??? 34/6/4. 835 EDM 34 Borough of Edmonton REPORT of the MEDICAL OFFICER OF HEALTH for the year 1949 Borough of Edmonton REPORT of the MEDICAL OFFICER OF HEALTH for the year 1949 Borough of Edmonton 1949 His Worship the Mayor Councillor C. G. Lacey, J.P. Deputy Mayor Councillor Mrs. A. M. Glover PUBLIC HEALTH COMMITTEE. Chairman:Councillor Mrs. A. M. Glover. Members: Councillor C. G. Lacey, J.P. (Ex-Officio) Alderman W. Preye Councillor L. E. Berridge „ C. W. A. Conway ,, A. J. Elliot „ J. D. Habgood „ Mrs. J. Halliday „ Mrs. V. E. Hindell „ Miss. M. L. F. Strutt 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, My Annual Report for 1949 is compiled in accordance with Ministry of Health Circular 2/50. It must be noted that this is the first complete year of separation of the Health Services (in general) from the Environmental Health Service of which latter is now the sole consideration of the Borough Council. The Annual Report in other years contained circumstances and facts relating to all the health conditions in the Borough, this year it is to be limited to those circumstances that come under the direct control of the Council as the Sanitary Authority. The Middlesex County Council under the National Health Service Act, 1946, is responsible for Maternal and Child Health and School Health under the Education Act, 1944. It would be wrong to think that the functions of the Borough Council have to a great extent been minimised by this separation of services. The Council will realise that in the person of their Medical Officer of Health as Area Medical Officer there exists a link which still binds all the Health Services together. There is also the representation from the Borough Council on the Local Area Committee which will help to unite the services also. It must, however, be borne in mind that, while the greater part of the time of the Medical Officer of Health is allocated to County Health Services, his functions under Environmental Health are nothing less than they were in the past. Instead of this being so the field of Environmental Medicine embodies greater responsibility and wider fields of investigation than ever. Environmental Medicine because of its more scientific application at the present day does not come into the limelight as much 4 as other functions of the Local Authority, this is partly due to the wider ramifications, the more systematic control and the scientific application as well as the higher degree of training of your officers. In this way a well-knit service under Environmental Medicine should never become the object of public concern, in other words the epidemics of days gone by are now nipped in the bud and many should no longer become epidemics. I will herein give a brief survey of the greater extension of the responsibilities which now fall on the shoulders of the Public Health Committee. Health Education should now become a prominent feature of the Council's Services to the people. Up to the present it formed an accidental corollary to other functions of your officers; when these functions became operative the officers availed themselves of the opportunity to teach. Now, education of the public in the circumstances of health is a duty which the Council must no longer neglect. It will be necessary, therefore, through the medium of the press, films and lectures, to bring to the notice of the public fundamental matters concerning health. The Ministry of Health considers that the Local Councils should not only contribute to the funds of Health Education but also actively become the source of information for its people. So many Councils consider they have done their share when they have paid their contributions—Edmonton Council must not rank as one of these, but must actually extend and develop its services to provide for its people all the information they need. It is the intention of the Council to hold a Clean Food Exhibition in the forthcoming year; this will afford an excellent opportunity to the members and officers combined to launch a campaign for the production and maintenance of clean food. I regret, however, to have to mention that your present staff is insufficient to maintain such a campaign; there are some 100 factories and 500 food shops and other premises in the Borough concerned with the manufacture, preparation, storage and sale of food. Your Sanitary Inspectors now deal with unsound food and its ultimate disposal. It is your responsibility not only to deal with unsound food as such, but also to investigate the reasons why it is 5 unsound, and to take steps to prevent so far as possible such things happening in future. Further, your Committee must take such steps as may be necessary to prevent contamination of food by food handlers. In addition it will be necessary to educate people so employed in order that they may make their contribution in this direction. The Council has done very little for the prevention of atmospheric pollution; it will be necessary to investigate to a much greater degree the causes of this, and to make every effort to prevent it. Housing Departments have in more recent years taken steps to instal appliances for the consumption of Smokeless Fuel. In the