34/6/9 Ac. 439 (1) EDM 39 BOROUGH OF EDMONTON REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 5 4 Borough of Edmonton With the Compliments of the Medical Officer of Health Public Health Department, Town Hall, Edmonton, N.9. BOROUGH OF EDMONTON REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1954 liimntglj nf ®bmnntnn 19 5 4 His Worship the Mayor - Alderman Mrs. F. Long, J.P. Deputy Mayor - - Alderman L. E. Berridge (Part year) Councillor M. Simpson (Part year) PUBLIC HEALTH COMMITTEE Chairman: Councillor J. E. Cooke. Vice-Chairman: Councillor Mrs. R. A. Smythe. Members: The Mayor (Alderman Mrs. F. Long, J.P.) (Ex Officio) The Deputy Mayor (Alderman L. E. Berridge) (Ex Officio) (Part year) (Councillor M. Simpson) (Ex Officio) (Part year) Councillor F. H. Brooks G. W. Burrows Mrs. A. M. Glover E. R. Holborn M. Simpson (Part year) C. E. Wright 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health : D. Regan, B.A., B.Sc., M.B., Ch.B., B.A.O., D.P.H.(L'pool.). Deputy Medical Officer of Health : Catherine A. Goggin, M.B., B.Ch., B.A.O., D.P.H. Senior Sanitary Inspector: abc John P. Farrar. District Sanitary Inspectors: abc F. Beilby abc H. W. Grieves abcd V. C. quin abcd R. H. Sandford ac G. W. Alexander (left 19.6.54) ac D. Harwood (left 4.4.54) ac R. D. Richards (left 30.4.54) abcd E. W. C. George (commenced 25.10.54) abcd F. A. Freeman (commenced 17.12.54) Woman Sanitary Inspector: Miss A. Hurley (left 2.6.54) Trainee Sanitary Inspectors: T. C. Oliver (commenced 12.10.54) J. T. Woolford (commenced 1.11.54) Senior Clerk: a F. J. Nash Clerical Staff: H. J. Weldon Miss I. Holloway A. Ballantine Mrs. E. J. Richards Mrs. I. Heard T. C. Oliver (until 11.10.54) Miss G. Maryan (died 25.12.54) B. English Shops Act and Street Trading Inspector: A. Robinson a Certificated Sanitary Inspector. b Certificate of Meat and Food Inspector. c Inspector under the Petroleum Acts. d Certificate of Smoke Inspector. 4 PREFACE Public Health Department, Town Hall, Edmonton, N.9. His Worship the Mayor, Aldermen and Councillors of the Borough of Edmonton. Your Worship, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1954 on the health and sanitary circumstances of the Borough. The Report is compiled in accordance with the requirements of the Ministry of Health Circular 28/54. Death Rate.—There is a fall in the Death Rate which is probably influenced by the reduction in the Infantile Mortality. The Adult Rate remaining much the same as previously. Birth Rate.—Shows a slight increase on 1953, which indicates that the slow decline so characteristic of previous years may be finished. Infantile Mortality Rate—15.82. This is a considerable decrease on the previous year and shows that with all the duties which your officers have now to face, interest in the children's welfare has not ceased. Maternal Mortality Rate—.77. Remains low, but we have not succeeded in having the clean slate that we had in 1953. As usual, the new year is ushered in with consideration of what happened in the previous year and new resolutions to make further progress in the year that lies ahead. 5 In the Epidemiological world, Tuberculosis, Poliomyelitis, Food Poisoning and Vaccination against Smallpox engaged our attention. Tuberculosis.—This is the first time that the incidence of Tuberculosis shows evidence that it has reached its peak in this district; whilst the new treatment of this disease was clearly gaining ground by a fall in the death rate, the incidence is showing an increase, but some of this increase could be explained by: (1) Better methods of diagnosis. (2) The growing knowledge by members of the public of the benefits of early diagnosis and treatment. (3) The efforts made by Doctors, Health Visitors, Sanitary Inspectors and the general Nursing Staff in advising the people and bringing to their notice the methods of treatment that are available. This is very much in evidence in the ever-increasing numbers who attend the sessions for mass radiography. The time has come when a Mass Radiography Unit should be permanently established in the district and made available to the general public. (4) Better housing. It need hardly be stated that the improved environmental conditions associated with housing is a great factor. There still remains, however, the great evil of the undiagnosed case which frequently adds untold damage before it is detected, but a prompt rehousing of the infected is well nigh impossible. Firstly, great pains should be taken to impress on the people the fact that Tuberculosis was still an infectious disease and should be dealt with as such in all the phases of prevention, detection, treatment and convalescence. The second point for emphasis is that it is a social disease, involving all the attendant circumstances connected with such a condition, viz., housing, nutrition, family disorganisation, rehabilitation and welfare of the family as a whole. The third point is the treatment. It is obvious that Chemotherapy alone is not all the answer. Detection, prevention and the allimportant one—the conduct and co-operation of the patient—is, of course, of supreme importance. The Minister of Health emphasised that prevention had the first priority and this was becoming true not only of Tuberculosis 6 urged that attention should now be focused on detective work and teamwork between Hospital, Medical Officer of Health and General Practitioner. The first objective was to find everyone with an active focus and having found and made available to him such treatment as was necessary, there was the further obligation of the Local Health Authority to ascertain if possible whence he had obtained his infection and whether he had or was likely to infect others. Early and complete notification of all detected cases was an essential contribution that clinicians in and out of hospital should make. If the same energy was put into tracing the source of Tuberculosis infection as was put into tracing the source of Typhoid or Smallpox the decline in incidence would be speeded up. A satisfactory scheme for the prevention of Tuberculosis was dependent on a number of people. The primary responsibility rests in this country on the Medical Officer of Health working through and with the Chest Physicians, the General Practitioner and Factory Doctor. It is essential that there should be close cooperation between them and that other Local Authority Staff should co-operate to the full. It is very important that the General Practitioner should be informed, as he is, and should be. the vital discoverer in the early case. No campaign which is not fully known to the General Practitioner and supported by him can succeed; the Health Visitor has a very important part to play, but the Sanitary Inspector, Housing Manager, Social Worker, the District Nurse and School Teacher are all concerned and so is the Medical Officer of Health as School Medical Officer. The Medical Officer of Health is now so much preoccupied by matters of a minor character that he has little time for schemes of an Epidemiological nature. Although progress has been made there is still no room for complacency. A matter which gives one uneasiness is the growing tendency of admitting suspected cases to the wards of General Hospitals. Some of our hospitals are unfit places for this purpose because of their structure and hygiene arrangements do not permit of the necessary measures for prevention to be taken and also no better place can be found, where more susceptible persons are congregated together for the spread of the disease. 