BOROUGH OF WOOD GREEN ANNUAL REPORT \ of the Medical Officer of Health for the Year 1947. MALCOLM MANSON, M.C., G.M.,M.A.,M.D.,D.P.H.. Medical Officer of Health. Crusha & Son, Ltd., Enfield. Wood Green and Tottenham. WOOD 29 BOROUGH OF WOOD GREEN PUBLIC HEALTH COMMITTEE. Alderman E. J. Anderton, J.P. (Chairman). The Mayor, Councillor J. W. Adams. Councillor W. H. Evans, Councillor J. S. Bamberger. J.P. Councillor Mrs. J. Cole. The Deputy Mayor, Councillor Mrs. S. L. Fowler. Councillor Major S. North. Councillor H. G. Hicklenton. Alderman F. G. Holmes, J.P. Councillor J. J. Wren. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor Mrs. H. S. Harrison (Chairman). Alderman E. J. Anderton, J.P. Alderman Mrs. Bolster, J.P. Councillor Mrs. J. Cole. Councillor Mrs. S. L. Fowler. Councillor H. G. Hicklenton. Co-opted Members. Mrs. A. M. Bennett. Mrs. F. E. Evans. Mrs. E. C. Waghorne. STAFF during 1947. *Medical Officer of Health.—Malcolm Manson, M.C., G.M., M.A., M.D., D.P.H. *l)eputy Medical Officer of Health.—Kathleen Mart Hart, M.D., D.P.H. Doctors employed on a Sessional basis at Infant Welfare Centres.— Dr. V. L. James; Dr. J. Waterhouse; Dr. M. OwenFlood; Dr. J. Humphrey. *District Sanitary Inspectors.—G. C. Billing, Cert.R.San.Inst., Cert. Meat and Food Inspection; W. McCauley, Cert.R.San.Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection; F, James, Cert.R.San.Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection. 2 *Health Visitors.—Miss F. L. Orwin, S.C.M. (retired January, 1947); Miss F. Medd, S.C.M.; Miss G. L. Shaw, S.C.M.; Miss P. C. Gould, S.C.M.; Miss E. T. Conway (appointed January, 1947). Midwives.—Miss V. Baker, S.R.N., S.C.M.; Miss C. Aherne, S.C.M.; Mrs. I. Milbank, S.R.N., S.C.M.; Miss M. E. M. Harman, S.C.M. Chief Clerk.—G. W. Jones. Assistant Clerks.—W. T. Gloster, G. Penberthy, K. Overy, Mrs. G. Ogden, Miss A. Sinclair (resigned May, 1947), Miss B. Margrove (appointed May, 1947). Clerks for Maternity and Child Welfare.—Mrs. N. Wass (retired March, 1947); Miss L. Winchester (appointed-February, 1947); Miss A. Elliott (appointed October, 1947). Matrons of Day Nurseries.—Miss D. Kingdon, S.R.N.; Mrs. I. A. Beale, S.R.F.N. Supervisor of Home Helps.—Mrs. L. Noakes. Each of the Health Visitors holds a General Training Certificate and Miss Shaw, Miss Gould and Miss Conway hold the Health Visitors Certificate. * Officers in respect of whom salary contributions are made under the Public Health Act by Exchequer Grants. 3 Public Health Department, White Hart Lane (Old) School, Wood Green, N.22. September 20th, 1948. To the Mayor, Aldermen and Councillors, of the BoroucJh of Wood Green. Mr. Mayor, Ladies and Gentlemen, I beg to present to you my Annual Report as Medical Officer of Health for the year 1947. The year has again been a good one so far as the health of the community is concerned. Infectious disease has not been unduly prevalent, and for the eighth year in succession no death from diphtheria has occurred in the borough. The Birth Rate is the highest recorded since 1920, and the Infantile Mortality Rate, the lowest, with one exception, in the history of Wood Green. As a result of the coming into force of the National Health Act, 1946, on July 5th, 1948, this report deals for the last time with a full year's work of the Maternity and Child Welfare Committee, and I have included in the body of the report, a short account of the development of this service in Wood Green. During the year the Public Health Committee lost one of its oldest members, and a former Chairman, by the death of Alderman Tudor Rhys. Alderman Rhys was always keenly interested in the work of the Health Department and was for many years one of the Council's representatives on the Joint Isolation Hospital Committee, in the work of which he always took a prominent part. Tribute has been paid elsewhere to the value of the services Alderman Rhys rendered to Wood Green, and I wish to take this opportunity of adding my tribute on behalf of the Health Department. 