Limm BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1956 ,0 WM. CLUNIE HARVEY, M.D.D.ph. Medical Officer of Health. WOOD 38 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1956 WM. CLUNIE HARVEY, m.d..d.p.h. Medical Officer of Health. Public Health Department, White Hart Lane (Old) School Wood Green N 22 July 1957 To The MAYOR ALDERMEN and COUNCILLORS cf the BOROUGH OF WOOD GREEN Mr Mayor Ladies and Gentlemen, I beg to present the Annual Report of the Medical Officer of Health for the year J956 1 should like to use this introduction to my Annual Report for what might be described as a somewhat unusual although very pleasant purpose It so happens that 1956 was a memorable year in the health history of Wood Green Fifty years ago in 1906- the Urban District Council of Wood Green recognised that the Public Health Department was no longei in its infancy but could now be regarded as at least a sturdy growing child A Health and Sanitary Committee was appointed for the first time at the Annual Meeting of the Council in April 1906 the Committee being set up to deal especially with matters intimately connected with the work carried out by the Public Health Department The Department was given more commodious offices and was "placed in direct telephonic connection with the Exchange thus obviating the delay that prevailed in dealing with the speecty removal of infectious cases as well as a great convenience to persons having business with the Department" The above quotation, taken from the Report of Mr A C Adams, Sanitary Inspector,, will perhaps give some slight indication of the changes which were taking place 1 thought it mignt be both useful and salutary to compare the vital statistics produced for the year 1906, with those appertaining to 1956 In order to make the comparison even clearer I have extracted statistics appearing in the Medical Officer of Health's Annual Report for 1931 the year which might be described as the half-way stage exactly 25 years ago In 1931 my predecessor. Dr Malcolm Manson.had been in Wood Green for approximately two years, and, although the statistics quoted cannot possibly indicate the value of Dr Manson's impact on the public health of the Borough they may give some indication of the forward steps which had been and were then being taken It would be quite ridiculous, of course to claim that the improvements shown by the vital statistics applicable to Wood Green were peculiar to our Borough, or that the Medical Officer of Health of 1956 is in any way superior to his predecessors That is the last impression I would like to leave with the Council The for ward march of public health has been nation- wide It can at least be said, however that for many years Wood Green pioneered numer ous advances in Public Health, and that it piayed its part; indeed more than its part: in the improvements which have been such a 3 salient feature of preventive medicine in this country over the past 50 years. I need scarcely point out that this is still the Borough Council's definite outlook. Cold statistics are poor material on which to build a living structure. But when one remembers the magnificent work carried out in the past in Wood Green relating to housing, the jealous preservation of open spaces, immunisation, maternity and child welfare - and Wood Green was indeed in the forefront here - and even such a small but significant factor as the provision of free washing facilities in our public conveniences, it will be apprec iated that our Borough has much of which it can be proud. I would like here to pay a most sincere tribute to my predecessors who have left me such a grand her" tage. This great work is still go ing on, and, although the difficulties which we face today are very much greater than they were even a decade ago, these difficulties are being met with vigour and resolution. The estimated population of Wood Green in December 1906 was just over 48,000. The 1931 census gave our population as 54,190. The figure supplied by the Registrar General for 1956 was 50,100, a decrease of 510 from that of the previous year. In other words, although the population of Wood Green grew rapidly during the first few years of the century, it then remained more or less static, and is now showing a decline. Bearing in mind the number of families which now occupy houses never intended for more than one unit, this decline in the population may not be inopportune. Overcrowding is today one of the gravest social menaces with which we are confronted. It brings in its wake many inescapable evils, evils which must be fought with every weapon at our command The steps which the Wood Green Borough Council is now taking to deal with clearance areas will be dealt with in more detail later in this Report. It can meantime be stated that this significant problem has by no means been overlooked. The corrected death rate for 1956 was 10.5. The corresponding death rate for 1906 was 10.6.In 1931 the death rate was 10.1 From this it will be seen that the death rate has not materially altered, at least in total. When one comes to consider deaths in the various age groups and from specific causes it will be seen that a very different and much more pleasing picture is thrown into immediate relief. Thus, of the total number of deaths which occurred in 1956, (537), no less than 377 occurred at the age of 65 or over. 120 deaths occurred over the age of 80 and 19 at ages exceeding 90. Comparable figures are not available for 1906,but it is recorded that 289 of the 549 deaths which occurred in 1931 occurred in persons over the age of 65. If, in fact, figures were available for 1906, I am quite convinced they would show that many more persons are now living to the age of 65 and over than was the case fifty years ago. This, of course, is in keeping with conditions throughout the country, indeed, in all civilised countries, and indicates with devastating clarity the increasing need for care of the aged. 4 When we turn to infant mortality i.e. the number of child ren dying before they have reached their first birthday the vast advances made within the past fifty years are even more apparent Ten deaths of infants under the age of one year occurred during 1956- giving an infantile mortality rate of 17 3 per thousand live births the lowest rate yet recorded in Wood Green,This compares with a total of 14 deaths and an infant mortality rate of 23.6 in 1955 In 1906 127 children died during the first year of life no less than 43 of these deaths being attributed to diarrhoea The infant mortality rate for that year was 103 It is satisfactory to note that no deaths from diarrhoea occurred in infants during 1956 Thirty-two children under the age of one year died during 1931 the infant mortality rate being 44 5 Two of these latter deaths were due to diarrhoea Although as I have just pointed out, mere statistics must of necessity be bald and capable of varying interpretation it must be clear that something has been happening which year by year has saved the lives of many infants This "something" includes more stringent care of mothers and children increased clinic facilities, tremendous advances in midwifery and in ante-natal care, together with the introduction of antibiotics.lt is not so many years ago that an infant mortality rate of 17 3 would have been considered more or less unthink able Such a figure is now accepted not I hasten to add as a total which cannot be improved, but as a figure which we must strive by every means to better. The care of mothers and children is, of course, the duty of the County Council but I know that the Borough Council would wish to have this information. My joint post as Medical Officer of Health for Wood Green and Area Medical Officer fortunately allows me to co ordinate and correlate this work to the advantage I humbly venture to suggest of the community An interesting side light on another change which has taken place concerns the number of inquests and post mortem examinations which take place year by year In 1956 19 inquests and a further 137 post-mortems were carried out 50 of these latter in the Prince of Wales Hospital Mortuary by arrangement with the Wood Green Borough Council In 1906 46 post-mortem examinations were carried out and 36 inquests held In 1931 the number of post-mortem ex aminations carried out and inquests held was 26 and 10 respectively. These figures would appear to show that post mortem examinations are now much more common than was previously the case Prom this one might reasonably assume that the desire to investigate the true causes of death in as many cases as possible has been accentuated This, of course, in no sense implies a desire to interfere with the private feelings of relatives but covers a genuine wish to increase our existing knowledge for the benefit of humanity, This is particularly apparent in the case of deaths of Infants, where I have never been entirely satisfied that we are fully aware of the true causes which result in the tragic death of an infant under the age of one year I have taken steps during the year to bring this matter to the notice of general practitioners, midwives and hospitals in the hope that all concerned, including parents, will co-operate in what is never a very happy procedure, but still a procedure which should be of infinite and obvious value to future generations, 5 Not one death occurred during 1956 as a result of childbirth. Indeed, only three deaths have resulted from this cause over the past ten years, during which time, 6, 496 Wood Green births have been recorded. Unfortunately, maternal mortality figures are not available for 1906. although we know only too well that puerperal sepsis and other causes took a heavy toll of women during and after child-birth at and about that time. Five mothers died as a result of child-birth in 1931. The reasons behind this spectacular improvement in maternal mortality are very much the same as those which apply to the saving of infant lives, particularly the great advances in midwifery, ante-natal care, and the introduction of antibiotics. The birth rate in 1956 was 11 5 per thousand population, as compared with 11.7 in 1955.Five hundred and seventy-eight births were recorded during the year. In 1906, 1,232 births were registered, corresponding to a birth rate of 26 78 per thousand population. In 1931, 719 live births were registered, the birth rate being 13.2. These figures will speak for themselves. We know that the birth rate has been steadily declining in this country over the past years, more especially during the post-war era. Whether, in view of existing overcrowding and the housing situation, we should take any active and immediate steps to check this decline remains an extremely difficult question. In no sphere has there been a greater change than in the field of infectious diseases The basic control of infectious diseases has not materially altered, although we have naturally adapted our outlook to changing conditions Thus, in 1906 it was thought that the removal of cases of infectious diseases to an isolation hospital would materially reduce the case rate and would, therefore, benefit the population as a whole. This, of course, explains why these hospitals were originally termed "isolation" hospitals. This premise has now been exploded. We know that only a small proportion of cases of infectious disease, apart from grave infectious diseases such as smallpox and poliomyelitis, require hospitalisation, and then only for such reasons as inadequate accommodation, the