HOR 40 BOROUGH OF HORNSEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR ENDING 31st DECEMBER, 1948 R. P. GARROW, M.D., D.P.H. Medical Officer of Health BOROUGH OF HORNSEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR ENDING 31st DECEMBER, 1948 R. P. GARROW, M.D., D.P.H. Medical Officer of Health Health Committee (as at 31st December, 1948) Chairman: Councillor Miss Anderson The Mayor—Alderman Mrs Cave, J.P. Alderman Bailey Alderman Goulding Alderman Miss McCullough Alderman Shipp Alderman Winkley Councillor Mrs Baxter Councillor Burns Councillor Mrs Clegg Councillor Crosland Councillor Disney Councillor Dunscombe Councillor Hardiman Councillor Kent Councillor Milne Councillor Muldoon Councillor Mrs St. John Councillor Thursby 3 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health and School R. P. Garrow, m.d., d.p.h. Medical Officer Deputy Medical Officer of Health Marion Lones, b.sc., m.b., b.s., and Assistant School Medical m.r.c.S., L.r.c.p., d.p.h., d.o.m.s. Officer Assistant Medical Officer of Health Margaret Robinson, m.b., ch.b., and Assistant School Medical d.t.m., & H. Officer Assistant Medical Officer of Health J. A. Montgomery, m.d. and Assistant School Medical Officer Veterinary Inspector F. G. Buxton, m.r.c.V.S. Senior Sanitary Inspector, Petroleum J. H. Jesse, m.s.i.a., Cert. R. Inspector, Shops Acts San. I., Cert. Insp. of Meat and Inspector Foods. Sanitary Inspectors and Shop Acts J. D. Chance, m.s.i.a., Cert. R. Inspectors San. I., Cert. Insp. of Meat and Foods. E. Hundy, m.s.i.a., Cert. R. San. I., Cert. Insp. of Meat and Foods, Cert. San. Science. R. Downes, m.s.i.a., Cert. R. San. I. J. Calderbank, m.s.i.a., m.r. San. I., Cert. R. San. I. & S.I.E. Joint Board, Cert. Insp. of Meat and Foods. W. J. Wilson, m.s.i.a., Cert. R. San. I., Cert. Insp. of Meat and Foods. S. Swinnerton, m.s.i.a., m.r.s.i., Cert. I. San. I. & S.I.E. Joint Boards, Cert. Insp. of Meat and Foods (appointed 2.5.48). Chief Clerk W. A. Simons (transferred 4.7.48). T. Hadley (promoted 5.7.48). (Resigned 3.10.48). H. Bradford (appointed 19.1.49). Assistant Clerks Miss S. P. Nunn. Miss M. Chesterman. Miss M. Humphreys. Miss M. S. Arnell. Rodent Operator E. Mead. Disinfectors and Mortuary attendants W. H. Lewis. P. F. Hall. P. Martin. Cleansing Station Attendant Mrs. H. J. Caulfield. 4 To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Mr Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report as Medical Officer of Health of the Borough of Hornsey for the year ending December 31st, 1948. An appendix to this report gives information relating to the prevalence of poliomyelitis in this district in 1949 up to September 5th. This is the twentieth and last whole year I have occupied the office of Medical Officer of Health and is in many respects the most remarkable of them all. VITAL STATISTICS It was a year in which the vital statistics were by far the best ever recorded. The birth rate was 17.6 per 1,000 of population; the death rate 10.3; and the infant mortality rate of 17.3 per thousand live births (compared with the previous best in Hornsey of 26.8 in 1947 and 34 for England and Wales in 1948). The infant mortality rate is regarded as the most delicate index of the state of the public health. The figure for 1948 surely makes Hornsey the healthiest town in the world! There were no maternal deaths in the 1,731 births occurring in 1948; and there were no deaths at any age from any of the common infectious diseases. This is the 7th successive year in which no death occurred from diphtheria. Trichotomy of Health Services In the middle of a year which furnished such abundant evidence of the Borough Council's success as a Health Authority it ceased to be a health authority. Its health functions suffered trichotomy—the parts of the dismembered whole being (1) Hospital beds; (2) Personal Health Services; (3) Environmental Health Services. 1. Hospital Beds Lying-in beds to the number of thirty at the Alexandra Maternity Home, Muswell Hill, were provided by Hornsey Borough Council. Beds for infectious diseases (160) were owned jointly at Coppetts Road, Muswell Hill, with the neighbouring districts of Finchley, Wood Green, and Friern Barnet. All of these were transferred with staffs and equipment to the newly formed North West Metropolitan Regional Hospital Board which administers all hospital beds for all purposes in an area stretching from Westminster to the borders of Northamptonshire. This area includes one quarter of London, nine-tenths of Middlesex, half of Hertfordshire, the whole of Bedfordshire, and parts of Berkshire and Buckinghamshire, and carries a population of 4,000,000. 