Library BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1954 WM. CLUNIE HARVEY, m.d.dph Medical Officer of Health. WOOD 36 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1954 WM. CLUNIE HARVEY, m.d.dph Medical Officer of Health. Public Health Department White Hart Lane (Old) School Wood Green N. 22 June 1955 To The MAYOR ALDERMEN and COUNCILLORS Of the BOROUGH OP WOOD GREEN Mr Mayor Ladies and Gentlemen I beg to present the Annual Report of the Medical Officer of Health for the year 1954 1954 was again a placid year with few if any highlights So far as infectious diseases were concerned the total number of cases notified during the year fell from 1 232 to 365 one of the lowest totals ever recorded in the Borough This, of course was very largely due to the marked decline in measles notifications from 778 to 29 These matters will be referred to in greater detail in the body of the Report but it is meantime satisfactory to be able to record a year in which infectious diseases played a comparatively minor part in the life of the community In previous Annual Reports I have emphasized the fact that epidemiology is no longer concerned merely with infectious diseases The term must now embrace the study of any condition or conditions prejudicial to health or to look at the matter from another angle conditions which are capable of causing actual disease Although Wood Green is extremely fortunate in its character and amenities especially the absence of major factory development and serious overcrowding on an optimum scale it is still our duty to make a careful search for any conditions hidden or disclosed which are detrimental to health and well being in this connection I need scarcely emphasize that it is infinitely easier to prevent the setting up of such conditions than to remove them once they have been established It is mainly for this reason that I have long pursued the policy of bringing all matters affecting health to the notice of the public Health Committee I count myself extremely fortunate that the Public Health Committee has always studied my statements and reports with the care which one has come to expect from Wood Green Borough Council This has greatly heartened me since it is almost a truism to say that unless the Public Health Committee can be supplied with full information the Medical Officer of Health has no right to expect that full measure of support without which success can never be achieved With regard to the vital statistics for 1954 these were also satisfactory.The birth rate (10,8)once again shows a slight decrease from the rate for 1953 which was 11 6 This gradual decline is of course in keeping with the trend shown throughout the country The death rate has also fallen from 11 5 in 1952 to 10 04 in 1953 and 9 6 in 1954 The Infantile Mortality Rate i e the death of infants under one year of age fell from 28 3 to 26 6 I would once again stress that the totals involved are too small to provide us with yearly variations which can be accorded real significance It is however satisfactory to be able to record that the Infant Mortality Rate has in fact fallen When 3 one knows as we do know, that the neo-natal mortality, i.e. the number of children dying within four weeks of birth made up the vast majority of infant deaths in Wood Green;and when one remembers that these tragedies were mostly due to such conditions as prematurity and congenital abnormalities,conditions which are not easily preventable, the fall in the infant mortality rate is all the more pleasing. Altogether as I have said, the vital statistics for 1954 indicate a placid year with no major occurrences. When one takes the long view, and considers every aspect relating to health, this can, I think, be regarded as satisfactory I need scarcely repeat that the personal health services operated in the Borough are under the control of the Middfesex County Council, It will be remembered that last year I included a report submitted to Area Health Committee No.2, as an appendix to my Annual Report. It is doubtful whether my statement to the Area Committee as it relates to 1954 will be ready by the time this Annual Report goes to press. I therefore intend to ask the County Council's permission to circulate my Area report to all members of the Council as soon as it is ready. I feel very strongly that the Borough Council should know what is happening within the Borough, not only the steps which the public Health Committee is taking to safeguard health, but the comparable action pursued by the County Council.In no other way can these separate but closely parallel activities be properly integrated, if and when Wood Green becomes an Area,it will, of course.be much easier to paint a composite picture. Until then, the steps which I have outlined above will, I hope, enable the Borough Council to appreciate more fully the various measures being taken within the Borough to improve and safeguard the health, not only of the individual but of the community. It has been my custom for several years to include, as an appendix to my Annual Report, a brief statement on health education. This year,I should like to incorporate this statement in the introductory section of the Report, since it is becoming more and more obvious that health education is playing an essential part in preventative medicine and that it deserves first-class priority. The significance of health education in the vast field of public health is now accepted. It has been stated that we are still only in the experimental phase of health education. We certainly have much to learn, both as to method and content. Be that as it may, we would do well to study and review from time to timethepart which health education can play, the contribution it has to offer, and the uses to which it can be put. I should now like to return to a subject which I have ventilated on several occasions, but which cannot be stressed too often or too strongly. Preventative medicine is and always will appear unspectacular to the general public, unless in those isolated instances where the discovery of a new vaccine or the introduction of important legislation are focused in the national press.The day-to-day measures designed to erect a barrier against the spread of infection and to encourage positive health, are still taken for granted by too many people. This, of course, is 4 both illogical and unfortunate, but the facts are to some extent understandable and must be accepted. When a child develops poliomyelitis, or when an adult is rushed to hospital with acute appendicitis, the whole family is acutely aware of the emergency, and equally grateful for the remedial measures undertaken. It is not so with preventive medi cine. Too often the public is to a great extent oblivious of the work being carried cut on its behalf in the realm of public health. It is here that health education can and should play such a vital part There are certainly pitfalls We must avoid creating a nation of hypochondriacs who are constantly dwelling upon the ills which might befall them We must equally avoid placing too much stress on aspects of health which have comparatively little significance. Our duty must be to enlighten the public on matters which vitally concern them, to choose our material with loving care, to establish and review from time to time our programme of priorities We should make quite certain that the services available to the public are fully known and understood We should draw attention to factors which have topical interest and are of immediate significance, e g measles and influenza outbreaks the existence of food poisoning or dysentery We should endeavour by every means available to stress the fundamental principles upon which a healthy individual and community are based Lastly,we should try to concentrate on those age groups and sections of the community which are most in need of education in its widest sense, without making the cardinal mistake of always preaching to the converted and so neglecting those groups which are most difficult to reach Our health education programme in Wood Green is. I venture to say reasonably comprehensive.Apart from the work carried octot from day to day by our Sanitary Inspectors, and so far as the County Council is concerned by Health Visitors both in the clinic and in the home, the Council will be aware that numerous talks and health film shows are given during the year, while articles appear from time to time in the local press We are extending our work in the schools,a field of paramount importance: while we undertake special campaigns from time to time, designed to focus attention on important aspects of health and the prev ention of disease. It must be realised that the results of our efforts are not readily discernible We cannot say that for a certain expenditure, we can guarantee certain results, Nor, although we believe this to be the case can we say that our expenditure on health education has saved the community a given sum of money What we can and do claim is that a progressive policy of health education sill be followed either immediately or over the years by results which have quite incalculable value If these results are some times intangible at least for a period their value is not there by diminished When one remembers the infinitesimal sums being expended on health education, as compared with other branches of local government expenditure, and when one realises that health education lies at the very root of a healthy community.the argu ments in its favour are surely undeniable. It must also be clear that Wood Green is in many ways an excellent district in which to put into operation an enlightened 5 and enlightening programme of health education. It may be said that most of our citizens are quite capable of knowing what to do and that in fact, they require the minimum of guidance. On the other hand, it must equally be realised that, for one reason or another, mistakes are made and errors committed Too often these mistakes or errors are not deliberate, or even accidental. They stem from lack of true knowledge, from the inherent apathy which has always beset the human race until something goes wrong, I make no