34/8/1 775 ENF 33 Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1949 Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1949 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1949 To the Chairman and Members of the Urban District Council of Enfield. My Annual Report for the year 1949 unfortunately does not include, as in former years, details of the Maternity and Child Welfare Service or the School Health Service, which are now the responsibility of the Middlesex County Council. No one regrets more than I do, this division of responsibility for the Environmental Health Service and the Personal Health Service, but the gap is bridged to some extent by the arrangement whereby I am also Area Medical Officer of the Middlesex County Council and therefore find it no difficult matter to keep myself informed continuously of my actions in both capacities—in fact, an improved version of Jekyll and Hyde, with, I hope, only the better characteristics evident. The main aspects of the Environmental Health Services are covered in the various paragraphs of my report, and it is only necessary for me to refer briefly to a few points. The incidence of infectious disease was greater than in the previous year, due mainly to the increase in the number of cases of measles, which characteristically tends to occur in two-year cycles. The number of cases of pulmonary tuberculosis showed a welcome decrease, mostly amongst females, and it was noted that although there was a slight overall decrease amongst the males, the higher age groups showed an increase over the previous year. The reasons for this must, I feel, remain at present a matter of conjecture. For the first time on record there were no cases of diphtheria. Although I am convinced that this achievement is mainly due to diphtheria immunisation, I must again this year emphasise that the number of parents accepting this service for their children is not sufficiently high to warrant any sense of security. 4 Another fact that disturbs me is the continued decrease in the number of infants who receive the protection of vaccination against smallpox. Fortunately, smallpox is not endemic in this country nowadays, due mainly, I consider, to vaccination, but during the last few years there have, been several outbreaks of this disease in the country and Enfield has not escaped its share of contacts. Although these contacts are offered immediate vaccination (which may be too late) and kept under surveillance for a period, the difficulties in controlling an outbreak in a community with a low state of vaccination are considerable. An outbreak of smallpox usually results in hurried mass vaccination with its consequent disorganisation and occasional additional risk to those not previously vaccinated in infancy. So long as reliance is placed on surveillance of contacts for control (and I favour stricter measures), and in view of the rapid travel by air from infected countries, the risk of smallpox appearing in the community will ever be present. During the year, only one case of food poisoning was notified, but, in addition, a mild outbreak of gastro-intestinal disturbance, involving a number of people employed in a factory, was brought to my notice and investigated. An account of this outbreak is given elsewhere in my report. I am convinced that there must be many instances of minor gastro-enteritic upsets due to food poisoning which are not notified owing to the mildness of the attack and for other reasons. We must try to impress on the housewife and the food handler the absolute necessity of cleanliness and attention to personal hygiene because it is not only the classical food poisoning organisms that must be kept at bay, but also those ubiquitous organisms present in and on the human body which, under certain conditions, can cause outbreaks. In conclusion, I should like to record my appreciation of the efforts of the staff of the Health Department during the past year. William D. Hyde, Medical Officer of Health. 5 URBAN DISTRICT COUNCIL OF ENFIELD Mrs. L. E. Daines, C.C., J.P. Chairman J. Cottenham, Esq Vice-Chairman Mrs. G. M. Jay, J.P. Mrs. E. A. Williams A. D. Bates, Esq. W. C. Bennett, Esq. G. Blandford, Esq. W. G. Bowyer, Esq. D. R. J. Boxall, Esq. T. H. M. Clarke, Esq. S. W. Cobbin, Esq. W. H. Cook, Esq. G. Deacock, Esq. A. M. Eeles, Esq. F. Greenwood, Esq. L. E. Harris, Esq. A. G. Hayward, Esq. J. W. Howes, Esq. J. G. Jamieson, Esq. W. G. Jollie, Esq. E. E. Leesmith, Esq. W. E. Lonsdale, Esq. E. L. Mackenzie, Esq. A. R. Oakden, Esq. C. Partington, Esq., J.P., M.R.S.T. P. L. Purnell, Esq. P. Robson, Esq. A. H. Saunders, Esq. D. Storar, Esq. A. A. F. Tatman, Esq. HEALTH COMMITTEE Mrs. G. M. Jay, J.P. Chairman A. A. F. Tatman, Esq Vice-Chairman also Mrs. L. E. Daines, Mrs. E. A. Williams and Messrs. Bates, Boxall, Cottenham, Harris, Leesmith and Mackenzie. 