serious nature of the illness and the fact that the mother goes out to work We also know that terminal disinfection, i.e. the disinfection of rooms, clothing, etc., after an infectious illness or when a case has been removed to hospital has nothing like the value once ascribed to it Lastly, the phenomenal advances recorded in the field of immunisation, in any one of its many forms, has to be considered None the less, the control of infectious diseases still rests on the adequate supervision of cases, contacts and carriers, satisfactory housing, personal hygiene, and the strict observance of general measures of public health In other words, prevention is invariably and indisputably better than cure Apart from our changing attitude to the control of infectious diseases as infectious diseases, we must take into careful account the great changes which have taken place in the character and incidence of many such diseases 6 For the ninth year in succession no case of diphtheria was notified in the Borough the last death took place in 1939 In 1906 74 cases of diphtheria were notified with nine deaths In 1931 39 cases were notified although happily all recovered, It is interesting to note that in 1931 immunisation had been the practice in Wood Green for just over two years, more than 1 100 children having been immunised Seventeen cases of scarlet fever were notified during 1956, the totals for the past four years being 66 61, 26 and 17 respectively In 1906, no fewer than 224 cases of scarlet fever were reported, with seven deaths In 1931 the number of cases reported was 97, with one death Measles only became a notifiable disease in 1940. so that comparable statistics for 1906 and 1931arenot available. Present evidence would show, however, that the incidence of measles has not materially altered, the disease occurring in epidemic form every second year. Very much the same remarks apply to pertussis (whooping cough) With regard to tuberculosis. 63 cases of tuberculosis were notified during 1956 as against 67 in 1955 Although the tuberculosis figures for 1906 are not entirely clear, it would seem that 43 deaths occurred from tuberculosis that year,whereas only two deaths occurred in 1956 Forty-two deaths were certified as due to tuberculosis in 1931, From these figures it will be seen that the changes occurring in the various common notifiable infectious diseases differ widely Diphtheria has almost disappeared from among the population, largely due one must presume, but not entirely, to the great drive in immunisation Scarlet fever notifications have dropped appreciably But that is by no means all. Scarlet fever was once an extremely serious disease, resulting in many unfortunate deaths. Scarlet fever today is little more than a trifling illness, seldom lasting more than ten days or a fortnight, and often not requiring the removal of the affected child to hospital In this connection one must remember that a similar drop in virulence was noted during the late Victorian era We must therefore be on our guard for a possible return of the type of scarlet fever which so many of us remember, realising that this disease, which has little more than nuisance value today,may at any time resume its former character. Measles, although just as prevalent in 1956 as it presumably was in 1906, has also declined in severity Few children require admission to hospital, complications, particularly broncho -pneumonia and middle ear disease, which formerly gave this disease its terrors, having largely vanished The incidence of pertussis has also apparently declined due in fact, one may venture to assume, to the vast numbers of children now immunised during the first few months of life Whooping cough, however, still remains one of the most deadly diseases of infancy and early childhood This is surely a cogent reason for continuing our present policy of immunisation which, although it may not provide full 7 immunity, can at least be guaranteed in the vast majority of instances to result in a much milder attack There is no evidence that the incidence of tuberculosis has decreased to any very marked extent over the past few decades. Here again, however, early diagnosis, careful supervision, the great work of chest clinics and mass radiography units, and the use of the newer antibiotics have very considerably eliminated the gravity of this disease. Today a person suffering from tuberculosis who is discovered reasonably early has an almost one hundred per cent chance of recovery. Deaths have fallen remarkably. This does not meanr of course, that we must relax our efforts in any way A local authority has still a very significant part to play - especially in the matter of housing - in the control of tuberculosis. All these matters will be considered in greater detail in the sections of the Report dealing with the supervision and control of infectious diseases. Although the figures provided in the Annual Report for 1906 do not provide us with all the information we might desire, we know that the community did not then have to face the onslaught of the various viruses which result in such illnesses as acute anterior poliomyelitis, virus pneumonia, virus influenza, winter vomiting, etc. There is also no way of comparing the incidence of such diseases as dysentery and food poisoning, diseases which are by no means new, and wnich must have taken a greater toll in those early days when the control of foodstuffs was not so strict as it is today It has been said that the disappearance from our midst of such diseases as diphtheria and, to a very marked extent, the typhoid fevers, together with the fact that such diseases as scarlet fever and measles have lost much of their former virulence, has resulted in the appearance of new diseases the assumption presumably being that nature abhors a vacuum There is, however, no scientific evidence to support this hypothesis We must at least be happy that the diseases with which we had to contend not so very long ago asmajor problems no longer hold the same threat. At the same time we must be prepared to tackle the newer virus diseases which are coming more to the fore The fact that vaccination against poliomyelitis is now being offered to more and more children and the ever-increasing attention which is being paid to hygiene, especially hygiene in our schools, is surely evidence that we are tackling the problem realistically and with every hope of practical results. As I write this Report we have recently been made aware of an epidemic of virus influenza in the Par East. In this connection, active steps are already being taken to prepare a suitable vaccine,while every country in the western world has been fully alerted It is by steps such as these, by the common effort of all peoples and governments, that the virus will eventually be conquered, We all have our part to play, and all must play their part Until comparatively recently it was the custom to record each year the number of deaths which had been caused by what'were then known as the "zymotic" diseases. These diseases comprise 8 smallpox, measles scarlet fever diphtheria, whooping cough and diarrhoea Eighty- one deaths from zymotic diseases were recorded in 1906. Nowadays, deaths from these diseases are so infrequent that they would call for individual mention as quite exceptional events As a corollary, it might further be mentioned that in his report for 1906 Dr. Connolly the Medical Officer for Wood Green at that time mentions that no cases of typhus fever had been reported during the year Having regard to the fact that typhus fever is now virtually unknown in this country, this fact alone will give some indication of the tremendous strides which have taken place over the past fifty years So far as diseases in general are concerned, i e what might be described for want of a better term as non-infectious diseases, it is interesting to note that of a total of 537 deaths recorded in 1956 no less than 190 deaths were attributed to diseases of the heart or circulation in one form or another In 1906 only 40 deaths were attributed to similar causes, although it must be admitted that terminology and accuracy of diagnosis have been greatly improved over the past fifty years It is equally interesting to note that in 1931, 155 of the 549 deaths recorded during that year were attributed to heart disease. In other words, heart disease has now appeared as a major killing factor, especially in middle and late life This is very possibly due to the additional stress and strain which the human organism has to face today. These conditions are very well summed up in the expression "adaptation syndrome", a phrase which is now taking on more and more significance every year Quite apart from these statistics, we also know that diseases of the heart and circulation are now taking their toll much earlier than was previously the case, so that men, who are much more subject to serious heart diseases than women, are often tragically cut off in late middle life One must also take into account a most important factor which has developed almost beyond recognition during the past fifty years This deals with what we know as mental health and its counterpart, mental ill-health Mental ill -health may not be a major killing disease, indeed, it can seldom be described as a disease at all. None the less, the evil influence of mental illhealth and the corresponding benefits of a full measure of mental health cannot be over-emphasized One finds meagre reference to mental health or mental instability in the Annual Reports of Medical Officers of Health prepared towards the beginning of this century although I need scarcely say that the problems,not only of insanity itself but of less grave mental disorders, were receiving and had received attention for a very long time. Only within comparatively recent times, however, has the impact of mental health and the tremendous significance of mental health come to be fully appreciated Nowadays this matter of mental health and the effect which it has on physical health, represents one of the most acute problems confronting the nation We know, for instance, that conditions which are being set up in many families and in many individuals exert amost significant influence on the health and well-being of increasing numbers 9 of the population, A serious attempt is being made to assess these factors at their proper value and to suggest ways in which the brake might be applied One has only to look at the work of our divorce courts, probation officers, the increasing number of "problem families" and juvenile delinquency to appreciate that the breaking point or something approaching the breaking point is being reached in more and more families today We have still a very long way to go before we find a solution to what I would again stress is one of the most serious problems facing us today But a solution must be found These matters are neither solely theoretical nor the vapourings of abstract sociology. I mention them here because the Public Health Department has a contribution to make. 1 feel confident that the Council will afford us full support in the efforts which we are taking to try to bring this problem under control Thirty-eight deaths from cancer were recorded in 1906 In 1931 the figure had risen to 69. In 1956,123 deaths were recorded from cancer or comparable causes In this connection it must be remembered that, because the population as a whole is now living longer - it is estimated that the expectation of life of a child born today