AC-439(1) EDM 35 34/6/5 1644 Borough of Edmonton REPORT of the MEDICAL OFFICER OF HEALTH for the year 1 950 Borough of Edmonton REPORT of the MEDICAL OFFICER OF HEALTH for the year 1 950 Borough of Edmonton 1950 Her Worship the Mayor - Councillor Mrs. A. M. Glover, J.P. Deputy Mayor Councillor R. J. Grant PUBLIC HEALTH COMMITTEE Chairman: Alderman Mrs. F. Long, J.P. Members'. Councillor Mrs. A. M. Glover, J.P. (Ex-Officio) R. J. Grant (Ex-Officio) L. E. Bfrridge F. H. Brooks J. E. Cooke H. F. Edwards J. D. Habgood Mrs. R. A. Smythe Miss M. L. F. Strutt 3 PREFACE Public Health Department, Town Hall, Edmonton, N.9. Her Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton Your Worship, Ladies and Gentlemen, I have the honour to present my 16th Annual Report for the year 1950 on the health and sanitary circumstances of the Borough. The Report has been compiled in accordance with the requirements of the Ministry of Health Circular 112/50. The separation of the Services formerly administered by the Local Authority has made little change in the relationship which exists between your Sanitary Department and the Health Services which are now administered by the County Council; that is mainly due to the fact that your Medical Officer of Health also functions as Joint Area Medical Officer for the Area No. 1. The administration is further facilitated by having all the services in the Town Hall within easy reach of one another. There are however, some fundamental points that might be mentioned which time and patience may overcome, i.e. the relationship which formerly existed between the Local Sanitary Authority, and their Officers has now to be directed to a wider field. In as much as those Officers which have been transferred to the Middlesex County Council have now to depend upon a more centralised administration ; this leads to a slowing down of procedure to which we are not yet accustomed. Further, the introduction of other ideas which are necessary in the administration of a County have often little import to our particular needs. Again, the relationship that existed between your Assistant Medical Officers and the persons they had to deal with is now very much different from what it was in the past, as only very little 5 medical attention can be given, other than to the principles of nutrition. In my opinion this relationship should be re-established and maintained as it was one of the greatest contributions to the achievement of positive health that could be made. This was singularly so in the case of the School Medical Services under the 1921 Act. On the other hand the field available for the treatment of patients is much wider, not only are the Medical Staff now concerned with the Juvenile population but also with the entire family unit. It is clear that a wider field is covered by problems connected with the aged, and that research in this direction is not purely of academic interest. Study of the aged is of practical importance, and has a direct bearing on problems in the family, in the clinic, and in the school, no less than upon the daily activities of adult life. Health problems which present themselves from the family standpoint and the means by which we will tend to solve them, serve to indicate the importance of the contribution which the new social services can make to health in the home. William Osier said "If you have the good fortune to command a large clinic, remember that one of your chief duties is the tabulation and analysis of the carefully recorded experience. Keep and compare your observations, study them, tabulate them, seek the points of contact that may reveal the underlying law. Some things can only be learned by statistical comparison." This is the policy which the Health Department endeavoured to practise over the last sixteen years. If we regard our District as our Clinic and consider the health and well-being of our population as a whole, as well as individually, we will soon find many problems to solve. Not the least among these is the housing of those who need it so badly. In the past housing was generally considered from an economic and indeed sometimes from a political standpoint. The circumstances which now present themselves to us clearly demonstrate that housing is a very important factor in the attainment of positive health. The difficulties that present themselves with the establishment of a housing policy now-a-days are neither economic or political. Such could easily be eliminated—the difficulty lies 6 however, in the obtaining of supplies. Until our housing difficulties are overcome Tuberculosis and other diseases will remain with us for a long time. The next important factor is the feeding of the Nation. There is a danger at present that National nutrition will receive too much attention to the detriment of the individual or family. Notwithstanding restrictions and rationing, the health of the average individual appears to be satisfactory under existing circumstances. The Public Health world in 1950, was ushered in by increased attention being drawn to two important factors: (1) Health Education (2) Clean Food these two points are really a corollary of one another. It was only on investigation and research of these factors that those of us who are immediately concerned about the health