Library BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health Year 1952 WM. CLUNIE HARVEY, md., d.p.h. Medical officer of health. WOOD 34 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1952 WM. CLUNIE HARVEY, m.d., d.p.h. Medical Officer of Health. Public Health Department, White Hart Lane (Old) School, Wood Green, N.22. 30th July, 1953. To The Mayor, Aldermen and Councillors of the Borough of Wood Green. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1952. It will be appreciated that Dr. Manson was Medical Officer of Health for Wood Green until his retirement on May 5th, 1952, and that he was therefore responsible for the work mentioned in this Report during the first four months of the year. The form taken by the Annual Report for 1952 is, broadly speaking, the same as that for previous years, except that I have taken the opportunity to comment specifically on several matters which in my opinion, should be brought to the notice of the Council. It will also be appreciated that the personal health services, i.e., the work carried out by the Maternity and Child Welfare Clinics, Immunisation, Vaccination and related matters, are carried out in Wood Green by the Middlesex County Council. It is generally understood that we should only comment on these services in an uncritical manner, as anything in advance of this would obviously be invidious. I am not suggesting in any way that the personal health services in Wood Green are unsatisfactory. As I am the Area Medical Officer, responsible for the day-to-day administration of the County Health Services operating within the Borough, i.e., the personal health services concerned, further comment will be unnecessary. None-the-less, it would be quite impossible to present a composite picture of the health of the community without including information relating to personal health services, and without linking up this work with environmental hygiene, for which the Borough Council is directly responsible. It is in many ways unfortunate that the present set-up, so far as local government is concerned, has divorced the personal health services from County Districts which were responsible for building up these services and whose record over so many years gives every reason for satisfaction. This has made it impracticable to include several paragraphs which were formerly a feature of the Medical Officer of Health's Report. We must abide by existing regulations, however, and hope that the contents of the Annual Report, although restricted, will still be of interest. It should not be thought from the remarks set out above that the work of the Public Health Department has dwindled to insignificance. This is very far from being the case. Although our work 3 may not be spectacular, and although it is sometimes difficult to see the results of that work over a limited period, we can still bring to bear a very significant influence upon the health, both of the community and of the individuals who make up that community. When it is remembered that the Public Health Department is responsible for all the work carried out by the Sanitary Inspectors, for epidemiology, in itself a vast and extremely important phase of preventive medicine, disinfection, rats and mice destruction, health education, to mention only the most important aspects of our work, it will be realized that the services which we provide, although reduced in number, nevertheless constitute an integral part of the life of our Borough. We must also remember that it is our duty to ensure that the standard of living in Wood Green is not allowed to deteriorate. This is never an easy matter in a fully built-up area, so near the heart of the metropolis. It will scarcely be necessary to point out that, although all the activities of the Borough Council are directed towards achieving this end, the work of our Sanitary Inspectors contributes materially to the same, very desirable object. So far as the health picture for 1952 is concerned, the pattern was pleasing. There were no major epidemics or outbreaks of infectious disease, except for the occurrence of a comparatively large number of measles cases, mostly of an extremely mild character. The Infantile Mortality Rate, i.e., the number of children dying within the first twelve months of life for every 1,000 births, was the lowest yet recorded in Wood Green, a state ment which gives me very great pleasure to be able to record. These matters will receive more detailed attention in the body of the report, but it can, meantime, be stated once again that 1952 was a placid, uneventful year, a state of affairs for which any district has every reason to be thankful. I should like to conclude this introduction by expressing my thanks to the Borough Council and to the Public Health Committee for their unfailing support and encouragement since I took up my position as Medical Officer of Health. I have been very conscious of this support and courtesy, which has assisted me greatly in my work. I should also like to express my thanks to the entire staff of the Public Health Department, especially to Mr. W. McCauley, Senior Sanitary Inspector, and Mr. W. T. Gloster, Chief Clerk. I have received the fullest and most whole-hearted co-operation from all members of my staff, a co-operation which made it easy for me to succeed my eminent predecessor, Dr. Manson. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, W. C. HARVEY, Medical Officer of Health. 4 BOROUGH OF WOOD GREEN PUBLIC HEALTH COMMITTEE Councillor E. W. Roberts (Chairman). Councillor R. V. Page (Vice-Chairman). The Mayor, Alderman A. R. Harrison, J.P. The Deputy Mayor, Alderman S. B. Cole. J.P. (Resigned 22.10.52). Alderman H. Barnes. (Resigned 24.9.52). Alderman Mrs. J. J. Bolster, J.P. Alderman F. Corbett, J.P. Councillor J. S. Bamberger. Councillor J. W. Barnett. (Appointed 24.9.52). Councillor G. Cathles. (Appointed 26.11.52). Councillor J. A. D. Greenfield. Councillor V. N. Jary. Councillor T. A. Jones. Councillor R. G. Kendall. (Appointed 24.9.52). Councillor J. J. Wren. (Resigned 24.9.52). STAFF during 1952 *Medical Officer of Health—Malcolm Manson, m.c., g.m., m.a., m.d., d.p.h. (Retired 5.5.52). *Medical Officer of Health—William Clunie Harvey, m.d., d.p.h. (Appointed 7.5.52). Deputy Medical Officer of Health—Effie Scott Stephen, m.b., ch.b., d.p.h. *Senior Sanitary Inspector—W. McCauley, Cert.R.San.Inst. and San. Insp. Joint Board, Cert. Meat and Food Inspection. (Appointed Senior 1.1.52). *Sanitary Inspectors—F. James, Cert.R.San.Inst. and San.Insp. Joint Board, Cert. Meat and Food Inspection; G. Penberthy, Cert.R.San.Inst. and San.Insp. Joint Board, Cert. Meat and Food Inspection (Feb., 1952); H. B. Parker, Cert.R. San.Inst. and San.Insp. Joint Board (Appointed 1.1.52). Chief Clerk— W. T. Gloster. General Clerks—Miss B. W. Bass (Resigned 9.2.52); P. V. Ingram (Permanent 1.1.52); Mrs. C. M. A. Moss, Shorthand Typist (Appointed 24.3.52). Rodent Operator—J. Harris. Disinfectors— H. Carlan, W. Woodcock. * Half the salaries of these Officers are paid by the Middlesex County Council under Section 109 of the Local Government Act, 1933. 5 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,607 Population—estimate supplied by the Registrar General 52,080 Number of inhabited houses (end of 1952) according to the Rate Books 13,883 Rateable Value, 1952 £545,360 Sum represented by a penny rate £2,226 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births : Total M. F. Legitimate 621 320 301 Birth Rate per Illegitimate 33 16 17 1,000 .