2. "Personal Health Services " The "Personal Health Services" are all services for expectant and nursing mothers, children under 5, and school children. The care of the mothers and some 5,000 children under 5 was formerly the responsibility of the Maternity and Child Welfare Committee 5 of the Borough Council. The School Health Services for some 10,000 children between the ages of 5 and 16 or over in primary, secondary, and special schools were administered by the Hornsey Education Committee. These, together with Clinics, Centres, Day Nurseries, and all staffs and equipment were transferred to Middlesex County Council as the Health Authority. The Maternity & Child Welfare Committee of the Borough Council was sunk without trace on July 5th, 1948. The transferred personal health services are now administered by Area No. 3 (Tottenham and Hornsey) Health Sub-Committee of the County Health Committee. As an illustration of how unnatural all these vast changes are, may be mentioned the fact that the Health Centre at the Hornsey Town Hall comprising a School Clinic and a Maternity & Child Welfare Centre, within 50 yards of the Medical Officer of Health's room in the Town Hall, will shortly be administered from No. 3 Area Headquarters situated in a building 3 miles away which used to be the Tottenham Grammar School! 3. Environmental Health Services These changes put the Borough Council firmly where it was in the nineteenth century—that is, in charge of the sanitary circumstances of its area. As a Sanitary Authority it is responsible for House Repairs, Nuisances, Food Inspection, Atmospheric Pollution, Destruction of Rats and Mice, Control of Infectious Diseases—very important functions which are the day-to-day duties of the Sanitary Inspectors. DICHOTOMY OF MEDICAL OFFICER OF HEALTH The trichotomy of the health services has led to dichotomy of the Medical Officer of Health. I have been split into two portions—the smaller of which, representing 40% of me, remains Medical Officer of Health of the Borough of Hornsey; the larger and, presumably, the more important portion 60%, becomes "Area Medical Officer" for the Hornsey part of Area No. 3 (Tottenham and Hornsey) of the County of Middlesex. In this capacity I am virtually an Assistant M.O.H. to the Middlesex County Medical Officer of Health, responsible to him for the carrying on, in this part of the area, of the personal health services which the Borough Council has gradually built up in the last half century and lost suddenly by a stroke of the legislative pen on July 5th, 1948. This is a position which neither the Borough Council nor its Medical Officer of Health sought or did anything to bring about. The change was imposed on us by the National Health Service Act, 1946. Widespread dissatisfaction and deep resentment are manifest in the current medical journals amongst many medical men and women at the adverse influence of the Act on their status and prospects—but I know of no reduction of status so drastic as that which has befallen Medical Officers of Health of Municipal Boroughs. The annals of fiction and crime contain many interesting references to that strange psychosis "split mind" or "split personality" or, as psychiatry calls it, "schizo-phrenia." In the various closely related and sometimes overlapping duties for which I am responsible in my dual 6 office of Medical Officer of Health and Area Medical Officer there is sometimes need for discussions between the 40% and the 60% of me, and these have furnished an interesting insight into the difficulties, confusions, contradictions, absurdities, frustrations and divided loyalties which are the constant lot of the schizo-phrenic. While it would have been my personal choice to remain whole to the end of my term of office, 100% M.O.H. of the Borough, it would be idle and indeed dishonest of me to pretend that that office was ever a bed of roses. It is often said that public servants enjoy a "sheltered position." The history of Chief Officers of the Council in my term of office does not support this view. They are all men who, before appointment, have to be examined medically as to fitness for their work and for participation in the Council's superannuation scheme. They are therefore physically and mentally sound men. Yet in a period of 10 years from my commencing duty in 1929 the death or early retirement on account of broken health of the Borough Electrical Engineer, Town Clerk, Borough Treasurer, Borough Surveyor, and Director of Education, left me as senior in years of service as a Chief Officer of the Council. With the exception of the Borough Librarian I am the only Chief Officer to retire at the full age of compulsory retirement since my appointment. In part-explanation of this high mortality and morbidity in Municipal Service, it should be remembered that the period covered has been one of exceptional difficulty and strain for everybody. The "economic blizzard" of 1931 followed by years of financial