Ac. 439 (1) ENF 42 Borough Council of Enfield ANNUAL REPORT of the Medical Officer of Health (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) for 1958 Borough Council of Enfield ANNUAL REPORT of the Medical Officer of Health (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1958 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1958. To the Mayor, Aldermen and Councillors of the Borough of Enfield. I have pleasure in presenting my Annual Report for 1958. The completion of the Cuffley Brook Branch Sewer of the East Middlesex Main Drainage Scheme enabled the Council to proceed with the first of two proposed schemes for district sewers in the Crews Hill Area. This first scheme has now been completed and 115 properties on the Crews Hill Estate, formerly on cesspool drainage, have been connected to the sewer. There are still a fair number of cesspools in use in the Borough but it is hoped that further district sewerage schemes, made possible by the Cuffley Brook Branch Sewer, will enable the majority to be dispensed with in the next few years. It is also hoped that another Branch Sewer will be constructed in the near future in connection with the East Middlesex Main Drainage Scheme, and that this will provide an outlet to which new district sewers can be connected to relieve surcharging in the Grange Park area. It is nearly ten years since I first drew attention in my Annual Report to the wisdom of cultivating regular habits in regard to exercise. Medical opinion points to the possible relationship between faulty diet, lack of exercise and some forms of heart disease, such as coronary thrombosis. Enfield is more fortunate than many other districts in the possession of open spaces and parks, and with the progressive improvement expected in due course from the Clean Air activities, their value should be enhanced. Full use should be made of these facilities. Each one of us should take the opportunities presented to participate in some form of outdoor activity to give the necessary exercise and training essential to good health. 4 This should be graded according to age, sex and physical ability and there is excuse for only few to lead a completely sedentary life. Conditions under which we work, or travel to and from work, may not be under our personal control, but certain statutory safeguards are present. Our leisure activities are mainly what we ourselves determine. Those whose occupations are more or less sedentary should endeavour, according to their needs and ability, to secure adequate outdoor activity, which, it is becoming increasingly clear, is a necessary party of preventive medicine. Although strict observance of what is considered a healthy way of life is no absolute guarantee of fitness and freedom from disease, and many seem to ignore it with impunity, the evidence in favour of abiding by the known rules of health is considerable. With regard to the incidence of notifiable infectious diseases, there is little upon which to comment this year, the incidence of many being lower than last year, and, apart from Tuberculosis and Pneumonia, the only death was due to meningococcal infection. Good progress was made during the year with vaccination against Poliomyelitis, but the numbers immunised against Diphtheria, Whooping Cough and Smallpox were less than the previous year. The efforts made to achieve a good acceptance of vaccination against poliomyelitis, inevitably had an adverse effect on the other immunisation acceptances and the present unduly large number of injections for these procedures also acts as a deterrent to their popularity. The importance of maintaining wide-spread immunity to Diphtheria, Whooping Cough and Smallpox still exists, and it would be a serious matter if immunisation against them were to be neglected. The vital statistics of the district show a satisfactory situation. The Birth Rate is up ; the Death Rate is down ; there were no deaths in consequence of childbirth ; and there was a comparatively low Infant Mortality Rate, although higher than last year's record low figure which was a remarkably low rate. Deaths from Cancer of the lungs and bronchi (sixty, of whom forty-eight were males) continue to increase, and those from Respiratory Tuberculosis (seven, all males) continue to decrease. The "Enfield Show," held annually in the Town Park, has been a popular event for some years now, and again it was decided to include a Health Department Exhibit. 5 One large Marquee was allocated for this purpose, and in view of the topical interest of Clean Air, and the proposals for a Smoke Control Area, the theme of the Exhibit was restricted this year to Clean Air. Whilst bearing in mind the fact that people attending the Show are seeking entertainment rather than education, previous success had led us to believe that many people would be interested, and our hopes were fully justified. In the selection and arrangement of material for display, the need for attractive and interesting material was borne in mind, and this no doubt, contributed to its success. The exhibits included displays of electric, gas, oil, and solid smokeless fuel appliances, some of which were in operation. Other stands demonstrated the dangers, and harmful effects on health and property, of air pollution, and how the problem is being tackled locally, with special emphasis on the first Smoke Control Area proposed in the Borough. In conclusion I would like to express my appreciation of the services of the Staff of the Health Department during the year and to record the promotion of Mr. S. N. Dance, Senior Clerk, to the position of Chief Clerk. William D. Hyde, Medical Officer of Health. 