BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1948. MALCOLM MANSON, M.C., G.M., M.A., M.D., D.P.H., Medical Officer of Health. Crusha & Son, Ltd.. (T.V.), Tottenham, Wood Green and Enfield. WOOD 30 BOROUGH OF WOOD GREEN PUBLIC HEALTH COMiMITTEE. Alderman E. J. Anderton, J.P. (Chairman). The Mayor, Councillor W. II. Evans, J.P. The Deputy Mayor, Councillor Major S. North. Alderman F. G. Holmes, J.P. Councillor J. W. Adams. Councillor J. S. Bamberger. Councillor Mrs. J. Cole. Councillor Mrs. S. L. Fowler. Councillor II. G. Hicklenton. Councillor J. J. Wren. MATERNITY AND CHILD WELFARE COMMITTEE. (up to the 4th July, 1948.) 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 1948. * Medical Officer of Health.—Malcolm Manson, M.C., G.M., M.A., M.D., D.P.H. *Deputy Medical Officer of Health.—Kathleen Mart Hart, M.D., D.P.H. Doctors employed on a Sessional basis at Infant Welfare Centres.— Dr. Y. L. James; Dr. J. Waterhouse; Dr. M. OwenFlood ; Dr. J. Humphrey. * 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. Medd, S.R.N., S.C.M.; Miss G. L. Shaw, S.R.N., S.C.M. ; H.V. Cert.; Miss P. C. Gould, S.R.N., S.C.M., H.V. Cert, (resigned November, 1948); Miss E. T. Conway, S.R.N., S.C.M., H.V. Cert. ; Miss A. M. Wigley, S.R.N., S.C.M., H.V. Cert, (appointed August, 1948). 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. (retired December, 1948.) Chief Clerk.—G. W. Jones. Assistant Clerks.—W. T. Gloster, G. Penberthy (Cert.R.San.Inst. and San. Insp. Joint Board, July, 1948). K. Overy (Cert.R.San.Inst, and San. Insp. Joint Board, July, 1948.) Mrs. G. Ogden, Miss B. Margrove. Clerks for Maternity and Child Welfare.—Mrs. L. Mackie ; Miss A. Elliott. 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. * Officers in respect of whom salary contributions are made under the Public Health Act by Exchequer Grants. Officers transferred to the Middlesex County Council on the 5th July, 1948:— Dr. K. M. Hart Miss F. Medd Miss G. L. Shaw Mr. G. W. Jones Miss E. T. Conway Mrs. L. Mackie Mrs. G. Ogden Miss A. Elliott Miss D. Kingdon. Mrs. I. A. Beale Mrs. L. Noakes 3 Public Health Department, Wood Green, N.22. September 7th, 1949. To the Mayor, Aldermen and Councillors, of the Borough 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 1948. So far as the general health of the community is concerned the year has again been a good one. Infectious disease has not been very prevalent, and for the ninth year in succession no death from diphtheria has occurred in Wood Green. The Birth Rate fell from 20.3 in 1947 to 15.1 in 1948, but the Death Rate at 9.8 was the lowest for twenty years. The Infantile Mortality Rate of 28 was the same as in 1947, and the lowest with one exception in the history of the borough. So far as the administration of the health services is concerned, 1948 has been a year of great change. Until 1945, when the Education Act, 1944, came into force, Wood Green Council had been for many years a Part III Education Authority, and the Medical Officer of Health was the Authority's School Medical Officer, responsible to it for the medical inspection and care of the school children. In 1945 when Part III Education Authorities ceased to exist, the medical inspection and the care of school children became the responsibility of the County Council acting through the Local Divisional Executive on which the Wood Green Council is strongly represented. In 1948 with the coming into force of the National Health Service Act, 1946, the Wood Green Council which had been actively engaged in Maternity and Child Welfare work for over 40 years, ceased to have any responsibility for this work, for which under the new Act, the County Council is now the responsible authority, acting by means of the Local Area Health Committee, 4 on which again the Wood Green Council is represented. It is true that the actual work of the Maternity and Child Welfare service is still carried on by the same personnel as formerly, but all the officers concerned are now, with the sole exception of the Medical Officer of Health, full-time officers of the County Council and no longer responsible for their work to the Wood Green Council. These two Acts, the Education Act, 1944, and the National Health Service Act, 1946, have very profoundly altered the responsibility of smaller authorities like Wood Green in health matters, and have taken away entirely all responsibility for the personal health services which they have administered for over 40 years. Whether this general movement away from small authorities to large authorities is a step