END 36 Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1952 SOCIAL MEDICINE UNIT, 8, SOUTH PARKS ROAD, OXFORD. Urban District Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B. Ch.B., D.P.H.) FOR 1952 4 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1952 To the Chairman and Members of the Urban District Council of Enfield. I have pleasure in presenting my Annual Report for 1952. Housing still remains a major public health matter and last year I said that further action in regard to demolitions and clearance orders would become necessary in the near future. During the year preliminary action was taken with regard to some of the more insanitary properties, and this involved a total of 44 houses, thirty of which were in a Clearance Area. Apart from action in securing that houses not fit for habitation are not occupied, a large proportion of the work of the Department has been devoted to ensuring that premises are maintained in a reasonably good state and to take such steps as are possible under present conditions to alleviate overcrowding. The problem of Clean and Safe Food continued to be given close attention during the year. A Clean Food Campaign was held in May. This was a less extensive campaign than that of the previous year but it did succeed in renewing the impetus given to the subject the previous year and steady progress has been maintained in effecting practical improvements in all types of establishments. This year again the most prevalent infectious disease was Measles. Notifications became numerous in September and the incidence rose sharply in succeeding months and continued throughout the Winter. Scarlet Fever was more prevalent than during the previous year but Whooping Cough notifications remained stationary. The mild type of Dysentery which had been more widespread than usual the previous year continued until April, after which month few notifications were received, and there were few cases of food poisoning. Unfortunately there were 16 cases of Poliomyelitis of varying degrees of severity and these are referred to elsewhere in my report. It is gratifying to report for the fourth 5 year in succession the absence of Diphtheria, but this, in my opinion, must not be interpreted as a sign of its complete elimination, 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*. In 1950 a very low number of deaths from all forms of Tuberculosis was recorded (about half the average for many preceding years) but unfortunately there was a remission in 1951. This year again, however, the low and encouraging figure of 21 deaths has been recorded. Enfield, in common with so many other localities, suffered from a few days of thick fog in December. As was to be expected, the death returns showed a sudden rise in deaths due to pneumonia and other respiratory conditions, in the period immediately following the fog. About 3 weeks after the fog, when the deaths due to respiratory conditions had fallen considerably, the number of notifications of pneumonia reached a fairly high level and this was again followed by an immediate rise in the number of deaths caused by pneumonia and other respiratory conditions, although these deaths were not related to the notifications. A careful study of the available vital statistics and meteorological data failed to elicit any information on which new conclusions could be based. The Birth Rate continuing its general post-war downward trend reached the lowest rate recorded this Century, namely 13.1. The Death Rate of 9.66 was lower than last year. Almost one quarter of the deaths occurred in persons over 80 years of age, one woman at the age of 101 years, one man at the age of 100 years, and 6 women between the ages of 95 years and 98 years. Although the total deaths were almost equally divided between males and females, only 41 per cent, of the deaths over 80 years 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. William D. Hyde, Medical Officer of Health. 6 URBAN DISTRICT COUNCIL OF ENFIELD W. J. Howes, Esq., J.P. Chairman A. A. F. Tatman, Esq., J.P. 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. W. H. Cook, Esq. J. CoTTENHAM, ESQ., J.P. 