9 ENF 35 34/8/3 1726 Drban District Council of Enfield r.» i>i,v.iHi.. ; ' <N». j ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1951 / , ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1951 URBAN DISTRICT COUNCIL OF ENFIELD With the Medical Officer of Health's Compliments PUBLIC OFFICES, ENFIELD. URBAN DISTRICT COUNCIL OF ENFIELD CLEAN FOOD CAMPAIGN Housewives Remember! YOU ALONE reign supreme in your own kitchens Buy all your food when it is fresh, Don't handle when you choose it, Do store it in a nice cool spot Until it's time to use it. Protect it also from the dust And animals and vermin; Keep out the vulgar feeding flies Who might bring some food germ in. Wash hands as often as you can, Especially after toilet; Imagine what the food could do If dirty hands did soil it. So if you have a septic spot On body, hands or face, Please treat and cover right away Lest germs do spread apace. [ P.T.O. For if the germs from septic spots, Or coughing, or from sneezing, Reach food which you've prepared to eat, Results may not be pleasing. 'Tis best to eat a meal that's cooked As soon as it is done, For warmed-up meals can often be As deadly as a gun. Watch garbage, pigbins, dustbins, too, Don't leave the lid awry; Kill off the rodents and the flies Before they multiply. The dull routine of " washing up " Requires you to beware; Use lots of water, very hot, Detergent, if you care. Make sure that knives and forks and spoons As well as all the crockery, Are not so dirty as to make Hygienic codes a mockery. Do not neglect the towels and cloths; A frequent wash and boil Will do a very great amount The germs' attacks to foil. The kitchen sink and draining board Must never be neglected, For if forgotten for a time With germs become infected. A most important point I make To keep the family happy, Don't use the bowl for " washing-up " AND rinsing baby's nappy. Do think of all these little points When food you do prepare, Then in your household you won't have A bad food-poisoning scare. Health Department, Public Offices, ENFIELD. Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1951 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1951 To the Chairman and Members of the Urban District Council of Enfield. I have pleasure in presenting my Annual Report for 1951. Last year I commented on the unlimited opportunities for Public Health to improve the health of the community and so relieve the burden on the curative side of the Health Services. As the success of preventive medicine will pay ample dividends, not only in preventing ill-health and saving life, but in reducing expenditure on curative medicine, which I imagine is most evident in the case of infectious disease, it is perhaps unfortunate that such financial advantages are not directly reflected in Local Authority expenditure. Although the Public Health Department can take action within the limits of existing legislation to promote health and remove factors adverse to healthy living, there remains much that individuals can and must do in their own interests. To a large extent this applies to the conditions under which we select to spend our leisure and I make no apology for reiterating my remarks of last year when I referred to Enfield's fortunate position with regard to parks and open spaces and pleaded for their proper use to the full extent. These opportunities for healthy out-door exercise should be seized during all seasons by each individual according to his capacity, and there is excuse only for a few to lead a completely sedentary life. By this, I am not drawing a picture of the citizens of Enfield, in gymnastic garb, undertaking athletic feats in the parks in all sorts of weather, but merely suggesting that all of us whose occupations are more or less sedentary should endeavour, according to our own needs and ability, to secure adequate outdoor activity to give the necessary exercise and training essential to good health. Although no action was taken during the year, under section 47 of the National Assistance Act, which deals with the compulsory removal of aged and infirm persons to Hospitals and Institutions, because of lack of proper care and attention at, home, sufficient cases were brought to my notice to make me realise that the problem of the proper care of the aged is growing yearly. We have known that the proportion of aged people in the population is increasing, but it is disturbing to find increasing evidence of lack of family unity 4 and responsibility. The