forward or a step backward, particularly in such a service as Maternity and Child Welfare is a debateable question which can only be answered in time; but it is the case that it is viewed with considerable misgiving by many who have devoted much of their professional life to these services. But while much has been taken from Wood Green as a health authority, much still remains, and with its depleted staff consisting now of a Medical Officer (part-time) a general office staff and an efficient body of Sanitary Inspectors, the work to be carried on in environmental hygiene, house inspection and repair of defects, inspection and supervision of food, hygiene of factories and workshops, and control over infectious disease is still very considerable and of prime importance to the welfare of the community. 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 53,080 Number of inhabited houses (end of 1948) according to the Rate Books 13,571 Rateable Value, 1948 £533,434 Sum represented by a penny rate £2,178 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Live Births:— Total M. F. Legitmate 784 414 370 Birth Rate 15.1 per 1,000 Illegitimate 21 12 9 Still Births 21 11 10 Rate per 1,000 births 26. Deaths 520 261 259 Death Rate 9.8 per 1,000. Deaths from Puerperal Causes:— Nil. Deaths of Infants under 1 year of age:— All Infants 23 Rate per 1,000 Live Births 28.0 Legitimate 21 Rate per 1,000 legitimate Live Births 27.0 Illegitimate 2 Rate per 1,000 Illegitimate Live Births 95.0 Deaths from:— Cancer (all ages) 97 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) 2 Number of Births notified 812 Number of Births Registered in the Borough 239 POPULATION. The mid-year estimate of the population supplied by the Registrar-General is 53,080, an increase of 790 over that for the previous year. The increase is in part due to the increased housing accommodation provided during the past year and in part to the high birth rate in 1947. 6 BIRTHS. The number of live births registered during the year was 805 which corresponds to a Birth Rate of 15.1 per 1,000 of population. This is a very marked fall as compared with the previous year when the births numbered 1,066 and the rate was 20.3. The number of still-births was 21 and the Still-Birth Rate 26 per 1,000 births. In 1947 the Still-Birth Rate was 19.3. DEATHS. The number of deaths credited to Wood Green after the necessary adjustments had been made for inward and outward transfers was 520. This gives a Death Rate of 9.8 per 1,000 of population, which compares very favourably with the Rate for 1947 which was 12.4, and is the lowest rate recorded since 1928. Of the total of 520 deaths no fewer than 373 or 71 per cent. occurred at ages over 65. 95 deaths occurred at ages over 80, and 12 at ages over 90. The individual causes of death are given in Table III in the Appendix. It will be seen there that as in all recent years the chief cause of death is heart disease, which was responsible for 155 deaths. Other diseases of the circulatory system caused 19 deaths, and intra-cranial vascular lesions 50 deaths, so that in all 224 deaths out of a total of 520 were attributed to diseases of the heart and circulation. This very high proportion of deaths attributed to diseases of the heart and circulation, as I have stated in previous reports, 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, so that the number of deaths from heart disease reflects the progressive ageing of the population. The number of deaths due to respiratory disease, apart from pulmonary tuberculosis was 62. Pulmonary tuberculosis was responsible for 21 deaths and other types of tuberculosis for 5. There were 97 deaths from cancer. Only two deaths occurred from the principal zymotic diseases. There were no deaths from enteric fever, smallpox, scarlet fever, diphtheria, measles or whooping cough, but two from diarrhoea in children under two years. The Zymotic Death Rate was 0.03 per 1,000 of population. 