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. P. Robson, Esq., J.P. A. H. Saunders, Esq. 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. Acting Deputy do. Dr. M. R. Gilmour. 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 Shops and Housing Inspector : Mr. M. Wilson. Rodent Investigator : Mr. P. W. Partridge. Chief Clerk : Mr. Sydney Coulter. Senior Clerk : Mr. C. W. Chapman (resigned 6th September, 1952). Mr. S. N. Dance (appointed 27th October, 1952). General Clerks : Mr. J. W. Viggers, Mrs. F. I. Dufton and Miss J. Pinkham. Shorthand-Typist: Miss H. E. Grout. STATISTICS AND SOCIAL CONDITIONS OF THE AREA POPULATION The population as estimated by the Registrar General is 109,700. The number of inhabited houses at the end of 1952, according to the Rate Books, was 29,924. Explanatory Note:— Definition of "Houses"—Structurally separate dwellings including flats. The rateable value of the District is £902,979 The net product (after allowing for cost of collection) of a penny rate is £3,651 AREA Area (in acres) 12,400 NEW HOUSES The number of houses erected during the course of the year was 254. 8 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,397 680 717 Illegitimate 41 22 19 Birth-rate—13.10 per 1,000 population. Still Births:— Total. Male. Female Legitimate 23 13 10 Illegitimate 1 - 1 Rate per 1,000 total births—16.34. Total. Male. Female. Deaths 1,060 546 514 Death-rate— 9.66 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— Deaths. Rate per 1,000 Total Births. From Puerperal Sepsis - 0.00 From other Puerperal causes 3 2.04 3 2.04 Death-rate of Infants under one year of age:— All infants per 1,000 live births 19.47 Legitimate infants per 1,000 legitimate live births 19.32 Illegitimate infants per 1,000 illegitimate live births 24.39 Deaths from Cancer (all forms) 197 Deaths from Cancer (Lungs and Bronchus) 46 Deaths from Tuberculosis (Respiratory) 19 Deaths from Tuberculosis (Other forms) 2 9 BIRTH, DEATH AND INFANT MORTALITY RATES. Birth-rate. Death-rate. Mortality rate Infant Live Still England and Wales 15.3 22.6 11.3 27.6 London 17.6 19.2 12.6 23.8 160 County Boroughs and Great Towns (including London) 16.9 24.6 12.1 31.2 160 Smaller Towns 15.5 23.0 11.2 25.8 enfield 13.10 16.34 9.66 19.47 DEATHS The number of deaths assigned to Enfield for 1952 was 1,060, a reduction of 94 on last year. The more prevalent causes of death during the year and the previous year were:— Cause of Death 1952 1951 All Ages:— Malignant Disease (Cancer) 197 200 Diseases of Heart 340 375 Other Diseases of Circulatory System 52 34 Pneumonia 42 50 Bronchitis 63 62 Vascular Lesions of Nervous System 164 149 Tuberculosis of Respiratory System 19 45 Children Under 1 Year:— Premature Birth 8 8 Congenital Malformations 3 5 Pneumonia 4 8 Gastritis 3 - Injury at Birth 1 1 Atelectasis 6 5 The net death-rate for the District is 9.66 per 1,000 population. Two-hundred-and-thirty-three deaths registered were of Enfield persons over 80 years of age, 95 being males and 138 females, one man dying at the advanced age of 100, three women at the age of 95 years, one at 96 years, one at 97 years, one at the age of 98, and one at the advanced age of 101 years. 10 TABLE I. Causes of Death during Year 1952. Causes of Death. Males. Females. Total. Whooping Cough - - - Diphtheria - - - Tuberculosis of Respiratory System 12 7 19 Other Forms of Tuberculosis 1 1 2 Syphilitic diseases 2 - 2 Influenza - 2 2 Measles - - - Other infective and parasitic diseases 1 1 2 Ac. Polio-myelitis - 1 1 Meningococcal infections - - - Malignant Neoplasm of stomach 17 12 29 Malignant Neoplasm, lung, bronchus 42 4 46 Do. of breast - 17 17 Malignant Neoplasm, uterus - 7 7 Other Malignant and Lymphatic Neoplasms 51 47 98 Leukaemia, aleukaemia 2 - 2 Diabetes - 2 2 Vascular lesions of nervous system 61 103 164 Coronary disease, angina 99 56 155 Hypertension with heart disease 13 16 29 Other Heart disease 68 88 156 Other Circulatory disease 19 33 52 Bronchitis 42 21 63 Pneumonia 22 20 42 Other diseases of Respiratory system 3 4 7 Ulcer of stomach and duodenum 13 6 19 Gastritis, Enteritis and Diarrhoea 1 3 4 Nephritis and Nephrosis 7 4 11 Hyperplasia