BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1953 WM. CLUNIE HARVEY, md.dp.h. Medical Officer of Health. WOOD 35 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1953 WM. CLUNIE HARVEY, m.d.,d.p.h. Medical Officer of Health. Public Health Department, White Hart Lane (Old) School, Wood Green, N.22 June, 1954. 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 1953. The form taken by this Report follows closely the pattern of previous years. As hitherto, the work carried out in Wood Green by the Middlesex County Council in regard to the personal health services receives uncritical mention only. It so happens, however, that I submitted to Area Health Committee No. 2 a brief report on the work carried out in this field during 1953. As Wood Green is one of the constituent districts which make up Area No. 2, I am including this document as Appendix 5 to this Report, with permission of the County Council. Without the information which it contains, the health picture for the district would remain incomplete. The year 1953 was, on the whole, a quiet one, with little spectacular to record. This is satisfactory since, although progress continues to be made in a variety of directions, it is seldom that spectacular or dramatic results can be reported in regard to public health or preventive medicine. The victories of preventive medicine are unobtrusive and too often pass unnoticed. Because of this, public health is frequently taken for granted. This attitude can lead to danger. Preventive medicine must always be regarded as the foundation on which our system of living, at least so far as positive health is concerned, should be based. For this very adequate reason, it merits our constant and most careful attention. Wood Green possesses many advantages, and not a few truly valuable health amenities. It must be our duty to maintain these amenities, so that the community can gain the fullest adtvantage from them. It is here that the work of public health can be so important. The Public Health Department is fully alive to the need for constant vigilance. The Department will continue to initiate such action as appears desirable to ensure, first, that conditions prejudicial to health are removed, and second, that a progressive policy is being pursued. The vital statistics for 1953 call for little comment. The birth rate (11.6) shows a slight decrease from the rate for 1952 which was 12.5. The death rate has also fallen, from 11.5 to 10.04. The 3 infant mortality rate, i.e., the deaths of infants under one year of age, rose from 21.4 to 28.3, although it must be remembered that the number of infants dying under the age of 12 months is so small that a few deaths raise the rate out of all proportion. Thus, the number of Wood Green infants under one year who died during 1953 was only 17; the number during 1952 was 14. That is always the difficulty in dealing with such small totals over a limited period. The picture is apt to be distorted, while it should again be stressed that it is virtually impossible to draw any worthwhile conclusions from such small numbers over a period of one year. One death occurred during the year from puerperal causes. In this connection it may be stated that 3,303 births have taken place in Wood Green over the past five years, with only three deaths. This is very different from the sombre picture which could have been painted before the war. The reasons behind this very satisfactory state of affairs are varied. They include recent advances in midwifery, a much fuller and more careful supervision of women before, during and after child-birth, together with the extraordinary advances in the use of antibiotics which have come about within recent years. It would indeed be difficult to place these three factors in order of priority. It is at least obvious that all have played their part. Apart from the number of measles cases which occurred during 1953, the district was free from epidemics or even serious outbreaks of infectious disease. The number of measles cases recorded was high (778), with a comparable rise in the number of pertussis (whooping cough) cases (202). This was in keeping with the figures from England and Wales as a whole, 1953 being a heavy year so far as measles was concerned. The number of dysentery cases reported also rose, from 12 to 51. This again was part of a nationwide pattern, which will be receiving more detailed comment later in the Report. Apart from the number of cases of infectious disease reported, it is, I think, important in some ways, more important to consider severity. This was extremely low, the number of cases of infectious disease, including tuberculosis, admitted during the year to hospital or sanatorium being no more than 102. The total number of deaths was 39, of which 32 were caused by pneumonia, mostly among the oldest age groups in our population. The number of complications and sequelae reported have also been extremely light. This again will receive comment in the section of the Report which deals specifically with infectious diseases. I would conclude this introduction by once again expressing my grateful thanks to the Borough Council and to the Public Health Committee for the constant encouragement which I have received at their hands. This has been extremely gratifying and has 4 been of the greatest help during the year. I should also like to express my thanks to the staff of the Public Health Department. Although all have played their part and have contributed to the team spirit so necessary for success, I would particularly mention Mr. W. Mc.Cauley, whose advancement to the rank of Chief Sanitary Inspector was so very well deserved. I would also thank Mr. W. T. Gloster, the Chief Clerk in the Public Health Department, who has been of unfailing assistance to me throughout the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, W. C. HARVEY, Medical Officer of Health. 5 BOROUGH OF WOOD GREEN PUBLIC HEALTH COMMITTEE Councillor A. Vitoria, J.P. (Chairman) Councillor R. G. Kendall (Vice-Chairman) The Mayor, Councillor E. A. Smeed Alderman J. J.Wren, J.P. Councillor Miss D. E. M. Hiscock Alderman A. R. Harrison Councillor G. Cathles Councillor J. W. Barnett STAFF during 1953 *Medical Officer of Health—William Clunie Harvey, m.d., d.p.h. Deputy Medical Officer of Health—Effie Scott Stephen, m.b., ch-b., d.p.h. (resigned 31/3/53) Deputy Medical Officer of Health—Janet Russell Campbell, m.b., ch.b.. d.p.h. (appointed 1/4/53) *Chief Sanitary Inspector—W. McCauley, Cert.R.San.Inst, and San. Insp., Joint Board, Cert. Meat and Food Inspection. (Appointed Chief 1/4/53). *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 and1 Food Inspection; H. B. Parker, Cert.R. San.Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection (May 1953). Chief Clerk—W. T. Gloster General Clerks—P. V. Ingram; Mrs. C. M. A. Moss, Shorthand Typist Rodent Operator—J. Harris Disinfectors—H. Carlan (resigned 8/8/53); W. Woodcock * Half the salaries of these Officers are paid by the Middlesex County Council under Section 109 of the Local Government Act, 1933. 6 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,607 Population—estimate supplied by the Registrar General 51,470 Number of inhabited houses (end of 1953) according to the Rate Books 13,907 Rateable Value, 1953 £544,436 Sum represented by a penny rate 2,235 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births : Total M. F. Legitimate 577 296 281 Birth Rate per Illegitimate 23 13 10 1,000 11.6 Still Births 14 8 6 Rate per 1,000 Births 22.8 Deaths 517 283 234 Death Rate per 1,000 10.04 Deaths from Puerperal causes 1 Rate per 1,000 Births 1.62 Deaths of infants under 1 year of age :— All infants 17 Rate per 1,000 live births 28.3 Legitimate 14 Rate per 1,000 legitimate live births 24.2 Illegitimate 3 Rate per 1,000 illegitimate live births 130.4 Deaths from :— Cancer (all ages) 100 Measles (all ages) — Whooping Cough (all ages) — Diarrhoea (under 2 years of age) 1 Number of Births notified 626 Number of Births registered in the Borough 128 POPULATION The mid-year estimate of the population supplied by the Registrar General is 51,470, a decrease of 610 from that of the previous year. BIRTHS The number of live births registered during the year was 600 corresponding to 11.6 per 1,000 of population. The rate for 1952 was 12.5. There were 14 still-births, giving a still-birth rate of 22.8 per 1,000 births. In 1952, the still-birth rate was 18.02. DEATHS The number of deaths credited to Wood Green after the necessary adjustments had been made for inward and outward transfers was 517, giving a crude death rate of 10.04 per 1,000 of 7 population and a corrected death rate of 9.24. This is a decrease of 85 from the total of the previous year, when the death rate was 11.5. Of the total of 517 deaths, no fewer than 330 occurred at ages over 65. Ninety-nine deaths occurred at ages over 80 and 12 at ages over 90. INQUESTS Twenty inquests were held following the deaths of Wood Green residents during 1953, six of these without post-mortem examination. A further 127 post-mortem examinations were carried out without an inquest, 77 of these in the Prince of Wales Hospital which, by arrangement with the Wood Green Borough Council, provides mortuary services. MATERNAL MORTALITY One death occurred during the year as a result of childbirth, the maternal mortality rate being 1.62 per 1,000 births. There were no maternal deaths during 1952. INFANT MORTALITY There were 17 deaths of infants under one year of age, giving an infant mortality rate of 28.3 per 1,000 live births. This compares with a total of 14 deaths and an infant mortality rate of 21.4 in 1952. Of the 17 infant deaths, 6 occurred within twenty-four hours of birth, 10 during the first week and 12 during the first four weeks of life. This gives a neo-natal mortality rate of 20. The corresponding figure for 1952 was 15. 