £29,200 VITAL STATISTICS. Live Births. M. F. Total. Grand Total. Legitimate 831 796 1,627 Illegitimate 28 31 59 1,686 Birth-rate per 1,000 of population 15.93 Stillbirths. Legitimate 26 17 43 Illegitimate 1 1 2 45 Total of live and stillbirths 1,731 Rate per 1,000 total births 25.99 7 Deaths. M. F. Total. Grand Total. Number 493 444 937 Rate per 1,000 population 8.85 Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and stillbirths). Puerperal and post-abortive sepsis 0 0.00 Other maternal causes 0 0.00 0 0.00 Death rate of infants under one year of age. M. F. Total. Number 33 27 60 All infants per 1,000 live births 35.58 Legitimate infants per 1,000 legitimate live births 35.03 Illegitimate infants per 1,000 illegitimate live births 50.84 Deaths from Cancer (all ages) 177 „ „ Measles (all ages) 4 „ „ Whooping Cough (all ages) 2 „ „ Diarrhoea (under 2 years of age) 8 The following causes of 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 ... ... ... Cerebro-spinal fever ... ... ... Scarlet fever ... ... ... Whooping cough 1 1 2 Diphtheria ... ... ... Tuberculosis of the respiratory system 24 23 47 Other forms of tuberculosis 4 2 6 Syphilitic diseases 3 1 4 Influenza 1 ... 1 Measles 1 3 4 Acute Poliomyelitis and Polio-encephalitis 1 ... 1 Acute infective encephalitis ... 1 1 Cancer of buccal cavity and oesophagus (M.) Uterus (F.) 8 10 18 Cancer of stomach and duodenum 25 14 39 Cancer of breast ... 21 21 Cancer of all other sites 69 30 99 Diabetes 1 2 3 Intra-cranial vascular lesions 38 64 102 Heart disease 121 107 228 Other diseases of the circulatory system 19 19 38 Bronchitis 46 30 76 Pneumonia 13 30 43 Other respiratory diseases 10 4 14 Ulcer of stomach or duodenum 11 1 12 Diarrhoea (under 2 years) 3 5 8 Appendicitis 2 2 4 Other digestive diseases 5 7 12 Nephritis 11 8 19 Puerperal and post-abortive sepsis ... ... ... Other maternal causes ... .... ... Premature birth 8 6 14 Congenital malformations, birth injuries, infant diseases 15 9 24 Suicide 7 7 14 Road traffic accidents 5 1 6 Other violent causes 14 8 22 All other causes 27 28 55 493 444 937 8 The two following tables give the deaths of those registered during the 53 weeks ended 1st January, 1949. The slight difference between the following tables 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. MALES. Causes of Death ALL 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 and over Whooping Cough 1 1 ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 25 ... ... ... 1 4 4 3 10 3 ... ... Other forms of Tuberculosis 3 ... ... 2 1 ... ... ... ... ... ... ... Syphilitic Diseases 3 ... ... ... ... ... ... ... 1 ... 1 1 Influenza 1 ... 1 ... ... ... ... ... ... ... ... ... Measles 1 ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis 1 ... ... ... ... 1 ... ... ... ... ... ... Cancer of Buccal Cavity and Oesophagus 8 ... ... ... ... ... ... ... 1 1 5 1 Cancer of Stomach and Duodenum 24 ... ... ... ... ... ... 2 4 6 9 3 Cancer of all other sites 70 ... ... ... ... ... 2 2 12 19 18 17 Diabetes 1 ... ... ... ... ... ... ... ... 1 ... ... Intra-cranial Vascular Lesions 38 ... ... ... ... ... 2 1 2 1 13 19 Heart Disease 121 ... ... ... ... ... 2 6 8 18 43 44 Other Circulatory Diseases 19 ... ... ... ... ... ... ... 2 2 7 8 Bronchitis 46 ... ... ... 1 ... ... 2 1 11 19 12 Pneumonia 14 3 ... ... ... ... ... ... 1 3 2 5 Other Respiratory Diseases 10 ... ... ... ... ... ... 3 1 2 2 2 Ulcer of Stomach or Duodenum 11 ... ... ... ... ... 1 1 3 3 1 2 Diarrhoea (under 2 years) 3 3 ... ... ... ... ... ... ... ... ... ... Appendicitis 2 ... ... ... ... 1 ... ... ... 1 ... ... Other Digestive Diseases 5 ... ... ... ... ... ... 1 1 1 2 ... Nephritis 11 ... ... ... ... 1 ... 1 2 2 2 3 Premature Birth 8 8 ... ... ... ... ... ... ... ... ... ... Cong. mal., birth injuries, infant dis. 15 14 ... 1 ... ... ... ... ... ... ... ... Suicide 7 ... ... ... ... ... 1 ... 3 ... 3 ... Road Traffic Accidents 5 ... ... 1 2 1 ... ... 1 ... ... ... Other violence 12 ... ... ... 1 ... 2 2 ... 1 3 3 All other causes 28 2 ... ... 1 5 2 1 4 2 6 5 Totals 493 32 1 4 7 13 16 25 57 77 136 125 9 FEMALES. Causes of death ALL 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 and over Whooping Cough 1 ... 1 ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 23 ... ... ... 1 9 7 6 ... ... ... ... Other forms of Tuberculosis 2 ... ... ... 2 ... ... ... ... ... ... ... Syphilitic Diseases 1 ... ... ... ... ... ... ... ... 1 ... ... Measles 3 1 1 ... 1 ... ... ... ... ... ... ... Acute Infective Encephalitis 1 ... ... ... ... ... 1 ... ... ... ... ... Cancer of Uterus 10 ... ... ... ... ... ... ... 2 4 4 ... Cancer of Stomach and Duodenum 16 ... ... ... ... ... ... ... ... 3 7 6 Cancer of Breast 21 ... ... ... ... ... ... 5 6 3 6 1 Cancer of all other sites 30 ... ... ... ... ... ... 4 3 7 7 9 Diabetes 2 ... ... ... ... ... ... ... ... 1 1 ... Intra-cranial Vascular Lesions 64 ... ... ... ... ... ... ... 6 11 21 26 Heart Disease 107 ... ... ... ... ... ... 3 5 6 34 59 Other Circulatory Diseases 19 ... ... ... ... ... ... ... ... ... 5 14 Bronchitis 30 ... ... ... ... ... ... ... 2 2 4 21 Pneumonia 30 5 1 ... ... ... ... 2 1 4 5 12 Other Respiratory Diseases 4 ... ... ... ... ... ... ... 1 ... ... 3 Ulcer of Stomach and Duodenum 1 ... ... ... ... ... ... ... ... ... 1 ... Diarrhoea (under 2 years) 5 4 1 ... ... ... ... ... ... ... ... ... Appendicitis 2 ... ... ... ... ... ... ... 2 ... ... ... Other Digestive Diseases 7 ... ... ... ... ... ... ... 1 ... 3 3 Nephritis 8 ... ... ... ... ... ... ... 1 ... 2 3 Puerperal and Post-abortive Sepsis ... ... ... ... ... ... ... ... ... ... ... ... Other Maternal Causes ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 6 6 ... ... ... ... ... ... ... ... ... ... Cong. mal., birth injuries, inf. dis. 9 8 1 ... ... ... ... ... ... ... ... ... Suicide 7 ... ... ... ... ... ... 2 1 1 2 1 Road traffic accidents 1 ... ... ... ... ... ... ... ... ... ... 1 Other violence 8 ... ... ... ... ... ... ... ... 2 2 4 All other causes 26 2 1 1 ... 2 2 ... 1 2 6 9 Totals 444 26 6 1 6 12 10 22 32 47 110 172 10 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M. F. Total Legitimate 31 26 57 Illegitimate 2 1 3 33 27 60 The death rate of all infants per 1,000 live births was 35.58. The death rate of all infants under one month of age per 1,000 live births was 18.38. A detailed sub-division of the causes, etc., of these DEATHS is as follows:— MALES. Causes of Death One 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 Measles ... ... ... ... ... ... 1 ... ... 1 Pneumonia ... ... ... ... ... ... 2 1 ... 3 Congenital Malformations 2 1 ... ... 3 ... ... ... ... 3 Premature Birth 7 l ... ... 8 ... ... ... ... 8 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Gastro-Enteritis ... ... ... ... ... 1 2 ... ... 3 Other causes 2 l ... ... 3 1 1 2 1 8 Violence ... ... ... ... ... ... ... ... ... ... Totals 16 3 ... ... 19 3 6 3 1 32 FEMALES. Causes of Death One 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 Measles ... ... ... ... ... ... ... ... 1 1 Gastro-enteritis ... ... ... ... ... ... 3 ... 1 4 Pneumonia ... 1 ... ... 1 1 2 ... 1 5 Premature Birth 5 ... ... ... 5 1 ... ... ... 6 Congenital Malformations 1 ... 1 ... 2 ... ... ... 1 3 Other Causes 1 ... ... ... 1 ... 2 1 ... 4 Injury at Birth 2 1 ... ... 3 ... ... ... ... 3 Totals 9 2 1 ... 