of prostate 8 - 8 Pregnancy, Childbirth and Abortion - 3 3 Congenital Malformations 4 2 6 Suicide 7 2 9 Motor Vehicle accidents 9 1 10 All Other accidents 4 11 15 Other defined and ill-defined diseases 38 40 78 Homicide and operations of war - - - Total 546 514 1,060 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 16 3 - 1 20 4 3 1 - 28 Uncertified - - - - - - - - - - Pneumonia (all forms) - - - - - - 3 1 - 4 Gastritis - - - - - 3 - - - 3 Injury at Birth 1 - - - 1 - - - - 1 Atelectasis 6 - - - 6 - - - - 6 Congenital Malformation 1 1 - 1 3 - - - - 3 Premature Birth 6 2 - - 8 - - - - 8 Atrophy, Debility and Marasmus - - - - - 1 - - - 1 Other Causes 2 - - - 2 - - - - 2 Totals 16 3 - 1 20 4 3 1 - 28 Net Births in the year:—Legitimate : Live births, 1,397 ; Stillbirths, 23. illegitimate : Live births, 41 ; Still-births, 1. Net Deaths in the year Legitimate Infants, 27 ; Illegitimate, 1. It will be seen from Table II that of the 28 infants who died before attaining the age of 1 year, 20 died within the first four weeks of life, and of this number 16 deaths occurred in infants under 1 week. The infant mortality rate for the District is 19.47 and this figure compares most favourably with the rest of the country. 12 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. 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 1952 715 747 1,462 13.32 0.38 INQUESTS Fifty-one inquests and one-hundred-and-ten Post-mortem examinations without inquests were held during the year. Of these, 115 deaths were due to natural causes, 32 to accidental causes, 8 to suicide, 4 to misadventure, and in 2 cases an open verdict was recorded. FATAL HOME ACCIDENTS. Last year I wrote at some length on the subject comparing Enfield figures with the National pattern. This year again in Enfield the emphasis is on fatal accidents to the aged, the youngest being 63 years old and the oldest 95 years old. The 11 fatal home accidents to Enfield residents involved 9 females and 2 males. The causes of death in five females were falls causing fractured bones followed by lung complications. The causes in three females and one male were falls causing fractured bones followed by cardiac failure, and in the case of one male and one female the cause was coal gas poisoning. 13 The outstanding points in these figures are the high proportion of elderly females, 82 per cent, of the total, and the fact that no children were involved. One hears much more about Road accidents than accidents in the Home, but this year, as last year, there were more fatal accidents to Enfield residents in the home than on the streets, 11 fatal home accidents compared with 10 fatal road accidents. In the case of road accidents, however, the proportion of males to females involved was practically the opposite to that for home accidents, and the average age was much lower. The figures I have quoted indicate the continued need for propaganda to impress on the public the need to take every possible precaution to prevent accidents in the home, particularly where the aged are concerned, as an accident resulting in a fall can so frequently lead to fatal complications. It might not be inappropriate to mention here the occurrence of 9 cases of suicide, seven males and two females, ages ranging from 17 years to 74 years ; the average age being 52 years. The method adopted in 6 cases was coal gas poisoning, in two cases hanging and in one case jumping in front of a train. NATIONAL ASSISTANCE ACTS, 1948 AND 1951. No action was necessary during the year under these Acts 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 South Lodge Hospital. Para-typhoid Fever 1 Erysipelas 6 Scarlet Fever 117 Meningococcal Infection 4 Poliomyelitis 13 Measles 28 Whooping Cough 7 Gastro-enteritis 4 Chicken pox 7 Chicken pox and Enteritis 1 German Measles 1 Mumps and Chicken pox 1 Mumps 1 191 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. The following table sets out the record of examinations carried out and the results. Throat and Nose Swabs. Diphtheria Bacilli - Haemolytic Streptococci 239 Vincent's Angina 4 Negative 569 812 C/fwd 812 15 B/fwd 812 Faeces. Shigellae 598 Giardia 68 Salmonella 48 Protozoa - Negative 1,959 2,673 Sputum. T.B. Smear 8 Other Organisms 42 Negative 68 118 Pertussis. Cough Plate 1 Postnasal Swab - Negative 14 15 Milk. Pasteurised 25 Other 1 Ice cream 32 58 Water. Domestic supplies, etc. 26 Swimming pools, etc. 13 39 Miscellaneous. 