— 12.5 Still Births 12 7 5 Rate per 1,000 Births 18.02 Deaths 602 289 313 Death Rate per 1,000 11.5 Deaths from Puer' peral Causes — Rate per 1,000 Births — Deaths of Infants under 1 year of age :— All Infants 14 Rate per 1,000 live births 21.4 Legitimate 12 Rate per 1,000 legitimate live births 19.3 Illegitimate 2 Rate per 1,000 illegitimate live births 60.6 Deaths from : Cancer (all ages) 121 Measles (all ages) — Whooping Cough (all ages) — Diarrhoea (under 2 years of age) 3 Number of Births notified 650 Number of Births registered in the Borough 137 POPULATION The mid-year estimate of the population supplied by the Registrar'General is 52,080, a decrease of 320 from that of the previous year. Although the child population of Wood Green is still relatively high, there can be little doubt that the population as a whole is ageing. This distribution of age groups in the community gives rise to very definite problems, some of which will be discussed later in this report. 6 BIRTHS The number of live-births registered during the year was 654, corresponding to 12.5 per 1,000 of population. This is very slightly higher than the rate for 1951, which was 12.4. There were 12 stillbirths, giving a still-birth rate of 18.02 per 1,000 births. In 1951, the still-birth rate was 18.3. DEATHS The number of deaths credited to Wood Green after the necessary adjustments had been made for inward and outward transfers was 602, giving a crude death rate of 11.5 per 1,000 of population and a corrected death rate of 10.9. This is a decrease of 113 from the total of the previous year, when the death rate was 13.6. Of the total of 602 deaths, no fewer than 414 or 69% occurred at ages over 65. One hundred and twenty-seven deaths occurred at ages over 80, and 19 at ages over 90. INQUESTS Twenty inquests were held following the deaths of Wood Green residents during 1952, two of these without post-mortem examination. A further 131 post-mortem examinations were carried out without an inquest, seventy-four of these in the Prince of Wales Hospital which, by arrangement with the Wood Green Borough Council, has provided mortuary services since the Wood Green mortuary was closed in 1945. MATERNAL MORTALITY No deaths occurred during the year as a result of childbirth. Only two maternal deaths have occurred in Wood Green over the past five years, during which time 3,508 births took place. This is very encouraging, and compares most favourably with the situation which we remember so well before the war. 7 INFANT MORTALITY There were 14 deaths of infants under one year of age, giving an Infant Mortality rate of 21.4 per 1,000 live-births. This com' pares with a total of 21 deaths, and an Infant Mortality rate of 32 in 1951. The Infant Mortality rate for 1952 is the lowest yet recorded in Wood Green. It must be appreciated, of course, that with such a few number of deaths, it would be extremely dangerous to draw significant conclusion from the figures for one year. It is, however, at least satisfactory to obtain evidence which seems to indicate that the services built up by the Borough Council and now implemented by the County Council are functioning on adequate lines. Of the 14 infant deaths, two occurred within 24 hours of birth, eight during the first week, and ten during the first four weeks of life. This gives a Neo-natal Mortality rate of 15. The corresponding figure for 1951 was 23. Of the two deaths occurring in the first 24 hours, both were due to birth injuries. The following table shows the causes of death at various ages under one year: Cause of Death Under 1 week 1 to 2 weeks 2 to 3 weeks 3 to 4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under One Year Prematurity - - - - - - - - - - Congenital Defects 1 1 - - 2 - - - - 2 Atelectasis 3 - - - 3 1 - - - 4 Gastro-enteritis 1 - - - 1 - - - - 1 Intra-cranial Haemorrhage 3 — - - 3 - - - - 3 Capillary Bronchitis — — - - — 1 1 - - 2 Asphyxia Neonatorum - - - - - - - - - - Icterus Gravis Neonatorum - - - - - - - - - - Volvulus - - - - - - - - 1 1 Whooping Cough — - - - - - - - - — Broncho-pneumonia — 1 — — 1 — — - — 1 Total 8 2 — - 10 2 1 — 1 14 8 GENERAL PROVISION OF HEALTH SERVICES Hospitals So far as admission to hospital is concerned, most difficulty is being experienced in regard to chronic, elderly sick. Admission to hospital of such cases has become more and more difficult each year, due almost entirely to acute staffing difficulties in hospitals. To the substantial number of cases met with almost every week, we must add the growing number of infirm, elderly persons who require care and attention in some type of institution or home, although they may not be suffering from any specific illness and may therefore not require actual treatment in hospital. It will be appreciated, of course, that the admission to hospital of sick persons, and the admission to a home or institution of an elderly individual, is not a matter which rests with the Borough Council, unless we have to take action under Section 47 of the National Assistance Act, 1948. The Public Health Department is nevertheless keenly interested in the welfare of these most unfortunate persons and never hesitate to take such action as is possible to alleviate their unhappy position. Thus, we co-operate very closely with the Area Health staff in seeking the provision of Home Helps and Home Nurses. We also co-operate with voluntary bodies, particularly the Wood Green Old People's Welfare Committee, and support general practitioners in their approach to hospitals. Quite recently, I became a member of a liaison committee set up under the auspices of the North Middlesex Branch of the British Medical Association. This committee has been considering the admission to hospital of elderly, chronic sick, and I have hopes that the outcome of its deliberations will improve what can only be described as a most unsatisfactory situation. Anything we can do at the moment is purely palliative, and does not present any hope of a permanent solution. The answer seems to lie very largely in the setting up of more geriatric units in our large hospitals, and the attraction of more recruits to the nursing profession. Further homes provided by the County Council are also required. As I have already stated, these are not matters over which the Borough Council has direct control. The Borough Council will still obviously be interested in the position, and will, I feel sure, be only too glad to press for measures which should assist perhaps the most unfortunate section of the community. It is pleasing to be able to record that the difficulty in obtaining admission to hospital of confinement cases has now very appreciably eased, since the difficult days immediately following the war. It is equally satisfactory to place on record the fact that admission to hospital of cases of infectious disease has worked very smoothly. 9 The infectious disease picture has changed materially over the past few years. This has eased the strain of hospital beds, although staffing problems are still acute. The principle which we now adopt in regard to the admission of cases of infectious disease to hospital can be briefly stated. Broadly speaking, admission to hospital is recommended in the case of patients for whom con' tinuous nursing and medical attention are required, or where the danger of complications and sequalæ is likely to arise. So far as mild infectious diseases are concerned, we do not press with admission to hospital unless suitable isolation cannot be provided in the home, or unless the employment of a bread-winner is affected. For practical purposes, 'suitable isolation' is defined as the availability of a room for the patient's sole use. General practitioners in the district co-operate most cordially in the application of these principles. Laboratory Facilities Summary of work carried out at Central Public Health Laboratories for the year 1952 : Positive Negative Swabs for diphtheria bacilli — — Sputa for tubercle bacilli 2 13 Throat and nose swabs 159 Faeces 155 Urine — Blood 7 Others 32 Ice Cream 77 Milk 27 Water (Swimming Pool) 3 Those who remember the pre-war days before the facilities offered by the Central Public Health Laboratory Service were available, are deeply appreciative of the speedy, effective services which we obtain from the Laboratory Service. Not only can we send specimens to the laboratory at any time; we can also call upon the laboratory for advice and practical assistance in the bacteriological study of an outbreak. This is an extremely valuable service, which has already proved its worth on several occasions. 