AC 439(1) library ENF 48 Borough Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1964 Borough Council of Enfield ANNUAL REPORT OF THE Medical Officer of Health (WILLIAM D. HYDE, M.B., Ch.B., D.P.H.) FOR 1964 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1964. To the Mayor, Aldermen and Councillors of the Borough of Enfield. I have pleasure in presenting my Annual Report for 1964. This is my last Report for the Borough which on 1st April, 1965, will become, with the Boroughs of Edmonton and Southgate, a constituent part of the London Borough of Enfield. As in previous years, the work of the Department has been directed mainly towards the control of infectious disease, the provision and maintenance of fit dwellings, sound drainage, pure and wholesome food and water, clean air and freedom from excessive noise. With regard to the Vital Statistics of the Borough, the Birth Rate is 16.66, compared with 14.73 last year. This year's figure is in fact the highest since that of 17.57 in 1948. The Death Rate is 10.02 compared with 10.73 last year, and is the lowest since that of 9.66 in 1952. The Infant Mortality Rate of 14.30 shows a considerable decrease from last year's figure of 20.44 and is the second lowest ever recorded, the exceptionally low figure of 10.26 being recorded in 1957. I am again pleased to report no Maternal Death during the year. With regard to Infectious Diseases there is a considerable reduction in the number of notifications, mainly due to a marked decrease in the number of cases of measles. Comments on the various aspects of the work of the Department are contained in the text of this Report and I regret that circumstances this year preclude any comprehensive exposition on the health of the district but I think, in this final report, a rapid comparative glance at the statistics at the beginning of the century and the present time might be interesting. From a population in 1900 of 43,394 the Borough has increased to 109,060 in 1964. The Birth Rate has fallen from 27.00 to 16.66, the Death Rate has fallen from 13.7 to 10.02, and the Infant Mortality Rate has made the remarkable reduction from 145.0 to 14.3. 4 In 1900 there were 52 cases of Enteric Fever, with 11 deaths, 107 cases of Diphtheria with 25 deaths, and 192 cases of Scarlet Fever with 4 deaths, whereas in 1964, there were no cases of Enteric Fever nor Diphtheria and only 37 cases of Scarlet Fever with no death. Undoubtedly, great progress has been made in Public Health over the years but much work remains to be done, and the Health Department of the new London Borough of Enfield, with responsibility for Environmental Health, Personal Health, and School Health Services, will enter an era of great responsibility and opportunity. In conclusion I would like to express my appreciation of the service of the Staff of the Health Department during a particularly difficult year. William D. Hyde, Medical Officer of Health. 5 BOROUGH OF ENFIELD Alderman E. L. Mackenzie, J.P. Mayor Councillor H. E. Latty Deputy Mayor Aldermen: W. G. Bowyer, Esq. F. C. Cunneen, Esq. D. R. J. Boxall, Esq., J.P. E. T. Hendrick, Esq. A. H. Chambers, Esq. Mrs. G. M. Jay, J.P. Miss C. E. Clough E. L. Mackenzie, Esq., J.P. W. H. Cook, Esq. E. J. Rayment, Esq. Councillors: J. A. Barkus, Esq. E. P. Lomer, Esq. A. D. Bates, Esq. A. M. MacLeod, Esq. J. R. Bentley, Esq. L. C. Merrion, Esq. C. Brown, Esq. F. L. Mezen, Esq. V. H. Clements, Esq. T. F. Millman, Esq. A. J. Cooper, Esq. E. J. C. O'Connor, Esq. J. J. Cusack, Esq. R. F. Skinner, Esq. A. P. Daines, Esq. Mrs. G. E. Stanford. G. D. Game, Esq. E. S. Stock, Esq. T. E. Graham, Esq. P. A. Thomas, Esq. B. G. Grayston, Esq. F. B. Varney, Esq. R. E. Humphrey, Esq. Mrs. F. E. Watson Mrs. R. E. Jones W. J. Watson, Esq. H. E. Latty, Esq. A. J. Young, Esq. E. E. Leesmith, Esq. HEALTH COMMITTEE Alderman Mrs. G. M. Jay, J.P. Chairman Councillor P. A. Thomas Vice-Chairman also Aldermen Miss Clough, Cook and Rayment Councillors Game, Humphrey, Merrion, Skinner, Stock, Varney and Mrs. F. E. Watson. 6 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. Senior Public Health Inspectors: Mr. D. C. Turner (resigned 31.1.64), Mr. G. E. A. Laney, Mr. R. E. Williams (appointed 1.3.64). District Public Health Inspectors and Inspectors of Meat and Foods: Mr. E. A. C. Kottman (resigned 12.7.64), Mr. A. J. Hattersley, Mr. R. E. Williams, Mr. W. C. Crossley. Technical Assistant : Mr. A. D. Barker (appointed 29.6.64). Student Public Health Inspectors: Mr. J. R. Jones (resigned 31.8.64), Mr. B. T. Barnett (appointed 13.4.64). Chief Clerk: Mr. S. N. Dance. Senior Clerk: Mr. D. C. Wakefield (resigned 10.5.64), Mr. S. J. Law (appointed 15.6.64). General Clerks: Mrs. V. M. Randall, Miss J. Cowlard, Miss D. A. Harding (resigned 10.3.64), Miss B. J. Haynes (appointed 16.3.64). Shorthand-Typist: Mrs. M. Houston (resigned 21.7.64)., Miss C. Walker (appointed 24/8/64, resigned 20/12/64). STATISTICS AND SOCIAL CONDITIONS OF THE AREA POPULATION The population as estimated by the Registrar General is 109,060. The number of inhabited houses at the end of 1964, according to the Rate Books, was 34,529. Explanatory Note: Definition of "Houses"—Structurally separate dwellings including flats. The rateable value of the Borough is £7,526,729 The net product (after allowing for cost of collection) of a penny rate is (Estimated) £30,000 AREA Area (in acres) 12,401 NEW HOUSES The number of houses erected during the course of the year was 621. 