of the people, were appalled at the actual contamination of food by thoughtless and negligent people. Health Education will reveal to the individual the necessity of eliminating such conditions. It has been stated by well-known hygienists that the standard of health and cleanliness which the population will receive, varies directly in proportion to the desire for it. In other words, if the customer seeks and endeavours to obtain clean food, served by clean people, from clean shops, they will ultimately get it without legislation of any kind. This also refers to the home. The standard of hygiene and cleanliness in the home is measured directly by the standard of the people who live therein. I cannot close my remarks here without drawing the attention of the Council to some of the dilapidated property which exists, alas, far too long, in our Borough. Some of this is having attention this year and I hope the Council will continue its efforts to eliminate all unsatisfactory property within its border. We were unfortunate enough to have an epidemic of Sonue Dysentry at the latter end of this year which threatens to be of far-reaching proportions—I have commented on this in the body of my Report. 7 I would like here to express my thanks to the Public Health Laboratory Service (Edmonton) under the direction of Doctor M. Thomas for the help, assistance and advice they have always so readily given us. Birth Rate—has again fallen below last year. The obtaining of suitable housing accommodation and the rising cost of living has no doubt had a direct bearing on this. Death Rate.—I am glad to say has fallen this year, and compares very favourably with the figure for the rest of the Country. Infantile Mortality Rate.—I am pleased to say is again lower than last year, and I have every hope of a still lower figure. Great credit is here due to the Doctors, Midwives and Health Visitors, as well as to the intelligent application of health principles by the mothers of the District. Maternal Mortality Rate.—Unfortunately this has again risen. Poliomyelitis.—Only two cases occurred in the Borough during the year. As this can be a very crippling disease it is a matter of congratulation to be without it. On the 30th April, 1950, we lost the services of a very conscientious and reliable Senior Sanitary Inspector in the person of Mr. W. Tillcock, who retired after almost 30 years in the service of the Borough. I wish him and Mrs. Tillcock every happiness for the future. Mr. J. P. Farrar who has been in the Public Health Department for 37 years, 25 years as a District Sanitary Inspector, was appointed to succeed Mr. Tillcock. I would like to thank my Staff for their great kindness and loyal co-operation to me during the year. Finally I wish to thank the Members of the Public Health Committee and the Council for their courtesy and help during this very difficult year. I have the honour to be, Ladies and Gentlemen. Your obedient Servant, D. REGAN Medical Officer of Health. 8 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 1950 105,500 Number of inhabited houses and tenements at the end of 1959 28,485 Number of inhabited houses and tenements at the end of 1949 28,333 Rateable value, April, 1950 £744,820 Estimated product of 1d. in the £ for the year ending March 31st, 1951 £3,000 Rates in the £ for the year ending March 31st, 1951 18s. l0d. VITAL STATISTICS. Live Births. M. F. Total. Grand Total. Legitimate 719 649 1,368 Illegitimate 35 30 65 1,433 Birth-rate per 1,000 of population 13.58 Stillbirths. Legitimate 19 10 29 Illegitimate 0 5 5 34 Total of live and stillbirths 1,467 Rate per 1,000 total births 23.17 Deaths. Number 503 488 991 Rate per 1,000 population 9.39 Maternal Mortality Deaths. Rate per 1,000 total (live and stillbirths). Toxaemias of Pregnancy 2 1.36 Complication of Pregnancy and Delivery 1 0.68 3 2.04 Death rate of infants under one year of age. M. F. Total. Number 22 13 35 All infants per 1,000 live births 24.42 Legitimate infants per 1,000 legitimate live births 24.85 Illegitimate infants per 1,000 illegitimate live births 15.38 Deaths from Cancer (all ages) 193 „ „ Measles (all ages) 0 „ „ Whooping Cough (all ages) 0 „ „ Diarrhoea (under 2 years of age) 1 9 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 Tuberculosis, respiratory 25 10 35 Tuberculosis, other 4 3 7 Syphilitic disease 4 ... 4 Diphtheria ... ... ... Whooping Cough ... ... ... Meningococcal infections ... 1 1 Acute Poliomyelitis ... ... ... Measles ... ... ... Other infective and parasitic diseases 2 ... 2 Malignant neoplasm, stomach 16 10 26 Malignant neoplasm, lung, bronchus 3D 6 36 Malignant neoplasm, breast ... 17 17 Malignant neoplasm, uterus ... 10 10 Other malignant and lymphatic neoplasms 67 37 104 Leukaemia, aleukæmia 5 ... 5 Diabetes 2 4 6 Vascular lesions of nervous system 43 79 122 Coronary disease, angina 54 46 100 Hypertension with heart disease 20 22 42 Other heart disease 53 92 145 Other circulatory disease 17 16 33 Influenza 2 1 3 Pneumonia 20 24 44 Bronchitis 43 24 67 Other diseases of the respiratory system 7 3 10 Ulcer of stomach and duodenum 10 3 13 Gastritis, Enteritis and Diarrhoea 3 3 6 Nephritis, and Nephrosis 3 4 7 Hyperplasia of Prostate 8 ... 8 Pregnancy, childbirth, abortion ... 