apology for once again stressing this point If we were to neglect health education either because the cost was considered exorbitant or because it was not thought to be worth the trouble the effects might not be immediately seen,but without the slightest doubt they would, in time be felt I would take this opportunity of thanking the Public Health Committee and the Borough Council for their continued support and encouragement without which our programme of health education could never have been carried out I am satisfied that we are working along the right lines, although I am still not convinced that we have fully explored all available avenues We will continue our policy of exploration until we can be reasonably sure that the public is fully informed on matters concerning health and well being the two terms are not necessarily synonymous ■ that no section of the community has been overlooked I have already thanked the Aldermen and Councillors of the Borough Council, including most especially the members of the Public Health Committee for their continued support and encouragement. I would be failing in my duty if I did not do so once again Nothing is more important in the life of a Medical Officer of Health: his efforts can be made or marred by the help which he receives from his Council and Public Health Committee I would again express my very sincere thanks to the staff of the Public Health Department for their continued loyalty and devotion to duty In this connection, I would make particular reference to the able assistance rendered by Mr W. McCauley Chief Sanitary Inspector and by Mr W. T. Gloster Chief Clerk in the Public Health Department, I would also thank my deputy., Dr Campbell, for her unfailing loyalty and assistance at all times I have particularly mentioned Dr Campbell, Mr McCauley and Mr Gloster but my thanks are due to all members of the staff,, a staff which can be regarded as a team in the truest sense of the word I am Mr Mayor Ladies and Gentlemen Your obedient servant W C HARVEY, Medical Officer of Health BOROUGH OF WOOD GREEN PUBLIC HEALTH COMMITTEE The Deputy Mayor, Alderman W. A. VANT, J.P. (Chairman) Councillor R. G. KENDALL, (7ice-Chairman) The Mayor, Councillor A. VITORIA, J.P, Councillor Miss DEM. HISCOCK. Alderman A. R. HARRISON. Councillor F. T. SKUDDER. Councillor J. W. BARNETT. Councillor E. A. B. WESSON. Councillor G. CATHLES *Medical Officer of Health - WILLIAM CLUNIE HARVEY, M.D,, D.P.H.. Deputy Medical Officer of Health - JANET RUSSELL CAMPBELL, M a. , CH.B.. D.P.H. *Chief Sanitary Inspector - W. McCAULEY, Cert.R.San.Inst, and ^an. insp. Joint Board, Cert. Meat and Food inspection. * Sanitary Inspectors - F. JAMES, Cert. R. San. Inst., and San. Insp. Joint Board, Cert. Meat and Food Inspection, G. PENBERTHY, Cert. R. San. Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection, H. B. PARKER,Cert. R. San. Inst, and San. Insp. Joint Board, Cert. Meat and Food Inspection. * W. E. GOODFELLOW (18. 2. 54.) and K. M. BELL (15, 3. 54). Sanitary Inspectors - (temporary) appointed to investigate the pollution of the Moselle Brook. Chief Clerk - W. T. GLOSTER. General Clerks - P. V. INGRAM: Mrs. C. M. A. MOSS. Shorthand Typist. Rodent Operator - J. HARRIS. Disinfector - w. WOODCOCK. *Half the salaries of these Officers are paid by the Middlesex County Council under Section 109 of the Local Government Act, 1933. STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,606 Population estimate supplied by the Registrar General 51,090 Number of inhabited houses (end of 1954) according to the Rate Books 13,965 Rateable Value, 1954 £547,724 Sum represented by a penny rate £2,210 Since taking up my appointment as Medical Officer of Health of Wood Green,I have been particularly struck by a feature which has been especially prominent in Wood Green. The point to which I refer is the importance accorded to cultural activities. Here, Wood Green is extremely fortunate.Within the Borough,the leisure time of the citizen is fully catered for. We have reason to be proud of the various organisations,societies and means of securing the right type of entertainment which exist within our boundaries. This may appear to be a very small point. It actually is not.Our cultural background should be part of our very existence and deserves its due mead of attention. It has been rightly said that everything which affects health comes within the purview of the Medical Officer of Health. It is for this reason that I mention this particular point. The fact that the name of Wood Green is associated with a Borough possessing first class amenities where the civic spirit is high, and where the citizens can enjoy a full and pleasant life has, in my submission, contributed in no small measure to the health of our Borough, EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births; Total M F Legitimate 539 261 278 Birth Rate per 1,000 11.03 Illegitimate 25 13 12 Still Births 10 8 2 Rate per 1 000 Births 17. 4 Deaths 533 284 249 Death Rate per 1,000 10,43 Deaths from Puerperal causes - Rate per 1,000 Births.. - Deaths of infants under 1 year of age: - All infants 15 Rate per 1,000 live births 26 6 Legitimate 15 Rate per 1,000 legitimate live births 27.8 Illegitimate - Rate per 1,000 illegitimate live births - Deaths from:- Cancer (all ages) 114 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) - Number of Births notified 559 Number of Births registered in the Borough .126 8 POPULATION The mid-year estimate of the population supplied by the Registrar General is 51,090, a decrease of 380 from that of the previous year. BIRTHS The number of live births registered during the year was 564 which gives a crude birth rate of 11 03 per 1 000 of population, and a corrected birth rate of 10 8, The rate for 1953 was 11.6. There were 10 still-births giving a still-birth rate of 17.4 per 1.000 births In 1953, the still birth rate was 22 8. DEATHS The number of deaths credited to Wood Green after the necessary adjustments had been made for inward and outward transfers was 533, giving a crude death rate of 10 43 per 1,000 of population and a corrected death rate of 9.6. The total number of deaths for the previous year was 517, when the death rate was 10 04. Of the total of 533 deaths, no fewer than 386 occurred at ages over 65,One hundred and eleven deaths occurred at ages over 80 and 16 at ages over 90 INQUESTS Twenty-four inquests were held following the deaths of Wood Green residents during 1954 three of these without post-mortem examination. A further 130 post mortem examinations were carried out without an inquest,68 of these in the Prince of Wales Hospi tal which, by arrangement with the Wood Green Borough Council provides mortuary services. MATERNAL MORTALITY No deaths occurred during the year as a result of childbirth, compared with one in 1953, when the maternal mortality rate was 1 62 per 1 000 births, INFANT MORTALITY There were 15 deaths of infants under one year of age,giving an infant mortality rate of 26 6 per 1 000 live births. This compares with a total of 17 deaths and an infant mortality rate of 28 3 in 1953. Of the 15 infant deaths 5 occurred within twenty-four hours of birth, 10 during the first week and 10 during the first four weeks of life This gives a neo-natal mortality rate of 17.7. The correspondine fieure for 1953 was 20 The following table shows the causes of death at various ages under one year Under 1 week 1 to 2 weeks 2 to 3 weeks| 13 to 4 weeksl 1 Total under! 4 weeks 4 weeks and under 3 mths 3 mths and under 6 mths 6 mths and under 9 mths 9 mths and under12mtte [Total deaths iunder one yi Prematurity 1 - - - 1 - - - - 1 Congenital Defects 1 - - - 1 - - - - 1 Atelectasis 1 - - - 1 - - - - 1 Gastro enteritis - - - - - - - 1 - 1 Intra-cranial Haemorrhagf 1 - - - 1 - - - - 1 Capillary Bronchitis - - - - - 1 - - - 1 Asphyxia 3 - - - - - 1 - - 4 Broncho pneumonia 1 - - - 1 1 - - - 2 Other causes 2 - - - 2 - - 1 - 3 Total 10 - - - 10 2 1 2 - 15 9 GENERAL PROVISION OF HEALTH SERVICES Hospitals The provision of hospital beds for Wood Green residents has shown no material alteration since my last Report was issued. On the whole, from what I learn, the admission of acute cases to hospital, both medical, surgical and gynaecological, has shown a tendency to ease, although it could not yet be said that the situation is entirely satisfactory.Until recently,most hospitals had comparatively lengthy waiting lists for children requiring admission to hospital for the removal of tonsils and adenoids. I am informed that these waiting lists have been drastically reduced, although it must be admitted that many of us are still not entirely satisfied that the removal of tonsils and adenoids is always confined to those cases where operative treatment is definitely indicated. That, however, is a matter over which I have little control, either as Medical officer or as Area Medical officer. The demand for maternity beds in hospitals has started to fall and will continue to fall in almost direct proportion to the availability of adequate housing. Where a hospital bed, in fact, was required little difficulty was found in arranging for this to be provided. When it comes to the admission to a chronic hospital or to an institution of elderly, infirm persons, the position is still extremely gloomy. It must be appreciated that,when hospital beds are at a premium,these beds should most readily be available for acute cases who require careful nursing and supervision,possibly with an operation. On the other hand, we know only too well that numbers of elderly,infirm persons have to remain at home,receiving only such attention as can be provided by the Home Nursing and Home Help Services and by charitable neighbours and voluntary organisations. We are quite aware that our domiciliary services are designed to reduce the demand on hospital beds indeed, that is the principal which we always have before us.There must still, however, be a percentage of elderly persons who should be in a chronic hospital because they cannot receive adequate attention in their own homes. In many cases those unfortunate individuals are virtually left alone for lengthy periods, both by day and by night, since the most that can be arranged is periodic visits from one or more of the sources indicated above.This is far from satisfactory, and must surely be regarded as a stigma on the social services available to the most vulnerable section of our community. Although I am a member of several Committees which are intimately concerned with the hospital services, and although ray numerous protests have always been sympathetically received, it is still obvious that liaison between the services provided by the Regional Hospital Board and the needs of the local authority presents many serious gaps.The situation has certainly improved, while we must remember that the present system has only been in operation since 1948. Those of us engaged in the public health service feel very strongly that the emphasis placed on curative rather than preventive medicine in the National Health Service Act is not entirely in the National interest. No one would deny the wonderful work being carried out by Hospital Boards throughout the country, nor can one shut one's eyes to the obvious difficulties presented by the post war social system. One would have hoped however, that during the seven years over which the National Health Service has been operating,the obvious drawbacks might have been noted and an adequate remedy devised. 