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 5 – – – 5 – – – – 5 Congenital Defects 2 1 – 1 4 1 – 1 – 6 Atelectasis 1 – – – 1 – – – – 1 Gastro–enteritis Intra–cranial Haemorrhage 2 – – – 2 – – – – 2 Capillary Bronchitis – – – – – 1 – – – 1 Asphyxia Neonatorum Icterus Gravis Neonatorum Volvulus – – – – – – – – – – Whooping Cough Broncho–pneumonia – – – – – 1 – – – 1 Tuberculous Meningitis – – – – – – – 1 – 1 Total 10 1 – 1 12 3 – 2 – 17 8 GENERAL PROVISION OF HEALTH SERVICES Hospitals The position in regard to admissions to hospital is virtually the same as that reported in the Annual Report for 1952. The greatest difficulty still remains in securing the admission to hospital or institution, of the chronic, elderly sick. This is a problem which applies forcibly to Wood Green, with its ageing population. I have taken the opportunity of mentioning our difficulties in several quarters, notably the Liaison Committee set up by the North Middlesex Division of the British Medical Association. There is at least the hope that the position will be improved, so far as the availability of beds and nursing staff permit. Similar remarks apply to the admission of elderly persons to homes. Quite obviously, the number of homes available does not in any way fill the need. Although the Public Health Department is not directly responsible for admissions to hospitals or homes, except to a very limited extent, we still take an active interest in the situation, and have, I think it would be fair to state, been able to influence the final result in quite a number of cases. In this field, the Public Health Department works in very close harmony with the Area Health Staff. This is one of those difficult matters in which co-operation is most desirable. I am happy to think that this co-operation does exist in Wood Green, and that it is working to the advantage of both the elderly and the infirm. As this Report is being written, news has been received that the County Council intends to hold a Conference to which members of local authorities will be invited. I most sincerely hope that this Conference may result in the setting up of a special committee in each district, to deal with the problems associated with the aged. At the moment, it would appear that proper liaison has not been maintained between all the statutory and voluntary bodies who are concerned in this problem. Nor does it appear that information regarding individual cases is always known. I am firmly convinced that an ad hoc Committee, with full representation, would represent an extremely useful step in the right direction. Meantime, we must await the results of the 'Conference mentioned above, in the hope that this problem, which is becoming more serious every year, can be tackled in a more practicable and effective manner. Mention might be made here of the scheme which I suggested during the year to deal with 'smog' victims, particularly those who are aged or infirm. It gives me great pleasure to report that my scheme received sympathetic consideration, both from the Public Health Committee and from the voluntary bodies which I approached. Fortunately, it was not necessary to put an emergency scheme into operation, but the very fact that the proposals were sympathetically considered gives ground for real satisfaction. 9 The admission of cases of tuberculosis to sanatoria and hospitals is still not entirely satisfactory, although there is evidence that it has improved and is still improving. It is obviously of the greatest importance that cases of tuberculosis which require hospitalisation should be given access to a hospital bed as quickly as possible. I understand that this matter is receiving urgent consideration, consideration which it full merits. Indeed, the rapidly extending facilities for the early diagnosis of cases of tuberculosis, particularly lung tuberculosis, make this a problem of the most acute urgency. The remarks set out in the Report for 1952 regarding the admission of cases of infectious disease to hospital remains unaltered. I should like to take this opportunity of thanking the Medical Superintendent and staff of Coppett's Wood Isolation Hospital for their unfailing co-operation, and for the excellent treatment afforded to Wood Green residents. Laboratory Facilities Summary of work carried out at Central Public Health Laboratories for the year 1953 : Positive Negative Swabs for diphtheria bacilli — — Sputa for tubercle bacilli 7 6 Throat and nose swabs 108 Faeces 463 Urine 11 Blood 6 Others 39 Ice Cream 37 Milk 17 Water (Swimming Pool) 9 Apart from the routine examination of bacteriological specimens sent to the Laboratory during the year, together with the examination of milk and ice-cream, it has not been necessary to call upon the Laboratory for any special investigations. We are none the less conscious of the fact that the Central Public Health Laboratory Service stands behind us, ready to assist in the investigation of any epidemiological problem. 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 1953 under this Section. NATIONAL ASSISTANCE ACT, 1948 Burial or Cremation of the Dead In accordance with Section 50 of this Act, one burial was carried out by the Council during 1953. Two burials were carried out during the previous year. 11 SANITARY SERVICES Inspections Public Health Act, 1936 634 Housing Act, 1936 261 Rag Flock and Other Filling Material Act, 1951 4 Pet Animals' Act, 1951 21 Factories and Outworkers 223 Food Preparing Premises 566 General Food Premises 856 Shops Act, 1950 61 Smoke Observations 38 Unsound Food 155 Complaints investigated 533 Interviews with owners, etc. 141 Re-visits to property under notice 2,505 Infectious Disease cases 142 Food Poisoning 17 Special enquiries in connection with infectious disease cases 335 Aged and infirm persons 11 Miscellaneous 616 Total 7,119 Informal Notices served: Shops Act 3 Complied with 2 Food & Drugs Act 33 ” ” 30 Public Health Act 279 ” ” 294 Housing Act 105 ” ” 115 Factories' Act 6 ” ” 1 Pet Animals' Act 1 ” ” 1 Rag Flock and other ” ” Filling Material Act — ” ” 1 Statutory Notices served: ” ” Public Health Act 24 Complied with 14 Housing Act 9 ” ” 10 Repairs to Houses Repairs have been carried out at 556 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 33 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 one instance it was found necessary for legal proceedings to be taken against the owner and a Court Order was obtained, with costs. The required work has since been executed by the Council. Repairs to six houses were carried out by the Council in the owners' default of statutory notices served under the Public Health Act, 1936 and the Housing Acts, 1936/49. The cost of the works is recoverable from the owners. 12 Of the 433 notices complied with, the repairs found necessary at 318 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 115 houses. In addition, defects at 123 houses were remedied in circumstances not requiring service of notices. It will be appreciated that the coming into force of the Housing Repairs and Rents Act, which it is anticipated will be placed on the Statute Book during 1954, will place additional burdens on the shoulders of the Public Health Department, particularly the Sanitary Inspectors. As this, however, is not a matter which falls within the purview of the Report for 1953, no more need be said on the subject for the time being. 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. I am happy to be able to report that the closest liaison exists between the Housing Section and the Public Health Department. Scarcely a week passes but consultation takes place between both Departments in regard to housing applications. This particularly applies, of course, to cases in which there is a medical background, especially cases of tuberculosis. It is very right that this co-operation should exist, and it gives me great satisfaction to believe that the weight of medical evidence invariably receives sympathetic and careful consideration. Rodent Control Out of a total of 1,735 premises inspected throughout the year, it was found necessary to carry out treatment at 177 of them; 156 dwelling houses and 21 other premises were treated for rat infestation ; a further 27 dwelling houses and 6 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. Two maintenance treatments of the soil sewers were carried out, the first in June and the second in November and December; 13 on both occasions 672 manholes were baited. In the second treatment the bait used was sausage rusk and the poison, arsenic. Of the manholes baited, 401 showed pre-bait take, and 362 part-take of poison. There were no complete takes of poison, whilst the complete takes of pre-bait were 120. 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 2,945 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 Fifteen public conveniences are available in the Borough, situated as follows:— Lordship Lane Station Road Albert Road Town Hall Park Chapman's Green Recreation Ground White Hart Lane Recreation Ground Albert Road Recreation Ground " King's Arms " Hotel, N.22. " Prince of Wales " Hotel, N.22. "Alexandra Tavern," N.22. " Duke of Edinburgh," N.22. "Springfield" Hotel, N.ll. "Ranelagh" Hotel, N.ll. " Seven Oaks," N.22. " Jolly Butchers " Hotel, N.22. 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. It is worth while remembering that Wood Green was one of 14 the first London Boroughs to abolish the charge in its main convenience for washing facilities. Although this was not an easy procedure to arrange, it is a matter for satisfaction that the facilities are not now being abused but, on the other hand, are being used to considerable advantage. Such facilities, can, of course, only be provided at conveniences which are fully manned. It might also be recorded that arrangements are now in hand for similar provisions to be available in all the maternity and child welfare and school clinics operated by the County Council in Wood Green. Food Hygiene During the year, 1,577 visits were made to food premises in the Borough, as against 1,062 in 1952. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. As the Council will remember, a special Clean Food Month was held in Wood Green during October. A copy of the Report which I submitted to the Public Health Committee in November will be found set out as Appendix 2 to this Report. There is no doubt that ventures such as our Clean Food Month are useful and that they can, with advantage, be repeated from time to time. The cost involved is very small indeed compared with the results which can be anticipated. I therefore hope to suggest to the Public Health Committee that a further effort might be made within the next two years. Although the possible formation of a Wood Green Clean Food Guild does not properly come within the purview of the Annual Report for 1953, it may be stated here that steps have been taken to institute such a Guild. The Guild has still to be finally launched but, at the time of writing this Report, progress has been satisfactory, operation of a Clean Food Guild should link up with the new Food and Drugs Act which, it is anticipated, will come into operation some time during 1954. The final provisions of this Act are not yet known, but it is generally felt that our powers will be increased and that this most vital issue, i.e., clean food, will be open to be tackled in a more realistic manner. I hope to be in a position to report much more fully on these two important subjects in the Annual Report for 1954. Meantime, we continue our efforts, drawing the attention of food handlers and public alike to the constant need for vigilance in the matter of clean food. There are few issues in the field of public health which are more urgent, or which hold out hope of greater success. As has truly been stated, our aim should be to ensure that Wood Green is not only regarded as one of the foremost shopping centres in North London; it should and most definitely can come to be regarded as the centre with the highest standards of food hygiene among premises, personnel and public alike. 