past, however, this was far from being the case; the popular demands for the open fire and bituminous coal was catered for instead of the smokeless fuels. More recently the Council has been responsible for Rodent Control. This has already done good work but, in my opinion, an intensification of the work in this direction is imperative. Situated as we are in the vicinity of the River Lea, the liability to become infested and continue to become infested by rats is very great. Hence the necessity for increased effort. The Council for some years has been the Authority under the Shops Acts. Although we have been constantly harping on this subject we have not made any real advance in regulating Street Trading. The storage of food before it is distributed to the public is of vital importance where street traders are concerned. It will be necessary to pay more attention to the existing Byelaws in granting licences to Street Traders. The solution of the problem, however, is the establishment of a market or a number of small markets in the Borough to meet the needs of the citizens. Housing.—The Public Health Department has a most important and, I might add, a most difficult responsibility with regard to housing. There are a number of houses which, in the opinion of the Department, are unfit for human habitation. It will be necessary to speed up your efforts in order to clear such undesirable property from your midst. Some of these are past the standard which should be expected in a residence for healthy occupation, while others are in such an insanitary condition which, while they do not come within the scope of unfit houses, are of 6 such a standard that they will become so within a decade unless some action is taken to prevent it. The number of families living in one room has reached such serious proportions that it will need a superhuman effort to solve the problem of providing housing accommodation for them. Epidemiology—has always been a function of the Local Authority, but only in a limited sense. It concerned itself with infectious disease. The aims of epidemiology today present a very different picture. Not only is your Public Health Department concerned with the notification, disinfection, investigation, isolation or removal of cases to hospital, exclusion of contacts, but also the aetiology and prevention of all diseases—this is as it should be. From this it can be seen that the Borough Council is concerned with everything which affects the health of the individual or community, whether in the factory or at home. We have now within our reach in the Public Health Laboratory Service a means to deal effectively with many circumstances relating to infection before it actually reaches the confines of the Borough. In this way it is to be hoped that in the near future even minor infections will come under control. The convenience of this Service should be one of particular interest to the Borough Council. Birth Rate—again fell slightly below last year, and it must be emphasised here that the economic outlook of the family as well as the difficulty of obtaining suitable housing accommodation is largely responsible for this. Death Rate.—Although comparing favourably with the rest of the country, has risen. There is nothing in particular to draw attention to as to the cause of this; it is due to a general rise all round. It should be noted, however, that there is an increase in the number of deaths from cancer. I am pleased to be able to say that there is a marked fall in the Infantile Death Rate, we have now achieved the creditably low figure of 24 per 1,000 live births. I think I mentioned to the Committee some time ago that the Infantile Death Rate should be capable of reduction to 22 per 1,000 live births, and it will be 7 noted that we have now almost achieved this objective. Maternal Mortality Rate has arisen, although still very low. It is to be regretted that this rise has occurred. Poliomyelitis—became a marked feature of attention from the Public Health Department during the year. There was an incidence of 15 cases, with three deaths. This is a very difficult disease to control, firstly because so little is known about the causative agent, and secondly there can be so many cases which go undiagnosed during an epidemic; all known contacts were seen and advised about the precautions to be taken. Because of the separation of the preventive and environmental health services, a greater responsibility now rests on the shoulders of the Medical Officer of Health, because it is only through him that co-operation and co-ordination of the Council's services can be effectually carried out. The possibilities, however, are that the health services will in time bear great fruit. It will be noted by members of the Council that this changeover of the Health Services has had an unsettling effect which, when overcome, will speed up the necessary services under the National Health Service Act, 1946. I would like to mention how deeply indebted I am for the kindly co-operation which has always been given to me by Dr. D. Latham Brown, Medical Superintendent, South Lodge Hospital. I would also mention the wonderful co-operation I received from every