10 NATIONAL ASSISTANCE ACT, 1948 (National Assistance Amendment Act, 1951) Section 47.-—Removal to suitable premises of persons in need of care and attention. No action was taken by the Council in 1952 under this section. NATIONAL ASSISTANCE ACT, 1948 Burial or Cremation of the Dead Under Section 50 of this Act, it is the duty of a local authority to arrange for the burial or cremation of any person who has died in the district where no suitable arrangements for the disposal of the body have been or are being made otherwise than by the authority. During the year, two burials were carried out by the Council. There were no such cases during the previous year. 11 SANITARY SERVICES Inspections and re-inspections of dwelling-houses :— Total 3,143 Enquiries in connection with Infectious Disease Total 205 Inspections of registered premises :— Total 1,593 Miscellaneous Inspections :— Total 438 Work carried out: Drains reconstructed 4 Drains repaired 89 New water closets 2 Water closets repaired 105 Premises cleansed, etc 4 Rooms disinfested 84 Accumulation of refuse removed 5 Keeping of animals discontinued — Dampness in premises remedied 323 Houses repaired 392 Miscellaneous 167 Total 1,175 Rent Restrictions Acts Certificates granted under the above heading during 1952 : Total 1 Repairs to Houses Repairs have been carried out at 532 houses during the year, principally following complaints from the occupiers of the houses. For the most part the work has been done after service, by the Sanitary Inspectors, of preliminary notices, but in 35 cases, statutory notices under the Public Health Act, 1936, or the Housing Acts, 1936/49, were served upon the owners after failure to comply with the preliminary notices. In three instances it was found necessary for legal proceedings to be taken against the owners and Court Orders were obtained, with costs. The required work has since been executed by the owners. Repairs to eight houses were carried out by the Council in the owners' default of statutory notices served under Section 9, Housing Act, 1936. The cost of these works is recoverable from the owners. 12 Of the 532 notices complied with, the repairs found necessary at 218 houses were of an extensive kind, and included such work as the provision or renewal of damp-proof courses, site concrete, eaves gutters, and rainwater pipes, major roof repairs, and renewal of flooring, and wall and ceiling plaster. Work of a less extensive character was required at the remaining 314 houses. Housing Applications The task of visiting housing applicants and the preparation of reports on their living conditions has been discontinued, with the exception of certain cases where information is required by the Council's Housing Officer, or by Housing Departments of outside districts, when a Wood Green resident is an applicant on their housing list. Several such visits were made by the Sanitary Inspectors during the year. Food Hygiene During the year 1,062 visits were made to food premises in the Borough, as against 1,157 in 1951. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. During 1953 it is hoped that we will be able to hold a Clean Food Month, probably in October. The object of this Clean Food Month will be to stimulate interest in food hygiene, both among food-handlers and among the general public. Owing to the present financial position, we can no longer obtain the whole-hearted assistance of the Ministry of Agriculture & Fisheries in staging a large food exhibition. I still feel, however, that there are many other activities which we can successfully include in our programme. These activities comprise the setting up of a Clean Food demonstration, probably in White Hart Lane (Old) School, talks, demonstrations and film shows to food-handlers and to any organizations in the Borough who wish to make use of the facilities available, co-operation in the Local Government Exhibition at the Gaumont Cinema, to be held from 19th October to 30th October, distribution of special bookmarks through our libraries, articles and advertisements in the local press, notices for food shops relating to the admission of dogs, display of posters, pamphlets, etc. It is not claimed that our projected effort will be either spectacular or unduly ambitious, but I do feel that a Clean Food Month of this nature will provide a useful stimulus which may have lasting effects. The cost will not be heavy, and should not exceed ,£100. 13 It will be understood that an effort such as that described above is additional to the regular programme of health education in food hygiene carried on throughout the year. Thus, our Sanitary Inspectors endeavour to carry out a policy of health education whenever they visit food premises, while quite a number of talks are given during the year on the important topic of clean, safe food. The importance of these efforts need not be stressed. There is no reason to believe that the standard of hygiene in Wood Green gives cause for alarm. Even allowing for this, it is no less than our duty to raise existing standards by every means possible, to supply information to all classes of the community, and to see that everything is being done to safeguard the food supply in all places and at all times. Altogether, we try to keep the matter of food hygiene constantly before the public, as this subject is not one which we can ever afford to neglect. 14 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 Sterilised 14 1 19 36 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority. Tuberculin Tested Accredited Pasteurised Sterilised 11 — 12 13 Twentyseven samples of milk were submitted for examination during the year and all of these conformed to the standards under the Milk (Special Designations) Regulations, 1949. (b) Ice Cream There are 11 premises registered for the manufacture of Ice Cream in the district, and 103 premises registered for retailing Ice Cream. During the year 193 visits were paid to these premises, and 77 samples were submitted for bacteriological examination. Of these samples 60 were Grade I 4 were Grade II 7 were Grade III 6 were Grade IV (c) Meat and Other Foods The under-mentioned foodstuffs were certified as unfit for human consumption during the year:— lbs. Tinned Food Tins Meat 671 Meat 391 Fish 525¾ Fish 29 Dried Fruit 328¾ Vegetables 260 Cheese 16 Fruit 470 Nuts 1,568 Evaporated Milk 78 Cakes, etc. 2½ Jam 112 Sweets 13½ Soup 34 Biscuits 137 Glace Cherries 14 Bacon 6 3,282½ 1,374 15 Miscellaneous Items Eggs 1,837 Meat and Fish Paste 1 Fish Cakes 104 Cakes, etc 268 Cake Mixture, etc. 15 packets Biscuits, etc. 168 packets Meat Pies 14 packets Milk 6 packets Cream 24 packets Gherkins 24 Fruit and Vegetables 4 jars Cheese 10 packets Beverages 1 packet Condiments 50 bottles Miscellaneous Packets 122 packets Cereals 6 packets (d) Inspection of Food Premises The following visits were made to food premises during the year, and where defects were found the requisite steps have been taken to have them remedied. Butchers' Shops 210 Dairies and Milk Shops 59 Ice Cream Premises 193 Fried Fish Shops 42 Stalls 66 Other Food Premises 492 Middlesex County Council Act, 1950. Section 11.