3 3 Congenital malformations 4 4 8 Other defined and ill-defined diseases 39 50 89 Motor Vehicle Accidents 5 2 7 All other accidents 9 7 16 Suicide 7 5 12 Homicide and operations of war 1 2 3 TOTALS 503 488 991 10 The two following tables give the deaths of those registered during the 52 weeks ended 30th December, 1950. 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 Tuberculosis, respiratory 27 ... ... ... ... 3 2 8 6 6 2 ... Tuberculosis, other 3 ... ... 2 1 ... ... ... ... ... ... ... Syphilitic disease 4 ... ... ... ... ... ... ... ... 4 ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Other infective and parasitic diseases 2 ... ... 1 ... ... ... ... ... 1 ... ... Malignant neoplasm, stomach 16 ... ... ... ... ... ... 2 1 7 2 4 Malignant neoplasm, lung, bronchus 27 ... ... ... ... ... 1 2 5 13 2 4 Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... ... ... Malignant neoplasm, uterus ... ... ... ... ... ... ... • • • ... ... ... ... Other malignant and lymphatic neoplasms 68 ... ... 1 1 1 4 4 15 16 26 Leukaemia, aleukæmia 5 ... ... ... ... 1 1 1 1 ... 1 Diabetes 2 ... ... ... ... ... ... ... ... ... ... 2 Vascular, lesions of nervous 43 ... ... ... ... ... ... 3 4 5 12 19 system ... ... ... ... ... ... ... ... ... ... ... Coronary disease, angina 52 ... ... ... ... ... ... 4 6 9 20 13 Hypertension with heart disease 21 ... ... ... ... ... ... ... 1 7 6 7 Other heart diseases 53 ... ... ... ... ... 2 ... 3 8 19 21 Other circulatory disease 16 ... ... ... ... ... ... 1 ... 1 5 9 Influenza 2 ... ... ... ... ... ... ... 1 ... ... 1 Pneumonia 20 ... ... ... ... ... ... ... 1 2 6 9 Bronchitis 43 ... ... ... ... ... ... 1 3 16 11 12 Other disease of respiratory system 7 ... ... ... ... ... ... l 1 2 1 2 Ulcer of stomach and duodenum 10 ... ... ... ... ... ... ... 1 5 3 1 Gastritis, Enteritis and Diarrhoea 2 ... ... ... ... 1 ... ... ... ... ... 1 Nephritis and nephrosis 3 ... ... ... ... ... ... l ... 2 ... ... Hyperplasia of prostate 8 ... ... ... ... ... ... ... ... 4 4 Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... Congenital malformations ... 4 3 ... ... ... ... 1 ... ... ... ... ... Other defined and ill-defined diseases 41 16 ... 2 1 1 ... l 4 1 5 10 Motor Vehicle Accidents 6 ... ... ... 1 ... 2 l ... ... ... 1 All other accidents Suicide 9 1 ... ... ... 1 2 3 ... 1 1 Homicide and operations of 7 ... ... ... ... ... 1 ... ... 3 1 2 war 1 ... ... ... 1 ... ... ... ... ... ... ... TOTALS 501 22 6 6 7 10 32 45 108 116 150 11 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 Tuberculosis, respiratory 14 1 ... 1 ... 4 ... 5 2 ... 1 ... Tuberculosis, other 1 ... ...... ... ... ... ... 1 ... ... ... ... Syphilitic disease ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal infections 1 ... 1 ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Other infective and parasitic diseases l ... ... ... ... ... ... ... ... 1 ... ... Malignant neoplasm, stomach 10 ... ... ... ... ... 1 ... 3 2 3 1 Malignant neoplasm, lung, bronchus 5 ... ... ... ... ... ... 3 ... ... 1 1 Malignant neoplasm, breast 18 ... ... ... ... ... 1 1 4 6 5 1 Malignant neoplasm, uterus. 10 ... ... ... ... ... ... ... 1 3 4 2 Other malignant and lymphatic neoplasms 38 ... ... ... 1 ... 1 1 6 12 7 10 Leukaemia, aleukaemia ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 4 ... ... ... ... ... ... ... ... 2 1 1 Vascular, lesions of nervous system 81 ... ... ... ... ... ... 2 6 6 29 38 Coronary disease, angina 43 ... ... ... ... ... ... ... 2 9 20 12 Hypertension with heart disease 22 ... ... ... ... ... ... 1 1 6 5 9 Other heart diseases 89 ... ... ... ... ... 4 3 3 8 21 50 Other circulatory disease 16 ... ... ... ... ... 1 ... ... 2 4 9 Influenza 1 ... ... ... ... ... ... ... ... 1 ... ... Pneumonia 24 2 1 ... ... ... ... ... ... 1 8 13 Bronchitis 24 ... ... ... ... ... ... ... 1 1 6 16 Other disease of respiratory system 3 ... ... ... ... ... ... ... ... ... 1 2 Ulcer of stomach and duodenum 3 ... ... ... ... ... ... ... ... 1 1 1 Gastritis, Enteritis and Diarrhoea 3 1 ... ... ... ... 1 ... ... ... ... 1 Nephritis and nephrosis 4 ... ... ... ... ... ... 1 1 ... 1 1 Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... ... ... Pregnancy, childbirth, abortion 3 ... ... ... ... 1 ... 2 ... ... ... ... Congenital malformations 4 4 ... ... ... ... ... ... ... ... ... ... Other defined and ill-defined diseases 50 5 l 3 ... 2 ... 1 5 2 6 25 Motor Vehicle Accidents 2 ... ... ... ... 1 1 ... ... ... ... All other accidents 8 ... ... ... ... ... ... ... ... ... ... 8 Suicide 5 ... ... ... ... ...... 1 2 ... 2 ... ... Homicide and operations of war 2 ... l ... 1 ... ... ... ... ... ... TOTALS 489 13 4 4 2 8 11 23 36 65 122 201 12 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M. F. Total Legitimate 21 13 34 Illegitimate 1 - 1 22 13 35 The death rate of all infants per 1,000 live births was 24.42. The death rate of all infants under one month of age per 1,000 live births was 17.44. 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 Pneumonia 1 ... 1 ... 2 2 1 ... ... 5 Congenital Malformations 1 1 ... ... 2 1 ... ... ... 3 Premature Birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis 4 1 ... ... 5 ... ... ... ... 5 Injury at Birth 4 ... ... ... 4 ... ... ... ... 4 Violence ... ... ... ... ... ... ... ... 1 1 Totals 14 2 1 ... 17 3 1 ... ... 