10 A freer exchange of information is quite obviously required, together with frank discussions,where the problems 6a both sides might be thoroughly ventilated.Few would deny that this could do anything but good. I must conclude this section by paying apersonal tribute to the hospitals serving this Area.The broad principles may require adjustment, but my personal relations with the hospital staffs, both medical and non-medical, and the co-operation which I invariably receive have always been most cordial. This, however, is not enough. So long as the principles are suspect, the machinery set up to put these principles into operation cannot be expected to function smoothly. Care of the Aged Pew subjects have received more attention within recent years than the care of the aged. We know that two new words have been introduced into our vocabulary, geriatrics and gerontology, both having to do with the process of growing old,and the afflictions which old age may bring with it.We also know that people s minds have been increasingly turned, not only to the urgent, often tragic problems which face an elderly individual but to the broader picture as it relates to the community and even to the country as a whole. I would require an entire document to do justice in any way to this enormous problem. That is not possible, although I feel that the Annual Report of the Medical Officer of Health should contain detailed reference to an aspect of health which affects a large and growing section of the community. Old age comes to many people in many ways.Some are relatively unaffected,retaining both their mental and physical powers until an advanced age, and remaining in the care of relatives or sym pathetic friends. Others are affected by old age at a relatively early period, and may require medical and nursing care either in the home or in a hospital or institution.To some elderly patients money is no object, others are wholly dependent on national assistance. Some elderly persons prefer to eat out, where they can be assured of company: others are confined to their houses or to one room, and welcome the meals provided by the Meals-onWheels service. These various examples are given, merely to show the divers factors which go to make up the quite gigantic problem contained within the two words " old age". No one would be so stupid or so churlish as to deny that much has been done in Wood Green for elderly persons. Apart from the help provided by such statutory bodies as the Borough Council, the Middlesex County Council through the Area Medical officer and the Area Welfare Officer, and the National Assistance Board, the help furnished by voluntary organisations,churches and by charitable individuals is much too generous and wide-spread to mention in detail. This is all very well, but it is by no means enough. It has long been obvious that the problem must be studied as a whole, not as an aggregation of individual units. In this way and in this way alone can we be reasonably certain that all aspects of the problem are receiving attention, that energy is not being uselessly expended, that there is no duplication and re-duplication that gaps are not being left unclosed. I have no doubt that, when the problem has been fully assessed, we will be able to integrate the various activities already being carried out, directing effort intothemost effective 11 channels;and expanding or even creating new services as and when these services seem to be required. Prom a humanitarian point of view,it is a truism to say that the aged are our responsibility, both as individuals and as a community. There is surely no slur no stigma in growing old it is and should be considered an honoured state, deserving of privilege demanding our sympathetic understanding and assistance. If we are to look on the matter from the most mundane angle, it would be equally true to say that unless the problem of the aged can be solved the national economy is quite certain to suffer. Our country has an ageing population, a fact which is apparent nowhere more than in Wood Green. But surely there is no need to take the latter standpoint. Let us think of those aged individuals.alone in their tiny rooms without friends, without company sometimes without comforts, without even the barest necessities of life. Such thoughts will surely awaken in us a sense of responsibility a sense of justice, a firm determination to ensure that everything possible is done for a section of the community which through no fault of its own has lagged behind in the race of life. I am very happy to be able to report that during the year steps were taken to form an Old People s Welfare Committee under the auspices of the Borough Council, An ad hoc organisation has already been set up to study and deal with this tremendous prob lem. I have no doubt that, when the local needs have been fully assessed, the Committee will be able to integrate the various activities already being carried out directing effort into the most effective channels and expanding or even creating new services where these seem to be required. Laboratory Facilities I would again record ray appreciation and thanks to the Staff of the Central Public Health Laboratory, both at Colindale and at Coppetts Wood Hospital, for their unfailing assistance during the year. Once again we did not have to call upon the Laboratory to any great extent during 1954 owing to the absence of major outbreaks of infectious disease. It is however, very satisfactory to remember that the Public Health Laboratory Service is available to us and that any calls which we make upon it will be readily and sympathetically met. Summary of work carried out at Central public Health Laboratories for the year 1954 Positive Negative Swabs for diphtheria bacilli .. - - Sputa for tubercle bacilli .. 1 8 Throat and nose swabs 34 Faeces 329 Urine 3 Blood 3 Others 39 Ice Cream 15 Milk 16 Water (Swimming Pool) 5 12 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 1954 under this Section. NATIONAL ASSISTANCE ACT, 1948 Burial or Cremation of the Dead In accordance with Section 50 of this Act two burials were carried out by the Council during 1954. One burial was carried out during the previous year 13 SANITARY SERVICES Inspections Public Health Act, 1936 587 Housing Act, 1936 804 Rag Flock and Other Pilling Material Act, 1951 4 Pet Animals1 Act, 1951 8 Factories and Outworkers 171 Food Preparing Premises 198 General Food Premises 680 Shops Act, 1950 57 Smoke Observations 46 Unsound Food 110 Complaints investigated 448 Interviews with owners, etc 185 Re-visits to property under notice 1,693 Infectious Disease cases 163 Food poisoning 56 Special enquiries in connection with infectious disease cases 108 Aged and infirm persons 33 Miscellaneous 500 Pests Act 200 6, 051 Informal Notices served; Shops Act 1 Complied with 1 Food & Drugs Act 12 " " 11 Public Health Act 257 " 197 Housing Act 73 " " 62 Factories Act 8 " 8 Pests Act 6 " " 5 Statutory Notices served Public Health Act 10 " " 20 Housing Act 6 " " 10 Factories Act 1 " " 1 Hous ing Statistics 1. Inspection of dwelling houses during the year; (1) (a) Total number of dwelling houses inspected 396 for housing defects (under Public Health or Housing Acts) (b) Number of inspect ions made for the purpose 1491 (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. 4 (3) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 79 2. Remedy of defects during the year without service of formal Notices Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 259 14 3. Action under Statutory Powers during the year: (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 6 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 10 (b) By Local Authority in default of owners 3 (B) Proceedings under Public Health Acts (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 10 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 20 (b) By Local Authority in default of owners 2 (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which demolition orders were made 2 (2) Number of dwelling-houses demolished in pursuance of demolition orders (D) Proceedings under Section 12 of the Housing Act,1936 (1) Number of separate tenements or underground rooms in respect of which closing orders were made 2 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit. In no instance was it found necessary for legal proceedings to be taken. 