AC 439 (1) ENF 44 Borough Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1960 Borough Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1960 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1960. To the Mayor, Aldermen and Councillors of the Borough of Enfield. I have pleasure in presenting my Annual Report for 1960. The main work of the Health Department continued more or less uneventfully along the usual lines. The environmental health services continue to be of basic importance, in spite of the recognised value attached to the more personal health services with which this report does not deal. The prevention of infectious disease is still one of the most important aspects of our work, and in spite of undoubted major successes in this field, particularly with the more serious diseases, continued efforts and vigilance are very necessary, as incidents in other districts have shown. I am continually stressing the need for protective procedures, and only by continued acceptance of immunisation methods can we hope to enjoy the measure of freedom from serious infectious disease that has been possible during the last number of years. It is not enough just for individuals to be protected, as only by a high community level of immunity can we have a satisfactory degree of safety, and I would urge parents to take advantage of the protection so readily available to their children and themselves. Having given this warning, it gives satisfaction to note that there has been no case of diphtheria in Enfield for over 12 years, and no case of poliomyelitis for over 2 years. Scarlet fever, in a milder form than it used to be, is still with us, and there were 63 cases during the year. Respiratory tuberculosis continued to decline and there were only 18 new cases and 5 deaths, an encouraging situation but not yet the final episode. Although there was a very marked reduction in the number of cases of measles, this is attributed to some extent to the normal 4 periodic cycle of this disease. There are hopes that successful immunisation against this disease may become available. There were more cases of Sonne Dysentery, a mild type of dysentery, which, although not usually a serious condition, has a definite nuisance value. It has been fairly widespread during recent years, due partly to its high infectivity, but it is a disease which it should be possible to control by strict observance of personal hygiene. Considerable attention is paid to all aspects of food hygiene, such as meat inspection at the slaughterhouse, control of milk supplies and ice cream, inspection of food shops and food preparing premises, as well as careful attention to restaurants, cafes, canteens, etc., and the results can be taken to be reflected in the fact that although there were a few cases of food poisoning notified, they were all single cases, and no outbreak associated with any premises occurred. Here, of course, as much depends on the methods and personal hygiene of staff as on the standard of premises and equipment. I referred last year to the increased interest being taken in regard to noise nuisance. In November there came into operation the Noise Abatement Act, 1960, but it is too early yet to assess the value of this legislation. Progress continues to be made in regard to Smoke Control Areas, one being already in operation and another large area due to become effective in the near future. Preparation for these Areas takes much effort, time and expense, but plans are laid for steady progress towards making the Borough smokeless in the foreseeable future. Apart from the Smoke Control Area provisions of the Clean Air Act, there are important aspects dealing with atmospheric pollution from industrial and other sources, and unfortunately there have been a few instances of concern in this direction which have required action. During the year, analyses of deposit gauges and lead peroxide instruments for measurement of atmospheric pollution were continued on the old basis, but consideration was given to the future installation of different equipment to provide even more useful information. Considerable effort has been put into work under the Housing Acts, but the work under the Rent Act has shown a progressive decline since its inauguration in 1957. On looking at the vital statistics for the year we find that the population has increased slightly, and although the number of houses has also increased, there is still a need for more. In general, the vital statistics present a satisfactory picture, with the Death Rate down, Still-birth Rate down, and no woman 5 dying in consequence of childbirth. These rates compare favourably with those for England and Wales, as does the Infant Mortality Rate which is very slightly higher than the previous year. The Birth Rate is higher than the previous year but is lower than that for England and Wales. When we look at the causes of death it is noticed that there is a slight decrease in the number of deaths from Cancer, including a reduction from 58 to 51 deaths from Cancer of the Lungs, but caution in assessing the significance of one year's figures is required. On the other hand there was a slight increase in the number of deaths from heart disease. It is difficult to know whether propaganda in regard to Home Accidents is having effect, but there was a significant decrease in numbers of fatal home accidents during the year. On the other hand, in spite of large-scale propaganda, there was an increase in the number of fatal road accidents, and although road accidents may not strictly be considered a public health matter, I feel impelled to repeat my impression that much could be achieved by eliminating haste, selfishness, impatience and downright bad manners on the part of all categories of road users. In conclusion I would like to express my appreciation of the services of the staff of the Health Department during the year. William D. Hyde, Medical Officer of Health. 