7 B.C.G. Vaccine is now unnecessarily withheld from the General Practitioner and the Public Health Doctors. Again the Chest Clinic gives cause for anxiety. While the staff in this Institution deserves the greatest praise for the quality and quantity of work done for those who are affected, the conditions under which they attend are still sadly lacking and fraught with danger to the many contacts who are sent there for diagnosis. Some improvement is suggested in the present building. This project merits the highest priority, but in the meantime the people must suffer on. Remember, Tuberculosis is an infectious disease and every effort should be made to check its progress. Poliomyelitis.—This disease merits every attention, not only because it has received widespread publicity in the press, but also because of its crippling effects. During this year we have been fairly free from it, but in the past the facilities available for the treatment of cases, after the infectious phase, were not adequate, except for small numbers. A Vaccine has been developed in the U.S.A. known as the " Salk " Vaccine. Three types of Poliomyelitis have been identified: Type 1 (Brunhilde), Type 2 (Lancing), Type 3 (Leon). The prevalent type at present is Type 1, but all three have occurred. Immunity to one type does not protect against the other two. The difficulty experienced in developing the Vaccine is that the virus will grow only on living tissue. A trivalint Vaccine has been grown on tissue culture on living kidney tissue of the Rhesus monkey. Clinical trials have shown that it is well tolerated and provides an active immunity which lasts a minimum of seven months. Investigation of this Vaccine and its production has been entrusted to the Medical Research Council in this country. It is to be hoped that this august body will not spend as much time in considering their verdict as in the case of B.C.G. Food Poisoning.—This district has not had many cases of this disease notified. Some cases on investigation did not prove to be food poisoning, others did cause some anxiety, but subsequently passed off without serious effects. 8 The Clean Food Campaign is not pressed forward vigorously enough and has not got down to the root of the problem yet. Smallpox.—The rate of vaccination against Smallpox is very unsatisfactory. The number vaccinated is by no means sufficient to prevent serious trouble in the event of an outbreak. The prejudice against smallpox vaccination so much in evidence some years ago has not yet been overcome. General Practice.—A great and appreciable service is rendered by the General Practitioners to the people of Edmonton. They have always been in every way a co-operative body. This co-operation is very much appreciated by your Public Health Department, and on the other hand the Department does everything possible to reciprocate. The policy of your Public Health Department will continue to develop this co-operation and if possible to improve on it. At the inception of the National Health Service Act, it was thought that greater facilities would come directly to the assistance of the General Practitioner in order that he may give a better service to his patients in their own homes. There does not seem to be any fulfilment of this expectation; no further efforts are made to bring diagnostic facilities nearer to the General Practitioner or to offer him post-graduate lectures to increase his knowledge for the benefit of his patients; the obtaining of a second opinion by the dissatisfied patient is lacking. To the enterprising General Practitioner this avenue is open, but frequently he is too busy and in some cases does not appreciate the nature of the case until it is too late. A second opinion is very much needed as an automatic process in the needs of the patient. Maternity.—It oftens happens that the doctor booked for a confinement by a patient is not present at any part of the confinement, but leaves the onus of the case on the midwife; the practitioner is, nevertheless, paid. This practice is on the increase and payment, or part of it, should be withheld if the doctor is not present at some part of the confinement. Mentally III and Educationally Sub-normal.—A brief word concerning educationally sub-normal children. 9 Every year a number of children of the above category are reported to the Local Health Authority and are dubbed, for the sake of convenience in administration, as " Mentally Defective," and their fate henceforward is decided by the Committee which deals with mental defectives. These children, though sub-normal, are not in any sense mentally defective and therefore should not be classified as such. Some of the educationally sub-normal children are referred to the Local Health Authority for " care and protection " (i) because their social environment is not secure, either because they have no parents or one or other parent is dead or missing, or one parent has re-married; (ii) their mental acumen is not very bright and therefore they may be easily led astray; (iii) danger of immoral taint in the family. The term " mental defective" should not be applied. Another point of great urgency is the housing of people who are mentally ill. Local Authorities are doing very little to alleviate the emotional distress of members of the public who are ill-housed or living with in-laws or sharing a house with other people. It is very difficult to see what local authorities can do, but the emotional strain is very great and in the case of children is often heartrending. In 1952 your Public Health Committee suggested combining a Welfare Home and Flatlets for old people as a gesture for Conoration Year. If this project could be brought about it would permit old people a social life of their own and also facilitate the nursing and welfare of these people in a concentrated form. This would relieve the overburdened wards of hospitals and would certainly be cheaper and save the necessity in many instances of these old people going into an institution. Health Education.—This is still struggling along to fill a great need in the complicated system of our present-day societv. It is our duty as citizens to overcome the hostile environment in which we live and to make easier the attainment of certain fundamental human needs. Our standard of life is becoming dailv more complicated and great numbers of purposeless, bewildered and perplexed people need the adjustment which is beyond their unaided ability. The result is frequently an intolerable situation 10 where the individual seeks to evade his responsibilities by escapism, or the development of ill-defined illness of mental, moral and social outlook. To overcome these defects in our society there is need of health education in greater measure than at present available. Any Health Department worthy of the name should be equipped with a sound health education programme in which all the staff would take their part. The Handicapped Pupil.