4 I wish to express my thanks to the Chairmen and members of the Public Health and Maternity and Child Welfare Committees for their support and encouragement at all times. On July 5th, 1948, the great majority of the members of the staff of the Health Department, the Deputy Medical Officer of Health, the part-time medical officers, the health visitors, midwives, matrons and nurses at the Day Nurseries, the Chief Clerk and several other members of the clerical staff go over to the employment of the Middlesex County Council, and it is fitting that I should make special mention now of my appreciation of the high standard of the services they have rendered, several of them for very many years to the health and well-being of the community, and of my personal indebtedness to them for their loyal co-operation and help at all times in the work of the Health Department. I wish to make particular mention in this connection of Mr. G. W. Jones, the Chief Clerk of the Department, on whose loyal assistance I have relied more and more during my years of service in Wood Green. I am, Ladies and Gentlemen, Your obedient servant, MALCOLM MANSON, Medical Officer of Health. 5 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA. Area (acres) 1,607 Population—Estimate supplied by the Registrar General 52,290 Number of inhabited houses (end of 1947) according to the Rate Books 13,420 Rateable Value, 1947 £555,497 Sum represented by a penny rate £2,200 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total M. F. Legitimate 1,025 534 491 Birth Rate 20.3 per 1,000 Illegitimate 41 19 22 Still Births 21 8 13 Rate per 1,000 births 19.3 Deaths 649 353 296 Death Rate 12.4 per 1,000 Deaths from Puerperal Causes :— Puerperal Sepsis 1 Rate per 1,000 Births 0.91 Other Puerperal Causes 2 Rate per 1,000 Births 1.8 Deaths of Infants under 1 year of age:— All Infants 30 Rate per 1,000 Live Births 28.1 Legitimate 29 Rate per 1,000 legitimate Live Births 28.2 Illegitimate 1 Rate per 1,000 illegitimate Live Births 24.4 Deaths from :— Cancer (all ages) 113 Measles (all ages) 2 Whooping Cough (all ages) 0 Diarrhoea (under 2 years of age) 4 Number of Births notified ... 1,056 Number of Births Registered in the Borough ... 446 POPULATION. The mid-year estimate of the population supplied by the Registrar General is 52,290, an increase of 1,610 over that for 6 1946. The increase is probably in part due to the increased housing accommodation provided during the past year and in part to the increase in the birth rate during the past two years. BIRTHS. The number of live births registered during the year was 1,066, which corresponds to a Birth Rate of 20.3 per 1,000 of population. This is an increase over the rate for 1946, which was 19.4, and is the highest rate recorded in Wood Green since 1920. The number of still-births was 21, and the Still-Birth Rate 19.3 per 1,000 births, an improvement on the previous year when the rate was 27.6. DEATHS. The number of deaths credited to Wood Green after the necessary adjustments had been made for inward and outward transfers was 649. This gives a Death Rate of 12.4 per 1,000 of population, the same rate as for 1946. Of the total of 649 deaths no fewer than 426 or 65.6 per cent occurred at ages over 65. By contrast the percentage of deaths of persons over 65 years of age in Wood Green was in 1907, 24.7, and in 1927, 48.1. 119 deaths occurred in 1947 at ages over 80 years, and 20 at ages over 90. The individual causes of death are given in Table III in the Appendix. It will be seen there that the chief cause of death is heart disease which was responsible for no fewer than 191 deaths, a very much larger number than that attributed to any other cause. Other diseases of the circulatory system caused 22 deaths, and intra-cranial vascular lesions 79 deaths, so that in all 292 deaths out of a total of 649 were attributed to diseases of the heart and circulation. This very high proportion of deaths attributed to diseases of the heart and circulation does not necessarily mean that there is a serious increase of heart disease in the community. The great majority of these deaths are of people in the later decades of life, and as "heart failure" is the last act in all forms of disease, weakness or disease of the heart muscle is apt to appear as a cause of death in the majority of death certificates for elderly people. 