208 208 3,923 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, and during the year fourteen samples of well water were examined bacteriologically and three chemically. MEDICAL ASSESSMENT OF EMPLOYEES. The following medical examinations or assessments of employees were carried out during the year:— (1) Superannuation Act: Medical examinations 120 Assessments without medical examinations 54 (2) Sick Pay Scheme : Medical examinations 51 Assessments without medical examinations 43 (3) Other Medical Examinations 5 HOUSING Number of new houses erected during the year by:— (a) Local Authority 232 (b) Other Local Authorities Nil (c) Other bodies or persons 22 With State assistance (included in above totals):— (a) Local Authority 232 (b) Other Local Authorities Nil (c) Other bodies or persons Nil 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 2,501 12,575 (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 47 119 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 44 (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.) 874 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 798 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 97 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 6 The number of house-to-house visitations made was:— Under Housing Regulations, 1925 and 1932 121 Apart from Do. Do. 549 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 66 12 Totals: 107 32 During the year 25 samples of Mill; were taken and tested; all were found to be satisfactory. 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 1952:— Article. Total samples procured. Unsatisfactory. Milk, various 360 15 Beef Suet 1 — Cakes, various 28 — Cake Mixture 1 1 Cherry Wine (non-alcoholic) 1 — Coffee 1 — Coffee and Chicory Essence 1 — Curry Powder 1 — Dessicated Coconut 1 — Drugs 7 — Fish, various 22 2 Fish Paste 2 — Ground Almonds 1 — Ice Cream 5 — Jams, various 3 — Jelly 1 — Lemon Cheese 1 — Marmalade 1 — Meats, cooked 11 — Meat Pie 3 — Mincemeat 1 — Non-brewed condiment 1 — Orange Juice 2 — Pineapple in Syrup 1 — Sausages, various 23 — Sausage Meat 1 1 Synthetic Cream 1 — Tripe 1 — Vinegar 24 8 Whisky 30 — Totals: 537 27 The 15 milk samples were, with one exception, all samples of new milk from farmers and in no case did they contain added water. They were unsatisfactory generally in small degree having either less than 3.0 per cent, fat or less than 8.5 per cent, solids-notfat. The farmer was informed and directed to advice, and the Milk Marketing Board, which is the purchaser, was also informed. 20 The unsatisfactory sample of cake mixture was one which was deficient in fat and an official caution was issued. The two samples of fish which were unsatisfactory were two sales of smoked cod for smoked haddock. In this case there was a prosecution and the trader was fined £2 and ordered to pay 3 guineas costs. The unsatisfactory sample of sausage meat was of pork sausage which was 21 per cent. deficient in meat content. A butcher's manager was prosecuted and fined £3 with £4 18s. Od. costs. The eight samples of vinegar were cases of the passing off of non-brewed condiment for vinegar and resulted in one prosecution (fine £2 with 2 guineas costs) and the issue of official cautions to four other traders. CLEAN AND SAFE FOOD In my report on the Clean and Safe Food Campaign in 1951 I expressed the view that the Campaign was only the beginning of the Health Department's special efforts to establish and maintain a high degree of food hygiene by the housewife, the trade and the public generally. Throughout the year the staff of the Health Department have striven to ensure that the standards attained as a result of the first Campaign were maintained and, where necessary, improved. The sanitary inspectors paid 2,156 visits to 825 food premises during the year, always taking the opportunity of emphasising the need for constant awareness that