individual General Practitioner in the Borough and how anxious they are to be of help and assistance. Usually there is some degree of friction between the General Practitioners and the Health Department, but I am glad to be able to report that I have never experienced that in Edmonton. I would like to record my very best thanks to the members of the Council, especially those members on the Public Health Committee who during the past few years had to endure the increasing strain of Local Government, but who at the same time never failed in their courtesy and consideration of the problems which from time to time presented themselves to me. I would like to thank my Chairman, Mrs. Councillor A. M. Glover, who for five years under difficult circumstances gave the Public Health Department every kindness and consideration. 8 Finally, I would like to pay tribute to the loyal co-operation of my staff in the help and assistance that they have always and unstintingly given to the Services and their fellow citizens. I have the honour to be, Ladies and Gentlemen, Your obedient servant, D. REGAN, Medical Officer of Health. 9 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,896 Population— Census of 1921 66,809 Census of 1931 77,652 Estimated by the Registrar-General for mid-year 1949 105,950 Number of inhabited houses and tenements at the end of 1949 28,333 Number of inhabited houses and tenements at the end of 1948 28,200 Rateable value, April, 1949 £749,913 Estimated product of 1d. in the £ for the year ending March 31st, 1950 £2,890 Rates in the £ for the year ending March 31st, 1950 17s. 11d. VITAL STATISTICS. Live Births. M. F. Total. Grand Total. Legitimate 722 739 1,461 Illegitimate 33 33 66 1,527 Birth-rate per 1,000 of population 14.41 Stillbirths. Legitimate 16 16 32 Illegitimate 1 3 4 36 Total of live and stillbirths 1,563 Rate per 1,000 total births 23.03 Deaths. Number 585 490 1,075 Rate per 1,000 population 10.14 Deaths from Puerperal Causes. Deaths. Rate per 1,000 total (live and stillbirths). Puerperal and post-abortive sepsis 0 0.00 Other maternal causes 3 1.91 3 1.91 Death rate of infants under one year of age. M. F. Total. Number 24 14 38 All infants per 1,000 live births 24.80 Legitimate infants per 1,000 legitimate live births 23.95 Illegitimate infants per 1,000 illegitimate live births 45.45 Deaths from Cancer (all ages) 205 „ „ Measles (all ages) 0 „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years of age) 0 11 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 Whooping cough 1 ... 1 Diphtheria ... ... ... Tuberculosis of the respiratory system 36 24 60 Other forms of tuberculosis 7 2 9 Syphilitic diseases 2 3 5 Influenza ••• 1 1 Measles ... ... ... Acute Poliomyelitis and Polio-encephalitis ... 2 2 Acute infective encephalitis 2 ... 2 Cancer of buccal cavity and oesophagus (M.) Uterus (F.) 1 11 12 Cancer of stomach and duodenum 19 9 28 Cancer of breast ... 16 16 Cancer of all other sites 97 52 149 Diabetes ... 3 3 Intra-cranial vascular lesions 48 60 108 Heart disease 141 148 289 Other diseases of the circulatory system 31 19 50 Bronchitis 46 32 78 Pneumonia 27 17 44 Other respiratory diseases 12 6 18 Ulcer of stomach or duodenum 12 7 19 Diarrhoea (under 2 years) ... ... ... Appendicitis ... 1 1 Other digestive diseases 7 9 16 Nephritis 12 10 22 Puerperal and post-abortive sepsis ... ... ... Other maternal causes ... 3 3 Premature birth 3 4 7 Congenital malformations, birth injuries, infant diseases 20 10 30 Suicide 6 3 9 Road traffic accidents 3 3 6 Other violent causes 14 9 23 All other causes 38 26 64 585 490 1,075 12 The two following tables give the deaths of those registered during the 52 weeks ended 31st December, 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 Acute Infective Encephaltis 2 ... ... ... ... ... ... 1 ... ... 1 ... Whooping Cough 1 1 ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 39 ... ... ... ... 4 8 5 5 11 6 ... Other forms of Tuberculosis 5 ... ... ... 2 2 ... ... ... ... 1 ... Syphilitic Diseases 2 ... ... ... ... ... ... ... 1 ... 1 ... Influenza 1 ... ... ... ... ... ... ... ... ... 1 ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis 1 ... ... ... ... 1 ... ... ... ... ... ... Cancer of Buccal Cavity and Oesophagus 1 ... ... ... ... ... ... ... ... ... ... 1 Cancer of Stomach and Duodenum 21 ... ... ... ... ... ... 3 3 4 8 3 Cancer of all other sites 99 ... ... ... 1 1 1 4 17 22 34 19 Diabetes ... ... ... ... ... ... ... ... ... ... ... ... Intra-cranial Vascular Lesions 49 ... ... ... ... 1 2 1 5 10 14 16 Heart Disease 141 ... ... ... ... 1 2 1 11 30 30 66 Other Circulatory Diseases 30 ... ... ... ... ... ... 2 5 1 12 10 Bronchitis 47 ... ... ... ... 1 ... 1 3 8 18 16 Pneumonia 28 2 ... ... ... ... ... ... ... 6 8 12 Other Respiratory Diseases 10 ... ... ... ... ... ... ... 2 2 6 ... Ulcer of Stomach or Duodenum 12 ... ... ... ... ... ... ... 2 6 4 ... Diarrhoea (under 2 years) ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis ... ... ... ... ... ... ... ... ... ... ... ... Other Digestive Diseases 8 ... ... ... ... 1 ... ... l 2 2 2 Nephritis 12 ... ... ... 1 ... 1 ... ... 6 4 ... Premature Birth 3 3 ... ... ... ... ... ... ... ... ... ... Cong. mal., birth injuries, infant dis. 18 17 ... ... ... ... 