problem is a difficult and complex one, and we must not be hasty to criticise, but there appears to be in some cases a need for the awakening of responsibility of the family to its aged members as well as to its younger members. At times, one also wonders if the old attribute of neighbourliness is not also on the decline. Whilst examples of the highest degree of neighbourliness come to my notice, there are occasions when a little neighbourliness would be preferable to, and take some of the burden off, the official social services which can be overburdened. It seems no time since I welcomed the disbandment of the Civil Defence Services as giving the Health Department the happy prospect of being able to apply its whole energy to its preventive health functions, but Civil Defence has again begun to require the consideration and some of the energy of the Department. Housing conditions continue to absorb a large proportion of the time of the Department and although during the year no action was taken in regard to demolitions or clearance orders, certain action in this sphere will become necessary in the near future. The most prevalent infectious disease was Measles which reached considerable proportions. A mild type of Dysentery was more widespread than usual and is referred to elsewhere in my report. It is gratifying to report for the third year in succession the absence of Diphtheria and to note that only one case of Poliomyelitis occurred. The reduction in the number of cases of Respiratory Tuberculosis by twenty-two was a very welcome improvement, but a regrettable feature was that the previous year's marked reduction in the number of deaths has not been maintained. The fact that Diphtheria has been absent from Enfield for three years in succession must not be interpreted as a sign of its complete elimination for all time, but rather as an encouragement and challenge to continue our efforts to secure that all children receive adequate and timely protection by immunisation in order to maintain this freedom from a serious disease. Only by continued vigilance and attention to immunisation can Diphtheria be kept at bay, and the number of parents accepting this service for their children is not sufficiently high to warrant any sense of security. The Birth-rate of 14.45 showed only a slight increase on the previous year's record low figure of 14.31, and was well below the figures for the War years and immediate Post-war years, and, of course, was only about half that recorded each year in the early years of the century. I am glad to record that the Still Birth-rate was markedly lower than the previous year. 5 The Infant Mortality-rate of 22.98 was slightly higher than the previous year's low record of 21.65. It was the second lowest recorded and compares favourably with the figure of 29.6 for England and Wales. The Death-rate of 10.5 was slightly higher than the previous year, there being an increase in the number of deaths from Cancer and Heart Disease. It is interesting to note that nearly onethird of the deaths occurred in persons over eighty years of age, one male being 93 years, two females 97 years, three females 98 years, and one female 100 years. Although the total deaths were almost equally divided between males and females, only 38.5 per cent. of the deaths over 80 years of age were males. These proportions are similar to the previous year's figures. In conclusion, I should like, once again, to record my appreciation of the efforts of the Staff of the Health Department during the past year, and to place on record the fifty years loyal and efficient service in the Health Department of Mr. Noel Smith, Senior Sanitary Inspector. William D. Hyde, Medical Officer of Health. 6 URBAN DISTRICT COUNCIL OF ENFIELD P. Robson, Esq., J.P Chairman W. J. Howes, Esq Vice-Chairman Mrs. L. E. Daines, C.C., J.P. Mrs. G. M. Jay, J.P. Mrs. E. M. Rowland Mrs. E. M. Siegler A. D. Bates, Esq. W. G. Bowyer, Esq. D. R. J. Boxall, Esq. T. H. M. Clarke, Esq. S. W. Cobbin, Esq. J. Cottenham, Esq., J.P. W. H. Cook, Esq. G. Deacock, Esq. A. M. Eeles, Esq. L. E. Harris, Esq. A. G. Hayward, Esq. A. R. Kemp, Esq. E. E. Leesmith, Esq. W. E. Lonsdale, Esq. W. F. Lowe, Esq. E. L. Mackenzie, Esq. L. Nicolls, Esq. C. Partington, Esq., J.P., M.R.S.T. G. H. Platten, Esq. P. L. Purnell, Esq., J.P. A. H. Saunders, Esq. A. A. F. Tatman, Esq., J.P. E. J. Tong, Esq. L. F. Wass, Esq. HEALTH COMMITTEE Mrs. G. M. Jay, J.P Chairman Mrs. E. M. Siegler Vice-Chairman also Mesdames Daines and Rowland, also Messrs. Boxall, Cottenham, Harris, Leesmith, Lowe and Platten. 