7 The number of deaths due to respiratory disease, apart from pulmonary tuberculosis was 86. Cancer was responsible for 113 deaths and tuberculosis 22. Six deaths occurred from the principal zymotic diseases. There were no deaths from enteric fever, smallpox, scarlet fever, diphtheria or whooping cough, but two deaths from measles, and four from diarrhcea in children under two years. The Zymotic Death Rate was 0.11 per 1,000 of population. INFANTILE MORTALITY. The number of deaths of infants under 12 months was 30, which gives an Infantile Mortality Rate of 28.1 per 1,000 live births. This rate was considerably better than that for the previous year which was 34.4, and only a little higher than that for 1945, which was 27.3, the lowest ever recorded in Wood Green. It compares very favourably with that for the country as a whole, which was 41, and with that of towns of comparable size which was 47. Of the 30 infantile deaths no fewer than 10 died within 24 hours of birth, and 22 during the first month of life. If to these 22 neonatal deaths we add the 21 still-births which occurred during the year we have a total loss of 43 infant lives either shortly before or within a few weeks following birth. Of the 22 neonatal deaths, 9 were certified as premature, 3 were due to injury at birth and 5 to congenital conditions which are usually fatal. It is in the direction of reducing the number of still-births which occur and preventing so far as is* humanly possible, the loss of so many premature babies that we must look for progress in the saving of infant lives, and as I have said in previous reports, both these objects are most likely of achievement by increased attention to the health of the mother particularly in the late months of pregnancy. MATERNAL MORTALITY. Three deaths occurred from the complications of child-birth, one of which was due to puerperal sepsis. The Maternal Mortality Rate was 2.81 per 1,000 births. During the two previous years there were no maternal deaths in the Borough. 8 MATERNITY AND CHILD WELFARE. The following is a list of the various clinics held throughout the year:— White Hart Lane Centre. Morning. Afternoon. Monday Ante-natal Child Welfare Tuesday Ante-natal Wednesday Child Welfare Friday Child Welfare Ante-natal Alexandra Park Congregational Church Hall. Thursday Morning—Child Welfare Gordon Road Centre. Morning. Afternoon. Tuesday Thursday Friday Child Welfare Ante-natal Immunisation (alternate weeks). Stuart Villa. Afternoon. Tuesday Dental clinic for expectant mothers and infants. Immunisation clinic (alternate weeks). The number of live births registered as belonging to Wood Green was 1,066 and the number notified under the Public Health Act was 1,039, which is 97.4 per cent, of the registered births. Of the 1,066 births registered, the number which actually occurred in Wood Green was 446, all the others taking place in hospitals, nursing homes, or in private dwellings outside the district. The following table shows where the great majority of these births took place:— Nursing Homes 154 North Middlesex Hospital 198 Royal Northern Hospital 47 University College Hospital 18 City of London Maternity Hospital 67 Mothers Hospital 81 9 Of the 446 births registered as taking place in the Borough, 351 were attended by the Council midwives. CHILD WELFARE CENTRES. The total attendances at the Infant Welfare Clinics at the White Hart Lane Centre were 15,663, as compared with 14,493 during the previous year. At Alexandra Park Centre the attendances were 3,585, as compared with 3,562 during 1946. The attendances at the new Gordon Road Centre, which was opened on October 6th, numbered 588. The number of children brought to the Centres was 2,728 of whom 1,384 were infants under one year of age and 1,344 children of from one to five years. The number of children seen at the Centres by the Medical Officers during the year was 2,554 and of these 1,330 were infants and 1,224 children from one to five years. Of the 30 infant deaths which occurred during the year, in nine cases the baby had been brought at least once to one of the Centres. Ante-Natal Clinics. Ante-Natal Clinics were held at the White Hart Lane Centre on Monday mornings, Tuesday afternoons, Friday afternoons and alternate Saturday mornings, throughout the year, and at Gordon Road Centre on Thursday afternoons since the Centre was opened in October. The number of expectant mothers who attended was 764, and in addition 134 attended for post-natal examinations. Premature Babies. The equipment recommended by the Ministry of Health for the care and nursing of premature babies in their homes has been provided and is available for use by the midwife whenever required. 