7 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total. Male. Female. Legitimate 1,725 866 859 Illegitimate 93 43 50 Birth-rate—16.66 per 1,000 population. Percentage illegitimate live births—5.11. Still Births:— Total. Male. Female. Legitimate 20 14 6 Illegitimate 4 2 2 Still birth-rate—13.02 per 1,000 total births. Deaths:— Total. Male. Female. 1,093 577 516 Death-rate—10.02 per 1,000 population. Maternal Deaths:— Number of women dying in, or in consequence of, childbirth (including abortion) or pregnancy: From Puerperal sepsis — From other puerperal causes — Total — Infant Deaths:— Number of deaths of infants under the age of one year—26. Infant Mortality Rate—14.30 per 1,000 live births. Legitimate Infant Mortality Rate—14.49 per 1,000 legitimate live births. Illegitimate Infant Mortality Rate—10.75 per 1,000 illegitimate live births. Neo-Natal Deaths:— Number of deaths of infants under the age of four weeks—21. Neo-Natal Mortality Rate—11.55 per 1,000 live births. Early Neo-Natal Deaths:— Number of deaths of infants under the age of one week—18. Early Neo-Natal Mortality Rate—9.90 per 1,000 live births. Perinatal Deaths:— Number of deaths of infants under one week of age, plus still-births—42. Perinatal Mortality Rate—22.80 per 1,000 total live and stillbirths. 8 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 1.02 and Deaths 1.07. BIRTH, DEATH AND INFANT MORTALITY RATES. Comparison of National and Local Rates. Birth-rate. Death-rate. Infant Mortality rate Live Still England and Wales 18 4 16 3 11.3 20.0 ENFIELD (Standardised) 16.99 13.28 10.72 14.30 DEATHS The number of deaths assigned to Enfield for 1964 was 1,093, 83 less than for last year. The more prevalent causes of death during the last two years were:— Cause of Death 1963 1964 All Ages:— Diseases of Heart 418 357 Cancer of Lungs and Bronchus 57 60 Other Malignant Disease (Cancer) 171 171 Vascular Lesions of Nervous System 128 143 Bronchitis 74 63 Other Diseases of Circulatory System 62 73 Pneumonia 55 38 Children Under 1 Year:— Premature Birth 8 12 Congenital defects 4 7 Bronchitis and Broncho-pneumonia 10 2 9 Three hundred and sixty-nine deaths registered were of Enfield persons aged 80 years or more, one hundred and thirty-three being males and two hundred and thirty-six females. Ten females were aged 95 years or more. It will be seen that 33.76 per cent, of the total deaths were of persons aged over 80 years of age. TABLE I. Causes of Death during Year 1964. Causes of Death. Males. Females. Total. Tuberculosis of Respiratory System 5 1 6 Other Forms of Tuberculosis — — — Syphilitic diseases 1 — 1 Diphtheria — — — Whooping Cough — — — Meningococcal infections — — — Ac. Polio-myelitis — — — Measles — — — Other infective and parasitic diseases 1 — 1 Malignant Neoplasm of stomach 17 15 32 Malignant Neoplasm, lung, bronchus 55 5 60 Do. of breast — 17 17 Malignant Neoplasm, uterus — 3 3 Other Malignant and Lymphatic Neoplasms 66 53 119 Leukaemia, aleukaemia 5 3 8 Diabetes 1 9 10 Vascular lesions of nervous system 47 96 143 Coronary disease, angina 153 76 229 Hypertension with heart disease 4 13 17 Other Heart disease 33 78 111 Other Circulatory disease 32 41 73 Influenza — — — Pneumonia 23 15 38 Bronchitis 48 15 63 Other diseases of Respiratory system 4 1 5 Ulcer of stomach and duodenum 7 5 12 Gastritis, Enteritis and Diarrhoea 3 8 11 Nephritis and Nephrosis 3 4 7 Hyperplasia of prostate 3 — 3 Pregnancy, Childbirth and Abortion — — — Congenital Malformations 5 2 7 Other defined and ill-defined diseases 39 43 82 Motor Vehicle accidents 9 8 17 All Other accidents 8 2 10 Suicide 5 2 7 Homicide and operations of war — 1 1 Total 577 516 1,093 10 INQUESTS Thirty-five inquests, and two hundred and fifty-three postmortems without inquests, were held during the year. Of these, two hundred and fifty-five deaths were due to natural causes, twenty-three to accidental causes, seven to suicide, one to misadventure, one to manslaughter, and in one case an open verdict was recorded. 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 1 1 1 21 2 1 2 — 26 Uncertified — — — — — — — — — — Pneumonia and Bronchitis — — — — — — — 2 — 2 Congenital defects 4 — — — 4 2 1 — — 7 Prematurity 10 — 1 1 12 — — — — 12 Birth injury 2 1 — — 3 — — — — 3 Atelectasis 2 — — — 2 — — — — 2 Totals. 18 1 1 1 21 2 1 2 — 26 Infant Mortality Rate—14.30 per 1,000 live births. (Number of deaths of infants under the age of one year per 1,000 live births.) Neo-Natal Mortality Rate—11.55 per 1,000 live births. (Number of deaths of infants under the age of four weeks per 1,000 live births.) Early Neo-Natal Mortality Rate—9.90 per 1,000 live births. (Number of deaths of infants under the age of one week per 1,000 live births.) Late Neo-Natal Mortality Rateb—1.65 per 1,000 live births. (Number of deaths of infants over one week but under four weeks of age per 1,000 live births.) Post Neo-Natal Mortality Rate—2.75 per 1,000 live births. (Number of deaths of infants aged four weeks but under one year of age per 1,000 live births.) 