7 PUBLIC HEALTH STAFF Medical Officer of Health : Dr. W. D. Hyde. Deputy do. Dr. A. C. McLeish (Resigned 4th December, 1951) Senior Sanitary Inspector: Mr. A. N. Smith. Sanitary Inspectors: Mr. H. Wiggett, Mr. A. Ramsden, Mr. D. C. Turner, Mr. C. Day, Mr. G. E. A. Laney and Mr. N. Smith (appointed 15th October, 1951). 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, Mrs. F. I. Dufton and Miss J. Pinkham. Shorthand-Typist: Miss H. E. Grout, Miss A. V. Frost (resigned). STATISTICS AND SOCIAL CONDITIONS OF THE AREA POPULATION The population as estimated by the Registrar General is 109,900. The number of inhabited houses at the end of 1951, according to the Rate Books, was 28,385. Explanatory Note :— Definition of " Houses "—Structurally separate dwellings including flats. The rateable value of the District is £891,541 The net product (after allowing for cost of collection) of a penny rate is £3,313 AREA Area (in acres) 12,400 NEW HOUSES The number of houses erected during the course of the year was 330. 8 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,525 743 782 Illegitimate 41 19 22 Birth-rate—14.25 per 1,000 population. Still Births:— Total. Male. Female Legitimate 21 12 9 Illegitimate 1 1 — Rate per 1,000 total births—13.85. Total. Male. Female. Deaths 1,154 606 548 Death-rate—10.50 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 2 1.26 2 1.26 The causes of death were as follows :— (1) Patient aged 29 years. Shock, haemorrhage, sepsis following abortion at 3J months. (2) Patient aged 30 years. Obstetric shock due to ante and post partum haemorrhage. Death-rate of Infants under one year of age : — All infants per 1,000 live births 22.98 Legitimate infants per 1,000 legitimate live births .. 22.95 Illegitimate infants per 1,000 illegitimate live births 24.39 Deaths from Cancer (all ages) 200 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 4 9 BIRTH, DEATH AND INFANT MORTALITY RATES. Birth-rate. Death-rate. Mortality rate Infant Live Still England and Wales 15.5 0.36 12.5 29.6 London 17.8 0.37 13.1 26.4 126 County Boroughs and Great Towns (including London) 17.3 0.45 13.4 33.9 148 Smaller Towns 16.7 0.38 12.5 27.6 ENFIELD 14.25 0.20 10.50 22.98 DEATHS The number of deaths assigned to Enfield for 1951 was 1,154, an increase of 140 on last year. The more prevalent causes of death during the year and the previous year were :— Cause of Death 1951 1950 All Ages:— Malignant Disease (Cancer) 200 179 Diseases of Heart 375 329 Other Diseases of Circulatory System 34 34 Pneumonia 50 37 Bronchitis 62 63 Vascular Lesions of Nervous System 149 140 Tuberculosis of Respiratory System 45 20 Children Under 1 Year :— Premature Birth 8 14 Congenital Malformations 5 6 Pneumonia 8 4 Bronchitis — 3 Injury at Birth 1 2 Atelectasis 5 2 The net death-rate for the District is 10.50 per 1,000 population. Three-hundred-and-sixty-six deaths registered in the District were persons over 80 years of age, 141 being males and 225 females, one man dying at the advanced age of 93, two women at the age of 97 years, three at the age of 98, and one at the age of 100 years. 10 TABLE I. Causes of Death during Year 1951. Causes of Death. Males. Females. Total. Typhoid and Para-Typhoid Fevers – – – Cerebro-spinal Fever — — — Scarlet Fever – – – Whooping Cough — 1 1 Diphtheria — — — Tuberculosis of Respiratory System 25 20 45 Other Forms of Tuberculosis 1 4 5 Syphilitic diseases 1 1 2 Influenza 13 11 24 Measles – – – Other infective and parasitic diseases – 1 1 Ac. Polio-myelitis — — — Meningococcal infections — — — Malignant Neoplasm of stomach 12 13 25 Malignant Neoplasm, lung, bronchus 29 3 32 Do. of breast – 16 16 Malignant Neoplasm, uterus — 6 6 Other Malignant and Lymphatic Neoplasms 71 50 121 Leukaemia, aleukaemia 2 4 6 Diabetes 2 5 7 Vascular lesions of nervous system 63 86 149 Coronary disease, angina 77 52 129 Hypertension with heart disease 30 27 57 Other Heart disease 87 102 189 Other Circulatory disease 21 13 34 Bronchitis 41 21 62 Pneumonia 24 26 50 Other diseases of Respiratory system 7 3 10 Ulcer of stomach and duodenum 11 3 14 Gastritis, Enteritis and Diarrhoea 3 1 4 Appendicitis — — — Other Digestive Diseases — — — Nephritis and Nephrosis 8 5 13 Hyperplasia of prostate 10 — 10 Pregnancy, Childbirth and Abortion — 2 2 Congenital Malformations 5 7 12 Suicide 3 5 8 Motor Vehicle accidents 6 4 10 All Other accidents 12 12 24 Other