6 BOROUGH OF ENFIELD Councillor F. C. Cunneen, J.P. Mayor Alderman A. A. F. Tatman, B.E.M., J.P. Deputy Mayor Aldermen: Mrs. G. M. Jay, J.P. W. G. Bowyer, Esq. D. R. J. Boxall, Esq. G. Deacock, Esq. A. M. Eeles, Esq. W. F. Lindsell, Esq. E. L. Mackenzie, Esq. C. Partington, Esq., T.P., M.R.S.T. A. H. Saunders, Esq. A. A. F. Tatman, Esq., B.E.M., JP. Councillors: Miss C. E. Clough Mrs. E. M. C. Ellis A. E. Antrobus, Esq. A. D. Bates, Esq. J. R. Bentley, Esq. E. W. Burville, Esq. A. H. Chambers, Esq. L. J. Collop Esq. W. H. Cook Esq. J. Cottenham, Esq., J.P. Mrs. J. L. Cronin J. J. Dunnett, Esq. Dr. N. Graham E. T. Hendrick, Esq. W. J. Howes, Esq. H. E. Latty, Esq. E. E. Leesmith, Esq. E. P. Lomer, Esq. F. L. Mezen, Esq. J. Murray, Esq. j. C. Pines, Esq., B.E.M. S. C. Piper, Esq. G. H. Platten, Esq. E. J. Rayment, Esq. R. A. Robertson, Esq. Mrs. G. E. Stanford P. A. Thomas, Esq. E. J. Tong, Esq. G. H. Watson, Esq. C. H. J. Wicks, Esq. HEALTH COMMITTEE Alderman A. H. Saunders Chairman Miss C. E. Clough Vice-Chairman also Alderman Boxall Councillors Mrs. Ellis, Antrobus, Latty, Leesmith, Mezen, Pines, b.e.m., Rayment, Thomas and Wicks. 7 PUBLIC HEALTH STAFF Medical Officer of Health: Dr. W. D. Hyde. Deputy do. Dr. Margaret R. Gilmour. Chief Public Health Inspector: Mr. J. C. Lightfoot. Public Health Inspectors and Inspectors of Meat and Foods: Mr. A. Ramsden, Mr. D. C. Turner, Mr. G. E. A. Laney, Mr. N. Smith, Mr. E. A. C. Kottman, Mr. A. J. Hattersley (appointed 1.1.58), Mr. R. Williams (appointed 1.4.58). Rodent Investigator: Mr. P. W. Partridge. Chief Clerk: Mr. S. N. Dance (appointed 15.4.58). Senior Clerk: Mr. R. W. Kirby (appointed 24.11.58). General Clerks: Mr. E. Gray, Mrs. V. M. Randall, Miss D. A. Harding (resigned 12.9.58), Miss J. Cowlard (appointed 15.9.58). Shorthand-Typist: Mrs. C. Meikle. STATISTICS AND SOCIAL CONDITIONS OF THE AREA POPULATION The population as estimated by the Registrar General is 109,300. The number of inhabited houses at the end of 1958, according to the Rate Books, was 32,577. Explanatory Note: Definition of "Houses"—Structurally separate dwellings including flats. The rateable value of the Borough is £1,770,361 The net product (after allowing for cost of collection) of a penny rate is (Estimated) £7,150 AREA Area (in acres) 12,401 NEW HOUSES The number of houses erected during the course of the year was 405. 8 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,451 779 672 Illegitimate 60 31 29 Birth-rate—13.82 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 38 17 21 Illegitimate 3 1 2 Rate per 1,000 total births—26.54. Total. Male. Female. Deaths 1,158 564 594 Death-rate—10.50 per 1,000 population. No woman died in, or in consequence of, childbirth. Death-rate of Infants under one year of age:— All infants per 1,000 live births 19.19 Legitimate infants per 1,000 legitimate live births 19.98 Deaths from Cancer (all forms) 228 Deaths from Cancer (Lungs and Bronchus) 60 Deaths from Tuberculosis (Respiratory) 7 Deaths from Tuberculosis (Other forms) 2 COMPARABILITY FACTORS In view of the differing sex and age distribution of local populations, the General Register Office supplies factors for adjusting the Birth and Death rates to enable comparisons to be made with the rates for other areas and the country as a whole. The factors are—Births 1.00 and Deaths 0.99. 9 BIRTH, DEATH AND INFANT MORTALITY RATES. Birth-rate. Death-rate. Infant Mortality rate Live Still England and Wales 16.40 21.60 11.70 22.5 ENFIELD (Standardised) 13.82 26.54 10.40 19.2 DEATHS The number of deaths assigned to Enfield for 1958 was 1,158, 27 less than for last year. The more prevalent causes of death during the last 2 years were:— Cause of Death 1957 1958 All Ages:— Diseases of Heart 432 399 Malignant Disease (Cancer) 242 228 Vascular Lesions of Nervous System 130 148 Bronchitis 61 68 Other Diseases of Circulatory System 63 59 Pneumonia 51 42 Tuberculosis of Respiratory System 8 7 Children Under 1 Year:— Atelectasis 3 2 Premature Birth 2 10 Congenital Malformations 6 4 Bronchitis and Broncho-pneumonia 3 7 The death-rate for the Borough is 10.50 per 1,000 population. Two hundred and seventy two deaths registered were of Enfield persons over 80 years of age, 99 being males and 173 females. 5 females were aged 95 years or more, one reaching the age of 101 years. It will be seen that 23.48 per cent. of the total deaths were of persons over 80 years of age. 10 TABLE I. Causes of Death during Year 1958. Causes of Death. Males. Females. Total. Tuberculosis of Respiratory System 7 - 7 Other Forms of Tuberculosis — 2 2 Syphilitic diseases — 2 2 Diphtheria — — — Whooping Cough — — — Meningococcal infections — 1 1 Ac. Polio-myelitis — — — Measles — - - Other infective and parasitic diseases 1 — 1 Malignant Neoplasm of stomach 22 10 32 Malignant Neoplasm, lung, bronchus 48 12 60 Do. of breast — 21 21 Malignant Neoplasm, uterus — 5 5 Other Malignant and Lymphatic Neoplasms 55 55 110 Leukaemia, aleukaemia 3 2 5 Diabetes 1 6 7 Vascular lesions of nervous system 53 95 148 Coronary disease, angina 123 55 178 Hypertension with heart disease 8 16 24 Other Heart