7 INFANTILE MORTALITY. The number of deaths of infants under 12 months was 23, which gives an Infantile Mortality Rate of 28.5 per 1,000 live births. This rate was practically the same as that for the previous year which was 28.1 and only a little higher than that for 1945, 27.3 the lowest so far recorded in Wood Green. It compared favourably with that for the country as a whole which was 34 and with that of a group of towns of comparable size which was 39. Of the 23 infantile deaths, 5 occurred within 24 hours of birth, and 12 during the first month of life. Of the five deaths occurring within 24 hours of birth, two were of premature babies, and two of babies suffering from congenital defects. The neonatal death-rate i.e. the rate of deaths in the first month per 1,000 births was 15 the lowest so far recorded in Wood Green. The very special care given to premature babies in recent years, by maternity hospitals, and local authority midwives and health visitors is reflected to some extent at least in this low rate, and it is in its further reduction by such special care and also increased attention to the health of the expectant mother that we must look for still further improvement in the Infant Mortality Rate. MATERNAL MORTALITY. No deaths were reported during the year arising from conditions associated with childbirth, so that the Maternal Mortality Rate was nil. 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 Maternity and Child Welfare work in Wood Green ceased to be the responsibility of the Wood Green Council and passed over to the care of the Middlesex County Council, to be administered by the Local Area Health Committee for No. 2 Area of the County, of which Wood Green forms a part, along with Southgate, Frie???n Barnet and Potters Bar. The work of the service has however been carried on under the new regime by exactly the same staff as under the old, and as the care of its mothers and children —no matter what the administrative set-up may be—must still be 8 of the greatest interest to a local health authority like Wood Green. I am reporting here on the service in Wood Green for the whole year, and not only for the first six months of the year, when the Wood Green Council was still the responsible authority. CLINIC SERVICES. The following is a list of the various clinics held throughout the year, including those which serve both children under school age, and school children. White Hart Lane Centre. Morning. Afternoon. Monday Ante-natal Child Welfare. Tuesday Ante-natal Wednesday Ophthalmic Child Welfare. Thursday Immunisation Ophthalmic. Aural (alternate weeks). Friday Child Welfare Ante-natal. Alexandra Park Congregational Church Hall. Thursday Morning—Child Welfare. Gordon Road Centre. Morning. Afternoon. Monday Minor Ailments Tuesday Child Welfare. Wednesday Minor Ailments Thursday Ante-natal. Friday Minor Ailments Immunisation (alternate weeks). Stuart Villa. Morning. Afternoon. Monday Minor Ailments Dental. Dental. Tuesday Minor Ailments Dental. Dental—Mothers and Infants. Wednesday Gas Dental Session Dental. Thursday Minor Ailments Dental. Friday Minor Ailments Dental. Dental. Saturday Minor Ailments Dental. 9 From July until the end of the year Stuart Villa was closed for repairs and alterations, and the services normally provided there had to be carried out elsewhere. The Dental Clinic was transferred to the Medical Inspection Room at White Hart Lane New School. The Gas Dental Session was held at Gordon Road Centre, and the Minor Ailment Clinic at Noel Park School. Orthopaedic Clinics. Children requiring orthopaedic advice or treatment attend by appointment at the Southgate Orthopaedic Clinic in Bowes Road. Speech Therapy. Miss Turpin, the speech therapist, conducts clinics for children with speech defects, on four half-days each week at White Hart (Old) School. Notification of Births. The number of live births registered as belonging to Wood Green was 805, and the number notified under the Public Health Act, 1936 was 792, which is 98.4 per cent, of the registered births. Of the 805 births registered, the number which actually occurred in Wood Green was 239, all the others taking place in hospitals, nursing homes or in private dwellings outside the district. The following table shows where most of these outside births took place:— Nursing Homes 110 North Middlesex Hospital 241 Royal Northern Hospital 42 University College Hospital.. 20 City of London Maternity Hospital 14 Mothers Hospital, Clapton 106 Of the 239 births registered as taking place in the borough, 189 were attended by the Municipal Midwives. All the Midwives have been trained in gas and air analgesia, and carry the special equipment in their cars so that this service is available for any mother who has expressed a wish for it and been medically examined at the AnteNatal Clinic beforehand. 10 Child Welfare Centres. The total attendances at the Infant Welfare Sessions at the various centres are shown in the following table. 