12 2 7 1 4 26 11 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 17.9 0.42 3.3 34 London 20.1 0.39 2.4 31 Edmonton 15.93 0.42 4.74 35.58 Annual Death Rate per 1,000 of Population. All Causes Whooping Cough Diphtheria Influenza England and Wales 10.8 0.02 0.00 0.03 London 11.6 0.01 0.01 0.02 Edmonton 8.85 0.01 0.01 0.00 The following table gives the number of births and deaths (registered) sub-divided into the four Wards of the Borough. It should be remembered that births are only those which occurred in Edmonton of residents ; these 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 those taken place outside the Borough, the information being given quarterly by the Registrar-General. Ward Births Deaths Infant Deaths M. F. M. F. M. F. Bury Street 214 208 151 131 18 9 Church Street 100 79 105 96 1 3 Angel Road 124 142 95 90 5 6 Silver Street 161 151 142 127 8 8 Vagrants ... ... ... ... ... ... 599 580 493 444 32 26 12 LABORATORY SERVICE. On the 1st October, 1948 the Council's Laboratory was taken over by Medical Research Council, and will in future operate as a branch laboratory for the Public Health Laboratory Service, Colindale, to serve Edmonton, Enfield, Friern Barnet, Southgate and Tottenham. The following examinations were carried out in the Council's Bacteriological Laboratory up to the 30th September, 1948:— Nature of Examination. Positive. Negative. Total. Aural swabs for presence of organisms — — 1 Blood Counts — — 38 Blood—Haemoglobin estimation — — 114 Blood—Sedimentation rate — — 1 Blood—Bleeding Time — — 2 Breast Milk for Fat Content — — 1 Cough plates for H. Pertussis — 5 5 Eye swabs for Gonococci — 2 2 Eye swabs for organisms — — 8 Faeces for organisms 54 314 368 Faeces for presence of parasites 10 163 173 Faeces for presence of Protozoa 1 7 8 Swabs for presence of C. Diphtheriæ:— (a) From Suspect cases — 103 103 (b) From Contacts — 7 7 (c) From Carriers and old cases, etc. — 58 58 Swabs for presence of Haemolytic Streptococci 54 116 170 Swabs for presence of Vincent's Angina I 24 25 Sputa for presence of Tubercle Bacilli — 4 4 Scalp hair for vermin 1 — 1 Urine—Chemical Examinations — — 183 Urine—Bacteriological Examinations — — 88 Urine—Microscopical Examinations — — 106 Vaginal Swabs for Trichomonas Vaginalis 2 12 14 Vaginal Swabs for Gonococci — 1 1 Vaginal Swabs for other organisms — — 4 Vaginal swabs for presence of yeast 2 1 3 Total Number of Examinations 1,488 The following specimens submitted from the Edmonton area were examined by the Medical Research Council Laboratories, during the year, as follows:— Nature of Examination. Positive. Negative. Total. Breast milk for fat content — — 2 Blood—Bleeding time — — 3 Blood—Count — — 21 Blood—Haemoglobin estimation — — 19 13 Nature of Examination. Positive. Negative. Total. Eye swabs for presence of organisms — 7 7 Ear swabs for presen e of organisms — — 3 Faeces for presence of Dysentery bacilli 6 15 21 Faeces for presence of pathogens 6 73 79 Faeces for presence of Protozoa — 4 4 Faeces for presence of Threadworm — 1 1 Gum swab for presence of organisms — — 1 Renal swabs for presence of pathogens — 1 1 Swabs for presence of C. Diptheriæ (a) From Suspects 2 290 292 (b) From Contacts — 23 23 (c) From Carriers, old cases, etc. — 116 116 Swabs for presence of Hæmolytic Streptococci 114 312 426 Swabs for presence of Vincent's Angina 5 95 100 Sputa for presence of Tubercle Bacilli — 1 1 Urine—Bacteriological examinations — — 110 Vaginal Swabs for presence of organisms — — 4 Vomit for presence of pathogens — — 1 Total Number of Examinations 1,235 MILK (SPECIAL DESIGNATIONS) REGULATIONS 1936-1948. 48 Samples of Designated Milks were examined during 1948. Results were as follows:— Pasteurised Milk. 20 Samples were examined by both the prescribed tests and 19 samples were found to be satisfactory. 1 Sample passed the Methylene Blue test only and failed the Phosphatase test. Tuberculin Tested Milk. 14 Samples were examined, 9 satisfied both the prescribed tests. 3 Samples failed to pass both the Methylene Blue and Coliform tests. 2 Samples failed to pass the Coliform Test only. Tuberculin Tested (Pasteurised) Milk. 14 Samples were examined by both the prescribed tests and found to be satisfactory. 14 Ambulance Facilities. The Council possesses four ambulances, and the following figures give some idea of the work carried out from 1-1 48 - 4-7-48 Private cases 9,376 Accident cases 456 Maternity cases 172 Not required 180 False calls 15 Bedside Apparatus 146 Analgesia 122 Special services 231 10,698 First Aid was rendered on 352 occasions. The resuscitating apparatus was in use on 11 occasions. The total mileage of the vehicles was 35,309 miles. National Health Service Act, 1948 The Borough Ambulance Service was transferred to the Middlesex County Council on 5th July, 1948, and is now incorporated in the County Fire and Ambulance Service. Nursing in the Home. This has been described in previous reports. Hospitals. Infectious diseases are normally admitted into the Enfield, Edmonton and Potters Bar Joint Isolation Hospital, situated in Enfield. This Hospital has been renamed - South Lodge Hospital - and now comes under the purview of the Enfield Group Hospital Management Committee. Arrangements for the treatment of ear, nose, and throat disorders amongst school children are made with the Prince of Wales's Hospital and North Middlesex Hospital. Nursing Homes Registration. Up to 5th July, 1948, one Nursing Home was registered by the Council. This is kept under supervision by the Medical Officer of Health. No new applications to be placed on the register were received during 1948. SANITARY CIRCUMSTANCES OF THE AREA. The water supply of the Borough has at all times been satisfactory both in quality and quantity. The Metropolitan Water Board is responsible for the supply which is piped direct to every dwelling-house throughout the Borough, and serves the entire population. The co-operation of the Board has at all times been of the fullest. 15 SANITARY INSPECTION IN THE AREA. Six District Sanitary Inspectors and one woman Sanitary Inspector are engaged in the sanitary supervision of the Borough, working under the supervision of the Senior Sanitary Inspector. The Senior Sanitary Inspector supervises the work of the Borough and is Inspector under the Canal Boats Acts. Sanitary Conveniences. There are seven Public Conveniences in the Borough which are kept under constant supervision by the Public Health Department. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. Under this heading your Senior Sanitary Inspector, as Officer-in-Charge, Rodent Control, reported as follows:— The Council have two Rodent Operatives and the part time services of a Junior Clerk, and appointed the District Sanitary Inspectors Rodent Officers, with Mr. Gaffney as Assistant Rodent Officer. Up to the end of the year, 5209 visits and re-visits have been made by the Rodent Operators in connection with complaints as to alleged rat infestation. It is pleasing to report that it was not found necessary to serve any notices during the year. Detestation has been carried out on request at 1471 premises (which number includes business and other premises) and at the end of the year 28 premises were in process of "detestation." The District Sanitary Inspectors in cases where there was a possibility of the infestation being due to defective drainage visited the premises and tested the drainage and any defects discovered were dealt with through the usual channels. Of 138 cases of Rat Infestation referred to the District Inspectors, owing to the possibility of defects in the drainage, in 57 per cent, of the cases defects were discovered and as one can quite appreciate entailed quite a large amount of work. During the year maintenance treatments of the sewers took place by the Borough Engineer's Department. Middlesex County Council Act, 1944, Section 279, Hawkers, Etc. This Act came into operation on the 1st October, 1944, and Section 279 replaced Section 71 of the Act of 1938. Only one person was registered during the year. Rent and Mortgage Interest (Restrictions) Acts 1920-1933 Daring the year your Senior Sanitary Inspector has issued 6 Certificates under the above Acts upon applications of Occupiers of dwelling-houses in the district. 