11 FATAL ACCIDENTS During the year under review there were five fatal home accidents to Enfield residents, which was an encouraging decrease of 15 on last year's figure. In one case, a boy of fifteen was electrocuted by a live television aerial. The remainder occurred amongst elderly people all of whom were over seventy-five years of age, the precipitating cause of death in three cases being a fall leading to fractured bones followed by lung complications, and the remaining death due to accidental coal gas poisoning. The number of fatal road accidents to Enfield residents was fifteen, a disturbing increase of ten on the previous year's figure. Unfortunately, there were also seven cases of suicide (five male and two female), although this was a reduction of two on the previous year. In each case death was due to coal gas poisoning. Two persons were aged between 23 and 44 years and five between 45 and 61 years. 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 Home. 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. AMBULANCE SERVICE The headquarters of this service which comes under the control of the County Medical Officer, Middlesex County Council, are at Kenton, Middlesex. 12 All telephone calls and enquiries regarding the ambulance service in Enfield are routed through an ambulance control depot which is situated in Edmonton. The Emergency telephone call service can be used for urgent calls. For dealing with emergencies in Enfield, one accident ambulance is kept at Ponders End Fire Station and another at the Ambulance Sick Removal Depot, The Ridgeway, near Chase Farm Hospital. There are also kept at the Sick Removal Depot, a number of ambulances for dealing with more routine duties including the transport of outpatients and sitting cases to hospitals for treatment. 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 61 Assessments without medical examinations 57 (2) Sick Pay Scheme : Medical examinations 52 Assessments without medical examinations 54 (3) Special examinations for fitness to continue employment 19 13 PUBLIC HEALTH ACT, 1961 The purpose of the Act is mainly to amend the provisions of the Public Health Act, 1936, relating to building bye-laws and trade effluents, and also public health matters formerly dealt with under local acts. Part II of the Act deals with building regulations, sewers, drains and sanitary conveniences; buildings and structures; accumulations of rubbish; and filthy or verminous premises and articles. Part III deals with the prevention and notification of infectious disease, and gives powers of medical examination of persons in certain circumstances; makes provision for information to be furnished by the occupier of premises in cases of notifiable disease or food poisoning; provides for the exclusion of children from places of entertainment, etc., with a view to preventing the spread of infectious disease; makes provisions for compensating persons who, on the request of the Medical Officer of Health discontinue work to prevent the spread of notifiable disease; and in connection with the selling to children under the age of fourteen years, by dealers in rags and old clothes, adds any animal, fish, bird or other living thing to "article" as used in the Public Health Act, 1936. Part IV deals with streets and public places. Part V deals with trade effluents. Part VI deals with a miscellaneous number of items, including the power to reduce the numbers of pigeons and other birds in built-up areas, as well as powers to make bye-laws relating to hairdressers and barbers. (Byelaws have been in existence in Enfield since 1937.) HOUSING Number of new houses erected during the year by:— (a) Local Authority 408 (b) Other Local Authorities — (c) Other bodies or persons 213 With State assistance (included in above totals):— (a) Local Authority 408 (b) Other Local Authorities — (c) Other bodies or persons — 1. Inspection of Dwelling-houses:— No. of No. of inspechouses. tions. (1) Total number of dwelling-houses inspected for housing-defects (under Public Health and Housing Acts and Regulations) and number of inspections made 1110 1,843 14 (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 63 (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 304 (The number here given is of houses where any insanitary conditions were found.) 2. Remedying 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 310 3. Action under Statutory Powers. A.—Proceedings under Sections 9, 10, 12, 17 and 78 of the Housing Act, 1957 and Sections 15 and 19 of the Housing Act, 1961:— (1) Number of dwelling-houses in respect of which Notices were served 4 (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 — B.—Proceedings under Public Health Act, 1936:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 85 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 56 (b) By Local Authority in default of owners 27 C.