disease 51 146 197 Other Circulatory disease 22 37 59 Influenza 2 3 5 Pneumonia 25 17 42 Bronchitis 45 23 68 Other diseases of Respiratory system 6 4 10 Ulcer of stomach and duodenum 7 6 13 Gastritis, Enteritis and Diarrhoea - 2 2 Nephritis and Nephrosis 1 4 5 Hyperplasia of prostate 11 — 11 Pregnancy, Childbirth and Abortion — — — Congenital Malformations 5 2 7 Other defined and ill-defined diseases 47 48 95 Motor Vehicle accidents 3 3 6 All Other accidents 8 13 21 Suicide 10 4 14 Homicide and operations of war — — — Total 564 594 1,158 11 TABLE II. Infant Mortality 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 2 - 3 23 1 3 - 2 29 Uncertified — — - — — - — - — — Atelectasis 2 - - - 2 - - - - 2 Pneumonia and Bronchitis — — - 3 3 1 3 - — 7 Congenital Malformations 3 — - — 3 - — - 1 4 Prematurity 8 2 - — 10 - — - - 10 Cerebral haemorrhage 4 — - — 4 - — - — 4 Anaemia 1 — - — 1 - — - — 1 Accidental — — - — — - — - 1 1 Totals 18 2 — 3 23 1 3 — 2 29 Births in the year:—Legitimate: Live births, 1,451; Stillbirths, 38. Illegitimate: Live births, 60; Still-births, 3. Deaths in the year:—Legitimate Infants, 29; Illegitimate, Nil. Of the 29 infants who died before reaching the age of 1 year, 23 died within the first 4 weeks of life, and of this number, 18 occurred in infants under 1 week. The infant mortality rate for the Borough is 19.2. INQUESTS Thirty-eight Inquests and one hundred and thirty three Postmortem examinations without inquests were held during the year. Of these, 133 deaths were due to natural causes, 20 to accidental causes, 14 to suicide, 3 to misadventure, and in 1 case an open verdict was recorded. 12 FATAL HOME ACCIDENTS. During the year under review there were 15 fatal home accidents to Enfield residents, being one less than the previous year. With the exception of 3 cases all these accidents occurred amongst adults, 9 being over 80, and 2 becween 70 and 80 years of age. The precipitating cause of death in 7 cases was a fall leading in most instances to fractured bones and followed usually by lung complications. One little girl aged 4 years died from a fractured skull due to a fall, another little girl aged 2 years died from shock due to scalds, and a little boy aged 11 months died from electrocution by domestic electric fire. The number of fatal Road Accidents to Enfield residents during the year was 6. Unfortunately there were also 14 (10 male, 4 female) cases of suicide, 5 of which were in the 35 - 50 years age group and 9 were over the age of 50. The method adopted in 6 cases was coal gas poisoning. It is disquieting to consider the sum total of human misery recorded in these paragraphs and to ponder over the fact that so much could, and should, be prevented. NATIONAL ASSISTANCE ACTS, 1948 AND 1951. Action was necessary during the year under these Acts with regard to the removal to hospital of one old lady in need of care and attention. Such other cases as were brought to the notice of the Health Department were dealt with by the Medical Officer of Health in cooperation either with the Medical Practitioners or Welfare Officer, and the patients voluntarily agreed to go to Hospital or suitable Institution. Most old people show a natural reluctance to leave their homes, which sometimes consist of a single room in a dirty and unhygienic state owing to their inability to look after the premises. Some should not be living alone, and although we must not be hasty to criticize, there appears to be in some cases a need for the awakening of responsibility of the family to its aged members. In some instances, where reluctance to leave their homes is encountered, provision of Home Help and District Nurse Services can be arranged and a careful watch on the situation maintained by members of the Health Department Staff, and compulsory removal in the interests of the old person is rarely enforced, as persuasion usually succeeds in the end. 13 AMBULANCE SERVICE The County Ambulance Service is operated in two distinct branches, i.e., the Accident Branch and the Sick Removal Branch. The Accident Service operates from Fire Stations and where an ambulance is required for accident or emergency purposes, the Emergency Exchange telephone facilities should be used, whereby calls are routed to the nearest Fire Station. The Sick Removal Service is housed locally in a depot adjacent to Chase Farm Hospital, where calls are received for both recumbent and sitting cases. WATER SUPPLY The Borough 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. There was no cause to suspect any contamination during the year. There is now only one dwelling in Enfield which relies solely on well water for its water supply and this is under regular supervision. The question of well-water supplies, both in connection with dwelling-houses and industrial premises, throughout the Borough 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. During the year four samples of well water were examined bacteriologically. In addition, four samples of drinking water other than from wells were bacteriologically examined, and found to be satisfactory. 