16 Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 254 „ „ „ „ return bedding 228 Rooms disinfected after infectious disease 397 „ „ „ phthisis 56 „ „ „ other cases 65 Disinfestation carried out after vermin 302 Bedding, clothing, etc., disinfected after infectious disease 1,942 articles Bedding, clothing, etc., disinfected after phthisis 512 „ „ „ „ „ „ other cases 897 „ The Council distribute a disinfecting powder and fluid to residents who apply for same at the Town Hall Yard. During the year, the applicants numbered 6,301. 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 398. Seven Council propei ties and 58 other houses were found to be infested, the total number of rooms disinfested was 232. The whole of the work is carried out by the Department, the materials used being Insecticides containing D.D.T. as a base. Petroleum (Regulations) Acts, 1928 and 1936. During the year seven new licences and 104 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences:— Petroleum spirit 580,519 gallons. Petroleum mixtures (cellulose) 7,668 „ Carbide of calcium 17 cwts. 2 qrs. 22 lbs Rubber Solution 100 lbs. Mortuary. During the year 73 bodies were deposited in the Mortuary, 71 by order of the Coroner and 2 for sanitary reasons. Inspections. The following tabular statement gives the number and nature of the inspections made during the year:— Complaints 2,998 Infectious disease 308 Tuberculosis 38 House-to-House 362 Factories with mechanical power 207 Factories without mechanical power 8 Outworkers 141 Schools 3 Shops and Stalls 115 Shops Act (Primary) 7 17 Shops Act (Re-inspections) 4 Sanitary conveniences and urinals 220 Smoke observations 15 Rat Infestation 141 Petroleum 31 General inspections 310 Sundry Visits 1,340 Cinemas and Halls 12 Visits to canal 6 Gipsies — Re-inspections 6,927 Inspection of Places where Food is Prepared. Butchers 52 Fish shops 12 Cafes 10 Dairies and milkshops 30 Slaughterhouses 31 Bakehouses 11 Ice Cream Shops 22 Number of Notices Served. Preliminary or Informal Notices 2,870 Statutory Notices 714 Defects Remedied. Houses repaired, cleansed, etc. 781 D.W. cisterns repaired, covered 21 Water fittings repaired 78 Water taken off mains — Drains examined, tested, etc. 42 Drains cleared, trapped, repaired 341 Drains reconstructed 61 Chambers inserted 24 Chambers sealed down 12 Soil and vent pipes repaired 61 W.C.s repaired, cleansed, etc. 307 Flushing cisterns repaired 121 Waste pipes repaired, etc. 87 Sinks repaired or renewed 213 Roofs repaired 850 Gutters and R.W.P.s repaired 630 Yards paved or repaved 111 Scullery floors repaired 46 Spaces under floors ventilated 15 Dampness remedied 118 Floors repaired 112 Coppers and stoves repaired, etc. 204 New dustbins supplied 294 Accumulation of refuse removed 5 Nuisances from animals abated 3 Other nuisances abated 1437 Water supply restored 3 Dustbins supplied in default 3 Dustbins supplied on request 36 18 Canal Boats Acts. During the year 5 visits were paid to the Canal and 3 boats were seen, but of this number none was fitted or used as a dwelling or registered under the Acts. Places of Public Entertainment. Twelve inspections of cinemas and other places of entertainment were made in accordance with the Circular of the Ministry of Health of 1920. Conditions were found to be generally satisfactory. FACTORIES ACTS, 1937 AND 1948. The following work has been carried out under the above Act :— 1.—Inspections for the Purpose of Provisions as to Health. Premises Number in Register Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 207 256 34 ... Factories without mechanical power 8 39 2 ... Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) ... ... ... ... Totals 215 295 36 ... 2.—Defects Found. Particulars Number of defects No. of defects in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of cleanliness 6 6 1 ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate ventilation ... ... 1 ... Sanitary Conveniences : Insufficient 6 5 ... ... Unsuitable or defective 42 40 ... ... Not separate for sexes ... ... ... ... Other offences (Not including offences relating to Home work or offences under Sections mentioned in the schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 5 3 ... ... Ineffective drainage of floors 4 4 ... ... Totals 63 58 2 ... 19 3.—OUTWORK—Sections 110 and 111 Nature of Work Section no Section hi No. of Outworkers in August list No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel, making, etc. 175 .. .. .. .. .. Curtains and furniture hangings 24 .. .. .. .. .. Artificial flowers 4 .. .. .. .. .. Sacks 1 .. .. .. .. .. The making of boxes or other receptacles or parts thereof made wholly or partially of paper 24 .. .. .. .. .. Brush making 9 .. .. .. .. .. Feather sorting 1 .. .. .. .. .. Carding, etc., of buttons, etc 5 .. .. .. .. .. Stuffed toys 20 .. .. .. .. .. Cosaques, Christmas crackers, Christmas stockings, etc. 3 .. .. .. .. .. Lampshades 1 .. .. .. .. .. Totals 267 .. .. .. .. .. FACTORIES. Defects Remedied. W.C. walls cleansed 6 W.C. cisterns repaired 15 W.C. Seats repaired or renewed 8 W.C. Flush pipes repaired — W.C. doors repaired 4 W.C. pans replaced 3 Roofs repaired — Workrooms cleansed — Sanitary accommodation improved 13 „ „ for Sexes provided — Urinals cleansed 2 Unreasonable Ventilation — Drainage to floors amended 4 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) 2,998 (b) Number of inspections made for the purpose 5,746 (2) (a) Number of dwelling houses (including under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 362 (b) Number of inspections made for the purpose 598 20 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 (4) Number of dwelling houses (exclusive of those referred to above under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,998 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 or their officers 902 3. Action under Statutory Powers During the Year. A.—Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 478 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 361 (b) By Local Authority in default of owners 30 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 236 (2) Number of houses in which defects were remedied after service of formal notices:— (a) By owners 165 (b) By Local Authority in default of owners 2 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which demolition orders were made 4 (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 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenements or rooms having been rendered fit. - SLAUGHTERHOUSES. Thirty-one visits were paid and the carcases and organs of 210 pigs were inspected during or shortly after slaughter, permission for slaughter having been obtained from the Area Meat and Livestock Officer, and the following surrendered :— 5 Sets of lungs. 4 Plucks. 4 Hearts. 5 Heads. 2 Legs. 21 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Various licences were granted as under :— Primary. Supplementary. Pasteurised 13 7 Tuberculin tested 9 5 22 12 One of the above retailers is licensed to bottle Tuberculin tested milk and two are licensed to pasteurise and bottle milk on the premises; one firm is licensed to bottle pasteurised milk on the premises. Supplementary licences 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 and retained as unfit for human consumption :— 2533 tins milk. 5 stone mackerel 590 „ meat. 6 ,, cat fish. 879 „ fish. 6 „ roes. 238 „ beans. 1 cwt. mussels 780 „ jam and marmalade. 418 lbs. Melts. 673 „ peas. 4 stone Chitterlings. 75 ,, pears. 2 bags whelks. 363 ,, soup. 17 lbs. cooked beef. 166 „ plums. 2 cases hares. 95 „ peaches. 10 cwt. chestnuts. 