—Proceedings under Clean Air Act, 1956:— (1) Number of dwelling houses in respect of which notices were served requiring owners to comply with the provisions of the Act 83 (2) Complied with by owners 71 15 HOUSING ACT, 1961. One of the most important provisions of this legislation is the power given to local authorities to deal with houses in multiple occupation, and action was taken in this respect during the year. HOUSE PURCHASE AND HOUSING ACT, 1959. This Act deals with financial assistance towards the provision of five basic housing improvements, namely, a bath or shower, a wash-hand basin, a water closet, a hot water system, and a food store. There is also a Discretionary Grant Scheme for a wider range of improvements and conversions. Many inspections are necessary in connection with these provisions, and during the year 920 visits to premises were made by the Inspectorial staff. RENT ACT 1957 No. of applications received for Certificates of Disrepair 10 No. of undertakings received from landlords 6 No. of Certificates of Disrepair issued 3 No. of applications for cancellation of Certificates of Disrepair received from landlords — No. of objections to cancellations received from tenants — No. of Certificates of Disrepair cancelled — No. of Certificates as to Remedying of Defects which the Landlord has Undertaken to Remedy: Issued to tenants — Issued to landlords 4 HOUSING ACT, 1964. The above Act came into operation during the year. Part 1 deals with assistance for Housing Societies providing housing accommodation. Part 2 deals with compulsory improvements of dwellings to provide standard amenities. Part 3 deals with assistance for improvement of dwellings. Part 4 deals with houses in multiple occupation. A survey of the district for the implementation of some of the provisions will be necessary. 16 FOOD AND DRUGS ACT, 1955. There are 320 Ice Cream retail premises and 192 Food Preparing premises registered under Section 16 of the Food and Drugs Act, 1955. 6 samples of ice cream were taken, of which 5 were Grade I, and 1 Grade II. Examination of Foods Number of inspections made of retail shops, stalls and food-preparing premises, etc. 383 Number and weight of articles, etc., of foodstuffs condemned as unfit for food:— Articles Foodstuffs Weight—lbs. 18 Custard 25 1,227 Fruits 1,353 1,263 Vegetables 943 40 Fish (Fresh) 70 194 Fish (Tinned) 101 444 Meats (Tinned) 1,377 21 Meat (Fresh) 260 55 Bacon 474 360 Soups 299 71 Paste 17 141 Baby foods (Tinned) 290 74 Rice 116 96 Macaroni and Spaghetti .. 85 158 Jams 141 1 Fats 1 483 Cream and Milk 320 15 Flour 37 144 Minerals 112 3167 Frozen Foods 970 23 Biscuits and Cakes 17 77 Cocoa, Tea and Coffee 26 180 Pickles, etc. 103 63 Miscellaneous 44 8,315 7,181 Total No. of articles, etc., condemned 8,315 No. of Certificates of condemnation issued 834 Total weight of foodstuffs condemned as unfit for human consumption:— 3 tons 4 cwts.-qrs. 13 lbs. 17 Method of Disposal of Condemned foods All unfit foodstuffs were destroyed in the Council's Refuse Destructor furnaces. THE FOOD HYGIENE (GENERAL) REGULATIONS, 1960. 758 visits were made to food premises of all types during the year. These include school and factory canteens, public houses, bakehouses, ice cream shops and vehicles, hawkers stalls and storage premises. Improvements of a general character were effected in nine instances. Food Stalls at the fairground owned by the Council, which was used on lease twice during the year, were again carefully supervised, some fourteen visits being made for this purpose. Care was again taken to ensure a satisfactory standard of food hygiene by the caterer at the annual Enfield Show in the Town Park. Canteens were provided in two new factories. Many visits were again made in connection with a number of complaints regarding food, and drink, and amongst the complaints investigated were those involving a fly in a cream doughnut, abnormal odour in meat, broken glass in a milk bottle, foreign body in bread, nail in fried fish, dirty milk bottles, lead pencil in fresh minced beef, insects in savoury straws and bread, mouldy sausages, pies, bacon, cakes and bread, cigarette end in kippers, insect in sausage roll, cigarette end in meat pie, decomposing meat, discolouration in tin of corned beef, unsound sausages, maggots on a leg of lamb, maggots in ham, beetle in a bottle of mouthwash, and a beetle in frozen peas. Eight prosecutions were taken during the year under Section 2 of the Food and Drugs Act, 1955, and one for contraventions of the Food Hygiene (General) Regulations, 1960. A firm of bakers was prosecuted for selling a loaf containing string and was fined £10 plus £5 5s. costs, and was also prosecuted for selling a loaf containing a piece of metal and was fined £5 plus £5 5s. costs. A confectioner was prosecuted for selling a chocolate sponge sandwich with stale and mouldy cream filling and was fined £5 plus £5 5s. costs. A delicatessen shop-keeper was prosecuted for selling a mouldy sausage roll