is approximately 15 years longer than its grandparentsit follows that many more individuals survive to the age when cancer is more common Unfortunately, there are no figures which show the comparative incidence of cancer of the lung in 1906 and 1956 We all know the vital part which health education plays in our health programme today. Although the cost of health education is infinitesimal when compared with the cost of other services, it has been proved beyond dispute that health education has played and is continuing to play a vital part in teaching us how to avoid disease and how to maintain positive health Yet. in the Report of the Medical Officer for 1906 the only specific reference which I can find to health education techniques refers to infantile diarrhoea The paragraphs in question read as follows "The circular which I printed in my last Annual Report has been left at every house from which a birth is registered, the lists being supplied each week by the Registrar, and I am glad to say so far as I can judge, it has been appreciated In several instances, where parents have mislaid the circular, application has been made for another to be sent " "The question of the appointment of a lady Health Visitor has been brought under the notice of the Council and is receiving the consideration of the Health and Sanitary Committee " We have gone a very long way since then and, although it is still difficult to assess the value of health education, either in pounds, shillings and pence or in actual health and well-being, it must be clear that our efforts have not been in vain. Health education has been a prominent feature in Wood Green for many years, I have never hesitated to invoke the aid of the press and 10 to make use of posters- leaflets, the magazine "Better Health", special exhibitions and booklets talks and film shows for the purpose of furthering knowledge in the field of health. I am very happy to think that I have always received the cordial co-operation of the Borough Council, the Public Health Committee and our local editors. I am equally happy that my staff has supported me with commendable enthusiasm and that I have been privileged to address so many local organizations As I have already stated, statistics have little life. Nonethe less. I felt that the Council would be interested to compare the vital statistics for 1906, 1931 and 1956 They are surely illuminating: eloquent evidence of the fight which Wood Green has constantly waged to conquer disease In reading the report for 1906, one cannot help but be struck by the positive ideas expressed therein It would certainly appear that the Council and its officials were well aware of the problems with which they were faced and were using such weapons and such knowledge as they then possessed to carry on the fight. We must be truly thankful that our knowledge has so vastly increased, and that the weapons at our disposal are now so plentiful I would like to quote here, without comment, one paragraph from the section of the Report for 1906 written by Mr Adams, the Sanitary Inspector:- "All of us have seen the country cowshed, with its cobblestone floor its dark, unventilated condition, and the malodorous smell from the adjacent manure heap without any proper dung-pit, the cows milked by the picturesque men and maidens straight from various duties, without any attempt at cleansing, to send the "new pure milk" to its various destinations, is it any wonder that municipal authorities are driven to municipal dairies, etc. , to give the children a proper and sufficient milk supply". May I conclude this Report by once again thanking the Public Health Committee and the Borough Council for their unfailing support and encouragement which has been of the very greatest help to me since I took up my duties as Medical Officer of Health in Wood Green in 1952 I would also thank the members of the PublicHealth Department for their excellent co-operation. Although I would refer particularly to the assistance rendered by my Deputy, Dr. J R Campbell, Mr W. McCauiey, Chief Public Health Inspector, and Mr. P V Ingram Chief Clerk, everyone in the Department has pulled hisorher weight asa member of an efficient, conscientious team, I am, Mr, Mayor, Ladies and Gentlemen, Your obedient Servant, W. C, HARVEY, Medical Officer of Health, 11 BOROUGH OF WOOD GREEN PUBLIC HEALTH COMMITTEE Councillor L. A, VITORIA (ChairmanJ Councillor C. W BUCKBY (Vice-Chairman) The Mayor, Alderman J. W, BARNETT. J,P. Alderman J J WTSN Councillor G. CATHLES, Councillor P T. SKUDDER. Councillor M SKUDDER Councillor PGM TRIPP Councillor E .A B, WESSON, STAFF *Medical Officer of Health - WILLIAM CLUNIE HARVEY, M D D P H. Deputy Medical Officer of Health - JANET RUSSELL CAMPBELL MB CH B D P H, *Chief Public Health Inspector - W, McCAULEY. CERT R San, Inst and San, Insp. Joint Board Cert, Meat and Food Inspection. *Public Health Inspectors - F JAMES, Cert, R. San, Inst , and San Insp, Joint Board, Cert Meat and Food Inspection Cert R Soc of Health, Smoke Inspector: W E GOODFELLOW, Cert R San Assoc of Scotland Cert Meat and Food Inspection, H J BAILEY, Cert, R San Inst and San Insp Joint Board, Cert Meat and Food Inspection; D G OLIVER, Cert R, San Inst and San Insp Joint Board, Cert Meat and Food Inspection Chief Clerk - W T GLOSTER (resigned 30 6 56 ) P, V INGRAM (appointed 1 7 56.) General Clerks - P V INGRAM: Miss J W POPE, Shorthand Typist, A E 0 NEILL (appointed 23, 7 56 ) 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. 12 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,606 Population estimate supplied by the Registrar General 50,100 Number of inhabited houses (end of 1956) according to Rate Books 14,283 Rateable Value (31. 3. 57) £867,514 ( 1. 4. 57) £813,668 Sum represented by a penny rate (estimated) £3,500 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Total M F Live Births - Legitimate 558 280 278) Birth Rate per 1,000 11.50 Illegitimate 20 14 6) Still Births 21 16 5 Rate per 1,000 Births 36.33 Deaths 537 282 255 Death Rate per 1,000 10.70 Deaths from Puerperal causes - Rate per 1,000 Births - Deaths of infants under one year of age All infants 10 Rate per 1 000 live births 17.30 Legitimate 9 Rate per 1,000 legitimate live births 16.13 illegitimate 1 Rate per 1,000 illegitimate live births 50.00 Deaths from:- Cancer (all ages) 125 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) 1 Number of Births notified 578 Number of Births registered in the Borough 134 POPULATION The mid-year estimate of the population supplied by the Registrar General is 50,100 a decrease of 510 from that of the previous year BIRTHS The number of live births registered during the year was 578 which gives a crude birth rate of 11 5 per 1 000 of population the corrected birth rate being the same figure The rate for 1955 was 11.7. There were 21 still-births giving a still birth rate of 36 33 per 1 000 births In 1955 the still-birth rate was 21 9 13 DEATHS The number of deaths credited to Wood Green after the nec essary adjustments had been made for inward and outward transfers was 537 giving a crude death rate of 10 7 per 1,000 of population and a corrected death rate of 10,5 The total number of deaths for the previous year was 519. when the death rate was 10 3 Of the total of 537 deaths no fewer than 377 occurred at ages over 65 and 120 deaths occurred at ages over 80 and 19 at ages over 90 INQUESTS Nineteen inquests were held following the deaths of Wood Green residents during 1956 A further 137 post mortem examinations were carried out without an inquest 50 of these in the Prince of Wales Hospital which, by arrangemnet with the Wood Green Borough Council, provides mortuary services MATERNAL MORTALITY Again as in the three previous years no deaths occurred as the result of childbirth INFANT MORTALITY There were 10 deaths of infants under one year of ages giving an infant mortality rate of 17.3 per 1 000 live births This com pares with a total of 14 deaths and an infant mortality rate of 23,6 in 1955 Of the 10 infant deaths, 4 occurred within twentyfour hours of birth 5 during the first wee« and one during the first four weeks of life This gives a neo-natal mortality sate of 15 6 The corresponding figure for 1955 was 16 9 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 3 to 4 weeks Total under 4 weeks 4 weeks and under 3 mths. 3 mths. and under 6 mtns. 6 mths. and under 9 mths. 9 mths. and under 12 mths. Total deaths under one yr. Prematurity 6 - - - 6 - - - . 6 Congenital Defects 2 - - - 2 - - - - 2 Atelectasis - - - - - - - - - - Gastro-enteritis - - - - - - - - - Intra-cranial Haemorrhage - - - - - - - - - - Capillary Bronchitis - - - - - - - - - - Asphyxia - - - - - - - - - - Broncho-pneumonia - - - - - - - - - - Other Causes - - 1 1 - - - 1 2 Total 8 - - 1 9 - - - 1 10 14 GENERAL PROVISION OF HEALTH SERVICES Hospitals The situation in regard to the availability of hospital beds is still more or less the same as that recorded in my Annual Reports for the last few years Difficulties met with still centre round the provision of sufficient Beds for the chronic sick particularly the elderly chronic sick So far as the provision of beds for the elderly chronic sick is concerned this is a matter which I have continued to pursue with the utmost vigour There is, in Wood Green a high percent age of old people, many living on a pension and many living alone Although these old people do not shout their difficulties from the housetops it needs very little imagination to appreciate their unfortunate situation It must be appreciated, of course, that the responsibility for having anyone admitted to hospital rests with the general practitioner I have, however, never hesitated to support general practitioners in their endeavour to have elderly persons removed to hospital I am happy to be able to state that on a number of occasions the added weight and evi dence which I have been able to put forward has been of use The Public Health Department plays its part in conjunction with the Area Health Office in trying to arrange for the admission of the most deserving old folk to a home or institution when this is the only course available. The co-operation between the two departments is close and has certainly resulted in easing the burden of quite a number of old people, We are only too conscious of our limitation but we can at least take up the cudgels on behalf of every old person whose needs are brought to our notice or where we leam of these needs in any other way This we invar iabiy do. The problem is increasing rapidly increasing This is a fact which must be faced and faced with the utmost determination Care of the Aged It would be a truism to say that care of the aged now has an established place in the health programme of the Borough More and more is now being done to help those who have reached the eventide of life and who, through no fault of their own, are dependent on others, very often strangers or mere acquaintances for little more than the bare necessities of life I should like to pay a very sincere tribute here to the work carried out by the Old People's Welfare Committee One has only to look at this problem to appreciate its magnitude and to realise the impact which is being made by this Committee Much obviously remains to be done, but the Borough Council, because of the great support which it has given to the Old People's Welfare Committee and be cause of the prominent part played by members of the Council, can at least have the satisfaction of knowing that the problem