184 „ tomatoes. 39 lbs. prunes. 26 „ spaghetti. 13 pkts. All Bran. 59 „ carrots. 23 ,, Weetabix. 17 „ rabbit. 26 stone sago. 4 ,, dried egg 2,663 lbs. rabbits. 283 „ mussels. 50 ,, walnuts. 28 ,, vegetables. 30 ,, currants. 29 „ beetroot. 49 fish cakes. 27 „ apples. 38 jars gherkins. 3 „ cherries. 1 leg pork. 20 „ puddings. 50 lbs semolina. 41 „ oranges. 15 pkts. barley. 24 ,, apricots 150 bags flour. 367 „ grapefruit. 130 lbs oats. 35 „ chocolate spread. 24 salmon rolls. 3 „ peanut butter. 1 gallon cream. 10 ,, apple puree. 50 lbs. sugar. 98 pots paste. 7 boxes dates. 33 „ horseradish sauce 36 lbs. sweets. 13 bottles sauce 95 pkts biscuits. 16 jars salad cream. 37 lbs beans. 16 „ red cabbage. 38 pkts. cereals. 22 8 jars fruit salad. 74 Sweetphat. 64 pickles. 14 boxes of cheese. 6 gals, pickled onions. 40 lbs. macaroni. 6 ,, mixed pickles 16 bars of chocolate. 2 boxes mixed fish. 952 loaves. 49½ stone rock eel. 408 rolls. 54 ,, kippers. 202 lbs. chicken. 108½ „ haddock. 20 „ duck. 30 lbs. herrings. 788 ,, peas 38 stone skate wings. 3 tins turkey. 50 „ dog fish. SHOPS ACTS and STREET TRADING The Shops Acts and Street Trading Inspector submits a monthly report to the Public Health Committee, and the following is a short summary of the work carried out during the year :— Visits to shops, Licensed Street Traders, etc. 1,650 Washing facilities, sink water heaters installed 8 Contraventions were in the main of a minor character, mostly concerned with the exhibition of notices. In this connection forms of explanation were circulated to shop-keepers in the Borough. Shops (Sunday Trading Restriction) Act 1936 : Some shop-keepers were experiencing difficulty in interpreting the requirements of this Act, in consequence forms containing an extract from the Act, together with other official information, were circulated to certain shopkeepers. Young Persons (Employment) Act 1938. Cinemas and Boot & Shoe Repairing are the only occupations where young persons are being employed under the above Act. The Registers kept at these premises are periodically inspected. Middlesex County Council Act 1944. Street Trading.—Legal proceedings were instituted and fines amounting to £21 10s. Od. were imposed during 1948. The inspection of shops, stalls and others traders' premises coming within the scope of the Acts has been carried out throughout the year, including Sundays and evenings, and the work of registering, indexing and classifying is still continuing. Chemical and Bacteriological Examinations of Food. The only examinations carried out by the Council are those for designated milks. The matter has been discussed previously. 23 PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. These diseases were made compulsorily notifiable in October, 1939. 647 cases of Measles and 297 cases of Whooping Cough were notified during the year. There were four deaths from Measles and two from Whooping Cough. Diphtheria. Only one case was notified during the year as compared with 8 in 1947. There were no deaths: Scarlet Fever. This disease continued to occur throughout the year in a mild form; there were 128 cases compared with 261 in 1947 ; there were no deaths. "Return" cases numbered 2 allowing for an interval of 28 days between a patient returning home from the Isolation Hospital and the onset of the disease in another inmate of the house. Smallpox. No cases of smallpox were notified during the year. Dysentery. 30 cases were notified (23 Sonne, 1 Amoebic, 6 not typed). They occurred in varios parts of the Borough throughout the year. All cases were fully investigated but no common source of infection was discovered. Cerebro Spinal Fever. Two cases were notified during the year. These cases were carefully investigated and precautions taken to prevent the spread of infection. No deaths took place. Puerperal Pyrexia and Ophthalmia Neonatorum. These are referred to later on under the heading of Maternity and Child Welfare. Food Poisoning. No cases were notified during the year. Pneumonia. 32 cases were notified during the year. Diarrhoea and Enteritis under 2 years of age. The death rate per 1,000 live births for London was 2.4 whilst that for Edmonton was 4.74 as compared with 4.8 and 6.82 respectively last year. 24 Poliomyelitis. During the year confirmed cases of Poliomyelitis occurred in the Borough. Notifications were received in January, February and December. There was one death. 18 cases were notified in 1947 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 those already under treatment at a hospital, for instance, the North Middlesex Hospital. This remark applies more particularly to the infections associated with parturition and includes puerperal pyrexia and ophthalmia neonatorum. The number of deaths from Pneumonia includes all forms of this disease. Disease Total No. of Cases No. Removed to Hospital Deaths to 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Scarlet Fever 128 116 ... ... 2 8 7 10 57 27 8 5 1 2 1 Diphtheria 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Measles 647 48 4 36 96 95 84 86 230 7 7 5 1 ... ... Whooping Cough 297 32 2 34 38 45 28 43 102 5 2 ... ... ... ... Pneumonia 32 9 43 1 4 ... ... 3 5 1 2 4 4 6 2 Puerp. Pyrexia 62 62 ... ... ... ... ... ... ... ... 9 40 13 Erysipelas 24 10 ... ... ... ... ... ... ... 3 ... 3 2 12 4 Enteric Fever 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Poliomyelitis 3 1 1 ... ... ... ... ... ... 1 ... 1 1 ... ... Ophth- Neonatorum 14 14 ... 14 ... ... ... ... ... ... ... ... ... ... ... Dysentery 30 7 ... 3 ... 12 2 ... 3 3 1 2 2 2 ... C.S.F 2 2 ... ... ... ... 1 ... 1 ... ... ... ... ... ... 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 N. Middx. Hosp. Other Instns. Total Scarlet Fever 34 21 22 51 ... ... 128 Diphtheria 1 ... ... ... ... ... 1 Measles 160 146 124 210 7 ... 647 Whooping Cough 65 78 79 72 3 ... 297 Pneumonia 7 2 9 12 ... 2 32 Puerperal Pyrexia ... ... ... ... 57 5 62 Erysipelas 11 2 3 3 ... 5 24 Enteric Fever ... ... ... ... ... 1 1 Poliomyelitis 2 1 ... ... ... ... 3 Ophth-Neonatorum ... ... ... ... 13 1 14 Dysentery 8 3 5 14 ... ... 30 C.S.F 1 ... ... ... 1 ... 2 25 IMMUNISATION. As and from 5th July, 1948, immunisation against Diphtheria and Whooping Cough became the responsibility of the Middlesex County Council. Diphtheria. During the year, 1,896 appointments were made—1,554 children completed treatment under the Council's arrangements ; of these 1.459 were under 5 years of age. 12 children were Schick tested. In 1947, 1,498 children completed immunisation treatment. In addition 205 children received a re-inforcing injection. Up to 31st December, 1948, 52.92% of children under 5 years of age and 72.14% of children from 5—15 years of age had completed immunisation treatment. Whooping Cough. During the year, 1,067 appointments were made for this treatment—875 children completed treatment and 18 children were given re-inforcing injection. CANCER. The incidence of Cancer relative to the various organs of the body is given as under:— Males. Females. Breast — 21 Uterus — 10 Buccal cavity and oesophagus 8 — Stomach and duodenum 24 16 All other sites 70 30 102 77 PREVENTION OF BLINDNESS. Cases of ophthalmia neonatorum are promptly visited and, if thought necessary, are removed to hospital for treatment. No cases of blindness have arisen during the year due to this cause. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. In 1941 the Council resolved that Part 7 of the Middlesex County Council Act. 1934, be put into operation in the Borough. 26 TUBERCULOSIS. The table below gives details of the ages and sex of new cases of Tuberculosis, also deaths from the disease; this latter figure includes 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 2 1 ... ... ... ... ... ... 