1 ... ... ... ... ... Suicide 6 ... ... ... ... ... ... 2 1 ... 3 ... Road Traffic Accidents 3 ... ... ... l ... 1 ... 1 ... ... ... Other violence 14 1 ... ... l ... 1 2 2 2 3 2 All other causes 31 ... ... ... 2 3 ... l 2 5 ... ... Totals 584 24 ... ... 8 15 17 23 61 115 162 159 13 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 Influenza 2 ... ... ... ... ... ... ... 1 ... 1 ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 24 ... ... ... ... 9 9 2 2 ... 2 ... Other forms of Tuberculosis 2 ... 1 ... ... ... ... ... ... 1 ... ... Syphilitic Diseases 3 1 ... ... ... ... ... ... ... ... ... 2 Measles ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis 2 ... ... ... ... 1 1 ... ... ... ... ... Cancer of Uterus 11 ... ... ... ... ... ... ... 1 4 4 2 Cancer of Stomach and Duodenum 8 ... ... ... ... ... ... 1 ... 3 1 3 Cancer of Breast 16 ... ... ... ... ... ... 3 5 3 2 3 Cancer of all other sites 54 ... ... ... 1 ... 2 1 11 13 16 10 Diabetes 3 ... ... ... ... ... ... ... ... 1 2 ... Intra-cranial Vascular Lesions 60 ... ... ... ... ... ... ... 3 4 25 28 Heart Disease 147 ... ... ... ... 1 ... 3 2 10 42 89 Other Circulatory Diseases 15 ... ... ... ... ... ... ... 1 1 4 9 Bronchitis 31 ... ... ... ... ... ... ... 3 4 6 18 Pneumonia 19 2 ... ... ... ... 1 1 1 3 2 9 Other Respiratory Diseases 6 ... ... ... ... ... ... ... ... 3 1 2 Ulcer of Stomach and Duodenum 8 ... ... ... ... ... ... ... ... 2 3 3 Diarrhoea (under 2 years) ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis 1 ... ... ... ... ... ... ... 1 ... ... ... Other Digestive Diseases 9 ... ... ... ... ... ... ... 1 2 1 5 Nephritis 11 ... ... ... ... ... ... 1 2 2 3 3 Puerperal and Post-abortive Sepsis ... ... ... ... ... ... ... ... ... ... ... ... Other Maternal Causes 3 ... ... ... ... ... ... 3 ... ... ... ... Premature Birth 4 4 ... ... ... ... ... ... ... ... ... ... Cong. mal., birth injuries, inf. dis. 8 7 ... 1 ... ... ... ... ... ... ... ... Suicide 3 ... ... ... ... ... ... 1 ... ... 1 1 Road traffic accidents 3 ... ... 1 ... ... ... ... ... 1 1 ... Other violence 9 ... ... ... 1 ... ... ... 1 1 2 4 All other causes 25 ... ... ... ... ... 3 ... 3 6 3 10 Totals 487 14 1 2 2 11 16 16 38 64 122 201 14 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M. F. Total Legitimate 22 13 35 Illegitimate 2 1 3 24 14 38 The death rate of all infants per 1,000 live births was 24.80. The death rate of all infants under one month of age per 1,000 live births was 20.95. 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 ... ... ... ... ... ... ... ... ... ... Pneumonia 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations ... ... ... 1 1 2 ... ... ... 3 Premature Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 7 ... ... ... 7 ... ... ... ... 7 Injury at Birth 6 ... ... ... 6 ... ... ... ... 6 Gastro-Enteritis ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... 1 ... ... ... 1 Violence ... ... ... ... ... ... 1 ... ... 1 Totals 18 ... ... 1 19 4 1 ... ... 24 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 Syphilitic Diseases 1 ... ... ... 1 ... ... ... ... 1 Measles ... ... ... ... ... ... ... ... ... ... Gastro-enteritis ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... .. 1 1 1 ... ... ... 2 Premature birth 3 ... ... 1 4 ... ... ... ... 4 Congenital Malformations 1 ... ... ... 1 ... ... ... ... 1 Other Causes ... ... ... 1 1 ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 1 ... ... 5 ... ... ... ... 5 Totals 9 1 ... 3 13 1 ... ... ... 14 15 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 16.7 0.39 3.7 32 London 18.5 0.37 1.7 29 Edmonton 14.41 0.33 0.00 24.80 Annual Death Rate per 1,000 of Population. All Causes Whooping Cough Diphtheria Influenza England and Wales 11.7 0.01 0.00 0.15 London 12.2 0.01 0.00 0.11 Edmonton 10.14 0.00 0.00 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 177 175 158 147 8 5 Church Street 67 81 128 99 5 1 Angel Road 103 110 145 100 6 3 Silver Street 136 148 153 140 5 5 Vagrants ... ... ... 1 ... ... 483 514 584 487 24 14 l6 LABORATORY SERVICE. On the 1st October, 1948 the Council's Laboratory was taken over by Medical Research Council, and now operates as a branch laboratory for the Public Health Laboratory Service, Colindale, to serve Edmonton, Enfield, Friern Barnet, Southgate and Tottenham. The following specimens submitted from the Edmonton area were examined by the Medical Research Council Laboratory (Edmonton), during the year, as follows:— Nature of Examination. Positive. Negative. Total. Blood Counts — — 75 Blood—Haemoglobin Estimation — — 67 Blood—Kahn Reation — — 419 Blood—Rhesus Factor — — 485 Blood—Grouping — — 484 Blood—Sedimentation rate — — 35 Blood—Wassermann Reaction — 1 1 Breast Milk for Fat Content — 1 Discharge from Boil — — 2 Dust from Schoolroom floor — — 2 Ear Swabs 1 3 4 Eye swabs for organisms 2 8 10 Faeces for the presence of organisms 12 75 87 Hairs from scalp for presence of Ringworm 4 3 7 Per-nasal swabs for H.Pertussis — 2 2 Piece of Toenail — — 1 Swabs for presence of C. Diphtheriæ:— (a) From Suspect cases — 545 545 (b) From Contacts — 329 329 (c) From Carriers and old cases, etc. — 14 14 Swabs for presence of Haemolytic Streptococci 104 645 749 Swabs for presence of Vincent's Angina 20 175 195 Swab from Ulcer — — 1 Swab from Mouth Ulcer — 2 2 Sludge from water tank (Town Hall Baths) — — 1 Urines — — 452 Vaginal Swabs for presence of organisms 3 50 53 Total Number of Examinations 4,023 17 MILK (SPECIAL DESIGNATIONS) REGULATIONS 1936-1948. 