6 PUBLIC HEALTH STAFF Medical Officer of Health: Dr. W. D. Hyde. Deputy do. Dr. C. E. Jamieson (resigned 31st March, 1949). Senior Sanitary Inspector: Mr. A. N. Smith. Sanitary Inspectors: Mr. H. Wiggett, Mr. A. Ramsden, Mr. D. C. Turner, Mr. C. Day and Mr. G. E. A. Laney. ' Shops and Housing Inspector: Mr. M. Wilson. Rodent Investigator : Mr. P. W. Partridge. Chief Clerk : Mr. Sydney Coulter. Senior Clerk : Mr. C. W. Chapman. General Clerks: Mr. J. W. Viggers and Miss J. Pinkham. Shorthand-Typist : Miss P. Gooday (resigned), Miss S. E. Davison. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 12,400 POPULATION The population as estimated by the Registrar-General is 111,150. The number of inhabited houses at the end of 1949, according to the Rate Books, was 29,116. Explanatory Note :— Definition of "Houses"—Structurally separate dwellings including flats. The rateable value of the District is *£867,428 The net product (after allowing for cost of collection) of a penny rate is £3,469 9 10 *Note.—The reduction in the rateable value of the District is due to the fact that Electricity and Railway Undertakings have been taken out of Rating. 7 SOCIAL CONDITIONS The number of houses erected during the course of the year was 199, which included 1 conversion into flats, 17 rebuilding of war-destroyed houses, and 2 reinstatements of extensively damaged houses. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,664 897 767 Illegitimate 62 30 32 Birth-rate—15.52 per 1,000 population. Still Births:— Total Male. Female Legitimate 35 24 11 Illegitimate 1 — 1 Rate per 1,000 total births—20.43. Total. Male. Female Deaths 1,047 533 514 Death-rate—9.41 per 1,000 population. Number of women dying in, or in consequence of, childbirth :— Deaths. Rate per 1,000 Total Births. From Puerperal Sepsis 0 0.00 From other Puerperal causes 0 0.00 0 0.00 Death-rate of Infants under one year of age: — All infants per 1,000 live births 26.65 Legitimate infants per 1,000 legitimate live births 26.44 Illegitimate infants per 1,000 illegitimate live births 32.25 Deaths from Cancer (all ages) 184 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 2 8 The following table gives the birth-rate, death-rate and infant mortality rate for Enfield as compared with those for England and Wales, London, 126 County Boroughs and Great Towns (including London) and 148 Smaller Towns:— Birth-rate. Death-rate. Mortality rate Infant Live Still England and Wales 16.7 0.39 11.7 32.00 London 18.5 0.37 12.2 29.00 126 County Boroughs and Great Towns (including London) 18.7 0.47 12.5 37.00 148 Smaller Towns 18.0 0 40 11.6 30.00 ENFIELD 15.52 0.32 9.41 26.65 DEATHS The number of deaths assigned to Enfield for 1949 was 1,047, an increase of 103 on last year. The more prevalent causes of death during the year and the previous year were:— Cause of Death 1949 1948 All Ages:— Malignant Disease (Cancer) 184 177 Heart Disease 296 247 Other Diseases of Circulatory System 47 36 Pneumonia 51 40 Bronchitis 69 45 Intra-cranial Vascular Lesions 117 103 Tuberculosis of Respiratory System 37 40 Children Under 1 Year:— Premature Birth 15 9 Congenital Malformations 6 11 Pneumonia 6 6 Meningitis — 4 Injury at Birth — 7 Atelectasis 7 7 9 The net death-rate for the District is 9.41 per 1,000 population. Three-hundred-and-two deaths registered in the District were persons over 80 years of age, 115 being males and 187 females, one man dying at the advanced age of 94, three women at the same age, three at the age of 95, and two at the age of 96 years. The following tables give the causes of deaths at all ages and of children under the age of 1 year:— TABLE I. Causes of Death during Year 1949. Causes of Death. Males. Females. Total. Typhoid and Para-Typhoid Fevers — — Cerebro-spinal Fever — — Scarlet Fever — — Whooping Cough — — — Diphtheria — — — Tuberculosis of Respiratory System 24 13 37 Other Forms of Tuberculosis 2 3 5 Syphilitic diseases 3 4 7 Influenza 1 6 7 Measles — — — Ac. Polio-myel : & polio-enceph. 2 1 3 Ac. Inf. Enceph. — — — Cancer of buc: cav. & oesoph. (M), uterus (F) 4 10 14 Cancer of stomach & duodenum 16 8 24 Cancer of breast — 22 22 Cancer of all other sites 76 48 124 Diabetes 1 6 7 Intracranial vascular lesions 48 69 117 Heart disease 157 139 296 Other diseases of Circulatory System 21 26 47 Bronchitis 41 28 69 Pneumonia 31 20 51 Other Respiratory Diseases 9 8 17 Ulcer of stomach or duodenum 5 4 9 Diarrhoea under 2 years 1 1 2 Appendicitis 1 I 2 Other Digestive Diseases 8 13 21 Nephritis 8 11 19 Puer. & Post-abort. Sepsis — — — Other Maternal Causes — — — Premature Birth 8 3 11 Con. mal: birth inj: infant dis. 12 13 25 Suicide 7 7 14 Road traffic accidents 6 3 9 Other violent causes 6 12 18 All other causes 35 35 70 Total 533 514 1.047 10 TABLE II. Infant Mortality Net Deaths from stated causes at various Ages under One Year of Age. Causes of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under One Year of Age All Causes—Certified Uncertified 29 4 2 1 36 6 3 1 — 46 Smallpox — — — — — — — — — — Chickenpox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions — — — — — — — — — — Laryngitis — — — — — — — — — — Bronchitis — — — 1 1 1 — 1 — 3 Pneumonia (all forms) 1 1 — — 2 3 1 — 6 Diarrhoea 1 — — — 1 — — — — 1 Enteritis — — — — — — 1 — — 1 Epidemic Diarrhœa — — — — — — — — — — Gastritis — — — — — — — — — — Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlying — — — — — — 1 — — 1 Injury at Birth — — — — — — — — — — Atelectasis 7 — — — 7 — — — — 7 Congenital Malformation 6 — — — 5 1 — — — 6 Premature Birth 12 2 —• — 14 1 — — — 15 Atrophy, Debilitv and Marasmus — — 2 — 2 — — — — 2 Other Causes 3 1 — — 4 — — — — 4 Totals 29 4 2 1 36 6 3 1 — 46 Net Births in the year:—Legitimate: Live births, 1,664; Stillbirths, 35. Illegitimate: Live births, 62; Still-births, 1. Net Deaths in the year:—Legitimate Infants, 44; Illegitimate, 2. 