1— 5 years 3 4 1 2 ... ... 2 ... 5—15 „ 8 12 5 9 1 1 1 2 15—25 „ 29 29 1 2 4 9 ... ... 25—35 „ 15 22 1 2 4 8 ... ... 35-45 „ 12 10 1 ... 3 5 ... ... 45—55 „ 9 1 1 1 10 ... ... ... 55—65 „ 11 2 ... ... 3 ... ... ... 65 years upwards 3 1 ... ... ••• ... ... ... 92 82 10 16 25 23 3 2 In addition 21 cases of pulmonary tuberculosis and 1 case 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, excluding of course, non-notified deaths was :— Males. Females. New cases (respiratory) 92 82 (non-respiratory) 10 16 Transferred cases (respiratory) 10 11 (non-respiratory) ... 1 112 110 The cases dying of Tuberculosis and not previously notified were :— Males. Females. Respiratory 4 — Non-respiratory — — There were thus 4 non-notified deaths out of a total of 53 persons registered as dying of tuberculosis (Registrar's figures). Regarding the nonnotification 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. Skin 1 1 Other bones and joints I 1 Glands 4 8 Spine — 1 Abdomen — 2 Brain 3 3 Anus 1 — 27 Public Health (Tuberculosis) Regulations, 1930. The number of cases of tuberculosis on the Register at the end of 1948. was :— Males. Females. Total. Pulmonary forms 427 358 785 Non-pulmonary forms 73 94 167 500 452 952 The corresponding figures at the end of 1947 were :— Males. Females. Total. Pulmonary forms 369 321 690 Non-pulmonary forms 73 84 157 442 405 847 Corresponding figures for previous years were :— Males. Females. Totals. 1946 417 375 792 1945 389 332 721 1944 370 319 689 1943 411 355 766 1942 348 304 652 1941 355 293 648 1940 349 313 662 1939 357 301 658 1938 363 297 660 1937 336 260 596 1936 315 252 567 1935 330 265 595 COUNCIL'S EMPLOYEES. During 1948 the Medical Officer of Health paid a total of 276 visits to those employees who had been on the sick list for longer than a fortnight and, when necessary, at fortnightly intervals. Of these 49 were " not at home " and 8 had already resumed duty. Also, during the year, 57 persons were examined prior to appointment to permanent posts. MUNICIPAL FOOT CLINIC Summary of Attendances and Treatment, 1948 During the year 1948, 266 patients made 2016 attendances, an average of 7.57 attendances per patient. New Cases Subsequent Attendances Total Attendances Old Age Pensioners Attendances Primary Secondary Men 58 800 858 22 465 Women 208 950 1158 66 433 Total 266 1750 2016 88 898 28 Defects Treated— Anidrosis 7 Hyperidrosis 35 Bursitis 114 Metetarsalgia 413 Callosities 1384 Nails, club 400 Corns, hard 1513 „ ingrowing 48 „ soft 180 Neuro vascular 52 „ minute 4 Pes Cavus 25 „ seed 70 ,, Planus 70 „ under nail 57 Synovitis 13 „ in nail groove 135 Verruca Pedis 9 Hallux Valgus 325 Infra Red 17 Rigidus 56 National Health Service Act, 1948 On the 5th July, 1948, this Service was taken over by the Middlesex County Council. 29 Maternity and Child Melfare Department 1948 COMMITTEE to 4th July. 1948:— Chairman : Alderman W. Preye, J.P. Members : Alderman Mrs. E. A. Young (Mayor) Ex-Officio. Alderman Gatward (Deputy Mayor) Ex-Officio. Councillor L. E. Berridge. „ F. G. Durham. „ Mrs. L. M. George. „ Mrs. A. M. Glover. „ Mrs. S. J. Halliday. „ Mrs. F. Long, J.P. „ Miss. E. J. Mattocks Service transferred to Middlesex County Council 5th July, 1948, under National Health Service Act, 1946. FOREWORD The year 1948 has been a very eventful one, a change from the old regime and an entry into a new sphere of life. The period from January 1st to July 5th was one in which no expansions could be made to the existing services, although they continued to flourish and be well patronised by the Public. Prior to the 5th July, the Immunisation and Foot Clinics formerly carried out by the Public Health Department, were transferred to the Maternity and Child Welfare Department and finally after the appointed day became part of the County Council's Health Service. These statistics for the year 1948 have however been included in the Public Health Section as in this way a complete picture of the work for the year is shown. Before the end of 1948 steps were being taken by the County to increase the number of sessions at the Foot Clinic as this is a very popular service. It is too early to judge the advantages in the change of the Home Nurses from voluntary to County control, but with wise leadership there is splendid scope for increasing this valuable work. The extension of the Home Help Service is an opportunity for real progress and will do much to relieve the minds of sick persons, particularly householders who have such an anxious time when laid aside by sickness. Unfortunately it is also a service which requires careful supervision if abuses are to be avoided. One of the depressing problems to be faced is the lack of medical, dental and nursing staff which greatly handicaps the work. In time, steady recruitment of these services will increase the number of people available for preventive medicine. The urgent need for education in all phases of health, both of the adult and child, cannot be over-emphasised and it is hoped that during the coming year more health propaganda can be organised and supplied to the Public. The Day Nurseries have continued to play an important part in local and national life, and with the very heavy waiting list of children requiring vacancies, it is to be regretted that more premises cannot be made available. I should like to place on record my sincere appreciation of the work carried out by the Staff—to the professional staff for their splendid efforts for the mothers and children of Edmonton under the prevailing difficult circumstances and to the clerical section of the Maternity and Child Welfare Department upon whose shoulders fell the entire burden of the work connected with the transfer to the County Council's Health Services from July 5th, 1948 and to whom much credit is due for the smooth running both before and after the appointed day. 32 The following information gives details of the Maternity and Child Welfare Clinics at the end of 1948 :— (1) Ante-Natal Clinic at Brookfield House, Fore Street (adjoining the Town Hall). Six sessions weekly. Ante-Natal Clinic at Weir Hall, Silver Street. One session weekly. (2) Child Welfare Centres :— (a) Brookfield House. Three sessions weekly. (b) Methodist Church Hall, Bush Hill Park. Two sessions weekly. (c) St. Edmund's Church Hall. Two sessions weekly. (d) Weir Hall. Two sessions weekly. (e) St. John's. One session weekly. (3) Post-Natal and Advisory Clinic at Brookfield House. One session weekly. Post-Natal and Advisory Clinic at Weir Hall. One session weekly. (4) Dental Clinic at Pymmes Park. Two sessions weekly. (5) Orthopaedic Clinic at Methodist Central Hall, Fore Street. Orthorpaedic Surgeon attends once a month. Open daily for treaament. (6) Obstetric Surgeon attends once a fortnight at Brookfield House. Births. The total number of births notified during 1948 are as follows :— Live births notified by midwives 2,588 „ „ „ doctors and parents 42 Still-births „ „ midwives 108 „ „ „ doctors 3 2,741 33 These figures include births which have taken place in the North Middlesex Hospital, both of Edmonton and non-Edmonton residents; excluding these latter the notified births of Edmonton residents are :— Live births notified by midwives 1,101 „ „ „ „ doctors and parents 40 Still-births „ „ midwives 35 „ „ „ doctors 2 1,178 Number of live Edmonton babies born in outlying institutions 550 Number of still-born Edmonton babies born in outlying institutions 10 The following table includes births of Edmonton residents and those born and registered in other districts :— Male. Female. Total. Live Births 888 865 1,753 Still-births 24 16 40 912 881 1,793 Premature Babies. Arrangements have been made for additional care and supervision to be