defined and ill-defined diseases 42 44 86 Homicide and operations of war — — — Total 606 548 1,154 11 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 18 3 3 – 24 4 3 4 1 36 Uncertified — — — – – – – – – – Smallpox – – – – – – – – – – Chickenpox – – – – – – – – – – Measles – – – – – – – – – – Scarlet Fever – – – – – – – – – – Whooping Cough – – – – – – – 1 — 1 Diphtheria and Croup – – – – – – – – – – Erysipelas – – – – – – – – – – Tuberculous Meningitis – – – – – – – – – – Abdominal Tuberculosis – – – – – – – – – – Other Tuberculous Diseases – – – – – – – 1 – 1 Meningitis (not Tuberculous) – – – – – – – – – 1 Convulsions – – – – – – – – – – Laryngitis – – – – – – – – – – Bronchitis – – – – – – – – – – Pneumonia (all forms) – 2 2 – 4 1 1 1 1 8 Diarrhoea – – – – – – – – – – Enteritis – – – – – – – – – – Epidemic Diarrhoea – – – – – – – – – – Gastritis – – – – – – – – – – Syphilis – – – – – – – – – – Rickets – – – – – – – – – – Suffocation, overlying – – – – – – – – – – Injury at Birth 1 – – – 1 – – – – 1 Atelectasis 4 1 – – 5 – – – – 5 Congenital Malformation 3 – – – 3 – 2 – – 5 Premature Birth 7 – 1 – 8 – – – – 8 Atrophy, Debility and Marasmus – – – – – – – – – – Other Causes 3 – – – 3 2 – 1 – 6 Totals 18 3 3 – 24 4 3 4 1 36 Net Births in the year :—Legitimate: Live births, 1,525 ; Stillbirths, 21. Illegitimate : Live births, 41 ; Still-births, 1. Net Deaths in the year :—Legitimate Infants, 35 ; Illegitimate, 1. 12 It will be seen from Table II that of the 36 infants who died before attaining the age of 1 year, 24 died within the first four weeks of life, and of this number 18 deaths occurred in infants under 1 week. The infant mortality rate for the District is 22.98 and this figure compares most favourably with the rest of the country. BIRTHS 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. 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 1950 816 782 1,598 14.31 0.57 1951 775 813 1,588 14.45 0.38 INQUESTS Forty-five inquests and one-hundred-and-twenty-six P.M.s without inquests were held during the year. Of these, 127 deaths were due to natural causes, 30 to accidental causes, 8 to suicide, 2 to misadventure, 1 to inattention at birth, and in 3 cases an open verdict was recorded. FATAL HOME ACCIDENTS. In 1949 I wrote about fatal home accidents in an article for the Enfield Road Safety Brochure, and once again my attention has been drawn to this subject by a publication of the Ministry of Health, from which the following depressing information is extracted. In 1949 in England and Wales there were 5,553 fatal accidents at home, although this figure was a distinct improvement on previous years. About 60 per cent. of these accidents occurrcd to persons over the age of 65 years, and about 20 per cent. to children under the age of 5 years. About 60 per cent. of these accidents were due to falls, and the remaining 40 per cent. to suffocation, burns and scalds, and coal gas. More children under 15 years died from accidents in their own homes than died from accidental causes elsewhere, including road accidents. More children under 15 years died 13 from accidents in the home than from any single infectious disease. When one considers that there must be many less serious, though perhaps crippling accidents for every fatal one, the extent of the problem can be realised. Bearing in mind these National figures for 1949, an analysis of the figures for Enfield residents for 1951 was made, but a completely similar pattern was not evident. 28 fatal accidents from all causes occurred to Enfield persons, equally divided between the sexes ; 11 were road accidents, 14 were home accidents ; 1 was a drowning accident; 1 was a railway accident, and 1 an accident in a park. Most of the 14 home accidents involved elderly women, and only 1 child (a boy of 18 months) was included. The average age of the male adults was 71 years and the female adults 78 years. 13 of the 14 deaths were due to falls, causing fracture of femur, followed by lung complications in 7 cases, and injury to the brain in 5 cases. Shock, due to burns by falling on the fire, was the cause of death in the thirteenth case. The remaining fatal accident was due to scalds from a hot water bottle. The outstanding points in these local figures of home accidents are the high proportion of elderly females involved, the single instance of one child, the fact that there were more fatal accidents in the home than on the roads, and that fatal home accidents equalled those from all other causes. 