particular care in the handling of foodstuffs is essential to ensure " Clean and Safe Food." A "Clean and Safe Food" Campaign, less extensive than the previous year's Campaign was held during the week 19th to 24th May 1952 and was directed primarily to secure the interest and cooperation of the housewives. During the week some 15,000 leaflets "Housewives, Remember !," were distributed to shops and to each of the Public Libraries. The leaflets were displayed in attractive holders inviting the public to take one. 21 Suitable posters were displayed on the Council's public noticeboards and vehicles, and in many shops. The proprietor of every food shop was given display notices signed by the Medical Officer of Health on behalf of the Council asking customers not to take dogs into food shops. The children in the schools were invited to submit an essay or a poster for competitions in three age groups. A total of 101 essays and 112 posters were received from thirteen schools. Many of the entries, particularly the posters, were very commendable. The winning entries in the Poster Competitions were displayed in the Public Libraries. Although this year's Campaign was not on such ambitious lines as last year there was evidence that very considerable interest was aroused. The tradesmen were of the opinion that the housewives were critical and interested. The response by the children was much better than in the previous year, and their greater appreciation of the reason behind the competitions was evidenced by the essays and posters. Lectures on Food Hygiene were given to school-children, Women's Guilds and other organisations. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES AND SCHOOLS 1952. 1951. Number of children notified by Head Teachers to be absent from School due to :— (a) Infectious Disease or suspected tious Disease 462 229 (b) Contact with Infectious Disease 16 9 Number of School children notified by General Practitioners as suffering from Infectious Disease 1,226 1,592 22 NOTIFIABLE DISEASES DURING THE YEARS 1951 AND 1952. 1952 1951 No. Removed. Deaths. No. Removed. Deaths. Smallpox — _ Cholera—Plague — — — — — — Diphtheria (inc. Membranous Croup) — — — — — — Diphtheria Carriers — — — — — — Erysipelas 25 6 — 22 6 — Scarlet Fever 343 123 — 171 90 Typhus Fever — — — — — — Typhoid Fever — — — — — — Paratyphoid Fever 2 2 — 1 1 — Relapsing Fever \ — — — — — — Continued Fever J — — — — — — Puerperal Pyrexia 48 46 — 36 26 — Meningococcal Infection 4 4 — 5 5 — Poliomyelitis (Paralytic and Non-Paralytic) .. 16 16 1 1 — — Acute-Encephalitis — — — — — — Ophthalmia Neonatorum 1 1 — 1 1 — Pulmonary Tuberculosis 126 — 19 113 — 45 Other forms of Tuberculosis 16 — 2 15 — 5 Food Poisoning 10 — — 13 1 — Malaria — — — — — — Pneumonia 37 2 42 94 8 50 Dysentery 181 — — 257 8 — Measles 1491 30 — 2466 31 — Whooping Cough 246 7 — 248 10 1 Totals 2546 237 64 3443 187 101 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 7 cases Scarlet Fever 268 33 3 3 — — — — Measles 834 241 47 6 2 — — Whooping Cough 151 34 9 — — — — Dysentery (Sonne) 67 20 15 4 — 1 1 Food Poisoning 6 2 — — — — — 23 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, 160 County Boroughs and Great Towns including London, 160 Smaller Towns with resident population 25,000-50,000 (1951 Census) and London Administrative County. ENFIELD. England and Wales. 160 C.B.s and Great Towns including London. 160 Smaller Towns Resident Pop. 25,000-50,000 1951 Census. London Adm. County. Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever . . 0.01 0.02 0.02 0.03 0.01 Meningococcal Infection 0.03 0.03 0.03 0.03 0.02 Scarlet Fever 3.12 1.53 1.75 1.58 1.56 Whooping Cough 2.24 2.61 2.74 2.57 1.66 Diphtheria 0.00 0.01 0.01 0.03 0.01 Erysipelas 0.22 0.14 0.15 0.12 0.14 Smallpox 0.00 0.00 0.00 0.00 Measles 13.59 8.86 10.11 8.49 9.23 Pneumonia 0.33 0.72 0.80 0.62 0.57 Acute Poliomyelitis (including Polio-encephalitis) Paralytic 0.10 0.06 0.06 0.06 0.06 Non-Paralytic 0.03 0.03 0.03 0.02 0.03 Food Poisoning 0.09 0.13 0.16 0.11 0.18 Puerperal Pyrexia . . 