15 INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply The following licences for the sale of milk under special designations have been granted. Tuberculin Tested Accedited Pasteurised Sterilised 14 1 20 , 38 Supplementary licences to sell milk from premises which are outside the area of the Licensing Authority. Tuberculin Tested Accedited Pasteurised Sterilised 11 — 12 13 Seventeen 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 105 premises registered for retailing Ice Cream. During the year, 179 visits were paid to these premises, and 37 samples were submitted for bacteriological examination. Of these samples : 28 were Grade I 4 were Grade II Nil were Grade III 5 were Grade IV (c) Meat and Other Foods The undermentioned foodstuffs were certified as unfit for human consumption during the year :— lbs. Tins Meat 1,870 Meat 185 Fish 296 Fish 22 Fruit 12 Vegetables 260 Cheese 8 Fruit 536 Meat pies 20 Evaporated Milk 123 Cakes, etc. 125½ Jam 78 Sweets 4½ Soup 32 Biscuits 25 Cereals 84 Sausages . 55 2,5003/4 1,236 16 Miscellaneous Items Eggs 5,224 Meat and Fish Paste 53 Fish Cakes 30 Cakes, etc. 1,373 Biscuits 62 Meat Pies 2 Fruit and Vegetables 1 Cheese 106 Condiments 45 Miscellaneous Packets 14 (d) Inspection of Food Premises The following visits were made to food premises during the year, and where defects were found the requisite steps were taken to have them remedied Butchers' shops 276 Dairies and Milk Shops 196 Ice Cream Premises 179 Fried Fish Shops 78 Stalls 96 Other Food Premises 752 Middlesex County Council Act, 1950. Section 11.—Registration of Hawkers of Food. Fifty-nine hawkers of food in the Borough are registered. 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 181 195 6 — Other premises in which Section 7 is enforced by the local authority 2 2 Total 223 226 6 — 17 2. Defects Found Particulars Number of cases in which defects where found Number of cases in which prosecutions were instituted Found Remedied Referred ToH.M. Inspector By H.M. Inspector Want of cleanliness 2 2 — — — Overcrowding — — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary conveniences : (a) insufficient — — — — (b) unsuitable or defective 1 1 — — — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) 5 5 — 5 — Total 8 8 — 5 — 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. 8 — — — — Household linen — — — — — — Lace, lace curtains and nets — — — — — — Curtains and furniture hangings 9 — — — — — Brass and brass articles — — — — — — Artificial flowers 7 — — — — — Feather sorting 19 — — — — — Cosaques, Christmas crackers and stockings 40 — — — — — Total 83 — — — — — WATER SUPPLY The whole Borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply. 18 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 one sample was taken and sent for analysis. The result was satisfactory. PET ANIMALS ACT, 1951 Under this Act, eight licences were renewed during the year after the premises had been 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. In addition, one new licence was issued. 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. Council Flats completed:— 26 at Barnes Court Council Flats in course of construction at end of year:— 28 at Ellenborough Court 6 at Winkfiel'd Road Private enterprise:— 8 war destroyed houses were rebuilt at Passmore Gardens, Victoria Road, Paisley Road and Tintern Road 3 new houses were erected at Grosvenor Road and Eldon Road. SWIMMING BATHS The figures of attendances at Western Road and Durnsford Road baths for the past two years are as follows :— Western Road Baths 1953 1952* Swimming Bath 50,327 12,721 do. Children (special sessions) 617 72 Children from Schools 23,612 2,898 Spectators 4,917 1,612 Slipper Baths 45,016 42,063 do. Old age Pensioners (free) 634 639 * Swimming Pool closed for repairs from 1st May to 31st October 19 Durnsford Road Open Air Bath 1953 1952. Swimmers—Adults 14,928 18,795 Swimmers—Children 28,752 35,926 Children from Schools 962 1,911 Season Ticket Holders 26,226 35,633 Spectators—Adults 5,711 6,444 do. —Children 703 1,177 Samples of the water were taken from both baths at regular intervals during the year. The results of the tests were uniformly satisfactory. The remarks which I set out in the Annual Report for 1952 regarding the value of our swimming baths, remain unaltered. In our closed and open-air swimming bath we have health amenities second to none. It is extremely pleasing to note that the open-air swimming bath at Durnsford Road continues to be regarded as one of the foremost of its kind in this county, and that its use is being sought by important outside bodies. This serves to bring the existence of the bath to the notice of residents and so to extend its usefulness. 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 Kitcher Waste, and one Bedford Lorry for Trade and Special refuse. During the year 1952/53 the total tonnage of refuse collected was 11,699 tons; from this, material salvaged was sold for £2,438. The quantities of salvage were:— Tons Cwts. Qrs. Paper 230 4 2 Cullet 10 2 0 Metals — 5 0 Mixed Scrap Iron 18 5 0 Rags 7 17 1 In addition 852 tons 123/4 cwts. of Kitchen Waste was collected and sold for £3,250. The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths. 20 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES In the table of infectious diseases set out on page it will be observed that 1,232 cases were notified during 1953, as against 740 in 1952. This gives an infectious sickness rate for the district of 23.9, as compared with 14.2 in the previous year. The increase is due entirely to the rise in measles and pertussis (whooping cough) notifications, to which attention has already been drawn. Apart from the prevalence of measles and pertussis, the only other features relating to infectious diseases during the year to which attention might be drawn, were the decrease in scarlet fever, 66 as against 93 in 1952, and the increase in food poisoning and dysentery notifications, 58 as against 21. These matters will be referred to later in this section of the Report. I would again stress that our concept of epidemiology has altered materially within recent years. The older infectious diseases have either very largely disappeared, e.g., diphtheria and typhoid fever, or are declining; others have completely altered in character. In addition, we now have to contend with the appearance of new infectious diseases, notably those caused by the virus family. Foremost amongst these is, of course, poliomyelitis, although there is abundant evidence that other virus diseases are beginning to make themselves felt. We must also appreciate that epidemiology itself has taken on a new and much broader outlook. We are no longer concerned only with infectious illnesses. Our duty must be to survey the whole field of health and try to remove such conditions as are prejudicial to health and which encourage both dis-ease and disease. This means that we must study the cause or causes of such ailments as diseases of the heart and circulation, cancer and! rheumatism. It is admittedly difficult to deal with these problems in any one district, especially a Borough such as Wood Green which is an integral part of greater London, since the issue is very often national rather than local. None the less, the new conception of epidemiology must never be forgotten, since it provides a fruitful field for study and research. It will readily be appreciated that housing and factory conditions together play a notable part in the causation and spread both of infectious and non-infectious illness in a district such as Wood Green. Indeed, it is becoming more and more clearly recognised that industrial medicine, i.e., the study of health problems associated with industry, can no longer be divorced, even partially divorced from public health. Many believe that this is a province in which the Medical Officer of Health and the Public Health Department as a whole should have greater powers and more close liaison with specialists in industrial medicine. Now that the personal health services have gone over to the County Council, it would surely not be 21 illogical to suggest that matters such as those referred to above should be controlled by the local Council since, as I have already stated, working conditions in factories, shops and similar premises have a very definite bearing on the health of the community. At the moment we are more or less confined to specific duties under the Factories and Workshops Acts. These duties we carry out, and have at least the satisfaction of knowing that our reports receive attention. Since taking up my duties in Wood Green, I have visited a number of factories in the Borough, and have seen for myself the conditions under which work is being carried on. Although I have been impressed by what I have seen and by the way in which I have been received, I still look forward to the day when our powers will be extended, when the Public Health Department will be privileged to take a much more intimate part in this important work. So far as housing is concerned, the year 1954 should see the beginnings of a new programme in housing, which will undoubtedly have a substantial effect upon the lives and health of the people. This is a matter upon which I hope to be able to report much more fully in next year's Annual Report. Meanwhile, we await the arrival of the Housing, Repairs and Rents Act with the keenest of interest. Diphtheria For the sixth year in succession, no case of diphtheria was notified in the Borough. The last death from diphtheria took place in 1939. As I remarked in last year's Annual Report, these figures are evidence of the great change which has come about within recent years, a change which can, at least in very great part, be attributed to immunisation. The paragraphs contained in the Report for 1952 relating to immunisation still hold. We have made several minor adjustments in our programme in the light of recent advances in this branch of preventive medicine. We also co-operated with the County Council in running a fortnight's intensive propaganda campaign, during which we made use of slides at cinemas, articles in local newspapers, advertisements, posters and leaflets. The latest figures would appear to show that 95% of Wood Green school children have been fully protected against diphtheria by immunisation, 57% of children under the age of five have also been protected. During the year, 696 children were immunised for the first time in Wood Green. Three hundred and seventy of these children were immunised against diphtheria only, 326 being immunised against diphtheria and pertussis. During the same period, 1,084 children received reinforcing injections. 