14 MEDICAL ASSESSMENT OF EMPLOYEES. The following medical examinations or assessments of employees were carried out during the year:— (1) Superannuation Act: Medical examinations 29 Assessments without medical examinations 23 (2) Sick Pay Scheme: Medical examinations 58 Assessments without medical examinations 60 HOUSING Number of new houses erected during the year by (a) Local Authority 112 (b) Other Local Authorities — (c) Other bodies or persons 293 With State assistance (included in above totals) (a) Local Authority 112 (b) Other Local Authorities — (c) Other bodies or persons — 1. Inspection of Dwelling-houses:— No. of houses. No. of inspections. (1) Total number of dwelling-houses inspected for housing-defects (under Public Health and Housing Acts and Regulations) and number of inspections made 2,606 8,328 (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 202 439 (3) Number of dwelling-houses represented to the Council by the Medical Officer of Health to be in a state so dangerous or injurious to health as to be unfit for human habitation 28 15 (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 297 (The number here given is of houses where any insanitary conditions were found.) 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 268 3. Action under Statutory Powers. A.—Proceedings under Sections 9, 10, 12 and 17 of the Housing Act, 1957:— (1) Number of dwelling-houses in respect of which Notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners — (b) By Local Authority in default of owner — B.—Proceedings under Public Health Act, 1936:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 164 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 69 (b) By Local Authority in default of owners 33 C.—Proceedings under Middlesex County Council Act 1956 Sec. 38 (1) Number of dwelling houses in respect of which Notices were served requiring drains to be cleared 4 16 (2) Number of houses at which drains were cleared after service of formal notices : (a) By owners 4 (b) By Local Authority in default of owners — RENT ACT 1957 No. of applications received for Certificates of Disrepair 198 No. of undertakings received from landlords 169 No. of Certificates of Disrepair issued 70 No. of applications for cancellation of Certificates of Disrepair received from landlords 53 No. of objections to cancellations received from tenants 22 No. of Certificates of Disrepair cancelled 37 No. of Certificates as to Remedying of Defects which the Landlord has Undertaken to Remedy: Issued to tenants 41 Issued to landlords 36 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 to 1952 Total number of carcases examined:— Bulls 2 Cows 213 Bullocks 426 Heifers 297 Calves 111 Swine 4,867 Sheep 14,063 Lambs 3,665 Goats 3 Total 23,647 Whole carcases, parts or organs found to be diseased 1,660 Weight of do. 3 tons 17 cwts. 2 qtrs. 14 lbs. 17 Carcases and Offal Inspected and condemned in whole or in part Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 725 213 111 17,728 4,867 3 Number inspected 725 213 111 17,728 4,867 3 All diseases except Tuberculosis and Cysticerci (a) Whole carcases condemned 2 - - 19 7 - (b) Part or organ condemned 212 — — 1,042 320 — Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 29.52 0.0 0.0 5.98 6.72 0.0 Tuberculosis only: (a) Whole carcases condemned - 1 1 - 1 - (b) Part or organ condemned 43 — — — 35 — Percentage of the number inspected affected with tuberculosis 5.93 0.47 0.9 - 0.76 - Cysticercosis (a) Carcases of which some part or organ was condemned - - - - - - (b) Carcases submitted to treatment by refrigeration - - - - - * (c) Generalised and totally condemned — — — — — — SLAUGHTERHOUSES ACT, 1958 The Slaughterhouses Act, 1958, came into operation on 1st August, 1958, and several Regulations and Orders in connection therewith had commencement dates in 1959. The Act amends certain of the provisions of the Food and Drugs Act, 1955, relating to slaughterhouses and knackers' yards and it also amends the Slaughter of Animals Acts, 1933 to 1954, and section 151 (I) of the Factories Act, 1937. 18 The Act concerns itself with construction standards for hygiene and the prevention of cruelty to animals, hygienic practices, isolation of slaughterhalls from dwellings, and the safety, health and welfare of workers in slaughterhouses and knackers' yards. There are also certain changes in the arrangements for licensing, and provision is made for each Local Authority to review and report to the Minister on the existing and probable facilities and future requirements of their district in regard to slaughterhouse facilities. THE MILK (SPECIAL DESIGNATIONS) (RAW MILK) AND (PASTEURISED AND STERILISED MILK) REGULATIONS, 1949 AND 1950. The following Licences were in operation at the end of the year : Grade. Dealers. Supplementary. Raw Milk: Tuberculin Tested 21 10 Pasteurised Milk 25 11 Sterilised Milk 83 12 Totals: 129 33 MILK AND DAIRIES REGULATIONS, 1949 There is 1 dairy in the District which is registered under the above Regulations. 54 persons were registered as distributors of milk during 1958. Forty inspections were made at the dairy and the premises used by distributors. FOOD AND DRUGS ACT, 1955. There are 283 Ice-Cream retail premises and 186 Food Preparing premises registered under Section 16 of the Food and Drugs Act 1955. All 23 samples of ice cream taken were satisfactory being Grade I. 19 Examination of Foods Number of inspections made of retail shops, stalls and food-preparing premises, etc. 4,140 Number and weight of articles, etc., of foodstuffs condemned as unfit for food:— Articles Foodstuffs Weight—lbs. 1,498 Fruits 1,536 751 Vegetables 567 2 Sauces and Pickles 2 146 Fish 393 261 Meats 846 1,882 Meat (Fresh) 10,019 27 Meat and Fish Pastes 20 103 Soups 88 21 Cordials, etc. 21 1 Cereals 1 3 Baby Foods 1 15 Macaroni and Spaghetti 13 177 Jams 89 34 Cheese 8 217 Cream and Milk 256 29 Puddings 54 2 Sugar 4 5,169 = 6 tons 4 cwts. 1 qtr. 2 lbs. 13,918 Total No. of articles, etc., condemned 5,169 No. of Certificates of condemnation issued 954 Total weight of foodstuffs condemned as unfit for human consumption:— 6 tons 4 cwts. 1 qtr. 2 lbs. Method of Disposal of Condemned foods All unfit foodstuffs were destroyed in the Council's Refuse Destructor furnaces. 