but successfully pleaded warranty, but the manufacturer was fined £20 plus £5 5s. costs. Another delicatessen shop-keeper was prosecuted for selling a scotch egg containing rodent excreta and was fined £10 plus £3 3s. legal fees and £6 6s. analyst's fee. 18 A firm of grocers was prosecuted for selling a tin of bone and vegetable broth which was stale and mouldy, and was fined £10 plus £3 3s. costs and £1 fee to witness. A butcher was prosecuted for selling stale and mouldy sausages, and was fined £20 plus £3 costs. An occupier of premises used for food storage and the manufacture of toffee apples was prosecuted for contravention of the Regulations on six counts and was fined £5 on each (total of £30) plus £3 3s. costs. A store was prosecuted for selling a mouldy loaf, and was fined £5 plus £2 2s. costs. FOOD AND DRUGS ACT, 1955 I regret I am unable to give a report on the samples of foods and drugs procured under the above Act by the Food and Drugs Authority, as the Authority is unable to make them available this year. NUMBER AND CLASSES OF FOOD PREMISES IN THE BOROUGH Restaurants and Cafes 58 Grocers and Provision Merchants 169 Butchers 69 Greengrocers 82 Fishmongers 27 Bakehouses 18 Bakers and Confectioners 38 Milkshops and Dairies 96 Ice Cream Retailers 320 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 one Hawker and one Hawker's Premises were registered. The following table shows the number of Hawkers' Premises on the Register 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 94 5 19 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES AND SCHOOLS 1963. 1964. Number of children notified by Head Teachers to be absent from School due to:— (a) Infectious Disease or suspected tious Disease 640 391 (b) Contact with Infectious Disease — — Number of School children notified by General Practitioners as suffering from Infectious Disease 901 276 NOTIFIABLE DISEASES DURING THE YEARS 1963 AND 1964. 1963 1964 No. Treated in Hospital Deaths. No. Treated in Hospital Deaths Smallpox — — — — — — Cholera—Plague — — — — — — Diphtheria (inc. Membranous Croup) — — — — — — Diphtheria Carriers — — — — — — Erysipelas 8 2 — 9 4 — Scarlet Fever 61 8 — 37 17 — Typhus Fever — — — — — — Typhoid Fever — — — — — — Paratyphoid Fever 2 2 — — — — Relapsing Fever — — — — — — Continued Fever — — — — — — Puerperal Pyrexia 24 21 — 35 28 — Meningococcal Infection 1 1 — — — — Poliomyelitis (Paralytic and Non-Paralytic) — — — — — — Acute-Encephalitis — — — — — — Ophthalmia Neonatorum 1 — — — — — Respiratory Tuberculosis: New cases 21 2 4 28 4 6 Inward Transfers, etc. 32 — — 12 — — Other forms of Tuberculosis : New cases 7 4 I 4 2 — Inward Transfers, etc. 1 — — 2 — — Food Poisoning 9 3 — 4 — — Malaria — — — — — — Pneumonia 20 8 55 14 3 38 Dysentery 28 4 — 55 3 — Measles 1663 7 — 484 5 — Whooping Cough 129 6 — 88 5 — Totals 2007 68 60 772 71 44 20 HOSPITAL FOR INFECTIOUS DISEASES During the year, the following cases were admitted from Enfield to South Lodge Hospital. Glandular fever 4 Dysentery 4 Measles 7 Scarlet Fever 9 Gastro-enteritis 12 Upper Respiratory Infection 1 Pneumonia 9 Erysipelas 2 Whooping Cough 10 B.Coli Infection 1 Puerperal pyrexia 1 Infective hepatitis 6 Malaria 1 Mumps 3 Others 18 88 DIPHTHERIA IMMUNISATION 1,853 children were immunised for the first time and 2,673 received reinforcing doses. DIPHTHERIA For the sixteenth year in succession no case of Diphtheria has occurred in the Borough. WHOOPING COUGH IMMUNISATION 1,561 children were immunised for the first time and 1,138 received reinforcing doses. TETANUS IMMUNISATION 1,917 children were immunised for the first time and 1,859 received reinforcing doses. POLIOMYELITIS IMMUNISATION 1,951 children were immunised for the first time and 1,522 received reinforcing doses. 21 POLIOMYELITIS For the sixth year in succession no case of Poliomyelitis has occurred in the Borough. SMALLPOX VACCINATION 955 persons received primary vaccination and 39 re-vaccination. FOOD POISONING Of the four cases of food poisoning which were notified during the year, all were due to Salmonella Organisms. SONNE DYSENTERY The incidence of mild dysentery due to Shigella Sonnei showed an increase on last year's figure, with fifty-five cases as against twenty-eight 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 1 - - - - - - - 10 to 15 — 1 - - - - - - 15 to 20 — 1 - - - - - - 20 to 25 - - - - - - - - 25 to 35 3 1 1 - - - - - 35 to 45 2 3 - 2 — — - — 45 to 55 6 2 1 - - - - - 55 to 65 — 1 — — 2 1 — — 65 and upwards 6 — — — 3 — — — Totals 18 10 2 2 5 1 — — 22 No. of cases transferred into the District from other areas: Respiratory 12 Other Forms 2 14 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 10,535 3 1 0.28 0.09 0.09 - Cambridge Road 10,635 2 1 0.19 0.10 — — Chase 7,541 1 — 0.13 — 0.13 - Enfield Wash 12,515 2 — 0.16 - - Green Street 10,602 1 — 0.09 - - Ordnance 13,469 1 2 0.07 0.14 0.14 - Ponders End 9,858 6 — 0.61 — - - The Town 11,085 4 — 0.35 - - - West 12,280 5 — 0.41 - 0.08 - Willow 10,540 3 — 0.28 — — — Total 109,060 28 4 0.26 0.04 0.04 — 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. Haemolytic Streptococci 33 Vincent's Angina 1 Negative 167 201 23 Brought forward 201 Faeces. Shigellae 268 Giardia 3 Salmonella 34 Negative 1047 1352 Sputum. Tubercle Bacillus 1 Other Organisms 4 Negative 12 17 Foods. Meat 1 Ice cream 6 7 Water. Domestic supplies, etc. 6 Swimming pools, etc. 9 Miscellaneous. 