given and special records are kept. Premature children in need of hospital care are admitted to the North Middlesex County Hospital, as in the past. No. of babies notified during 1948 who weighed 5½ lbs. or less:— (a) Born at home 28 (b) Born in hospital 47 75 VISITS PAID BY THE HEALTH VISITORS. The following table gives details as to the visits paid by the Health Visitors:— To children under 1 year of age :— First visits 1,734 Total visits 8,188 To children between 1 and 5 years of age 10,536 Infant Protection visits to children 5-9 years 113 Visits re adoption 114 Futile visits 3,751 Total visits paid 22,702 34 CLINICS Ante-Natal Clinic. The clinic at Brookfield House was held six times weekly (one session being for new patients only), and at Weir Hall, one session weekly. The following are the figures for the year :— Number of general sessions in the year 315 Number of prospective mothers 2,094 Number of consultations 954 Total number of attendances 9,418 Average number of attendances :— (a) Per session 29 89 (b) For consultation 2525 Clinic for New Patients :— (а) No. of sessions 53 (b) New cases 1,274 (c) Total number of attendances 1,382 The Ante-Natal Clinics are under the supervision of the Non-Medical Supervisor of Midwives, with the help of the Midwifery Staff. POST-NATAL AND ADVISORY CLINICS. Post-Natal Clinic. Brookfield House and Weir Hall. Number of sessions 84 Actual number of mothers who attended 604 Number of consultations 2,119 New cases 481 Total attendances at clinic 2,177 Average attendance per session 25.91 Advisory Clinic. Brookfield House and Weir Hall. New Cases 59 Number of mothers seen by Doctor 197 Total attendances 213 Specialist's Clinic. The consulting Specialist made 25 visits during the year and saw 155 cases, making an average of 6.2 per session. Child Welfare Clinics. The figures relating to attendances are :— Brookfield House. Methodist Hall. St. Edmunds. Weir Hall. St. Johns. Number oi sessions 152 103 106 103 52 New cases—(a) Under 1 year 447 199 328 290 175 (b) 1—5 years 123 51 89 58 35 Attendances— (a) U nder 1 year 8,388 4,771 6,002 6,871 3,874 (6) 1—5 years 3,419 2,261 3,572 3,690 1,499 Total Attendances 11,807 7,032 9,574 10,561 5,373 Average attendances 77.68 68.27 90.32 102.53 103.32 Doctor's consultations 3,393 1,965 2,240 2,561 1,231 35 ORTHOPÆDIC CLINIC. The Clinic is Held twice weekly and the following are the figures for the year:— Attendances. Surgeon's days 403 Treatments given 956 No. of children attending for treatment 621 No. of wedges fitted 186 DENTAL CLINCS. The following report for the year has been submitted by the Senior Dental Officer :— DENTAL REPORT M. & C.W. 1948. "July of this year marks the end of the Welfare Dental Sessions under our old system, and the introduction of that required under the National Health Service Act. A major difference in these two systems and one which has altered considerably the balance of attendances between adults and children, is the abolition of our custom of treating mothers right up to the time when their children became of school age. Many of these mothers and their children visited me periodically over a number of years, and a kind of family Dental relationship existed between us, which was to the advantage of all. I propose, in this report, to divide the year into two halves: (a) The pre-Act period (January—June) and (b) the Act period (July—December). (a) It is interesting to compare the figures over the last five years (1944—June 1948) in order to assess the steady progress and growth in popularity of this service. In this comparison I shall not include the later half of 1948 (vide supra para. 2) but shall confine myself to the years 1944— 1947 as full years, and then the first six months of 1947—48. 1944 1945 1946 1947 Mothers Children M. C. M. C. M. C. No. of attendances 946 260 868 386 1097 489 1220 618 ,, ,, new cases 310 130 310 205 338 245 395 317 Total number treated 918 256 598 360 596 458 714 585 „ fillings 78 - 100 - 95 - 131 - „ dressings 20 405 23 621 41 812 37 1046 „ scalings 71 - 56 - 47 - 43 - Extractions (No. of teeth): (a). General anæsthetics 1133 174 1400 210 1579 223 1594 323 (b). Local ,, 31 - 22 - 13 - 22 - Total general „ 349 93 393 131 426 133 504 215 Dentures supplied 77 - 61 - 91 - 90 - No. of sessions 103 - 94 - 100 - 105 - 36 It will be seen from these figures that the average total increase in new cases over this four year period is 90.7 per annum, an indication of the growing interest in this Clinic. The numbers treated show a corresponding average increase of 41.7 p.a. The sessions during this period were booked to capacity and it was not possible to materially enlarge upon this average. Similar increases will be seen in all items of these tables with the exception of extractions with local anaesthetics and scalings, which show a small decline. The overall figures show a pleasing and progressive picture. At the beginning of 1948, it was evident that extra sessions would have to be devoted to the M. & C.W. work to deal with the larger numbers now requiring treatment. In consequence of which, an additional session was introduced once a month at the Croyland Road Clinic, which continued until the introduction of the Act on the 5th July. The following tables will show a continued increase in new cases, and cases actually treated, of 63 and 170 respectively, over the six month period January—June 30th, 1947, during the first six months of 1948. The remaining items speak for themselves and, I think, require no further comment. Jan - June 1947 Jan - June 1948 Mothers Children Mothers Children No. of attendances 537 289 728 367 „ „ new cases 180 141 208 176 „ treated 302 272 397 347 „ fillings 63 - 86 - ,, dressing 14 467 36 648 „ scalings 13 - 24 - Extraction (No. of teeth) (a). General anesthetics 687 136 921 195 (b). Local , 6 - 16 - No. of sessions 49 59 The first half of the year showed great promise and but for the sad lack of premises and shortage of staff, much might have been done to create a large and flourishing service, which I am convinced would have grown very rapidly. In this brief survey I have endeavoured to give a rough idea of the progress of our M. & C.W. Dental Service under the 1918 Act period. In many respects I am sorry that it has gone so far as it concerns this particular work. (b) The Act Period (5th July—December, 1948). The coming of the Health Act, upset our smooth running to some extent, many of our mothers were confused and did not understand to what extent the service was still open to them. Many of them, no longer nursing mothers, whose children were over one year of age, were no longer entitled to seek treatment for themselves through the medium of the Welfare Service, and were obliged to attend privately with their family Dentists. Others in this class were already under treatment, and presented something of a problem. However, I was permitted to finish the work in hand before finally concluding their visits. 37 This new arrangement produced a marked decline in our adult attendance during the last six months of the year, an average drop of 41 (36% approx.) per month, under the corresponding six monthly periods of 1947, whilst the average child attendance showed a constant average under the same conditions. conditions. During the same periods new cases show an average fall of 41.1% mothers and 12.6% children approximately. 