6 BOROUGH OF ENFIELD Alderman A. M. Eeles, J.P Mayor Alderman E. J. Rayment Deputy Mayor Aldermen: Mrs. G. M. Jay, J.P. A. M. Eeles, Esq., J.P. W. G. Bowyer, Esq. E. J. Rayment, Esq. D. R. J. Boxall, Esq. E. L. Mackenzie, Esq., J.P. J. Cottenham, Esq., J.P. A. H. Saunders, Esq., Deceased. G. Deacock, Esq. A. A. F. Tatman, Esq., B.E.M., JP. Councillors: A. D. Bates, Esq. W. J. Howes, Esq. J. R. Bentley, Esq. H. E. Latty, Esq. F. H. Blanchard, Esq. E. P. Lomer, Esq. E. W. Burville, Esq. L. C. Merrion, Esq. H. E. Campbell, Esq. F. L. Mezen, Esq. A. H. Chambers, Esq. J. C. Pines, Esq., B.E.M. Miss C. E. Clough S. C. Piper, Esq. L. J. Collop, Esq., Deceased E. J. Prickett, Esq. W. H. Cook, Esq. P. L. Purnell, Esq., J.P. Mrs. J. L. Cronin E. S. Stock, Esq. F. C. Cunneen, Esq. P. A. Thomas, Esq. J. J. Dunnett, Esq. E. J. Tong, Esq. Mrs. E. M. C. Ellis W. J. Watson, Esq. G. D. Game, Esq. C. H. J. Wicks, Esq. E. T. Hendrick, Esq. A. J. Young, Esq. HEALTH COMMITTEE Alderman E. J. Rayment, Esq. Chairman Alderman Mrs. G. M. Jay, J.P.Vice-Chairman also Alderman Boxall Councillors Mrs. Ellis, Miss Clough, Dunnett, Game, Wicks, Mezen, Pines, B.E.M. Thomas and Young. 7 PUBLIC HEALTH STAFF Medical Officer of Health: Dr. W. D. Hyde. Deputy Medical Officer of Health: 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 (resigned 31.7.60), Mr. E. A. C. Kottman, Mr. A. J. Hattersley, Mr. R. Williams, Mr. D. Ratliff (appointed 1.8.60). Student Public Health Inspector: Mr. J. R. Jones (appointed 5.10.60). Rodent Investigator: Mr. P. W. Partridge (Deceased). Chief Clerk: Mr. S. N. Dance. Senior Clerk: Mr. R. W. Kirby (resigned 25.5.60), Mr. D. C. Wakefield (appointed 11.7.60). General Clerks: Mr. B. Bayford, Mrs. V. M. Randall, Miss J. Cowlard. Shorthand-Typist: Mrs. C. Meikle. STATISTICS AND SOCIAL CONDITIONS OF THE AREA POPULATION The population as estimated by the Registrar General is 110,240. The number of inhabited houses at the end of 1960, according to the Rate Books, was 33,448. Explanatory Note: Definition of "Houses"—Structurally separate dwellings including flats. The rateable value of the Borough is £2,126,234 The net product (after allowing for cost of collection) of a penny rate is (Estimated) £8,700 AREA Area (in acres) 12,401 NEW HOUSES The number of houses erected during the course of the year was 318. 8 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total Male. Female. Legitimate 1,556 810 746 Illegitimate 62 33 29 Birth-rate—14.67 per 1,000 population. Still Births:— Total. Male. Female. Legitimate 16 9 7 Illegitimate 1 — 1 Rate per 1,000 total births—10.39. Total. Male. Female. Deaths 1,108 565 543 Death-rate—10.05 per 1,000 population. Number of women dying in, or in consequence of childbirth:— Deaths. Rate per 1,000 Total births. From Puerperal Sepsis — — From other Puerperal causes — — — — Death-rate of Infants under one year of age:— All infants per 1,000 live births 21.01 Legitimate infants per 1,000 legitimate live births 20.56 Illegitimate infants per 1,000 illegitimate live births 32.25 Deaths from Cancer (all forms) 203 Deaths from Cancer (Lungs and Bronchus) 51 Deaths from Tuberculosis (Respiratory) 5 Deaths from Tuberculosis (Other forms) 1 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 1.10. 9 BIRTH, DEATH AND INFANT MORTALITY RATES. Birth-rate. Death-rate. Infant Mortality rate Live Still England and Wales 17.1 19.7 11.5 21.7 ENFIELD (Standardised) 14.67 10.39 11.05 21.01 DEATHS The number of deaths assigned to Enfield for 1960 was 1,108 2 less than for last year. The more prevalent causes of death during the last 2 years were:— Cause of Death 1959 1960 All Ages:— Diseases of Heart 378 390 Malignant Disease (Cancer) 227 203 Vascular Lesions of Nervous System 118 146 Bronchitis 63 46 Other Diseases of Circulatory System 78 71 Pneumonia 36 40 Tuberculosis of Respiratory System 5 5 Children Under 1 Year:- Premature Birth 9 13 Congenital Malformations 4 6 Bronchitis and Broncho-pneumonia 7 10 The death rate for the Borough is 10.05 per 1,000 population. Two hundred and sixty deaths registered were of Enfield persons aged 80 years or more, 95 being males and 165 females. 