11 It will be seen from Table II that of the 46 infants who died before attaining the age of 1 year, 29 died within the first week of life. The infant mortality rate for the District is 26.65 and this figure compares most favourably with the rest of the country. BIRTHS The actual number of births registered in the District was as follows:— Males Females Total 926 803 1,729 including 30 male and 22 female illegitimate births. In addition 25 male and 9 female still births were registered. The corrected birth rates for both sexes, live and still births, which takes into consideration those born outside the District and those in the District not rightly recorded to the District, and also the corrected birth rates for the last five years are:— Year. Boys. Girls. Total. Birth-rate per 1,000 Population. Illegitimate Birth-rate per 1,000 Population. 1945 923 843 1,766 18.65 1.15 1946 1,120 1,110 2,230 21.39 0.91 1947 1,213 1,142 2,355 21.82 0.69 1948 1.013 943 1,956 17.57 0.36 1949 951 811 1,762 15.85 0.56 INQUESTS Fifty-seven inquests and one-hundred-and-nine P.M.s without inquests were held on Enfield residents during the year. Out of these, 111 deaths were due to natural causes, 31 to accidental causes, 17 to suicide, 4 to misadventure, 1 to murder, and in 2 cases an open verdict was recorded. NATIONAL ASSISTANCE ACT, 1948 No action was necessary during the year under Section 47 of the National Assistance Act, 1948, with regard to the removal to suitable premises of persons in need of care and attention. Such cases as were brought to the notice of the Health Department were dealt with by the Medical Officer of Health in co-operation with the Medical Practitioners, and the patients voluntarily agreed to go to suitable institutions. 12 AMBULANCE FACILITIES Under the National Health Service Act, 1946, the duty of providing an Ambulance Service devolves upon the County Council, and from the 5th July, 1948 the Middlesex County Council Fire and Ambulance Service have been responsible for the Ambulance Service previously controlled by the Health Department of the Enfield Council. INFECTIOUS DISEASES During the year, the following cases were admitted from Enfield to the South Lodge Isolation Hospital. Erysipelas 4 Scarlet Fever 103 Puerperal Pyrexia 1 Cerebro-Spinal Meningitis 1 Poliomyelitis 17 Polio-Encephalitis 1 Food Poisoning 1 Pneumonia 7 Dysentery 6 Measles 28 Whooping Cough 16 Gastro Enteritis 2 Chicken Pox 1 Tonsilitis 2 Infective Jaundice 1 Mumps 1 Quinsey 1 Contact with Scarlet Fever 1 Erythema 1 Scabies 1 ? Anthrax 1 197 LABORATORY FACILITIES The examination of all specimens is now carried out by the Public Health Laboratory Service either at the Central Laboratory, Colindale, or the branch laboratory situated at the Town Hall Edmonton. 13 The following table sets out the record of examinations carried out and the results. Throat and Nose Swabs. Diphtheria Bacilli 1 Haemolytic Streptococci 111 Vincent's Angina 8 Negative 353 473 Faeces. Shigellae 5 Salmonella — Protozoa — Negative 28 33 Sputum. T.B. Smear 7 Other Organisms — Negative 44 51 Pertussis. Cough Plate — Postnasal Swab 1 Negative 4 5 Milk. Pasteurised — Other — Ice cream 87 87 Water. Domestic supplies, etc. — Swimming pools 4 4 Miscellaneous. 43 43 696 14 WATER SUPPLY The District of Enfield is supplied with water by the Metropolitan Water Board, except for part of the Hadley Wood and Cockfosters area, which is supplied by the Barnet District Gas and Water Company. Both of these Authorities take regular and frequent samples for analysis. Copies of these reports are sent to the Health Department, and have shown satisfactory results. There was no cause to suspect any contamination during the year and no complaints were received as to the quality and quantity of water supplied by the above-mentioned undertakings. There are four dwellings in Enfield which receive their water supply other than from a public company; these are under constant supervision. There are no houses in the district which receive their water supplies by means of standpipes. The question of well-water supplies, both in connection with dwelling-houses and industrial premises, throughout the district has received the careful attention of the Department during the year, and every care has been exercised to see that such supplies are not used for drinking purposes where mains water supply is available. Two samples of well water were examined during the year and found to be satisfactory. MEDICAL EXAMINATION OF STAFF During the year, 70 medical examinations for the purposes of the Superannuation Acts were carried out by the Medical Officers INFECTIOUS DISEASES AND SCHOOLS 1949. 