10 Home Visiting. The Health Visitors made a total of 7,282 home visits during the year. Of these 537 were ante-natal visits to expectant mothers, 3,260 to babies under one year and 3,485 to children of from one to five years. The Health Visitors also continue to act as Infant Life Protection Visitors, visiting registered foster-mothers and foster-children at regular intervals. There were 8 foster-mothers and 10 fosterchildren on the Register at the end of the year. In their work the Health Visitors from time to time have to deal with unsatisfactory conditions in which negligence on the part of the parents fails to yield to the ordinary methods of advice and persuasion, and it is necessary to call in the assistance of the National Society for the Protection and Care of Children. The help readily given by Inspector Martin, the officer of the Society for this district is much appreciated by the staff. Care of the Unmarried Mother and her Child. For many years there has been co-operation between the health visitors and the social welfare worker of the Tottenham Deanery Association for Moral Welfare, in dealing with the unmarried mother and her child. Every effort is made where it is necessary to obtain the admission of the mother to a hostel, and later to induce the mother to retain her baby with her. In the majority of cases this is possible and the mother and baby can then be under the care of the health visitor, but when this is not possible, assistance is given in finding suitable foster-mothers or advising as to adoption. Free Food. Free food, consisting of dried milk and cod-liver oil emulsion was issued to necessitous expectant and nursing mothers attending the centres, at a cost of £10 1s. 8d. Home Help. The services of four home helps were made use of during the year, the number of confinements in which help was given being 21. 11 Domestic Help. Six domestic helps were in constant employment throughout the year, the number of homes in which assistance was provided being 105. Day Nurseries. The two Day Nurseries, St. Michael's and White Hart Lane have been filled to capacity throughout the year, apart from periods of quarantine due to outbreaks of measles and chickenpox. The average attendance at St. Michael's for the whole year was 27, and at White Hart Lane 40. The demand for admission of children to the nurseries remains as great as ever, and the waiting lists are very long. A formal request has been made by the St. Michael's Church Council for the return of the St. Michael's Nursery premises to its former use as an Infants' School, and if this is acceded to, steps must be taken to find other premises for use as a Day Nursery. MATERNITY AND CHILD WELFARE SERVICE IN WOOD GREEN. With the coming into force of the National Health Service Act, 1946, on July 5th, 1948, the personal medical services such as Maternity and Child Welfare, are no longer the responsibility of county districts like Wood Green, but pass into the control of larger health authorities, counties and county boroughs. This is therefore the last annual report in which I shall be reporting on a full year's work of the maternity and child welfare services provided by the Borough of Wood Green, and it may be of interest to the members of the Council to give a short resume of the development of these services. The first evidence of the Council's official interest in child welfare work in Wood Green was the appointment in December, 1907, of a lady health visitor for an initial period of three months. During the previous year there had been no fewer than 43 deaths of infants under one year from infantile diarrhoea, and it was apparently felt that the appointment of someone to advise the mothers on the feeding and general care of their babies might be of value in reducing the very high infantile mortality rate, which 12 in 1906 was 103 per 1,000 live births. The lady appointed—Mrs. Parnell—although not a trained nurse and at first, at least, devoting only a portion of her time to health visiting, served the community