-Registration of Hawkers of Food. Fifty-eight hawkers of food in the borough are registered. Rodent Control Out of a total of 1,566 premises inspected throughout the year, it was found necessary to carry out treatment in 143 of them; 115 dwelling houses and 28 other premises were treated for rat infestation; a further 13 dwelling houses and 8 other premises were treated for the presence of mice. Where there is suspicion or evidence that the rats are coming from defective drains, the Sanitary Inspector is informed, a test with the smoke testing machine applied, and any necessary action taken. 16 Two maintenance treatments of the soil sewers were carried out, one in June and one in November—December. Of 672 manholes baited in June, 289 showed part poison takes. At the request of the Ministry of Agriculture and Fisheries, the second treatment was on the modified system, i.e., 16 ozs. of poison bait was laid in each manhole showing complete take of 8 oz. pre-bait. Of 319 manholes showing pre-bait take 100 showed complete pre-bait take and these latter treated with 16 oz. poison baits, bread rusk and arsenic being used. There were 292 manholes showing part-take poison baits, but none with complete takes. The sewer treatment was carried out in co-operation with the Borough Engineer and Surveyor's Department. The Public Health Department employs a whole-time rodent operator who made 2,909 visits to premises during the year. Ponds and Rubbish Dumps These are regularly inspected with the object of preventing the breeding of insect pests. The pond in White Hart Lane is emptied and cleansed periodically by the Borough Engineer and Surveyor's Department, whilst that at Alexandra Palace is supervised by the Alexandra Palace Trustees. Public Conveniences Sixteen public conveniences are available in the borough, situated as follows:— Lordship Lane. Station Road. Albert Road. Town Hall Park. Chapmans Green Recreation Ground. White Hart Lane Recreation Ground. Albert Road Recreation Ground. "King's Arms" Hotel, N.22. "Nightingale" Hotel, N.22. "Prince of Wales" Hotel, N.22. "Alexandra" Hotel, N.22. "Duke of Edinburgh," N.22. "Springfield" Hotel, N.ll. "Ranelagh" Hotel, N.ll. The "Nag's Head," N.22. "Alexandra Park" Hotel, N.22. 17 Conveniences provided by the London Transport Executive are also available to the public at Bounds Green Underground Station. Regular inspections of all public conveniences are made by members of the Public Health Department staff. These inspections include conveniences in our parks and open spaces and those provided for the use of the public in hotels and public houses. Defects are reported to the Borough Engineer and Surveyor's Department or are brought to the notice of the proprietors of the premises in which the public convenience in question is situated. 18 FACTORIES AND HOMEWORK 1. INSPECTIONS Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories Without mechanical power 40 29 — — Factories With mechanical power 183 195 6 — Other Premises in which section 7 is enforced by the local authority 2 2 — — Total 225 226 6 — 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 1 1 - - - Overcrowding — — — — - Unreasonable temperature - — — — - Inadequate ventilation — — — — - Ineffective drainage of floors - - - - - Sanitary conveniences — - — — - (a) insufficient 1 1 — — - (b) unsuitable or defective 6 6 - - - (c) not separate for sexes 4 4 - - - Other offences against the Act (not including offences relating to outwork) 6 6 - 5 - Total 18 18 — 5 — 19 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: Making, etc. 12 - - - - - Household linen 1 — — — — - Lace, lace curtains and nets 1 - - - - - Curtains and furniture hangings 3 - - - - - Artificial flowers 7 — — — — — Feather sorting 15 — — — — — Cosaques, Christmas Crackers and stockings 28 - - - - — Total 67 — — — — — WATER SUPPLY The whole borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Three premises in the Borough are registered under the above Act. The premises are periodically visited and during the year, six samples were taken and sent for analysis; in each case the result was satisfactory. PET ANIMALS ACT, 1951 Under this Act, which came into operation on the 1st April, 1952, eight licences were issued, after the premises were inspected and found to be satisfactory. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Four existing licences under the Middlesex County Council Act, 1950, were renewed during the year. HOUSING The Borough Surveyor has kindly supplied me with the following figures showing the number of houses which have been erected or rebuilt during the year. 20 Council Flats completed :— 10 at Bounds Green Court 6 at Marlborough Court Council Flats in course of construction at end of year :— 26 at Clarence/Trinity Roads 28 at Lordship Lane/Ellenborough Road Private enterprise:— Six flats were built by private enterprise at junction of Palace and Edith Roads. SWIMMING BATHS The figures of attendances at Western Road and Durnsford Road baths for the past two years are as follows : Western Road Baths 1952* 1951 Swimming Bath 12,72'1 40,677 do. Children (special sessions) 72 982 Children from Schools 2,898 26,023 Spectators 1,612 4,316 Slipper Baths 42,063 43,134 do. Old age Pensioners (free) 639 381 * Swimming pool closed for repairs from 1st May to 31st October. Durnsford Road Open Air Bath 1952 1951* Swimmers—Adults 18,795 1,384 Swimmers—Children 35,926 5,810 Children from Schools 1,911 — Season Ticket Holders 35,633 — Spectators—Adults 6,444 1,082 do. —Children 1,177 404 * The Pool was only open from 11th August to 30th September in 1951. Samples of the water were taken from both baths at regular intervals during the year. The results of the tests were uniformly satisfactory. There is no doubt that the facilities provided at our swimming baths represent an extremely valuable health amenity. A visit to a swimming bath, particularly an open-air swimming bath during the summer months, not only provides pleasant relaxation : it enables the visitor to build up reserves of strength which will be of great value during the coming winter. When we remember the state of purity of the water, together with the standard of 21 cleanliness maintained in our baths, parents can be safely recommended to send their children, in the assurance that they will almost certainly benefit. Every now and again, one receives a query as to the safety of visiting a swimming bath, particularly an open-air swimming bath, where poliomyelitis is about. The answer is very simple. Unless and until specific instructions are issued, parents need have no fear on this count. We watch the situation very carefully during the summer months, and will have no hesitation in issuing such instructions when circumstances are thought to warrant it then. Up to the present, such action has not been necessary. COLLECTION AND DISPOSAL OF REFUSE The Borough Engineer and Surveyor, who is responsible for this service, reports as follows :— (a) Household refuse is collected weekly by vehicles operated on the relay system. (b) Kitchen waste is collected daily from bins distributed at strategic points throughout the Borough. (c) Trade and Special refuse is collected as and when required. Nine 12 cubic yard capacity Scammell Containers and two Mechanical Horses are used for collection of Household refuse; one special Scammell Container and Mechanical Horse for Kitchen Waste, and one Bedford Lorry for Trade and Special refuse. During the year 1951/52 the total tonnage of refuse collected was 11,365 tons; from this, material salvaged was sold for £4.727 18s. 4d. The quantities of salvage were:— Tons Cwts. Qrs. Paper 265 12 0 Gullet 6 9 2 Metals 2 17 2 Mixed Scrap Iron 15 18 3 Rags 7 16 2 In addition 879 tons 19 cwts. 2 qrs. of Kitchen Waste was collected and sold for £2,913. The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths. 22 