1948. Number of children notified to be absent from School due to:— (a) Infectious Disease or suspected tious Disease 371 176 (b) Contact with Infectious Disease 23 4 Number of children notified as suffering from Infectious Disease 940 513 15 HOUSING Number of new houses erected during the year:— Totals. With State Assistance (included in Totals). Local Authority Other Local Authorities Other Bodies or Persons Local Authority Other Local Authorities Other Bodies or Persons Temporary Houses Nil Nil Nil Nil Nil Nil Permanent Houses 163 Nil 16 163 Nil Nil Conversions into Flats Nil Nil 1 Nil Nil Nil Conversion into Halfway House Nil Nil Nil Nil Nil Nil Rebuilding of War Destroyed Houses Nil Nil 17 Nil Nil Nil Reinstatement of Extensively Damaged Houses Nil Nil 2 Nil Nil Nil Totals 163 Nil 36 163 Nil Nil 1. Inspection of Dwelling-houses:— No. of houses. No. of inspections. (1) Total number of dwelling-houses inspected for housing-defects (under Public Health Housing Acts) and number of inspections made 2,861 15,279 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932, and the number of inspections made Nil Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,444 (The number here given is of houses where any insanitary conditions were found.) 16 2. Remedy of defects without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1.049 3. Action under Statutory Powers. 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 Nil (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners Nil (b) By Local Authority in default of owner Nil B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 174 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 149 (b) By Local Authority in default of owners Nil The number of house-to-house visitations made was:— Under Housing Regulations, 1925 and 1932 12 Apart from Do. Do. 2,051 SLAUGHTER-HOUSES There are eight slaughter-houses in Enfield, none of which is in use at present. MILK The new Milk and Dairies Regulations, 1949, came into force on 1st October, 1949, and have meant considerable changes in the administration. The local authority is no longer responsible for the registration of cowkeepers, dairy farms, or dairymen, or inspection of their premises as heretofore. 17 THE MILK (SPECIAL DESIGNATIONS) (RAW MILK) AND (PASTEURISED AND STERILISED MILK) REGULATIONS, 1949. These Regulations came into force on the 1st October, 1949, and for the first time it became necessary to licence all dealers selling Sterilised Milk. At the end of the year the following licences were in operation : Grade. Dealers. Supplementary. Raw Milk: Tuberculin Tested 18 8 Accredited — 1 Pasteurised Milk 23 8 Sterilised Milk 35 21 Totals: 76 38 During the year samples of Milk were taken and tested ; all were found to be satisfactory. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The number of cases of Scarlet Fever was 175, compared with 124 in 1948, of Diphtheria nil, as compared with 3; of Pulmonary Tuberculosis 132, as compared with 147; and of Pneumonia 85, as compared with 61. There were no deaths from Scarlet Fever during the year, as was also the case in 1948. 18 NOTIFIABLE DISEASES DURING THE YEAR 1949. No. Removed. Deaths. Smallpox — — — Cholera—Plague — — — Diphtheria (inc. Membranous Croup) — — — Diphtheria Carriers — — — Erysipelas 19 4 — Scarlet Fever 175 103 — Typhus Fever — — — Typhoid Fever — — — Paratyphoid Fever — — — Relapsing Fever — — — Continued Fever — — — Puerperal Pyrexia 10 8 — Cerebro-Spinal Meningitis 1 1 — Poliomyelitis 17 17 2 Polio-Encephalitis 1 1 1 Ophthalmia Neonatorum 5 5 — Pulmonary Tuberculosis 132 — 37 Other forms of Tuberculosis 12 — 5 Encephalitis Lethargica — — — Food Poisoning 1 1 — Malaria 2 — — Pneumonia 85 7 51 Dysentery 7 6 — Measles 1,344 28 — Whooping Cough 559 16 — Totals 2,370 197 96 The above figures are in respect of Civilians and NonCivilians. The following table shows the number of houses in which cases of infectious diseases occurred during the year. In many instances, more than one family were occupying the houses. Disease 1 case 2 cases 3 cases 4 cases 5 cases 6 cases Scarlet Fever 138 17 1 Measles 897 167 29 5 — 1 Whooping Cough 339 81 14 4 — — Poliomyelitis 15 1 — — — — 19 The following table shows the number of notifications of cases of Infectious Disease per 1,000 civilian population in Enfield as compared with England and Wales, 126 County Boroughs and Great Towns including London, 148 Smaller Towns with resident population 25,000-50,000 (1931 Census) and London Administrative County. ENFIELD. England and Wales. 126 C.B.s and Great Towns including London. 