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. 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 has been responsible for the Ambulance Service previously controlled by the Health Department of the Enfield Council. 14 INFECTIOUS DISEASES During the year, the following cases were admitted from Enfield to the South Lodge Isolation Hospital. Para-typhoid Fever 1 Erysipelas 5 Scarlet Fever 87 Meningococcal Infection 3 Croup 1 Food Poisoning 1 Pneumonia and Pleurisy 8 Measles 30 Whooping Cough 10 Gastro Enteritis 6 Chicken Pox 5 Puerperal Pyrexia 2 Glandular Fever 1 Inflamed Eyes 1 Infective Hepatitis 1 Dysentery 5 167 LABORATORY FACILITIS3 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. The following table sets out the record of examinations carried out and the results. Throat and Nose Swabs. Diphtheria Bacilli — Haemolytic Streptococci 137 Vincent's Angina 10 Negative 498 645 C/fwd 645 15 B/fwd 645 Faeces. Shigellae 826 Giardia 14 Salmonella 2 Protozoa — Negative 1,967 2,809 Sputum. T.B. Smear 9 Other Organisms 19 Negative 45 73 Pertussis. Cough Plate 4 Postnasal Swab — Negative 39 43 Milk. Pasteurised 15 Other — Ice cream 40 55 Water. Domestic supplies, etc. 10 Swimming pools 4 14 Miscellaneous. 102 102 3,741 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 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. 16 There was no cause to suspect any contamination during the year. 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. Five samples of well water were examined bacteriologically and one sample chemically, during the year and found to be satisfactory. MEDICAL EXAMINATION OF STAFF During the year, 35 medical examinations for the purposes of the Superannuation Acts were carried out by the Medical Officers HOUSING Number of new houses erected during the year by:— (a) Local Authority 283 (b) Other Local Authorities Nil (c) Other bodies or persons 47 With State assistance (included in above totals):— (a) Local Authority 283 (b) Other Local Authorities Nil (c) Other bodies or persons 20 17 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 2,416 12,210 (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 2 2 (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 (The number here given is of houses where any insanitary conditions were found.) 1,111 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 932 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 112 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 52 (b) By Local Authority in default of owners Nil The number of house-to-house visitations made was:— Under Housing Regulations, 1925 and 1932 2 Apart from Do. Do. 236 SLAUGHTER-HOUSES There are eight slaughter-houses in Enfield, none of which is in use at present. THE MILK (SPECIAL DESIGNATIONS) (RAW MILK) AND (PASTEURISED AND STERILISED MILK) REGULATIONS, 1949. The following Licences were in operation at the end of the year Grade. Dealers. Supplementary. Raw Milk: Tuberculin Tested 17 10 Accredited — — Pasteurised Milk 24 10 Sterilised Milk 54 12 Totals: 95 32 During the year 15 samples of Milk were taken and tested; all were found to be satisfactory, with the exception of one, and the necessary action was taken in regard thereto. 19 FOOD AND DRUGS ACT, 1938 The following table gives details of the samples procured under the above Act in Enfield by the Food and Drugs Authority during 1951:— Article. Total samples procured. Unsatisfactory. Milk 247 7 Cakes 38 — Camphorated Oil 1 — Cherry Wine (non-alcoholic) 2 1 Codein Compound 1 — Cooked Meat 5 — Fish 26 — Fish and Chips 2 — Flour batter 1 — Frying Fat 1 — Gin 4 — Glace Fruits 1 — Golden Raising Pudding 1 — Ice Cream 3 — Ice Cream Mixture 1 — Lemon Cheese 1 — Luncheon Meat 4 — Macaroni 2 — Meat Pie 3 — Meringue Mixture 1 — Mincemeat 2 — Morfat Whip 1 — Orange Juice 1 — Potatoes (cooked) 3 — Sausages (various) 26 1 Sausage Meat 4 2 Sausage Rolls 2 — Sherbet 1 — Tiger Nuts 2 — Vinegar 2 — Whisky 12 — White Pepper 1 — Zinc Ointment 1 — Totals: 403 11 20 CLEAN AND SAFE FOOD A Clean and Safe Food Campaign was held during the period 7th to 12th May, 1951, and a full report of this Campaign was given in my Annual Report for 1950, as the preliminary steps were taken in 1950 and the Campaign week had been held prior to the publication of my Report for 1950. Following upon the successful conclusion of the Campaign Week, steps were taken to keep this subject in the minds of the Food Trade and the public, and to press for every possible improvement in the hygienic handling and preparation of food. Towards the end of the year the Committee decided to hold another Campaign during 1952. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES AND SCHOOLS 1951. 1950. Number of children notified by Head Teachers to be absent from School due to:— (a) Infectious Disease or suspected Infectious Disease 229 160 (b) Contact with Infectious Disease 9 12 Number of School children notified by General Practitioners as suffering from Infectious Disease 1,592 395 21 NOTIFIABLE DISEASES DURING THE YEARS 1950 AND 1951. 1951 1950 No. Removed. Deaths. No. Removed. Deaths. Smallpox — — — — — — Cholera—Plague — — — — — — Diphtheria (inc. Membranous Croup) — — — — — — Diphtheria Carriers — — — — — — Erysipelas 22 6 — 20 2 — Scarlet Fever 171 90 — 149 60 — Typhus Fever — — — — — — Typhoid Fever — — — — — — Paratyphoid Fever 1 1 — 1 1 — Relapsing Fever — — — — — — Continued Fever — — — — — — Puerperal Pyrexia 36 26 — 13 13 — Meningococcal Infection 5 5 — 1 1 — Poliomyelitis (Paralytic and Non-Paralytic) 1 — — 8 7 2 Acute-Encephalitis — — — — — — Ophthalmia Neonatorum 1 1 — 2 2 — Pulmonary Tuberculosis 113 — 45 135 — 20 Other forms of Tuberculosis 15 — 5 16 — — Food Poisoning 13 1 — 13 8 1 Malaria — — — 1 — — Pneumonia 94 8 50 97 6 37 Dysentery 257 8 — 24 — — Measles 2466 31 — 344 13 — Whooping Cough 248 10 1 332 5 — Totals 3443 187 101 1156 118 60 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 132 15 3 — — — Measles 1,440 361 82 10 — — Whooping Cough 42 81 12 2 — — Dysentery (Sonné) 110 33 10 6 3 2 22 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 0.00 0.00 0.00 0.01 Paratyphoid Fever 0.01 0.02 0.03 0.02 0.01 Meningococcal Infection 0.04 0.03 0.04 0.03 0.03 Scarlet Fever 1.55 1.11 1.20 1.20 1.10 Whooping Cough 2.25 3.87 3.62 4.00 3.11 Diphtheria 0.00 0.02 0.02 0.03 0.01 Erysipelas 0.20 0.14 0.15 0.12 0.15 Smallpox 0.00 0.00 0.00 0.00 — Measles 22.43 14.07 13.93 14.82 14.64 Pneumonia 0.85 0.99 1.04 0.96 0.72 Acute Poliomyelitis (including Polio-encephalitis) Paralytic 0.01 0.03 0.03 0.03 0.02 Non-Paralytic 0.00 0.02 0.02 0.03 0.02 Food Poisoning 0.11 0.13 0.15 0.08 0.23 DIPHTHERIA For the third year in succession no case of Diphtheria occurred in the District. DIPHTHERIA IMMUNISATION 1,624 children were immunised for the first time and 2,321 received subsequent reinforcing doses during the year. Although these figures show an improvement on last year's figures, the number of parents accepting this service for their children is not yet sufficiently high to warrant any sense of security. WHOOPING COUGH IMMUNISATION 774 children were immunised against Whooping Cough during the year. 23 POLIOMYELITIS AND ACUTE ENCEPHALITIS. During the course of the year, only one case of poliomyelitis was notified. This is a reduction on the previous year's figure of 8 cases of poliomyelitis with one death. The one case notified was an adult female. Symptoms were mild and doubtful but the case is recorded as Poliomyelitis. FOOD POISONING Thirteen cases of food poisoning were notified during the year ; all were isolated single cases and no outbreak occurred. SONNE DYSENTERY The incidence of mild dysentery due to Shigella Sonnei, rose towards the end of 1950, and more cases than usual were notified during 1951 (257 in 1951, 24 in 1950). The prevalence of Sonné Dysentery has been more marked during recent years, but more accurate diagnosis by bacteriological methods which are now more readily available, may partly account for this increase in notifications, as well as the more intensive bacteriological investigations of contacts. It was found necessary to take more active steps to exclude contacts from Day Nurseries, Schools and certain occupations, and the procedure adopted in investigating bacteriologically these contacts, and following up of positive cases until free from infection, involved a considerable amount of work, but it is believed that the spread of infection was materially reduced by these means. 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 — — 1 — — — 1 to 5 3 2 1 1 — — 1 1 5 to 10 5 2 2 — — — — — 10 to 15 3 2 — 1 — — — — 15 to 20 8 5 — — 2 — — — 20 to 25 6 4 1 — — 1 — — 25 to 35 9 11 2 2 2 3 — 2 35 to 45 8 13 2 2 4 6 — — 45 to 55 10 4 — — 5 3 — — 55 to 65 9 1 — 1 7 5 — 1 65 and upwards 3 4 — — 4 2 — — Totals 64 49 8 7 25 20 1 4 24 The following table shows the incidence of Tuberculosis and death-rates from this disease in the various Wards in the District during 1951. Ward. Estimated Population. No. of Cases. T.B. Case-rate. T.B. Death-rate. Pulm. Other. Pulm. Other. Pulm. Other. North-East 25,922 25 3 0.95 0.11 0.34 0.00 South-East 20,761 18 4 0.86 0 19 0.43 0.09 Central 20,887 23 2 1.09 0.09 0.47 0.04 South-West 18,625 23 1 1.22 0.05 0.21 0.00 West 23,705 24 5 1.00 0.20 0.54 0.08 Total 109,900 113 15 1.02 0.13 0.40 0.04 PREVENTION OF DAMAGE BY PESTS ACT, 1949. 