—The maxim that the patient must be treated as well as the disease from which he suffers is an old one; it is more especially true today than ever before. Too often has the social aspects of disease been neglected while the disease itself was being remedied. In the past the handicapped were left to decay and wilt in the old ill-kept Union Workhouse. Today great progress has been made. When faced with a patient who suffers from disease or disability, we shall be wanting in our duty, unless we ensure that by modifying his outlook and his environment in the right direction, we can enable him to take his place in the community as a wage-earner, or as near that as his disability will allow. Again, there is no need for complacency; the existing schemes should be examined anew to see what further can be done to raise the capacity of the wage-earner as far above the margin of efficiency as possible. The Functions of the Medical Officer of Health as suggested by the Society of Medical Officers of Health. " The Medical Officer of Health should be the leader of a team of professional men and women trained and practised in the application of preventive and social medicine. He should co-ordinate their common task of protecting the community health. " The Medical Officer of Health should be prepared to undertake whatever duties the protection of the community health may call for and no other boundary to his work should be recognised. These duties may be at the office desk or in the Committee Room; they may take him to the homes of the people, to schools and factories or they may involve the administration of certain institutions concerned with community health. In addition, he should have special knowledge of clinical medicine in the treatment and control of communicable diseases. 11 " The protection of community health also requires that the Medical Officer of Health shall be assisted by all the developments of modern medicine in the form of diagnostic clinics, specially equipped institutions for priority classes, and by the assistance of various specialists. Whatever may be the division of responsibility, it must be ensured that the Medical Officer of Health is in a position to make the most effective integration of such special services." Only too often does the Medical Officer of Health find himself frustrated by delays in administration and other factors. It is necessary, therefore, that the sentiments expressed above should be recognised in association with the position of the Medical Officer of Health. The National Society for the Prevention of Cruelty to Children. Children.—We owe a great deal to the National Society whose wonderful work has brought great benefit to the children in this district. Easily, unobtrusively, a great service is brought to the aid of the citizen without cost to himself. Frequently some of the most heart-rending cases have their problems solved by this Society. In Edmonton we have now been allocated the services of an officer, wholly for the use of this district. Suffice it to say, the work done by the National Society and the manner of its purpose is worthy of the highest praise. Accommodation.—Two buildings formerly used as Day Nurseries have now been converted to Clinic use. They are filling a much-needed service, long overdue. The altered buildings are fitting quite adequately into the new service. Sanitary Inspectors.—Further to my Report of 1953, we were again faced with a considerably depleted staff of Sanitary Inspectors during the past year, with the consequent difficulty of maintaining the continuity of their work, which is so essential to the Public Health Services. At one period during the year we were reduced to one-half of our establishment of Sanitary Inspectors. In July, 1954, the Council decided to introduce Trainee Sanitary Inspectors, and two such Trainees were subsequently appointed. 12 In my opinion this procedure will not, in itself, solve the present acute national shortage of Sanitary Inspectors, a problem which is a very serious one. To my Staff I tender most hearty thanks for their assistance and loyalty throughout the year. To you, my Council, I am very grateful for the help and assistance which you have given during the year 1954. I have the honour to be, Your Worship, Ladies and Gentlemen, D. REGAN, Medical Officer of Health. 13 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,896 Population— Census of 1921 66,809 Census of 1931 77,652 Census of 1951 104,270 Estimated by the Registrar-General for mid-year 1954 100,300 Number of inhabited houses and separate dwellings at the end of 1954 28,758 Number of inhabited houses and separate dwellings at the end of 1953 28,662 Rateable value, April, 1954 £757.803 Estimated product of Id. in the £ for the year ending March 31st, 1955 £3,087 Rates in the £ for the year ending March 31st, 1955 23s. Id. VITAL STATISTICS. Live Births. Grand M. F. Total Total Legitimate 600 617 1,217 Illegitimate 20 27 47 1,264 Birth-rate per 1,000 of population 12.60 Stillbirths. Legitimate 19 10 29 Illegitimate — 3 3 32 Total of live and stillbirths • • • ... ... 1.296 Rate per 1.000 total births ... ... ... 24.69 Deaths. Number 418 380 798 Rate per 1.000 population ... ... ... 7.95 Maternal Mortality. Deaths Rate per 1,000 total live and stillbirths Toxaemias of Pregnancy — — Complication of Pregnancy and Delivery 1 0.77 1 0.77 Death rate of Infants under one year of age. M F. Total Number 12 8 20 All infants per 1,000 live births 15.82 Legitimate infants per 1,000 legitimate live births 15.61 Illegitimate infants Der 1.000 illegitimate live births 21.27 Deaths from Cancer (all ages) 185 Measles (all ages) — Whooping Cough (all ages) — Diarrhoea (under 2 years of age) — 14 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 9 3 12 Tuberculosis, other 1 ... 1 Syphilitic disease 1 ... 1 Diphtheria ... ... ... Whooping Cough ... ... ... Meningococcal infections ... ... ... Acute Poliomyelitis ... ... ... Measles ... ... ... Other infective and parasitic diseases ... ... ... Malignant neoplasm, stomach 18 12 30 Malignant neoplasm, lung, bronchus 37 6 43 Malignant neoplasm, breast ... 12 12 Malignant neoplasm, uterus ... 7 7 Other malignant and lymphatic neoplasms 49 44 93 Leukaemia, aleukæmia 3 1 4 Diabetes 1 4 5 Vascular lesions of nervous system 35 62 97 Coronary disease, angina 75 44 119 Hypertension with heart disease 11 8 19 Other heart disease 36 72 108 Other circulatory disease 18 20 38 Influenza ... ... ... Pneumonia 27 21 48 Bronchitis 34 12 46 Other diseases of the respiratory system 5 1 6 Ulcer of stomach and duodenum 4 4 8 Gastritis, Enteritis and Diarrhoea 2 2 4 Nephritis, and Nephrosis 4 5 9 Hyperplasia of Prostate 5 ... 