1 male and 6 females were aged 95 years or more. It will be seen that 23.46 per cent, of the total deaths were of persons over 80 years of age. 10 TABLE I. Causes of Death during Year 1960. Causes of Death. Males. Females. Total. Tuberculosis of Respiratory System 3 2 5 Other Forms of Tuberculosis — 1 1 Syphilitic diseases 1 1 2 Diphtheria — — — Whooping Cough — — — Meningococcal infections — — — Ac. Polio-myelitis — — — Measles — — — Other infective and parasitic diseases 1 3 4 Malignant Neoplasm of stomach 12 7 19 Malignant Neoplasm, lung, bronchus 44 7 51 Do. of breast 1 22 23 Malignant Neoplasm, uterus — 9 9 Other Malignant and Lymphatic Neoplasms 52 49 101 Leukaemia, aleukaemia 2 4 6 Diabetes 2 8 10 Vascular lesions of nervous system 56 90 146 Coronary disease, angina 127 74 201 Hypertension with heart disease 16 12 28 Other Heart disease 76 85 161 Other Circulatory disease 41 30 71 Influenza — — — Pneumonia 15 25 40 Bronchitis 30 16 46 Other diseases of Respiratory system 6 4 10 Ulcer of stomach and duodenum 6 7 13 Gastritis, Enteritis and Diarrhoea 1 5 6 Nephritis and Nephrosis 4 5 9 Hyperplasia of prostate 6 — 6 Pregnancy, Childbirth and Abortion — — — Congenital Malformations 9 1 10 Other defined and ill-defined diseases 32 62 94 Motor Vehicle accidents 11 1 12 All Other accidents 4 7 11 Suicide 7 5 12 Homicide and operations of war — 1 1 Total 565 543 1,108 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 23 3 1 1 28 2 4 — — 34 Uncertified — — — — — — — — — — Atelectasis 2 — — — 2 — — — — 2 Bronchitis and Pneumonia — 3 — 1 4 2 4 — — 10 Congenital Malformations 6 — — — 6 — — — — 6 Prematurity 13 — — — 13 — — — — 13 Cerebral haemorrhage 1 — — — 1 — — — — 1 Cardiac failure 1 — 1 — 2 — — — — 2 Totals 23 3 1 1 28 2 4 — — 34 Births in the year:—Legitimate: Live births, 1,556; Stillbirths, 16. Illegitimate: Live births, 62; Still-births, 1. Deaths in the year:—Legitimate Infants, 32; Illegitimate, 2. Of the 34 infants who died before reaching the age of 1 year, 28 died within the first 4 weeks of life, and of this number, 23 occurred in infants under 1 week. The infant mortality rate for the Borough is 21.01. INQUESTS Thirty six inquests and two hundred and six post mortem examinations without inquests were held during the year. Of these 206 deaths were due to natural causes, 20 to accidental causes, 12 to suicide, 3 to misadventure and in one case the verdict was "industrial disease—pneumonokoniosis due to exposure to talc." 12 FATAL HOME ACCIDENTS During the year under review there were 5 fatal home accidents to Enfield residents being 4 less than the previous year. All of these accidents occurred amongst elderly people, 2 being over 80 years of age and 3 between 75 and 80 years of age. The precipitating cause of death in all 5 cases was a fall leading in most instances to fractured bones and followed usually by lung complications. The number of fatal Road Accidents to Enfield residents during the year was 12 which was an increase of 4 on the previous year. Unfortunately there were also 12 (7 male, 5 female) cases of suicide, 3 of which were in the 25-45 years age group, 8 aged between 45 and 65 years and 1 aged 74 years. It is disquieting to note 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. No action was necessary during the year under these Acts. Such 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. 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 Lee Valley Water Company. Both of these Authorities take regular and frequent samples for analysis. Copies of the reports on these are sent to the Health Department, and have shown satisfactory results. There was no cause to suspect any contamination during the year. 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. There is now only one dwelling in Enfield which relies solely on well water for its water supply and this is under regular supervision. MEDICAL ASSESSMENT OF EMPLOYEES. The following medical examinations or assessments of employees were carried out during the year:— (1) Superannuation Act: Medical examinations 37 Assessments without medical examinations 41 (2) Sick Pay Scheme: Medical examinations 56 Assessments without medical examinations 41 14 HOUSING Number of new houses erected during the year by:— (a) Local Authority 114 (b) Other Local Authorities — (c) Other bodies or persons 204 With State assistance (included in above totals):- (a) Local Authority 114 (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 1,334 3,754 (2) Number of dwelling-houses reported 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 58 (3) 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 438 (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 398 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 1 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners 1 (b) By Local Authority in default of owner — 15 B.—Proceedings under Public Health Act, 1936:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 91 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 80 (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 1 (2) Number of houses at which drains were cleared after service of formal notices: (a) By owners — (b) By Local Authority in default of owners 1 D.