Prevalence and Control of Infectious Diseases From the table of infectious diseases set out on page 39, it will be seen that 740 cases were notified during 1952, as against 916 in 1951. This gave an Infectious Sickness Rate for the district of 14.2, as compared with 17.4 during the previous year. As has been the case for several years, measles and pertussis (whooping cough) noti' fications made up more than half the total. It has become more and more obvious since the war that the infectious diseases picture has been changing materially. Thus, although measles is still as prevalent to-day as it was fifty years ago, the disease is very much milder. Complications and disturbing sequalae are relatively rare, while the fatality rate has also been reduced. There is some evidence that pertussis (whooping cough) is also less severe, although this is not so marked as in the case of measles. When we come to consider scarlet fever, we find that the case-rate has not fallen, although the disease is very different indeed from the severe illness of pre-war days. The older, serious type of scarlet fever with the danger of nephritis, adenitis and other serious and trying disorders, is almost unknown today. Indeed, as I have stated on many occasions, it is extremely doubtful whether this particular disease should continue to be notified. Very often the patients are recovering or have actually recovered by the time notification is received, while it is now known that infection lasts for a very much shorter time than was previously thought to be the case. For this reason, exclusion of contacts from school for even a week is of very doubtful value. As will also be known, diphtheria has practically disappeared from the list of common infectious diseases. Such diseases as typhoid and para-typhoid fever are also relatively uncommon, while erysiplas and pneumonia, although still met with, no longer hold the terrors for which they were once feared. On the other hand, we are faced today with an increase in the type of disease caused by viruses. The most important of these are probably acute anterior poliomyelitis (infantile paralysis) and virus influenza. We have still a lot to learn about viruses, although our knowledge is rapidly increasing. In the meantime, we must remember the part which viruses now play in the infectious diseases picture, and be prepared to set up an adequate resistance. As the Council will be aware, the study of the control and spread of infectious disease is described as epidemiology. Not so very long ago, epidemiology was virtually confined to communicable diseases. We now realize that the scope of epidemiology goes a great deal further than that. We must discipline ourselves to study the causes of disease generally in our district, and to try to eliminate 23 any factor or factors which encourage the origin or spread of infection and disease. In other words, epidemiology can now be taken to cover all the various and widely differing factors with which lack of health is known to be associated. When we remember that housing in one form or another, underlies and materially affects many such factors, it will be seen that it is much easier to make a statement such as this than to carry it into practical effect. None the less, the Public Health Department will continue to investigate the matter from the widest possible angle, and will bring to the notice of the Public Health Committee any condition or conditions which can and should be remedied. That is one of the reasons why I have made it a practice to comment each month on epidemiology in my report to the Public Health Committee. I trust that the practice meets with approval. Diphtheria For the fifth year in succession, no case of diphtheria was notified in the borough. The last death from diphtheria took place in 1939. These figures are evidence of the remarkable change in respect to this disease which has come about within recent years. Few will deny that the great increase in the popularity of immunisation has been largely responsible for this happy state of affairs. It is not, of course, claimed that immunisation alone has produced this transformation. We know, however, that the decline in the incidence and fatality of diphtheria has been coincident with the extension of immunisation within these islands. Although immunisation against diphtheria is the concern of the Middlesex County Council in Wood Green, I feel sure that thg Borough Council would wish to be aware of the steps which are being taken to implement this policy in the borough. Very briefly, the measures now adopted are as follows: 1. Immunisation is available each week at White Hart Lane Clinic and at Gordon Road Clinic. Immunisation against diphtheria, pertussis (whooping cough), or diphtheria and pertussis combined is carried out at these clinics, while reinforcing ("boosting") injections are also given. Mothers are encouraged to avail themselves of the facilities offered. The choice of immunisation, i.e. diphtheria alone or combined inoculation, is left entirely to the decision of the mothers, although the Health Visitors and Assistant Medical Officers concerned naturally give such advice as appears desirable. 2. All maintained and private schools in the borough are visited once each year. These visits are mostly for the purpose of carrying out reinforcing ("boosting") injections, although children requiring immunisation for the first time also receive attention. 24 Parents receive a letter once each year, informing them of the proposed school visit so that they may be present if they so desire. The letter also reminds parents of the value of immunisation. This letter brings the value of immunisation to the notice of every Wood Green parent at least once every twelve months, and enables the Area Health Office to offer reinforcing injections (required every four to five years) to all children throughout their school life in Wood Green. The latest figures would appear to show that 84% of Wood Green school children have been fully protected against diphtheria by immunisation, 66% of children under the age of five have also been protected. The continued absence of diphtheria from the borough would indicate that our present policy is having the desired effect. 3. Apart from our yearly letters to the parents of school children, propaganda advocating immunisation is carried out by the display of leaflets at our Welfare Centres and in the Public Health Depart' ment, by occasional articles in the Press, during talks to local organizations and parent/teacher associations, and by the advice of the Middlesex County Council Health Visitors, both in the clinic and in the home. This continuous policy of health education is reinforced approximately once each year by a short, more extensive campaign sponsored by the County Council. 4. Apart from the immunisation carried out by the Area Health Staff, similar protection can be supplied by most family doctors. Material for immunisation against diphtheria is supplied free of charge through the Area Health Office. During the year, 560 children were immunised for the first time in Wood Green. Two hundred and fifty-five of these children were immunised against diphtheria only, 305 being immunised against diphtheria and pertussis. During the same period, 1,844 children received reinforcing injections. As already indicated, immunisation is carried out in Wood Green by the Middlesex County Council. As Area Medical Officer, I have put forward certain suggestions based on recent scientific advances to extend our scheme, mainly in the direction of offering immunisation for the first time at an earlier age, and enlarging the protection afforded by combined inoculation against diphtheria and pertussis. The Borough Council can be assured that immunisation against diphtheria, either alone or in conjunction with pertussis, is constantly under review, and that it is being actively pursued in Wood Green. 