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 out side 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 particu larly 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 15 Housing Survey The Mi.nis.ter of Housing and Local Government directed last August that all local authorities throughout the country should within a year, submit to him proposals for dealing with houses which are unfit for human habitation and with any other houses within the district, which in the opinion of the authority are or ought to be included in clearance areas. The preliminary survey of houses in the Borough has been completed and it is estimated at first glance that almost 200 houses are of such category as to be unfit for human habitation. These houses will be considered by the appropriate committee as to the best method of dealing with them and how soon they can be dealt with. This figure of 200 by no means covers the exact extent of the housing problem. Wood Green is a fairly built-up area and in order to obtain sites for building it may be necessary to purchase houses unfit to a lesser degree as well as other properties in close proximity to the proposed clearance areas. Compulsory Purchase Orders would have to be made at the same time as the clearance areas were declared. In a good number of the houses declared unfit there is more than one family residing and this greatly adds to the number of new dwellings which will be required. The Moselle Brook Early in 1954 the Wood Green Borough Council received notifi cation that the Moselle Brook which passed through Wood Green, was being grossly contaminated by the discharge of soil water from sinks, baths lavatory basins and some water closets. The Council quite rightly took a serious view of the matter and decided that immediate action was necessary to eliminate the sources of pollution For this purpose two Sanitary Inspectors were engaged in a temporary capacity in March 1954 They have been assisted by two men each from the Borough Engineer & Surveyor s department in this work. The method of procedure is as follows In order to trace the flow of drains the Sanitary Inspector uses various kinds of concentrated coloured powder which is placed in the drains at any convenient opening. Both sets of drains surface water and soil are tested at the same time A cover to the inspection chamber of the soil sewer is removed and the coloured water awaited. Only in this manner is it possible to trace the correct flow of sewage. I submit below a summary of the work carried out during the year in question.Besides the Notices served to remedy the defective drainage advice was given to owners or their representatives at interviews and the work done in accordance with such Notices, supervised Re-inspections were made in all cases in order to enforce the conditions of the Notices, in this respect, it was found necessary in a number of instances to make several calls before the work was completed. The Moselle Brook was once an open watercourse as it passed through Wood Green. It is now completely piped in and covered, but a part which passes through the Tottenham recreation ground is still open for a considerable distance. Access to the culvert is gained at the end of Westbury Avenue and all inlets to the Brook from Wood Green are periodically tested by Inspectors from the Lea Conservancy Board. It is worthy of mention I think, that the Moselle Brook 16 empties into the River Lea, and the latter into the Thames at a considerable distance up the river. The Brook should receive only surface water or underground water and the rainwater from those houses which drain into it. There are two systems of drainage to almost all houses in Wood Green, the intention being that the surface water should discharge into the Moselle Brook and the soil from the soil sewers into tanks at Tottenham for treatment. Houses tested Business premises tested Defective Bain Water to soil Prelim inary Notices Statutory Notices Reins pection Completed W.Cs. Sinks Baths Wash hand basins 4, 396 488 19 149 60 48 440 197 - 289 129 A glance at the summary of the work done will, I am sure you will agree,show that a good job of work has been carried out. It has not been an easy task, and as you will remember, the weather during the year left much to be desired, and was anything but favourable for open work of this kind. Rodent Control Out of a total of 1 883 premises inspected throughout the year, it was found necessary to carry out treatment at 137 of them; 93 dwelling houses and 15 other premises were treated for rat infestation:a further 21 dwelling houses and 8 other premises were treated for the presence of mice. During the year 15 to 20 baiting points have been maintained on the Council" s tip at White Hart Lane, at the commencement of this treatment complete takes were recorded. By October when the tip was levelled, only small or part takes were noted; since the levelling, 15 points have been used showing only small takes.The poison used in every case was ' Warfarin''. 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; 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, 379 showed pre bait take, and 368 part take of poison. There were no complete takes of poison, whilst the complete takes of pre-bait were 136. 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 2,388 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. 17 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. ' Spnngfield' 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. 18 INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply The following licences for the sale of milk under special designations have been granted Tuberculin Tested pasteurised Sterilised 15 20 39 Supplementary licences to sell milk from premises which are outside the area of the Licensing Authority Tuberculin Tested Pasteurised Sterilised 11 12 13 Sixteen 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 107 premises registered for retailing Ice Cream. During the year, 77 visits were paid to these premises and 15 samples were submitted for bacteriological examination. Of these samples 14 were Grade I 1 was Grade II (c) Meat and Other Foods The undermentioned foodstuffs were certified as unfit for human consumption during the year:- lbs. Tins Meat 1, 094 Meat 122 Fish 172 Fish 29 Fruit 63 Vegetables 154 Cheese 954 Fruit 258 Cakes, etc. 116 Evaporated Milk 45 Sweets 38 Jam 4 Biscuits 88 Soup 21 Cereals 19 Cheese 7 Vegetables 168 Cream 47 1,767¾ 687 Miscellaneous Items Eggs 5,377 Chocolate Bars 36 Minced Meat 1 Jellies 2 Meat and Fish Paste 1 Cakes, etc 60 Cake Mixture 12 Biscuits 33 Meat Pies 24 Fruit and Vegetables 2 Cheese 29 Condiments 5 Beverages 2 Jam 3 Miscellaneous packets 2 19 (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 1 105 Dairies and Milk Shops 85 Ice Cream Premises 77 Fried Fish Shops 9 Stalls 24 Other Food Premises 575 Middlesex County Council Act,1950 • Section 11 - Registration of Hawkers of Food. Sixty hawkers of food in the Borough are registered, FACTORIES AND HOMEWORK 1. 1nspect ions Premises Number on Register Number of Inspec tions Written Notices Occupiers prosecuted FACTORIES WITHOUT mechanical power 41 29 FACTORIES WITH mechanical power 180 80 9 _ OTHER PREMISES in which Section 7 is enforced by the local authority 2 2 _ .. Total 223 111 9 - 2. Defects Found Particulars Number of cases in which defects were found Number of cases in which prosecu tions were instituted Found Remedied Referred To H M Inspec tor By H.M. Inspector Want of cleanliness - - - - - 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) 4 4 - 4 - Total 5 5 - 5 - 20 3 Outwork Nature of Work No. of out workers in August 1 ist No. of cases of default in sending lists to Council No. of prosecutions for failure to supply lists No. of instances of work in un wholesome premises Noti ces served Pros ecu t ions Wearing appar el Making etc. 10 - - - - Household linen 5 - - - - - Lace Lace cur tains and nets - - - - - - Curtains and furniture hangings 1 - - - - - Brass and Brass articles - - - - - - Artificial Flowers 7 - - - - - Feather sorting 13 - - - - - Cosaques Christ mas crackers and stockings 41 - - - - - Total 77 - - - - WATER SUPPLY The whole Borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply, RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Three premises in the Borough are registered under the above Act. The premises are periodically visited and during the year three samples were taken and sent for analysis. The results were satisfactory. PET ANIMALS ACT, 1951 Under the Act one new 1icence was granted and eight licences were renewed during th e year after thepremises 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 properties completed - 28 Flats and 4 shops at Ellenborough Court 6 Flats at Charter Court 6 Flats at Winkfield Road 21 Council properties in course of construction at end of year: 38 dwellings at Corbett Grove 21 flats at Eldon Road Private enterprise:- 1 new house at Windermere Road 1 new house at Alexandra Park Road 2 new houses at Moselle Avenue 23 new houses at Farrant Avenue All on bomb damaged sites. SWIMMING BATHS The figures of attendances at Western Road and Durnsford Road baths for the past two years are as follows:- Western Road Baths 1954 1953 Swimming Bath 60,976 50,327 do. Children (Special sessions) 276 617 Children from Schools 25,130 23,612 Spectators 6,741 4,917 Slipper Baths 42,804 45,016 do. Old Age pensioners (free) 1,282 634 Durnsford Road Open Air Baths Swimmers Adults 6, 257 14,928 Swimmers - Children 17 222 28 752 Children from Schools 2 993 962 Season Ticket Holders 14. 762 26 226 Spectators Adults 3 799 5 711 Spectators Children 552 703 Samples of water were taken from both baths at regular inter vals during the year. The results of the tests were uniformly satisfactory, 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) 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, and one Bedford Lorry for trade and special refuse. During the year 1953/4 the total tonnage of refuse collected was 12 304 tons:from this material salvaged was sold for £2 068. The quantities of salvage were Tons Cwts, Qtrs Paper 258 11 0 Mixed Scrap Iron . 