148 Smaller Towns Resident Pop. 25,000-50,000 1931 Census. London Adm. County. Typhoid Fever 0.00 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.00 0.01 0.02 0.01 0.01 Cerebro-Spinal Fever 0.00 0.02 0.03 0.02 0.02 Scarlet Fever 1.57 1.63 1.72 1.83 1.46 Whooping Cough 5.02 2.39 2.44 2.39 1.70 Diphtheria 0.00 0.04 0.05 0.04 0.07 Erysipelas 0.17 0.19 0.20 0.19 0.17 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 12.09 8.95 8.91 9.18 8.54 Pneumonia 0.76 0.80 0.91 0.65 0.55 Acute Poliomyelitis 0.01 0.13 0.13 0.12 0.18 Acute Polioencephalitis 0.01 0.01 0.01 0.02 0.01 Food Poisoning 0.01 0.14 0.16 0.14 0.19 DIPHTHERIA No cases of Diphtheria occurred in the District during the year. This is the first occasion that it has been possible to record the fact that the District has been free from Diphtheria for a whole year. DIPHTHERIA IMMUNISATION 1,585 children were immunised for the first time and 1,783 received subsequent reinforcing doses during the year. The number of parents accepting this service for their children is not yet sufficiently high to warrant any sense of security. WHOOPING COUGH IMMUNISATION 847 children were immunised against Whooping Cough during the year. 20 POLIOMYELITIS AND POLIO-ENCEPHALITIS. The epidemic of 1947, which abated in 1948, was again in evidence throughout the country during 1949, and unfortunately was of a rather severe type. In the course of the year, 17 cases of poliomyelitis with two deaths and one case of polio-encephalitis, which also proved fatal, occurred in the district. The outbreak moderated towards the close of the year and no further cases were notified after the end of November. The following table shows the age and sex distribution of the cases notified. Age Groups Poliomyelitis Polio-Encephalitis Males Females Total Males Females Total Under 1 2 — 2 — — 1- 5 3 2 5 — — — 5-15 3 2 5 — — — 15-25 2 2 4 1 — 1 25-45 1 — 1 — — — Totals 11 6 17 1 — 1 Every known possible precaution against the spread of poliomyelitis was taken in addition to paying attention to watercourses in co-operation with the Metropolitan Water and Lee Catchment Boards. FOOD POISONING Although only one case of food poisoning was notified during the year, my attention was drawn to an attack of gastro-enteritis affecting about 30 people of both sexes engaged at a factory with a factory canteen available. The illness was not of a serious nature, most of those affected continuing at work and being practically recovered by the time I was informed of the outbreak. All those affected had partaken of a mid-day meal at the factory canteen the previous day. 21 A sample of the meal was sent for examination, specimens of faeces were taken from those complaining of symptoms, and, in addition, the canteen staff were examined and swabs taken from their noses, throats, and hands. The only significant feature found during these investigations was the presence in a portion of the meal of an organism not usually associated with food poisoning. The method of cooking and storing and the standard of cleanliness in this canteen appeared satisfactory, although certain minor recommendations were made to the Management during my visits. TUBERCULOSIS. The following table gives particulars of the ages of the new cases notified and deaths from this disease during the year. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. Under 1 — — — — — — — 1 to 5 2 1 2 1 — 2 1 5 to 10 1 1 1 — — — — — 10 to15 2 — 1 — — — — — 15 to20 7 5 1 — — 1 — — 20 to 25 12 11 — — — — — — 25 to 35 13 21 2 2 4 3 — — 35 to 45 10 8 — 1 4 6 — — 45 to 55 17 4 — — 9 1 — 1 55 to 65 12 1 — — 4 2 — 1 65 and upwards 3 1 — 1 3 — — — Totals 79 53 7 5 24 13 2 3 The following table shows the incidence of Tuberculosis and death-rates from this disease in the various Wards in the District during 1949. 22 Ward. Estimated Population. No. of Cases. T.B. Case-rate. T.B. Death-rate. Pulm. Other. Pulm. Other. Pulm. Other. North-East 26,240 38 4 1.44 0.15 0.22 0.11 South-East 21,003 28 2 1.33 0.09 0.61 0.00 Central 21,131 28 2 1.32 0.09 0.18 0.00 South-West 18,835 16 2 0.84 0.10 0.31 0.00 West 23,981 22 2 0.91 0.08 0.33 0.08 Total 111,190 132 12 1.18 0.10 0.33 0.04 MASS RADIOGRAPHY Following upon representations made by the Council, the North-East Metropolitan Regional Hospital Board arranged for their Mass X-Ray Unit to be set up in various parts of the district, and to carry out a comprehensive campaign to cover the whole of the district. Arrangements were made for school children over the age of 12 years, in addition to adults, to be X-rayed, and, in the case of the former, no school child was X-rayed without the written consent of the parent or guardian. Special sessions were set aside so that organised parties from the various schools could be attended to during school hours and without any undue length of time being taken up on account of large attendances. The afternoon and evening public sessions were extremely well attended, and I cannot pay too high a tribute to the capabilities and efficiency of the staff of the Unit who conducted the whole of the campaign with outstanding success. Thanks are also due to the various organisations in the district for their wholehearted support and co-operation. The Unit was set up, in the first instance, in the Wesleyan Hall, Church Street, and remained there from the middle to the end of September. From there it proceeded to the Co-operative Hall, Hertford Road, Enfield Highway, remaining there for approximately two weeks. After the completion of these two campaigns, the Unit was set up in the factories of the Enfield Cable Co., Brimsdown, and Chase Side Engineering Co., Great Cambridge Road, Enfield, to cater for the needs of the industrial populations of those areas. 