54 Samples of Designated Milks were examined during 1949. Results were as follows:— Pasteurised Milk. 32 Samples were examined. 20 Samples satisfied both the prescribed tests. 3 Samples failed to pass the Methylene Blue test. (2 of these results may be disregarded in view of the rise in temperature to above 65°F.) 1 Sample failed the Methylene Blue and Phosphatase test. 8 Samples were subjected to the Phosphatase test only and were found to be satisfactory. Tuberculin Tested (Pasteurised) Milk. 21 Samples were examined 14 Samples satisfied both the prescribed tests. 1 Sample failed both tests. 1 Sample failed the Methylene Blue test. 1 Sample failed the Methylene Blue test but the result may be disregarded in view of the rise in temparature to above 65°F. 4 Samples were subjected to the Phosphatase test only and all were found to be satisfactory. Tuberculin Tested Milk. 1 Sample was examined by both the prescribed tests and found to be satisfactory. Hospitals. Cases of infectious diseases are normally admitted to South Lodge Hospital which is now 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. SANITARY CIRCUMSTANCES OP 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. 18 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, 7241 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 989 premises (which number includes business and other premises) and at the end of the year 58 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 166 cases of Rat Infestation referred to the District Inspectors, owing to the possibility of defects in the drainage, in 80 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. Four persons were registered during the year. Rent and Mortgage Interest (Restrictions) Acts 1920-1933 During the year your Senior Sanitary Inspector has issued 4 Certificates under the above Acts upon applications of Occupiers of dwelling-houses in the district. 19 Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 249 „ „ return bedding 232 Rooms disinfected after infectious disease 298 „ phthisis 103 ,, „ ,, other cases 63 Disinfestation carried out after vermin 394 Bedding, clothing, etc., disinfected after infectious disease 1,572 articles Bedding, clothing, etc., disinfected after phthisis 502 „ „ „ „ „ „ other cases 783 „ 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 6,766. 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 355. Eight Council properties and 135 other houses were found to be infested, the total number of rooms disinfested was 394. 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 eight new licences and 117 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences :— Petroleum spirit 500,229 gallons. Petroleum mixtures (cellulose) 11,753 Carbide of calcium 17 cwts. 2 qrs. 22 lbs. Rubber Solution 100 lbs and 780 gallons. Mortuary. During the year 77 bodies were deposited in the Mortuary, 62 by order of the Coroner and 15 for sanitary reasons. Inspections. The following tabular statement gives the number and nature of the inspections made during the year :— Complaints 2,879 Infectious disease 262 Tuberculosis 5 House-to-House 262 Factories with mechanical power 281 Factories without mechanical power 42 Outworkers 215 Schools... 1 Shops and Stalls 200 Shops Act (Primary) 2 20 Shops Act (Re-inspections) — Sanitary conveniences and urinals 227 Smoke observations 19 Rat Infestation 282 Petroleum 36 General inspections 737 Sundry Visits 2,203 Cinemas and Halls 12 Visits to canal 3 Gipsies 48 Re-inspections 8,026 Inspection of Places where Food is Prepared. Butchers 89 Fish shops 58 Cafes 143 Dairies and milkshops 69 Slaughterhouses 16 Bakehouses 30 Ice Cream Shops 163 Number of Notices Served. Preliminary or Informal Notices 2,662 Statutory Notices 609 Defects Remedied. Houses repaired, cleansed, etc. 1317 D.W. cisterns repaired, covered 13 Water fittings repaired 51 Water taken off mains 5 Drains examined, tested, etc. 517 Drains cleared, trapped, repaired 436 Drains reconstructed 104 Chambers inserted 90 Chambers sealed down 34 Soil and vent pipes repaired 120 W.C.s repaired, cleansed, etc. 512 Flushing cisterns repaired 136 Waste pipes repaired, etc 144 Sinks repaired or renewed 48 Roofs repaired 1114 Gutters and R.W.P.s repaired 589 Yards paved or repaved 160 Scullery floors repaired 76 Spaces under floors ventilated 103 Dampness remedied 329 Floors repaired 264 Coppers and stoves repaired, etc. 387 New dustbins supplied 172 Accumulation of refuse removed 10 Nuisances from animals abated 1 Other nuisances abated 2449 Water supply restored 6 Dustbins supplied in default 2 Dustbins supplied on request 51 21 Canal Boats Acts. During the year 3 visits were paid to the Canal and 2 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 207 281 32 — Factories without mechanical power 10 42 3 — Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) — — — — Totals 217 323 35 — 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 9 9 1 — Overcrowding — — 1 — Unreasonable temperature — — — — Inadequate ventilation 1 1 1 — Sanitary Conveniences : Insufficient 5 4 — — Unsuitable or defective 22 22 — — Not separate for sexes 4 4 — — 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.) 