1948 1947 White Hart Lane 13,742 15,663 Alexandra Park 2,996 3,585 Gordon Road 3,934 588 Totals 20,672 19,836 The number of children brought to the Centres was 2,304, of whom 1,336 were infants under one year, and 968 children of from one to five years. The number of examinations of children carried out by the Medical Officers at the centres was 3,204, and of these 1,698 were of infants under one year, and 1,506 of children from one to five years. Of the 23 infant deaths which occurred during the year, in 10 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 and Friday afternoons and alternate Saturday mornings and at Gordon Road Centre on Thursday afternoons throughout the year. These Clinics are conducted by the Medical Officers assisted by the Midwives. For the past two years, blood examinations have been carried out in all expectant mothers attending for the first time, for the presence or absence of the Rhesus factor and also the Kahn Test. A note of the blood grouping, Rhesus condition and Kahn Test is given to each mother to be kept for future reference in case of need, and all Rhesus negative mothers are referred by arrangement, to the North Middlesex Hospital Maternity Department for observation and treatment in case of need. It is hoped that this systematic blood examination in pregnancy will be the means of preventing at least a few neo-natal deaths. 11 575 women attended the Ante-Natal clinics during the year and made the following attendances:— White Hart Lane Centre 3,254 Gordon Road Centre 904 In addition 127 mothers attended at White Hart Lane for postnatal examination, and 53 at Gordon Road. Premature Babies. Special cots and other 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 midwives whenever required. Of the 805 live births belonging to Wood Green in 1948, 28 or 3.5 per cent. were of premature babies, i.e. babies weighing 5½ lbs. or less at birth. Of these 16 were born in hospital and 12 at home. One died in a few hours, but all the others were alive at the end of a month after birth, and at the end of the year. Home Visiting. The most important duty which a Health Visitor is called on to perform is, in my opinion, to visit regularly in the homes of the mothers and children in her district. It is in these visits, more than in the clinic sessions, that she establishes the closest contact with the mothers and babies and is best able to act not only as professional adviser but as friend and guide. It is important therefore that as much time as possible be given to this side of the work. During the year the number of home visits paid was 6,976. Of these 468 were ante-natal visits to expectant mothers, 3,610 to babies under one year, and 2,898 to children of from one to five years. The Health Visitors have also continued to act as Infant Life Protection Visitors, visiting registered foster-mothers and fosterchildren at regular intervals. At the end of the year there were 6 foster-mothers and 9 foster-children on the register. In their work the Health Visitors have had as in former years the active co-operation of Inspector Martin of the National Society for the Protection and Care of Children in cases calling for his assistance. 12 Care of the Unmarried Mother and her Child. As in former years the help of the Social Welfare Worker of the Tottenham Deanery Association for Moral Welfare has been available to the department in dealing with cases of unmarried mothers and their children. This is usually in the direction of arranging admission of the mother to a suitable hostel, and helping her to look after her child. Where 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 necessitious expectant and nursing mothers attending the centres at a cost of £8 16s. 7d. (from January 1st to July 4th, 1948). In addition very good advantage was taken of the issue by the Food Office of cod liver oil, orange juice and vitamin tablets, and the local Food Office has kindly supplied me with the following information of supplies issued in Wood Green:— At Food Office. At Food Advice Centre High Road. Child Welfare Centres. Day Nurseries & Schools. Cod Liver Oil 6,680 12,274 2,939 482 Orange Juice 30,334 55,285 10,874 1,482 Vitamins 1,948 2,323 460 — Home Help Service. There was considerable development of this service during 1948 and in all 64 home helps were employed during the year. The number of confinements for which a home help was provided was 29, and assistance was provided in 206 homes on medical grounds. This is a very valuable service, very much in demand and to judge by the letters of thanks received for assistance provided, very much appreciated. Day Nurseries. The two Day Nurseries, St. Michael's and White Hart Lane have been full to capacity throughout the year and long