5 Pregnancy, childbirth, abortion ... 1 1 Congenital malformations 4 2 6 Other defined and ill-defined diseases 21 26 47 Motor Vehicle Accidents 7 2 9 All other accidents 7 6 13 Suicide 4 3 7 Homicide and operations of war ... ... ... TOTALS 418 380 798 15 The two following tables give the deaths of those registered during the 52 weeks ended 2nd Jannuary, 1954. 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 10 ... ... ... ... ••• ... 1 5 1 ... 3 Tuberculosis, other 1 ... ... ... ... ... 1 ... ... ... ... ... Syphilitic disease 1 ... ... ... ... ... ... ... 1 ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal infections ... ... ... ... ... ... ... ... ... ... ••• ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ...... ... ... ... ... ... Other infective and parasitic diseases ... ... ... ... ... ... ... ... ... ... ... ... Malignant neoplasm, stomach 16 ... ... ... ... ... ... 2 1 5 3 6 Malignant neoplasm, lung, bronchus 36 ... ... ... ... ... ... 4 8 13 9 2 Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... ... ... Malignant neoplasm, uterus ... ... ... ... ... ... ... ... ... ... ... ... Other malignant and lymphatic neoplasms 51 ... ... ... ... 1 ... ... 5 11 13 21 Leukaemia. aleukaemia 2 ... ... ... ... ... ... ... 1 1 ... ... Diabetes 1 ... ... ... ... ... 1 ... ... ... ... ... Vascular lesions of nervous system 36 ... ... ... 1 ... ... 2 3 11 4 15 Coronary disease, angina 76 ... ... ... ... ... ... 2 15 17 24 18 Hypertension with heart disease 13 ... ... ... ... ... ... ... ... 3 4 6 Other heart diseases 34 ... ... ... ... ... ... 1 1 3 9 20 Other circulatory disease 20 ... ... ... ... ... 1 1 2 4 7 5 Influenza ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 27 2 ... ... ... ... ... ... 4 2 4 15 Bronchitis 34 ... ... ... ... ... ... 1 5 7 10 11 Other disease of respiratory system 4 1 ... ... ... ... ... ... ... 3 ... ... Ulcer of stomach and duodenum 4 ... ... ... ... ... ... ... ... ... 2 2 Gastritis, Enteritis and Diarrhoea 1 ... ... ... ... ... ... ... ... ... ... 1 Nephritis and nephrosis 4 ... ... ... ... 1 ... ... 1 ... ... 2 Hyperplasia of prostate 5 ... ... ... ... ... ... ... ... ... 1 4 Pregnancy, childbirth, abortion .. ... ... ... ... ... ... ... ... ... ... ... Congenital malformations 4 4 ... ... ... ... ... ... ... ... ... ... Other defined and ill-defined diseases 21 5 ... ... ... ... l 1 2 3 5 4 Motor Vehicle Accidents 7 ... ... ... ... 1 2 ... ... 3 l ... All other accidents 7 ... ... ... ... 1 ... 2 ... ... 1 5 Suicide 4 ... ... ... ... ... ... 1 1 1 1 ... Homicide and operations of war ... ... ... ... ... ... ... ... ... 1 ... ... TOTALS 419 12 ... ... 1 4 6 18 55 88 98 137 16 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 4 ... ... ... ... ... 1 2 ... ... ... 1 Tuberculosis, other ... ... ... ... ... ... ... ... ... ... ... ... Syphilitic disease ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... Other infective and parasitic diseases ... ... ... ... ... ... ... ... ... ... ... ... Malignant neoplasm, stomach 12 ... ... ... ... ... ... ... 2 3 6 2 Malignant neoplasm, lung, bronchus 6 ... ... ... ... ... ... 1 ... ... 4 1 Malignant neoplasm, breast 12 ... ... ... ... ... 1 1 2 1 4 3 Malignant neoplasm, uterus 7 ... ... ... ... ... ... ... 1 3 1 2 Other malignant and lymphatic neoplasms 44 ... ... ... ... 1 ... 2 6 10 11 14 Leukaemia, aleukæmia 1 ... ... ... ... ... ... ... ... ... ... 1 Diabetes 4 ... ... ... ... ... ... ... ... ... 1 3 Vascular lesions of nervous system 63 ... 1 ... ... ... ... 1 2 10 24 25 Coronary disease, angina 45 ... ... ... ... ... ... 2 1 7 23 12 Hypertension with heart disease 8 ... ... ... ... ... ... ... ... ... 3 5 Other heart diseases 72 ... ... ... ... ... ... ... 2 3 13 50 Other circulatory disease 14 ... ... ... ... ... ... ... 2 1 5 6 Influenza ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 21 2 ... ... ... ... 1 1 1 1 4 11 Bronchitis 13 ... ... ... ... ... ... ... ... 1 5 7 Other disease of respiratory system 1 ... ... ... ... ... ... ... ... ... ... 1 Ulcer of stomach and duodenum 4 ... ... ... ... ... ... ... 1 ... 2 1 Gastritis, Enteritis and Diarrhoea 2 ... ... ... ... ... ... ... ... ... 1 1 Nephritis and nephrosis 6 ... ... ... ... ... ... ... 2 ... 2 2 Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... ... ... Pregnancy, childbirth, abortion 1 ... ... ... ... ... 1 ... ... ... ... ... Congenital malformations 2 1 ... ... ... ... ... ... 1 ... ... ... Other defined and ill-defined diseases 27 5 ... ... ... 1 ... ... 2 2 6 10 Motor Vehicle Accidents 2 ... ... ... ... ... ... ... ... 1 ... 1 All other accidents 6 ... ... ... ... 2 ... ... ... 1 2 1 Suicide 3 ... ... ... ... ... ... ... 1 1 1 ... Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... TOTALS 380 8 1 ... ... 4 4 15 26 45 117 160 17 INFANTILE MORTALITY. The deaths of infants under one year of age were as follows:— M. F. Total Legitimate 12 7 19 Illegitimate 1 1 12 8 20 The death rate of all infants per 1,000 live births was 15.82. The death rate of all infants under one month of age per 1,000 live births was 11.86. 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 Other Diseases of Respiratory System ... ... ... ... ... 1 ... ... ... 1 Premature Birth 3 ... ... ... 3 ... ... ... ... 3 Birth Injury 1 ... ... ... 1 ... ... ... ... 1 Other Causes 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 4 ... ... ... 4 ... ... ... ... 4 Totals 9 ... ... ... 9 1 1 1 ... 12 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 Pneumonia ... ... ... ... ... 1 1 ... ... 2 Premature Birth 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations ... ... 1 ... 1 ... ... ... ... 1 Other Causes 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Totals 6 ... 1 ... 6 1 1 ... ... 8 18 COMPARATIVE STATISTICS Birth-rate Death Rate Infant Mortality Rate Live Still England and Wales 15.20 24.00 11.30 25.50 Middlesex 13.10 18.30 9.40 18 80 Edmonton 12.60 24.69 7.95 15. 82 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 121 150 120 107 6 1 Church Street 51 54 78 110 2 1 Angel Road 82 88 83 71 2 4 Silver Street 99 90 138 92 2 2 Vagrants ... ... ... ... ... ... 353 382 419 380 12 8 19 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 — — 65 Blood—Haemoglobin Estimation — — 263 Blood—Kahn Reaction — — 150 Blood—Rhesus Factor — — 150 Blood—Grouping — — 151 Blood—Sedimentation Rate — — — Eye swabs for organisms — 4 4 Faeces for the presence of organisms 450 1,777 2,227 Per-nasal Swabs for H. Pertussis — — — Swabs for presence of C. Diphtheria: (a) From Suspect Cases 11 11 (b) From Contacts — 30 30 (c) From Carriers and old cases, etc. — — — Swabs for presence of Haemolytic Streptococci 253 1,301 1,554 Swabs for presence of Vincent's Angina — 10 10 Urines — — 265 Vaginal swabs for presence of organisms — — — ,, ,, ,, ,, ,, Trich. Vag. 1 38 39 Swabs from Vesicle — 1 1 Ear swabs — — 1 Sputum for Tubercle Bacilli — 1 1 Milk Bottle — — 1 Blancmange — — 1 Cervical Swab — — 2 Swab from finger — — 1 Pus from ear 2 1 3 Total 4,930 20 MILK (SPECIAL DESIGNATION) REGULATIONS, 1949. 