22 Scarlet Fever Sixty-six cases of scarlet fever were notified during 1953, as against 93 in 1952. No deaths occurred during the year. The disease was once again extremely mild, complications and sequelae being almost entirely absent. Indeed, it now appears that quite a number of cases of scarlet fever are never even seen by the family doctor. It must be remembered that, although the existing type of scarlet fever is exceptionally mild, this must not be taken to mean that the present mildness will continue. During the latter half of the nineteenth century, for instance, scarlet fever was an extremely mild disease. Then, after quite a period, virulence increased and the disease became one which could both cripple and kill. We cannot therefore treat the situation with complacency, but must be prepared for a change in virulence at any time. In the meantime, we rejoice in the fact that scarlet fever cannot at present be regarded as a serious disease. We plan our control measures and arrangements for admission to hospitals accordingly. Acute Anterior Poliomyelitis Five cases of poliomyelitis occurred during the year, as against 3 in 1952. Four of the cases were paralytic. Four were children and one adult. One death occurred. One case of polio-encephalitis was notified, a male adult, and this proved fatal. We found it desirable to stop combined immunisation against diphtheria and pertussis during parts of August and September, because at that time a number of cases of poliomyelitis were being reported from this part of North London. Immunisation against diphtheria continued as usual, since the risk of poliomyelitis is extremely slight and virtually negligible with this type of inoculation. Although it is not possible to report any spectacular progress in the investigations which are constantly taking place into the causation and mode of spread of poliomyelitis, it can at least be stated that definite progress has been and is still being made. In America, for instance, claims are being put forward that inoculation against poliomyelitis may be available within the relatively near future, while gamma globulin, a fraction of blood plasma has been used with advantage as a means of protection. For the time being, however, we have to depend on more general measures, especially the vital matter of personal hygiene. During the year I took the opportunity of writing to general practitioners and to head teachers, giving them the latest available information and, in the case of schools, detailing simple measures which might be carried out to protect children. I am happy to be able to report that I received the fullest co-operation both from general practitioners and from 23 head teachers, co-operation which is a feature of our work in Wood Green. Measles 778 cases of measles were notified during 1953, as against 449 in 1952. This is one of the highest totals recorded in Wood Green and shows, as previously indicated, that Wood Green shared in the nation-wide epidemic. There is at least the satisfaction of knowing that 1954 will almost certainly show a decrease in notifications; there is the even greater satisfaction in being able to state that the type of disease continues extremely mild. It must be appreciated that, in spite of all our efforts, measles still continues to appear in epidemic form, approximately every two years. We can protect children in closed communities such as day nurseries, but, so far as the school and pre-school population at large is concerned, spread continued unabated. At the present moment, of course, the disease has little more than nuisance value, severe complications such as otitis media, eye conditions and broncho-pneumonia being almost things of the past. Pertussis (Whooping Cough) 202 cases of pertussis occurred during 1953 as against 89 in 1952. Here again the disease was comparatively mild, although pertussis is still regarded as the most serious disease of early childhood. It is too soon yet to state categorically that our campaign of immunisation either against pertussis alone or in conjunction with diphtheria, is having material effect. None the less, we are continuing our present efforts, and now await the final blessing of the Ministry of Health. A definite pronouncement should not long be delayed, as the Medical Research Council has been conducting widespread investigations in England. These investigations were directed towards establishing the true value of immunisation, and the advantage of using one type of antigen against another. If, as we all hope, these investigations prove satisfactory, we may yet be able to deal with pertussis as we have with diphtheria. That is by no means a Utopian dream, since pertussis has been almost banished from many large cities in America. Food Poisoning and Dysentery As noted in the introduction to this section of the Report, 51 cases of dysentery and 7 of food poisoning were reported during the year. I would again stress that these notifications by no means give a true index of the incidence of these diseases in the Borough, since many cases are never reported either to the family doctor or to the Public Health Department. The work of investigating cases of dysentery throws quite an appreciable burden on the shoulders of our sanitary staff. This has 24 been so much in evidence that I am seriously considering a modification of our present procedure. There is little doubt that dysentery, particularly the type of dysentery known as Sonne dysentery, has now taken a firm hold on this country, becoming what is known as indigenous. If that is the case, and ail available evidence points in that direction, it is not at all clear that the work which we have previously carried out in tracing and supervising contacts is fully justified. I hope to be able to submit a report to the Public Health Committee during the coming year on the question of dysentery, which I have to deal with not only as Medical Officer of Health, but also as District School Medical Officer. Our aim must be to arrive at a programme which will confine the risk of infection within reasonable limits, without placing an unnecessary burden on staff who are already fully occupied. This also applies to the quite important issue of exclusion from school, a matter in which we are extremely interested. It seems quite illogical to keep children who are contacts from school without very good reason. It is largely in this connection that I propose to amend our present procedure. Needless to say, we still propose to exclude adults from work if they are contacts and if they are connected in any way with food. So far as food poisoning is concerned, all cases are carefully investigated, in an endeavour to trace the source of poisoning and to prevent spread. During 1953, all the cases which occurred were sporadic and did not present themselves as outbreaks. Unfortunately, we seldom hear of cases of food poisoning sufficiently early to be able to trace a definite source. If and when we do, the necessary action is taken. Puerperal Pyrexia No cases of puerperal pyrexia were notified during the year. This compares very favourably with conditions which existed not so long ago, when this disease was not only much more prevalent, but extremely dangerous. Smallpox No case of smallpox occurred in Wood Green during 1953. For the first time in many years, I was not asked to see any doubtful rashes. Mention might be made here of the extremely low vaccination state of the general population. Although smallpox has not appeared in epidemic form in this country for several years, there is always the chance of the Asiatic type of smallpox being imported in ships or by air transport. We must therefore continue to remain unsatisfied until the vaccination state has been raised to such a level as will remove the danger of an outbreak or epidemic occurring. 25 To this end, the County Council has given us permission to carry out vaccination at our Child Welfare Clinics. This vaccination is now being performed and will, one hopes, make a definite contribution to the vaccination state, especially of infants. Tuberculosis Ninety cases of tuberculosis (80 pulmonary) were notified during the year, as against 59 in 1952. Of the 90 new cases, 19 were transfers from other districts, 71 cases being new notifications. A broad classification of the cases notified during the last two years in relation to employment was: 1953 1952 Clerical 12 7 Manual Labour 23 7 Housewives 11 6 Factory Workers 4 5 Children 4 3 Professional classes 4 2 Domestic Service — 1 Nurses — 1 Shop Assistants 2 1 Armed Forces — 1 Retired persons 3 — Unclassified 8 6 Totals 71 40 The number of cases on the register at the end of the year was as follows : Pulmonary 247 males N on-pulmonary 11 males 215 females 32 females Total—462 Total—43 Reference has already been made to the close liaison which exists between the Housing Section and the Public Health Department in relation to tuberculosis. This liaison also includes the Tottenham Chest Clinic, which is most helpful and co-operative. There is no doubt that housing plays a most important part in the spread of tuberculosis, especially overcrowding and insanitary conditions. The Housing Repairs and Rents Act should help materially, and should provide an added weapon to reinforce the many, often spectacular advances in the treatment of this extremely serious disease. Prevention is always better than cure. It therefore seems more than ever illogical that vast sums have to be spent in treating cases of tuberculosis which, in a properly organised society, should never have occurred. This is a field in which local authorities can play a 26 notable part. Wood Green has certainly played its part, is still doing so. More remains to be done until we can rest content that conditions which encourage the spread of tuberculosis have been banished from our midst. Certain schools in Wood Green are still taking part in the Medical Research Council's scheme for determining whether or not vaccination by B.C.G. should be supplied to school leavers. It will be some time yet before the final outcome of these investigations is known. During 1953, Mass Radiography Unit 6a visited Wood Green. The Public Health Department co-operated very closely in this venture, while the County Council placed White Hart Lane Child Welfare Clinic at the disposal of the Unit. The Public Health Department addressed invitations to members of local organisations to attend for X-ray, while, through the courtesy of the press, I was able to have a lengthy article inserted in local papers. We also arranged for the display of posters and the distribution of leaflets together with a banner at a prominent site. For the first time, the parents of children of 12 years and over attending our maintained schools were invited to take advantage of the presence of the Unit in Wood Green, on behalf of their children. The Secretary of the Unit has supplied the following information relating to the work carried out by the Unit over the 8 days during which it operated in Wood Green: Groups Male Female Total. Schoolchildren Number of miniatures 371 398 769 Number recalled for large film 6 1 •47 School Staff Miniatures 46 39 85 Recalled for large film 1 1 2 Public Sessions Miniatures 772 1,236 2,008 Recalled for large film 37 54 91 Did not attend for large film 1 2 3 Organised Groups Miniatures 599 330 929 Recalled for large film 17 9 26 Did not attend for large film 1 1 2 Total number of miniatures all groups 1,788 2,003 3,791 Total number of large films all groups 61 75 136 Did not attend for large film 2 3 5 27 Groups Male Female Total. Cases of pulmonary tuberculosis discovered: Active post primary lesions 6 4 10 Inactive post primary lesions 18 15 33 Groups in which active cases were discovered: Schoolchildren 1 1 Public Sessions 4 9 Other interesting abnormalities discovered: Pneumonitis 2 2 Bronchiectasis 1 1 2 Cardiovascular Lesions (Acquired) 3 9 12 Cardiovascular Lesions (Congenital) 1 1 Von Recklinghausen's Disease — 1 1 Congenital Maldevelopment of chest — 1 1 Emphsematous Bulla 1 — 1 Lipoma 1 — 1 Did not attend for clinical investigation 1 1 I have every hope that the Unit will continue to visit Wood Green at regular intervals to X-ray members of the general public, school leavers and factory employees. DISINFECTION AND DISINFESTATION The number of articles dealt with at the Disinfection Station was as follows:— Articles disinfected 118 Articles destroyed 146 95 rooms were disinfected on account of infectious disease. 