174 15 174 1766 PREVENTION OF DAMAGE BY PESTS ACT, 1949. Two of the rodent operatives carried out sewer treatment by Sodium Fluoracetate in damp coarse oatmeal involving 2,016 manholes. The other two operatives dealt with surface infestations. 1,214 premises were inspected during the year, and of these 506 were found to be infested with rats or mice. The total number of treatments carried out by the Department including domestic, business and factory premises, was 506. 24 During the year the Public Health Inspectors and Rodent Investigating Staff made altogether 2,328 visits concerning rat infestation. 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. INFESTATION WITH INSECTS, ETC. Number of Council Houses found to be infested 4 Number of Council houses disinfested as precautionary measure 6 Number of other houses found to be infested 17 Number of other houses disinfested as precautionary measure 11 Number of articles of clothing, bedding, etc., disinfested 96 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 1964. The total number of inspections and visits made during the year for all purposes was 13,398. No. of Inspections of Premises :— Inspections Public Health Act, 1936 2,463 Housing Acts, 1936, 1957, 1961 and 1964 521 Rent Act, 1957 47 Infectious Disease 159 Complaint by tenants of insanitary conditions 1,467 Vermin 321 Agriculture, (Safety Health and Welfare Provisions) Act, 1956 — Housing Act, 1936 Sec. 62—Permitted Numbers 3 Offices, Shops and Railway Premises Act, 1963 204 Consumer Protection Act, 1961 21 C/fwd 5,206 25 No. of Inspections B/fwd 5,206 Animal Boarding Establishments Act, 1963 8 Pet Animals Act, 1951 6 Public Conveniences 4 Schools 14 School Canteens 8 Cinemas, Halls, etc. 34 Fair-grounds 14 Hairdressers 1 Milkshops and Dairies 1 Food Premises 758 Food Hawkers' Stands 4 Food Hawkers (Storage) 1 Bakehouses 7 Ice-Cream Shops 15 Public-houses 21 Outworkers' Premises 3 Factories 25 Smoke Observations 176 Clean Air Act, 1956 1,286 Visits:— Wasps nests 7 Infectious Diseases 46 Dysentery 615 Food Poisoning 30 Overcrowding 4 Shops Act, 1950 8 Improvement Grants 920 Food Inspections 222 Moveable Dwellings 451 Rats 353 Mice 28 Piggeries 8 Well and Main Water Supplies 48 Swimming Pools and Paddling Pools 17 Atmospheric Pollution 943 Cesspools 12 Noise nuisance 88 Food offences 114 Licensing Act, 1961 and Betting and Gaming Act, 1960 51 Other Visits 1,841 13,398 26 Visits by Rodent Dept. Staff :— Rats and Mice 3,414 Wasps, etc. 189 3,603 Samples taken—Water—Wells and Main Supply 17 Swimming Baths 11 Ice-Cream 6 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. 211 Roofs repaired 107 Gutters and downpipes repaired 70 Dampness remedied 47 Floors repaired 13 Yards paved or made good 6 Dustbins provided or renewed 4 Improvements effected in food premises 9 Drains—Examined 554 Cleared by Health Dept. 181 Tested—Smoke 45 Water 4 Repaired, etc. 40 Sink wastes repaired 7 Water-closets—New pans provided 11 Apparatus repaired or renewed 38 Water—Water laid on or restored 14 Other nuisances abated—Stoves, etc., repaired or renewed 2 Windows repaired or renewed 48 Doors repaired 6 Caravans removed 263 Miscellaneous 40 27 NOTICES ISSUED Public Health Act: Statutory (Insanitary Conditions) 84 Do. Informal ( Do. ) 301 Do. Infectious Diseases 445 Housing Act: Informal 3 Do. Formal 4 Food and Drugs Act and Informal 14 Food Hygiene Regulations. Clean Air Act: Informal 2 Do. Formal 83 Prevention of Damage by Pests Act, 1949 1 937 Number of Requisitions for Information dealt with 3,152 Result of Service of Statutory and Informal Notices:— Statutory. Informal. Number complied with 157 326 Number outstanding 96 247 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 44 Number of articles of clothing, bedding, etc., disinfected 576 Number of Library books disinfected 661 Number of articles of clothing, bedding, etc., destroyed 98 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. There are four premises in Enfield which are registered under this Act. 28 NOISE ABATEMENT ACT, 1960 This Act 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. Several investigations regarding complaints of noise were carried out during the year. CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 This Act makes 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 has also issued Model Standards under section 5 of the Act. ITINERANT CARAVAN DWELLERS For many years one of the department's major problems has been dealing with groups of itinerant caravan dwellers. Many of these persons leave their camping sites in a filthy condition with domestic refuse, unwanted scrap metal, rags, etc., and sometimes human excreta. The camping sites are mainly in the industrial area where there are a number of waste, undeveloped sites and the department's efforts have been directed to securing these sites against trespass, by means of fencing, trenching and earthworks. Considerable success has been achieved in 1964 by both the private owners of the building land at Bilton Way and by the Borough Council in respect of acquired land at Suez/Aden Roads, Jute Lane, Grove Road and Warwick Field. This success is reflected in the reduction of the number of caravans removed from 478 to 263. The problem is now reduced to a small hardcore of caravan dwellers parking for a few days on roadside verges and these are dealt with by Court action. 