23 The Unit completed its campaign just before Christmas and I have no hesitation in stating that it was an outstanding success and the efforts of everyone connected with the organisation were amply repaid. Results. The following tables give details of the results of the campaign. Table I. Group Nos. X-rayed Totals Nos. recalled for large films Totals Males Females Males Females School children 1,072 869 1,941 31 27 58 Council staff 53 36 89 1 3 4 General Public 1,000 1,309 2,309 61 78 139 Miscellaneous groups 273 320 593 16 19 35 Industrial groups 3,158 1,363 4,521 186 63 249 Totals 5,556 3,897 9,453 295 190 485 Table II. No. recalled for investigation 234 No. referred to Clinic and Hospital 132 No. requiring no further action 99 No. who did not attend for investigation 3 234 24 TABLE III 14 and under 15-24 25-34 35-44 45-59 60 + Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Active Pulmonary Tuberculosis — — 2 1 4 2 — 4 2 1 1 — 9 8 Inactive Pulmonary Tuberculosis 9 10 24 26 36 34 49 34 48 31 16 7 182 142 Cardiac Lesions — 1 1 4 1 — — 3 3 9 4 3 9 20 Bronchiectasis — — 3 — 2 — 2 — 1 — — — 8 — Carcinoma of the Bronchus — — — — — — — — 2 1* — — 2 1 Lung Abscess — — 1 — — — — — — — — — 1 — Pneumokoniosis — — — — — — 1 — 3 — — — 4 — Pleural Effusion (Non-Tuberculous) — — — — 1 — — — — — — — 1 — Pneumonitis 1 — — — — 1 — — — — — 1 1 2 Totals 10 11 31 31 44 37 52 41 59 42 21 11 217 173 * Carcinoma with active Pulmonary Tuberculosis. Nos. who did not attend for:— Large film to be taken Males 5. Females 2. Total 7 Investigation do. 2. do. 1. do. 3 Clinic do. 4. do. 1. do. 5 1 Male awaiting diagnosis (to be admitted to the London Chest Hospital). To be of any real value, Mass X-ray surveys should be carried out every two years, and it is hoped that such programmes will become a normal and routine feature in the future. RATS AND MICE DESTRUCTION During the year a Rodent Investigating Officer and three operators were engaged on control of rat infestation at dwellinghouses and other premises and of the sewers in the district. The Council decided that this service should be available to the occupiers of all dwelling-houses free of charge; industrial and 25 business premises are dealt with at the request of the proprietors who pay the full cost of any disinfestation undertaken at their premises. During the year the Sanitary Inspectors and Rodent Investigating Officer made 1,470 visits concerning rat infestation. All the sewers in the district have been systematically examined and the Ministry's scheme for the extermination of rats in sewers has been closely followed. Experience gained during these investigations has proved extremely useful to the Department, and it has been possible to trace any colony or heavy infestation; such infestations as were discovered were confined to small areas far apart from one another. During the initial investigations 1,384 manholes were examined and 1,175 pre-baits and 209 poison-baits were laid. The necessary follow-up treatment continues so that the rat population of the sewers may be kept under control. ERADICATION OF BED BUGS Number of Council Houses found to be infested 39 Number of Council houses disinfested 39 Number of other houses found to be infested 65 Number of other houses disinfested 65 Householders are urged to seek the assistance of the Health Department immediately they suspect the presence of bugs or similar pests. SANITARY INSPECTOR'S REPORT The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1949. The total number of inspections made during the year for all purposes was 24,068. The following table shows the number of inspections carried out by the Sanitary Inspectors during the year. No. of Inspections Housing Act, 1936 12 On account of Infectious Disease 180 Carried forward 192 26 Brought forward 192 On account of Tuberculosis 78 „ „ „ Complaint or otherwise 14,789 „ „ „ Vermin 220 Rag Flock Acts — Public Conveniences 151 Ice-Cream Shops 502 Schools 8 Cinemas, Halls, etc. 20 Public Houses 2 Hairdressers 25 Cowsheds 28 Milkshops and Dairies 83 Food Preparing Premises 825 Food Hawkers' Stands 48 Food Hawkers (Storage) 69 Bakehouses 56 Outworkers' Premises 223 Factories 267 Smoke Observations 105 Visits re Infectious Diseases 133 Tuberculosis 90 Housing Act,1936 (Sec. 62)—Permitted Numbers 2,051 Shops Acts 2,215 Gipsy Vans 23 Rats 1,470 Overcrowding 9 Scabies 3 Piggeries 82 Stables 17 Well Water Supplies 5 Wasps, Beetles, etc. 143 Other Visits 136 24,068 Samples taken—Water—Wells 2 Mains 2 Swimming Baths 5 Parks Lakes 12 Milk 2 Milk bottles—after washing 5 Ice-Cream 111 Rag Flock Nil Fowl Swabs 12 27 The following list of repairs executed during the course of the year shows that the defects found as the result of the Sanitary Inspectors' visits were varied and general in character. Houses or parts of houses cleansed, repaired, etc. 658 Roofs repaired 543 Gutters