75 rooms were disinfested on account of the presence of vermin. 10 premises were treated for infestations of cockroaches, wasps and flies. 85 library books were brought to the Department during the year for disinfection. 28 29 INFECTIOUS DISEASES FOR THE PAST 25 YEARS 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 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 1953 — 93 66 — — — 36 64 5 5 4 7 1 2 449 778 — 89 202 — 3 6 2 N = Notifications. *D = Deaths. APPENDIX 1. HEALTH EDUCATION The programme of health education set out in detail in the Report for 1952 was again carried out during 1953. It is now obvious that health education must play an important part in any health programme. The cost of health education when compared with other health services is negligible. Although the results cannot readily be assessed, they are undoubtedly many and lasting. I have been particularly pleased at the warm manner in which I have been received by local organisations, when asked to give a health talk or to show a film. This is particularly encouraging, and shows that there is a demand for knowledge by the community. I will continue my efforts in this direction, and sincerely hope that I will have the very great privilege of extending them. I would also take this opportunity of expressing my most sincere thanks to the editors of our local papers for their unfailing cooperation and courtesy. Not once has space been refused, even when this was extremely valuable. The help afforded by the press has been truly magnificent, and has allowed the message of health to find its way into many homes which could not otherwise have been reached. APPENDIX 2. CLEAN FOOD MONTH Special Report to Public Health Committee dated 26/11/53 Set out below is a list of the expenses incurred in running the Clean Food Month held in October last. As the Committee will note, the total expenses were well under the £100 originally allocated for this effort:— Item Firm or Authority concerned Cost £ s. d. Advertisements in Press Local Papers 9 14 0 Posters (50) Barnard & Crannis 5 0 0 Dog notices (650) Barnard & Crannis 3 10 0 Book markers (5,000) Barnard & Crannis 11 5 0 Cinema slides Morgan Slide Projected Publicity 1 1 9 Films Central Film Library 10 15 0 Wages and Overtime (Projectionist) Southgate Borough Council 27 3 4 Temporary A.C. supply Eastern Electricity Board 5 11 6 Photographs J. W. Young 1 17 0 Exhibition material Central Council for Health Education 10 0 0 Insurance 1 2 1 Sundry expenses Various 1 14 10 Total £88 14 6 As the Committee will be aware the main purpose of the Clean Food Month was to interest food handlers, members of the general public and school children in the matter of clean food. The Committee will also be aware that the programme included the giving of talks and film shows, mainly in the Public Health Department where a special clean food exhibit was set up; the display of posters; the issue of book markers through the libraries; articles in the local press; the showing of cinema slides; the insertion of advertisements in the local press; the preparation of a clean food exhibit at the Civic Exhibition, together with the issue of notices to shop keepers advising the public to abstain from bringing; doers into food shops. 31 Clean Food Month — October, 1953 Lecture Room, White Hart Lane (Old) School, N.22 I think it could be said that the Clean Food Month was successful. It is, of course, not possible to determine the effect of the stimulus produced but I am reasonably confident that we did emphasise the need for food hygiene, particularly among food handlers and school children The total numbers who attended our various talks, with or without film shows were as follows:— Food Handlers 440 School Meals Service 138 Local Organisations 246 School children 2,101 Total 2,925 I have thanked all those who helped us in the organisation and running of our Clean Food Month which we hope to repeat when occasion demands. Civic Exhibition at the Gaumont Cinema — October, 1953 Clean Food Exhibition Stand 35 APPENDIX 3 Table I. Vital Statistics of Wood Green, 1931-53 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 1953 51,470 600 11.6 23 17 28 3 130 517 10.04 36 Table II. Birth Rate, Death Rate and Analysis of Mortality during 1953 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 15.5 11.4 0.00 0.00 0.01 0.00 0.16 1.1 26.8 160 County Boroughs and Great Towns (including London) 17.0 12.2 0.00 0.00 0.01 0.00 0.15 1.3 30.8 160 Smaller Towns (population 25.00050,000 at Census 1951) 15.9 11.3 0.00 0.00 0.00 0.00 0 17 0.9 24.3 London 17.5 12.5 0.00 0.00 0.00 0.00 0.15 1.1 24.8 Wood Green 11.6 10.0 0.00 0.00 0.00 0.00 0.10 1.6 28.3 Table III. Causes of Death during the year 1953 Causes of Death Male Female. Tuberculosis, respiratory 5 — Tuberculosis, other 2 — Syphilitic disease 2 — Diphtheria — — Whooping Cough — — Meningococcal infections — — Acute Poliomyelitis 2 — Measles — Other infective and parasitic diseases — 1 Malignant neoplasm, stomach 13 2 Malignant neoplasm, lung, bronchus 19 2 Malignant neoplasm, breast — 7 Malignant neoplasm, uterus — 5 Other malignant and lymphatic neoplasms 22 30 Leukaemia, aleukaemia — 1 Diabetes 2 3 Vascular lesions of nervous system 27 30 Coronary disease, angina 55 17 Hypertension with heart disease 8 9 Other heart diseases 25 27 Other circulatory disease 12 12 Influenza 3 3 Pneumonia 10 16 Bronchitis 30 24 Other diseases of respiratory system — — Ulcer of stomach and duodenum 6 3 Gastritis, enteritis and diarrhoea — 1 Nephritis and nephrosis 1 3 Hyperplasia of prostate 6 — Pregnancy, childbirth, abortion — 1 Congenital malformations 4 6 Other defined and ill-defined diseases 17 14 Motor vehicle accidents 2 2 All other accidents 3 11 Suicide 7 4 Homicide and operations of war — — Totals 283 234 37 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 5 — — — — 2 — 1 1 1 Tuberculosis, other 2 1 — 1 Syphilitic disease 2 — — — — — — 1 1 — — — Diphtheria — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — Meningococcal infections — — — — — — — — — — — — Acute Poliomyelitis 2 — — — 1 1 — — — — — — Measles — — — — — — — — — — — — Other infective and parasitic diseases — — — — — — — — — — — — Malignant neoplasm, stomach 13 — — — — — — — 2 5 3 3 Malignant neoplasm, lung, bronchus 19 — — — — — — 2 2 5 8 2 Malignant neoplasm, breast — — — — — — — — — — — — Malignant neoplasm, uterus — — — — — — — — — — — — Other malignant and lymphatic neoplasms 22 _ 1 1 1 5 7 7 Leukaemia, aleukaemia — — — — — — — — — — — — Diabetes ... 2 — — — — — — — — — 1 1 Vascular lesions of nervous system 27 — — — — — — — 1 4 10 12 Coronary disease, angina 55 — — — — — — 2 9 13 19 12 Hypertension with heart disease 8 — — — — — — — — 3 4 1 Other heart diseases 25 — — — — — — — 1 7 6 11 Other circulatory disease 12 — — — — — — — 2 2 4 4 Influenza 3 — — — — — — — — — — 3 Pneumonia 10 — — — — — — — 1 4 3 2 Bronchitis 30 1 — — — — — — 2 5 8 14 Other disease of respiratory system — — — — — — — — — — — Ulcer of stomach and duodenum 6 — — — — — — — 1 — 3 2 Gastritis, Enteritis and Diarrhoea — — — — — — — — — — — — Nephritis and nephrosis 1 — — — — — — — 1 — — — Hyperplasia of prostate 6 — — — — — — — — — —I 5 Pregnancy, childbirth, abortion — — — — — — — — — — — — Congenital malformations 4 4 — — — — — — — — — — Other defined and illdefined diseases 17 4 — — 1 — 3 2 3 2 2 Motor vehicle accidents 2 — — — — — — 2 — — — — All other accidents 3 — — — — — 1 — 1 1 — Suicide 7 — — — — — 2 — — 3 2 — Homicide and operations of war — — — — — — — — — — — — Totals 283 10 — — 2 1 9 11 25 61 83 81 38 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 75and over Tuberculosis, respiratory — — — — — — — — — — — — Tuberculosis, other — — — — — — — — — — — — Syphilitic disease — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — Meningococcal infections — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — Measles — — — — — — — — — — — — Other infective and parasitic diseases 1 — — — — — — — — 1 — — Malignant neoplasm, stomach 2 — — — — — — — — — 1 1 Malignant neoplasm, lung, bronchus 2 — — — — — — — — — 1 1 Malignant neoplasm, breast 7 — — — — — — — 1 2 3 1 Malignant neoplasm, uterus 5 — — — — — — — — — 3 2 Other malignant and lymphatic neoplasms 30 — — — — — — — 5 4 10 11 Leukaemia, aleukaemia 1 — — — — — — — 1 — — — Diabetes 3 — — — — — — — — — 1 2 Vascular lesions of nervous system 30 — — — — — — — 1 5 7 17 Coronary disease, angina 17 — — — — — — — 2 2 4 9 Hypertension with heart disease 9 — — — — — — — — 2 3 4 Other heart diseases 27 — — — — — 1 2 2 1 10 11 Other circulatory disease 12 — — — — — — — — — 5 7 Influenza 3 — — — — — — 1 — 1 1 — Pneumonia 16 1 — — — — — — 1 — 5 9 Bronchitis 24 — — — — — — 1 — 1 5 17 Other disease of respiratory system — — — — — — — — — — — — Ulcer of stomach and duodenum 3 — — — — — — — — 1 1 1 Gastritis. Enteritis and Diarrhoea 1 — — — — — — — — — — 1 Nephritis and nephrosis 3 — — — — — — — — — 2 1 Hyperplasia of prostate — — — — — — — — — — — — Pregnancy, childbirth, abortion 1 — — — — — 1 — — — — — Congenital malformations 6 6 — — — — — — — — — — Other defined and illdefined diseases 14 — 1 1 1 — — 3 1 3 2 2 Motor vehicle accidents 2 — — — — 1 — 1 — — — — All other accidents 11 — — — — — — — 2 3 1 5 Suicide 4 — — — 1 — — 1 1 1 — — Homicide and operations of war — — — — — — — — — — — — Totals 234 7 1 1 2 1 2 9 17 27 65 102 39 Table IV. Infectious Diseases Notified during the year 1953 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 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 and upwards AlexandraBowes Town Hall Noel Park Scarlet Fever 66 — 11 42 9 3 — — — — 1 — 23 21 22 28 — Diphtheria — — — — — — — — — — — — — — — — — Cerebro-Spinal Fever 1 1 — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — Erysipelas 4 — — — — — — — — — 2 2 2 1 1 1 — Pneumonia 44 — 1 1 1 1 1 6 4 4 11 14 17 10 17 20 26 Acute Poliomyelitis 5 — 3 1 — — 1 — — 1 — — 3 1 1 2 1 Polio-encephalitis 1 — — — — — — — — — — — 1 — — 1 1 Puerperal Pyrexia — — — — — — — — — — — — — — — — — Pulm. Tuberculosis 64 — — — — 8 14 12 9 10 7 4 21 14 29 9 5 Non-Pulm. Tuberculosis 7 1 — — 1 1 — 2 1 1 — — 4 1 2 1 2 Malaria 1 — — — — — 1 — — — — — — 1 — — — Measles 778 13 350 402 8 4 1 — — — — — 251 289 238 18 — Pertussis (Whooping Cough) 202 7 - 82 104 4 — — 1 4 — — — 57 61 84 14 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — 1 — — — — Dysentery 51 — 7 18 7 2 1 2 6 2 2 4 16 26 9 5 — Food Poisoning 7 — — — — — 1 1 2 2 1 — 4 3 — — — Totals 1,232 23 454 568 30 19 20 24 26 20 24 24 400 429 403 99 35 40 Table V. TUBERCULOSIS New Cases and Mortality during 1953 Age Periods New Cases Deaths Respiratory Nonrespiratory Respiratory Nonrespiratory m. f. m. f. m. f. m. f. 0 — — 1 — — — 1 — 1 — — — — — — — — 5 1 1 1 1 — — — — 15 10 15 1 — — — — — 25 5 11 2 — 1 — 1 35 7 6 2 — 2 — — — 45 11 1 1 1 2 — — — 55 8 — — — — — — — 65 and upwards 4 — — — — — — — Totals 46 34 8 2 5 — 2 — Above includes transfers (19) from other districts. One non-notified tuberculosis death occurred. 