is being actively tackled in the Borough Until we can be sure that the welfare of the older age groups of the population age groups which are extending every year, remains in the forefront of our minds and until we can be sure that all practical steps are being taken to give this matter the attention it demands,we should not, indeed we cannot stand aside 15 I do not apologise for making these remarks in the Annual Report which I present as Medical Officer of Health The older age groups of the population have every reason to expect special consideration As I have just said,Wood Green has not been lacking in this respect. Indeed, the work carried out in this Borough to help the aged has been little less than monumental This is a task in which everyone should play his or her part Until this fact is fully realised, the problem will remain stark,menancing and increasing month by month Laboratory Facilities Summary of work carried out at Central Public Health Laboratories for the year 1956:- Positive Negative Swabs for diphtheria bacilli - - Sputa for tubercle bacilli 2 8 Throat and nose swabs 6 Faeces 456 Urine 2 Blood 1 Others 14 Ice Cream 6 Milk 18 Water (Swimming Pool) 5 16 NATIONAL ASSISTANCE ACT 1918 (National Assistance Amendment Act, i95i) SECTION 47 Removal, to suitable premises of persons m need of care and attention It was not found necessary for the Council to take any action under this Section during 1956 It is never pleasant and very often most unprofitable to take action under Section 47 of the National Assistance Act 1948 Persons almost invariably very aged persons removed to an institution against their will seldom seem to derive much benefit from the removal Indeed the result of this removal is more often than not early death For this reason every effort is made to persuade individuals who are either a danger to themselves or to other people and who should be cared for in a home or institution to agree to voluntary removal Up to the present, we have been able to obtain this consent in every case This is seldom an easy job taking up a great deal of time and requiring infinite patience But one must remember that these old people however elderly and infirm are net units but human beings with feelings and opinions of their own I am entirely satisfied that however much time we spend on this matter time will be amply repaid NATIONAL ASSISTANCE ACT. i948 SECTION 50 Burial or Cremation of the Dead For the second year in succession the need did not arise for the Council to undertake any burials Two burials were carried out during the year 1954 17 SANITARY SERVICES Change of Designation Of Sanitary inspectors The change of designation from 'Sanitary Inspector' to that of 'Public Health Inspector' was brought about in August 1956 by the Sanitary Inspectors (Change of Designation) Act, 1956, This change was widely commented upon much of this comment was I am pleased to say, good-natured, some arose from complete ignorance of the duties involved Although the new designation Public Health Inspector® is not altogether ideal, it does give to the public in general a far more comprehensive idea of the nature and range of the duties involved. Inspections Public Health Act, 1936 819 Housing Act, 1936 248 Rag Flock and Other Pilling Material Act. 1951 1 Pet Animals Act, 1951. 7 Factories and Outworkers 297 Food Preparing Premises 195 General Food Premises 899 Shops Act, 1950 454 Smoke Observations 89 Unsound Food 85 Complaints investigated 661 Interviews with owners, etc. 140 Revisits to property under notice 1.953 Infectious Diseases Cases 85 Food Poisoning 13 Special enquiries in connection with infectious disease cases 115 Aged and infirm persons 8 Miscellaneous 292 Pests Act 182 6,643 Housing Repairs and Rents Act, 1954. Certificates of Disrepair:- Granted 9 Rejected Nil Revocation of Certificates of Disrepair- Revoked 6 Rejected 1 Number of visits made in connection with above 18 Informal Notices served- Shops Act 25 Complied with 32 Food & Drugs Act 82 '' '' 46 Public Health Act 412 '' '' 433 Housing Act 5 '' '' 4 Factories Act 9 '' '' 15 Pests Act 4 '' '' 3 Statutory Notices served:- Public Health Act 85 '' '' 92 Housing Act 3 '' '' 3 Factories Act ~ '' '' - Food & Drugs Act 1 '' '' - 18 Housing Statistics 1 Inspection of dwelling houses during the year: (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 417 (b) Number of inspections made for the purpose 1,067 (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (a) Number of dwelling-houses (exclusive of those referred to under the preceding sub heading) found not to be in all respects reasonably fit for human habitation 7 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 417 3, Action under Statutory Powers during the year;- (1) Proceedings under Sections 9 10 and 16 of the Housing Act, 1936:- (a) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (b) Number of dwelling-houses which were rendered fit after service of formal notices- (i) By owners 3 (ii) By Local Authority in default of owners 1 (2) Proceedings under Public Health Acts:- (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 85 (b) Number of dwelling-houses in which defects were remedied after service of formal notices (i) By owners 92 (ii) By Local Authority in default of owners (3) Proceedings under Sections 11 and 13 of the Housing Act. 1936:- (a) Number of dwelling-houses in respect of which demolition orders were made (b) Number of dwelling-houses demolished in pursuance of demolition orders 1 19 (4) Proceedings under Section 12 of the Housing Act, 1936:- (a) Number of separate tenements or underground rooms in respect of which closing orders were made - (b) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit - In 5 instances it was 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 outside districts when a Wood Green resident is an applicant on their Housing List, Several such visits were made by the Public Health 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 know that the weight of medical evidence invariably receives sympathetic and careful consideration. Hous ing Survey At the beginning of the year the Minister of Housing and Local Government approved the Council's proposals for dealing with the slums in the Borough. One of the major slum areas is the Winkfield/Acacia Roads area, in which the great majority of the houses were erected between 1863 and 1893. It was with this area that the Council decided to begin their campaign, A comparatively large area such as this could not be tackled in one operation, because before declaring an area to be a Clearance Area the Council must first of all be satisfied as to their ability and resources to provide suitable alternative accommodation for the persons who will be displaced. This problem is especially difficult in a. built-up Borough like Wood Green where there is a grdat shortage of suitable building land, Of necessity, therefore, the proposals for the area could only proceed in stages. The first phase of the scheme for this area comprised the group of properties at the Douglas Road end of Winkfield and Acacia Roads. Detailed inspections of every house in this group were carried out by the Public Health Inspectors, and in February I submitted my official representation under Section 25 of the Housing Act, 1936, that eighteen of the houses were unfit for human habitation, and that, in my opinion, the most satisfactory method of dealing with the conditions in the area was the demolition of all the buildings therein. In March the Council resolved that these eighteen properties 20 should be declared a clearance area, and a copy of that resolution together with the particulars of the Council's proposals for rehousing the families who would be displaced, were duly forwarded to the Minister. In September the Council considered proposals for the redevelopment for housing purposes of the land included in the first phase; and decided that the acquisition of twelve properties adjoining the clearance area was reasonably necessary for the satisfactory development or user of the clearance area. Accordingly, a Compulsory Purchase Order under Section 29 of the Housing Act, 1936. was made in respect of the eighteen houses and the twelve adjoining properties. This Order was submitted to the Minister in October for confirmation. At the time of the making of the Order there were thirty-one families comprising seventy-one persons living in the unfit houses; and eighteen families comprising fifty persons living in the twelve adjoining properties. Muswell Stream I mentioned in my last annual report that, owing to the time of the year (November) when darkness set in early permission had been obtained to suspend operations until the end of February 1956. Investigation into the source of pollution of this stream recommenced, therefore, in March 1956 and has now been completed. I submit below a final summary of the work tarried out in the eradication of this pollution. Besides the Notices served to remedy the defective drainage advice was given to owners or their agents regarding the work required to be done. Reinspections were made in all cases so as to ensure complete compliance with the Notices. Houses tested Business premises tested Defective Rain Water to soil Prelim inary Notices Reins pection Stat utory ces Somple ted W.Cs Sinks Baths Wash hand basins 1,068 24 - 45 10 20 - 68 203 - 68 Rodent Control Out of a total of 2,346 premises inspected throughout the year, it was found necessary to carry out treatment at 191 of them: 127 dwelling-houses and 23 other premises were treated for rat infestation; a further 31 dwelling-houses and 10 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. The poison used in every case was "warfarin". Where there is suspicion or evidence that the rats are coming from defective drains, the Public Health Inspector is informed, a test with the smoke testing machine applied, and any necessary action taken. The Public Health Department employs a whole-time rodent operator who made 3,584 visits to premises during the year. Twice a year the sewers are baited for the control of rats. The Borough is divided into ten districts for this purpose each containing approximately 67 manholes. Two gangs of two men each are employed for just over three weeks prebaiting the manholes with unpoisoned 21 bait for the first two days and poisoned bait on the third day. The next day a further inspection is made to ascertain the amount of poison taken. The number of manholes so treated is approximately 672. Below is a summary of the work carried out for the two treatments during 1956. In the treatment for May/June the poison used was "Antu", whilst that for November was zinc phosphide. Of the 672 manholes baited in the first treatment there were 553 pre-bait takes comprising 320 complete takes and 233 partly taken. Although there were only six manholes where complete takes of poison were registered, there were no less than 451 part takes of poisoned bait. In the November treatment there were 414 prebait takes of which 217 were complete takes. No complete takes of poisoned bait were recorded, although there were 364 part takes. The sewer treatments were carried out in co-operation with the Borough Engineer and Surveyor's Department. Ponds and Rubbish Dumps These are regularly inspected with the object of preventing the breeding of insect pests. The pond in White Hart Lane is emptied and cleansed periodically by the Borough Engineer and Surveyor's Department, whilst that at Alexandra Palace is supervised by the Alexandra Palace Trustees. Public Conveniences Sixteen public conveniences are available in the Borough, situated as follows:Lordship Lane Station Road Albert Road Town Hall Park Town Hall Park, High Road/Earlham Road (opened 5th May, 1956) Chapman's Green Recreation Ground White Hart Lane Recreation Ground Albert Road Recreation Ground "Kings Arms" Hotel, N. 22. "Prince of Wales" Hotel, N. 22. "Alexandra Tavern", N. 22. "Duke of Edinburgh", N. 22. "Springfield" Hotel, N. 11. "Ranelagh" Hotel, N. 11. "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. Control of the Council's public conveniences was transferred from the Public Health Department to the Borough Engineer and Surveyor's Department as from the 1st July, 1956. 