and downpipes repaired 217 Downpipes disconnected from drains 6 Dampness remedied 247 Ventilation provided under floors 15 Floors repaired 157 Yards paved or made good 18 Rooms stripped, etc., after infectious disease 2 Dustbins provided or renewed 88 Food stores provided 1 Drains—Examined 285 Tested—Smoke 33 Water 32 Reconstructed 28 Repaired, etc. 213 Vents provided — Vents repaired 7 Cesspools abolished 2 Sink wastes repaired 36 New sinks provided 43 Water-closets—New ones provided 71 Provided with flushing cistern or water supply 5 Repaired 165 Water—Cistern provided — Cisterns cleansed, covered, etc. 13 Wells cleansed, repaired, etc. 2 Water laid on or restored 10 Nuisances—Fowls, etc., removed Manure, etc., removed 4 Ditches, etc., cleaned out 5 Other nuisances abated—Coppers repaired, etc. 8 Stoves repaired or renewed 159 Windows repaired or renewed 315 Gipsy vans removed 35 Overcrowding abated 1 Miscellaneous 275 Houses demolished — 28 The Inspector appointed to carry out the requirements of Section 58 of the Housing Act, 1936, and the provisions of the Shops Acts, 1912 to 1936, made the following number of visits during the year:— Housing Act, 1936 2,051 Shops Acts, 1912-1936 2,215 Total 4,266 NOTICES ISSUED Statutory (Insanitary Conditions) 174 Informal ( Do. ) 1,493 Other Notices (Infectious Diseases) 2,590 4,257 Other Letters sent 4,184 Number of Certificates issued in connection with plans Nil Number of Certificates issued in connection with disinfection 21 Number of Certificates issued in connection with unsound foods 514 Number of Requisitions for Information dealt with 2,070 Number of Certificates issued under Rent Restrictions Acts, 1920 to 1939 16 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 149 1,188 Number outstanding 25 305 174 1,493 TOTAL INSPECTIONS Two-hundred-and-twenty-three visits were paid in respect of infectious diseases during the year, and the total number of inspections and visits for all purposes made by the Sanitary Inspectors was 24.068. INTERVIEWS A considerable amount of the time of the staff of the Health Department is taken up in interviewing members of the public who call at the offices for advice on matters concerning health and complaints as to the condition of their houses. DISINFECTION Number of houses disinfected after infectious disease and verminous cases 527 Number of articles of clothing, bedding, etc., disinfected 2,531 Number of Library books disinfected 103 Number of articles of clothing, bedding, etc., destroyed 256 29 From the beginning of April to the end of the year 424 such interviews were afforded members of the public. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. Number on Register. Number of Inspections. Written notices. Occupiers prosecuted. (1) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 52 7 — — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 342 316 3 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 16 — — — Total 410 323 3 — FACTORIES ACT, 1937 A register is kept of all the factories in the District, and during the year 323 inspections were carried out. 30 2.—Cases in which DEFECTS were found. Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Remedied. Referred. To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) 3 3 — 2 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 — 1 — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) (a) Insufficient 3 2 — 3 — (b) Unsuitable or defective 15 14 — 15 — (c) Not separate for sexes — — — — — Other offences (not including offences relating to Homework) 1 1 — 1 — Total 24 22 — 22 — OUTWORKERS Forty-seven lists containing the names and addresses of 328 out-workers were received during the year. One-hundred-andtwenty-four addresses of outworkers were forwarded to other districts. The following table gives details of the work carried out:— Outwork. Nature of Work. No. of Outworkers. Prosecutions. Notices served. Household Linen 4 — — Lace, Lace Curtains and Nets 1 — — Curtains and Furniture Hangings 1 — — Making Wearing Apparel 173 — — Cardboard Boxes, etc. 13 — — Shoes and Slippers 6 — — Feather sorting, etc. 5 — — Carding of Buttons, etc. 1 — — Artificial Flowers 2 — — Brush Making 34 — — Buckles 1 — — Toys and Games 80 — — Stuffed Toys 1 — — Stationery 2 — — Gloves 4 — — Total 328 — — 31 PLACES OF PUBLIC ENTERTAINMENT Number of inspections 20 OFFENSIVE TRADES Four offensive trade premises are established in the district, and during the year no complaints were received in connection therewith. SMOKE ABATEMENT During the course of the year observations have been kept on the factory chimneys of the district for nuisances due to the issue of an excessive amount of smoke. Although the industrial works in the Enfield urban district, with very few exceptions, are situated in a fairly well defined area on the eastern side of the district, complaints have been received throughout the year of (a) dust, ash, and grit from electricity works within the industrial area referred to and (b) smoke fumes and gritty deposit from a smelting works, which is not in this industrial area. Because