41 APPENDIX 4. Miscellaneous (a) Letters to Doctors The following letters were sent to general practitioners practising in Wood Green during 1953: June Notifying case of poliomyelitis July do. August do. August do. August do. August 6th Admission to Hospital of Cases of Infectious Disease August 7th Holiday arrangements October 22nd Mass Radiography December Collection of Laboratory Specimens. (b) Medical Examinations During the year, thirty-one medical examinations were carried out. Seven of these were in respect of entrants to the Council's employ, for acceptance into the superannuation scheme, and twenty-four in respect of workmen in the Council's employ, for acceptance into the superannuation scheme. In addition, thirty-one medical reports were issued relating to employees absent from duty through sickness. 42 APPENDIX 5. COUNTY COUNCIL OF MIDDLESEX (Area No. 2) (Friern Barnet, Potters Bar, Southgate, Wood Green) Area Health Office, Southgate Town Hall, Palmers Green, N.13. 1. Introductory The purpose of this Report is to present to the Committee an over-all picture of the work carried out in the Area during 1953. It will be appreciated that the Report is, of necessity, brief, and that it has only been possible to touch on the more important aspects and statistics relating to each section of the Area work. It will also be appreciated that, to include the work of the School Health Service, would call for a separate document. For this reason mainly, the matter of the School Health Service has been for the moment deferred, although I hope to be able to present a statement to the Committee at a later date. It would be true to state that the work carried out by the Area Health Staff in Area No. 2 last year was relatively uneventful. Opportunity has been taken to improve and extendi our services wherever possible, and to introduce newer and more up-to-date methods. Minor changes in administration have also taken place; the more important of these will be referred to in the body of the Report. Altogether, the picture can, I think, be justly claimed to be one of steady progress. 2. Area Statistics THE YEAR, 1953 Population : 169,050 Friern Barnet 28,260 Potters Bar 17,210 Southgate 72,110 Wood Green 51,470 Area (in acres) : 12,840 Friern Barnet 1,340 Potters Bar 6,129 Southgate 3,764 Wood Green 1,607 43 Birth Rate 11.52 (per 1,000 population) Friern Barnet 13.23 Potters Bar 14.18 Southgate 10.54 Wood Green 11.65 Infantile Mortality Rate 25.68 (per 1,000 live births) Friern Barnet 23.33 Potters Bar 16.39 Southgate 27.63 Wood Green 28.33 Maternal Mortality Rate 0.51 (per 1,000 births). 3. Medical Staff The medical staff in Area No. 2 consists of myself, as Area Medical Officer, my Deputy, the Senior Assistant Medical Officer, and six Assistant Medical Officers. Dr. Campbell, my Deputy, assists me generally in my work, and is particularly responsible for the day-to-day administration of the School Health Service. The duties of the Senior Assistant Medical Officer are mainly those of supervising the health visiting, home nursing and domiciliary midwives' services, although she undertakes many other duties, including those of supervising nursing homes and work under the Child Minders' Regulations. Each of the six Assistant Medical Officers is based at a Clinic, and has a number of schools allocated to her. These medical officers are directly responsible for the work carried out at the clinic, and for the school health service duties undertaken in their district. I would like to pay a warm tribute to our medical staff, who have co-operated wholeheartedly in the efforts made to maintain and improve the standard of the services provided in the Area. I would particularly refer to Dr. Janet Campbell, my Deputy, who has been my unfailing ally in all aspects of my work. In the same way, Dr. E. S. Stephen, the Senior Assistant Medical Officer, has played a notable part in co-ordinating the services for which she is responsible. 4. Clerical Section The Clerical Section is housed at the Area Health Office, Town Hall, Palmers Green, N.13, and at White Hart Lane (Old) School, N.22. This dichotomy is still necessary, as it has not yet been 44 possible to obtain central accommodation which could be made available as an Area Health Office. The separation of members of the staff in this way is unfortunate, and is a problem which we hope will one day be solved. Clerks are also stationed at most of the Maternity and Child Welfare Centres in the Area. This arrangement facilitates the clerical work carried out at these Centres. The clerical staff employed in the Area consists of the following: 1 Chief Clerk 1 Deputy Chief Clerk 2 APT. IV. 1 Higher Clerical Division 4 Clerical Division 20½ General Division 1 Telephonist. The work is, to a certain extent sectionalised, although the setting-up of watertight compartments has been carefully avoided. Minor changes in the administrative pattern take place from time to time, in the light of experience. During the year, five members of the clerical staff resigned for various reasons, their places being filled in each instance. As the Committee will be aware, Mr. P. E. Barber, the Chief Clerk, suffered a heart attack in November last. The Committee will also be aware that Mr. Barber has not returned to work, but has expressed his intention to retire. I should like to pay a sincere tribute to Mr. Barber, who has been associated with me personally, first as Chief Clerk in the Southgate Public Health Department and later as Area Chief Clerk, for the past twenty-three years. No one could have wished for a better or more zealous and conscientious colleague, although we are extremely happy to have, in Mr. G. W. Jones, a very worthy successor. 5. Ante-Natal, Post-Natal and Child Welfare Clinics By the end: of 1953, Ante-natal Clinics, at which post-natal cases also attended, were provided in eight premises throughout the Area, approximately nine sessions being held every week, with an average attendance of 14. Both Health Visitors and Midwives attended these clinics, acting under the direction of an Assistant Medical Officer. In addition, one session was held each week in Southgate, at which midwives only attended. The average attendance at this session was nine. During the year considerable extension of our Ante-natal Relaxation Classes took place, so that, by the end of the year, each 45 district in the Area could take advantage of these excellent facilities. 81 sessions were held during 1953, with an average attendance of 12. This average is steadily increasing. Child Welfare Clinics were held at 13 premises throughout the Area, special toddler sessions being a feature at most of these premises. A total of 26 sessions on an average was held each week, with an average attendance of 37. During the earlier part of 1953, approval was given to provide vaccination against smallpox at our clinics, where immunisation against diphtheria, pertussis (whooping cough) or diphtheria and pertussis combined has been supplied for many years. Vaccination facilities are now available at most clinics in the Area. Graphs are kept of the quarterly figures relating to attendances at each of our welfare centres. These graphs allow us to judge the usefulness of our clinics, both on a geographical and numerical basis, and enable us to formulate our policy in advance. The graphs will be available for inspection by the Committee. A feature of the work carried out at our Child Welfare Clinics during the past few years has been the holding of special Birthday Sessions. Approximately one Birthday Session is held each month at all our Clinics. Birthday letters are sent to parents of children up to the age of five, who have at any time attended the Clinic. Special pre-school record cards are kept, so that an accurate record can be maintained of progress. When a child reaches its fifth birthday, these cards are attached to the routine school medical cards, and are available throughout the child's school life. These clinics are definitely appreciated by mothers, and allow us to pick up stragglers whose attendances have been irregular. Of the thirteen premises used as comprehensive clinics, throughout the Area, four are church halls, two in Friern Barnet, one in Wood Green and one in Potters Bar. It will readily be understood that the use of church halls is not entirely satisfactory, since they compare unfavourably with ad hoc premises. Within recent years, we have transferred clinics from two church halls in Southgate to our own premises, with advantage to the services and to the mothers and children who take advantage of them. Plans are now being prepared to erect two new comprehensive centres, one in Friern Barnet and one in Potters Bar. It will presumably be some time before these centres are available, but we look forward eagerly to their inception. With regard to the number of mothers who use our infant welfare centres, we made a very careful check of approximately half the Area, over a five year period from 1947 to the end of 1951. This census was completed in 1952, but the Committee might be interested to see the results, which are illuminating. The mothers 46 attending our clinics were divided into the five income classes used for Census purposes. The results of our enquiry was as follows: Southgate Potters Bar Class 1—65.25% Class 1—72.22% „ 2—81.36% „ 2—82.99% „ 3—87.84% „ 3—82.52% „ 4—84.93% „ 4—76.03% „ 5—76.92% „ 5—95.45% Average—85.51% Average—81.76 % The time occupied in compiling these figures was not inconsiderable, but was deemed worth while, as we were able to judge the class of population upon which we should concentrate, and were also able to compare the work of one health visitor with another. If time permits, we hope to extend the analysis to the whole of the Area. In concluding this section of the Report, I would pay great tribute to the help afforded at our clinics by the Voluntary Helpers who attend so regularly. These ladies give unstintingly of their services, many having attended our clinics for a great number of years. We consider them part of the Area team, and we are delighted to think that they not only represent the continuance of voluntary service in the community, but are able to assist us materially in our work. 6. Special Clinics Children under five may be referred for treatment to the following clinics established in Area 2 : Ophthalmic Ear, Nose and Throat Orthoptic Speech Therapy Orthopædic (including physiotherapy). 7. Health Visiting With one exception, Health Visitors employed in the Area occupy a combined post, being also School Nurses. In addition, we have two Health Assistants, both of whom perform most useful work. Our average strength of Health Visitors in the Area during the year has been as follows : 20 Health Visitors and School Nurses 1 School Nurse 2 Health Assistants. 