29 PET ANIMALS ACT, 1951. This Act controls the keeping of pet shops. During the course of the year five premises previously licensed by the local authority were re-licensed. CONSUMER PROTECTION ACT, 1961. THE HEATING APPLIANCES (FIREGUARDS) REGULATIONS, 1953. THE OIL HEATERS REGULATIONS, 1962. THE CHILDREN'S NIGHTDRESSES REGULATIONS, 1964. Under Section One of the Consumer Protection Act, 1961, the Secretary of State may by regulation, impose safety requirements respecting any prescribed class of goods or component parts, and also secure that such goods or component parts are in a prescribed manner, marked with, or accompanied by, any warning or instructions which are considered expedient. Section Two of the Act, prohibits the sale of goods not complying with regulations made under Section One. The Heating Appliances (Fireguards) Act, 1952, was repealed by the Consumer Protection Act, 1961, but Regulations made under the former Act in 1953, remain effective as if made under Section One of the Consumer Protection Act, 1961. These Regulations require 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. The Oil Burners (Standards) Act, 1960, was also repealed by the Consumer Protection Act, 1961, but under the latter Act, the Oil Heaters Regulations 1962, came into operation on 1st June, 1962, and imposed certain requirements regarding oil heaters with a view to preventing, or reducing, risk of death or personal injury. The Regulations relate to warning notices to be borne by heaters; their construction, design and performance generally; tests of risk of fire to walls and floors and for test of resistance to draughts. Provision is also made for tests of goods purchased for the purpose by a local authority, to be carried out at the expense of the local authority by any such person or body as may be authorised by the Secretary of State. 30 The Children's Nightdresses Regulations, 1964, were made with a view to preventing or reducing risk of death or personal injury through ignition of children's nightwear made from flammable material. These regulations impose requirements in relation to children's nightdresses in that subject to certain exceptions no person may sell or have in his possession to sell, a child's nightdress not complying with the regulations. 21 visits were made by the Public Health Inspectors in connection with these regulations. LICENSING ACT, 1961. Under this new legislation, any applications to the licensing justices for licences to retail intoxicating liquor, are first referred to the Borough Council for opinion as to the general suitability including satisfactory siting of the premises, the provision of adequate sanitary accommodation, and compliance with the Food Hygiene Regulations. 26 applications were referred during the year which necessitated 48 visits being made to premises by the Public Health Inspectors. FACTORIES ACT, 1961 A register is kept of all the factories in the Borough, and during the year 18 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 16 4 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 252 14 1 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 20 - - - Total 288 18 1 — 31 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 - - - Overcrowding (S.2) - — - - - Unreasonable temperature (S.3) - 2 - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient - 2 1 1 - (b) Unsuitable or defective 2 1 - 2 - (c) Not separate for sexes - - - - - Other offences (not including offences relating to Outwork) - - - - - Total 2 7 1 3 — OUTWORKERS Forty-two lists containing the names and addresses of 428 outworkers were received during the year. 54 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. 121 - - Cardboard Boxes, etc. 1 - — Carding of Buttons, etc. 24 - — Artificial Flowers 7 - — Electrical Cables, etc. 193 - — Christmas Crackers, etc. 5 - — Stuffed Toys, Games and Toys 11 - — Millinery 2 - — Brass Articles 10 — - Total 374 — — 32 THE OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963. This Act came into operation during the year and made provision for securing the health, safety and welfare of persons employed to work in offices, shops or railway premises. Provisions are included which will ensure cleanliness, prevention of over-crowding, reasonable temperature, ventilation, lighting, sanitary conveniences and accident prevention. These, together with other items will collectively ensure the comfort and well-being of employees in these premises. By the end of December, 708 premises had been registered in Enfield and a survey commenced of such premises in the district. 