22 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 Tuberculosis Respiratory ... ... ... ... ... 1 ... ... ... 1 Gastro-enteritis ... ... ... ... ... ... ... 1 ... 1 Pneumonia ... ... ... ... ... ... 1 ... 1 2 Premature Birth 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations 3 ... ... ... 3 ... 1 ... ... 4 Other Causes 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Totals 8 ... ... ... 8 1 2 1 l 13 13 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 16.8 0.37 1.9 29.8 London 17.8 0.36 1.0 26.3 Edmonton 13.58 0.32 0.69 24.42 Annual Death Rate per 1,000 of Population. All Causes Whooping Cough Diphtheria Influenza England and Wales 11.6 0.01 0.00 0.10 London 11.8 0.01 0.00 0.07 Edmonton 9.39 0.00 0.00 0.02 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 169 162 145 140 7 4 Church Street 61 52 104 105 2 2 Angel Road 115 94 103 108 7 2 Silver Street 120 101 149 136 6 5 Vagrants ... ... ... ... ... .... 465 409 501 489 22 13 14 LABORATORY SERVICE 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 — — 47 Blood—Haemoglobin Estimation — — 387 Blood—Kahn Reaction — — 440 Blood—Rhesus Factor — — 444 Blood—Grouping — — 443 Blood—Sedimentation Rate — — 3 Blood—Wassermann Reaction — — 1 Breast Milk for Fat Content — — 2 Cartons of Cream — — 2 Eye swabs for organisms — 4 4 Faeces for the presence of organisms 248 1283 1531 Faeces for presence of roundworm 1 — 1 Hairs from scalp for presence of Ringworm — 2 Meat Loaf and Luncheon Sausage — 1 1 Meat Pudding — — 1 Per-nasal swabs for H.Pertussis — 4 Perineal swab — — 1 Pus from neck gland — — 1 Pus from abscess in leg of mutton — — 1 Sardines — — 1 Swabs for presence of C. Diphtherias:— (a) From Suspect Cases — 468 468 (b) From Contacts — 190 190 (c) From Carriers and old cases, etc. — 285 285 Swabs for presence of Haemolytic Streptococci 591 3316 3907 Swabs for presence of Vincent's Angina 2 92 94 Swab from Ulcer — 4 4 Swab from Mouth Ulcer — 2 2 Urines — — 649 Vaginal swabs for presence of organisms — 68 68 Vesicle fluid — — 2 Water from storage cistern in school cloakroom — — 1 Total Number of Examinations 8,987 15 MILK (SPECIAL DESIGNATION) REGULATIONS 1949. 64 Samples of Designated Milks were examined during 1950. Results were as follows:— Pasteurised Milk. 27 Samples were examined. 13 Samples satisfied both the prescribed tests. 4 Samples failed to pass the Methylene Blue test. (3 of these results may be disregarded in view of the rise in temperature to above 65°F.) 10 Samples were subjected to the Phosphate test only and were found to be satisfactory. Tuberculin Tested (Pasteurised) Milk. 18 Samples were examined. 14 Samples satisfied both the prescribed tests. 1 Sample failed the Methylene Blue test but the result may be disregarded in view of the rise in temperature to above 65°F. 3 Samples were subjected to the Phosphate test only and all were found to be satisfactory. Tuberculin Tested Milk. 1 Sample was examined and failed the Methylene Blue test. Sterilised Milk. 18 Samples were examined and all passed the Turbidity test. 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. 16 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. Sanitary Conveniences. There are seven Public Conveniences in the Borough which are kept under constant supervision by the Public Health Department. Rodent Control. Under this heading your Senior Sanitary Inspector, as Officer-in-Charge, Rodent Control, reported as follows:— The Prevention of Damage by Pests Act, 1949 came into force on the 31st March, 1950, and repealed the Rats and Mice (Destruction) Act, 1919. The Council have an Assistant Rodent Officer, two Rodent Operators, the part-time services of a Junior Clerk and appointed the District Sanitary Inspectors as Rodent Officers. 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. In 80 per cent of the cases defects were discovered and as one can quite appreciate entailed quite a large amount of work. The following table gives details of the work carried out during the year. 1. Prevalence of Rats and Mice. Type of Property. Infestations notified by Occupier. Otherwise Discovered. Total. Infestations. Mice Only. Major Minor. Local Authority's Premises 15 2 17 12 3 2 Dwelling Houses 579 53 632 3 552 77 Business Premises 85 6 91 26 54 11 Total 679 61 740 41 609 90 2. Measures of Control. Type of Property. Properties Inspected. No. of Inspections Notices Served. Treatment Completed. Block Treatments Rats. Mice. Local Authority's Premises 17 134 ... 31 1 ... Dwelling Houses 837 2,928 ... 403 63 ... Business Premises 91 746 ... 90 17 3 Total 945 3,808 ... 524 81 3 During the year maintenance treatments of the sewers took place by the Borough Engineer's Department. 17 Middlesex County Council Act, 1944, Section 279, Hawkers, Etc. This Act will be superceded by the Middlesex County Council Act, 1950 Section II from the 1st April, 1951. No persons were registered. Rent and Mortgage Interest (Restrictions) Acts 1920-1933 During the year your Senior Sanitary Inspector has not issued any Certificates under the above Acts upon applications of Occupiers of dwelling-houses in the District. Disinfection and Disinfestation. The following table gives some idea of the work carried out:— Number of journeys to collect bedding 285 „ return bedding 245 Rooms disinfected after infectious disease 431 „ phthisis 93 „ other cases 36 Disinfestation carried out after vermin 458 Bedding, clothing, etc., disinfected after infectious disease 2,309 articles Bedding, clothing, etc., disinfected after phthisis 489 „ Bedding, clothing, etc., disinfected after other cases 502 „ 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 8,523 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 1,582. 