2 1 0 Rags 3 2 0 In addition 827 tons 1054 cwts of kitchen waste was collected and sold for £3 374 This collection has now been discontinued. The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths, 22 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 41 it will be observed that 365 cases of infectious disease were notified during the year as against 1,232 in 1953. The infectious sickness rate for the district was therefore 7,14, as compared with 23.9 during the previous year. The decrease is almost due entirely to the fall in measles and pertussis (whooping cough) notifications. Scarlet fever notifications remained almost constant at the very low total of 61: food poisoning and dysentery notifications showed a slight rise (65 against 58). These matters will be referred to later in rel ation to each disease. The total number of infectious diseases notified during the year (365) is the lowest recorded in Wood Green since measles and pertussis were added to the list of notifiable diseases. In the introduction to this Report I once again mentioned the fact that the term epidemiology has now taken on a new signi ficance. We must no longer confine our attention to infectious diseases £er se but must concern ourselves with any disease or contributory cause of disease which makes itself apparent among the population. So far as Wood Green is concerned this more or less reduces itself to the investigation of unusual illnesses which may have sprung from quite unexpected sources. Here of course, one is very largely dependent on information received from general practitioners. Thus in the past, I have been in formed of cases of infective hepatitis among school children some time before the information could have been obtained from the schools concerned while family doctors and schools have been very helpful in letting us know of outbreaks of such diseases as winter vomiting I am most grateful for this assistance and have communicated my thanks both to general practitioners and to head teachers. Although as I say Wood Green is not the type of district in which it could be said that conditions especially favourable to the spread of disease exist we must continue to search for such conditions, which may very well be latent. We must also strive to take such steps as are possible to prevent these diseases producing factors from arising from taking root in our midst. This is the true meaning of epidemiology in its widest its most modern sense. Leaving aside the important question of epidemiology as we know it today, the picture in regard to infectious diseases is still relatively fluent In my Annual Report for 1953 I mentioned the reduction in severity, particularly as it affects a disease such as scarlet fever. These remarks still apply. We also know that virus diseases many indeterminate and still being investi gated have shown a definite tendency to increase. Among these diseases, the complaint known as winter vomiting is particularly apparent. This disease has little more than nuisance value and has not shown itself capable of producing either a serious ill ness or dangerous after effects. None-the-less the appearance of new virus diseases must be treated with great caution since we know only too well the ravages which a virus disease such as poliomyelitis can produce. Unfortunately, only a proportion virtually an unknown proportion, of virus infections are at present notifiable. This is inevitable,as many of these diseases are extremely mild, while their relationship to other diseases and their precise position in the general pattern have not yet beenfiisllly established. In the meantime, therefore, we continue 23 to hold a watching brief, prepared to change our attitude in the light of experience and information. So far as housing and factories are concerned, the remarks set out in last year s Annual Report still hold. I continue to visit factories from time to time since, although the Medical Officer of Health has limited powers in this field we should obviously know what is going on so that we are familiar with the hazards and can attempt to deal with such conditions as are likely to have significance. I am not yet in a position to report fully on the housing survey which has been taking place under the Housing (Rents and Repairs) Act 1953. This work is well in hand and will be the subject of a comprehensive report submitted to the proper Committee of the Borough Council during 1955. There can be no doubt that this survey will have a far reaching effect. Not only in the field of infectious disease but in relation to the health of the community in its wider aspect. I would conclude this section of the Report by making refer ence to influenza.Towards the end of 1953 the Ministry of Health asked us to supply information on the prevalence of influenza particularly the specific type of influenza complicated by pneumonia and by cerebral sequelae. I communicated on several occasions with general practitioners and obtained a miscellaneous bag of information which I correlated and transmitted to the Ministry, At that time there did not appear to be any evidence that influenza was unduly prevalent. Later however the number of cases did increase so much so that we might have had to put into operation certain emergency domiciliary nursing measures for which we were fully prepared. Fortunately the number of . serious complications and deaths gave no cause for alarm.. This however, is an example of the type of co operation which one heartily endorses Only when the central authority the local authority and the body of general practitioners concerned are prepared to work together interchanging information to the fullest possible extent can we say that we are ready to cope with any situation.The fact that special measures were never necessary in this particular instance should not be allowed to militate against this excellent principle. D i phther ia For the seventh year in succession no case of diphtheria was notified in the Borough The last death took place in 1939 Our immunisation programme is broadly speaking the same as that set out in recent Annual Reports. Various minor modifications have been introduced particularly to ensure the use of the most efficient antigen and to lay down special precautions relating to infants and children who are likely to be allergic, I intend to embody our immunisation time table in a memorandum which will set out in detail the programme upon which we have decided together with those precautions considered necessary.When the time table is ready I will furnish each general practitioner with a copy so that we will, so fai as is possible be working along the same lines It was not necessary during 1954 to suspend the use of the combined type of antigen designed to produce immunisation against diphtheria and pertussis As will be remembered this was done during 1953 because of the occurrence of cases of poliomyelitis in the neighbourhood. The immunisation figures relating to Wood Green for 1954 might be summarised as follows 24  Diphtheria only Combined Diphtheria and Whooping Cough Whooping Cough only Number of children who completed full course of primary immunisation 149 388 29 Number of children receiving reinforcing injections 1,286 58 3 Number of persons vaccinated 219 Number of persons re-vaccinated 39 I think it can fairly be said that our scheme of immunisation either against diphtheria alone or against diphtheria and pertus sis, is comprehensive, and that so long as the present level of immunisation is maintained,diphtheria will continue to be a com paratively rare disease. For some time past I have been anxious to use the new triple antigen which protects children against diphtheria pertussis and tetanus. The Ministry of Health has still not given its blessing to the use of the triple antigen, however,and we must therefore wait until approval is forthcoming. It will not be necessary for me to say that the work of immunisation in Wood Green is carried out by the County Council. I know, howevei, that the Borough Council is extremely interested in this vital weapon and that it would wish to be fully informed as to the precautions being taken in Wood Green. For some time past we have not been entirely satisfied with the literature available in respect of immunisation,particularly immunisation against diphtheria. This especially applied to the time-table advocated in the various pamphlets and leaflets at present at our disposal since it was becoming more and more obvious that the suggested time table very often conflicted with the advice issued from the Area Health Office and given at our clinics. I raised this matter at the Middlesex Medical Advisory Committee and was invited to produce an up-to-date pamphlet which would be generally acceptable throughout the county. I duly prepared a statement after which I had several consultations with the principal of the Ealing School of Art,where most attractive illustrations have been drawn up, The general lay-out and wording is now awaiting consideration and will it is hoped, furnish a pamphlet which should be generally acceptable and of practical use to parents. Scarlet Fever Scarlet fever notifications during 1954 showed a marked de cline over the figures for the previous year. The notifications for the past three years were 93. 66 and 61 respectively. The type of disease met with has been universally mild. Indeed, it is extremely doubtful whether more than a percentage of all the cases which occurred were ever seen by a doctor. I would repeat the remarks which I made in last year- s Annual Report, that scarlet fever may be going through a temporary phase of reduced virulence. We must therefore continue to watch the trend,and be prepared for a return at any time of the more severe type of infection previously encountered. 