47 During the year, four members of the staff left our service. Fortunately, although Health Visitors are in very short supply, it was possible to recruit three whole-time Health Visitors and one part-time Health Visitor to take their places. During the year, 1,318 visits were paid to expectant mothers; 20,872 to children under 5; 2,684 to school children, and 1,976 to other cases, including old persons. In making these visits, approximately 15,500 households were visited. Our Health Visitors, School Nurses and Health Assistants are supervised by an Area Superintendent of Health Visitors and by a Deputy Superintendent. Both ladies are under the immediate control of the Senior Assistant Medical Officer. In supplying the figures set out above, it is quite impossible to present an adequate picture of the work of a Health Visitor. The duties of the modern Health Visitor have been greatly extended since the coming into force of the National Health Service Act. Thus, their duties are no longer confined to the care of mothers and children under the age of five; they are now expected to undertake much wider duties, including the care of the aged and close liaison with general practitioners working in the districts for which they are responsible. The influence which Health Visitors can bring to bear on mothers during visits to the home or during talks at the clinic, is invaluable. Their work in regard to schools and school children is of equal importance. Our Health Visitors are allocated to main clinics, from which they operate. They are thus enabled to get to know their district, and to establish close and cordial relationship with the mothers with whom they come into contact. In like way, each Health Visitor is allocated several schools in the same district, so that their work among children under five and school children can be closely integrated and will follow on as a natural sequence. We encourage Health Visitors to visit schools, to consult with Head Teachers, and to be aware of problems as they arise. We are fortunate in the fact that many of our Health Visitors have worked in this Area for a number of years. We are thus able to build on a solid foundation, which is of the very greatest help to us in our work. 8. Midwifery Service The number of births which occurred in Area No. 2 during 1953 was just over 2,000. Of these, approximately 80% took place in hospitals and nursing homes; the remainder were domiciliary cases. Almost all the domiciliary cases were attended by our own midwives, 242 in the capacity of midwife, 153 as maternity nurse. In attending these cases, more than 7,000 visits were made, an average of approximately 18 visits per case. In addition, a percentage of the children born in hospitals and nursing homes were 48 discharged sufficiently early to become, for a time, the responsibility of a domiciliary midwife. These cases accounted for a total of 225 visits. At the beginning of 1953 there were nine midwives on the staff. During the year two midwives left, one to be married and the other to take up a post in Indonesia. The approval of the County Council was obtained to replace these midwives, although considerable difficulty was experienced in filling both vacancies. Thanks to the generosity of the Potters Bar Urban District Council, we have obtained the provision of a flatlet, which has recently been occupied by a full-time midwife. We are equally grateful to the Urban District Council of Friern Barnet, where similar provision has been made. In addition to the nine midwives mentioned above, we usually have two pupil midwives undergoing part of their training in the Area. These are normally resident at ' Osidge,' where there is a resident approved midwife teacher responsible for their training. All our domiciliary midwives are subject to the supervision of the Senior Assistant Medical Officer and the non-medical Supervisor of Midwives. Our midwives are all qualified to administer gas and air analgæsia All have the use of portable apparatus for the administration of gas and air. In just over three out of four cases attended by our midwives, gas and air analgaesia was given by a midwife; in approximately three out of five cases, pethidine was administered, again by a midwife. The availability of transport for our midwives has been adequate, due in large measure to the excellent fleet of cars handed over to the County Council in 1948 by the Southgate Queen's Nursing Association. Communication by telephone is provided in the homes of all those midwives who are not resident at ' Osidge.' 9. Home Nursing Service In addition to the Superintendent of Home Nurses, who is also Non-medical Supervisor of Midwives, and the Superintendent at ' Osidge,' 21 whole-time and six part-time Home Nurses were employed at the end of 1953. Owing to the sharp rise in the demands on this service, the approved establishment for the Area was increased during the year from 24 to 26. During the year, our nurses paid a total of 77,335 visits to 3,140 cases. These cases were divided as follows : Medical 2,612 Surgical 301 Infectious diseases 45 Tuberculosis 112 Maternal complications 45 Others 25 49 The local arrangements for operating the Home Nursing Service vary from district to district. In Potters Bar, the Urban District Council has provided a Council house, from which one full-time and one part-time nurse operate. In Southgate, ' Osidge ' is the administrative centre for the service, although not all the home nurses are resident there. In Wood Green, a central office is provided in a room in the branch Area Health Office. In Friern Barnet, a small headquarters is housed in an ad hoc building in Wetherill Road. These arrangements are not entirely satisfactory. The room used by the nurses in Wood Green is inadequate, since it is shared by two clerks and is not provided with a running water supply. We have made representations for the use of an extra room in this building. The result of this application is not yet known. Our administrative arrangements for the supply of a Home Nurse following the request of a general practitioner appear to be working satisfactorily. There is no evidence that the service is being abused or that unnecessary visits are being requested. This matter is kept under close review, and I would have no hesitation in making representations to the Committee if I thought that alterations should be made. With regard to transport, five nurses are provided with County cars, and one with a County auto-cycle. 11 nurses receive an allowance for using their bicycles; the remainder use public transport. Recent experience has shown that the services of a Male Home Nurse would toe advantageous. We are therefore taking steps to make such an appointment. 10. Home Help Service The equivalent number of whole-time Home Helps at the end of 1953 was 63½, the actual number being 86. During the year, 671 cases were provided with help, as follows : Maternity 121 Tuberculosis 33 Chronic sick (including aged and infirm) 214 Others 303 There is an Organiser of Home Helps and an Assistant Organiser. The Organiser is provided with transport on one day each week, with occasional extra transport to assist in urgent visiting. The County Council regulations as to priorities are strictly observed in operating the Home Help Service. This is one of the most difficult services to organise and run, since the number of 50 Home Helps available is seldom, if ever, able to meet requirements. It will also be appreciated that our Home Helps come and go with disturbing frequency, being drawn from that section of the community which is not particularly interested in long-term employment. This will be seen from the fact that the number of resignations from the Home Help Service during 1953 was 27. Yet another difficulty lies in the fact that most of our Home Helps are married and have their own children, all of whom are liable to the illnesses associated with childhood. When this happens, the Home Help Organiser is liable to find herself without a number of Home Helps, at a time when these are most required. Continuous steps are taken to implement the number of women used in this service, since there can be no doubt that the Home Help Service does supply a very definite need. The matter of payment for services rendered is dealt with by the Finance Department, while there is a Panel which meets regularly to consider appeals. 11. Day Nurseries Two Day Nurseries were available in the Area at the beginning of 1953. Both were 50 place Nurseries, and comprised a training Nursery in Wood Green (White Hart Lane) and a nontraining Nursery in Southgate (Hoppers Road). Changes in Policy relating to conditions of admission and charges resulted in a continued fall in the number of cases attending these Nurseries. It was therefore decided to close Hoppers Road Day Nursery, closure taking place on 30th October, 1953. At the end of the year five children under the age of two and 35 children between the ages of two and five were on the register of White Hart Lane Day Nursery. At that time, the Nursery employed an equivalent of whole-time non-domestic staff, together with three part-time domestic staff. Having regard to all relevant circumstances, I am of opinion, that one Day Nursery will continue to be required in the Area. The site on which White Hart Lane Day Nursery stands—the site is owned by Wood Green Borough Council—is eminently suited to this purpose. 12. Immunisation I have already reported in some detail in a previous report on the position in regard to immunisation against diphtheria, pertussis (whooping cough) or diphtheria and pertussis combined. I will therefore confine myself to stating that, during 1953, 1,953 children were protected for the first time against diphtheria alone or against diphtheria and pertussis combined. In addition, 4,372 children were given reinforcing injections, mostly in the schools. 51 Approximately 58% of infants in Area No. 2 were fully immunised before reaching their second birthday. The results which can be attributed to immunisation will be too well-known to require re-emphasis. The state of immunisation, both in infants and in school children, is high. This must not encourage complacency, as continued efforts will be required to maintain our present standards. 