waiting 13 lists for admission show that the demand is as great as ever. There is a prospect that the church authorities may require possession of the old infant school in which the St. Michael's Nursery is housed, and a request has been made to the County Council to take the necessary step to find a site for a new Day Nursery. The total attendances and the average daily attendance at the nurseries during the year were as follows:— Total attendances. Average Daily Attendance. White Hart Lane 12,140 45.1 St. Michael's 8,592 32.7 Diphtheria Immunisation. Diphtheria Immunisation Clinics have been held regularly throughout the year at Stuart Villa, White Hart Lane and Gordon Road. The total number of children immunised for the first time was 968 and in addition 54 children were immunised by private doctors. Re-inforcing doses were given at the clinics to 632 children who had been previously immunised, and 12 re-inforcing doses were given by private doctors. Immunisation has now been carried out regularly in Wood Green since 1929, and on the whole the state of immunisation of the child population is fairly satisfactory, although it is not as good as I would like to see it, of children under five years. Our records show that 59 per cent. have had a full course of immunisation, while of children from five to fourteen 78 per cent. have been fully immunised. So far as results go these must be regarded as satisfactory. For the ninth year in succession no death occurred from diphtheria in Wood Green, in 1948, and for the first time in our records no case of diphtheria occurred during the year in the Borough. INFECTIOUS DISEASE. Table IV in the Appendix gives details of all the cases of infectious disease notified during the year. The total of 762 cases is practically the same as in 1947 when it was 753 and as in that year 14 also two-thirds of the notifications were accounted for by measles 408 cases, and whooping cough 174 cases. In neither of these diseases was the infection of a very severe type, and no deaths were reported. There were 69 cases of scarlet fever notified, 42 of whom were admitted to hospital. There were no deaths from this disease. For the first time on record, no cases of diphtheria occurred in the Borough, and for the ninth year in succession there were no deaths from this disease. Anterior Poliomyelitis.—Although 1948 was not an epidemic year so far as this disease is concerned, five cases occurred in Wood Green in the months of June, July and August, as compared with two in the previous year when the disease was much more prevalent throughout the country. In one case—a young woman of 24 years— death occurred in an Isolation Hospital to which she had been removed from a general hospital. In the four remaining cases recovery took place completely in one case, and in two with some residual paralysis for which they are still under treatment at the Orthopaedic Clinic, while the fourth is still under treatment in hospital. Tuberculosis.—74 new cases of tuberculosis were notified, 65 pulmonary and 9 non-pulmonary, an increase of 12 over the previous year, when there were 62 cases, 52 pulmonary and 10 non-pulmonary. Death from pulmonary tuberculosis occurred in 21 cases, 13 male and 8 female, and from non-pulmonary tuberculosis in 5 cases, 2 male and 3 female. The death rate from tuberculosis of all forms was 0.49 per 1,000 of population, as compared with 0.42 for the previous year. From the information given in Table V it will be seen that the heaviest incidence of new cases was in the ages from fifteen to forty-five, and among females it was particularly high between fifteen and thirty-five. By arrangement with the North-West Metropolitan Regional Hospital Board, one of the Board's Mass X-ray Units functioned at the Alexandra Palace from October 26th to November 8th. The 15 number examined at all ages was 2,052, 1,206 male and 846 female. 79 of these were recalled for large film examination, 6 of whom did not keep the appointment. Of the 73 re-examined 41 were reported as perfectly well, and 32 referred for further investigation. SCABIES. All cases of scabies requiring treatment during 1948 were sent to the Hornsey Cleansing Station, by arrangement with the Hornsey Borough Council, and a total of 51 cases were so dealt with. Of these, 5 were under school age, 27 were school children, and 19 were adults. The number dealt with in the previous year was 57. 