depression, and then the drift into World War No. 2, with its unparalleled disruption of the entire social life of the country, made up a term of years during which one urgent problem followed another in local government. There was no peace of mind or body for anybody engaged in public service. The upheaval of 1948 bids fair to keep this turmoil going. In these circumstances it is with a feeling of real relief that I give up the reins of office, and in taking farewell, I desire to record my appreciation of the great kindness and encouragement I have always received from members of the Council and especially from the Chairmen of the Committees discharging health functions. I am deeply grateful for the loyal and devoted work of the staffs and voluntary workers in office, schools, centres, nurseries and in the field, and for the constant help, advice, guidance, and co-operation of colleagues in other departments of the Council. I am singularly fortunate in having had the privilege to serve for over 20 years a population so intelligent and responsive as that of Hornsey, for only with the best human material is it possible to get results on the Hornsey standard. By the time this swan song is in the hands of members of the Council I will be many thousands of miles away on a sea trip for my own health. I have the honour to be, Mr Mayor, Ladies and Gentlemen, Your obedient Servant, R. P. GARROW, Medical Officer of Health. 7 Statistics for 1948 SOCIAL AND ECONOMIC STATISTICS Area (acres) 2,872 Area (square miles) 4.49 Population (Census 1931) 95,524 Population—Registrar-General's estimate 1948 98,560 Number of separately assessed inhabited premises according to Rate Books 24,021 Rateable value (General Rate) £1,066,697 Product of a penny rate £4,250 VITAL STATISTICS LIVE BIRTHS M F Total Legitimate 867 776 1,643 Illegitimate 46 42 88 913 818 1,731 Comparable Live Birth Rates (per 1,000 population) Hornsey — 17.6 England and Wales 17.9 126 County Boroughs and Great Towns including London 20.0 148 Smaller Towns 19.2 London Administrative County 20.1 STILL-BIRTHS M F Total Legitimate 22 17 39 Illegitimate 1 – 1 23 17 40 Comparable Still-birth Rates (per 1,000 population) Hornsey — 0.40 England and Wales 0.42 126 County Boroughs and Great Towns including London 0.52 148 Smaller Towns 0.43 London Administrative County 0.39 8 DEATHS Males 495 Females 525 1,020 Comparable Death Rates (per 1,000 population) Hornsey — 10.3 England and Wales 10.8 126 County Boroughs and Great Towns including London 11.6 148 Smaller Towns 10.7 London Administrative Count 11.6 INFANT DEATHS (under one year of age) M F Total Legitimate 16 11 27 Illegitimate 1 2 3 17 13 30 INFANT MORTALITY RATES Hornsey All Infants 17.3 per 1,000 live births Legitimate Infants 16.4 per 1,000 legitimate births Illegitimate Infants 34.1 per 1,000 illegitimate births Comparable Infant Mortality Rates (per 1,000 related births) England and Wales 34 126 County Boroughs and Great Towns including London 39 148 Smaller Towns 32 London Administrative County 31 MATERNAL DEATHS Hornsey — Nil England and Wales—Maternal Mortality Rate 1.02 (per 1,000 total live and still-births) PUERPERAL FEVER AND PUERPERAL PYREXIA Number of Notifications 2 Puerperal Pyrexia Rates (per 1,000 total live and still-births) Hornsey — 1.1 England and Wales 6.89 126 County Boroughs and Great Towns including London 8.90 148 Smaller Towns 4.71 London Administrative County 7.34 9 DEATHS STATISTICS Cerebro-spinal Fever 1 Tuberculosis of respiratory system 37 Other forms of tuberculosis 6 Syphilitic disease 8 Cancer 205 Diabetes 11 Intra-cranial vascular lesions 99 Heart diseases 288 Other diseases of circulatory system 56 Bronchitis 44 Pneumonia 56 Other respiratory diseases 19 Ulcer of stomach or duodenum 16 Diarrhoea under 2 years 2 Appendicitis 3 Other digestive diseases 19 Nephritis 17 Premature birth 6 Congenital malformations, birth injuries, etc. 13 Suicide 15 Road traffic accidents 8 Other violent causes 23 All other causes 68 1,020 10 11 INFANT DEATHS CAUSES BY AGE GROUPS AND SEXES Under 1 Day 1—6 Days 1 Week 2 Weeks 3 Weeks Total Under 1 Month 1—2 Months 3—5 Months 6—8 Months 9—11 Months Total M F M F M F M F M F M F M F M F M F M F M F Congenital syphilis — — — — — — — — — — — — — 1 — — — — — — — 1 Bronchitis — — — — — — — — — — — — — — — — — 1 — — — 1 Pneumonia — — — — 1 — — — 1 — 2 — 1 1 — 1 — — 1 — 4 2 Enteritis and diarrhoea — — — — — — — — — — — — — 1 — — 1 — — — 1 1 Congenital malformations 1 — — — — — — — — — 1 — 1 — — — — — — — 2 — Premature birth 1 1 3 1 — — — — — — 4 2 — — — — — — — — 4 2 Injury at birth 2 2 — — — — — — — — 2 2 — — — — — — — — 2 2 Other diseases peculiar to first year of life 1 1 1 1 — — — — — — 2 2 — — — — — — — — 2 2 Other causes 1 — — — — — — — — — 1 — — — — 1 — — 1 1 2 2 TOTALS 6 4 4 2 1 — — — 1 — 12 6 2 