22 INSPECTION AND SUPERVISION OF FOOD (a) Food Premises in the Borough Bakers' Shops 27 Butchers Shops 41 Cafes and Restaurants 50 Chemists Shops 16 Confectionery and Sweet Shops 86 Dairies and Milk Shops 39 Pried Pish Shops 11 Wet Pish Shops 12 Greengrocers Shops 46 Grocers' Shops 88 Public Houses and Off-licences 37 Pood Factories 9 (b) Milk Supply The following licences for the sale of milk under special designations have been granted to the 39 premises registered for the sale of milk in the Borough:- Tuberculin Tested 9 Pasteurised 13 Sterilised 32 Supplementary licences to sell milk from premises which are outside the area of the Licensing Authority Tuberculin Tested 7 Pasteurised 8 Sterilised 12 Eighteen 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. Great advances have been made during the past 50 years to protect the public's health and ensure that the milk supply of this country is second to none. The Pood & Drugs Act, 1955 consolidates previous Acts and Regulations relating to milk. Yet in 1906 it was a different story as can be seen from the following extract from the report of that year "It is unfortunate that Local Authorities are bound to register all applicants for registration quite apart from the state of the premises from which the milk is sold or stored or whether the premises are suitable for storage of milk. Having regard to the importance of a pure milk supply, especially with respect to infantile mortality, it is a matter of surprise that an Act has not been made whereby ail dairies, cowsheds and milk shops would have to be certificated by the Local Authorities before being allowed to sell an article of such vital importance. There is no doubt that Urban Districts have during the past few years put in force all the powers given them with respect to the Milk Trade, but it requires the cooperation of Rural Districts at the source of supply, and Carriers in Transit, before the problem of a purer milk supply is solved." 23 By 1931 advances had been made in the legislation towards a pure milk supply, The greater part of the milk supply for the district was by this time in the hands of large firms and combines, which supplied the milk in bottles filled at their depots outside the district-no longer were cattle kept in the district of Wood Green. Premises from which milk was sold had to be registered and licences issued permitting them to sell graded milk only, and the Council had by this time the power to refuse and revoke the registration of any retailer, although during that year it was not found necessary to take any such action. During that year 95 espies of milk were taken-these were not bacteriological tests but tests for adulteration, only one case of which was found. Today we enjoy that proper and sufficient milk supply that was so earnestly sought fifty years ago. (c) Food and Drugs Act, 1955, Section 16. There are 11 premises registered for the manufacture of Ice Cream in the district and 113 premises registered for retailing Ice Cream. During the year, 57 visits were paid to these premises and 6 samples were submitted for bacteriological examination. These 6 samples were all Grade I. Also 43 premises are registered under this Section for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. Visits to these premises during the year numbered 132. (d) Middlesex C .unty Council Act, 1950. Section II. -Registration of Hawkers of Pood. Sixty-three hawkers of food in the Borough are registered. (e) Meat and Other Foods Condemned. The under-mentioned foodstuffs were certified as unfit for human consumption during the year:- lbs. Meat Pish Dried Fruit Paprika 917% 42 6 1 Meat Pish Vegetables Fruit Evaporated Milk Marmalade Soup Jelly Creamed Rice Tomato Juice Tins 87 15 65 187 6 1 3 3 2 6 966½ 375 Miscellaneous Items Fruit and Vegetables 9 Cheese 12 Condiments 3 Marmalade 1 24 After examination by the Public Health Inspector condemned food is collected by this Department' s van, which has a specially constructed metal floor for this purpose. It is then removed to the Council's Refuse Disposal Plant where it is destroyed by incineration, In some instances food is brought to the Department's offices for examination and the same method of disposal applies. (f) Food and Drugs Act, 1955.-Food Hygiene Regulations, 1955. Although the Pood Hygiene Regulations 1955 made under the Pood and Drugs Act 1955 came into operation on the 1st January. 1956 certain provisions in these Regulations only took effect as from the 1st July, 1956, All food premises in the Borough were visited initially to introduce the Regulations, and a brochure giving the general requirements was left in each case. The Public Health Inspectors have since revisited these food premises and in a number of cases where contraventions of the Pood Hygiene Regulations have been observed a letter has been sent to the responsible person, while in other instances matters have been put right after verbal instructions were given to the proprietor. Contraventions observed numbered 355 and 143 letters were sent. In 201 instances the contraventions have been remedied. In all, 1,094 visits were made to food premises as set out below:- Dairies and Milk Shops 62 (registered) Ice Cream Premises 57 (registered) Stalls (registered) 25 Butchers 124 Pried Pish Shops 18 Other Food Premises 808 The general standard of premises equipment and plant used in the preparation and sale of food has improved during the year,, due in the most part to the requirements of the Pood Hygiene Regulations. There has also been a general improvement in the standard of food handling brought about, I feel sure, by the improvement in the structural standards of food premises. Propaganda in the form of posters and leaflets were distributed throughout the year to make the requirements of the Regulations more generally known to food handlers and the public alike and a number of talks were given on the subject of clean food and the provisions of the Pood and Drugs Act 1955 to local organizations. FACTORIES AND HOMEWORK 1. Inspections Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted FACTORIES WITHOUT mechanical power 37 31 - - FACTORIES WITH mechanical power 179 70 9 -. OTHER PREMISES in which Section 7 is enforced by the local authority 2 2 - - Total 218 103 9 - 25 2. Defects Found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Pound Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 3 - - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors . Sanitary conveniences (a) insufficient 1 1 - - - (b) unsuitable or defective - - - - - (c) not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to outwork) 4 4 - 3 - Total 9 6 - 3 - 3. Outwork 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. 10 - - - - - Household linen - - - - - - Lace, Lace curtains and nets - - - - - - Curtains and furniture hangings - - - - - - Brass and brass articles - - - - - - Artificial Flowers 12 - - - - - Feather sorting Cosaques, Christmas crackers - - - - - - and stockings 40 - - - - - Total 62 - - - - - 26 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 a sample was taken and sent for analysis. The result was satisfactory. Pet Animals Act, 1951 Under the Act, nine licences were renewed during the year after the premises had been inspected and found to be satisfactory. Establishments for Massage or Special Treatment Five existing licences under the Middlesex County Council Act, 1950, were renewed during the year. Housing The Borough Surveyor has kindly supplied me with the following figures showing the number of houses which have been erected or rebuilt during the year. Council properties completed:9 flats at Grosvenor Road 2 flats at Albert Road 18 flats at Granville Road 2 flats at Grainger Road 6 flats at Ellenborough Road 3 flats at New Road 1 house at Lordship Lane Council properties in course of construction at end of year:18 flats at Albert Close 40 maisonettes at Crescent Rise. Private enterprise properties completed or in course of construction - Nil. Swimming Baths The figures of attendances at Western Road and Durnsford Road Baths for the past two years are as follows:- Western Road Baths 1956 1955 Swimming Bath 69,804 58,046 -do- Children (Special sessions) 516 725 Children from Schools 27,360 24,797 Spectators 7,133 6,227 Slipper Baths 39,894 41,826 -do- Old Age Pensioners (free) 2,794 2,089 27 Durnsford Road Open Air Baths 1956 1955 Adults 8.446 29,356 Children 25,874 52.726 Children from Schools 1 637 1,321 Season Ticket Holders 22,298 31,155 Spectators-Adults 5,235 10,409 Children 626 993 Samples of water were taken from both baths at regular intervals 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 Seven 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 1955/56 the total tonnage of refuse collected was 13 749 tons; from this, material salvaged was sold for £1,855. The quantities of salvage were;- Tons Cwts. Qtrs Paper 194 11 0 Mixed Scrap Iron 7 10 0 Rags 2 9 0 Non-ferrous Metals 2 1 0 The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths. 28 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 41 it will be seen that 265 cases of infectious diseases were notified during the year, as against 852 in 1955. The Infectious Sickness Rate for the district was therefore 5.29. as compared with l0.83 during the previous year. Although this figure is very satisfactory, it must be remembered that 1956 was a year in which measles was non-epidemic. This is the main reason why the total number of infectious diseases notified during the year fell so considerably. Apart from the fall in measles notifications (27 against 635), there is very little to which detailed attention need be drawn. Scarlet fever notifications fell from 26 in 1955 to 17 in 1956; pertussis notifications rose from 28 to 37; food poisoning (including sonne dysentery) notifications rose from 61 to 94, while tuberculosis notifications remained almost stationary (63 cases in 1955: 67 cases in 1956). Five cases of poliomyelitis were notified during the year, the same figure as for 1955. I have drawn attention in a number of previous Annual Reports indeed, in the introduction to this Report, to the fact that the severity of infectious diseases as a whole has appreciably decreased. This is very clearly manifested by the small percentage of cases which now have to be admitted to hospital. When one remembers that many of these cases are only sent to hospital because of home conditions or because both the mother and the father go out to work, it will be more than ever apparent that the picture has completely altered. Indeed, it is now considered by many authorities that the need for ad hoc isolation hospitals has almost passed. Many existing isolation hospitals are now being used for multiple purposes, of which the treatment of infectious