1947 July Aug. Sept. Oct. Nov. Dec. M. C. M. C M. C. M. C. M. C. M. C. No. of attendances 131 60 102 49 122 59 103 61 110 50 115 50 ,, ,, new cases 40 26 35 26 32 28 33 33 43 30 33 31 1948 July Aug. Sept. Oct Nov. Dec. M. C. M. C. M. C. M. C. M. C. M. C. No. of attendances 106 58 84 55 96 32 67 62 55 55 66 66 No. of new cases 21 22 27 19 22 20 16 33 20 30 19 28 During the year 1948, 102 dentures were supplied to mothers; of these 61 were supplied prior to July 5th and 41 during the latter half of the year. The fall in the adult figures was expected and inevitable under the new conditions, whilst that of the children, I think, can be attributed to prevalent uncertainty during this time, and will in fact re-assert itself when the public have become better acquainted with the new order of things." Sunlight Clinic. 1,547 treatments were given to children referred for sunlight during the year. The work of the Clinic had to be curtailed in order to to devote more time to the Orthopaedic Clinic. Ophthalmic Clinic. Prior to 5th July, 1948. 85 children under 5 years of age attended this Clinic; 42 attendances were made for Refraction, 14 attendances were made for examination and 84 attendances were made for re-examination. The examinations consist of cases other than refractions who on their first visit to the Clinic were suffering from persistent discharge of the eyes styes Tarsal cysts, blinking, ptosis, etc, The re-examinations refer to the follow-up visits ot children who have already attended once for refractions or examinations With the introduction of the National Health Service Act 1946, this service ceased for children not at school. Speech Clinic. Arrangements are made for children under 5 years of age to attend the Speech Clinic and 10 children were referred during the year. 38 Convalescent Cases. Prior to July 5th, 1948, 5 children were sent away under the contract with the Invalid Children's Aid Association. Tonsils and Adenoids. 125 children were referred for operation during 1948. INFECTIOUS DISEASES. Ophthalmia Neonatorum. 14 cases were notified during the year and all occurred in the North Middlesex Hospital of which 3 were Edmonton cases. Puerperal Pyrexia. 61 cases were notified during the year all of which occured in the North Middlesex Hospital of which 26 were Edmonton cases. It must be understood that the more serious cases of midwifery are referred to the Hospital, and therefore complications are more likely to occur. MIDWIFERY SERVICE. Analysis of work. Actual confinements attended by midwives 581 Attended by midwives, but women admitted to hospital before or during confinement 175 Left district before confinement 13 In addition to the actual 581 confinements attended, a total of 14,806 visits were paid by midwives as under:— Ante-Natal visits to homes 2,270 Post-Natal Visits 10,231 Additional evening visits 111 Visits after fourteenth day 89 False alarms 433 Special Visits 418 Second Nurse for Gas and Air Analgesia 1 Miscellaneous 1,253 Medical Aid. The number of claims made by doctors for Medical Aid during the year 1948 was 122 Gas and Air Analgesia. 245 women had gas and air analgesia during the year. 39 Blood Transfusion Service. Under an arrangement with the North Middlesex Hospital, Medical Practitioners can now call upon the Blood Transfusion Service, and four cases were attended during the year. Home Helps. 163 women had the services of a Home Help. Sterilised Maternity Outfits. 429 Sterilised Maternity Outfits were issued during the year Day Nurseries. Attendances for the whole year were:— Fore Street 16,710 Hertford Road 13,648. Florence Road 13,186 Silver Street 13,767 Mcdical Inspections in Nursery Schools and Classes. 29 medical inspections were arranged in Nursery Schools and Classes during the year, and in addition the Health Visitor/School Nurses carried out routine visits of inspection to the children. INFANT LIFE PROTECTION. Each Health Visitor employed by the Council is an Officer for Infant Life Protection and great care was taken by them in supervising this part of the work. The number of persons on the register at 5th July 1948 was nine and the number of children eleven. The Deputy Medical Officer of Health also made periodic visits of inspection to the homes. Adoption of Children (Regulation) Act, 1939. The Health Visitors were responsible for the carrying out of this work, viz.:— Number of persons who gave notice under Section 7 (3) between 1. 1. 48 and 4. 7. 48 18 Number of children in respect of whom notice was given in above period 18 Number of children under supervision at end of that period ... 6 40 COUNTY COUNCIL OF MIDDLESEX BOROUGH OF EDMONTON Education Committee 19 4 8 Chairman - - ----- Alderman A. J. G. Hollywood Vice-Chairman - ----- Councillor Mrs. F. Long, J.P. Aldermen : W. T. Green, W. Preye, J. Reid, J.P., R. W. Ricketts and Mrs. E. A. Young, J.P. Councillors : J. A. G. Beattie, Mrs. L. M. George, R. J. Grant, Mrs. S. J. Halliday, Mrs. V. E. Hindell, W. C. Humphries, C. G. Lacey, Miss E. J. Mattocks, M. Simpson, C. F. Watkinson and A. Wright. County Councillor: T. H. Joyce. County Alderman : Mrs. L. R. Ithell, J.P. Co-opted Members: S. W. Eykel, M. Kennett, A. J. Smith and E. S. Taylor. 41 To the Chairman and Members of the Education Committee, Ladies and Gentlemen, I beg to submit my annual report on the School Health Service for the year 1948. The report is compiled in respect of the health and well-being of the school children of Edmonton in accordance with the wishes of the Ministry of Education conveyed to me through the medium of the Middlesex County Council. This is the last occasion on which I shall have the pleasure of submitting this report to you as the statistics and other relevant information will in future years be included in the report of the County School Medical Officer. The year has been uneventful but this is mostly due to my staff, to whom I owe a great deal for the efficiency, courtesy, conscientiousness and the general interest which they display in their routine work. I would like to express my thanks to the members of the Education Committee for the help and assistance they have given during the year. I also take this opportunity of expressing to Head Teachers and their staffs my special thanks for their kindly assistance and friendly co-operation given at all times. I have the honour to remain, Ladies and Gentlemen, Your obedient Servant, D. REGAN, School Medical Officer. 42 1 CO-ORDINATION. I am pleased to report that every assistance is given by head teachers, private practitioners, the Chest Clinic, local and Metropolitan Hospitals, social services and various departments of the County Council, thus enabling the co-ordination to run smoothly as in previous years. 2. MEDICAL INSPECTION. During the year 1948, 5,021 children attending Primary and Secondary Schools were given a full routine medical inspection and the analysis of the age groups was as follows:- Entrants 1,390 Second Age Group 2,120 Third Age Group 883 Other Periodic Inspections 628 Special inspections and re-inspections totalled 15,102 during the year. 3. FINDINGS OF MEDICAL INSPECTIONS. (a) Classification of the Nutrition of Children inspected during the year:— Number A B C Inspected (Good) (Fair) (Poor) 5,021 2,091 2,619 311 (b) Cleanliness. The total number of examinations carried out in the schools by the school nurses was 48,675 and the total number of individual pupils found to be infested 556, in respect of whom cleansing notices under Section 54 (2) of the Education Act, 1944, were issued. The number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3)) was 237. (c) Minor Ailments and Diseases of the Skin. The total attendances at the two Minor Ailments Clinics during the year were 32,004, as follows:— Pymmes Park Clinic 16,168 Croyland Road Clinic 15,836 (d) Visual Defects and External Eye Diseases. The progressive increase in the number of school children and children under school age, which has been going on since the Ophthalmic Clinic commenced, is even more marked than in previous years, and the total attendances have reached the very high figure of 3,688. 