31 28 2 — Ineffective drainage of floors 5 5 — — Totals 77 73 5 — 22 3.—OUTWORK—Sections 110 and 111 Nature of Work Section 110 Section111 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. 346 Household linen 11 — Artificial flowers 9 — — Furniture and upholstery 1 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 37 — — — — — Brush making 57 — — — — — Feather sorting 4 — — — — — Carding, etc., of buttons, etc 1 — — — — Stuffed toys 56 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 8 — — — — — Lampshades 4 — — — — — Brass and Brass articles 9 — — — — — Nets, other than wire nets 1 — — — — Textile weaving 1 — — — — — Totals 545 — — — — — FACTORIES. Defects Remedied. W.C.—Unsuitable or defective 22 Workrooms cleansed 9 Unreasonable ventilation 1 Drainage to floors amended 5 Sanitary accommodation improved 4 „ „ provided for Sexes 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) 2,895 (6) Number of inspections made for the purpose 7,654 (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 262 (b) Number of inspections made for the purpose 565 23 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 2,854 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 871 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 365 (2) Number of dwelling houses which were rendered fit after service of formal notices :— («) By owners 295 (b) By Local Authority in default of owners 11 B.-—Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 244 (2) Number of houses in which defects were remedied after service of formal notices :— (a) By owners 183 (b) By Local Authority in default of owners 17 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 6 (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 rendered fit. — SLAUGHTERHOUSES. Sixteen visits were paid and the carcases and organs of 15 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 :— 1 Carcase and organs. 1 Pluck. 24 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Various licences were granted as under :— Primary. Supplementary. Pasteurised 15 9 Tuberculin tested 12 8 27 17 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 :— 799 tins meat 3,655 „ milk 1,032 „ fish 599 „ jams 443 ,, beans 1,035 „ peas 351 „ soup 200 ,. carrots 126 beetroot 118 ,, vegetables 8 ,, spinach 79 cwt. potatoes 73 tins rhubarb 191 „ plums 21 „ pears 54 „ apples 21 „ cherries 62 lbs. prunes 13/4 „ strawberries 4 boxes blackcurrant: 12 tins apricots 579 „ fruit juices 96 „ grapes 29 „ peaches 689 „ tomatoes 386 „ grapefruit 11 „ damsons 2 „ lychees 2() ,, gooseberries 9 „ golden berries 66 lbs. prawns 163 jars pickles 28 cases oranges 40 boxes pears 41 „ apricots 48 tins quince 40 boats tomatoes 167 pkts. pastry mixture 80 „ cake flour 17 „ pudding mixture 17 „ flour 133 ,, sweetphat 333/4 lbs sultanas 75 ,, liver sausage 3½ stone cods roes 10 „ bream 73 „ cod 144 ,, skate 14 ,, herrings 19½ „ rock eel 53/4 „ witches 1513/4 ,, haddock 5 ,, salmon 4 „ kippers 55 ,, lemon soles 42 lbs. eels 4½ stone hake 10½ „ whiting 5 ,, rock salmon 45 „ plaice 74 „ dog fish 65 jars mussels 24 ,, walnuts 139 bottles sauce 25 184 jars paste 171 puddings 42 pkts. cereals 8½ lbs. ham 124 „ beef 17 joints beef 125¼ lbs. broken biscuits 1,652 lbs. rabbits 38 tins 193½ lbs. chicken 7 tins ,, 51 „ Mustard 104 tins spaghetti 81 pkts. chocolate spread 70 bottles salad cream 174 lbs. cheese 63 pkts. ,, 72 lbs lamb and mutton 15 joints „ „ „ 106 lbs. cake 47 cases cake 90 lbs. sausages 4 pkts. dried egg 2 gallons tinned cream Clean rood Campaign. It has been decidcd to hold a Clean Food Exhibition in the Borough duiing the forthcoming year. SHOPS ACTS and STREET TRADING In addition to the administration of the Shops Act, 1912 to 1936, and Young Persons (Employment) Act, 1938, the Department administers three Orders under the Shops Acts, 1912 to 1928. There are approximately 1,190 shops and places other than shops in the Borough which are liable to inspection. 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. 1,610 Washing facilities, sink water heaters installed 7 Contraventions were in the main of a minor character, mostly concerned with the exhibition of notices. Shops Act, 1912: Provisions as to assistants' half-holiday. One verbal caution was issued where an assistant was found in a shop on the afternoon of his half-holiday. Shops (Sunday Trading Restriction) Act 1936 : Thirty-five shops were visited in addition to supervisory operations and observations. Two contraventions were discovered ; a letter of warning was sent in each case. Young Persons (Employment) Act 1938. Cinemas and Boot and 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 in seven instances and fines amounting to £6 Is. were imposed during 1949. In 20 other instances letters of warning were issued. The inspection of shops, stalls and other 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. 