3 — 2 1 1 2 1 17 13 SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLY The water supply for Hornsey is provided by the Metropolitan Water Board. The supply has been satisfactory both in quantity and quality during the year 1948. Hornsey is supplied from two sources:— (a) Water from the New River, treated at the Board's filtration works at Hornsey, and (b) River Thames water stored in Littleton Reservoir and treated at the Board's filtration works at Kempton Park. Water is pumped from these works into service reservoirs at Crouch Hill. Samples of water are collected on five days in every week at each stage of the purification process and tests include physical, chemical and microbiological examination. The water supply to this area is not plumbo-solvent. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically to ensure efficient disinfection. Bacteriological Results Bact. coli Test No. of Agar Colney Neg. Bact. coli Bad. coli Samples Count per 100 ml. per 100 ml. Stoke Newington 314 5.5 99.7% 0.080 Kempton Park 954 18.5 100.0% Nil SANITARY INSPECTIONS The following statement of the work of the Sanitary Inspectors has been prepared by Mr J. H. Jesse, Chief Sanitary Inspector:— Complaints 2,766 Re-inspections 9,522 Information from Builder 360 Other reasons 436 Drainage 584 Water Tests applied (new drains) 101 Smoke and Chemical Tests (old drains) 126 Verminous conditions 83 Overcrowding conditions 50 Overcrowding re-inspections 4 12 Sanitation Inspections—continued Surveys (Permitted Number) 63 Re-surveys (Permitted Number) 48 Notifiable Infectious Diseases 323 Scabies 1 Smallpox Contacts 13 Public Health (Aircraft) Regulations, 1938 13 Shops Acts Inspections 150 Shops Acts Re-inspections 23 Sunday Trading Inspections 351 Music and Dancing Licences 28 Housing Inspections 8 Petroleum Stores 146 Registration of Hawkers 13 Building Licences 977 W.B.A. Certificates 81 Rats and Mice (Destruction) Act, 1919 145 Street Trading 2 Smoke Observations 6 Rent Restrictions Acts 1 Moselle Pollution 382 House to House Inspections 123 Stables and Urinals 10 16,939 NOTICES The Notices served during the year are as follows:— Verbal Preliminary Statutory Public Health and Housing Acts 170 1,777 198 Housing Byelaws — 30 — Shops Acts 2 13 — Food and Drugs Act — 14 — 172 1,834 198 13 SUMMARY OF SANITARY IMPROVEMENTS CARRIED OUT DRAINAGE Number of houses and premises redrained 38 Repairs or amendments to existing drains 230 Drains or gullies unstopped or cleansed 238 Manholes provided 65 Manholes repaired 89 Intercepting traps fixed 22 New gulley traps fixed 106 New soil pipes and ventilating shafts fixed 65 Soil pipes and ventilating shafts repaired 105 WATER-CLOSET AND SANITARY FITTINGS New water-closet buildings 10 New water-closet pans fixed 205 Water-closets unstopped, cleansed or repaired 184 New sinks provided 47 New lavatory basins provided 69 Waste-pipes trapped, repaired or unstopped 239 Waste-pipes diverted into proper drain 20 Baths provided or made usable 32 Urinals cleansed 5 MISCELLANEOUS Roofs repaired 1,069 Eaves guttering renewed, cleansed or repaired 669 Rain-water pipes provided, repaired 531 Damp-proof courses inserted 129 Damp walls remedied 600 Paving of yards repaired 189 Rooms cleansed, distempered or papered 1,762 Premises disinfestated of vermin 53 Drinking-water cisterns repaired, cleansed or covered 105 Water supply pipes repaired 79 Water supply (additional) provided 7 Windows and skylights provided or made usable 900 Sub-floor ventilation 212 Floors repaired 534 14 Summary of Sanitary Improvements—continued Walls and ceilings repaired 2,681 Windows sills repaired 210 Sashcords and fittings repaired 641 Sanitary dustbins provided 68 Accumulations of manure and refuse removed 51 Stoves, ranges and coppers repaired or renewed 391 Food stores provided 17 Sundry items 394 BYELAWS relating to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family Fifteen houses have been dealt with under these Byelaws during the year and the following work carried out:— Byelaws 4(b) Water supply 9 4(c) Washing accommodation 3 4(d) Food stores 7 5(a) Repairs to drains 2 5(b) Means of carrying off waste water 12 5(g) Staircase repairs 4 5(h) Handrails provided 3 HOUSING STATISTICS The housing statistics of the year as required by the Ministry of Health are set out below:— 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,342 (b) Number of inspections made for the purpose 8,330 (2) (a) Number of dwelling houses (included under head (I) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (b) Number of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 15 Housing Statistics - continued (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,956 2.—Remedy of Defects during the Year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,684 3.—Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices (a) by owners — (b) by Local Authority in default of owners 1 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 198 (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) by owners 198 (b) by Local Authority in default of owners 1 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 4.—Overcrowding:— Twenty-seven cases of overcrowding have been reported during the year. Twenty-three inspections were also made at the request of other Local Authorities in connection with re-housing. 16 17 FACTORIES ACT, 1937 The following tables show the work carried out by the Sanitary Inspectors under this Act:— 1. Inspections of Factories Premises Number of Inspections Written Notices Prosecutions Factories with Mechanical Power 181 3 NIL Factories without Mechanical Power — — TOTALS 181 3 2. Defects Found Particulars No. of defects Found Remedied Referred to H.M. Inspector Number of defects in respect of which Prosecutions were instituted. Want of Cleanliness 3 3 NIL NIL Overcrowding Unreasonable Temperature — — Inadequate ventilation — — Ineffective drainage of floors — — Sanitary Conveniences (a) insufficient — — (b) unsuitable or defective 1 1 (c) Not separate for sexes — — Other offences — — TOTALS 4 4 OUTWORKERS There are 640 Outworkers on the register engaged in the following occupations :— Wearing apparel 356 Household linen 3 Lace, lace curtains and nets 7 Furniture and Upholstery 1 Electro-plate 1 Brass and brass articles 1 Umbrellas, etc 2 Artificial flowers 28 Paper bags 1 Boxes, etc 160 Brush making 2 Feather sorting 4 Art jewellery repairs 2 142 visits were paid to outworkers' premises during the year. Carding, etc., of buttons, etc. 5 Toys 32 Basket making 3 Xmas crackers, etc 5 Hair Stylists 2 Bundling thongings 1 Leather goods 2 Handbags 4 Stationery 8 Embroidery 6 Printers and Publishers 3 Filling hand 1 lbs. ozs. Canned Vegetables 928 12 Canned Fruit 832 6 Canned Meat 1,464 10 Canned Fish 639 7 Canned Milk 1,035 4 Canned Soup 59 4 Canned Marmalade 197 8 Canned Jam 176 8 Canned Bacon 10 4 18 INSPECTION AND SUPERVISION OF FOOD The inspection and supervision of premises where food is prepared and sold has been carried out by the Sannary Inspectors during the year. Regular inspections are an important feature in the control of these premises and a large measure of improvement in conditions has been brought about by informal action. Special attention has been directed to the inspection of cafes, restaurants, snack-bars, etc., to ensure that hygienic methods are being carried out in preparing and serving of food and the efficient cleansing and sterilization of utensils and receptacles. It is essential that all persons engaged in the preparation or handling of food should practice clean habits. The importance of the regular washing of hands has been pointed out to the staffs of catering and food premises and as far as practicable in these days of shortages the requirements of the Food and Drugs Act, 1938, as to the provision of a supply of hot water, soap and clean towels for the use of the staff, have been enforced. No outbreak of food poisoning has been reported during the year. Inspections of food premises have been made during the year as follows :— Butchers' Shops 124 Grocers' Shops 98 FIsh Shops 35 Greengrocers' Shops 7 Cooked Meats Shops 2 Restaurant Kitchens 113 Bakehouses 38 Milkshops 20 Other Food Shops 24 Ice Cream Premises 115 The following is a list of food condemned as unfit for human consumption. In accordance with the Ministry of Health Cicrulars 2468 and 2886 and Ministry of Food Circular M.F. 3/48 certain articles of food condemned were salvaged through the Ministry of Food Salvage Division. lbs. ozs. Cheese 19 5 Butter 1 6 Margarine 24 o Tea 4 12 Sugar 64 o Oatmeal 50 8 Cereals 894 14 Mincemeat 1 14 Golden Syrup 7 0 TOTAL Food Condemned—18,185lbs. 130ZS. and 220 Eggs. Slaughterhouses.—The Live Stock (Restriction of Slaughtering) Order 1940 continued in force and no slaughtering was carried out during the year. THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1936—1946 L icences for the sale of special designated milk are renewed annually. Licences in force are as follows :— Sale of Pasteurised Milk 21 Sale of Pasteurised Milk (Supplementary) 7 Sale of Tuberculin Tested Milk 8 Sale of Tuberculin Tested Milk (Supplementary) 8 ICE CREAM There are 109 premises in the Borough registered for the sale, manufacture or storage of ice cream. Ice Cream (Heat Treatment) Regulations 1947 The Ice Cream (Heat Treatment) Regulations came into force on the 1st May, 1947, except for certain requirements relating to recording thermometers which will operate from a date to be appointed by the Minister of Health. The administration of these Regulations has increased the work of the Department considerably, particularly in view of the large increase in the number of persons dealing in this commodity. 