120 samples of Designated Milks were examined during 1954. Results were as follows:— Pasteurised Milk. 42 Samples were examined and all satisfied both the prescribed tests. Tuberculin Tested (Pasteurised) Milk. 38 Samples were examined and all satisfied both the prescribed tests. Sterilised Milk. 40 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. SANITARY INSPECTION IN THE AREA. Seven 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 under the supervision of the Senior Sanitary Inspector. The free use of W.Cs. at Women's Conveniences was continued throughout the year; free hand-washing facilities are provided in both the males' and females' conveniences and paper towels are supplied. 21 Rodent Control. Your Senior Sanitary Inspector, as Officer-in-Charge, Rodent Control, reported as follows:— The Council have an Assistant Rodent Officer, two Rodent Operators, the part-time services of a Clerk and appointed the District Sanitary Inspectors as Rodent Officers. During the year the treatment of business premises by " Warfarin " was continued and has proved very successful. The new method of rodent control has the advantage that the materials are undetectable by rats and mice, therefore poison shyness does not occur, and the rodents continue to feed until all are dead. Further, no prebaiting is necessary and the baiting is continuous. " Warfarin " destroys the ability of the blood to clot and the rats become weaker and die painlessly from internal haemorrhage. 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 Local Authority Dwellinghouses Agricultural All other (including Business and Industrial) Total 1. Number of Properties inspected by the Local Authority during 1954 as a result (a) of notification or (b) otherwise (a) 6 536 ... 53 595 (b) 29 2,455 ... 92 2,576 2. Number of Properties (under 1) found to be infested by rats Major 3 2 ... 13 18 Minor 3 375 ... 8 386 3. Number of Porperties (under 1) found to be seriously infested by mice 1 80 ... 12 93 4. Number of Infested Properties (under 2 and 3) treated by the Local Authority 7 440 ... 32 479 5. Number of Notices served under Section 4: (1) Treatment ... ... ... ... ... (2) Structural Works (i.e., Proofing) ... ... ... ... ... 22 2. Measures of Control. Type of Property. Properties Inspected. No. of Inspections Notices Served. Treatment Completed. Block Treatments. Rats. Mice. Local Authority's Premises 35 199 .. 6 1 .. Dwelling Houses 2,991 5,550 . . 422 67 .. Business Premises 145 352 .. 10 17 .. Total 3,171 6,101 ,, 438 85 .. During the year maintenance treatments of the sewers took place by the Borough Engineer's Department, and I am indebted to the Borough Engineer for the following report:— Rat Destruction in Sewers, Since the report of 1953 the 14th, 15th and 16th Maintenance Treatments have been carried out. The following summary shows the results of treatment Nos. 10 to 16:— Commencement Date No. of Treatment No. of M.Hs. Baited Prebait Takes (Total) Prebait Takes (Complete) Poison Takes (Total) Bodies seen Poison used Oct., 1951 10 1.096 481 244 461 81 Zinc Phosphide Apr., 1952 11 1,122 495 210 467 23 Arsenius Oxide Oct., 1952 12 1,132 547 266 533 46 Zinc Phosphide Apr., 1953 13 800 559 249 423 28 Arsenius Oxide Nov., 1953 14 1,139 703 298 677 73 Zinc Phosphide Apr.. 1954 15 966 618 240 573 12 Arsenius Oxide Nov., 1954 16 1,075 521 260 518 62 Zinc Phosphide The percentage of prebait takes to number of manholes baited is as follows:— Treatment No. 10 43.88% „ 11 44.11% „ 12 48.32% „ 13 69.87% „ 14 61.72% „ 15 64.00% „ 16 48.47% The results of 3½ years of treatments continue to show that the rat population of the sewers remains fairly stationary. In order to prevent increase in the rat population, I would advise carrying on with the treatment of the whole system of sewers as at present. Middlesex County Council Act, 1950, Section II. Section II of this Act, which relates to Hawkers of Food and their Premises, came into operation on the 1st of April. 1951. One person and premises were registered during the year. No persons were registered to trade in the Borough where storage premises are located in other districts. There were 126 hawkers on the Register at the end of 1954. 23 Disinfection and Disinfestation. The following table gives some idea of the work carried out: — Number of journeys to collect bedding 265 „ return bedding 238 Rooms disinfected after infectious disease 165 phthisis 47 „ other cases 67 „ vermin 231 Bedding, clothing, etc., disinfected after infectious disease 1,465 articles ,, ,, phthisis 225 „ „ „ „ „ other cases 2,791 „ „ „ „ „ vermin 496 „ 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 5,390. 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 555. Four Council properties and 79 other houses were found to be infested; the total number of rooms disinfested was 231. 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 13 new licences and 112 renewals were granted by the Council. The following is a list of particulars of quantities, etc., affected by these licences: — Petroleum spirit 446,078 galls. Petroleum mixtures (cellulose) 9,048 galls. Rubber solution 100 lb. & 850 galls. Mortuary. The use of the Council's Mortuary for the reception of bodies was discontinued after 31st March. 1953, and by arrangement with the North East Metropolitan Regional Hospital Board, on and after 1st April, 1953, all bodies which would normally have been received at the Council's Mortuary are received at the Prince of Wales's Hospital, Tottenham, Mortuary. Inspections. The following tabular statement gives the number and the nature of the inspections made during the year: — Complaints 1,618 Infectious Diseases 254 Food Poisoning 12 House-to-house 96 24 Factories with mechanical power 174 Factories without mechanical power 3 Housing Rents and Repairs Act, 1954 201 Housing Act, 1949, Improvement Grants 2 Factories (other) 3 Outworkers 20 Schools 3 Offensive trades 7 Shops and Stalls 8 Shops Act 14 Pet Shops 18 Sanitary conveniences and urinals 204 Smoke observations 242 Rat infestation 284 Petroleum 136 General inspections 847 Sundry visits 1,305 Cinemas and Halls 26 Stables and Piggeries 42 Moveable Dwellings 19 Sampling Water 11 Sampling Ice Cream 3 Sampling Milk 111 Re-inspections 4,077 Inspection of Places where Food is Prepared. Butchers 97 Fish shops 81 Cafes and Restaurants 248 Dairies and milkshops 48 Slaughterhouses 37 Bakehouses (Factory) 19 Bakehouses (Workshops) 3 Ice cream shops 131 Canteens 80 Other food premises 276 Defects Remedied. Roofs repaired 416 Gutters and rainwater pipes repaired 251 Brickwork or Pointing Repaired 172 Chimney Stacks, etc., repaired or rebuilt 63 Yards or forecourts repaved or repaired 52 Drains examined, tested or exposed 545 Drains cleared, trapped or repaired 334 Drains reconstructed 140 Chambers inserted or built up to ground level 59 25 Soil and vent pipes, new fixed or repaired 76 W.Cs repaired or improved 199 Flushing