faithfully and well for twenty years, until her retirement in 1927. During her first year of work as a health visitor, the number of births in Wood Green was 1,282, and Mrs. Parnell appears to have visited 1,211 of these babies, of whom she reported that 854 were breast-fed. This first health visitor carried on her work of visiting mothers and babies in their homes unaided until 1915. when a qualified nurse was appointed. A maternity centre was opened at the same time in the School Clinic, White Hart Lane, by arrangement with the Education Committee, and the nurse attended there on two days each week, to interview expectant and nursing mothers, together with infants and children under school age. No doctor was in attendance but cases requiring medical advice were referred to the Medical Officer of Health, if a private doctor was not available. Attendances at this child welfare centre were so good that two years later a second centre was opened in the Congregational Church Hall, Lordship Lane. By 1919 there were three trained health visitors on the Council's staff and two more child welfare centres had been opened, and dental treatment for mothers and children under school age was being provided. Hospital accommodation for maternity cases had also been provided at the North Middlesex Hospital, by arrangement with the Edmonton Board of Guardians. In the previous year a day nursery had been opened at Stuart Villa to take the place of one which had been functioning for several years in Mayes Road. In 1920 it was apparently felt that the work of maternity and child welfare had made such progress—the attendances at the centres in that year numbered 16,953—that the Council decided to appoint a lady doctor to attend at the clinics. In March, 1921, Dr. Aileen Boyd-Mackay, was appointed part-time Assistant Medical Officer, to conduct one ante-natal and two infant welfare clinics per week. Dr. Boyd-Mackay continued to serve Wood Green both in child welfare and in school medical work for the next ten years, during which time the work of both these services made 13 steady progress. In 1928 a new child welfare centre was erected in White Hart Lane, to take the place of all the clinics held in church halls throughout the district, except that in Alexandra Park. In 1931 the first full-time Assistant Medical Officer for maternity and child welfare and school medical work was appointed, an appointment which made it possible to devote more time to these expanding services. In 1929 immunisation of children under school age, and of school children was commenced, and has been carried on ever since as a routine measure. For the past twenty years there has been a slow but steady development of the maternity and child welfare service. In 1938 four Council midwives were appointed by arrangement with Middlesex County Council, the local supervising authority under the Midwives Acts. In 1939 on the outbreak of war the day nursery at Stuart Villa was evacuated to Essex, and in 1942 and 1943 respectively, war-time day nurseries were opened at St. Michael's Infant School and in White Hart Lane. In 1947 a new child welfare centre was opened in Gordon Road, which has already proved very useful in the Bounds Green area. With the slow but steady development of the child welfare service, there has been a steady but very definite improvement in the state of the child population, in which it can be claimed that the medical and nursing staff of the Council have played some part. In their work they have been supported and encouraged at all times by the members of the Maternity and Child Welfare Committee, who have shown an active interest in the work. During the twenty years I have been associated with the work I have had as Chairmen of the Committee, Mrs. Bolster, Mrs. Duncan, Mr. Anderton, Mrs. Vant and Mrs. Harrison. To all these I have been much indebted for the keen interest they have shown in the work and the support they have always given to the efforts of the staff. I am also indebted to all the members of the Maternity and Child Welfare Committee, to the voluntary workers at the Welfare Centres whose help has always been of the very greatest value to the Health Visitors, and to all the staff of the Health Department, the Maternity and Child Welfare