of the nuisance and discomfort experienced from the existing power station, grave concern was expressed by the residents in the neighbourhood when they heard that proposals were being made to extend the electricity works. During the latter part of the year, a local Inquiry was held by the Minister of Fuel and Power into an application by the British Electricity Authority to extend their Brimsdown Electricity Generating Station by the installation of one 60,000 k.w. generator, two 360,000 lbs./hr. boilers, and two cooling towers. In spite of opposition from the Council and Residents' Associations, the Minister gave his consent to the proposals, subject, inter alia, to the continuous use of the most efficient methods which may for the time being be reasonably practicable for the elimination of smoke and grit and the avoidance of noise and vibration. It is understood that the extension will include the installation in the new plant of multi-cell cyclones and that proposed modifications and improvement of the existing works will reduce the emission of dust and grit from the older chimney stacks. Complaints were received concerning noise and the emission of smoke, fumes and grit from a smelting works in the district. The owners of the works changed their furnaces from solid fuel to oil-burning in an effort to prevent smoke, but there have been complaints of frequent intermittent fumes and smoke from the smelting pots, and of gritty deposit. 32 Conferences between the Works Management, Council members and officers and nearby residents have so far failed to secure the permanent improvement anticipated. Continual observations are still being taken with a view to enforcing, as far as possible within present legislation, the best practicable means of preventing a nuisance, not only in the two cases referred to but also at other premises liable to cause a smoke nuisance. SWIMMING BATHS AND POOL The water at each of the Baths in Enfield is tested twice daily by the Superintendents to ascertain the concentration of Chlorine in the water. In addition, samples are taken each week by my Department and examined in the Laboratory at the Office for chlorine content and alkalinity. During the warm part of the Season samples of the water have been sent to the Public Health Laboratories where a full bacteriological examination is carried out. I was satisfied that throughout the Season the purity of the water in the Baths was satisfactorily maintained. SCHOOLS The sanitary condition of the County Schools in the District is under the constant supervision of the Sanitary Inspectors and any defects found are immediately brought to the notice of the Authorities concerned. The sanitary conveniences at all the voluntary schools are attended to daily by an employee of the Health Department. PUBLIC HEALTH (MEAT) REGULATIONS, 1924 Total number of carcases examined Nil Number, or parts, found to be diseased (in Butchers' shops) 32 Weight of do. do. do. 2,227½ lbs. Number of Certificates issued 32 FOOD AND DRUGS ACT, 1938 The number of Food Preparing and Ice-Cream premises in the District and number of inspections and visits made by the Sanitary Inspectors in regard thereto are as follows:— 33 Premises No. No. of Inspections and Visits Food Preparing 181 825 Ice-Cream (Sale and/or Manufacture) 165 502 Ice-Cream As will be seen from the tabulated statement above, frequent inspections of ice-cream premises were made during the year. During these visits 111 samples of ice-cream were taken and the reports on these samples are summarised as follows:— Grade No. of Samples I 72 II 7 III 8 IV 13 Examined for Pathogenic Organisms, but not graded 11 Total 111 Examination of Foods Number of inspections made to retail shops, stalls and food-preparing premises 1,500 Total No. of articles, etc., condemned 5,137 Total No. of Certificates issued 514 Total weight of foodstuffs (other than fresh meat) condemned as unfit for food:— 6 tons 0 cwts. 1 qrs. 3½ lbs. Meat and Other Foods Although there are 8 slaughterhouses in the district, none are now in use for slaughtering purposes, and therefore no examinations or inspections of animals or carcases were carried out during the year. MIDDLESEX COUNTY COUNCIL ACT, 1944 SECTION 279 The provisions of the above require all Hawkers of Meat, Fish, Fruit and Vegetables and Storage Premises used in connection therewith to be registered by the Council; during the year 22 Hawkers were registered. 34 The following table shows the number of Hawkers' Premises, etc., registered and the number of inspections made by the Sanitary Inspectors during the year in connection therewith. No. of Premises, etc., on Register No. of inspections 86 117 CARAVANS Number of applications received for consent Nil Number of applications granted Nil REMOVAL OF HOUSE REFUSE CESSPOOL EMPTYING SEWER FLUSHING The above services are under the control of the Engineer and Surveyor's Department. PUBLIC MORTUARY There is now no public mortuary in Enfield, but use is made at present of a Hospital Mortuary. Printed by Stanley Woodfikld 8-12, Windmill Hill, Enfield - Middlesex.