28 Council properties and 149 other houses were found to be infested, the total number of rooms disinfested was 458. 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 8 new licences and 113 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences:— Petroleum spirit 436,444 galls. Petroleum mixtures (cellulose) 3,893 „ Carbide of calcium 1,200 lbs. Rubber solution 880 galls. Mortuary. During the year 120 bodies were deposited in the Mortuary, 110 by order of the Coroner and 10 for sanitary reasons. 18 Inspections. The following tabular statement gives the number and the nature of the inspections made during the year: — Complaints 2,572 Infectious disease 1,082 Food Poisoning 22 Tuberculosis 1 House-to-House 174 Factories with mechanical power 339 Factories without mechanical power 6 Factories (other) 6 Outworkers 42 Schools 8 Offensive trades 5 Shops and Stalls 139 Shops Act (Primary) 10 Shops Act (Re-inspections) 11 Sanitary conveniences and urinals 201 Smoke observations 64 Rat infestation 314 Petroleum 62 General inspections 738 Sundry visits 1,160 Cinemas and Halls 27 Stables 87 Piggeries 69 Gipsies 136 Re-inspections 8,878 Inspection of Places where Food is Prepared. Butchers 98 Fish shops 51 Cafes 134 Dairies and milkshops 63 Slaughterhouses 20 Bakehouses 29 Ice cream shops 198 Number of Notices Served. Preliminary or Informal Notices 1,954 Statutory Notices 708 Defects Remedied. Houses, repaired, cleansed, etc. 1,579 D.W. cisterns repaired, covered 8 Water fittings repaired 20 Water taken off mains 2 19 Drains examined, tested, etc. 624 Drains cleared, trapped, repaired 360 Drains reconstructed 309 Chambers inserted 114 Chambers sealed down 35 Soil and vent pipes repaired 163 W.C.s repaired, cleansed, etc. 498 Flushing cisterns repaired 126 Waste pipes repaired, etc. 155 Sinks repaired or renewed 81 Roofs repaired 1,226 Gutters and R.W.P.s repaired 677 Yards paved or repaved 114 Scullery floors repaired 55 Spaces under floors ventilated 95 Dampness remedied 268 Floors repaired 272 Coppers and stoves repaired, etc. 306 New dustbins supplied 185 Gipsies removed 28 Accumulation of refuse removed 32 Rooms cleansed after infectious disease 13 Other nuisances abated 3,170 Water supply restored c 6 Dustbins supplied in default 13 Dustbins supplied on request 48 Places of Public Entertainment. Twenty-seven 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 194 339 31 – Factories without mechanical power 7 6 1 – Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) 5 6 – – Totals 206 351 32 — 20 2.—Defects Found. Particulars Number of defects No. of defects in respect of which prosecutions were instituted Found Remedied Referred by H.M. Inspector Want of cleanliness 2 2 1 – Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — Sanitary Conveniences : Insufficient 3 2 – – Unsuitable or defective 17 16 3 — Not separate for sexes — 1 — — Other offences (Not including offences relating to outwork) 3 3 – – Totals 25 24 4 — 3.—OUTWORK—Sections 110 and 111 Nature of Work Section 110 Section 111 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. 268 9 — – – – Artificial flowers 12 — — — — — Furniture and upholstery 3 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 42 – – – – – Brush making 55 — — — — — Stuffed toys 46 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 6 – – – – – Lampshades 3 – — — — — Brass and Brass articles 6 – — — — — Lace, Lace Curtains and Nets 18 — — — — — Totals 459 9 — — — — 21 FACTORIES. Defects Remedied. W.C.—Unsuitable or defective 16 Workrooms cleansed 2 Sanitary accommodation improved 2 „ „ provided for Sexes 1 Intervening ventiliated space provided 2 New sanitary accommodation provided 2 HOUSING—HOUSING ACT, 1936. Following representation by the Medical Officer of Health, the Council on the 12th July, 1950, made a Clearance Area Compulsory Purchase Order under Part 3, Housing Act, 1936, comprising the following premises:— 1. Osman Road Clearance Area. 1950. 402, 404, 406, 416, 418, 420, 422 & 424, Fore Street; 1 to 21 (odd numbers inclusive), Osman Road. 2 to 26 (even numbers inclusive), Osman Road ; 3 to 23 (odd numbers inclusive), Beaconsfield Road ; making a total of 43 houses and involving 134 persons. A Public Inquiry was held and the Ministry of Health subsequently confirmed the Order in December, 1950. 2. Inspection of Dwelling Houses During the Year :— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,415 (b) Number of inspections made for the purpose 10,246 (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 174 (b) Number of inspections made for the purpose 592 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 58 (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 2,211 3. 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 995 22 4. 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 350 (2) Number of dwelling houses which were rendered fit after service of formal notices :— (a) By owners 233 (b) By Local Authority in default of owners 22 B.—Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 623 (2) Number of houses in which defects were remedied after service of formal notices :— (a) By owners 432 (b) By Local Authority in default of owners 20 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 14 (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. Sixteen visits were paid and the carcases and organs of 21 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 set of lungs. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Various licences were granted as under: — Primary Supplementary Pasteurised 46 18 Tuberculin tested 23 15 Sterilised 74 16 143 49 Suplementary 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 the premises are situate. 23 Ice Cream. Seventeen new registrations were granted during the year. Number on Register at end of year: — Manufacturers and Vendors 7 Vendors only 159 During the year 35 Samples were submitted for bacteriological examination, of these 10 were Grade 1 9 were Grade 3 11 were Grade 2 5 were Grade 4 Unsound Food. The following is a list of the food surrendered for examination and retained as unfit for human consumption: — 1217 tins Meat 143½ stone Haddock 3275 „ Milk 10 „ Halibut 1352 „ Fish 17 „ Herrings 284 „ Jams & Mrmlde. 14 lbs. Kippers 464 „ Soups 13 stone Plaice 757 „ Beans 17 „ Rock Eel 241 „ Beetroot 26 „ Rock Salmon 129 „ Carrots 251 „ Skate 62 „ Mixed Veg. 4 „ Witches 25 „ Veg. Macedoine 1 box Mixed Fish 1257 „ Peas 8½ stone Roes 79 cwts. Potatoes 1165½ lbs. Ham 61 tins Spinach 2 only Chickens 15 „ Turnips 80 lbs. Walnuts 93 „ Apples 28 „ Liquid Egg 5 „ Blackcurrants 36 „ Flour 77 „ Cherries 3 „ Suet 40 „ Damsons 2 „ Sweets 2½ lbs. Dates 6½ cwt. Cake 12 „ Figs 11 packets Cake Mixture 5 tins Gooseberries 14 only Choc. Biscuits 3 „ Grapefruit 1 cwt. Semolina 22 „ Grapes 4½ lbs. Rice 4 „ Lychees 46 packets Cereals 652 „ Plums 490 Puddings 9 „ Prunes 37 packets Custard Powder 22 „ Peaches 3½ ozs. Butter 69 „ Pears 6 tins Peanut Butter 3 „ Pineapple 1 „ Bournvita 2 „ Oranges 4125 bottles Salad Gream 75 „ Rhubarb 30¾ lbs. Sultanas 5 „ Strawberries 33 tins Tomato Juice 580 „ Tomatoes 1 „ Honey 121 „ Fruit Juices 7 „ Syrup 251 lbs. Offal Trimmings 7 „ Molasses 116 „ Beef 11 packets Macaroni 24 118 lbs. Lamb 99 lbs. & 27 „ Pork 130 packets Cheese 34 „ Lambs Plucks 213 jars Pickle 100 „ Ox Cheek 59 bottles Sauce 85J „ Rabbit 272 tins Fish Paste 56 „ Sheeps Heads 76 „ Meat Paste 5 cases Pigs Maws 22 cartons Choc. Spread 3 joints Meat 16 „ Savoury Spread 8 stone Cat Fish 66 tins Spaghetti 16½ Cod 14 „ Baby Food 10 „ Dog Fish 320 loaves Bread 5 „ Fillet 30 only Coconuts Clean Food Campaign. In collaboration with the Infestation Control Division of the Ministry of Agriculture and Fisheries, a Clean Food Exhibition was held in the Town Hall during the week 23rd to 28th October, 1950. The Exhibition, which was opened by Mr. Austen Albu, Member of Parliament for Edmonton, included exhibits relating to:— Infestation Division of the Ministry of Agriculture and Fisheries, Ministry of Food, Ice Cream Manufacture, Production of Clean Milk, Hygiene in Communal Feeding, Sterilizing of Eating and Drinking Utensils, Food Borne Infections, Personal Hygiene, etc., also the work of the Public Health Department in safeguarding the food supply of the Borough. Films were shown at intervals throughout the week. 1,928 persons, including several organised parties of school children visited the Exhibition, and although I would have wished for a much larger attendance, the value of the Exhibition cannot be measured purely by the numbers attending. However, if the lesson of how infection is caused and how contamination can be avoided has been learned by those who did attend, then the Exhibition was worthwhile. I should like to record my deep appreciation to Dr. M. Thomas and Mr. J. Cowlard of the Public Health Laboratory Service (Edmonton) for the valuable and interesting lectures which they gave to the visitors throughout the week, also to all those who assisted with the Exhibition. A communication was received from a local resident following her visit to the Exhibition regarding the provision of free facilities for the washing of hands in the Public Conveniences, after using the W.C. I hope to be able to report further on this matter in my next report. At the latter end of the year the Council decided to make Byelaws with respect to Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, based on the Model Byelaws issued by the Ministry of Food. I welcome the Council's action in this matter, but, nevertheless, I feel our primary duty lies in the education of all those concerned with the handling, preparation and sale of food for human consumption. We must 25 be ready at all times to give lectures and demonstrations to the various organisations, youth clubs, etc., in addition to regular and frequent inspections of the factory canteens, restaurants, cafes, shops and other places where food is handled and prepared for human consumption. In order to do this, and to ensure that the provisions of the proposed Byelaws are being observed, it will be necessary to appoint two additional Sanitary Inspectors whose primary duties will be in this direction. 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. 