—Proceedings under Clean Air Act, 1956:— Number of dwelling houses in respect of which notices were served requiring owners to comply with the provisions of the Act 3 HOUSE PURCHASE AND HOUSING ACT, 1959 This Act which came into operation on 14th June, 1959, made provision for house owners and certain leaseholders to claim, as a right, half the cost up to a maximum of £155 of installing five basic improvements:—a bath or shower, a wash-hand basin, a water closet, a hot water system and a food store. To qualify for a standard grant, a house must, after improvement, be provided with all five standard amenities and they must be for the exclusive use of the occupants. If a house is already provided with some of the standard amenities, a grant can be claimed towards the cost of installing the remainder. The popularity of this Act is evinced from the increased number of visits made by the inspectorial staff, 2,232 against 1,366 for the previous year, for in addition, there is the existing Discretionary Grant Scheme where grants are payable for a wider range and more extensive forms of improvements including the conversion or adaptation of larger houses and other buildings. 16 Commencing with a preliminary inspection to determine the fitness of the property and its suitability for a grant, it is necessary , upon the Council agreeing to make a grant, to make several subsequent visits to ensure that the conditions of the Grant Scheme are being observed. RENT ACT 1957 No. of applications received for Certificates of Disrepair 24 No. of undertakings received from landlords 22 No. of Certificates of Disrepair issued 5 No. of applications for cancellation of Certificates of Disrepair received from landlords 12 No. of objections to cancellations received from tenants 6 No. of Certificates of Disrepair cancelled 8 No. of Certificates as to Remedying of Defects which the Landlord has Undertaken to Remedy: Issued to tenants 1 Issued to landlords 13 THE SLAUGHTERHOUSES ACT, 1958. THE SLAUGHTERHOUSES (HYGIENE) REGS., 1958. THE SLAUGHTER OF ANIMALS (PREVENTION OF CRUELTY) REGS. 1958. THE SLAUGHTERHOUSE REPORTS (APPOINTED DAY) ORDER, 1959. Last year I referred to the Slaughterhouses Act and Regulations which dealt with construction standards for slaughterhouses 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. During the year under review, the Council submitted to the Minister the required Slaughterhouse Report on the existing and probable future requirements of the district and the facilities which are available to meet these requirements. There is only one slaughterhouse in the Borough and action was undertaken to ensure that it complied with the requirements of the Regulations and that the "Appointed Day" could be fixed by the Minister. In the meantime the owners have submitted proposals for enlarging the slaughterhouse but the Council favour the re-location of the slaughterhouse. PUBLIC HEALTH (MEAT) REGULATIONS, 1924 to 1952 Total number of carcases examined:— Cows 111 Bullocks 727 17 Heifers 463 Calves 88 Swine 7,546 Sheep 14,780 Lambs 3,513 Goats 4 Total 27,232 Whole carcases, parts or organs found to be diseased 2,431 Weight of do. 7 tons 12 cwts. 1 qtr. 24 lbs. Carcases and Offal inspected and condemned in whole or in part Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 1190 111 88 18,293 7,546 4 Number inspected 1190 111 88 18,293 7,546 4 All diseases except Tuberculosis and Cysticerci (a) Whole carcases condemned 7 4 1 101 4 (b) Part or organ condemned 244 — 1 1,450 571 — Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 21.15 3.6 2.3 8.48 7.62 - Tuberculosis only: (a) Whole carcases condemned — — — — — — (b) Part or organ condemned — — — — 48 — Percentage of the number inspected affected with tuberculosis — — — — 0.63 — Cysticercosis (a)Carcases of which some part or organ was condemned — — — — — — (b) Carcases submitted to treatment by refrigeration — — — — — — (c) Generalised and totally condemned — — — — — — 18 THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1960 The following Licences were in operation at the end of the year: Grade. Dealers. Supplementary. Raw Milk: Tuberculin Tested 19 10 Pasteurised Milk 23 10 Sterilised Milk 81 12 Totals: 123 32 MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 There is 1 dairy in the District which is registered under the above Regulations. 3 additional persons were registered as distributors of milk during 1960. 11 inspections were made at the dairy and the premises used by distributors. FOOD AND DRUGS ACT, 1955. There are 302 Ice Cream retail premises and 189 Food Preparing premises registered under Section 16 of the Food and Drugs Act, 1955. 28 samples of ice cream were taken of which 25 were Grade I, 2 Grade II and 1 Grade IV. Examination of Foods Number of inspections made of retail shops, stalls and food-preparing premises, etc. 1,836 19 Number and weight of articles, etc., of foodstuffs condemned as unfit for food:— Articles Foodstuffs Weight—lbs. 1,364 Fruits 1,642 490 Vegetables 383 9 Fish (Fresh) 186 136 Fish (Tinned) 87 627 Meats (Tinned) 2,111 2,472 Meat (Fresh) 17,205 127 Bacon 1,515 150 Soups 127 86 Beans 61 11 Shellfish 4 42 Rice 48 32 Macaroni and Spaghetti 40 13 Jams 19 83 Fats 56 142 Cream and Milk 170 36 Currants and Sultanas 68 7 Sugar 4 7 Suet 3 5,834 23,729 Total No. of articles, etc., condemned 5,834 No. of Certificates of condemnation issued 1,037 Total weight of foodstuffs condemned as unfit for human consumption:— 10 tons 11 cwts. 3 qrs. 13 lbs. Method of Disposal of Condemned foods All unfit foodstuffs were destroyed in the Council's Refuse Destructor furnaces. THE FOOD HYGIENE (GENERAL) REGULATIONS, 1960. These Regulations revoked the Food Hygiene Regulations, 1955-1957, and also Regulations 10, 11 and 12 of the Food and Drugs (Whalemeat) Regulations, 1949. 