20 THE FOOD HYGIENE REGULATIONS 1955 to 1957 Food Hygiene continued to form a prominent part of the Department's work and during the year 2,974 visits were made to food premises of all types. In a number of factory canteens structural alterations and modernisation of equipment was carried out. The importance of protecting food by refrigeration was again stressed and the improvements in this connection were most encouraging. The number of fittings installed and improvements affected were: Basins 6, Sinks 5, Hot Water 8, Clothes Lockers 4, Screening 10, Food Premises cleansed and repaired 42, Alterations and improvements 47. Three entirely open-fronted fish shops, unfortunately, still remain. Two of these are owned by a large firm of retail fishmongers and it was hoped that these shops would be modernised during the year, and indeed plans for this have been prepared. For various reasons however, work had to be postponed but it is confidently expected that work will start early in 1959. Sampling of washing-up water and swab testing of kitchen utensils and equipment were continued throughout the year at 64 premises including restaurants, cafes, school kitchens and sculleries, factory canteens, hotel kitchens, public houses and shops. Altogether 44 samples of washing up water and 118 swabs from utensils and equipment were examined and in 35 cases, results were considered to be unsatisfactory. In most of these cases it was found that faulty washing up methods were to blame rather than disregard for hygienic practices. Advice on washing up technique was given and readily accepted. Follow up sampling and swabbing were carried out with satisfactory results. A shopkeeper was prosecuted under Section 8 of the Food and Drugs Act, 1955, for selling a French Jam Sandwich which was unfit for human consumption and was fined £10 with £2 3s. 0d. costs. Another shopkeeper was prosecuted under this Section for selling a loaf of bread which was unfit for human consumption and was unconditionally discharged on payment of £13 13s. 0d. costs to the Council. 21 FOOD AND DRUGS ACT, 1955 The following table gives details of the samples of foods and drugs procured under the above Act in Enfield by the Food and Drugs Authority during 1958:— Article. Total samples procured. Unsatisfactory. Milk (various) 74 1 Milk (new) 123 4 Butter 10 — Cakes, etc. 12 — Cheese 9 — Cooked meat 18 — Cream 10 — Drugs 16 — Fish and Fish Products 27 1 Fruit juice etc. 3 — Ice cream 10 — Margarine 7 — Meat and Meat Products 43 — Preserves 5 — Liver 9 — Sausages 15 — Soup 4 1 Spirits 3 — Vinegar 29 — Miscellaneous 24 1 Totals: 451 8 With regard to the 8 samples noted as unsatisfactory, the following comments are made: Milk. One sample of milk was found to be contaminated by mould and an official caution was sent to the sellers. The other four unsatisfactory samples were of new milk consigned to milk receiving depots in this district; three of the samples were from one consignment, and one from another. These samples were from individual churns of new milk and, as the average composition of the whole of each consignment was satisfactory, no further action was taken. Fish. Smoked cod was supplied on one occasion when smoked haddock was requested. A subsequent sample from the same source was satisfactory. 22 Soup. A sample of “Cream of Leek” soup mix was found, when made up in accordance with the manufacturer's directions, to contain less fat than is required for tinned cream of leek soup. A letter of caution was sent to the seller pointing out the misleading nature of the label attached to this food. Merchandise Marks Acts, 1887 - 1953. The majority of the inspection work carried out under the provisions of the above Acts relates to ensuring that the requirements of the various Marking Orders made under the provisions of the Act of 1926, and which relate to the marking of certain imported foodstuffs when exposed for sale or sold, are complied with. Inspections were made at 264 separate premises of 1,270 separate displays of meat, apples, tomatoes, poultry, dried fruit, bacon, butter and salmon. One firm of butchers was prosecuted for twelve offences of failing to mark imported meat with an indication of origin and three offences for marking South African and Australian meat as “Argentine.” The defendant Company was fined a total of £54 0s. 0d. Another firm of butchers was prosecuted for selling and for exposing for sale New Zealand lamb marked “English” they were fined a total of £30 0s. 0d. together with £4 15s. 7d. costs. One other Company was prosecuted for exposing tomatoes for sale with a false indication of origin, and were fined £5 0s. 0d. with £2 2s. 0d. costs. Another Company received an official caution for exposing for sale Dutch tomatoes labelled “Home Grown.” Labelling of Food Order, 1953. This Order