992 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 letter of warning was issued where 2 assistants were found in a shop on the afternoon of their half-holiday. Shops (Sunday Trading Restriction) Act, 1936 Twenty-nine shops were visited in addition to supervisory operations and observations. Two contraventions were discovered ; a letter of warning was sent in each case. Registers required to be kept under this Act were inspected periodically. 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 were perodically inspected. Middlesex County Council Act, 1944 Street Trading.—No Legal proceedings were instituted during 1950. In ten 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 has now been completed. 26 PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. These diseases were made compulsory notifiable in October, 1939. 796 cases of Measles and 285 cases of Whooping Cough were notified during the year. There were no deaths from Measles or Whooping Cough. Diphtheria. No cases were notified during the year ; one case was notified in 1949. Scarlet Fever. Continued to occur throughout the year in a mild form. There were 331 cases compared with 188 in 1949 ; there were no deaths. "Return" cases numbered four, 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. Following information received from a neighbouring Authority a letter was sent on the 27th November, 1950 to the General Practitioners in Edmonton, asking for their co-operation in sending to the Town Hall, Specimens for culture and diagnosis in any cases of Enteritis, mild or otherwise, in order that such steps as may be necessary be taken to check the disease. On the 4th December, 1950 a further letter was sent informing them of an outbreak of Diarrhoea and vomiting in the Borough mainly due to Sonne Dysentery. At this time the outbreak appeared to be mainly concentrated in the Raynham Road School Area and the Nursery Class of this school was closed for the time being. The following steps were taken to deal with the situation : — (1) Faeces outfits were supplied by the Public Health Department to all children in the class and where specimens were found to be negative the children were allowed to return to school, after submitting 2 further negative specimens. (2) Where found positive, parents were advised to consult their private doctor. (3) No child was allowed to return to school until 3 consecutive negative specimens were obtained. Within a few days it was apparent that the disease was spreading to other parts of the Borough, and I therefore requested the Borough Education Officer to circularise all schools in the area that every child must wash its hands 27 immediately on arrival at the school and immediately after using the W.C.— paper towels to be provided. Wash basins and W.C.s at all schools to be thoroughly cleansed each day with a solution of Lysol. I also asked that any child absent from school during the past 2 weeks on account of Diarrhoea or sickness to be sent home at once and the Head Teacher to inform the Public Health Department of the name and address of each child sent home, so that the Sanitary Inspector might call at the home and arrange for the submission of 2 faeces specimens and if these proved negative the child would return to school. Within a few days several hundred children were notified to me to be absent from school as suffering from or to have recently suffered from Diarrhoea and/or vomiting. Each of these children was visited and faeces outfits left at the homes. The inhabitants of the Borough were informed through the Local Press of the outbreak of Dysentery in the area, and advised of the necssity for the strictest attention to personal hygiene. Children suffering from Diarrhoea to be kept away from School, and all persons so suffering to consult their own doctors at once. Care in the preparation of food, and the disinfection of soiled personal clothing or bedding. Specimens were requested from home contacts—Positive cases employed in food handling were excluded until 3 consecutive negative specimens were obtained. Home contacts of school age were also excluded until the patient submitted 3 consecutive negative specimens, and they themselves submitted 3 consecutive negative specimens. Between 29th November, 1950 and 23rd December, 1950—the Public Health Department submitted 1,178 fæces specimens for examination by the Public Health Laboratory Service (Edmonton), 196 were found to be positive. Up to the end of the year 94 cases of Dysentery had been notified—91 Sonne. 2 Bacillary and 1 Flexner. So far investigation has failed to show the source of the outbreak ; owing to the generally mild nature of the illness, I strongly suspect the disease must have been prevalent in the Borough for some time, but the action taken by the Department following the outbreak in the Nursery Class, referred to above, revealed the extent of the incidence. The Flexner patient proved to be contact of a case of this disease which had occurred in a neighbouring Borough. I should like to record my appreciation of the valuable co-operation received from the General Practitioners, Education Department and Teachers, also the Staff of the Public Health Laboratory Service (Edmonton) with whom we have maintained the closest contact. Meningococcal Infection- Four cases were notified during the year. 28 Ophthalmia Neonatorum. Eight cases were notified during the year (1 at home, 6 in North Middlesex Hospital, and 1 in other Institution) of this total 3 were Edmonton cases. Puerperal Pyrexia. 