20 1,383 visits were made to food premises of all types during the year. Although this number of visits is below that of previous years, due to the Department's energies having been directed to other fields, resulting from new legislation, the continued importance of food hygiene has not been overlooked. The principal requirements of the Food Hygiene Regulations were effected during previous years, but further improvements above the minimum, continued to be successfully encouraged. Two completely new factory canteens were erected during the year. In two public houses additional sanitary accommodation was provided including, in each case, suitable hand-washing facilities for the use of customers, and plans advanced on the same lines respecting two others. Improvements of a general character were carried out in 49 food premises. The planned improvement of conditions at the only private Slaughterhouse in the Borough continued throughout the year. No entirely open fronted fish shop now remains, although in one case protection is afforded only by baffle screening of the display bed. Protection by refrigeration of food on display continued most encouragingly. A grocer was prosecuted under Section 8 of the Food and Drugs Act, 1955, for selling a mouldy, cream filled, Swiss roll, and was fined £25 with £2 2s. 0d. costs. A baker was prosecuted under Section 2 of the Act for selling a bun containing a piece of string and was fined £3 with £2 2s. 0d. costs. Amongst the many complaints investigated were those about food and drink containing articles such as wire, hair-pin, glass, cement, string, hair, insects, maggots and mould, and also complaints about discolouration and abnormal smells. 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 1960:— Article. Total samples procured. Unsatisfactory. Milk (various) 98 1 Milk (new) 103 23 Butter and Margarine 23 — Cakes and Biscuits 11 — Cheese 8 - Meat, Meat Products and Liver 78 - Cream 10 2 Drugs 13 — Fish and Fish Products 24 — Sweets 7 — Ice cream and Lollies 9 — Fruit—Fresh and Canned, etc. 8 — Vinegar and Non-brewed Condiments 21 Miscellaneous 27 — Totals: 440 26 With regard to the samples noted on the list as being unsatisfactory, the following comments are made. Milk. 23 samples of milk were found to be slightly deficient in butter fat and solids-not-fat. Each of these samples was drawn from churns forming a part of large consignments of milk to dairies. The average quality of the whole consignment was satisfactory in each case, and follow-up samples showed an improvement in quality. A bottle of school milk was found to contain glass splinters. Legal proceedings were instituted against the dairy concerned, and a fine of £15 was imposed and an order for costs of £5 5s. Od. was made. Cream. A purchase of a carton of cream by a resident of the Borough was found to contain a barbiturate tablet. The cream was not contaminated by the tablet, because such tablets are not readily soluble in a fatty substance such as cream. Extensive investigations showed that it was difficult to prove that the tablet was in the carton of cream at the time of sale, and an official caution was issued. 22 A sample of thick cream purchased within the Borough was found to be deficient in the milk fat. An official caution was issued to the retailing company who had accidentally labelled ordinary cream as "Thick Cream." Merchandise Marks Acts, 1887-1953. The majority of 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 are complied with. These Orders apply to the marking of the country of origin of imported food-stuffs, principally meat, apples, tomatoes, currants, raisins, sultanas, bacon, ham, poultry, butter and honey, upon sale and exposure for sale. Inspections were made at 244 premises of 955 displays of these foodstuffs. Any minor infringements detected were dealt with by verbal warnings. A butchery company was fined a total of £78 and ordered to pay £3 3s. Od. costs on a total of 13 summonses for falsely describing the country of origin of meat. A butchery manager for another company was fined £15 and ordered to pay £3 3s. Od. costs for removing the brand marks on meat indicating the country of origin of the meat. Labelling of Food Order, 1953. This Order requires prepacked food to be marked with the name and address or with the registered trademark of the packer or labeller. It also requires such food to be labelled with its common or usual name (if any) and in the case of a compounded food with the names of the ingredients in descending order of proportion by weight. 