diseases is only one. We must, of course, remember that the virulence of infectious diseases has been known to change in the past, so that we can never be sure that conditions which many of us still remember only too vividly will not return. It is mainly for this reason that sufficient beds can still be made available for the treatment of infectious diseases in hospital should circumstances change. Our policy with regard to the exclusion of contacts of infectious diseases from school has recently been revised. It is now virtually certain that a child suffering from an infectious disease does not remain infective for anything like the length of time previously believed. We have, therefore, been able to reduce the exclusion period in the case of contacts of many infectious diseases, especially the milder type of infectious disease such as scarlet fever and measles. Needless to say, of course, the period of exclusion of contacts of such diseases as poliomyelitis, where the duration of infectivity is still not clearly known and where the disease itself can be very serious, remains more or less as before. Broadly speaking, the Medical Officer of Health is given a wide latitude in the matter of school exclusion. I have referred to this matter on several occasions in submitting detailed reports to the Public Health Committee, and will continue to keep the Committee informed of any changes in policy. Our present system aims at obviating unnecessary loss of school 29 attendance, while adopting such safeguards as are obviously necessary. Our existing policy has not resulted, so far as we know, in any increase in infectious diseases generally or in the spread of outbreaks or epidemics in schools It is interesting to note that in 1906 the average attendance at school was the basis on which the education grant was made. The effect of this may be judged from paragraphs written by Dr Connolly in his Report for that year:- "The fact that the average attendance is the basis on which the education grant is given tends to cause an undue influence to be exercised on parents to send their children to school when in an unfit state To a certain extent there is an antagonism between the interests of the public health and the apparent interest of the Education Authority and an utterly illogical and improper magnification of the importance of a high average attendance as a test of efficiency is caused." "All the recent contributions to the questions of National Education of any value emphasize the paramount importance of securing the highest possible physical development of the children, and I hope the Council will discourage any attempt to suggest that the average attendances of scholars, whether high or low, reflects the slightest credit or discredit on the masters or mistresses in charge of any particular school The masters and mistresses should be relieved of any responsibility in this matter and their time and energy devoted to the far more valuable and important duties of their profession, " It need scarcely be said that this state of affairs no longer exists. Indeed, there is the closest possible liaison between the Public Health Department and the schools This is particularly seen in the case of such serious diseases as poliomyelitis, although the co-operation exists throughout the field of health and has undoubtedly made a worth-while contribution to the health and well being of our school children, Diphtheria For the ninth year in succession no case of diphtheria was notified in the Borough, The last death took place in 1939 These figures would appear to indicate that diphtheria can no longer be considered a serious menace, or perhaps it would be more true to say that, for the time being diphtheria has lost its terrors The fact that several cases of diphtheria have been notified from various parts of the country within the past year, and that some of these cases were extremely serious, points to the fact, however, that the possibility of diphtheria returning as a major infectious disease can still not be dismissed Every now and again we receive a laboratory report which suggests that the causative organism might have been the diphtheria baceillus We also hear of cases which clinically resemble diphtheria being admitted to an isolation hospital. Up to the present, none of these cases have been substantiated. But we know only too well that, should the rate of immunisation among children fall to any appreciable extent, we might at any time be faced with quite a serious problem. 30 Although immunisation in Wood Green is carried out by the Middlesex County Council, this might be an opportune moment to refer in some greater detail to our immunisation programme. During 1956, our policy was altered only in minor respects. Thus, we decided to use the latest available type of diphtheria antigen (formol toxoid), this antigen having proved both efficient and safe. We also carried out most of our immunisation by the combined method, i.e. pertussis (whooping cough) and diphtheria, thus limiting the number of visits which mothers would have to pay to clinics for the immunisation of their infants. We also found that general practitioners were themselves immunising children in increasing numbers, either against diphtheria alone, against diphtheria and pertussis, or by the triple method, i.e. against diphtheria, pertussis and tetanus. Incidentally, the County Council scheme of inmunisation does not permit of the triple method being used. This was the position at the end of 1956, although even by that time we were beginning to become aware of certain difficulties. What has transpired since belongs rightly to a future report. It may, however, be stated briefly that an investigation carried out by the Medical Research Council has shown conclusively that immunisation by the combined method leaves the children so immunised at greater risk of, contracting poliomyelitis than would otherwise be the case. The risk is admittedly not great, but the fact remains that immunisation by any combined method which contains the pertussis antigen raises this issue. By the time this report is written, we will have changed to the single type of inoculation i.e. against diphtheria alone and against pertussis alone. General practitioners have been advised of the new policy. This will obviously entail more numerous visits to our clinics and to doctors' surgeries where practitioners decide to adopt a similar procedure. There will thus be added inconvenience so far as mothers are concerned. We will await the results of our amended programme with interest, if not with some apprehension. Portunately, it is hoped that the Ministry of Health will shortly issue a statement which will clarify the situation and may eventually allow us to resume our previous policy. Scarlet Fever Seventeen cases of scarlet fever were notified during the year, as against 26 cases in 1955 and 61 in 1954. From the number of scarlet fever cases notified during the two previous years, i.e. 1953 and 1952 (66 and 93 respectively), it will be seen that scarlet fever has declined progressively and substantially over the past five years. This does not mean that scarlet fever is becoming extinct. The whole character of this disease has altered materially, so much so that what was once a very serious illness now has seldom more than nuisance value. For this reason it may well be that very mild cases-and there must be many such - pass unnoticed. So long as scarlet fever maintains its present mild character, there is no reason for alarm. As I have said several times before, however, we must still assess the situation from time to time, in order to make quite sure that the virulence which formerly characterised scarlet fever is not returning. 31 Acute Anterior Poliomyelitis Four cases of paralytic poliomyelitis and one case of nonparalytic poliomyelitis were notified during the year, as against three paralytic cases and one non-paralytic case in 1955 It will be remembered that inoculation against poliomyelitis was offered to certain age groups in 1956 (children bom between the years 1947 and 1954), this work being carried out by the Area Health Staff. One hundred and five Wood Green children were inoculated during May and June, the inoculations propeeding without incident A further sixteen children were inoculated towards the end of the year. This work will continue in 1957, when it is anticipated that more plentiful supplies of vaccine will be available, It is interesting to note that reactions reported following the inoculations-and these were very carefully scrutinised were infinitesmal. No child inoculated developed poliomyelitis, nor did any other member of a family in which a child had been protected by inoculation. Although it is known that inoculation does provide what can at least be described as a reasonable measure of protection,, it need scarcely be said that the more general measures designed to safeguard the population, both infants and children, and adults alike, must not be in any way relaxed, I have taken the oportunity to provide our schools with notes on the simple safeguards which can and should be put into force, In my dual capacity as Medical Officer of Health for Wood Green and District School Medical Officer, I have taken active steps to impress upon everyone concerned the vital need for the strietest measures of hygiene in schools, above all else the washing of children's hands after using the toilet. In this I have received the utmost co-operation from Mr. Goodchild, the Divisional Education Officer; co-operation which I gladly acknowledge The schools have also been most helpful. We look forward to the day when our children can and will be protected against poliomyelitis by means of vaccination But until that day arrives, and even after that day, arrives, we cannot afford to neglect any matter which will reduce the ravages of the responsible virus, In this connection, I would draw attention to the notices displayed round the yachting pond in White Hart Lane indicating the danger of infection which arises when children use the pond for paddling and even bathing purposes for which the yachting pond was never intended. Measles As noted elsewhere, 27 cases of measles were notified during the year, as against 635 cases in 1955. These facts indicate that 1956 was not a "measles year". Once again, the disease itself was mild in the extreme. Indeed, admission to hospital was required in only one case. Pertussis (Whooping Cough) Thirty seven cases of pertussis were notified during the year, as against 28 in 1955. Although many of our children have been immunised by the combined method, which includes an appreciable measure of protection against pertussis, it must be remembered that inoculation against pertussis does not claim and never has 32 pretended to claim that full protection can be guaranteed. Our only claim has been that many children inoculated against pertussis will remain fully protected for several years, at least until pertussis ceases to be a killing or even a dangerous disease; and that the remaining children inoculated, if they develop the disease, will only do so in a mild form. When the percentage of children in the Borough inoculated against pertussis is as high as that protected against diphtheria, the results of inoculation will become increasingly apparent, Until that time arrives, there is evidence that our present policy is correct. We are endeavouring to persuade mothers to have their children inoculated against pertussis at or about