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 business premises are dealt with at the request of the proprietors who pay the full cost of any disinfestation undertaken at their premises. 777 premises were inspected during the year for rat and mice infestation, and of these 660 were found to be affected. The total number of treatments carried out by the Department (including domestic, business and factory premises, and re-infestations) was 614. During the year the Sanitary Inspectors and Rodent Investigating Officer made 9,717 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 1,295 manholes were examined and 742 pre-baits and 161 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 21 Number of Council houses disinfested 21 Number of other houses found to be infested 45 Number of other houses disinfested 45 Householders are urged to seek the assistance of the Health Department immediately they suspect the presence of bugs or similar pests. 25 SANITARY INSPECTOR S REPORT The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1951. The total number of inspections made during the year for all purposes was 30,604. The following table shows the number of inspections carried out by the Sanitary Inspectors during the year. Inspections:— No. of Inspections Housing Act, 1936 2 Infectious Disease 222 Tuberculosis 104 Complaint or otherwise 11,610 Vermin 272 Rag Flock Acts 13 Public Conveniences 148 Ice-Cream Shops 175 Schools 12 Cinemas, Halls, etc. 33 Public Houses — Fair-grounds 2 Hairdressers 11 Milkshops and Dairies 97 Food Preparing Premises 1,477 Food Hawkers' Stands 40 Food Hawkers (Storage) 36 Bakehouses 51 Outworkers' Premises 57 Factories 28 Smoke Observations 2 Visits:— Infectious Diseases 1,358 Tuberculosis 129 Housing Act, 1936 (Sec. 62)—Permitted Numbers 236 Shops Acts 3,354 Gipsy Vans 68 Rats 9,717 Overcrowding 27 Sub-letting 1 Piggeries 10 Stables 11 Well Water Supplies 6 Wasps, Beetles, etc. 146 Other Visits 1,149 30,604 26 Samples taken—Water—Wells 6 Mains 4 Swimming Baths 5 Parks Lakes etc. 15 Milk 15 Water-cress 8 Ice-Cream 40 Rag Flock Nil 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. 432 Roofs repaired 428 Gutters and downpipes repaired 204 Downpipes disconnected from drains 6 Dampness remedied 225 Ventilation provided under floors 8 Floors repaired 80 Yards paved or made good 15 Rooms stripped, etc., after infectious disease Nil Dustbins provided or renewed 46 Food stores provided Nil Food stores cleansed, etc. 2 Drains—Examined 191 Tested—Smoke 35 Water 4 Reconstructed 1 Repaired, etc. 119 Vents provided Nil Vents repaired 4 Cesspools abolished Nil Sink wastes repaired 33 New sinks provided 8 Washing facilities provided in food-stores 1 Water-closets—New ones provided 31 Provided with flushing cistern or water supply Nil Repaired 89 Water—Cistern provided 1 Cisterns cleansed, covered, etc. 1 Wells cleansed, repaired, etc. Nil Water laid on or restored 7 Nuisances—Fowls, etc., removed 1 Manure, etc., removed 3 Ditches, etc., cleaned out Nil 27 Other nuisances abated—Coppers repaired, etc. 2 Stoves repaired or renewed 68 Windows repaired or renewed 145 Gipsy vans removed 27 Overcrowding abated 1 Miscellaneous 109 Wasps Nests destroyed 144 Houses demolished Nil NOTICES ISSUED Statutory (Insanitary Conditions) 171 Informal ( Do.) 865 Other Notices (Infectious Diseases) 3,173 4,209 Other Letters sent 2,701 Number of Certificates issued in connection with plans Nil Number of Certificates issued in connection with disinfection 3 Number of Certificates issued in connection with unsound foods 755 Number of Requisitions for Information dealt with 2,038 Number of Certificates issued under Rent Restrictions Acts, 1920 to 1939 2 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 121 642 Number outstanding 50 223 171 865 TOTAL INSPECTIONS One-thousand-eight-hundred-and-thirteen 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 30,604. 