cisterns repaired or new fixed 101 Sink waste pipes repaired or new fixed 50 New sinks fixed 30 Drinking water cisterns covered, cleansed, repaired 3 Water fittings repaired 34 Water taken off main or restored 5 Internal walls 394 Ceilings repaired, cleansed, etc 274 Door frames repaired 2 Floors repaired 134 Floors ventilated 54 Dampness remedied 219 Window frames or sashes repaired or renewed 474 Fireplaces, stoves repaired 87 Coppers repaired 4 New dustbins supplied 8 Premises rat-proofed 21 Improper keeping of animals discontinued 2 Foul accumulations removed 2 Other nuisances abated 218 Moveable dwellings removed 9 Places of Public Entertainment. Twenty-six 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 & 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 203 174 19 — Factories without mechanical power 18 3 2 — Other premises under the Act (including works of building and engineering and construction but not including outworkers' premises) 3 3 — — Totals 224 180 21 — 26 2. Defects Found. Particulars Number of defects No. of defects in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector by H.M. Inspector Want of cleanliness 2 2 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences : Insufficient — — — — — Unsuitable or defective 58 66 — 3 — Not separate for sexes — — — — — Other offences (Not including offences relating to outwork) — — — — — Totals 60 68 — 3 — 3. Outwork—Sections 110 & 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. 187 — — — — — Artificial flowers 6 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 20 — — — — — Brush making 51 — — — — — Stuffed toys 20 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 14 — — — — — Curtains and Furniture Hangings 2 — — — — — Household Linen 5 — — — — — Paper Bags 7 — — — — — Feather Sorting 1 — — — — — Umbrellas, etc. 2 — — — — — Totals .. 315 — — — — — 27 Rag Flock and Other Filling Materials Act, 1951. This Act came into force on the 1st November, 1951. Number on Register at end of year: — Premises where filling materials used 13 Licences granted for storage of rag flock 2 HOUSING. 1. Re-development Areas. Following representations by the Medical Officer of Health, the Council on the 22nd September, 1953, made Clearance Area Compulsory Purchase Orders under Part 3 of the Housing Act, 1936, comprising the following premises:— (a) The Broadway, Edmonton, Clearance Area, 1953 31 to 45 (consecutive inclusive) The Broadway. Making a total of 15 houses involving 38 persons. A Public Inquiry was held in February, 1954, and the Minister of Housing and Local Government subsequently confirmed the Order. Following representations made by the Medical Officer of Health, the Council on the 13th April, 1954, made Clearance Area Compulsory Purchase Orders under Part 3 of the Housing Act, 1936, comprising the following premises:— (b) Snells Park (No. 1) Clearance Area, 1954. 1 to 29 (odd numbers inclusive), 10 to 32 (even numbers inclusive), 34a, 38 to 48 (even numbers inclusive) and 52 to 78 (even numbers inclusive), Snells Park. 2 to 12 (even numbers inclusive) Grove Street. 3, 11 to 17 (odd numbers inclusive) and 45 to 55 (odd numbers inclusive) Fore Street. Making a total of 65 houses involving 289 persons. (c) Snells Park (No. 2) Clearance Area, 1954. 2 to 8 (even numbers inclusive) Snells Park. Making a total of 4 houses, involving 36 persons. A Public Inquiry was held in October, 1954. 28 2. Action taken under the Housing and Public Health Acts. (1) Inspection of Dwelling-houses during the year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,812 (b) Number of inspections made for the purpose 7,350 (2) (a) Number of dwelling-houses (including under sub-head (1) above) which were inspected and recordel under the Housing Consolidated Regulations. 1925 and 1932 96 (b) Number of inspections made for the purpose 282 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 69 (4) Number of dwelling-houses (exclusive of those referred to above under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,122 (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 621 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 41 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 29 (b) By Local Authority in default of owners 1 B. Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 391 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 309 (b) By Local Authority in default of owners 39 C. Proceedings under Sections 11 and 13 of Housing Act, 1936: (1) Number of dwelling-houses in respect of which demolition orders were made 1 (2) Number of dwelling-houses demolished in pursuance of demolition orders 1 29 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 tenement or room having been rendered fit — E. Proceedings under Section 25 of the Housing Act, 1936: Number of dwelling-houses demolished as a result of Clearance Area procedure: (a) Part III 50 (b) Part V 7 Housing Repairs and Rents Act, 1954. This Act came into operation in 1954, and among the requirements Local Authorities have to submit to the Minister of Housing and Local Government an estimate of the total number of houses unfit for human habitation and suitable for demolition, together with their proposals for dealing with the same. This programme is in course of preparation. Certificates of Disrepair. The following table gives details of the applications for certificates of disrepair dealt with up to the 31st December, 1954: Applications received 159 Certificates granted 148 Certificates revoked on completion of repairs 3 SLAUGHTERHOUSES. Thirty-seven visits were paid and the carcases and organs of 78 pigs killed were inspected during or shortly after slaughter. None was found to be affected with tuberculosis. 24 carcases of which some part or organ was condemned showed a percentage of the number inspected affected with disease, other than tuberculosis, of 30.76. The following organs were surrendered:— 18 sets of lungs, 3 plucks, 3 kidneys, 1 liver, 1 heart, also two whole carcases. 