Centres, and the Day Nurseries. Statistical evidence of the success of the efforts of all concerned may be seen in the fact that the Infantile Mortality Rate, which in the year before the first health visitor was appointed was 103 per 1,000 live births, has exceeded 40 per 1,000 only once in the past 14 ten years, and has been as low as 27 in 1945 and 28 in 1947. Further reduction is still possible, but in the nature of things it cannot be very great, and the Maternity and Child Welfare Committee as it hands over its charge to its successors, may be well satisfied with the work which it has accomplished, and the results it has achieved. INFECTIOUS DISEASE. Table IV in the Appendix gives details of all the cases of infectious disease notified during the year. The total of 753 is higher than that of the previous year which was 671. It will be seen that measles with 410 notifications and whooping cough with 171, accounted for two-thirds of the cases notified. Only 10 cases of diphtheria were notified and for the eighth year in succession no death occurred from this disease in Wood Green, a highly satisfactory record. 46 cases of scarlet fever were notified without a death, and there were only two deaths in 410 notified cases of measles. 52 cases of pulmonary tuberculosis were notified with 17 deaths and 10 cases of non-pulmonary tuberculosis with 5 deaths. There were 34 notifications of pneumonia and 29 deaths from this disease. There were two cases of anterior poliomyelitis notified, both of which recovered, one completely without any resulting paralysis. DIPHTHERIA IMMUNISATION. Immunisation against diphtheria was continued as in former years, the number of children immunised for the first time being 926. 811 of these were under five years of age, the vast majority being immunised about the time of their first birthday, and 115 were at ages from 5 to 15 years. In addition 515 children who had been previously immunised received reinforcing injections, mostly at the time of admission to an infant school. The immunising material used in all cases was Alum Precipitated Toxoid, provided free by the Ministry of Health. SCABIES. All cases of scabies requiring treatment during 1947 were sent to the Hornsey Cleansing Station, by arrangement with the Hornsey 15 Borough Council, and a total of 57 cases were so dealt with. Of these, 9 were under school age, 24 were school children, and 24 were adults. The number dealt with in the previous year was 147. BACTERIOLOGICAL WORK. All the bacteriological work required for the Borough was carried out at the Central Public Health Laboratory, Colindale. The specimens examined during the year were as follows:— Positive. Negative Total. Diphtheria 25 168 337 Haemolytic Streptococci 137 Vincent's Angina 7 Faeces — 9 9 Sputum (for tubercle bacilli) 3 37 40 Pertussis — 4 4 172 218 390 In addition 66 Ice Cream samples were examined. DISINFECTION AND DISINFESTATION. The number of articles dealt with at the Disinfecting Station was as follows:— Articles disinfected 521 Articles destroyed 119 112 rooms were disinfected on account of infectious disease, and 149 disinfested on account of the presence of vermin. HOUSING. In common with most districts throughout the country there has been in Wood Green since the end of the war a very acute shortage of houses, partly due to destruction of property by enemy action, and partly to the high marriage rate following the war resulting in large numbers of young people desiring houses of their own. I am indebted to the Borough Surveyor for the following figures showing what has been done so far in Wood Green to meet the housing needs. 