25 Acute Anterior Poliomyelitis One case of acute anterior poliomyelitis was notified in 1954 as against five during the previous year.This case was paralytic. Shortly before this Report was written the news was received that an efficient vaccine against poliomyelitis was at last avail able in the united States. Since then of course further news has come to hand of actual cases of poliomyelitis occurring very shortly after vaccination while it has been stated that parents have been affected presumably as the result of intimate contact. I think it would be safe to say. however that we can look forward to the day in the relatively near future when a safe and effici ent vaccine will be available in this country to protect children against poliomyelitis just as they have been protected against diphtheria and to a lesser extent against pertussis. In the meantime we must continue our general measures of protection, basing our actions on the knowledge available to us. I need scarcely point out that propaganda in regard to poliomyelitis is regularly carried out mainly through the schools. I also make a point of informing general practitioners of any undue occurrences. This propaganda is extremely valuable the one proviso being that any feeling of alarm must at all costs be avoided Measles 29 cases of measles were notified during the year as against 778 in 1953 This is the lowest figure recorded in Wood Green since measles became notifiable in 1940 Admission to hospital was only required in three cases an indication of the mild character of the disease Once again we must remember that the character of measles may change from year to year there being no guarantee that the pres ent low virulence will be maintained I am satisfied that the vast majority of Wood Green parents appreciate the situation and take the necessary precautions This being so it only remains to make certain that thepossible dangers resulting from an attack of measles especially in a young child are made known from time to time. Pertuss is Eighty cases of pertussis were notified during the year as against 202 in 1953. It will thus be seen that the number of pertussis cases which occurred during the year was actually higher than the corresponding measles total This could almost be des cribed as a phenomenon. We have continued our policy of immunisation both against pertussis alone and against diphtheria and pertussis combined Although pertussis immunisation does not give a full guarantee of protection it is generally agreed that efficient immunisation will modify an attack. This modified attack which represents merely a trifling illness is then followed by life long immunity Although there is an obvious danger that these modified attacks may go unnoticed thus helping to keep infection alive and so passing on the infection to other children available evidence would seem to show that our present programme of immunisation coupled with health education is correct and that it should be vigorously pursued It can at least be said that Wood Green parents show a decided preference for combined immunisation as against immunisation against diphtheria and pertussis at different times. The choice is left entirely to the parent although we recommend the combined method unless any contra indications exist. 26 Food Poisoning (including Sonne Dysentery) Twenty four cases of food poisoning and 41 cases of dysentery were reported in 1954,as against totals of 7 and 51 respectively during the previous year.I must again point out that these cases represent notifications and do not fully indicate the incidence either of food poisoning or of dysentery within the Borough. None the less they are extremely useful for comparative purposes as it can presumably be accepted that the factors which militate against the complete notification of food poisoning and dysentery do not materially alter from year to year. It will be remembered that, in my Annual Report for 1953, I suggested that we might put into operation a modified procedure designed to discover the presence of carriers" without throw ing an unnecessary burden on the Sanitary Inspectors and what is more important, without causing undue absences from school. This procedure was in fact, introduced during 1953 and is working very well. Broadly speaking, the system depends on the exclusion from school for one week of all children who have had diarrhoea or sickness in any school where the incidence of diarrhoea and sickness has clearly been shown to be above aver age. This procedure might mean, of course that children are occasionally excluded for transient reasons which have no epidemiological significance. On the other hand, it has already been shown that the system has reduced the absence from school of " carriers" of Sonne dysentery or food poisoning organisms, and causes much less upset in a family than did our previous procedure. We have prepared special letters which are available to all Head Teachers and which are used by teachers as and when occasion demands As always our Head Teachers have been most co operative, and seem to appreciate the reason for the change. "Carriers of food poisoning or Sonne Dysentery organisms who are food handlers are still excluded in the usual way, until the requisite number of negative specimens has been obtained. Altogether, this has been an extremely quiet year so far as Sonne Dysentery is concerned. No outbreaks of any magnitude were reported. It will be remembered that a small outbreak of food poisoning occurred in Wood Green just before Christmas. A special report was submitted to the Public Health Committee at its January meeting. This report is included as Appendix 1 of this Report. Apart from this limited outbreak, food poisoning did not present a serious problem during 1954. This outbreak did however indicate the clear need for constant vigilance in regard to all matters related to food hygiene. Puerperal Pyrexia No cases of puerperal pyrexia were notified during the year and there were none in 1953. No deaths were attributable to puerperal causes. Having regard to the fact that, in the vast majority of instances, puerperal pyrexia is no longer a disease which either kills or even incapacitates, it has been claimed that notification is no longer required. It would certainly be true to say that most cases of puerperal pyrexia are due to such simple causes as constipation or a common head cold occurring shortly after childbirth. Against this, we know that there are other causes for a rise in temperature during the puerperium, and that these causes may be highly significant. As midwives must be prevented at all costs from moving from one infected mother to 27 another.it would seem highly proper that even the mild conditions now known as puerperal pyrexia should continue to be brought to our notice. Smal1 pox No case of smallpox occurred in Wood Green during 1954. Once again, I was not even asked to see any doubtful rashes. I am glad to be able to report that the number of mothers seeking vaccination for their infants at Child Welfare Clinics in Wood Green, shows a definite increase. I have communicated with general practitioners, asking them to advocate vaccination as strongly as possible because of the extremely low vaccination state prevailing throughout the country.Wood Green practitioners will shortly be supplied with an attractive display card urging vaccination as well as immunisation.I have asked them to display this card in their waiting rooms.and have little doubt that they will co-operate. Tuberculos is Ninety four cases of tuberculosis (86 pulmonary 8 non pulm onary) were notified during theyear as against 90 cases in 1953. Of the 94 new cases. 13 were transferred from other districts, 81 being new notifications. A broad classification of the new notifications during the past three years in relation to employment was: 1954 1953 1952 Clerical 16 12 7 Manual Labour 14 23 7 Housewives 20 11 6 Factory Workers 7 4 5 Children 5 4 3 professional classes 1 4 2 Domestic Service – – 1 Nurses – – 1 Shop Assistants 8 2 1 Armed Forces – – 1 Retired Persons 2 3 – Unclassified 8 8 6 81 71 40 The number of cases on the register at the end of the year was as follows Pulmonary 269 males 242 females Total 511 Non pulmonary 11 males 35 females Total 46 It will be seen that the number of cases of tuberculosis not ified during the past three years has varied from 40 to 81. These figures have at best a limited significance, in view of the short period covered and the low totals involved. They are how ever useful as a basis of comparison and will become more use ful still as the years progress. I therefore propose to continue this classification so that the Council may have a broad picture of the various sections of the community in which tuberculosis appears most likely to occur It is also worthy of note that the incidence of tuberculosis 28 has not fallen in the country as a whole during the post-war period. This is undoubtedly due, in part at least,to the greatly improved facilities for discovering the disease in its early stages,more especially in the work of Mass Radiography Units and Chest Clinics. There does not appear to be any reason to believe that Wood Green has more than its share of fresh cases every year, or that any unusual conditions exist within the Borough which favour the spread of tuberculosis. In passing, it should of course be mentioned that, although the incidence of tuberculosis has not shown any decrease, the death rate is falling quite rapidly. In other words, although just as many cases are occurring today as occurred,say,ten years ago, many more patients are being kept not only alive, but fit, able to work and capable of leading a happy, healthy life. We were once again favoured with a visit from the Mass Radiography Unit 6A during 1954 As before, the Public Health Department co-operated very closely in this venture,while the Education Committee kindly placed accommodation in White Hart Lane (Old) School at the disposal of the Unit. The Secretary of the Unit supplied the following information relating to the work carried out by the Unit over the twelve days during which the Unit visited Wood Green: Groups Male Female Total Schoolchildren Number of miniatures 336 455 791 Number recalled for large film 1 6 7 School Staff Number of miniatures 17 24 41 Number recalled for large film – 2 2 Public Sessions Number of miniatures 646 854 1, 500 Number recalled for large film 15 28 43 Organized Groups Number of miniatures 1,281 1,036 2,317 Number recalled for large film 37 26 63 Total number of miniatures all groups 2,280 2,363 4,649 Total number of large films all groups 53 62 115 Active Post-Primary Lesions discovered 1 4 5 1 case still outstanding provisionally classified as active Pulmonary Tuberculosis 1 1 Inactive Post Primary Lesions discovered 13 10 23 Groups in which Active Lesions were discovered Organised Groups 2 2 Tublic Sessions 1 3 4 29 Groups Male Female Total Other interesting abnormalities d iscovered: Pneumonia 1 1 Bronchiectasis 2 1 3 Pleural Effusion (non tubercular) 