26 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. PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. These diseases were made compulsorily notifiable in October, 1939. 938 cases of Measles and 169 cases of Whooping Cough were notified during the year. There were no deaths from Measles and one from Whooping Cough. Diphtheria. Only one case was notified during the year ; one case was notified in 1948. There were no deaths: Scarlet Fever. Continued to occur throughout the year in a mild form, but during the last few weeks of the year there was a sharp rise in the incidence of this disease. There were 188 cases compared with 128 in 1948 ; there were no deaths. In October, I was informed by the Medical Superintendent, South Lodge Hospital, that the number of Scarlet Fever cases for admission to this hospital would have to be restricted owing to insufficient nursing staff, and that the cases would have to be discharged much earlier than has been the practice heretofore and. further, that only 35 beds would be available for this disease in' the hospital. I was greatly disturbed at the receipt of this information, as this could raise very difficult circumstances in an area such as Edmonton, where it is almost impossible to isolate effectively an infectious disease case in more than half the houses in the Borough. A meeting was held between the Medical Superintendent, myself and the Medical Officers of Health of Enfield and Southgate, when it was agreed we would do everything to help during the nursing crisis to keep mild cases of Scarlet Fever at home where isolation was possible and where the economic circumstances of the families would not interfere and that, as soon as the crisis ceased, we would revert to our normal procedure. I circularised the Medical Practitioners in the Borough, explaining the situation at the hospital and asking the doctors to co-operate as far as possible without interfering with the wellbeing and safety of the patients, and laid down four postulates: (1) Can the patient be efficiently isolated in a separate room. (2) Are proper facilities for simple nursing and attention available at home, e.g., are both parents out at work and no other person available to stay in the home. (3) Is the case sufficiently severe to warrant admission to hospital, or developed complications during the course of the illness. (4) The economic circumstances of the family may be such as to compel the removal of the patient to hospital. 27 The matter was reported to the Council, when it was resolved to take all possible steps to ensure that hospital accommodation shall be available for Edmonton cases, particularly having regard to the serious housing position in Edmonton. " Return " cases numbered one, 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. One case was notified (Amoebic). The case was fully investigated but the source of infection was not discovered. Cerebro Spinal Fever. No cases were notified during the year. Ophthalmia Neonatorum. 3 cases were notified during the year and all occurred in the North Middlesex Hospital. There were no Edmonton Cases. Puerperal Pyrexia. 51 cases were notified during the year (4 at home, 44 in North Middlesex Hospital and 3 in other Institutions). Of this total, 17 were Edmonton cases. Food Poisoning. One case only (non fatal) was notified during the year. The patient was an adult male and the food causing the illness was suspected to have been a meal partaken at a social function outside the Borough. The organism or other agent responsible for the illness was not discovered. Pneumonia. 29 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 1.7 whilst that for Edmonton was 0.00 as compared with 2.4 and 4.74 respectively last year. 28 Poliomyelitis. During the year 15 confirmed cases of Poliomyelitis occurred in the Borough. Notifications were received in May (1), June (1), August (1), September (4), October (5), November (2), December (1). There were 3 deaths. 3 cases were notified in 1948. 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 188 145 ... ... 1 13 13 27 116 15 3 ... ... ... ... Diphtheria 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Measles 938 32 ... 36 128 130 98 140 375 10 4 8 ... ... ... Whooping Cough 169 11 1 13 19 30 29 20 54 2 ... 1 1 ... ... Pneumonia 29 7 44 8 1 2 ... ... 3 1 1 3 2 5 3 Puerp. Pyrexia 51 48 ... ... ... ... ... ... ... ... 6 36 9 ... ... Erysipelas 24 11 ... 1 ... ... ... ... ... 5 2 3 6 5 2 Food Poisoning 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Poliomyelitis 15 14 3 1 3 ... 1 1 3 1 3 2 ... ... ... Ophth- Neonatorum 3 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Malaria 1 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 60 32 20 76 ... ... 188 Diphtheria 1 ... ... ... ... ... 1 Measles 316 209 151 253 9 ... 938 Whooping Cough 74 37 31 27 ... ... 169 Pneumonia 10 ... 12 7 ... ... 29 Puerperal Pyrexia 1 ... ... 3 44 3 51 Erysipelas 8 5 2 9 ... ... 24 Food Poisoning ... ... ... 1 ... ... 1 Poliomyelitis 7 3 2 3 ... ... 15 Ophth-Neonatorum ... ... ... ... 3 ... 3 Dysentery 1 ... ... ... ... ... 1 Malaria ... ... ... ... 1 ... 