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 733 articles of prepacked food was examined at 197 different premises to ascertain whether there was compliance with the above resgulations. No serious infringements were disclosed. False and Misleading Descriptions. Food advertisements and labels have been scrutinised for false and misleading statements and descriptions. No serious infringements were disclosed. Corrective action taken within the whole area of the County has equal effect within the Boroughs, and work under this heading is combined with inspections made under the Merchandise Marks Acts and the Labelling of Food Order. Examples where corrective action was sought are: Oranges, tangerines and grapefruit described as "seedless " but found to contain seeds. Cream doughnuts and jam cream sponge found to contain imitation cream. Television and press advertisements which falsely suggested that a cheese was a cream cheese. 23 Special Designated Milk. During 1960 there was issued one Dealer's (Pasteuriser's) Licence and one Dealer's (Steriliser's) Licence in respect of premises within the Borough where milk is processed. These premises were regularly inspected and compliance with statutory requirements was well maintained. A total of 64 samples of designated milk was taken, none of which failed to obtain a satisfactory certificate. Safe Milk. In addition to the foregoing, 28 samples of raw milk were procured in 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 64 Grocers and Provision Merchants 172 Butchers 67 Greengrocers 83 Fishmongers 25 Bakehouses 22 Bakers and Confectioners 38 Milkshops and Dairies 96 Ice Cream Retailers 301 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 3 Hawkers and 3 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 85 51 24 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES AND SCHOOLS 1959. 1960. Number of children notified by Head Teachers to be absent from School due to:— (a) Infectious Disease or suspected tious Disease 365 278 (b) Contact with Infectious Disease 6 5 Number of School children notified by General Practitioners as suffering from Infectious Disease 497 280 NOTIFIABLE DISEASES DURING THE YEARS 1959 AND 1960. 1959 1960 No. Treated io Hospital Deaths No. Treated in Hospital Deaths. Smallpox — - - - - - Cholera—Plague - - - - - - Diphtheria (inc. Membranous Croup) - - - - - - Diphtheria Carriers - - - - - - Erysipelas 13 3 — 8 1 — Scarlet Fever 98 40 — 63 22 — Typhus Fever — — — — - - Typhoid Fever — — — — — — Paratyphoid Fever — — — 1 — — Relapsing Fever — — — — — — Continued Fever - - - - - - Puerperal Pyrexia 10 7 — 4 4 — Meningococcal Infection — — — 1 1 — Poliomyelitis (Paralytic and Non-Paralytic) - - - - - - Acute-Encephalitis - - — — - — Ophthalmia Neonatorum 1 - - - - - Respiratory Tuberculosis: New cases 33 12 5 18 3 5 Inward Transfers, etc. 44 — — 18 - - Other forms of Tuberculosis: New cases 1 — 1 4 — 1 Inward Transfers, etc. 3 — — 1 — - Food Poisoning 5 2 — 11 — — Malaria — — — — — — Pneumonia 51 2 36 27 3 40 Dysentery 38 — — 171 6 — Measles 853 4 — 146 4 — Whooping Cough 64 5 — 154 5 — Totals 1214 75 42 627 49 46 25 HOSPITAL FOR INFECTIOUS DISEASES During the year, the following cases were admitted from Enfield to South Lodge Hospital. Dysentery 6 Measles 1 Scarlet Fever 22 Whooping Cough 5 Gastro-enteritis 11 Upper Respiratory Infection 1 Pneumonia 3 Erysipelas 1 Quinsy 1 Mumps 3 Tuberculosis 2 Chickenpox 3 Others 15 74 DIPHTHERIA For the twelfth year in succession no case of Diphtheria occurred in the Borough. DIPHTHERIA IMMUNISATION 1,936 children were immunised for the first time and 3,067 received reinforcing doses during the year. WHOOPING COUGH IMMUNISATION 1,710 children were immunised against Whooping Cough for the first time during the year, and 376 received re-inforcing doses. POLIOMYELITIS VACCINATION During the year, 9,860 people completed a course of three injections, and 5,888 received two injections. TETANUS IMMUNISATION 991 children were immunised against Tetanus and 318 received a reinforcing dose. 26 SMALLPOX VACCINATION 855 persons received primary vaccination and 152 tion. POLIOMYELITIS AND ACUTE ENCEPHALITIS. No cases of Poliomyelitis or Acute Encephalitis occurred during the year. FOOD POISONING Of the 11 cases of food poisoning which were notified during the year, all were single cases, 10 being due to Salmonella Organisms and 1 due to CI. Welchi. SONNE DYSENTERY The incidence of mild dysentery due to Shigella Sonnei showed an increase on last year's figure, with 171 cases as against 38 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 - - 1 - - - - - 5 to 10 - - - - - - - - 10 to 15 — 1 - - - - - - 15 to 20 — 1 - - - - - - 20 to 25 — 1 — 1 — — — — 25 to 35 1 1 — — 1 1 — — 35 to 45 2 1 - - - - - - 45 to 55 3 — 1 — 2 1 — — 55 to 65 2 — — — — — — — 65 and upwards 4 1 — 1 — — — 1 Totals 12 6 2 2 3 2 — 1 27 No. of cases transferred into the District from other areas: Respiratory 18 Other Forms 1 19 No. of cases restored to Register during the year:— Respiratory — Other Forms — 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. Tuberculosis Case-rate. Tuberculosis Death-rate. Respiratory Other Forms Respiratory Other Forms Respiratory Other Forms Bush Hill Park 10,655 1 - 0.09 — 0.09 Cambridge Road 10,753 2 — 0.18 — — — Chase 7,659 1 — 0.13 — — — Enfield Wash 12,635 1 1 0 07 0.07 — — Green Street 10,720 2 — 0.18 — 0.18 — Ordnance 13,587 — 2 — 0.14 0.07 — Ponders End 9,973 7 — 0.70 — — 0.01 The Town 11,200 2 1 0.17 0.08 0.17 — West 12,398 1 — 0.08 — — — Willow 10,660 1 — 0.09 — — — Total 110,240 18 4 0.12 0.02 0.05 0.00 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. The following table sets out the record of examinations carried out and the results. Throat and Nose Swabs. Diphtheria Bacilli — Haemolytic Streptococci 31 Vincent's Angina — Negative 218 249 28 Brought forward 249 Faeces. Shigellae 628 Giardia 5 Salmonella 62 Para-typhoid B 1 Welchii 1 Negative 1736 2433 Sputum. Tubercle Bacillus — Other Organisms 3 Negative 45 48 Other Foods. Milk 8 Meat 4 Meat Pudding 1 Marshmallows 2 Ice cream 28 43 Water. Domestic supplies, etc. 4 Swimming pools, etc. 23 27 Miscellaneous. 