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 21 207 334 Haemolytic Streptococci 121 Vincent's Angina 4 Faeces 1 18 19 Sputum (for tubercle bacilli) 9 26 35 Pertussis 1 — 1 138 251 389 In addition 57 Ice Cream samples were examined. DISINFECTION AND DISINFESTATION. The number of articles dealt with at the Disinfecting Station was as follows:— Articles disinfected 432 Articles destroyed 73 123 rooms were disinfected on account of infectious disease, and 118 disinfested on account of the presence of vermin. 16 HOUSING. In Wood Green as in most other districts the housing conditions under which so many of the people live constitute the most serious of our public health problems. The general condition of a large proportion of occupied houses has deteriorated during the war years, partly as a result of war damage, and partly through the difficulty of carrying out necessary repairs, in spite of the efforts of the Council's Sanitary Inspectors. The high marriage rate since the war, and the very high birth rate in 1946 and 1947 have also caused a great increase in overcrowding, for which it is impossible at the moment to find an adequate solution. In a district which is practically completely built up, it is not easy to suggest clearance schemes, or largescale demolition of unsatisfactory houses, owing to the difficulty of rehousing the displaced families while demolition and rebuilding is being carried out. This is a problem, however, which will have to be faced in the near future. I am indebted to the Borough Surveyor for the following figures showing what has been done in housing during 1948. Council Houses Completed :— Tunnell Gardens 12 "Orlit" houses, completing this estate of 32 houses. Park Grove 26 "Orlit" houses, completing this estate of 26 houses. Park Court 18 flats. Council Houses in hand at end of year-.— Durnsford Road 12 "Orlit" houses. Palmerston Road 24 flats. Bounds Green Road 40 flats. Pellatt Grove 12 flats. Private Enterprise. 39 war-destroyed houses and flats were rebuilt during the year by private enterprise, and a further 21 houses and flats were under construction, giving 51 housing units completed, and 23 housing units in progress. In addition a block of 9 new flats was erected. 17 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 5,217 Enquiries in connection with Infectious Diseases:— Total 153 Inspections of registered premises:— Total 1,186 Miscellaneous Inspections:— Total 259 Work Carried Out:— Drains reconstructed 3 Drains repaired 101 New water closets 2 Water closets repaired 165 Premises cleansed, etc. 4 Rooms disinfested 118 Accumulations of refuse removed 6 Keeping of animals discontinued 1 Dampness in premises remedied 569 Houses repaired 500 Miscellaneous 354 Total 1,823 Investigations in connection with Housing Applications:— Total 302 Rent Restrictions Acts. Certificates granted under above heading during 1948:— Total 3 FACTORIES AND HOMEWORK. 1. Inspections. Premises. Number on Register Number of Inspections Written notices Occupiers prosecuted Factories without mechanical power 55 46 — — Factories with mechanical power 185 109 — — Other premises in which Section 7 is enforced by the local authority 2 2 Total 242 157 — — 18 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. By H.M. Inspector Inspector Want of cleanliness 1 1 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences: (a) insufficient — — — — — (b) unsuitable or defective 6 6 — 1 — (c) not separate for sexes — — — — — Other offences against the — — — — — Act (not including offences relating to Outwork). 3 — 3 — — Total 10 7 3 1 — 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. 75 — — — — — (b) Cleaning and washing — — — — — — Curtains and furniture hangings 1 — — — — — Furniture and upholstery 1 — — — — — Brass and brass articles 9 — — — — — Total 86 — — — — — WATER SUPPLY. The whole borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply. 19 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 — 16 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 57 samples of Ice Cream have been taken and submitted for analysis to the Central Public Health Laboratory, Colindale. 102 visits have been made to ice cream premises. (c) Meat and Other Foods. The undermentioned foodstuffs were certified as unfit for human consumption during the year:— lbs. Tinned Food. tins. Meat 97 Meat 356 Chicken 217 Fish 114 Fish 1,997 Vegetables 204 Vegetables 289 Fruit 122 Fruit 148 Evaporated milk 367 Fats 2¾ Jam 90 Cheese 12¾ Soup, etc. 42 Cereals 10 Dried egg 1 Nuts 13½ Cheese 1 Sugar 8 Puddings 2 Cakes, etc. 159 1,299 Sweets 61 Dried egg 14 Desiccated Coconut 437 3,466 20 Miscellaneous Items. Meat and Fish paste 23 jars Pickles, etc. 363 jars Meat Pies 211 Fruit, Vegetables, etc. 3 jars Fish Cakes 194 Cake mixture, etc. 183 pkts. Coffee 11 bottles. Cakes, etc. 682 Cheese 89 pkts. Eggs 1,534 (d) Inspection of Food Premises. The following visits have been made to food premises during the year, and where defects have been discovered the requisite steps have been taken to have them remedied. Butchers' shops 190 Dairies and milk shops 23 Fried fish shops 18 Ice cream premises 102 Stalls 70 Other food premises 221 Rats and Mice (Destruction) Act, 1919. 