36 cases were notified during the year (1 at home, 30 in North Middlesex Hospital and 5 in other Institution). Of this total, 12 were Edmonton cases. Food Poisoning. Six cases (non fatal) were notified during the year, as follows: — Case No. Sex Age Suspected Cause of Illness Organism Responsible 1 M 51 Duck Eggs Salmonella Typhi-Murium 2 F 29 1 Meal eaten at tea rooms outside the Borough Unknown 3 M 36 Unknown 4 M 35 Duck Eggs Salmonella Typhi-Murium 5 M 7/12 Unknown Salmonella Typhi-Murium 6 F 3 Unknown Salmonella Typhi-Murium Pneumonia. 22 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 1.0 whilst that for Edmonton was 0.69 as compared with 1.7 and 0.00 respectively last year. Poliomyelitis. During the year 2 confirmed cases of Poliomyelitis (1 Paralytic and 1 nonParalytic) occurred in the Borough. Notifications were received in February (1), October (1). There were no deaths. 15 cases were notified in 1949. 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. 29 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 331 201 ... ... 5 28 41 48 172 28 7 2 ... ... ... Measles 796 15 ... 27 76 89 124 132 335 4 3 4 1 1 ... Whooping Cough 285 11 ... 24 19 32 45 45 112 1 ... 1 5 1 ... Pneumonia 22 3 44 1 1 2 ... 1 2 1 4 2 1 4 3 Puerp. Pyrexia 36 35 ... ... ... ... ... ... ... ... 3 26 7 ... ... Erysipelas 16 5 ... ... ... ... ... ... 1 ... ... 2 1 8 4 Food Poisoning 6 ... ... 1 ... ... 1 ... ... ... ... 1 2 1 ... Poliomyelitis 2 2 ... ... ... 1 ... ... 1 ... ... ... ... ... ... Ophth- Neonatorum 8 7 ... 8 ... ... ... ... ... ... ... ... ... ... ... Dysentery 94 1 ... 3 3 6 6 19 35 8 1 4 6 2 1 Meningococcal Infection 4 4 1 ... 1 ... 1 ... ... 1 ... 1 ... ... ... The folowing 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 152 46 62 71 ... ... 331 Measles 166 251 138 237 4 ... 796 Whooping Cough 91 90 24 80 ... ... 285 Pneumonia 1 4 8 9 ... ... 22 Puerperal Pyrexia ... ... 1 ... 30 5 36 Erysipelas 6 2 2 6 ... ... 16 Food Poisoning 2 3 ... 1 ... ... 6 Poliomyelitis 1 1 ... ... ... ... 2 Ophth-Neonatorum ... ... ... 1 6 1 8 Dysentery 4 2 81 ... 7 ... 94 Meningococcal Infection ... 2 ... 2 ... ... 4 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, 1,561 appointments were made—1,243 children completed treatment; of these 1,065 were under 5 years of age. In October, 1949, combined Diphtheria and Whooping Cough immunisation was introduced : 467 children completed this treatment. Of the 1,065 children referred to above, 456 received the combined treatment. 14 children were Shick tested. In addition 1,294 children received a re-inforcing injection. Up to 31st December, 1950, 55.75% of children under 5 years of age and 78.04% of children from 5—15 years of age had completed immunisation treatment. 30 Whooping Cough. During the year 81 appointments were made for this treatment—72 children completed treatment. In addition, 467 children completed combined Diphtheria and Whooping Cough treatment. 7 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 — 18 Uterus — 10 Lung, Bronchus 27 5 Stomach 16 10 All other sites 68 38 111 81 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. Seven existing licences under the Middlesex County Council Act were renewed during the year. 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 ... ... 1— 5 years 5 1 2 ... ... 1 2 ... 5—15 ,, 3 4 1 1 ... ... 1 ... 15—25 „ 17 24 3 3 3 4 ... ... 25—35 „ 9 17 ... 3 2 ... ... ... 35—45 „ 10 7 1 ... 8 5 ... 1 45—55 ,, 5 3 1 ... 6 2 ... ... 55—65 „ 7 4 ... ... 6 ... ... ... 65 years upwards 4 2 ... ... 2 1 ... ... 60 63 9 7 27 14 3 1 31 In addition 19 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 60 63 (non-respiratory) 9 7 Transferred cases (respiratory) 12 7 (non-respiratory) 1 — 82 77 The cases dying of Tuberculosis and not previously notified were: — Males Females Respiratory — 1 Non-respiratory — — There was thus 1 non-notified death out of a total of 42 persons registered as dying of tuberculosis (Registrar's figures). Regarding the non-notification of the above case, 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 2 Glands 3 1 Spine 1 — Genito-Urinary System — 4 Public Health (Tuberculosis) Regulations, 1930. The number of cases of tuberculosis on the Register at the end of 1950 was: — Males Females Total Pumonary forms 452 403 855 Non-pulmonary forms 67 95 162 519 498 1,017 32 The corresponding figures at the end of 1949 were: — Males Females Total Pulmonary forms 444 377 821 Non-pulmonary forms 65 91 156 509 468 977 Corresponding figures for previous years were: — Males Females Total 1948 500 452 952 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 COUNCIL'S EMPLOYEES. During 1950 the Medical Officer of Health paid a total of 160 visits to those employees who had been on the sick list for longer than a fortnight and when necessary, at fortnightly intervals. Of these 22 were "not at home" and 11 had already resumed duty. Also, during the year, 46 persons were examined prior to appointment to permanent posts. 33 Printed by Jolly the Printer Ltd. 238, Street Edmonton, N.18