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 236 Shops Acts, 1912-1936 3,354 Total 3,590 28 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. During the course of the year 673 such interviews were afforded members of the public. DISINFECTION Number of houses disinfected after infectious disease and verminous cases 365 Number of articles of clothing, bedding, etc., disinfected 2,987 Number of Library books disinfected 180 Number of articles of clothing, bedding, etc., destroyed 141 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. The Act controlling premises in which these materials are used came into force on 1st November, 1951. Six premises were registered for the manufacture of new articles containing filling materials. FACTORIES ACT, 1937 A register is kept of all the factories in the District, and during the year 79 inspections were carried out. 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 45 — 1 — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 359 79 7 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 18 — — — Total 422 79 8 — 29 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) 1 1 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 1 1 — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 5 5 — 4 — (b) Unsuitable or defective 11 4 — 17 — (c) Not separate for sexes — — — — — Other offences (not including offences relating to Outwork) 2 2 — — — Total 20 13 — 21 — OUTWORKERS Seventy-three lists containing the names and addresses of 555 out-workers were received during the year. Two-hundredand-five 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. Pot Scourers 1 — — Curtains and Furniture Hangings 2 — — Making Wearing Apparel, etc. 164 — — Cardboard Boxes, etc. 25 — — Feather sorting and mounting 6 — — Carding of Buttons, etc. 6 — — Artificial Flowers 8 — — Brush Making and Artist's Materials 134 — — Electrical Accessories 160 — — Xmas Crackers, etc. 25 — — Stuffed Toys, etc. 4 — — Textile weaving etc. 16 — — Paper Bags 3 — — Industrial Safety Equipment 1 — — Total 555 — — 30 PLACES OF PUBLIC ENTERTAINMENT Number of inspections 33 OFFENSIVE TRADES There is only one offensive trade business 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. SWIMMING BATHS AND POOL Enfield has two public swimming pools, a relatively modern open air pool, built in 1932, situated next to the Sports Stadium, and indoor baths at Enfield Lock, built in 1895. Within the limits of their construction, both baths are maintained at a high level of efficiency and cleanliness. Reports on the twice-daily examinations for chlorine content and alkalinity of the water are sent to the Medical Officer of Health, and Sanitary Inspectors take samples regularly for bacteriological tests. As regards the purification of the water, the most up-to-date method of break-point chlorination with continuous filtration and aeration is installed at the open air pool and this works satisfactorily and undoubtedly gives a safe and pleasant bathing water. The old indoor swimming bath of Enfield Lock still uses the "Fill-and-empty" system, changing the water twice a week and chlorinating with a proprietory solution twice a day. This method is of course, not nowadays installed because it cannot achieve the same clarity and purity of water which more modern methods of continuous filtration and chlorination provide. It must be stressed, however, that the baths are very efficiently maintained and, despite their limitations, they have proved themselves to be not only popular but safe as regards the state of the water. 31 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) 49 Weight of do. do. do. 1,361 lbs. Number of Certificates issued 37 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:— Premises No. No. of Inspections and Visits Food Preparing 205 1,477 Ice-Cream (Sale and/or Manufacture) 280 175 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 40 samples of ice-cream were taken and the reports on these samples are summarised as follows:— Grade No. of Samples I 11 II 15 III 6 IV 8 Examined for Pathogenic Organisms, but not graded Nil Total 40 Examination of Foods Number of inspections made to retail shops, stalls and food-preparing premises 1,779 Total No. of articles, etc., condemned 6,145 Total No. of Certificates issued 718 Total weight of foodstuffs (other than fresh meat) condemned as unfit for food:— 5 tons 0 cwts. 1 qrs. 20¾ 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 13 Hawkers were registered. 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 75 76 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 Woodfield, 8-12, Windmill Hill, Enfield, Middx.