16 During 1947, 30 permanent houses were completed by the Council and 28 houses and 18 flats were in course of construction at the end of the year. 25 flats were provided by private enterprise during the year, and 17 houses and 6 flats rebuilt after bombing. During the year also, 91 prefabricated houses were erected, making with the 75 erected in 1946 a total of 166 prefabricated houses. WORK OF THE SANITARY INSPECTORS. The following tables give a brief summary of the routine work of the Sanitary Inspectors during the year:— Inspections and Re-inspections of dwelling houses:— Total 5,580 Enquiries in connection with Infectious Diseases:— Total 124 Inspections of registered premises:— Total 712 Miscellaneous Inspections:— Total 313 Work Carried Out:— Drains reconstructed Nil Drains repaired 131 New water closets 1 Water closets repaired 170 Premises cleansed, etc. 8 Rooms disinfested 149 Accumulations of refuse removed 5 Keeping of animals discontinued 1 Dampness in premises remedied 626 Houses repaired 607 Miscellaneous 357 Total 2.055 Investigations in connection with Housing Applications:— Total 849 Rent Restrictions Acts. Certificates granted under above heading during 1947:— Total 9 From the above tables it will be observed that a great deal of work is still carried out in connection with the repair and maintenance of dwelling houses in the district, although owing to the general shortage of materials and the necessity to obtain licences for work over £10 per annum, it is increasingly difficult to get such work done, and there is a much greater lapse of time between the discovery of defects and their ultimate remedy. 17 FACTORIES AND HOMEWORK. 1. Inspections. Premises. Number on Register Number of Inspections Written notices Occupiers prosecuted Factories without mechanical power 65 31 — — Factories with mechanical power 160 87 — — Other premises in which Section 7 is enforced by the local authority 2 2 — — Total 227 120 — — 2. Defects 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 3 3 — 3 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation 1 1 — 1 — Ineffective drainage of floors — — — — — Sanitary Conveniences: (a) insufficient — — — — — (b) unsuitable or defective 3 3 — 3 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork). — — — — — Total 6 6 — 6 — 18 3. Outwork. Nature of Work. No. of outworkers in August list No. of cases of default in sending lists to Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel: (a) Making, etc 84 — — — — — (b) Cleaning and washing — — — — Curtains and furniture hangings 2 — — — — — Furniture and upholstery 3 — — — — — Brass and brass articles 6 — — — — — Total.. 95 — — — — — WATER SUPPLY. The whole borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The following licences for the sale of milk under special designations have been granted:— Tuberculin Tested. Accredited. Pasteurised. 7 — 15 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. Tuberculin Tested. Accredited. Pasteurised. 3 — 4 (6) Ice Cream. During the year 66 samples of Ice Cream have been taken and submitted for analysis to the Central Public Health Laboratory, Colindale. 19 (c) Other Foods. The under-mentioned foodstuffs were certified as unfit for human consumption during the year :— lbs. Tinned Food. tins Meat 821¾ Meat 531 Fish 3,545½ Fish 436 Vegetables 6,460¼ Vegetables 302 Fruit 626 Fruit 111 Cheese 45 Evaporated milk 791 Flour 61 Dried milk 24 Sugar 42 Jam 80 Cakes, etc. 110 Soup, etc. 53 Sweets 43¼ 11,754¾ 2,328 Miscellaneous Items. Whelks 28 gals. Eggs 1,378 Fish cakes 280 Cake mixture, etc. 102 pkts. Fruit, vegetables etc. 85 jars Cakes, etc. 1,619 Cheese 72 boxes Meat pies 15 Synthetic Cream 11 gals. Rats and Mice (Destruction) Act, 1919. 598 premises have been inspected by the Council's Rodent Operator, and it was found necessary to carry out treatment in 143 of these. Two thousand and seventy-three visits were made. During the year two maintenance treatments of the soil sewers were carried out; one in April, and one in November-December. In April, 642 manholes were baited; in 88 of them a complete prebait take was registered, and in 235 a partial prebait take. In the November-December treatment, 203 complete prebait takes were registered and 54 partial takes. All the manholes in which prebait takes were registered were poison baited. The Public Health Department and the Borough Engineer's Department again co-operated in carrying through the sewer treatment, the Borough Engineer supplying the men to do the work. 20 APPENDIX. Table I. Vital Statistics of Wood Green, 1931-47. Year. Population estimated to middle of each year. Nett Births belonging to the District. Nett Deaths belonging to the District. Under 1 year of age. At all ages. Total No. Rate per 1,000 population. Illegitimate No. Total No. Rate per 1,000 live births. Illegitimate No. Rate per 1,000 illegitimate births. No. Rate per 1,000 population . (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 1931 54,520 719 13.2 30 32 44 2 66 549 10.1 1932 54,500 681 12.5 20 28 41 4 200 556 10.2 1933 54,210 601 11.1 24 32 53 2 83 565 10.4 1934 53,755 564 10.5 16 21 37 2 125 562 10.5 1935 53,470 570 10.7 22 27 47 1 45 529 9.9 1936. 