1 think it can be said that these efforts are being made, and that they might be regarded as adequate. Reference has already been made to the yearly campaign for immunisation against diphtheria, in which Area No. 2 plays its part. This campaign includes the showing of slides in local cinemas, advertisements and articles in local newspapers, special talks at clinics, and the display of posters. Members of our staff are constantly bringing the need for immunisation to the notice of parents, especially stressing the fact that immunisation should be complete some time before the end of the first year. We also make a point of acquainting general practitioners with our policy from time to time, so that the work of immunisation can be properly integrated. Thus, we notify general practitioners of changes in procedure as, for instance, when we discontinued immunisation against diphtheria and pertussis for a short time during the summer months because of the local prevalence of poliomyelitis. The Committee will be aware that health education in Middlesex is shared between the areas and the district councils which make up these areas. We co-operate very closely with the Borough and Urban District Councils concerned, so that maximum benefit can be expected. The work of health education in Area No. 2 includes: The circulation of the magazine " Better Health "; health talks and film shows at clinics and to local organisations; the display of posters; the supply of leaflets and pamphlets in the Area Health Office; libraries and at Clinics; articles in the local press, and special efforts designed as periodic stimuli, e.g., a yearly immunising campaign. Apart from these activities, it must always be remembered that the basis of health education lies in the advice given to mothers in the home and at Clinics by Medical Officers, Health Visitors, Midwives, Home Nurses and' other members of the staff. We have also tried to make it known that the Area Health Office is to be regarded as an information bureau, to which any special problem can be brought and where advice and assistance will readily be forthcoming. 52 Although the effects of health education are not readily discernible, I am convinced that we must always consider this to be an integral part of our work. Without health education, little progress of lasting value can be anticipated. It is for this reason that we have concentrated on health education, and that no avenue will be left unexplored. In this connection, it might be mentioned that we have collaborated with Messrs. Marmite Ltd., in the making of a sound film, during which Cranborne Clinic was used. I would very much like to have the pleasure of arranging a sound film in which the general health activities in Area No. 2 were depicted. The Committee will remember that this has already been discussed and strongly supported by the Committee. As several years have now elapsed since the project was first mentioned, may I put forward the suggestion that it might, with profit, be revived. 13. Dental Care of Expectant and Nursing Mothers and Children under School Age At the end of 1953 there were four whole-time and five part-time dental officers employed in the Area, representing a total of 6½ whole-time staff. During the year, 232 sessions were allocated to this service. A total of 177 expectant and nursing mothers and 584 children under the age of five were treated. I need not remind the Committee that great difficulty has been experienced in the past in obtaining the services of sufficient Dental Officers to deal with the priority and school dental services in the Area. The situation did improve during 1953, when our available establishment was higher than has been the case for many years. This allowed us to deal with arrears of work urgently required. The position is so variable that I would not hazard a guess as to how long this happy state of affairs is likely to continue. Each Dental Officer is provided with the services of a Dental Attendant, who combines chair-side assistance, the keeping of necessary records and the making of appointments. The Dental Service is under the direction of an Area Dental Officer, Mr. G. S. Williams. Mr. Williams has a difficult task to perform, as he also acts as Dental Surgeon at a very busy Clinic. He has carried out his many duties with devotion, and I am glad to have this opportunity of expressing my thanks to him. 14. Care of Old People The problem of old people, especially the aged and chronic infirm, is one which constantly occupies our attention. This is a problem with numerous facets, in which many bodies and 53 authorities are concerned. Although the problem of old age is predominantly a welfare matter, it will be obvious that it is one which cannot be disassociated with public health. Up to the moment, our activities have mainly been directed towards the supply of Home Helps and Home Nurses, where admission to hospital is either undesirable or cannot be arranged. We also use our Health Visitors to visit old people in their homes, while we assist at least one large hospital in paying geriatric visits. I am especially perturbed to think that cases of extreme hardship occur among old people which may never come to our attention. For this reason I recently addressed a letter to general practitioners and to local organisations, asking them to let us know whenever such cases are discovered, so that we might play our part in helping to effect a remedy. I have also instructed my staff to act in a similar capacity. There is no doubt that the question of old age and its problems is one which is not only here to stay, but which will obviously increase. I am of opinion that steps might be taken to correlate the activities of all the various bodies engaged in this work, so that over-lapping could be avoided and the best practical results achieved in the shortest time. 15. Co-operation A feature of our work in Area No. 2 has always been cooperation with other bodies. I am happy to think that we offer and receive cordial co-operation from those other authorities and bodies with whom we come into contact. Thus, our relations with the district councils which constitute the Area, with Hospital Management Committees and hospitals generally, with general practitioners and with voluntary bodies, have been close and cordial. I am completely satisfied that this aspect of our work is important, and that it must never be neglected. As an instance of what is being done, it might be noted that the Area Health Staff is represented on the Executive Committee of the North Middlesex Division of the British Medical Association, the Liaison Committee set up by the same Division, the Northern Group Medical Advisory Committee, various Old People's Welfare Committees, local Social Service Councils, and the Executive Committee of the Southgate Physiotherapy Association. The fact that I am Medical Officer of Health for three of the constituent districts making up Area No. 2, and that the Deputy Area Medical Officer is my Deputy in two of these districts, is also of the greatest value. The Committee will remember that an attempt was made during 1953 to interest general practitioners and head teachers in the work of our clinics, by inviting them to " Open Days " at each 54 clinic. The venture was successful, and it is hoped that it will be repeated during 1954. Opportunity is taken from time to time to communicate with general practitioners and' also with schools, so that matters which seem to call for attention can be brought to their notice. This has become a regular feature of our work and is, I believe, appreciated by the recipients. 16. Investigation and Research Although it is not always easy for a fully-occupied staff to carry out research, it is highly desirable that this should be done. We have therefore tried to follow such lines of investigation as lie within our power, and will continue to do so. All children attending for birthday examination at the welfare centres are given a tuberculin jelly test. These tests are also applied on children before admission to the Day Nursery. After consultation with the Chest Physician at the Finchley Chest Clinic, we have agreed to extend the scheme still further, to include school entrants and school leavers attending certain of our schools. This work gives us valuable information relating to tuberculosis, and allows us to refer cases to the Chest Clinic for further investigation. We were privileged to take part in an investigation relating to the pre-menstrual syndrome, carried out by a general practitioner in conjunction with a hospital medical officer. This investigation has recently been published and won the Charles Oliver Hawthorne Award of the British Medical Association. We now hope to cooperate with the same general practitioner in a further study relating to the treatment of toxæmia of pregnancy. This is an extension of the previous work and will, it is hoped, produce significant results which should materially advance our knowledge of the cause and treatment of this distressing and serious phenomenon. Although, as I have already indicated, work under the School Health Service does not properly come within the scope of this Report, it might be noted that we co-operated with the Medical Research Council in two schemes of research. One was designed to investigate hæmoglobin levels in the blood, with particular regard to seasonal and other variations. The second investigation, which is still proceeding, relates to the possible efficacy of B.C.G. inoculation of school leavers. We were also able to assist in arranging a visit of Mass Radiography Units to Southgate, Wood Green and Friern Barnet and, for the first time, were permitted to include the examination of school leavers. Our work also involves the carrying out from time to time, of investigations which are requested for County purposes, and also on behalf of the Ministry of Health and other authorities. 55 As I have already stated, we are not ideally equipped to undertake research on a large scale. None the less, this branch of our work is so important that we feel more than justified in devoting such time as is available to its pursuit. 17. Additional In addition to the work set out in the foregoing paragraphs we carry out inspections of nursing homes, welfare establishments and children's homes in the Area. We are also responsible for duties under the Nurseries' and Child Minders' Regulation Act. Considerable work is done in regard to the medical assessment of County staff appointed to or resident in Area No. 2, together with the medical examination and assessment of Student Teachers, prior to their entry to training colleges. We are also responsible for assessing the needs of persons of all ages applying for admission to holiday homes. So far as these duties are concerned, it may be stated that the Area staff is acting more or less directly on behalf of the County Medical Officer. 18. Conclusion I would once again stress that this Report merely tries to supply a composite picture of the work carried out in the Area during 1953. I would conclude by paying tribute to the Area Staff generally for their unfailing loyalty and sense of duty. I would also most sincerely thank the Chairman and Members of the Area Health Committee for their continuous courtesy and support, which have been of the very greatest help to me in my work. Finally, I would take this opportunity of expressing my keen appreciation of the generous assistance provided by Dr. Perkins and his staff at head office, together with the equally valuable advice and assistance supplied by all other departments of the County Council. W. C. HARVEY, Area Medical Officer. Area Health Office (Area No. 2) Southgate Town Hall, Palmers Green N.13. May, 1954. 56 Printed by Barnard & Crannis Ltd., 103, Myddleton Road, Bowes Park - N.22