115 visits have been paid to ice cream premises during the year. 19 Inspection and Supervision of Food -continued Dried Fruit 105 2 Dried Milk 36 0 Dried Egg 2 9 Meat 2,124 0 Fish 5,574 8 Rabbits 678 o Poultry 2 14 Bacon 40 4 Offal 16 0 Eggs 220 Pickles 51 2 Cocoa 120 8 Coffee 1 o Essence 9 2 Sweets 21 0 Cake Mixture 27 8 Tomatoes 1,708 o Fruit 346 10 Vegetables 909 15 The Methylene Blue Test The Minister of Health recommends the testing of ice cream by the Methylene Blue Test. The basis of this test is that the amount of bacterial contamination present is indicated by the time taken to decolourise methylene blue dye. As pointed out, however, in the Ministry of Health's Bulletin for March 1947, the conclusions and suggested grading are at present provisional, but the Minister is advised that this test of bacterial cleanliness appears to provide the best available for the present purpose, at the same time it is simple and cheap to perform. It is suggested that if out of the four grades recommended, ice cream consistently fails to reach grades one and two, it would be reasonable to regard this as indicating defects of manufacture or of handling which call for further investigation. Thirty samples of ice cream were taken during the year and sent to the Central Public Health Laboratory, Hendon, for testing. The results were as follows :— Grade 1 Grade 2 Grade 3 Grade 4 5 2 11 12 Grade 1 showing, according to the test, the least contamination, and grade 4 the highest. When samples have consistently fallen into Grade 4, observations have been kept on the methods of manufacturing and handling with a view to the product'on of a cleaner ice cream. RODENT CONTROL During the twelve months ending 31st December, 1948, the following work was carried out under the Rats and Mice (Destruction) Act 1919 :— Visits by the Sanitary Inspectors 145 Visits by the Rodent Operator 3,431 Premises disinfested for Rats 191 Premises disinfested for Mice 57 No evidence of infestation — Disinfestation in hand—Rats 138 Disinfestation in hand—Mice 92 The investigation of complaints of rat and mice infestations at private and business premises is carried out by the Sanitary Inspectors. The disinfestation of the premises either by gassing, poisoning or trapping is performed by the Rodent Operator. Regular sewer maintenance treatments were carried out during the year. 20 21 LEGAL PROCEEDINGS Legal proceedings were taken in 12 instances. Date of Hearing Premises Act or Byelaws Result of Proceedings 26/5/48 112 Hampden Road, N.8. P.H.A. 1936 Court order for execution within 21 days. 28/7/48 87 Mount View Road, N.4. P.H.A. 1936 Court order for execution within 2 months. 4/8/48 16 Osborne Grove, N.4. P.H.A. 1936 Court order for execution within 1 month. 28/8/48 15, 20, 21 Alyn Court, Crescent Road, N.8. P.H.A. 1936 Court order for execution within 28 days £1:1:0 costs. 11/8/48 11 Northwood Road, N.6. P.H.A. 1936 Court order for execution within 28 days. 10/6 costs. 18/8/48 31 Enfield Road, N.8. P.H.A. 1936 Court order for execution within 14 days. 10/6 costs. 18/8 48 128 Stapleton Hall Road, N.4. P.H.A. 1936 Court order for execu-. tion within 28 days 10/6 costs. 3/11/48 74 Carr.psbourne Road, N.8. P.H.A. 1936 Court order for execution within 28 days. £2:2:0 costs. 17/11/48 87 Mount View Road, N.4. P.H.A. 1936 Work to be carried out forthwith. £5 fine and £2:2:0 costs. 24/11/48. 3, 9, 11 Hanbury Road, N.8. P.H.A. 1936 Work to be completed within 6 weeks. £1.1.0 costs on each summons. 24/11/48 502 Archway Road, N.6. P.H.A. 1936 Court order for execution within 21 days. £1:1:0 costs. 24/11/48 23 Hampstead Lane, N.6. P.H.A. 1936 Court order for execution within 3 months. £1:1:0 costs. DISEASES OF ANIMALS ACTS Mr F. G. Buxton, the Veternary Inspector, has kindly supplied me with details of his work in the Borough under the Diseases of Animals Acts and Orders during 1948, as follows:— Total number of Licences issued under the Contagious Diseases of Animals Acts 0 Inspections made under the Contagious Diseases of Animals Acts (on fowls) 2 Number of fowls inspected 18 Inspections made under the Riding Establishments Act, 1939 4 Number of horses inspected 35 No action was necessary under the Tuberculosis Order, 1925. CLEANSING STATIONS Persons Treated Hornsey Other Districts Other Other verminous verminous Scabies conditions Scabies conditions Total Women and Children :— Pear Tree Cottage, rear of Town Hall 42 42 45 — 129 Men and Youths:— Central Depot, High Street, N.8 11 1 9 1 22 22 23 INFECTIOUS DISEASES Corrected Notifications during 1948 (By Age and Sex) AGE Scarlet Fever Whooping Cough Ac. Poliomyelitis Measles Diphtheria M F M F M F M F M F 0-1 — 1 14 10 — — 14 10 — — 1-3 10 5 