30 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Various licences were granted as under: — Primary Supplementary Pasteurised 49 19 Tuberculin tested 25 16 Sterilised 104 18 178 53 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. The number of Dairies registered at 31st December, 1954, was 10. Tinned Cream. Following the radio and press warnings to the public not to consume a certain brand of tinned cream pending further investigations, it was found that an Edmonton shopkeeper had a stock of this cream. As some of the cream had probably been sold, steps were taken to warn the Edmonton public. Later, information was received from the Ministry of Health with regard to the batch numbers of cream which might justifiably be regarded as unfit for human consumption. None of the tins brought to the Public Health Department bore the respective numbers and were therefore returned to the retailers. Food and Drug Act, 1938 — Section 14. During the year 11 premises were registered for the Sale and Storage of Ice Cream. Number on Register at end of year:— Manufacturers and Vendors 8 Vendors only 219 During the year no premises were registered for the Preparation or Manufacture of Preserved Food, etc. Number on Register at end of year 39 Unsound Food. The following is a list of the food surrendered for examination and retained as unfit for human consumption:— Meat 1,270 tins Parsnips 2 bags Milk 1,833 „ Onions 14 Fish 280 „ Lettuce 5 boxes Jams, etc 128 „ Cucumbers 36 Soups 176 „ Bananas 9 boxes 31 Beans 5 cases, 8 boxes and 287 tins Dates 50 „ Lemons 4 „ Beetroot 1 box and 40 tins Beef 1,128 lb. Lamb 61 „ Carrots 5 bags and 8 tins Pork 467½ „ Offal 318½ „ Mixed Veg. 13 tins Rabbits 154 „ Peas 35 cases and 6,391 tins Chickens 1 only Ham 475 lb. Prunes 34 tins Cod 318 „ Apples 128 boxes and 60 tins Dog Fish 266 „ Haddock 56 „ Apricots 111 tins Plaice 119 „ Blackcurrants 125 „ Skate 140 „ Cherries 876 „ Soles 14 „ Damsons 28 „ Butter 182½ „ Gooseberries 32 „ Tea 70 „ Grapefruit 5 cases and 28 tins Sugar 152 „ Cakes 11 whole and 3½ lb. Grapes 5 trays and 144 tins Cereals 172 pkts. Greengages 12 tins Cheeses 88½ lb. and 3,354 pkts. Oranges 6 boxes and 142 tins Chocolate Spread 1 pkt. Peaches 10 trays and 73 tins Fish Paste 292 tins Macaroni 21 „ Pears 5 boxes and 85 tins Meat Paste 1,659 jars Pickle 94 „ Pineapple 387 tins Puddings 89 Plums 4 boxes and 2,689 tins Vinegar 288 botts. Sauce 267 „ Raspberries 55 tins Spaghetti 29 tins Rhubarb 23 „ Coconut 11 „ Strawberries 14 „ Sandwich Spread 12 jars Tomatoes 40 boats. 56 trays and 76 tins Bacon 35 lb. Rice 56 Peanuts 5 bags Tomato Juice 37 tins Coffee 20 botts. Fruit Juices 105 „ Turkeys 8 Potatoes 25 bags Biscuits 36 pkts. and 265 lb. Turnips 2 „ Cabbage 5 boxes Eggs (Frozen) 14 lb. Cauliflower 2 „ Flour 186 „ The food examined and condemned by the Officers of the Public Health Department is disposed of either at the Council's Refuse Disposal Incinerating Plant or the Council's Refuse Disposal Pit. 32 CLEAN FOOD CAMPAIGN. The survey of food premises commenced in 1952 was continued during 1954. The statement set out below shows the nature and number of the inspections made and the work carried out during the year:— Inspections Visits to Cafes, etc 200 „ Industrial Canteens 71 „ Other Food Premises 85 „ Fish Shops 61 „ Ice Cream Shops 59 Work Done Roofs repaired — Walls cleansed and redecorated 17 Ceilings cleansed and redecorated 14 Windows repaired or cleansed 2 Floors repaired or cleansed 8 Equipment and/or fittings cleansed 8 ,, ,, ,, ,, renewed or repaired 23 Additional sinks provided 23 Defective sinks replaced 4 Drains repaired or cleansed — Refuse bins replaced or provided 4 Washing-up methods improved 16 Sanitary accommodation improved 5 Ventilation improved 3 Indicating notices re hand-washing provided 46 Personal washing facilities provided 10 Provision of food display cabinets 7 Lighting improved 2 Summary of Food Premises registered under Section 14 of the Food and Drugs Act, 1938. Manufacture and Sale of Ice Cream 8 Sale only of Ice Cream 219 Manufacture of Sausages 24 Manufacture of Sausages and Sale of Pressed, Pickled, Preserved, Potted Meats and other foods 13 Manufacture of Cooked Meat 1 Manufacture of Preserved Foods 1 Summary of Food Premises. Butchers 60 Fish Shops 35 Bakers and Confectioners 23 Fruiterers and Greengrocers 73 Cafes 108 Grocers & Provision Dealers 188 Dairies 10 Retail Purveyors of Milk 108 Factory Canteens 73 33 Pet Animals Act, 1951. This Act, which came into operation on 1st April, 1952, regulates the sale of pet animals, and provides that no person shall keep a pet shop except under the authority of a licence granted by the Borough Council. During the year one new licence was granted, and 3 licences were discontinued. Number on Register at end of year was 9. Game Dealers' Licences. During the year 3 licences to sell Game were renewed and one licence was discontinued. SHOPS ACT AND STREET TRADING. The Department administers three local Orders under the Act: The Edmonton Hairdressers and Barbers (Late Day) Order, 1947, made under the Shops (Hours of Closing) Act, 1928; The Shops Act, 1912, Edmonton Weekly Half-holiday Order, Section 4(2) and (6) (Butchers); The Shops Act, 1912, Edmpnton Weekly Half-holiday Order, Section 4(2), all the Orders stand amended by the Shops Act, 1950. There are approximately 1,268 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. 1,214 Washing facilities, sink water heaters installed 9 Contraventions were in the main of a minor character, mostly concerned with the exhibition of notices. Shops Act, 1950—Part I, Section 1(2). Edmonton Weekly Half-holiday Order.— A letter of warning was sent to the occupier of a shop where the above Order was being contravened in that the shop was not closed for the serving of customers on a Thursday afternoon. Shops Act, 1950—Part 1, Section 13 (1)—Shops where more than one trade or business is carried on. One letter of warning was sent to the occupier of a shop in respect of Notices not conspicuously exhibited on a Thursday afternoon. 34 Shops Act, 1950, Part II, Section 17(1)—Conditions of Employment. Provisions as to assistants' half-holiday. Letters of warning were sent to the occupiers of 6 shops where assistants were found working during the occasion of their weekly half-holiday. Shops Act, 1950, Part IV—Sunday Trading. Thirty-seven shops were visited in addition to supervisory operations and observations. Three 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, 1944-1950—Street Trading. Under the provisions of the Byelaws made by the Council under the above Acts, five letters of warning were sent for contraventions of certain provisions of the Byelaws. three to licensed street traders and two to unlicensed street traders, of whom one was a boy of 14 years of age. Particulars of this case were submitted to the Middlesex County Council. In three other cases legal proceedings were instituted and fines amounting to £2 10s. Od. and costs of £3 3s. Od. were imposed. 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. Heating Appliances (Fireguards) Act, 1952. The above-named Act came into operation on the 23rd March, 1953. Regulations made thereunder which came into operation on 1st October, 1953, require fireguards to be fitted to gas fires, electric fires and oil heaters. Standards of construction and fitting for guards and the tests to be employed are set out in the Schedule and the necessary apparatus for testing the guards has been obtained. Under Regulations 5, heating appliances, other than imported appliances, manufactured before the date of the coming into operation of the Regulations and not fitted with the requisite guard may be sold or let until the end of September, 1954. The Shops Act Inspector has been appointed the Authorised Officer under the Act. 35 PREVALENCE OF INFECTIOUS DISEASE. Measles and Whooping Cough. These diseases were made compulsorily notifiable in October, 1939. 