requires pre-packed food to be marked with the name and address, or with the registered trade mark, of the packer or labeller. It also requires such food to be labelled with its common or usual name (if any) and with the names of the ingredients of a compounded food. It also controls the manner in which the presence of vitamins and minerals is disclosed and prescribes specific labelling of certain foods. A total of 2,252 articles of pre-packed food were examined at 222 premises to ascertain whether the above requirements were complied with; no serious infringements of this Order were detected. False or Misleading Descriptions. As in previous years food advertisements and labels have been scrutinised for false or misleading statements and descriptions. Much of this scrutiny of food labels can be combined with inspection work under the Labelling of Food Order. No serious infringements were disclosed. Corrective action was secured in relation to descriptions applied to "milk block," "Double Tea," an imitation cream powder, cakes filled with a mixture of butter and sugar, canned mixed vegetables, raspberry syrup, powdered soup mixes, medium red salmon, gorgonzola cheese spread and cheese spread. 23 Special Designated Milk. During 1958 the County Council issued one Dealer's (Pasteuriser's) and one Dealer's (Steriliser's) licence in respect of premises within Enfield where milk is processed. These premises were regularly inspected, and compliance with statutory requirements was well maintained. A total of 69 samples of designated milk were taken, all of which were certified as being satisfactory. Safe Milk. In addition to the foregoing, 38 samples of raw milk were procured within the borough and submitted to test for the presence of tubercle bacilli. None was found contaminated. NUMBER AND CLASSES OF FOOD PREMISES IN BOROUGH Restaurants and Cafes 60 Grocers and Provision Merchants 176 Butchers 68 Greengrocers 80 Fishmongers 30 Bakehouses 21 Bakers and Confectioners 37 Milkshops and Dairies 93 Ice Cream Retailers 283 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 9 Hawkers and 9 Hawkers' Premises were registered. The following table shows the number of Hawkers' Premises registered and the number of inspections made by the Public Health Inspectors during the year in connection therewith. No. of Premises, etc., on Register No. of inspections 79 80 24 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES AND SCHOOLS 1957. 1958. Number of children notified by Head Teachers to be absent from School due to:— (a) Infectious Disease or suspected tious Disease 584 518 (b) Contact with Infectious Disease 3 2 Number of School children notified by General Practitioners as suffering from Infectious Disease 981 795 NOTIFIABLE DISEASES DURING THE YEARS 1957 AND 1958. 1957 1958 No. Treated in Hospital Deaths No. Treated in Hospital Deaths. Smallpox - - - - - - Cholera—Plague - - - - - - Diphtheria (inc. branous Croup) - - - - - - Diphtheria Carriers - - - - - - Erysipelas 16 2 - 17 3 - Scarlet Fever 126 44 - 101 33 - Typhus Fever — — - - — - Typhoid Fever — — - - — - Paratyphoid Fever — — - 1 1 - Relapsing Fever — — — - — - Continued Fever — — — - — - Puerperal Pyrexia 71 67 — 36 34 - Meningococcal Infection 1 1 — 2 2 1 Poliomyelitis (Paralytic and Non-Paralytic) 5 5 1 4 3 - Acute-Encephalitis — — — — — - Ophthalmia Neonatorum 13 13 - 11 11 - Respiratory Tuberculosis: New cases 27 — 8 45 - 7 Transfers, etc. 35 - - 38 - — Other forms of Tuberculosis: New cases 9 - - 11 - 2 Transfers, etc. 1 - - - - - Food Poisoning 10 — — 12 - - Malaria - — — 1 - - Pneumonia 84 28 51 74 22 42 Dysentery 100 — — 10 1 - Measles 1244 5 — 1186 15 — Whooping Cough 246 6 — 17 2 —- Totals 1988 171 60 1566 127 52 25 HOSPITAL FOR INFECTIOUS DISEASES During the year, the following cases were admitted from Enfield to South Lodge Hospital. Measles 15 Meningococcal Infection 2 Scarlet Fever 33 Poliomyelitis 1 Whooping Cough 2 Gastro-enteritis 7 Diarrhoea and Vomiting 2 Upper Respiratory Infection 1 Pyrexia 7 Pneumonia 18 Erysipelas 3 Quinsy 3 Bronchitis 3 Others 21 118 DIPHTHERIA For the tenth year in succession no case of Diphtheria occurred in the Borough. DIPHTHERIA IMMUNISATION 1,129 children were immunised for the first time and 1,138 received subsequent reinforcing doses during the year. WHOOPING COUGH IMMUNISATION 922 children were immunised against Whooping Cough for the first time during the year, and 121 received subsequent re-inforcing doses. POLIOMYELITIS VACCINATION At the end of the year, 5,957 people had completed a course of three injections, 166 had received only one injection, and about 10,000 had received two injections. 26 SMALLPOX VACCINATION 1,087 persons received primary vaccination and 128 re-vaccination. POLIOMYELITIS AND ACUTE ENCEPHALITIS. During the course of the year, 4 cases of poliomyelitis occurred in the Borough. Of these 2 were males aged 30 years and 14 years and 2 were females aged 24 years and 4 months. All these cases were paralytic type, but none proved fatal. None of the patients had been immunised. FOOD POISONING Of the 12 cases of food poisoning which were notified during the year, all were single cases, due to Salmonella Organisms. SONNE DYSENTERY The incidence of mild dysentery due to Shigella Sonnei, showed a marked decrease on last year's figure, 10 cases as against 100 for the previous year, but this is an infection which is likely to vary considerably in incidence, especially as its spread is so easily encouraged by careless personal hygiene. 