32.83(a) 17.87(a) 23.94(a) 10.22(a) 30.77(a) (a) Per 1,000 Total (Live and Still) Births. DIPHTHERIA For the fourth year in succession no case of Diphtheria occurred in the District. DIPHTHERIA IMMUNISATION 1,341 children were immunised for the first time and 2,026 received subsequent reinforcing doses during the year. These figures are lower than 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 757 children were immunised against Whooping Cough during the year. 24 POLIOMYELITIS AND ACUTE ENCEPHALITIS. During the course of the year sixteen cases of poliomyelitis were notified, varying in degree from slight to severe. 11 cases were males and 4 females, and 5 cases were under the age of 5 years, 6 between 5 years and 15 years and 5 over the age of 15 years. All but one of the cases occurred in the second half of the year and in no instance was there evidence of other members of the family having associated illness. FOOD POISONING Ten cases of food poisoning were notified during the year, but all were isolated instances and no outbreak occurred. SONNE DYSENTERY The incidence of mild dysentery due to Shigella Sonnei, which rose to a higher level than usual the previous year, showed a reduction of 76 cases. Most of the 181 cases occurred during the early months of the year, being a continuance of the outbreak of the previous Autumn. Only 11 cases were notified from May to December inclusive. It is believed that the spread of infection was materially reduced by the steps taken to exclude contacts from Day Nurseries, Schools and certain occupations, and by the intensive search for contacts, followed by bacteriological investigation, and control of those found to be positive, but it put a considerable strain on the Department and the Laboratory. 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. Non- Respiratory Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. Under 1 1 — — — — — — — 1 to 5 2 1 — 2 — — — — 5 to 10 1 2 1 — — — — — 10 to 15 2 2 — — — — — — 15 to 20 4 5 — 1 — — — — 20 to 25 13 11 1 3 — 1 — 1 25 to 35 21 11 4 — — 1 — — 35 to 45 10 6 1 — 2 3 1 — 45 to 55 13 4 — 2 2 — — — 55 to 65 7 3 — — 3 1 — — 65 and upwaids 6 1 1 — 5 1 — — Totals 80 46 8 8 12 7 1 1 25 The following table shows the incidence of Tuberculosis and death-rates from this disease in the various Wards in the District during the year. Ward. Estimated Population. No. of Cases. T.B. Case-rate. T.B. Death-rate. Pulm. Other. Pulm. Other. Pulm. Other. Bush Hill Park 10,620 8 1 0.75 0.09 0.18 0.00 Cambridge Road 10,718 11 3 1.02 0.27 0.09 0.00 Chase 7,557 10 4 1.32 0.53 0.13 0,13 Enfield Wash 12,608 15 2 1.19 0.15 0.15 0.07 Green Street 10,718 22 2 2.04 0.18 0.18 0.00 Ordnance 13,485 17 2 1.26 0.14 0.22 0.00 Ponders End 9,929 15 — 1.51 0.00 0.40 0.00 The Town 11,119 8 1 0.71 0.08 0.08 0.00 West 12,321 6 1 0.48 0.08 0.08 0.00 Willow 10,625 14 — 1.31 0.00 0.18 0.00 Total 109,700 126 16 1.14 0.14 0.17 0.01 MASS RADIOGRAPHY Arrangements were made with the North-East Metropolitan Regional Hospital Board for another visit by the Mass X-Ray Unit. Previous visits had not only shown the usefulness of the work undertaken by the Unit, but also the encouraging response by Enfield residents to the facility provided. Through co-operation between the Health Department and the Unit, arrangements were made for the Unit to commence operation at the Wesleyan Church Hall, Church Street, on 9th October, 1952. Owing to the greater mobility of the present Unit, facilities were also provided at the Wesleyan Church Hall, High Street, Ponders End, St. George's Church Hall, Hertford Road, and many industrial and other premises throughout the district. The visit continued well into 1953 and the final results of the survey are not yet known, although 16,900 persons were examined, compared with 7,789 in 1946 and 9,453 in 1949. PREVENTION OF DAMAGE BY PESTS ACT, 1949. During the year a Rodent Investigating Officer and four operators were engaged on control of rat infestation at dwellinghouses and other premises and of the sewers in the district. 26 The Council provides this service to the occupiers of all dwellinghouses 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. 