42 cases of Measles and 129 cases of Whooping Cough were notified during the year. There were no deaths from these diseases. Diphtheria. One case was notified during the year. The patient was a 19-year-old girl who had been immunised in 1947. One case was notified in 1953. Scarlet Fever. Continued to occur throughout the year in a mild form. There were 133 cases compared with 220 in 1953; there were no deaths. "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. Enteric Fever. One case of Paratyphoid "B" and one case of Typhoid Fever were notified during the year. Investigation failed to reveal the source of infection in the Paratyphoid "B" case. In the case of Typhoid Fever, the patient visited Italy and the onset commenced four days before returning to England. The source of infection was suspected to be water which was not sterilised before drinking. Dysentery. During the year 255 cases of Dysentery were notified—181 Sonne, 35 Giardia, 30 Salmonella Typhi-murium. 1 Salmonella Enteritidis and 8 unspecified. The control measures, detailed in my Report for 1950. were maintained, and again I wish to record my appreciation of the co-operation and assistance 36 I received from the General Practitioners, Dr. M. Thomas and Staff of the Public Health Laboratory Service (Edmonton), Education Department and Teachers, and the Staff of the Health Department. Meningoccal Infection. Four cases were notified during the year. Ophthalmia Neonatorum. Twelve cases were notified during the year (8 in North Middlesex Hospital, 2 at home and 1 in Other Institution). Of this total 7 were Edmonton cases. Puerperal Pyrexia. The Puerperal Pyrexia Regulations 1951 which came into operation on 1st August, 1951, replaces Regulations previously in force, and modify the definition of Puerperal Pyrexia. 120 cases were notified during the year (5 at home and 115 in North Middlesex Hospital). Of this total 35 were Edmonton cases. During 1953 184 cases were notified. Food Poisoning. Ten cases (non-fatal) were notified during the year, as follows:— Case No. Sex Age Suspected Cause of Illness Organism Responsible 1 F 38 Duck egg Salmonella Typhi-murium 2 M 65 Unknown ,, ,, ,, 3 M 28 ? Meat pie Unknown 4 M 23 Duck egg Salmonella Typhi-murium 5 F 16 ,, ,, ,, ,, ,, 6 M 40 ,, ,, ,, ,, ,, 7 F 34 ,, ,, ,, ,, ,, 8 M 11 ,, ,, ,, ,, ,, 9 M 28 Unknown Unknown 10 M 2 ,, ,, Pneumonia. 143 cases were notified during the year. 37 Poliomyelitis. During the year one confirmed case of Poliomyelitis (Non-Paralytic) occurred in the Borough. Notification was received in October. There were no deaths from this disease. Six cases were notified in 1953. 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 133 84 ... ... ... 6 12 18 79 15 2 1 ... ... ... Measles 42 1 ... 4 6 3 2 6 21 ... ... ... ... ... ... WhoopingCougb 129 2 ... 5 9 13 18 17 61 4 1 ... ... 1 ... Pneumonia 143 16 48 4 2 5 6 4 9 6 2 29 20 39 18 Puerp. Pyrexia 120 115 ... ... ... ... ... ... ... ... 7 100 13 ... ... Erysipelas 24 2 ... ... ... ... ... ... ... ... 1 3 4 13 3 Food Poisoning 10 2 ... ... ... 1 ... ... ... 1 1 4 2 ... 1 Poliomyelitis 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Ophth- Neonatorum 12 10 ... 12 ... ... ... ... ... ... ... ... ... ... ... Dysentery 255 14 ... 16 20 27 28 31 43 22 4 27 20 14 3 Meningococcal Infection 4 4 ... 1 ... 1 ... ... ... ... ... ... ... ... 2 Diphtheria 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Paratyphoid 'B' 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Typhoid Fever 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Malaria 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 38 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 37 46 22 28 ... ... 133 Measles 11 7 9 15 ... ... 42 Whooping Cough 42 13 34 40 ... ... 129 Pneumonia 114 7 8 14 ... ... 143 Puerperal Pyrexia 4 1 1 2 112 ... 120 Erysipelas 18 1 1 4 ... ... 24 Food Poisoning 4 1 5 ... ... ... 10 Poliomyelitis 1 ... ... ... ... ... 1 Ophth-Neonatorum 1 ... ... 1 8 2 12 Dysentery 147 37 43 27 1 ... 255 Meningococcal Infec. 2 ... 1 1 ... ... 4 Diphtheria ... ... 1 ... ... 1 Paratyphoid 'B' ... 1 ... ... ... ... 1 Typhoid Fever 1 ... ... ... ... ... 1 Malaria 1 ... ... ... ... ... 1 IMMUNISATION. As and from 5th July, 1948, immunisation against Diphtheria and Whooping Cough became the responsibility of the Middlesex County Council. Set out below are details of the Treatment given during 1954:— Age Children who completed a full course of primary immunisation Children given a reinforcing injection Diphtheria only Combined Diphtheria and Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria and Whooping Cough Whooping Cough only (1) (2) (3) (4) (5) (6) (7) Under 1 77 549 2 — — — 1 50 147 4 — — — 2 19 21 5 1 1 1 3 15 17 2 7 7 1 4 30 9 5 317 40 — 5—9 75 3 3 359 31 1 10—14 50 4 1 523 2 — 15 and over — — — — — — Total 316 750 22 1,207 81 3 CANCER. The incidence of Cancer relative to the various organs of the body is given as under: — Males Females Breast — 12 Uterus — 7 Lung, Bronchus 36 6 Stomach 16 12 All other sites 51 44 103 81 39 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. MIDDLESEX COUNTY COUNCIL ACT, 1944. Establishments for Massage or Special Treatment. Six existing licences were renewed during the year, and one licence discontinued. 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 N on-respiratory M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1— 5 years 2 ... 2 ... ... ... ... ... 5—15 „ 2 3 ... ... ... ... ... ... 15—25 „ 10 17 ... 1 ... ... ... ... 25—35 „ 16 5 ... ... ... 1 1 ... 35—45 „ 14 6 2 1 1 2 ... ... 45—55 „ 18 6 ... 2 5 ... ... ... 55—65 „ 7 2 ... ... 1 ... ... ... 65 years upwards 4 1 2 ... 3 1 ... ... 73 39 6 4 10 4 1 ... In addition, 39 cases of pulmonary tuberculosis and 3 cases of nonpulmonary tuberculosis previously notified in other areas, moved into Edmonton. The total number of names added to the Register for the first time during the vear, excluding of course, non-notified deaths was: — Males Females New cases (respiratory) 73 39 (non-respiratory) 6 4 Transferred cases (respiratory) 19 20 (non-respiratory 1 2 99 65 There were no non-notified deaths. 40 The non-respiratory forms of tuberculosis notified were: — Males Females Other bones and joints 2 1 Glands 2 1 Spine 1 — Genito-Urinary System — 2 Meninges 1 — The number of cases of tuberculosis on the Register at the end of 1954 was:— Males Females Total Pulmonary forms 627 512 1,139 Non-pulmonary forms 74 96 170 701 608 1,309 The corresponding figures at the end of 1953 were:— Males Females Total Pulmonary forms 597 505 1,102 Non-pulmonary forms 71 93 164 668 598 1,266 Corresponding figures for previous years were: — Males Females Total 1952 635 567 1,202 1951 570 536 1,106 1950 519 498 1,017 1949 509 468 977 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 1954 the Medical Officer of Health paid a total of 346 visits to those employees who had been on the sick list for longer than a fortnight and when necessary, at fortnightly intervals. Of these, 39 were " not at home " and 16 had already resumed duty. Also, during the year, 127 persons were examined prior to appointment to permanent posts. 41