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. Other Forms Respiratory. Other Forms M. F. M. F. M. F. M. F. Under 1 - - -_ - - - - - 1 to 5 - - - - - - - - 5 to 10 1 2 - - - - - - 10 to 15 - 3 - - - - - - 15 to 20 1 2 1 - - - - 20 to 25 2 1 1 2 - - - — 25 to 35 3 3 - 2 - -- - - 35 to 45 9 1 - 1 - — — 1 45 to 55 4 — 1 1 3 — — 1 55 to 65 4 — - - — — - - 65 and upwards 4 5 — 2 4 — — — Totals 28 17 3 8 7 — - 2 27 No. of cases transferred into the District from other areas: Respiratory 38 Other Forms - 38 No. of cases restored to Register during the year:— Respiratory 2 Other Forms — 2 The following table shows the incidence of Tuberculosis and death-rates from this disease in the various Wards in the Borough during the year. Ward. Estimated Population. No. of Cases. T.B. Case-rate. T.B. Death-rate. Respiratory Other Forms Respiratory Other Forms Respiratory Other Forms Bush Hill Park 10,561 4 - 0.37 0.00 0.00 0.00 Cambridge Road 10,659 2 1 0.18 0.09 0.09 0.00 Chase 7,565 6 2 0.79 0.26 0.00 0.00 Enfield Wash 12,541 3 — 0 23 0.00 0.00 0.00 Green Street 10,659 5 1 0.45 0.09 0.00 0.00 Ordnance 13,460 2 1 0.14 0.07 0.14 0.00 Ponders End 9,879 8 1 0.80 0.10 0.20 0.00 The Town 11,106 9 2 0.81 0.18 0.18 0.09 West 12,304 4 1 0.32 0.08 0.00 0.08 Willow 10,566 2 2 0.18 0.18 0.00 0.00 Total 109,300 45 11 0.42 0.10 0.06 0.01 The following table sets out the record of examinations carried out and the results. Throat and Nose Swabs. Diphtheria Bacilli Haemolytic Streptococci 97 Vincent's Angina 5 Others 17 Negative 397 516 LABORATORY FACILITIES The examination of specimens is carried out by the Public Health Laboratory Service either at the Branch Laboratory situated at the Town Hall, Edmonton, or the Central Laboratory, Colindale. 28 Faeces. Shigellae 16 Giardia 8 Salmonella 76 Gastro-Enteritis Coli — Protozoa — Welchii 1 Negative 483 584 Sputum. Tubercle Bacillus — Other Organisms 23 Negative 37 60 Milk. Pasteurised 8 Tuberculin Tested 4 Sterilised 1 Ice cream 23 36 Other Foods. Watercress 1 3 Water. Domestic supplies, etc. 11 Swimming pools, etc. 7 18 Miscellaneous. 225 225 1,442 29 PREVENTION OF DAMAGE BY PESTS ACT, 1949. 0During 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 Borough. 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. 1,098 premises were inspected during the year for rat and mice infestation, and of these 364 were found to be affected. The total number of treatments carried out by the Department including domestic, business and factory premises, was 294. During the year the Public Health Inspectors and Rodent Investigating Staff made 5,379 visits concerning rat infestation. During the year a new method of sewer disinfestation treatment was started in conjunction with the Infestation Control Division of the Ministry of Agriculture, Fisheries and Food. It is intended to carry out quarterly direct poison treatment with Sodium Fluoracetate in damp coarse oatmeal, as this is a very efficient poison, and two such treatments were carried out during the year. ERADICATION OF BED BUGS Number of Council Houses suspected to be infested 15 Number of Council houses disinfested as precautionary measure 15 Number of other houses found to be infested 6 Number of other houses disinfested 6 Householders are urged to seek the assistance of the Health Department immediately they suspect the presence of bugs or similar pests. 30 PUBLIC HEALTH INSPECTORS' INSPECTIONS AND VISITS The following report, in condensed form, gives detail of the work of the Public Health Inspectors during the year 1958. The total number of inspections and visits made during the year for all purposes was 22,800. No. of Inspections of Premises:— Inspections Housing Acts, 1936 and 1957 439 Housing Repairs and Rents Act, 1954 and Rent Act, 1957 599 Infectious Disease 82 Tuberculosis 1 Complaint by tenants of insanitary conditions 6,723 Vermin 443 Rag Flock and Other Filling Materials Act, 1951 7 Pet Animals Act, 1951 12 Public Conveniences 74 Schools 14 School Canteens 20 Cinemas, Halls, etc 27 Fair-grounds 11 Hairdressers 16 Milkshops and Dairies 40 Food Premises 2,974 Food Hawkers'Stands 41 Food Hawkers (Storage) 39 Bakehouses 26 Ice-Cream Shops 88 Public-houses 51 Outworkers' Premises Factories 350 Smoke Observations 936 Visits :— Ifectious Diseases 217 Dysentery 84 Food Poisoning 82 Housing Act, 1936 (Sec. 62)—Permitted Numbers 6 Overcrowding 16 Slaughterhouse 881 Shops Act, 1950 48 Improvement Grants 587 Builder's Notices 19 C/fwd 14,986 31 B/fwd 14,986 Food Inspections 172 Moveable Dwellings 391 Rats 629 Piggeries 83 Stables 18 Well and Main Water Supplies 4 Swimming Pools 8 Paddling Pools in Parks 6 Atmospheric Pollution 117 Cesspools 112 Other Visits 1,379 17,905 Visits by Rodent Dept. Staff :— Rats 4,850 Wasps, Beetles, etc 45 4,895 Samples taken—Water—Wells 4 Mains 4 Swimming Baths 4 Parks Lakes, etc. 3 Ice-Cream 23 The following list of repairs executed during the course of the year shows that the defects found as a result of the Public Health Inspectors' visits were varied and general in character. Houses or parts of houses cleansed, repaired, etc. 178 Roofs repaired 164 Gutters and downpipes repaired 106 Dampness remedied 118 Floors repaired 48 Yards paved or made good 17 Dustbins provided or renewed 55 