25 Scarlet Fever Ninety-three cases of scarlet fever were notified during 1952, as against 196 in 1951. No deaths occurred during the year. It will be seen that notifications fell considerably during the year, although the total number of cases notified during 1952 approximated to the average for the past fifteen years. As noted in the introduction to this section of my report, scarlet fever is now a very mild disease, with rapid recovery, in almost all cases, few complications and little epidemiological significance. It now seems quite anomalous that cases of severe tonsillitis due to the hemolytic streptococcus are not notifiable and need not be excluded from school, while cases of scarlet fever, due to the same organism receive a great deal of attention, merely because they are accompanied by a rash. I have been of opinion for a number of years that our outlook towards scarlet fever should be modified, and that an overhaul of our present system of exclusion from school and supervision of contacts in regard to this disease is long overdue. Acute Anterior Poliomyelitis Three cases of acute anterior poliomyelitis (infantile paralysis) occurred during 1952, against one during 1951. Two of the cases were paralytic, although the patients were not severely affected. In each of these two cases, slight paralysis has persisted. The third patient made a complete recovery. All the cases were children. It has not been found necessary to issue any special instructions to the general public relating to the prevalence of poliomyelitis. One must be extremely careful in regard to this type of publicity, which may give rise to unnecessary alarm, without achieving any useful purpose. The position is constantly reviewed, not only so far as notifications in Wood Green are concerned, but also in respect of cases occurring in surrounding districts. Measles Four hundred and forty-nine cases of measles were notified during 1952, as against 434 in 1951. We used to be able to predict with considerable accuracy the appearance of a measles epidemic, which occurred approximately every two years. This cycle has not been interrupted as will be shown by the fact that the number of measles cases reported in Wood Green over the past six years has never fallen below 400 each year. Having regard to the fact that measles is now an extremely mild disease, it is highly probable that many cases are never seen by a doctor, so that the notifications received during any twelve months cannot be said to represent accurately the number of cases which actually occur. 26 Pertussis (Whooping Cough) Eighty-nine cases of pertussis occurred during 1952, as against 127 in 1951. As the Council will doubtless be aware, immunisation against pertussis is available in Wood Green, at County Council clinics. In addition, the vast majority of mothers accepting immunisation against diphtheria prefer the combined type of safeguard, which protects against diphtheria and pertussis at the same time. It would not be safe to infer that immunisation against pertussis in Wood Green has yet had any appreciable effect on the incidence of this disease within the Borough. Unless and until immunisation against pertussis is generally accepted by the bulk of the population both in Wood Green and elsewhere, we cannot expect results comparable to those which have been such a feature in the history of diphtheria. I am none the less satisfied that this is the end towards which we should work, as there does not appear to be any valid reason why the incidence of pertussis should not be affected in the same way as has been the case with diphtheria. When we remember that pertussis is now perhaps the most serious of all diseases in infancy, an active policy of immunisation is to be recommended. Food Poisoning and Dysentery Nine cases of food poisoning were notified during 1952, as against 15 cases in 1951. Of the nine cases notified, the cause was identified as duck egg in one instance. In another case, duck egg was thought to be responsible, although confirmation was not obtainable. In three other cases, the results of bacteriological examination were completely negative. No investigations were possible in the remaining four cases, as the period between the occurrence of the disease and its notification was too lengthy. Twelve cases of sonne dysentery were notified during the year, as compared with 27 in 1951. It must always be remembered that many cases of food poisoning are extremely mild, while sonne dysentery, especially in children, is an illness which seldom lasts for more than several days. For those reasons, it would appear virtually certain that many cases are never seen by a doctor, and are never notified. Even allowing for this, the incidence of food poisoning and dysentery within the Borough gave no reason for alarm during 1952. Apart from the fact that the total of individual cases was extremely low, there was no evidence of even the most limited outbreak. 27 All the cases reported are very thoroughly investigated. This entails a good deal of work, and many visits by our Sanitary Inspectors. I hope to be able to review the position in detail during 1953, in an effort to arrive at a programme which should ensure adequate safeguards, without throwing an unnecessary burden on the shoulders of the Public Health Department. Although the control of food poisoning is obviously important, and is a matter in which we are most keenly interested, I am at the same time anxious that we should not pursue a policy which may divert part of our time and energy into unproductive channels. Puerperal Pyrexia Two cases of puerperal pyrexia were notified during the year, as against 3 in 1951. No deaths were attributable to puerperal causes. Smallpox Although no cases of smallpox occurred in Wood Green during 1952, several doubtful rashes were reported. The occurrence of cases of a mild type of smallpox in Lancashire early in 1952, and the later appearance of severe Asiatic smallpox in Lancashire and Yorkshire, has once again drawn attention to the fact that the vaccination state of this country is most unsatisfactory. The County Council is now proposing to offer vaccination at selected Welfare Centres. At the time of writing this report, the system is already in operation in Wood Green. We are constantly encouraging mothers to have their infants vaccinated, and I have recently reviewed our time table of vaccination and immunisation, so that these necessary safeguards can be provided during the first year of life without unduly upsetting the infant or the family concerned. Although the policy of vaccination is under the control of the County Council, the control of smallpox itself is vested in the Borough Council. We are therefore intimately concerned with such measures as are directed towards controlling the incidence and spread of this disease. Tuberculosis Fifty-nine cases of tuberculosis (52 pulmonary and 7 nonpulmonary) were notified during the year, as against 69 in 1951, and 83 in 1950. Of the 59 new cases, nineteen were transfers from other districts, 40 cases being new notifications. 