1,293 premises have been inspected, and it was found necessary to carry out treatment in 156 of these. Two thousand seven hundred and fifty-six visits were made. A maintenance treatment of the sewers was carried out in May and June when 641 manholes were prebaited; 294 of these showed a prebait take and were poison-baited. A second treatment was carried out in November and December when 306 of the 671 manholes prebaited showed a prebait take and were then poison-baited. As in past years the Public Health Department and the Borough Engineer's Department co-operated in carrying through the sewer treatment, the Borough Engineer supplying the men to do the work. 21 APPENDIX. Table I. Vital Statistics of Wood Green, 1931 -48. 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 44,710 756 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 1948 53,080 805 15.1 21 23 28 2 95 520 9.8 22 Table II. Birth-Rate, Death-Rate and Analysis of Mortality during 1948. 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. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 years). Total Deaths under1 year. England and Wales 17.9 10.8 0.00 0.00 0.00 0.00 0.02 0.00 0.03 3.3 34 126 County Boroughs and Great Towns (including London) 20.0 11.6 0.00 0.00 0.00 0.00 0.02 0.00 0.03 4.5 39 148 Smaller Towns (population 25,000-50,000 at Census 1931) 19.2 10.7 0.00 0.00 0.00 0.00 0.02 0.00 0.04 2.1 32 London 20.1 11.6 0.00 0.00 0.00 0.00 0.01 0.01 0.02 2.4 31 Wood Green 15.1 9.8 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.5 28 23 Table III Causes of Death during the year 1948. Causes of Death. Male. Female. Typhoid and Paratyphoid Fevers — — Cerebro-Spinal Fever — — Scarlet Fever — — Whooping Cough — — Diphtheria — — Tuberculosis of Respiratory System 13 8 Other forms of Tuberoulosis 2 3 Syphilitic Diseases 4 4 Influenza — — Measles — — Acute Polio-myelitis and Polio-encephalitis — 1 Acute Inf. Encephalitis — — Cancer of Buc. Cav. and Oesophagus—Male 3 — Uterus—Female — 4 Cancer of Stomach and Duodenum 10 7 Cancer of Breast 1 10 Cancer of all other sites 36 26 Diabetes 2 2 Intra-Cranial Vascular Lesions 19 31 Heart Disease 72 83 Other Diseases of Circulatory System 11 8 Bronchitis 21 12 Pneumonia 6 15 Other Respiratory Diseases 6 2 Ulcer of Stomach or Duodenum 3 5 Diarrhoea under 2 years of age 1 1 Appendicitis 1 — Other Digestive Diseases 5 2 Nephritis 3 6 Puerperal and Post-Abort. Sepsis — — Other Maternal Causes — — Premature Birth 3 — Congenital Malformations, Birth Injuries, Infantile Diseases 9 3 Suicide 5 1 Road Traffic Accidents 1 3 Other Violent causes 8 4 All other causes 16 18 Totals 261 259 24 Table IV. Infectious Diseases Notified during the year 1948. 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 69 — 12 40 9 5 — 1 2 — — — 35 20 14 42 — Diphtheria — — — — — — — — — — — — — — — — — Cerebro-Spinal Fever 3 — 1 — — — — 1 1 — — — 2 — 1 3 — Enteric Fever — — — — — — — — — — — — — — — — — Erysipelas 10 — — 1 — 1 — 2 — 2 3 1 5 3 2 1 — Pneumonia 15 1 3 — 1 — 1 3 1 1 1 3 7 7 1 2 21 Acute Poliomyelitis 5 — 1 2 1 — 1 — — — — — 2 2 1 5 1 Puerperal Pyrexia 2 — — — — 1 — 1 — — — — 2 — — 2 — Pulm. Tuberculosis 65 — 1 4 3 3 16 14 7 8 4 5 32 19 14 41 21 Non-Pulm. Tuberculosis 9 — — 1 1 — 2 2 — 2 1 — 3 2 4 2 5 Malaria — — — — — — — — — — — — — — — — — Measles 408 19 193 190 1 1 1 2 1 — — — 171 102 135 15 — Whooping Cough 174 21 96 55 1 — — 1 — — — — 83 35 56 10 — Ophthalmia Neonatorum — — — — — — — — — — — — — — — — — Dysentery 2 2 — — — — — — — — — — 2 — — 2 — Food Poisoning — — — — — — — — — — — — — — — Totals 762 43 307 293 17 11 21 27 12 13 9 9 344 190 228 125 48 25 Table V. TUBERCULOSIS. New Cases and Mortality during 1948. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. m. F. m. F. m. F. m. F. 0 — — — — — — — — 1 1 — — — — — — — 5 3 5 1 1 — — — — 15 6 12 1 2 — — — — 25 6 9 2 — 1 3 — 1 35 7 3 — — 2 1 — — 45 7 3 — 2 1 3 1 2 55 3 1 1 — 5 — 1 — 65 and upwards 4 1 — — 4 1 — — Totals 37 34 5 5 13 8 2 3 Above includes transfers (7) from other Districts. 3 non-notified tuberculosis deaths occurred.