236 236 3,036 PREVENTION OF DAMAGE BY PESTS ACT, 1949. During the year a Rodent Investigating Officer and three operators were engaged on control of rat infestation at dwellinghouses and other premises and of the sewers in the 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. 29 1,432 premises were inspected during the year for rat and mice infestation, and of these 425 were found to be affected. The total number of treatments carried out by the Department including domestic, business and factory premises, was 425. During the year the Public Health Inspectors and Rodent Investigating Staff made 4,782 visits concerning rat infestation. During the year the treatment of sewers by Sodium Fluoracetate in damp coarse Oatmeal has continued, three treatments involving 351 manholes being carried out. DISINFESTATION Number of Council Houses suspected to be infested 12 Number of Council houses disinfested as precautionary measure 12 Number of other houses suspected to be infested 15 Number of other houses disinfested as precautionary measure 23 Number of articles of clothing, bedding, etc., disinfested 181 Householders are urged to seek the assistance of the Health Department immediately they suspect the presence of bugs or similar pests. PUBLIC HEALTH INSPECTORS' INSPECTIONS AND VISITS The following report, in condensed form, gives details of the work of the Public Health Inspectors during the year 1960. The total number of inspections and visits made during the year for all purposes was 21,255. Inspections of Premises:— No. of Inspections Public Health Act, 1936 3,096 Housing Acts, 1936 and 1957 658 Rent Act, 1957 206 Infectious Disease 254 Complaint by tenants of insanitary conditions 1,114 Vermin 294 Agriculture (Safety Health and Welfare Provisions) Act, 1956 61 C/fwd 5,683 30  No. of Inspections B/fwd 5,683 Rag Flock and Other Filling Materials Act, 1951 1 Pet Animals Act, 1951 9 Public Conveniences 31 Schools 27 School Canteens 24 Cinemas, Halls, etc. 70 Fair-grounds 4 Hairdressers 22 Milkshops and Dairies 11 Food Premises 1,127 Food Hawkers' Stands 44 Food Hawkers (Storage) 7 Bakehouses 26 Ice-Cream Shops 71 Public-houses 97 Outworkers' Premises 7 actories 229 Smoke Observations 285 Clean Air Act, 1956 5,672 Slaughterhouse 59 Visits:— Infectious Diseases 135 Dysentery 1,107 Food Poisoning 72 Housing Act, 1936 (Sec. 62)—Permitted Numbers 4 Overcrowding 12 Slaughterhouse 762 Shops Act, 1950 12 Improvement Grants 2,232 Food Inspections 296 Moveable Dwellings 428 Rats 531 Mice 11 Piggeries 84 Stables 4 Well and Main Water Supplies 36 Swimming Pools 7 Paddling Pools in Parks 16 Atmospheric Pollution 70 Cesspools 17 Noise nuisance 65 Food offences 72 Other Visits 1,776 21,255 31 Visits by Rodent Dept. Staff:— Rats 4,240 Wasps, Beetles, etc. 365 4,605 Samples taken—Water—Wells 1 Mains 3 Swimming Baths 7 Parks, Lakes, etc. 16 Ice-Cream 28 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. 246 Roofs repaired 168 Gutters and downpipes repaired 82 Dampness remedied 128 Floors repaired 31 Yards paved or made good 15 Dustbins provided or renewed 38 Improvements effected in food storage facilities 49 Drains—Examined 632 Cleared by Health Dept. 161 Tested—Smoke 43 Water 32 Repaired, etc. 84 Vents repaired 9 Sink wastes repaired 16 New sinks provided 5 Water-closets—New ones provided 6 New pans provided 7 Apparatus repaired or renewed 35 Water—Water laid on or restored 5 Cisterns cleansed, covered, etc. 4 Other nuisances abated—Stoves, etc., repaired or renewed 24 Windows repaired or renewed 81 Doors repaired 30 Caravans removed 59 Ditches cleared 1 Miscellaneous 84 32 NOTICES ISSUED Public Health Act : Statutory (Insanitary Conditions) 91 Do. Informal ( Do. ) 437 Do. Infectious Diseases 535 Housing Act : Formal (Insanitary Conditions) 1 Food and Drugs Act and Informal 53 Food Hygiene Regulations. Clean Air Act: Formal 3 1,120 Number of Requisitions for Information dealt with 2,477 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 99 398 Number outstanding 44 292 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 56 Number of articles of clothing, bedding, etc., disinfected 908 Number of Library books disinfected 155 Number of articles of clothing, bedding, etc., destroyed 53 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. There are four premises in Enfield which are registered under this Act. 33 NOISE ABATEMENT ACT, 1960 This Act which came into operation on the 27th November, 1960, makes