28 A broad classification of the cases notified during the year in relation to employment was: Clerical 7 Manual labour 7 Housewives 6 Factory workers 5 Children 3 Professional classes 2 Domestic service 1 Nurses 1 Shop assistants 1 Armed forces 1 Unclassified 6 Total 40 From the notifications of tuberculosis over the past three years, it would appear at first sight that this disease has been declining in Wood Green. This would be an extremely dangerous assumption, due to the short period and the comparatively small number of cases involved. This year's total (59) is certainly small, but it should not lead to any complacency. We must still be perturbed by the fact that so many cases of tuberculosis are occurring each year within the Borough, each case being a potential focus of infection. I have already mentioned the part which housing plays in the control of tuberculosis. For this reason and I have had many consultations with the Housing Officer in regard to the housing of families in which a case of tuberculosis has occurred, I am very glad of the opportunity to express my sincere appreciation of the co-operation which I have always received from the Housing Committee and from the Housing Officer. There is no doubt that the spending of very large sums of money on sanatoria and treatment is illogical if the fundamental factors governing the occurrence and spread of tuberculosis, mainly housing and nutrition, are left to fend for themselves. One must admit that this is a national problem, which should be tackled at national level. In spite of this, local authorities can play their part, and should become a potent influence in combating this most serious disease. During 1952, the Ministry of Health notified us that certain changes would be made in the registration of cases of tuberculosis. Broadly speaking, the official register is now being maintained by the appropriate Chest Clinics, although the Minister stated that he hoped an unofficial register would continue to be kept by local authorities. We have done this, so that we may know at any given time what is happening in the Borough. 29 Our Sanitary Inspectors continue to visit cases of tuberculosis, not for the purpose of making unnecessary enquiries, but in order to ascertain whether there is any way in which the Public Health Department can be of assistance. Occassionally, we are told by the Chest Clinic that a patient does not wish us to visit. In such circumstances, a visit is not made. During the past year certain schools in Wood Green have been taking part in an extensive scheme to ascertain whether or not it might be valuable to give the vaccine B.C.G. to school-leavers. This scheme has been sponsored by the Medical Research Council, and is being carried out under the auspices of the County Council. It is too soon yet to hope for definite results, but it can at least be stated that B.C.G. has already proved its worth in providing a measure of protection against tuberculosis. DISINFECTION AND DISINFESTATION The number of articles dealt with at the Disinfection Station was as follows: Articles disinfected 395 Articles destroyed 86 148 rooms were disinfected on account of infectious disease; 84 disinfested on account of the presence of vermin. 20 premises were treated for infestations of cockroaches, wasps and flies. 99 library books were brought to the department during the year for disinfection. 30 31 INFECTIOUS DISEASES 1928 to 1952 Year Diphtheria Scarlet Fever Enteric Fever Pulmonary Tuberculosis Nonpulmonary Tuberculosis Measles Pertussis Poliomyelitis †N *D †N *D †N *D †N *D †N *D †N *D †N *D †N *D 1928 42 — 142 - 4 - 39 33 8 2 4 2 - - 1929 128 2 187 1 1 2 57 38 7 5 — 10 — - 1930 97 4 234 - 2 - 55 42 14 3 4 1 — - 1931 39 1 97 1 1 — 58 35 9 8 1 3 — - 1932 33 1 110 - 3 — 41 37 15 4 3 3 2 - 1933 24 1 192 - — — 57 26 9 6 — 1 1 - 1934 31 3 292 - 1 — 56 32 12 3 1 2 1 - 1935 39 4 201 1 4 — 47 23 5 1 — — 1 - 1936 99 12 98 - 5 —. 51 46 8 5 2 2 2 - 1937 46 3 72 1 2 - 49 24 8 2 1 5 2 - 1938 63 2 92 - 1 — 59 21 10 7 3 — 1 - 1939 24 1 63 - — — 45 26 6 2 — 1 2 - 1940 26 — 61 - 7 — 55 22 10 4 89 — 24 2 — - 1941 42 — 51 - 2 - 57 26 7 4 401 2 192 1 1 - 1942 22 — 87 - — — 69 30 4 4 361 2 95 1 1 - 1943 26 — 155 - — — 43 22 3 3 356 — 106 1 — - 1944 9 — 51 - — — 44 20 5 4 232 — 134 1 1 - 1945 2 — 62 - 2 — 56 27 7 4 172 — 117 — 2 - 1946 7 — 73 - 1 — 76 22 10 3 346 — 89 — - 1 1947 10 — 46 - — — 52 17 10 5 410 2 171 — 2 - 1948 — — 69 - — — 65 21 9 5 408 — 174 — 5 1 1949 — — 71 - 2 — 68 19 9 — 678 — 46 — 6 1 1950 — — 99 - 1 - 57 10 6 2 421 — 376 1 4 - 1951 — — 196 - 1 — 50 13 5 2 434 — 127 1 1 - 1952 — — 93 — — — 36 5 4 1 449 — 89 — 3 — †N = Notifications. *D = Deaths. APPENDIX 1. HEALTH EDUCATION As this is the first Annual Report which I have had the privilege of presenting as Medical Officer of Health for Wood Green, I should like to take this opportunity of mentioning the various health education activities which are at present being carried out in the Borough. These might be enumerated as follows: (1) Thanks to the generous co-operation of local editors, articles of topical health interest are published from time to time in the local press. I should like to stress my personal thanks to the editors concerned for their generous and unfailing courtesy. Without this co-operation, the work of health education in Wood Green would undoubtedly suffer. (2) The magazine BETTER HEALTH is distributed throughout the Borough, through the Public Health Department, Town Hall, Infant Welfare Centres, and our Public Libraries. This magazine is supplied by the County Council. It may be thought desirable in the near future to increase the number of copies available, by the purchase of additional copies by the Borough Council. (3) Pamphlets and leaflets relating to health are available in the entrance to the Public Health Department, and seem to have been appreciated by members of the general public. (4) Arrangements were made to purchase a Light Display Stand from the Central Council for Health Education. The topics featured on this Stand are changed periodically. The Stand is displayed in the Public Health Department, and in the Public Library. (5) A letter is sent to local organizations in the Borough each year offering a health talk by the Medical Officer of Health or by a member of his staff. During 1952 three talks were given. This policy enables me to meet the members of local organizations, a privilege which I consider a pleasure rather than a duty. It also enables me to talk on matters of current health interest, with particular reference to the organization or society concerned. 32 (6) It is hoped that a Wood Green Public Health Services Handbook will be ready for issue during 1953. This handbook supplies information relating to the health services and will, it is hoped, be of interest and assistance to local residents. It will scarcely be necessary for me to say that Health Education is playing a more and more important part in preventive medicine as we know it to-day. Our aim is to make available to the general public information which can be used to advantage. Our programme must therefore be continuous. In addition to a continuous, long-term programme, occasional stimuli can be superimposed. Thus, as noted elsewhere in this report, we are planning to hold a Clean Food Month during 1953. Our yearly campaign for immunisation against diphtheria comes under the same heading. The Council will be aware that health education is a function which is shared by the Borough Council and by the County Council in a Borough such as Wood Green. The staff of the Public Health Department and of the Area Health Office both undertake the work ; each supplements and assists the other. This is one example of the importance of team-work in health. In conclusion, I look forward to extending the work of health education in Wood Green, as I am convinced that health education, health propaganda, call it what you will, is one of the most powerful weapons placed in our hands. I hope to be able to submit a comprehensive report to the Public Health Committee on this subject when the needs of the district have been more accurately assessed. 