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 96 OFFENSIVE TRADES. Byelaws with respect to the regulation of the offensive trade of a dealer in butchers' waste were confirmed by the Minister of Housing and Local Government and came into operation on 1st April, 1963. ATMOSPHERIC POLLUTION CLEAN AIR ACT, 1956 Smoke Control Areas. During the year a central area of the Borough was surveyed in preparation for a further Smoke Control Order. This area is bounded on the north by Lancaster Road and Lavender Hill, on the west by The Ridgeway, on the south by Windmill Hill, Church Street and The Town, and on the east by Silver Street and Baker Street. It covers an area of 405 acres and contains 3,267 dwelling houses and 295 commercial and other premises. 33 When this new Order becomes operative a total of 11,835 premises and 8,292 acres of the Borough will be included in Smoke Control Areas. Prior Approval of Furnaces—Section 3. Ten applications for Prior Approval of new furnaces were received during the year. These varied from small central heating boilers to medium sized industrial plant. Of these, eight were oil fired installations, one coal fired by means of an underfeed stoker and one incinerator for the destruction of domestic waste. The latter applicant was advised on an alternative method of refuse disposal and agreed not to proceed with the installation of the incinerator. The other nine applications were all given approval. Advice was given in a number of other instances where new furnaces were being considered. Chimney Heights—Section 10. Approval of plans, where new chimneys were proposed, were sought from fourteen applicants in accordance with Section 10 of the act relating to the minimum height of chimneys. In five instances the proposed height as shown on the plan was deemed to be sufficient. On the basis of fuel consumption, etc., the other nine chimneys planned were of insufficient height and were required to be raised considerably. In one instance a height of 32 feet was proposed against a requisite 60 feet. Another had to be raised to 104 feet from a proposed 71 feet. Offences. There was one successful prosecution for a contravention of the Act relating to business premises situated in a Smoke Control Area. Smoke was seen to be emitted from a chimney on the premises which on investigation was seen to be produced from coal. A fine of £5, and £l, 1s. costs were imposed on the occupier by the magistrates. National Survey of Pollution. Estimations of daily smoke and sulphur dioxide concentrations were continued at the four sites in the Borough throughout the year in connection with the National Investigation of Atmospheric Pollution. This is the third year that these sites have been operative. Station 1. Honilands School (Smoke Control Area). „ 2. Brimsdown Pumping Station (Industrial Area). „ 3. Merryhills School (Residential District with low population density). „ 4. Bush Hill Park Library (Residential District with high population density). 34 The average daily amounts for each month of the year are shown in tables A and B. A. Smoke (microgrammes per cubic metre). Average daily amounts. Station Jan. Feb. March April May June 1. 122 86 45 37 23 23 2. 171 158 198 57 37 40 3. 155 94 44 38 28 24 4. 235 181 109 89 32 29 Station July Aug. Sept. Oct. Nov. Dec. 1. 17 21 31 83 68 112 2. 32 34 59 118 164 268 3. 14 12 23 87 116 196 4. 16 36 35 132 208 324 B. Sulphur dioxide (microgrammes per cubic metre). Average daily amounts. Station Jan. Feb. March April May June 1. 252 183 114 117 74 72 2. 243 258 257 102 44 31 3. 249 186 110 107 84 70 4. 357 293 185 162 92 88 Station July Aug. Sept. Oct. Nov. Dec. 1. 63 61 73 179 143 211 2. 50 104 89 273 265 333 3. 64 49 82 167 142 199 4. 79 73 97 254 195 276 The No. 4. Smoke Control Area (North West Area of the Borough) became operative in December, 1963, but its effect is not revealed in the tables because of its situation in relation to the sites of the measuring apparatus, and also because of the direction of the prevailing wind. 35 C. Smoke/Sulphur dioxide Ratio. Station Jan. Feb. March April May June 1. 0.48 0.47 0.39 0.32 0.31 0.32 2. 0.70 0.61 0.77 0.56 0.84 1.29 3. 0.62 0.51 0.40 0.36 0.33 0.34 4. 0.66 0.62 0.59 0.55 0.35 0.33 Station July Aug. Sept. Oct. Nov. Dec. 1. 0.27 0.34 0.42 0.46 0.47 0.53 2. 0.64 0.32 0.66 0.43 0.62 0.80 3. 0.22 0.24 0.28 0.52 0.81 0.99 4. 0.20 0.49 0.36 0.52 1.06 0.85 D. Annual Averages. Figures for 1963 in parentheses. Station Smoke Sulphur Dioxide Smoke/Sulphur Dioxide ratio. 1 56 (55) 129 (108) 0.40 (0.43) 2 111 (92) 171 (223) 0.69 (0.49) 3 69 (56) 118 (117) 0.47 (0.43) 4 119 (103) 179 (173) 0.55 (0.55) 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 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 examinations for chlorine and alkalinity of the water, which are made several times daily, 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. 36 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. Entield. Middx. 22 JR 2/68