1 – 1 Carcinoma of Bronchus 1 – 1 Cardiovascular lesions (acquired) 1 2 3 1 case still outstanding provisionally classified as Cardiovascular lesion (acquired) 1 1 Potts disease of Spine – 1 1 Transposition of Viscera 1 1 2 Calcified Chondroma – 1 1 Congenital Cyst of Lung – 1 1 I would conclude by making a special plea for the re housing of families in which an open case of tuberculosis is known to exist. I fully appreciate the difficulties which confront the Housing Committee and the Council in providing adequate housing accommodation as well as the fact that housing needs are by no means confined to tuberculous families On the other hand, the needs of a patient suffering from tuberculosis are not the only desideratum. If a tuberculous family occupies premises which are overcrowded, the risk of spreading infection very greatly increases. No one can say how far the net will be spread.or what the ultimate effect will be. Thus, not only on humanitarian, but on strictly epidemiological lines it is of paramount importance that the rehousing of families from which a case of tuberculosis has been notified especially where the patient continues to live at home should be granted high priority.I am very happy to think that the Housing Committee has always given the most sympathetic consideration to my representations. I am fully convinced that this is the proper course to adopt and that not only the family, but the Borough as a whole will very definitely benefit. DISINFECTION AND DIS INFESTATION The number of articles dealt with at the Disinfection Station was as follows Articles disinfected 1ll Articles destroyed 167 74 rooms were disinfected on account of infectious disease. 56 rooms were disinfested on account of the nresence of vermin. 33 premises were treated for infestations of cockroaches, wasps, ants flies, fleas beetles and moths. 68 library books were brought to the Department during the year for disinfection. 30 31 INFECTIOUS DISEASES FOR THE PAST 25 YEARS Year Diphtheria Scarlet Fever : = Enteric Fever 1 Pulmonary Tuberculosis Nonpulmonary Tuberculosis Measles Pertussis Poliomyelitis /N *D /N *D /N *D /N *D /N *D /N *D /N *D /N *D 1930 97 4 234 – 2 – 55 42 14 3 4 1 – – 1931 3??? 1 97 1 1 – 58 35 9 8 1 3 – – 1932 33 1 110 – 3 – 41 37 15 4 3 3 2 – 1933 24 1 192 – – – 57 26 9 6 – 1 1 – 1934 31 3 292 – 1 – 56 32 12 3 1 2 1 – 1935 39 4 201 1 4 – 47 23 5 1 – – 1 – 1936 99 12 98 – 5 – 51 46 8 5 2 2 2 – 1937 46 3 72 1 2 – 49 24 8 2 1 5 2 – 1938 63 2 92 – 1 – 59 21 10 7 3 – 1 – 1939 24 1 63 – – – 45 26 6 2 – 1 2 – 1940 26 – 61 – 7 – 55 22 10 4 89 – 24 2 – – 1941 42 – 51 – 2 – 57 26 7 4 401 2 192 1 1 – 1942 22 – 87 – – – 69 30 4 4 361 2 95 1 1 – 1943 26 – 155 – – – 43 22 3 3 356 – 106 1 – – 1944 9 – 51 – – – 44 20 5 4 232 – 134 1 1 – 1945 2 – 62 – 2 – 56 27 7 4 172 – 117 – 2 – 1946 7 – 73 – 1 – 76 22 10 3 346 – 89 – – 1 1947 10 – 46 – – – 52 17 10 5 410 2 171 – 2 – 1948 – – 69 – – – 65 21 9 5 408 – 174 – 5 1 1949 – – 71 – 2 – 68 19 9 – 678 – 46 – 6 1 1950 – – 99 – 1 – 57 10 6 2 421 – 376 1 4 – 1951 – – 196 – 1 – 50 13 5 2 434 – 127 1 1 – 1952 – – 93 – – – 36 5 4 1 449 – 89 – 3 – 1953 – – 66 – – – 64 5 7 2 778 – 202 – 6 2 1954 – – 61 – – – 73 6 8 1 29 – 80 – 1 – /N - Notifications *D- Deaths APPENDIX I FOOD POISONING Special Report to the Public Health Commi ttee - 3rd January, 1955. On Wednesday, 22nd December, we were notified of four cases of food poisoning in the same part of Wood Green, Investigations were immediately begun, and revealed some interesting facts. It appeared that all four cases had the same symptoms,nausea and vomiting, diarrhoea and severe prostration. The symptoms varied in intensity from case to case, but all four patients appeared gravely ill, so much so that one elderly lady was admitted to hospital during the early hours of the same morning. It further appeared that all four patients had eaten brawn prepared in a local butcher's shop and that their illness had begun approximately three hours after the brawn had been eaten. In this connection, I should like to pay a very sincere tribute to Dr.Hancock of Arcadian Gardens. Dr. Hancock,who attended two of the patients,suspected brawn as the vehicle of poisoning. He therefore paid a visit at 8 a.m. to the butcher's shop in which the brawn had been made, informing the proprietor that he was quite sure the Public Health Department would wish to prohibit the further sale of this product. He then informed us of his action. The second doctor concerned, Dr. Laverick of High Road, N. 22. was equally prompt in notifying the two cases which he was treating, and was also able to state that they had purchased and eaten brawn from the same shop. Enquiries at the butcher's shop showed that approximately 10 lbs. of brawn had been made the previous day. Some 3Vi lbs. had already been sold before Dr. Hancock visited the premises; the remainder of the brawn was still available. Unfortunately, we could not trace the customers or casual visitors to the butcher- s shop who had purchased the suspected brawn, although the butcher himself was most co -operative.By this time fresh cases were being reported. Contact was made with the Central Public Health Laboratory, and arrangements concluded for sending to the Laboratory the remainder of the brawn from the butcher's shop, specimens of faeces and vomit from patients, and specimens of faeces and nose swabs from the butcher and the butcher's assistant. The latter had actually made the Drawn. I also telephoned the Ministry of Health,explaining what had happened and asking whether the matter was considered sufficiently serious to approach the B. B. C. I was informed that this was not desirable in view of the presumptive nature of the food poisoning, the fact that such a small quantity of brawn had actually -been sold and the scare which might develop.The Central Public Health Laboratory gave the same advice. I did, however, telephone all Wood Green practitioners, warning them of the cases which had occurred, and asking them to notify us of fresh cases. My Sanitary Inspectors also canvassed the area around the butcher's shop,in an effort to find families where brawn had been purchased but not yet eaten. Within forty-eight hours we had obtained reports from the Laboratory.These showed that the brawn was heavily infected with an organism known as the staphylococcus, which causes a type of food poisoning which is acute but seldom of long duration. The reports also showed that the assistant who had made the brawn 32 was carrying the same organisms in his nose. We therefore knew that we were dealing with a staphylococcal type of food poisoning presumably caused by a "carrier" who had conveyed the organisms to the brawn. I took immediate steps to contact the Town Clerk and to ask him to take action under Regulation 4 of Part 3 of the Public Health (Infectious Diseases) Regulations,1953. These regulations allow the local authority to give notice to any person who is a food handler and who has been proved to be inaposition to spread disease, to abstain from work until the risk of spreading infection has passed. At the same time, I contacted the assistant's doctor.informing him of the position and asking for his co operation. The situation now is that the assistant is off work, attending his own doctor. He will not be allowed to return to work until I am satisfied that he is no longer in a position to spread infection. Practitioners in Wood Green were again telephoned and asked to report any fresh cases of food poisoning to me at any time of the day or night and over the Christmas period, and also to let me know if they heard of any family which had purchased brawn from the butcher s shop concerned but had not yet eaten it. Further visits were paid to the butcher's shop to ensure that the assistant was no longer at work, and that no other reason seemed to exist for the spread of infection. I would again state that the butcher in question has been most co-operative although even after constant pressure he was never able to give us information concerning the persons who might have purchased the infected brawn. Up to the moment we have heard of ten cases of food poisoning all directly traced back to the brawn Most of the patients were elderly all seem to have made a satisfactory recovery, with the exception of one elderly lady who was suffering from a very severe heart infection and had to be confined to bed for some time. This lady was admitted to hospital and is stated to be progressing satisfactorily. All the ten cases reported were taken ill on Tuesday, 21st December, 1954. There is no evidence that further cases of food poisoning occurred after that date,It would appear reasonable to assume that the infected brawn has now all been eaten, and that either the other persons who consumed the brawn escaped, or that their illness was so slight that a doctor was not called. A detailed report will be made to the Ministry of Health on this limited outbreak as soon as the laboratory findings are available.In the meantime I should like to take this opportunity of thanking the Sanitary Inspectors, who gave me unstinted help in the investigation.lt is at least pleasing to be able to record that we apparently discovered the cause of the poisoning within twenty-four hours, and that no further cases would seem to have occurred after the original cases were notified. 