38 31 1 — 113 98 — — 3-5 21 23 44 37 — — 117 III — — 5-1o 54 39 27 32 — — 200 164 — — 10-15 8 9 2 4 1 — 8 9 2 — 15-25 9 8 — 2 — — 4 6 — — 25— 2 7 1 3 1 1 1 4 — — Age unknown — — — — — — — TOTALS 104 92 126 119 3 1 457 402 2 — 196 245 4 859 2 AGE Ac. Pneumonia Dysentery Erysipelas Cerebro Spinal Fever Puerperal Pyrexia Ophthalmia Neonatorum M F M F M F M F M F M F 0-5 8 2 1 1 — — 3 2 — — 1 2 5-15 3 4 — 1 1 — 1 — — — — — 15-45 4 7 — 2 1 2 I — — 2 — — 45-65 6 9 — — 3 6 — — — — — — 65 5 4 — — 2 2 — — — — — — Age unknown — — — 1 — — 1 — — — — — TOTALS 26 26 1 5 7 10 6 2 — 2 1 2 52 6 17 8 2 3 24 INFECTIOUS DISEASES NURSING OF CASES Removed to Isol. Hosp. Removed to Other Hosps. Nursed at home TOTAL Scarlet Fever 109 4 83 196 Whooping Cough 17 3 225 245 Ac. Poliomyelitis 3 1 — 4 Measles 32 4 823 859 Diphtheria 1 1 — 2 Pneumonia 8 2 42 52 Dysentery 6 — — 6 Erysipelas 5 — 12 17 Cerebro Spinal Fever 5 3 — 8 Puerperal Pyrexia — 1 I 2 Ophthalmia Neonatorum 3 3 TOTALS 186 19 1,189 i>394 CORRECTED NOTIFICATIONS DURING 1948 (By Wards) DISEASE Highgate Muswell Hill Crouch End Central Hornsey North Har'ngay South Har'ngay Stroud Green | Finsbury Park Scarlet Fever 29 44 14 24 12 12 30 31 Whooping Cough 23 49 20 35 29 16 40 33 Ac. Poliomyelitis — — — — — 2 1 Measles 61 122 58 135 75 100 153 | 155 Diphtheria - — 1 — 1 - ! — Pneumonia 5 7 6 10 6 9 9 — Dysentery - 1 2 1 — - 1 1 Erysipelas 4 1 — 4 - — 6 2 Cerebro Spinal Fever 2 1 1 3 1 — | — Puerperal Pyrexia - — — - - 1 " 1 Ophthalmia Neonatorum — — — 1 — — 2 — TOTALS 125 225 102 213 124 139 242 224 DIPHTHERIA IMMUNISATION Regular sessions for this purpose are held at the Welfare Centres and the parents of children attending the Day Nurseries arc also encouraged to allow their children to be immunised. 1.—Immunisation during 1948:— Number of children who had completed a full course of immunisation at any time up to 31st December, 1948. Age at 31/12/48 Under 1 1 2 3 4 5—9 10—14 Total i.e. born in year 1948 1947 1946 1945 1944 1939-1943 1934-1938 under 15 Number immunised 50 1,628 1,603 1,110 1,238 4,014 4,095 13,738 Estimated mid-year Children under five Children 5—14 child population 8,286 9,627 1948 2.—Diphtheria Notifications and Deaths in relation to Immunisation: Age at date No. oj cases Number of cases included in of notified preceding column in which the nc.Tm Notification child had completed a full course of immunisation Under 1 o o 10 o 2 0 o 30 o NIL 40 o 5-9 o o 10-14 2 o TOTALS ... 2 o OPHTHALMIA NEONATORUM Domiciliary Institutional confinements confinements Cases notified 1 2 Cases removed to hospital — — Cases in which vision was unimpaired 3 25 to <M TUBERCULOSIS The total number of cases on the Tuberculosis Register at the end of 1948 was 1,324, viz., pulmonary 1,069, non-pulmonary 255, an increase of 35 on the total for last year. TUBERCULOSIS REGISTER, 1948 Pulmonary Non- Pulmonaiy Total Male Female Male Female Male Female (a) Number of Cases on Register at Commencement of 1948 556 477 136 120 692 597 (b) Number of Cases notified for first time during year under Regulations 58 55 4 10 62 65 (c) Cases restored to Register during 1948 I 2 1 — 2 2 (d) Cases added to Register otherwise than by notifications under Regulations : (1) Transferred from other Districts 21 13 2 1 23 14 (2) From Death Returns 5 1 — 5 1 (e) Number of Cases removed from Register during 1948 69 51 12 7 81 58 (f) Number of Cases remaining on Register at end of 1948 572 497 131 124 703 621 Cases removed from the Register shown under (e) are accounted for as follows :— Found not to be T.B. Recovered Removed to another area Died at home Died at Sanatorium or other Institution TOTALS M F M F M F M F M F M F Pulm onary 4 — 16 14 26 19 17 11 6 7 69 51 Non-Pu lmonary — — 7 2 4 5 - 1 ~ 12 7 LABORATORY SERVICES Pathological specimens are forwarded for examination to the Central Public Health Laboratory at Hendon which was established by the Medical Research Council on behalf of the Ministry of Health. The assistance of the technical staff attached to the Laboratory is also available in connection with outbreaks of infectious diseases at Day Nurseries and Schools and this assistance is of extreme value in controlling the spread of infection. Details of specimens examined at the Central Public Health Laboratory are as follows :— Throat and Nose Swabs Diphtheria bacilli 1 Haemolytic streptococci 289 Vincents angina 8 Negative 671 969 Faeces Shigella 4 Salmonella 9 Protoza I Negative 45 59 Sputum Tubercular smear 9 Other organisms 21 Negative 63 93 Pertussis Cough plates — Postnasal swabs — Negative 44 44 Milk Ice cream 30 30 Miscellaneous 128 128 1.323 27 Appendix The Prevalence of Polio-encephalo-myelitis in 1949 The prevalence of polio-myelitis in the Borough in 1949 commenced on June 28th in a child age four living in Highgate. Up to the time