680 premises were inspected during the year for rat and mice infestation, and of these 609 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 565. During the year the Sanitary Inspectors and Rodent Investigating Staff made 7,095 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 504 manholes were examined and 306 pre-baits and 117 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 22 Number of Council houses disinfested 22 Number of other houses found to be infested 41 Number of other houses disinfested 41 Householders are urged to seek the assistance of the Health Department immediately they suspect the presence of bugs or similar pests. 27 SANITARY INSPECTOR'S REPORT The following report, in condensed form, gives details of the work of the Sanitary Inspectors during the year 1952. The total number of inspections made during the year for all purposes was 29,408. The following table shows the number of inspections carried out by the Sanitary Inspectors during the year. No. of Inspections :— Inspections Housing Act, 1936 121 Infectious Disease 414 Tuberculosis 116 Complaint or otherwise 11,715 Vermin 209 Rag Flock and Other Filling Materials Act 6 Pet Animals Act 13 Public Conveniences 291 Ice-Cream Shops 208 Schools 115 Cinemas, Halls, etc. 41 Public Houses — Fair-grounds 4 Hairdressers 22 Milkshops and Dairies 175 Food Preparing Premises 1,643 Food Hawkers' Stands 29 Food Hawkers (Storage) 41 Bakehouses 60 Outworkers' Premises 59 Factories 81 Smoke Observations 24 Visits :— Infectious Diseases 1,618 Tuberculosis 81 Housing Act, 1936 (Sec. 62)—Permitted Numbers 549 Shops Act 3,116 Improvements Grants 261 Builder's Notices 30 Cesspool Examinations 100 Washing Facilities in Food-shops 3 C/fwd .. 21,145 28 B/fwd .. 21,145 Food Inspections 158 Gipsy Vans 73 Rats 7,095 Overcrowding 32 Sub-letting — Piggeries 44 Stables 25 Well Water Supplies 15 Wasps, Beetles, etc. 113 Other Visits 708 28,408 Samples taken—Water—Wells 17 Mains, etc. 9 Subsoil Water 1 Swimming Baths 7 Parks Lakes etc 6 Milk 25 Ice-Cream 32 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. 393 Roofs repaired 378 Gutters and downpipes repaired 951 Downpipes disconnected from drains — Dampness remedied 228 Ventilation provided under floors Floors repaired 70 Yards paved or made good 12 Rooms stripped, etc., after infectious disease — Dustbins provided or renewed 39 Food stores provided — Food stores cleansed, etc. — Drains—Examined 251 Tested—Smoke 41 Water 19 Reconstructed 12 Repaired, etc. 189 Vents provided — Vents repaired 9 Cesspools abolished — Sink wastes repaired 24 29 New sinks provided 9 Washing facilities provided in food-stores — Water-closets—New ones provided 13 New pans provided 35 Apparatus repaired or renewed 65 Water—Cistern provided — Cisterns cleansed, covered, etc. 1 Wells cleansed, repaired, etc. Water laid on or restored 6 Nuisances—Fowls, etc., removed 3 Manure, etc., removed 9 Ditches, etc., cleaned out — Other nuisances abated—Stoves repaired or renewed 65 Windows repaired or renewed 230 Gipsy vans removed 40 Overcrowding abated 2 Miscellaneous 118 Wasps Nests destroyed 113 Houses demolished 2 NOTICES ISSUED Statutory (Insanitary Conditions) 99 Informal ( Do. ) 610 Other Notices (Infectious Diseases) 4,408 5,117 Other Letters sent 2,655 Number of Certificates issued in connection with plans Nil Number of Certificates issued in connection with disinfection 1 Number of Certificates issued in connection with unsound foods 871 Number of Requisitions for Information dealt with 1,812 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 77 449 Number outstanding 22 161 99 610 30 TOTAL INSPECTIONS Two-thousand-two-hundred-and-twenty-nine 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 29,408. The Inspector appointed to carry out the requirements of Section 58 of the Housing Act, 1936, and the provisions of the Shops Act, 1950, made the following number of visits during the year:— Housing Act, 1936 549 Shop Act, 1950 3,116 Total 3,665 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 548 members of the public were afforded such interviews. DISINFECTION Number of houses disinfected after infectious disease and verminous cases 509 Number of articles of clothing, bedding, etc., disinfected 3,135 Number of Library books disinfected 679 Number of articles of clothing, bedding, etc., destroyed 129 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 have been registered for the manufacture of new articles containing filling materials. PET ANIMALS ACT, 1951 This Act, which controls the keeping of a pet shop, came into force on the 1st April, 1952. During the course of the year 4 premises were licensed by the local authority. 