33 34 APPENDIX 2 Table 1 Vital Statistics of Wood Green, 1931-52 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 1949 52,780 719 13.6 33 18 25 0 - 631 11.9 1950 52,710 677 12.8 25 17 25 1 40 630 11.9 1951 52,400 653 12.4 15 21 32 1 67 715 13.6 1952 52,080 654 12.5 33 14 21 2 60 602 11.5 35 Table II Birth Rate, Death Rate and Analysis of Mortality during 1952 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 Whooping Cough Diphtheria Influenza Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year England and Wales 15.3 11.3 0.00 0.00 0.00 0.00 0.04 1.1 27.6 160 County Boroughs and Great Towns (including London) 16.9 12.1 0.00 0,00 0.00 0.00 0.04 1.3 31.2 160 Smaller Towns (population 25,00050,000 at Census 1951) 15.5 11.2 0.00 0.00 0.00 0.00 0.04 0.5 25.8 London 17.6 12.6 0.00 0.00 0.00 0.00 0.05 0.7 23.8 Wood Green 12.5 11.5 0.00 0.00 0.00 0.00 0.01 4.5 21.4 Table III Causes of Death during the year 1952 Causes of Death Male Female Tuberculosis, respiratory 3 2 Tuberculosis, other 1 — Syphilitic disease — — Diphtheria — — Whooping Cough — — Meningococcal infections 1 — Acute Poliomyelitis — — Measles — — Other infective and parasitic diseases — 1 Malignant neoplasm, stomach 11 6 Malignant neoplasm, lung, bronchus 19 6 Malignant neoplasm, breast — 17 Malignant neoplasm, uterus — 5 Other malignant and lymphatic neoplasms 26 31 Leukæmia, aleukæmia 2 4 Diabetes 1 2 Vascular lesions of nervous system 26 57 Coronary disease, angina 47 30 Hypertension with heart disease 10 10 Other heart diseases 18 41 Other circulatory disease 7 17 Influenza 1 — Pneumonia 18 14 Bronchitis 47 23 Other diseases of respiratory system 3 1 Ulcer of stomach and duodenum 7 1 Gastritis, enteritis and diarrhœa 1 2 Nephritis and nephrosis 3 6 Hyperplasia of prostate 3 — Pregnancy, childbirth, abortion — — Congenital malformations 5 1 Other defined and ill-defined diseases 19 28 Motor vehicle accidents 3 1 All other accidents 2 6 Suicide 5 1 Homicide and operations of war — — TOTALS 289 313 36 Table IIIa MALES Causes of Death All ages Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis, respiratory 3 - - - - - - 1 1 1 - - Tuberculosis, other 1 - - - - - - - - 1 - - Syphilitic disease - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal infections 1 - - 1 - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasm, stomach 11 - - - - - - - 3 1 5 2 Malignant neoplasm, lung, bronchus 19 - - - - - - - 1 8 8 2 Malignant neoplasm, breast - - - - - - - - - - - - Malignant neoplasm, uterus - - - - - - - - - - - - Other malignant and lymphatic neoplasms 26 - - - - - 1 2 1 3 11 8 Leukaemia, aleukaemia 2 — — — — — — — 1 1 — — Diabetes 1 - - - - - 1 - - - - - Vascular lesions of nervous system 26 - - - - - - - 1 5 8 12 Coronary disease, angina 47 - - - - - - - 6 10 9 22 Hypertension with heart disease 10 - - - - - - - - 2 5 3 Other heart diseases 18 - - - - - - - 1 3 5 9 Other circulatory diseases 7 - - - - - - - 1 1 2 3 Influenza 1 - - - - - - - - 1 - - Pneumonia 18 1 - - - - - - 1 4 5 7 Bronchitis 47 2 - - - - - - 4 6 11 24 Other disease of respiratory system 3 - - - - - - - - - 1 2 Ulcer of stomach and duodenum 7 - - - - - - 1 1 1 2 2 Gastritis, Enteritis and Diarrhoea 1 1 - - - - - - - - - - Nephritis and nephrosis 3 — — — — — 1 — — 1 1 — Hyperplasia of prostate 3 - - - - - - - - - 1 2 Pregnancy, childbirth, abortion - - - - - - - - - - - - Congenitalmalformations 5 5 - - - - - - - - - - Other defined and illdefined diseases 19 1 1 1 1 2 1 1 3 2 1 5 Motor vehicle accidents 3 - - - - - 2 - - - 1 — All other accidents 2 — — — — — - - 1 - 1 — Suicide 5 - - - - - - 1 - - 1 3 Homicide and operations of war — — — — — — — — — — — — Totals 289 10 1 2 1 2 6 6 26 51 78 106 37 Table IIIa FEMALES Causes of Death All ages Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis, respiratory 2 — - - - — 1 1 - - - - Tuberculosis, other - - - - - - - - - - - - Syphilitic disease - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - Whooping Cough - - - - — - - - - - - - Meningococcal infections - - - - - - - - - - - - Acute Poliomyelitis - - - - — - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases 1 - - - - - 1 - - - - - Malignant neoplasm, stomach 6 - - - - - - - 1 1 2 2 Malignant neoplasm, lung, bronchus 6 - - - - - - - - - 2 4 Malignant neoplasm, breast 17 - - - - - - - 1 4 7 5 Malignant neoplasm, uterus, 5 - - - - - - - - - 4 1 Other malignant and lymphatic neoplasms 31 - - - - - 1 2 6 4 10 8 Leukaemia, aleukaemia 4 — — — — 1 — — 2 — 1 — Diabetes 2 - - - - - - - - - 1 1 Vascular lesions of nervous system 57 - - - - - - - 1 9 16 31 Coronary disease, angina 30 - - - - - - - 2 4 9 15 Hypertension with heart disease 10 - - - - - - - 1 2 3 4 Other heart diseases 41 - - - - - - - 1 4 10 26 Other circulatory diseases 17 - - - - - - - - 3 4 10 Influenza - - - - - - - - - - - - Pneumonia 14 1 - - - - - - 3 4 2 4 Bronchitis 23 - - - - - - - 2 1 8 12 Other disease of respiratory system 1 - - - - - - - - - - 1 Ulcer of stomach and duodenum 1 - - - - - - - - - - 1 Gastritis, Enteritis and Diarrhoea 2 - - - - - - - - - - 2 Nephritis and nephrosis 6 - - - - - - - 1 — 2 3 Hyperplasia of prostate - - - - - - - - - - - - Pregnancy, childbirth, abortion - - - - - - - - - - - - Congenitalmalformations 1 1 - - - - - - - - - - Other defined and illdefined diseases 28 2 - - 2 - - 1 3 5 9 6 Motor vehicle accidents 1 - - - - - - - - - - 1 All other accidents 6 - - - - - - 1 1 2 — 2 Suicide 1 - - - - - - - - - 1 — Homicide and operations of war - - - - - - - - - - - - Totals 313 4 — — 2 1 3 5 25 43 91 139 38 39 Table IV Infectious Diseases Notified during the year 1952 Notifiable Disease. Cases Notified in Whole Borough Total Cases Notified in each Ward Total Cases Removed to Hospital or Sanatorium Total Deaths All Ages At Ages—Years 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 and upwards AlexandraBowes Town Hall Noel Park Scarlet Fever 93 - 23 54 11 3 1 1 - - - - 25 28 40 56 - Diphtheria - - - — — — - - - - - - — — — — - Cerebro-Spinal Fever 4 - 3 1 - - - - - - - - 1 2 1 4 1 Enteric Fever - - - - - - - - - - - - - - - - - Erysipelas 11 - - - - - 1 1 1 3 2 3 4 2 5 4 - Pneumonia 28 1 3 1 1 — 1 — 3 4 6 8 15 3 10 6 32 Acute Poliomyelitis 3 - 1 — 2 — — — — — — — 1 1 1 3 — Polio-encephalitis - - - - - - - - - - - - - - - - - Puerperal Pyrexia 2 - — — — — 2 — — — — — 1 — 1 — — Pulm. Tuberculosis 36 - 1 1 — 3 5 6 9 6 3 2 19 8 9 — 5 Non-Pulm. Tuberculosis 4 - - - 2 - - 1 - 1 - - - 3 1 — 1 Malaria — - — — — — — — — — — — — — — — — Measles 449 16 204 215 8 2 2 2 — — — — 127 147 175 22 — Whooping Cough 89 10 31 45 1 1 — — — — 1 — 27 39 23 4 — Ophthalmia Neonatorum — — — — — — — — — — — — - — — — — Dysentery 12 — 5 — 1 1 — 1 2 1 — 1 11 1 — 3 — Food Poisoning 9 — — — — 1 1 2 3 2 — — 9 — — — — Totals 740 27 271 317 26 11 13 14 18 17 12 14 240 234 266 102 39 Table V TUBERCULOSIS New Cases and Mortality during 1952 Age Periods New Cases Deaths Respiratory Nonrespiratory Respiratory Nonrespiratory M. F. M. F. M. F. M. F. 0 — — — — — — — - 1 1 1 — - - - - - 5 1 - - 2 - - - - 15 3 9 1 — — - - - 25 7 7 2 1 — 1 - - 35 7 3 — — 1 1 - - 45 6 — 1 — 1 — - - 55 4 1 — — 1 — 1 - 65 and upwards 1 1 - - - - - - Totals 30 22 4 3 3 2 1 — Above includes transfers (19) from other districts. One non-notified tuberculosis death occurred. 40 APPENDIX 3 Miscellaneous (a) Letters to Doctors The following letters were sent to general practitioners practising in Wood Green during 1952: May 1st - The Public Health (Tuberculosis) Regulations, 1952. August 2nd - Poliomyelitis. August 7th - Food Poisoning and Dysentery. October 10th - Vaccinia. October 15th - Poliomyelitis. October 16th - Poliomyelitis. October 22nd - Scarlet Fever. December 15th - Collection of Laboratory Specimens. (b) Medical Examinations During the year six medical examinations were carried out in respect of entrants to the Council's employ, for acceptance into the superannuation scheme. In addition, 29 medical reports were issued relating to employees absent from duty through sickness. 41