of writing this report, on September 5th, 28 notifications were received. The last case occurred on August 14th, over three weeks ago, so that it would appear that the prevalence has been checked for the time being, and perhaps for this season However, it must be borne in mind that the normal season of poliomyelitis prevalence runs to the end of September and possibly into October. It would appear that much depends on weather conditions. A continuance of the dry warm summer into the autumn may mean a recrudescence of the disease between now and October. Four of the notifications turned out to be other conditions— " teething," " tonsillitis," " osteo-myelitis" and " common cold." Amongst the remaining twenty-four cases, five were polio-encephalitis of the bulbar type in which the disease attacks the vital centres of respiration and circulation in the brain. One of these was in a woman age 37, and four in males ages 5, 6, 18, 25—all five proved fatal. Seven of the cases showed no signs of paralysis at any stage of their illness, but the diagnosis of poliomyelitis on clinical symptoms was supported by the laboratory examination of the cerebro-spinal fluid obtained by lumbar puncture. The most characteristic change in this fluid is increase in the number of lymphocytes from 10 or fewer per cubic millimetre to perhaps hundreds. This illness was therefore named " benign lymphocytic meningitis." " Poliomyelitis without paralysis " is a better name because there can be no doubt that it is produced by invasion of the central nervous system by the same virus as that which causes paralytic poliomyelitis. Moreover, it is possible that the number of cases of this mild non-paralytic form of the disease is very much greater than the notifications indicate. It has been suggested in some investigations of outbreaks of polio-encephalo-myelitis that for every case showing paralysis there may be ten to one hundred cases of "poliomyelitis without paralysis." If this is an accurate scientific concept, then it follows that measures for control of outbreaks of the disease are rendered ineffective by the immense reservoir of infection prevailing during epidemic periods. The remaining twelve notified cases showed some degree of paralysis of one or more limbs. All of them are still under treatment in hospital or are attending as out-patients after discharge from hospital. Progress towards recovery is practically complete in many and in no case is the 28 residual paralysis likely to be so severe as to put the child in the class of " handicapped children " requiring special education. This is a very fortunate outcome after the early threat of an extensive and crippling invasion. The age incidence of the twenty-four confirmed cases is practically identical with the age distribution of the twenty-one cases which occurred in the summer of 1947. In both of these outbreaks there was no case below the age of 1 year. Between ages 2 and 7 inclusive there were 16 cases in 1949 and 15 cases in 1947. Then comes a gap from ages 8 to 14 inclusive in which no case occurred in either outbreak. Both outbreaks furnished one case at each of the ages 15, 17, 18, 19 and 25. In 1949 there were three cases over 25 (ages 33, 37, 37). In 1947 one case occurred over 25 (age 37). The most arresting feature of this age incidence is the absence in both outbreaks of any case at ages 7 to 14, although there must be about 7,000 children in this age group in the Borough. No explanation can be offered of their immunity. The geographical distribution in the two years 1947 and 1949 was entirely different. The brunt of the 1949 outbreak fell west of a northsouth line in the region of Park Road in the centre of the Borough—that is to say Highgate and Muswell Hill suffered most. In 1947 the great majority of the cases fell east of this line. No firm explanation can be given of this or, indeed, of any of the epidemiological features of this baffling disease. It may be that the eastern half of the Borough was " salted " or immunised by the 1947 prevalence and so escaped in 1949. But this offers no explanation of the great variations in incidence in neighbouring Boroughs, one of which suffered as severely as Hornsey in 1949, while others escaped with no cases. Here, then, is a yearly menace to child life and limb and the little we can do to prevent or control it is summarised in: (1) Don't have your children's tonsils and adenoids operated on in times of poliomyelitis prevalence; (2) Avoid physical exertion to the stage of fatigue or exhaustion; (3) Rest in bed from the beginning of feeling ill—all very feeble compared with the measures which can be undertaken, with complete confidence in their success, to prevent such diseases as smallpox, enteric, diphtheria, etc. 29 printed By R0BERI5 A NEWTON L™ London, n.8-