33 34 APPENDIX 2 TABLE I Vital Statistics of Wood Green, 1934-54 Year Population estimated to middle of each year Nett Births belonging to the District Nett Deaths belonging to the District Under l year of age At all ages Total No. Rate per 1,000 popula tion Illegitimate No. Total No. Rate per 1,000 1 ive births illegitimate No. Rate per 1, 000 i llegitim ate births No. Rate per 1,000 popula t ion (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 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 1954 51,090 564 11.03 25 15 26 0 – 533 10.4 35 TABLE II Birth Rate, Death Rate and Analysis of Mortality during 1954 Birth-rate per 1,000 Population Annual Death-rate per 1,000 Population All Causes Rate per 1,000 Births Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year England and Wales 15.2 11.3 0.8 25.5 160 County Boroughs and Great Towns (including London) 16.8 12.0 0.9 29.1 160 Smaller Towns (population 25,000-50,000 at Census 1951) 15.4 11.3 0.5 23.7 Wood Green 11.03 10.4 0.1 26.6 TABLE III Causes of death during the year 1951 Causes of Death Male Female Tuberculosis, respiratory 5 1 Tuberculosis, other – 1 Syphilitic disease – – Diphtheria – – Whooping Cough – – Meningococcal infections – – Acute Poliomyelitis – – Measles – – Other infective and parasitic diseases 2 1 Malignant neoplasm, stomach 10 3 Malignant neoplasm, lung, bronchus 26 8 Malignant neoplasm, uterus – 2 Malignant neoplasm, breast – 4 Other malignant and lymphatic neoplasms 29 32 Leukaemia, aleukaemia – 2 Diabetes 1 1 Vascular lesions of nervous system 22 34 Coronary disease, angina 55 38 Hypertension with heart disease 4 4 Other heart diseases 29 34 Other circulatory disease 14 18 Influenza 2 1 Pneumonia 14 16 Bronchitis 20 10 Other diseases of respiratory system 2 – Ulcer of stomach and duodenum 4 3 Gastritis, enteritis and diarrhoea 1 3 Nephritis and nephrosis 3 1 Hyperplasia of prostate 5 – Pregnancy, childbirth, abortion – – Congenital malformations 2 1 Other defined and ill-defined diseases 21 19 Motor vehicle accidents – – All other accidents 5 9 Suicide 7 3 Homicide and operations of war 1 – Totals 284 249 36 TABLE IIIA Males Causes of death All ages Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis,respiratory 5 – – – – –– – – – 3 1 1 Tuberculosis, other – – – – – – – – – – – – Syphilitic disease – – – – – – – – – – – – Diphtheria – – – – – – – – – – – – Whooping Cough – – – – – – – – – – – – Meningococcal infections – – – – – – – – – – – – Acute Poliomyelitis – – – – – – – – – – – – Measles – – – – – – – – – – – – Other infective and parasitic diseases 2 – – – – – – – – – 2 – Malignant neoplasm, stomach 10 – – – – – – – 1 2 6 1 Malignant neoplasm, lung, bronchus 26 – – – – – – 1 4 11 8 2 Malignant neoplasm, breast – – – – – – – – – – – – Malignant neoplasm, uterus – – – – – – – – – – – – Other malignant and lymphatic neoplasms 29 – – – – – – 1 2 6 12 8 Leukaemia,aleukaemia – – – – – – – – – – – – Diabetes 1 – – – – – – – – – – 1 Vascular lesions of nervous system 22 – – – – – – – 1 4 6 11 Coronary disease, angina 55 – – – – – – 3 8 10 21 13 Hypertension with heart disease 4 – – – – – – – – – 2 2 Other heart diseases 29 – – – – – – – 2 1 14 12 Other circulatory disease 14 – – – – – – – – 2 7 5 Influenza 2 1 – – – – – – 1 – – – Pneumonia 14 1 – – – – – – – – 8 5 Bronchitis 20 1 – – – – 1 2 – 3 8 5 Other disease of respiratory system 2 – – – – – – – – 1 1 – Ulcer of stomach and duodenum 4 – – – – – – – – – 1 3 Gastritis, Enteritis and Diarrhoea 1 – – – – – – – – – 1 – Nephritis & nephrosis 3 – – – – – – – – – 1 2 Hyperplasia of prostate 5 – – – – – – – – – 1 4 Pregnancy,childbirth, abortion – – – – – – – – – – – – Congenital malformations 2 2 – – – – – – – – – – Totals carried forward 250 5 – – – – 1 7 19 43 100 75 37 TABLE IIIA (Cont'd,) 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 brought forward 250 5 – – – – 1 7 19 43 100 75 Other defined and illdefined diseases 21 5 – – 1 1 – 2 2 2 5 3 Motor vehicle accidents – – – – – – – – – – – – All other accidents 5 – – – – – 1 1 1 1 1 – Suicide 7 – – – – – 1 – 2 3 1 Homicide and operations of war 1 – – – – – – – – – 1 – Totals 284 10 – – 1 1 2 11 22 48 110 79 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 75 and over Tuberculosis, respiratory 1 – – – – – – – – 1 – – Tuberculosis, other 1 – – – – – – – – – – 1 Syphilitic disease – – – – – – – – – – – – Diphtheria – – – – – – – – – – – – Whooping Cough – – – – – – – – – – – – Meningococcal infections – – – – – – – – – – – – Acute Poliomyelitis – – – – – – – – – – – – Measles – – – – – – – – – – – – Other infective and parasitic diseases 1 – – – – – – – – – 1 – Malignant neoplasm, stomach 3 – – – – – 1 – – 1 – 1 Malignant neoplasm, lung, bronchus 8 – – – – – – 1 1 2 3 1 Malignant neoplasm, breast 4 – – – – – – – 1 – 1 2 Malignant neoplasm, uterus 2 – – – – – – – – 1 1 – Other malignant and lymphatic neoplasms 32 – – – – – 1 1 6 4 12 8 Leukaemia,aleukaemia 2 – – – – – – – – – 1 1 Diabetes 1 – – – – – – – – – 1 – Vascular lesions of nervous system 34 – – – – – – 1 – 3 13 17 Coronary disease, angina 38 – – – – – – – 2 4 9 23 Hypertension with heart disease 4 – – – – – – – – – 2 2 Other heart diseases 34 – – – – – – 1 – 2 14 17 Other circulatory disease 18 – – – – – – 1 – 1 6 10 Influenza 1 – – – – – – – – – – 1 Pneumonia 16 1 – – – – – 1 2 1 4 7 Bronchitis 10 – – – – – – – – 1 2 7 Other disease of respiratory system – – – – – – – – – – – – Ulcer of stomach and duodenum 3 – – – – – – – – – – 3 Gastritis,Enteritis and Diarrhoea 3 1 – – – – – – – – 1 1 Nephritis and nephrosis 1 – – – – – – – – – 1 – Hyperplasia of prostate – – – – – – – – – – – – Pregnancy,childbirth, abortion – – – – – – – – – – – – Congenital malformations 1 1 – – – – – – – – – – Totals carried forward 218 3 – – – – 2 6 12 21 72 102 39 TABLE IIIA (Cont'd ) Females Causes of death All ages Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over brought forward 218 3 – – – – 2 6 12 21 72 102 Other defined and illdefined diseases 19 2 – – – – 1 2 1 3 4 6 Motor vehicle accidents All other accidents 9 – – – – – 1 1 – 1 3 3 Suicide 3 – – – – – 2 1 – – – – Homicide and operations of war – – – – – – – – – – – – Totals 249 5 – – – – 6 10 13 25 79 111 40 41 TABLE IV Infectious Diseases Notified during the year 1954 Notifiable Disease Cases Notified in Whole Borough Total Cases Notified in each Ward Total Cases removed to Hospital or Sanatorium Total Deaths All Ages At Ages - Years Under 1 year 1 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years 20 to 25 years 25 to 35 years 35 to 45 years 45 to 55 years 55 to 65 years 65 and upwards Alexandra Bowes Town Hall Noel park Scarlet Fever 61 2 9 46 1 2 – – – – 1 – 37 12 12 18 – Diphtheria – – – – – – – – – – – – – – – – – Cerebro Spinal Fever – – – – – – – – – – – – – – – – – Enteric Fever – – – – – – – – – – – – – – – – – Erysipelas 2 – – – – 1 – – – – 1 – – – 2 – – Pneumonia 45 – 1 4 1 3 2 9 4 5 8 8 20 9 16 22 30 Acute Poliomyelitis 1 – 1 – – – – – – – – – 1 – – 1 – Polio encephalitis – – – – – – – – – – – – – – – – – Puerperal Pyrexia – – – – – – – – – – – – – – – – – Pulm. Tuberculosis 73 – 1 2 2 6 11 21 12 9 5 4 31 16 26 20 6 Non Pulm. Tuberculosis 8 – – – – 1 2 1 2 – 1 1 4 1 3 1 1 Malaria – – – – – – – – – – – – – – – – – Measles 29 3 17 7 1 – – 1 – – – – 15 5 9 3 – Whooping Cough 80 3 33 41 – – – 1 1 – – 1 28 25 27 5 – Ophthalmia Neonatorum 1 1 – – – – – – – – – – 1 – – 1 – Dysentery 41 – 4 5 2 5 2 6 2 8 6 1 22 17 2 3 – Food Poisoning 24 – – 3 1 – 1 2 4 3 2 8 11 11 2 7 – Totals 365 9 66 108 8 18 18 41 25 25 24 23 170 96 99 81 37 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary NonPulmonary Total No. of cases on Register at end of 1953 M. P. M. F. 505 247 215 11 32 New cases notified during 1954 42 31 1 7 81 Transfers from other Districts 5 8 – – 13 No. of cases removed from Register 25 12 1 4 42 No. of cases on Register at end of 1954 269 242 11 35 557 New Cases and Mortality during 1954 Age Periods New Cases Deaths Respi ratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 – – – – – – – – 1 – 1 – – – – – – 5 3 1 – – – – – – 15 10 9 – 3 – – – – 25 12 16 – 1 – – – – 35 7 9 – 2 – – – – 45 7 3 – – – 1 – – 55 4 – 1 – 3 – – – 65 and upwards 4 – – 1 2 – – 1 Totals 47 39 1 7 5 1 – 1 Above includes transfers (13) from other districts. 42 APPENDIX 3 M i see 11aneous (a) Letters to Doctors The following letters were sent to practitioners during 1954 January Infectious Diseases. February Sonne Dysentery. March Collection of Laboratory Specimens. May Demonstration at Central public Health Laboratory. June Exclusion from School. June Public Health Services Handbook. September Notification of Infectious Diseases. October Mass Radiography. October Investigation into Salmonella Infections. December Influenza. December Notifying case of Poliomyelitis. (b) Medical Examinations During the year forty four medical examinations were carried out. Ten of these were in respect of entrants to the Council s employ, for acceptance into the Superannuation Scheme thirteen in respect of workmen in the Council's employ for acceptance into the Superannuation Scheme and twenty-one in respect of workmen for acceptance into the sickness pay scheme. In addition twenty five medical reports were issued relating to employees absent from duty through sickness. (c) Accidents in the Home As the Public Herlth Department is keenly interested in all the factors which influence health or which are likely to be followed by a state of ill-health, the question of accidents in the home has received attention. After full consideration I came to the conclusion that accidents in the home was a subject which properly belonged to the personal health services, and which should primarily be considered as part of my duties as Area Medical Officer.Although the Borough Council has always shown a keen interest in thismost important subject it will be appreciated that,to avoid over-lap ping a problem of this nature and magnitude must of necessity be given the force ofsingle direction.As I am Area Medical Officer as well as Medical Officer of Health for Wood Green and could, there fore easily correlate the campaign this presented no difficulty. During the year we accepted the offer of an attractive booklet setting out in considerable detail hazards in the home what they were and how they could be avoided. This booklet was published on behalf of the Area Health Committee, but had a cover design incorporating the Coat of Arms of the Boroughs and Urban District Councils included in Area No. 2. Distribution of the booklet, which proved most acceptable to parents and to citizens generally was undertaken by the Public Health Department the Area Health Office, clinics and libraries. I have also taken the opportunity to refer to accidents in the home,, indeed to accidents generally, in various articles which I wrote for 'Better Health and which, with the usual courtesy of the Editors of our local press,, have appeared from time to time in local newspapers. 43 Printed and Published by Wood Green Borough Council Town Hall, N.22.