the second month of life. As pertussis remains one of the major fatal diseases of infancy during the first six months of a child's life, early inoculation will, we believe, tide the child over that dangerous period. Thereafter,, as I have already pointed out, the danger progressively diminishes, Food Poisoning (including Sonne Dysentery) Eighteen cases of food poisoning and 76 cases of dysentery were reported in 1956 as against totals of 27 and 34 respectively during the previous year, I must again state that these figures are only useful for purposes of comparison, as we know perfectly well that many cases of food poisoning and dysentery are never brought to our notice, or even to the notice of general practitioners. The scheme set out in my Annual Report for 1954 relating to the exclusion from school of cases of diarrhoea, with or without sickness, continues to work satisfactorily It would be too soon yet to state categorically that this scheme has reduced the incidence of dysentery among school children, but we certainly do know that it has eased the work of our already overburdened Public Health Inspectors, without appearing in any way to have increased the number of cases in our schools, It is also interesting to note that the hygienic precautions to which I referred when dealing with the spread of poliomyelitis in schools apply equally to the spread of dysentery and that more recent bug-bear, winter vomiting, All our schools are visited as soon as we receive information that multiple cases of dysentery or winter vomiting have occurred In this connection, I would take this opportunity of thanking our head teachers for their prompt, invaluable co-operation. We are in this way enabled to take immediate action, In the spread of infectious diseases, immediate action may save endless trouble at a later date. This fact is particularly evident in the case of intestinal infections, Para-typhoid Fever One case of para-typhoid fever was notified in 1956 compared with two cases in 1955, The difficulty recorded in my Annual Report for 1955 relating to infected egg products has therefore not recurred, although we are constantly on our guard against the occurrence of cases which can be ascribed to this or to a similar source. Puerperal Pyrexia Two cases of puerperal pyrexia were notified during the year. 33 Both cases made an uneventful recovery. No cases were reported during 1955. It is not so long ago since each case of puerperal pyrexia was regarded as a serious event Indeed the death rate from puerperal causes was tragically high only a few years ago. Nowadays puerperal pyrexia is seldom due to septic causes being normally attributable to some intercurrent cause such as influenza a head cold or even constipation This is an indication of the revolutionary change which has taken place within the last decade in the care of mothers during and after pregnancy Several factors have contributed to this happy state fundamental advances in midwifery closer supervision, effective liaison between general practitioner, hospital, domiciliary midwives and clinic and the introduction of antibiotics. Puerperal sepsis as against a rise in temperature during the puerperium (the official designation of "puerperal pyrexia") is seldom encountered This explains why the death of a mother during or after childbirth is now looked upon almost as a rarity. Smallpox No case of smallpox occurred in Wood Green during 1956 nor were any doubtful cases reported. It is once again my pleasure to report that the numbers of mothers bringing their infants to child welfare clinics in Wood Green for vaccination and the number of mothers requesting the same service from their family doctor, is still increasing. The latest figures show that the number of children under the age of two years who have been protected against smallpox by vaccination, either at clinics or by the family doctor, is now upwards of 60% When compared with the tiny percentages which held not so many years ago, these figures can be allowed to speak for themselves. Tuberculosis Sixty-three cases of tuberculosis (55 pulmonary,8 non-pulmonary) were notified during the year, as against 67 cases in 1955 of the 63 cases, 26 were transferred from other districts, 37 being new cases. A broad classification of the new notifications during the past three years in relation to employment was- [ 1954 1955 1956 Clerical 16 12 5 Manual Labour 14 17 7 Housewives 20 8 3 Factory Workers 7 - 5 Children 5 5 5 Professional classes 1 2 3 Domestic Service - 2 - Nurses - 1 - Shop Assistants 8 4 1 Armed Forces - 2 - Retired Persons 2 2 2 Unclassified 8 1 6 81 56 37 34 The number of cases on the register at the end of the year was as follows:- Pulmonary 308 males Non-pulmonary 12 males 247 females 40 females Total 555 52 From the table of new cases of tuberculosis notified over the past three years, it would appear that the numbers are definitely declining. It must be pointed out, however, that it would be most unwise to draw any lasting conclusions from figures which cover such a short period and such a comparatively small number of cases. We know that the incidence of tuberculosis is declining throughout the country as a whole. More important still, there is abundant evidence that the previous terrors very properly associated with tuberculosis have largely disappeared Early diagnosis, the use of the newer antibiotics, and the greater availability of beds in sanatoria and hospitals have contributed to this very happy result, None the less it need scarcely be said that everything possible must still be done to reduce the incidence and spread of tuberculosis throughout the population Indeed, it would now appear that the pendulum has tended to swing in the opposite direction, and that the rapid cures so often effected in the case of tuberculosis have produced what is almost a nonchalant attitude towards the disease This is very wrong Tuberculosis can still be a killing and incapacitating disease, which takes its toll year by year, month by month, from all age groups of the population. May I conclude my remarks on tuberculosis generally by making a special appeal for the rehousing of families in which an open case of tuberculosis is known to exist, and where the accommodation is such as to favour the spread of the disease to other members of the family I am fully aware of the great difficulties which confront the Council and the Housing Committee in the provision of adequate housing accommodation I also appreciate that housing needs are by no means confined to tuberculous families The needs of the tuberculous patient on the other hand are not the only desideratum If the family of a tuberculous patient occupies premises which are overcrowded, the risk of the infection spreading is greatly Increased indeed, no one can foresee what the effect of such a situation will ultimately be. It is of paramount importance that the rehousing of families in which a case of tuberculosis occurs, especially where the patient continues to live at home, should be granted high priority, not only on humanitarian grounds but from the epidemologieal standpoint. In this connection I am fully conscious that the Housing Committee has in the past always given most sympathetic consideration to such representations as I have made and would express my sincere gratitude for the action taken Mass Radiography Mass Radiography Unit 6A once again visited Wood Green between 11th and 27th September, 1956, for the purpose of X-raying members of the public, factory groups, special groups and senior school children. Leaflets were prepared by the Unit and distributed by 35 them and by the Public Health Department giving the piace and times at which sessions were to be held Letters were sent by the Public Health Department to local organizations general practic tioners and the local press supplying full particulars and inviting the public to take full advantage of the Unit s visit The Unit Secretary also communicated with firms and organizations throughout the district while posters were displayed on public notice boards and in shop windows The London Co operative Society provided a window for a fortnight in their High Road Branch for the display of propaganda Facilities were also offered to us by the Wood Green Horticultural Society at their Annual Show for advance publicity The Unit was sited at Spouters Corner the response being even better than on previous visits A large caravan was obtained and used as an office This was by way of being an experiment which the Unit Organizer informs me proved so successful that they are hoping to be able tc adopt this method as their estab lished technique in the future Set out below is an analysis of the survey On the previous visit of the Unit in 1954 the total number attending public sessions was 1,500: on this latest visit the figure was 4 219 an increase of no less than 2,719 The prime factor in this larger attendance was without doubt the central position from which the Unit operated I should like to take this opportunity of expressing my sincere thanks to Dr. Ramsey. Medical Director of Mass Radiography Unit 6A and to Mrs Waters Secretary of the Unit for the great help which they have given Wood Green. Indeed all members of the Unit staff deserve our gratitude It has always been a very real pleasure to work with Unit 6A We now look forward eagerly to a return visit, probably in 1958 Analysis of Mass Radiography Survey From the tables set out on Pages 36 and 37 it will be clear that cases of active and doubtful tuberculosis were brought to light by the visit of Mass Radiography Unit 6A It will also be noted that conditions other than tuberculosis were discovered The Secretary of the Unit informs me that fewer cases were discovered during the. recent visit, as compared with the previous visit in 1954 This, of course, is very satisfactory 36 ANALYSIS OF MASS RADIOGRAPHY SURVEY PULMONARY TUBERCULOSIS GROUP Number examined Recalled for Large Film l Recalled for Clinical Interview Did not attend for Large Film or Interview Presumed Healed Suspect T.B. not yet confirmed Occasional Clinic Supervision Close Clinic Supervision Requiring immediate treatment Carcinoma of Bronchus Cardio-vascular lesions Other Abnormalities PUBLIC SESSIONS Male 1,634 49 37 3 9 - 9 1 - 3 2 12 Female 2,585 48 32 - 7 - 7 - 3 - 4 10 ORGANISED GROUPS Male 573 14 7 1 - - 3 - - 1 - 5 Female 637 12 9 - 1 - 1 - 2 - 3 2 SCHOOLCHILDREN Male 312 3 1 - - - - - - - - 2 Female 471 2 - - - - - - - - 2 TOTAL Male 2,519 66 45 4 9 - 12 1 - 4 2 19 Female 3,693 62 41 - 8 - 8 - 5 - 7 14 TOTAL 6,212 128 86 4 17 - 20 1 5 4 9 33 37 Other Abnormalities discovered include:- Male Female Total Microlithiasis Alveolaris 1 - 1 Bronchiectasis 1 - 1 Hodgkin's Disease 1 - 1 Abnormalities of Diaphragm 2 1 3 Pneumatocoele 1 - 1 Benign Thyroid Enlargement 1 - 1 Sarcoidosis 1 - 1 D ISINFECTION AND D IS INFESTATION The number of articles dealt with at the Disinfection Station was as follows Articles disinfected 192 Articles destroyed 86 28 rooms were disinfected on account of infectious disease 16 premises were disinfested on account of the presence of vermin which involved the disinfestation of 33 rooms 33 premises were treated for infestations of cockroaches wasps ants, flies, fleas, beetles booklice and hornets 83 library books were brought to the Department during the year for disinfection 38 APPENDIX 1 TABLE ! Vital Statistics of Wood Green, 1936-56 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) 1936 53,620 700 31.1 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 1955 50,610 592 11.7 17 14 23.6 1 58,8 519 10.3 1956 50,100 578 11.5 20 10 17.3 1 50,0 537 10.7 TABLE II INFECTIOUS DISEASES FOR THE PAST 25 YEARS Year Diphtheria Scarlet Fever Enteric Pever Pulmonary Tuberculosis Nonpulmonary Tuberculosis Measles Pertussis Poliomyelitis /N *D /N *D /N *D /N *D /N *D /N *D /N *D /N *D 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 - - - 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 - 1955 - - 26 - - - 51 6 5 1 635 - 28 1 4 - 1956 - - 17 - - - 30 1 7 1 27 - 37 5 - /N- Notifications *D- Deaths 40 TABLE III Infectious Diseases Notified during the year 1956 Notifiable Disease Cases Notified in Whole Borough Total Cases Notified in each Ward Total Cases removed to Hospital or Sanatorium 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 Alexandra Bowes Town Hall Noel Park Scarlet Pever 17 0 3 9 3 1 - 1 - - - - 3 5 9 5 - Diphtheria - - - - - - - - - - - - - - Cerebro-Spinal Pever - - - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - - Para-typhoid Pever -1 - - - 1 - - - - - - - - - 1 1 - Erysipelas 1 - - - - - - - -. 