31 FACTORIES ACT, 1937 A register is kept of all the factories in the District, and during the year 141 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 46 30 – – (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 357 111 – – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 18 – – Total 421 141 — –— 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) – – Overcrowding (S.2) – – – Unreasonable temperature (S 3) – – – Inadequate ventilation (S.4) – – 1 _. Ineffective drainage of floors (S.6) – – – Sanitary Conveniences (S.7) – – – – (a) Insufficient 1 1 – (b) Unsuitable or defective 7 9 4 – (c) Not separate for sexes 1 – – Other offences (not including offences relating to Outwork) 1 1 – — – Total 10 11 1 4 — 32 OUTWORKERS Forty-seven lists containing the names and addresses of 680 out-workers were received during the year. One-hundred-andninety 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 4 — — Curtains and Furniture Hangings 2 — — Making Wearing Apparel, etc. 125 — — Cardboard Boxes, etc. 9 — — Feather sorting and mounting 6 — — Carding of Buttons, etc. 19 — — Artificial Flowers 11 — — Brush Making and Artist's Materials 305 — — Electrical Accessories 74 — — Xmas Crackers, etc. 1 — — Stuffed Toys, etc. 85 — — Textile weaving etc. 2 — — Paper Bags 2 — — Handbags 3 — — Paper Folding 10 — — Stationery 14 — — Boots and Shoes 3 — — Goggles and Masks 1 — — Druggists Sundries 1 — — Sweet Making 3 — — Total 680 — — PLACES OF PUBLIC ENTERTAINMENT Number of inspections 41 OFFENSIVE TRADES There is only one offensive trade business established in the district, and during the year no complaints were received in connection therewith. 33 ATMOSPHERIC POLLUTION. Complaints of atmospheric pollution have been confined to a few specific areas, and have referred to smoke, grit, dust and charred wood particles. Despite the expressed desire of the works' management to prevent emission of " smoke " from the chimney shafts, the Health Department has experienced considerable difficulty, in some cases, in securing a consistent and maintained improvement. In only one instance, however, was statutory action necessary. One firm has gone to a great deal of trouble and expense to install special plant which is efficiently eliminating the trouble previously occasioned by the burning of sawdust and wood waste. 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, and consideration is now being given to the installation of a modern filtration and chlorination plant. 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. 34 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 to 1952 Total number of carcases examined Nil Number, or parts, found to be diseased (in Butchers' shops) 115 Weight of do. do. do. 2.695¼ lbs. Number of Certificates issued 67 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 1,643 Ice-Cream (Sale and/or Manufacture) 298 208 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 32 samples of ice-cream were taken and the reports on these samples are summarised as follows :— Grade No. of Samples I 17 II 9 II I 4 IV 2 Examined for Pathogenic Organisms, but not graded Nil Total 32 Examination of Foods Number of inspections made to retail shops, stalls and food-preparing premises 1,981 Total No. of articles, etc., condemned 5,783 Total No. of Certificates issued 804 Total weight of foodstuffs (other than fresh meat) condemned as unfit for food :— 3 tons 17 cwts. 3 qrs. 4J lbs. 35 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, 1950 SECTION 11 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 7 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 82 70 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. 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.