noise or vibration which would amount to a nuisance at common law a statutory nuisance which can be dealt with according to the procedure provided in part III of the Public Health Act, 1936. It also deals with the use of loudspeakers in streets. The Act does not apply to noise or vibration caused by aircraft nor to noise or vibration caused by statutory undertakers in the exercise of their powers. The Act has not been in operation long enough to assess its value. CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 This Act, which came into operation during the latter half of the year, makes further provision for the licensing and control of caravan sites, and authorises local authorities to provide and operate caravan sites. The Ministry of Housing and Local Government also issued Model Standards under section 5 of the Act. In view of the difficulties experienced in the district with regard to caravan dwellers it is hoped that this new legislation will give effective powers for controlling caravan sites. 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 five premises previously licensed by the local authority were re-licensed. THE HEATING APPLIANCES (FIREGUARDS) ACT, 1952. THE HEATING APPLIANCES (FIREGUARDS) REGULATIONS, 1953. The above legislation requires 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. Each of the Public Health Inspectors is a duly appointed officer under the Act. 34 FACTORIES ACTS, 1937 TO 1959 A register is kept of all the factories in the Borough, and during the year 229 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 9 34 1 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 354 195 11 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 13 - - - Total 376 229 12 — 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) 2 3 - 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 1 2 - 1 - (b) Unsuitable or defective 8 15 - 2 - (c) Not separate for sexes - - - - - Other offences (not including offences relating to Outwork) 1 — — - — Total 14 22 — 4 — 35 OUTWORKERS Sixty one lists containing the names and addresses of 840 outworkers were received during the year. 133 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. 235 - - Cardboard Boxes, etc. 83 — - Carding of Buttons, etc. 2 — - Artificial Flowers 14 — - Brush Making and Artist's Materials 47 - - Electrical Cables, etc. 426 — - Christmas Crackers, etc. 7 — - Stuffed Toys, Games and Toys 11 — - Druggist's Sundries 2 — - Brass Articles 12 — - Jewellery 1 — - Total 840 — - HAIRDRESSERS' AND BARBERS' PREMISES. Byelaws were made in 1937 for the purpose of securing the cleanliness of any premises used for 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 70 OFFENSIVE TRADES During the year the Council by Order declared a business in Enfield dealing with butchers' waste to be an offensive trade. The Order has been submitted to the Minister of Housing and Local Government and is awaiting confirmation. 36 ATMOSPHERIC POLLUTION CLEAN AIR ACT, 1956 The provisions of the above Act include those relating to the prohibition of dark smoke from chimneys, measures for dealing with grit and dust from furnaces, abatement of smoke nuisance and the application of the Act to railway engines, vessels and Crown premises. The first Enfield Smoke Control Area, which included the Haddon Estate, has now been in operation for more than a year, and the second Area has now been confirmed by the Minister of Housing and Local Government, who has decided that November 1st, 1961, shall be the date upon which the Order becomes effective. The second Area, which comprises 2,733 dwelling houses and 98 other premises, completely surrounds the first Area. It is the Council's intention to make the entire Borough a Smoke Control Area by 1973 and a programme has been prepared up to 1963. Preliminary surveys are now being made in respect of proposed Smoke Control Areas 3 and 4. Area No. 3 is to the South of Carterhatch Lane extending to Southbury Road from Hertford Road in the East to the New River on the West. Area No. 4 includes that part of the Borough, West of a line extending from the Northern boundary, down Bulls Cross and Forty Hill to Clay Hill; along Clay Hill and Strayfield Road, across the footpath by Rectory Farm to The Ridgeway; along The Ridgeway to the top of Windmill Hill; down Slades Hill and Enfield Road to the boundary. In carrying out the Smoke Control programme, a considerable amount of work is involved on the part of both the inspectorial and administrative staff. After the initial survey, the proposals of the householder in adapting and converting appliances must be approved by the Health Department, and after completion the work must be inspected and claims investigated before the grant is finally paid. With regard to the measurement of atmospheric pollution, analyses of deposit gauges and lead peroxide instruments at four sites in the Borough were continued. Numerous complaints were received about a "fishy" smell in the Brimsdown area and intensive and extensive investigations were made. It is hoped that action taken by a factory management will eliminate this source of complaint. 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.