1 - 1 - - 1 - Pneumonia 39 - - 3 - - 1 1 8 5 5 16 18 7 14 4 29 Acute Poliomyelitis 5 - 1 2 1 - - - 1 - - - - 1 4 4 - Polio-Encephalitis - - - - - - - - - - - - - - - - - Puerperal Pyrexia 2 - - - - - 1 1 - - - - 1 - 1 1 - Pulrn, Tuberculosis 30 - 3 1 - - 6 8 6 3 - 3 12 4 14 - 1 Non-Pulm,. Tuberculosis 7 - 1 1 - - - 3 - 1 - 1 3 1 3 - 1 Malaria - - - - - - - - - - - - - - - -~ - Chickenpox 5 - 3 1 - - - 1 - - - - 5 - - 5 - Mearles 27 2 11 12 1 - - - 1 - - - 10 6 11 1 - Whooping Cough 37 5 17 14 - - - - - - - 1 10 4 23 3 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - Dysentery 76 5 12 27 11 - 1 9 6 2 2 1 18 23 35 9 - Pood Poisoning 18 - 3 - - 1 1 4 3 2 1 3 5 3 10 4 - Totals 265 12 54 70 17 2 10 28 25 13 9 25 86 54 125 38 31 41 TABLE IV Causes of death during the year 1956 Causes of Death Male Female Tuberculosis, respiratory 1 - Tuberculosis, other - 1 Syphilitic disease - - Diphtheria - - Whooping Cough - - Meningococcal infections - - Acute Poliomyelitis - - Measles - - Other infective and parasitic diseases - - Malignant neoplasm, stomach 10 8 Malignant neoplasm, lung, bronchus 24 2 Malignant neoplasm, uterus - 3 Malignant neoplasm, breast - 12 Other malignant and lymphatic neoplasms 31 33 Leukaemia, aleukaemia 2 1 Diabetes 1 1 Vascular lesions of nervous system 26 38 Coronary disease, angina 66 34 Hypertension with heart disease 2 12 Other heart diseases 21 33 Other circulatory disease 15 7 Influenza - - Pneumonia 14 15 Bronchitis 27 17 Other diseases of respiratory system 4 - Ulcer of stomach and duodenum 2 1 Gastritis, enteritis and diarrhoea - 3 Nephritis and nephrosis, 2 1 Hyperplasia of prostate 2 - Pregnancy, childbirth, abortion - - Congenital malformations 5 1 Other defined and ill-defined diseases 16 21 Motor vehicle accidents 3 2 All other accidents 5 8 Suicide 3 1 Homicide and operations of war - - Totals 282 255 42 TABLE IVA 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 1 - - - - - - - - - 1 - Tuberculosis, other - - - - - - - - - - - - Syphilitic disease - - - - - - - - - - - - Dyphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal Infections - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasmstomach 10 - - - - - - - - 1 5 4 Malignant neoplasmlung, bronchus 24 - - - - - - 2 1 8 4 9 Malignant neoplasm, breast - - - - - - - - - - - - Other malignant and lymphatic neoplasms 31 - - - - - - 1 2 8 7 12 Leukaemia, aleukaemia 2 - - - - - - 1 1 - - - Diabetes 1 - - - - - - - 1 - - - Vascular lesions of nervous system 26 - - - - - - 1 2 7 10 6 Coronary disease, angina 66 - - - - - - 1 4 14 20 27 Hypertension with heart disease 2 - - - - - - - - 1 - 1 Other heart diseases 21 - - - - - - - 1 2 9 9 Other circulatory disease 15 - - - - - - 1 3 2 5 4 Influenza - - - - - - - - - - - - Pneumonia 14 - - - - - - - - - 3 11 Bronchitis 27 - - - - - - - 1 6 10 10 Other disease of respiratory system 4 - - - - - - - - 1 1 2 Ulcer of stomach and duodenum 2 - - - - - - - - - 1 1 Gastritis, Enteritis and Diarrhoea - - - - - - - - - - - - Nephritis & nephrosis 2 - - - - - - - 1 1 - - Hyperplasia of prostate 2 - - - - - - - - - 1 1 Totals carried forward 250 - - - - 1 - 7 17 51 77 97 43 TABLE IVA (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 - - - - - - 7 17 51 77 97 Congenital malformations 5 4 - - - - - - 1 - - - Other defined and illdefined diseases 16 4 - 1 - - 1 - - 2 3 5 Motor vehicle accidents 3 - - - 1 - - - - 1 1 - All other accidents 5 - - - - - 1 - 2 1 - 1 Suicide 3 - - - - - - i 1 1 - - Homicide and operations of war - - - - - - - - - - - - Totals 282 8 - 1 l 1 2 8 21 56 81 103 44 TABLE IVB 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 - - - - - - - - - - - - Tuberculosis, other 1 - - - - - - - 1 - - - Syphilitic disease - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasm, stomach 8 - - - - - - - 3 1 1 3 Malignant neoplasm, lung, bronchus 2 - - - - - - - - 1 1 - Malignant neoplasm, breast 12 - - - - - 1 - 2 3 5 1 Malignant neoplasm, uterus 3 - - - - - - - - 2 1 - Other malignant and lymphatic neoplasms 33 - - - - - 1 2 3 7 10 10 Leukaemia, aleukaemia 1 - - - - - - - - 1 - - Diabetes 1 - - - - - - - - - - - Vascular lesions of nervous system 38 - - - - - - - 1 6 17 14 Coronary Disease, angina 34 - - - - - - - 1 4 8 21 Hypertension with heart disease 12 - - - - - - 1 - 1 5 5 Other heart diseases 33 - - - - - - - - 2 9 22 Other circulatory disease 7 - - - - - - - 2 - 2 3 Influenza - - - - - - - - - - - - Pneumonia 15 - - - - - - - - 2 5 8 Bronchitis 17 - - - - - - - - 1 4 12 Other disease of respiratory system - - - - - - - - - - - - Ulcer of stomach and duodenum 1 - - - - - - - - 1 - - Gastritis, Enteritis and Diarrhoea 3 - 1 - - - - - - 1 1 - Nephritis and nephrosis 1 - - - - - - - - - - 1 Totals carried forward 222 - 1 - - - 2 3 13 33 69 100 45 TABLE IVB (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 222 .. 1 .. .. .. 2 3 13 38 69 100 Pregnancy, Childbirth Abortion .. .. .. .. .. .. .. .. .. .. .. .. Congenital malformations 1 1 .. .. .. .. .. .. .. .. .. .. Other defined and illdefined diseases 21 1 1 .. .. .. .. 1 2 2 8 6 Motor vehicle accidents 2 .. .. .. .. .. .. 1 .. .. 1 .. All other accidents 8 .. .. .. .. .. .. .. .. 1 2 5 Suicide 1 .. .. .. .. .. .. .. .. .. 1 .. Homicide and operations of war .. .. .. .. .. .. .. .. .. .. .. .. Totals 255 2 2 .. .. .. 2 5 15 36 81 111 46 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary NonPulmonary Total M. F. M. F. No. of cases on Register at end of 1955 287 252 10 39 588 New cases notified during 1956 26 4 3 4 37 Transfers from other Districts 11 13 - 2 26 No. of cases removed from Register 16 22 1 5 44 No. of cases on Register at end of 1956 308 247 12 40 607 New Cases and Mortality during 1956 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F M. F. M. F. 0 - - - - - - - - 1 3 - 1 - - - - - 5 1 - - 1 - - - - 15 7 8 - - - - - - 25 13 5 2 1 - - - - 35 5 2 - 2 - - - - 45 4 1 - 1 - - - 1 55 1 - - - - - - - 65 and upwards 4 - - 1 1 - - - Totals 38 16 3 6 1 - - 1 Above includes transfers (26) from other districts. 47 APPENDIX 2 Miscellaneous (a) Letters to Doctors Letters on the following subjects were circulated to Wood Green practitioners during 1956, some being sent under ray signa ture as Medical Officer of Health others either as Area Medical Officer, District School Medical Officer or jointly As all the matters covered in these letters have a direct bearing on the health of at least a section of the community and as it is ex tremely difficult to divide one s responsibility in such a vital matter as that of health. I have included all the topics covered Exclusion from school for winter vomiting or dysentery Winter vomiting, dysentery and poliomyelitis (hygienic precautions in schools) Acute Anterior Poliomyelitis (8 letters) Poliomyelitis and suspension of immunisation Inoculation against Poliomyelitis (4 letters) Ante-natal supervision. Haemoplegia PlantRr Warts Audiology Paratyphoid 'B' Fever (2 letters) Specimens for the Laboratory Restrictions on Use of Petrol Collection of specimens during Christmas I have set out this list of letters in detail as I hold very strongly that the transfer of information between the Public Health Department (and Area Health Office) and general practitioners is of the utmost importance. I am very happy to say that as has long been the case in Wood Green, the relationship between the Public Health Department and general practitioners is close and cordial, We on our part., try to keep general practitioners fully acquainted with changes in policy,and with any matters of topical importance. General practitioners reciprocate by letting me know of incidents occurring in their practice which may have epidemi ological significance, This two way traffic is most valuable In this connection, I might also say that a great deal has been done within the past few years to strengthen the links between the local health services and local hospitals This is not always an easy matter, but my attendance on various committees, notably the North Middlesex (British Medical Association) Liaison Committee and the Northern Group Medical Advisory Committee my personal contacts with members of local hospital staffs and the visits I pay to hospitals have helped considerably (b) Medical Examinations During the year 68 medical examinations were carried out Eighteen of these were in respect of entrants to the Council s employ for acceptance into the Superannuation Scheme 18 in res pect of workmen already . the Council's employ for acceptance into the Superannuation Scheme and 27 in respect of workmen for 48 acceptance into the Sickness Pay Scheme. In addition, 20 medical reports were issued relating to employees absent from duty through sickness. (c) Additional Reports to Public Health Committee January Slum Clearance. Housing Act 1936, Section 25. Accidents in the Home. March Muswell Stream (Pinal Report). Steam Disinfector (Estimate for overhaul). Public Conveniences (Staffing). Food Hygiene Conference. August Mass X-Ray (Forthcoming visit of Radiography Unit). Bedding Van (Renewal of tyres). November Food & Drugs Act, 1955, Food Hygiene Regulations 1955 (Progress Report). Poliomyelitis (Incidence in Borough). Immunisation Campaign, December Annual General Meeting of S. E District of the National Smoke Abatement Society. 49 APPENDIX 3 Legal Proceedings during 1956 Statutory nuisance, Public Health Act 1936 Bounds Green Road Statutory nuisance. Public Health Act„ 1936 Imperial Road Statutory nuisance. Public Health Act 1936 Bounds Green Road Statutory nuisance, Public Health Act0 1936 = Albert Road Selling food not of the substance demanded,, Section 2 of Pood and Drugs Act, 1955 = Statutory nuisance Public Health Act, 1936 - Ranelagh Road Statutory nuisance. Public Health Act 1936 ~ Commerce Road Statutory nuisance, public Health Act 1936 - Clyde Road Statutory nuisance,, Public Health Act, 1936 - Palace Gates Road Statutory nuisance, Public Health Act„ 1936 - Herbert Road Work carried out after institution of proceedings Costs £1 1 0 Order to abate nuisance Costs £1X0 Costs of £3 3 0 awarded « nuisance abated before hearing Order to abate nuisance within 14 days - Penalty of £2, Costs £1 1 0 F'med £50 Costs £3 3 0 Work completed no order as to cost a Work completed before hearing - Costs £1,1,0 Work completed - Costs £1 10 Work completed Costs £1 1, 0 Nuisance abated befcrf hearing Costs 10s go 50 Printed and Published by Wood Green Borough Council Town Hall, :: N, 22=