53,620 700 13.1 23 38 54 0 — 588 10.9 1937 53,510 659 12.3 21 32 48 2 95 593 11.1 1938 53,190 652 12.3 17 25 38 1 59 540 10.1 1939 52,700 and 50,700 624 11.8 25 21 34 2 83 594 11.7 1940 46,230 605 13.1 42 23 39 3 71 737 15.9 1941 43,870 523 11.9 25 16 31 0 589 13.4 1942 44,840 704 15.7 29 25 37 1 34 573 12.7 1943 44,710 156 16.8 37 31 41 0 — 553 12.3 1944 44,060 824 18.7 46 26 31 5 108 564 12.8 1945 44,940 694 15.9 47 19 27 1 21 616 13.7 1946 50,680 986 19.4 48 34 34 2 42 629 12.4 1947 52,290 1,066 20.3 41 30 28 1 24 649 12.4 21 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1947. Birth-rate per 1,000 population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Births. All Causes. Typhoid and Paratyphoid Fevers. Smallpox. Measles. Soarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. England and Wales 20.5 12.0 0.00 0.00 0.01 0.00 0.02 0.01 0.09 5.8 41 126 County Boroughs and Great Towns (including London) 23.3 13.0 0.00 0.00 0.02 0.00 0.03 0.01 0.09 8.0 47 148 Smaller Towns (population 25,000-50,000 at Census 1931) 22.2 11.9 0.00 0.00 0.02 0.00 0.02 0.01 0.08 3.7 36 London 22.7 12.8 0.00 0.00 0.01 0.00 0.02 0.01 0.08 4.8 37 Wood Green 20.3 12.4 0.00 0.00 0.03 0.00 0.00 0.00 0.09 3.7 28 22 Table III. Causes of Death during the year 1947. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers — — Cerebro-Spinal Fever — — Scarlet Fever — — Whooping Cough — — Diphtheria — — Tuberculosis of Respiratory System 11 6 Other forms of Tuberculosis 2 3 Syphilitic Diseases 2 2 Influenza 1 4 Measles 2 — Acute Polio-myelitis and Polio-encephalitis — — Acute Inf. Encephalitis — — Cancer of Buc. Cav. and Oesophagus—Male 4 — Uterus—Female — 4 Cancer of Stomach and Duodenum 10 6 Cancer of Breast — 19 Cancer of all other sites 37 33 Diabetes 2 4 Intra-Cranial Vascular Lesions 39 40 . Heart Disease 89 102 Other Diseases of Circulatory System 11 11 Bronchitis 38 10 Pneumonia 24 5 Other Respiratory Diseases 3 6 Ulcer of Stomach or Duodenum 5 1 Diarrhoea under 2 years of age 3 1 Appendicitis 1 1 Other Digestive Diseases 13 4 Nephritis 10 6 Puerperal and Post-Abort. Sepsis — 1 Other Maternal Causes — 2 Premature Birth 6 1 Congenital Malformations, Birth Injuries, Infantile Diseases 8 4 Suicide 4 1 Road Traffic Accidents 2 0 Other Violent causes 1 2 All other causes 25 17 Totals 353 296 23 Table IV. Infectious Diseases Notified during the year 1947. Notifiable Disease. Cases Notified in Whole Borough. Total Cases Notified in each Ward. Total Cases removed to Hospital or Sanatorium. Total Deaths. At Ages—Years. AlexandraBowes. Town Hall. Noel Park. All Ages. Under 1 year. 1 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years. 65 & upwards. Scarlet Fever 46 1 11 17 11 1 2 — 3 — — — 24 11 11 33 — Diphtheria 10 — 3 2 1 — 1 2 1 — — — 2 8 — 10 — Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — Erysipelas 9 — — — — — — — 2 2 4 1 2 4 3 2 — Pneumonia 34 — — 4 — 1 1 5 5 5 6 7 14 14 6 8 29 Acute Poliomyelitis 2 — 1 — — 1 — — — — — — — 2 — 2 — Puerperal Pyrexia 3 — — — — 1 — 1 1 — — — — 2 1 3 — Pulm. Tuberculosis 52 — 1 1 — 5 11 14 12 4 2 2 23 11 18 35 17 Non-Pulm. Tuberculosis 10 — — 1 1 1 — 3 i 2 1 5 1 4 3 5 Malaria — — — — — — — — — — — — — — — — — Measles 410 9 208 178 8 2 3 2 — — — — 194 98 118 10 2 Whooping Cough 171 14 93 60 2 1 — 1 — — — — 75 47 49 5 — Ophthalmia Neonatorum 2 2 — — — — — — — — — — 2 — — 1 — Dvsentery 1 — — -— — — — — — — 1 — 1 — — — — Food Poisoning 3 — — — — I — — — — — 2 — — 3 — — Totals 753 26 317 263 22 14 19 25 27 12 15 13 342 198 213 112 53 24 Table V. TUBERCULOSIS. New Cases and Mortality during 1947. Age Periods. New Cases. Deaths. Respiratory, Nonrespiratory. Respiratory. Nonrespiratory. M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 1 — — — — — — — 5 — 1 1 1 — — — — 15 8 11 1 1 — — — — 25 11 9 — — 2 2 — — 35 10 6 2 1 1 2 1 — 45 3 1 1 — 2 1 — 1 55 3 — — 2 3 — 1 1 65 and upwards 2 — 1 — 3 1 1 — Totals 38 28 6 5 11 6 3 2 Above includes transfers (15) from other Distriots 5 non-notified tuberculosis deaths occurred.