1 29 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, 1,710 appointments were made—1,395 children completed treatment ; of these 1.297 were under 5 years of age. In October, 1949, combined Diphtheria and Whooping Cough immunisation was introduced ; 150 childreu received this treatment. Of the 1,297 children referred to above, 146 received the combined treatment. 18 children were Schick tested. In 1948, 1,554 children completed immunisation treatment. In addition 283 children received a re-inforcing injection. Up to 31st December, 1949, 53.84% of children under 5 years of age and 75.21% of children from 5—15 years of age had completed immunisation treatment. Whooping Cough. During the year, 714 appointments were made for this treatment—584 children completed treatment. In addition, 150 children completed combined Diphtheria and Whooping Cough treatment. 31 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 — 16 Uterus — 11 Buccal cavity and oesophagus 1 — Stomach and duodenum 21 8 All other sites 99 54 121 89 NATIONAL ASSISTANCE ACT, 1948. Section 47.—Removal to suitable premises of persons in need of care and attention. No action was necessary during the year under this Section. Several cases were dealt with by the Public Health Department, and admission to suitable premises was obtained without recourse of legal action. 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. 30 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 1 ... ... ... ... ... ... ... 1— 5 years 3 1 1 ... ... ... ... 1 5—15 „ 7 4 4 1 ... ... 2 ... 15—25 „ 12 20 1 2 4 9 2 ... 25—35 „ 13 21 2 1 8 9 ... ... 35—45 „ 11 10 1 ... 5 2 ... ... 45—55 „ 13 6 ... ... 5 2 ... ... 55—65 „ 2 2 ... 1 11 ... ... 1 65 years upwards 3 2 1 ... 6 2 1 ... 65 66 10 5 39 24 5 2 In addition 26 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) 65 66 (non-respiratory) 10 5 Transferred cases (respiratory) 19 7 (non-respiratory) ... 1 94 79 The cases dying of Tuberculosis and not previously notified were — Males. Females. Respiratory 4 3 Non-respiratory — — There were thus 7 non-notified deaths out of a total of 70 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. Other bones and joints 2 1 Glands 1 — Spine 1 — Abdomen 1 3 Brain 4 — Anus — 1 Eye 1 — 31 Public Health (Tuberculosis) Regulations, 1930. The number of cases of tuberculosis on the Register at the end of 1949. was :— Males. Females. Total. Pulmonary forms 444 377 821 Non-pulmonary forms 0 65 91 156 509 468 977 The corresponding figures at the end of 1948 were :— Males. Females. Total. Pulmonary forms 427 358 785 Non-pulmonary forms 73 94 167 500 452 952 Corresponding figures for previous years were :— Males. Females. Totals. 1947 442 405 847 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 MASS RADIOGRAPHY The North East Metropolitan Regional Hospital Board Mass Radiography Unit visited the Borough during May and June, 1949, and set out below is the rpnnrt of the Medical Director — Total number X-rayed 6,845 Number of large films called 296 Number of films regarded as normal 6,474 Group Male Female Total Factory Groups at British Oxygen Co. 2,036 955 2,991 Large films 97 32 129 Public Session at Dysons Road 480 546 1,026 Large films 44 27 71 Schools (including teachers and staff) 1.034 1,276 2,310 Large films 32 35 67 Edmonton Borough Council 349 169 518 Large films 20 9 29 TOTAL Miniatures 3,899 2,946 6,845 Large films 193 103 296 32 Number of cases of Pulmonary Tuberculosis : Female Male Total Inactive Primary 44 45 89 Inactive Post Primary 27 64 91 Active Primary — — — Active Post Primary 7 6 13 Pleural Effusion 1 1 2 Disposal of Active Pulmonary Tuberculosis Cases referred to Clinics: Female Male Total Recommended for admission to Hospital or Sanatorium I (PI. Eff.) 4 6 (i) 10 Refered to Dispensary 3 1(PI. Eff.) (i) 3 The Active Cases discovered were in the following Groups : Female Male Total Local Firms 1 (PI. Eff) 4 1 (PI. Eff.) 3 (2) 7 Public Sessions 1 2 3 Middlesex County Council 1 — 1 Edmonton Borough Council 1 — 1 Displaced Persons Agricultural Camp Hitchen — 1 1 Cases not Classified Failed to attend for large film 7 Failed to attend Clinic 1 Awaiting classification at Clinic 1 Some Abnormalities discovered (other than Pulmonary Tuberculosis) Bronchiectasis 7 Cardiovascular lesions — congenital 2 Cardiovascular lesions — acquired 23 Agenesis right lung 1 Cystic rib tumour 1 It would appear from this survey, that there was every cause to be cheerful about the results. I would remind the Council however, that your staff and that of the local Chest Clinic has already eliminated many of those who might have been amongst the ranks of those examined. I am rather concerned about the increase in Tuberculosis amongst the younger members of the population and I must here state that in my opinion, this is mostly due to the very unhealthy conditions under which some of the citizens exist 33 COUNCIL'S EMPLOYEES. During 1949 the Medical Officer of Health paid a total of 190 visits to those employees who had been on the sick list for longer than a fortnight and, when necessary, at fortnightly intervals. Of these 33 were " not at home " and I had already resumed duty. Also, during the year, 83 persons were examined prior to appointment to permanent posts. 34