43 ARRANGEMENTS FOR TREATMENT The arrangements for treatment at the various clinics were as follows:— (1) Minor Ailments: Pymmes Park Clinic and Croyland Road Clinic. Doctor and Nurse in attendance every morning. (2) Rheumatic : Clinic held once monthly—the third Thursday. By appointment only. (3) Aural: Clinic held twice monthly—the second and fourth Friday. By appointment only. (4) Ophthalmic : Held at Pymmes Park Clinic every Monday and alternate Tuesdays. New cases by appointment only. (5) Orthopaedic: Surgeon attends on the second and fourth Friday in each month. Treatment carried out every morning at Central Hall, Fore Street, N.9. (6) Dental: Clinics held at Hazelbury Road, Pymmes Park and Croyland Road. (7) Orthodontic : The Specialist attends on the first, second and third Monday each month, one session at each clinic. By appointment only. (8) Speech : Held at Pymmes Park Clinic on five sessions a week. By appointment only. (9) Ultra Violet Light: This clinic is held at the Orthopaedic Clinic, Central Hall, on four afternoons per week. By appointment only. (10) Asthma : Held at Pymmes Park Clinic every Thursday after' noon. Cases are first referred to Dr. Freeman at St. Mary's Hospital, Paddington, who examines them and recommends the necessary vaccine. 44 MINISTRY OF EDUCATION Medical Inspection Returns YEAR ENDED 31st DECEMBER, 1948 Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.— Periodic Medical Inspections Number of Inspections in the Prescribed Groups:— Entrants 1,390 Second Age Group 2,120 Third Age Group 863 Total 4,393 Number of other Periodic Inspections 628 GRAND TOTAL 5,021 B.—Other Inspections. Number of Special Inspections 7,628 Number of Re-Inspections 7,474 TOTAL 15,102 C.—Pupils Found to Require Treatment. NUMBER OF INDIVIDUAL PUPILS FOUND AT PERIODIC MEDICAL INSPECTION TO REQUIRE TREATMENT (excluding Dental Diseases and Infestation with Vermin). Group For defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total of individual pupils (i) (2) (3) (4) Entrants 4 497 497 Second Age Group 176 803 9°3 Third Age Group 78 290 352 Total (prescribed groups) 258 1.590 1,752 Other Periodic Inspections 2 175 164 Grand Total 260 1.765 1,916 45 Table II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1948. Detect Code No. Defect or Disease (1) PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of Defects No. of Defects Requiring Treatment (2) Requiring to be kept under observation but not requiring treatment (3) Requiring Treatment (4) Requiring to be kept under observation but not requiring treatment (5) 4 Skin 108 17 2,293 45 5 Eyes—a. Vision 260 56 95 11 b. Squint 22 4 23 — c. Other 78 7 456 17 6 Ears—a. Hearing 22 17 28 9 b. Otitis Media 4 3 147 12 c. Other 43 22 252 12 7 Nose or Throat 313 291 743 142 8 Speech 23 7 7 4 9 Cervical Glands 12 64 47 5 10 Heart and Circulation 29 50 21 12 11 Lungs 85 55 226 111 12 Developmental— a. Hernia 4 1 1 1 b. Other — 1 1 1 13 Orthopaedic— a. Posture 237 20 33 2 b. Flat foot 244 33 32 1 c. Other 228 50 266 36 14 Nervous system— a. Epilepsy — 1 3 8 b. Other 27 10 29 10 15 Psychological— a. Development 3 5 — — b. Stability 1 2 6 '3 16 Other 597 259 1.574 563 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Groups Number of Pupils Inspected A (Good) B (Fair) C (Poor) No. , % of col. 2 No. % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants .. 1390 801 57 63 506 36.40 83 5-97 Second Age Gronp 2120 691 32 59 1298 61.23 '3i 6.18 Third Age Group.. 883 408 46.21 437 49-49 38 4-3o Other Periodic Inspections .. 628 191 3° 4i 378 60.19 59 9.40 Total 5021 2091 4165 2619 52.16 3" 6.19 46 Table III—Treatment Tables GROUP 1.—MINOR AILMENTS (EXCLUDING UNCLEANLINESS, FOR WHICH SEE TABLE V). Number of Defects treated, or under treatment during the year (a) Skin— Ringworm—Scalp— (i) X-Ray treatment. If none, indicate by dash — (ii) Other treatment 1 Ringworm—Body 30 Scabies 14 Impetigo 119 Other Skin Diseases 3015 Eye Disease 812 (External and other, but excluding errors of refraction, squint and cases admitted to hospital) Ear Defects (Treatment for serious diseases of the ear (e.g., operative treatment in hospital should not be recorded here but in the body of the School Medical Officer's Annual Report) 800 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 6473 Total 11264 b) Total number of attendances at Authority's minor ailments clinics 32004 GROUP II.—DEFECTIVE VISION AND SQUINT (EXCLUDING EYE DISEASE TREATED AS MINOR AILMENTS—GROUP I) No. of defects dealt with Errors of Refraction (including squint) 1,382 Other defect or disease of the eyes (excluding those recorded in Group I.) — Total 1,382 Number of pupils for whom spectacles were:— (a) Prescribed 1,329 (6) Obtained 981 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 262 (b) for other nose and throat conditions — Received other forms of treatment 221 Total 483 47 GROUP IV.—ORTHOPEDIC AND POSTURAL DEFECTS (a) Number treated as in-patients in hospitals or hospital schools 8 (b) Number treated otherwise, e.g., in clinics or out-patient departments 545 GROUP V.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY Number of pupils (a) under Child Guidance arrangements 134 (b) under Speech Therapy arrangements 169 Table IV. DENTAL INSPECTION AND TREATMENT.* (1) Number of pupils inspected by the Authority's Dental Officers — (a) Periodic Age Groups 4.562 (b) Specials 1,749 (c) Total (Periodic and Specials) 6,311 (2) Number found to require treatment 4,404 (3) Number actually treated 4,467 (4) Attendance made by pupils for treatment 10,291 (5) Half-days devoted to:— (a) Inspection 29 (b) Treatment 1,293 Total (a) and (b) 1,322 (6) Fillings:— Permanent Teeth 4,188 Temporary Teeth 173 Total 4,361 (7) Extractions:— Permanent Teeth 990 Temporary Teeth 4,664 Total 5,654 (8) Administrations of general anaesthetics for extractions 3,096 (9) Other Operations:— (a) Permanent Teeth 1,128 (b) Temporary Teeth 8,780 Total (a) and (b) 9,908 * For the present the Ministry are not asking for information regarding treatment carried out apart from the Authority's Scheme Table V. INFESTATION WITH VERMIN Notes — A statement as to the arrangements made by the Local Education Authority for the examination and cleansing of infested pupils should appear in the body of the School Medical Officer s Report. AH cases of infestation, however slight, should be recorded. The return should relate to individual pupils and not to instances of infestation. 1. Total number of examinations in the schools by the school nurses or other authorised persons 48.675 2. Total number of individual pupils found to be infested 556 3 Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 556 4 Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 237 48 Details Required for the Ministry of Education Return and School Medical Officer's Report for 1948 Employment of Children and Young Persons. (1) Number of children medically examined, in order to ascertain whether they were physically fit to undertake employment of a light nature outstrip school hours 2 (2) Number of instances in which the state of health was found to be such that certificates were withheld Nil (3) Number of children examined as to fitness to take part in entertainments 17 (4) Number of cases in which certificates to take part in entertainments were withheld 2 Medical Examination of Teachers and First Appointments. (a) Number of Teachers examined as to fitness for appointment 10 (b) Number of Students examined as to fitness for first appointment 5 Education Act, 1944 - Sections 57 (3) and 57 (5) Cases notified under Section 57, Education Act, 1944:— Sub-section 3 13 Sub-section 5 2 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 Nil 49