Improvements effected in Food premises 122 32 Drains—Examined 316 Tested—Smoke 28 Water 17 Reconstructed 14 Repaired, etc. 163 Vents repaired 5 Sink wastes repaired 12 New sinks provided 7 Water-closets—New ones provided 6 New pans provided 23 Apparatus repaired or renewed 47 Water—Water laid on or restored 11 Cisterns cleansed, covered, etc. l Wells cleansed, repaired, etc. 1 Nuisances—Manure, etc., removed 3 Other nuisances abated—Stoves, etc., repaired or renewed 17 Windows repaired or renewed 107 Caravans removed 16 Miscellaneous 137 Wasps Nests destroyed 39 Fowls removed 1 NOTICES ISSUED Statutory (Insanitary Conditions) 168 Informal (Do.) (P.H. Act) 523 Informal (Insanitary Conditions) (Housing Act) — Informal—Food and Drugs Act and Food Hygiene Regulations 185 Other Notices (Infectious Diseases) 2,878 3,754 33 Number of Requisitions for Information dealt with 2,683 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 106 268 Number outstanding 62 157 168 425 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 238 Number of articles of clothing, bedding, etc., disinfected 1,655 Number of Library books disinfected 176 Number of articles of clothing, bedding, etc., destroyed 144 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. There are five registered premises in the District. 34 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 the 7 premises previously licensed by the local authority were re-licensed. THE HEATING APPLIANCES (FIREGUARDS) ACT, 1952. The above Act, requiring fireguards to be fitted to gas fires, electric fires and oil heaters of types so designed that they are suitable for domestic use, and so constructed that without a guard there is likelihood of injury by burning, or of ignition of clothing by reason of contact with, or proximity to the heating element or flame, came into operation on the 23rd March, 1953, and the regulations made under this Act came into force on the 1 st October, 1954. Each of the Public Health Inspectors has been appointed a duly appointed officer under the Act. FACTORIES ACTS, 1937 AND 1948 A register is kept of all the factories in the Borough, and during the year 350 inspections were carried out. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health 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 51 89 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 353 271 3 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 18 6 - - Total 422 366 3 — 35 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) - 2 - 2 - Ineffective drainage of floors (S.6) - — - — - Sanitary Conveniences (S.7) (a) Insufficient - - - - - (b) Unsuitable or defective 3 6 - 3 - (c) Not separate for sexes - - - - - Other offences (not including offences relating to Outwork) — — — — — Total 4 9 - 5 — OUTWORKERS Seventy lists containing the names and addresses of 644 outworkers were received during the year. 190 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. Wearing Apparel, etc. 113 - - Cardboard Boxes, etc. 3 - - Carding of Buttons, etc. 21 - - Artificial Flowers 7 - - Brush Making and Artist's Materials 68 - - Electrical Cables, etc. 185 - - Christmas Crackers, etc. 5 - - Stuffed Toys, Games and Toys 8 - - Druggist's Sundries 2 - Furniture and Upholstery 5 - Brass Articles 6 - — Total 423 — — 36 HAIRDRESSERS' AND BARBERS' PREMISES. Byelaws were made in 1937 for the purpose of securing the cleanliness of any premises used for the purpose of carrying on the business of a hairdresser or barber and of the instruments, towels, and materials used in such premises. These byelaws have proved useful in maintaining a high standard in the premises of the Borough. PLACES OF PUBLIC ENTERTAINMENT Number of inspections of sanitary accommodation 27 OFFENSIVE TRADES There are now no offensive trade businesses established in the Borough. ATMOSPHERIC POLLUTION CLEAN AIR ACT, 1956 Under the Clean Air Act, 1956 (Appointed Day) Order, 1958, the remaining provisions of the Act were brought into operation on the 1st June, 1958. These provisions included those relating to the prohibition of dark smoke from chimneys, measures for dealing with grit and dust from furnaces, abatement of smoke nuisances and the application of the Act to railway engines, vessels and Crown premises. Smoke emission from chimneys in certain parts of the district caused some concern and close attention is being paid to these few offenders. Further progress was made in the action necessary to inaugurate a Smoke Control Area in 1959 and analyses of deposit gauges and lead peroxide instruments at four sites in the Borough were continued. 37 SWIMMING BATH AND POOL Enfield has two public swimming pools, a relatively modern open-air pool, built in 1932, situated next to the Sports Stadium, and an indoor bath at Enfield Lock, built in 1895, but recently greatly improved by extensions and modernisation. As regards the purification of the water, the up-to-date method of chlorination, filtration and aeration is used at both premises. This gives a safe and pleasant bathing water. Reports on the twice-daily examinations for chlorine and alkalinity of the water are sent to the Medical Officer of Health, and the Public Health Inspectors take samples for bacteriological tests at appropriate intervals. At both the open-air pool and the indoor bath, slipper bath facilities are available. 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.