BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1957 WM. CLUNIE HARVEY, md., d.p.h. Medical Officer of Health. WOOD 39 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1957 WM. CLUNIE HARVEY, m.d., d.p.h. Medical Officer of Health. Public Health Department, Town Hall, Wood Green, N. 22. July, 1958. To THE MAYOR, ALDERMEN and COUNCILLORS of the BOROUGH OF WOOD WEEN. Mr. Mayor, Ladles and Gentlemen, I beg to present the Annual Report for 1957. The year under review was again relatively uneventful. Apart from the two-yearly epidemic of measles which arrived in 1957, the year was free from epidemics or even what might be termed outbreaks of infectious disease. This matter will receive more detailed attention in the section of the report dealing with the prevalence and control of infectious diseases. The vital statistics for 1957 were also satisfactory, with the usual proviso that the figures for one year in respect of a population of less than one hundred thousand cannot be regarded as in any way conclusive. The birth rate rose from 11.5 to 13.2. The death rate was 9.6, as against 10.7 for 1956. There were again no deaths from puerperal causes. The infantile mortality rate, i.e. the number of infants who died during the first year of life for every thousand live births, fell from 17.3 to 16.8. These matters will be discussed again in the section of the report dealing with statistics and social additions of the Area, Work under the Housing Repairs and Rents Act 1954 continued during the year and will be fully dealt with in the section of the report covering this important field. The position in regard to the setting up of our Smoke Control Area in Wood Green was further explored. After very careful deliberation, details of a proposed Smoke Control Area were submitted to the Ministry of Housing and Local Government. The Minister s approval was obtained and a detailed survey of the selected area was commenced in the latter part of the year. This matter will be dealt with more fully in another part of the report, The coming into force of the Rent Act, 1957, has placed a certain amount of extra work on the shoulders of the Public Health Department. So far as the Department itself is concerned, this work has proceeded without incident. The Annual Report for 1957 is not, of course, the proper place in which to discuss the final implications of such a far-reaching Act. Altogether, the year 1957 has not presented any significant problems other than those problems which we have come to know so well. Housing still remains one of our fundamental difficulties, 3 and will surely remain an obstacle to the establishment of what we know as positive health, until we are satisfied that the entire population of Wood Green is adequately housed. It will not need me to indicate the immensity of this problem. The problem of the old folk increases year by year, not only the problems associated with the admission of the elderly chronic sick to hospital, but also the more general problems affecting loneliness, chiropody and other matters too numerous to mention. The Public Health Department has endeavoured in every way possible to play its part in this great work, and is prepared to offer its services to an even greater extent. The increasing responsibility brought about by the new Food Regulations has also been accepted and, indeed, implemented throughout the Borough. The closest liaison is maintained between the Public Health Department and the Area Health Office. After six years of acting as Medical Officer of Health for Wood Green and Area Medical Officer for Health Area No. 2 County of Middlesex, it is more than ever obvious that the close and harmonious liaison which exists between these two Departments, both of them engaged in the work of preventive medicine has at least done something to obviate the difficulties which arose following the splitting up of the health functions between the local health authority and the local authority. It is indeed fortunate that our relations with the County Council in the field of public health are close and harmonious and even that many members of the Area Health Staff have worked in Wood Green for very many years and are therefore familiar with the conditions which exist, both from the standpoint of environmental health and personal health. Although this may not seem a very important point I am convinced that it is none the less significant, I would again express my grateful thanks to the Health and Cleansing Committee and to the Borough Council for the help and courtesy extended to me as Medical Officer of Health during the year. I would also express my thanks to the Members of the Public Health Staff for their continued service- I would particularly mention my Deputy, Dr Janet Campbell, Mr. McCauley,Chief Public Health Inspector, and Mr. Ingram, Chief Clerk, but every member of the Department gave generously of his or her service throughout the entire year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. 4 BOROUGH OF WOOD GREEN PUBLIC HEALTH COMMITTEE Councillor L. A. VITORIA (Chairman) Councillor C. W. BUCKBY (Vice-Chairman) The Mayor, Councillor A. C. PARTRIDGE, J. P. Alderman J. W. BARNETT Councillor G. CATHLES Councillor E. C. HALE Councillor E. E. NICE STAFF *Medical Officer of Health - WILLIAM CLUNIE HARVEY, M.D., D.P.H. Deputy Medical Officer of Health - JANET ROSSELL CAMPBELL, M.B. 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 - P. V. INGRAM. General Clerks - Miss J. W. POPE, Shorthand Typist A. E. 0 NEILL 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, 5 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,606 Population - estimate supplied by the Registrar General 49,500 Number of inhabited houses (end of 1957) according to Rate Books 14,269 Rateable Value (1958) £814,595 Sum represented by a penny rate (estimated) £3,210 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Total M F Live Births - Legitimate 627 303 324 Birth Rate per 16 1,000 Illegitimate 28 12 13.2 Still Births 11 8 3 Rate per 1,000 Births 16.8 Deaths 485 268 217 Death Rate per 1,000 9.6 Deaths from Puerperal causes - Rate per 1,000 Births - Deaths of infants under one year of age All infants 11 Rate per 1 000 live births 16.8 Legitimate 10 Rate per 1,000 legitimate live births 15.27 Illegitimate 1 Rate per 1,000 illegitimate live births 35.71 Deaths from- Tuberculosis 7 Cancer (all ages) 107 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) 1 Number of Births notified 655 Number of Births registered in the Borough 113 POPULATION The mid-year estimate of the population supplied by the Registrar General is 49,500, a decrease of 600 from that of the previous year, BKRTHS The number of live births registered during the year was 655, which gives a crude birth rate of 13.2 per 1,000 of population the corrected birth rate being the same figure- The rate for 1956 was 11.5. There were 11 still-births, giving a stillbirth rate of 16.79 per 1,000 births In 1956 the still-birth rate was 36.33. 6 DEATHS The number of deaths credited to Wood Green after the necessary adjustments had been made for inward and outward transfers was 585, giving a crude death rate of 9.5 per 1,000 of population and a corrected death rate of 9.6. The total number of deaths for the previous year was 537, when the death rate was 10.5. Of the total of 585 deaths no fewer than 324 occurred at ages over 65, while 104 deaths occurred at ages of 80 and 9 at ages over 90. Apart from the fact that the major causes of death as shown by the Registrar-General s return are still deaths from diseases of the heart and circulation and lung cancer, I would comment on two specific death rates. The tuberculosis death rates forWood Green have not altered a great deal over the past four years, the number of yearly deaths varying from 7 in 1957 to 2 in 1956. In 1957, the death rate from tuberculosis was 0,12 per thousand of the population, the fourth highest rate in Middlesex. In 1956 the death rate from tuberculosis was the second lowest in Middlesex (0.02), while in 1955 the death rate (0-11 per thousand population) was exactly the average for the County In 1954 the Wood Green rate was somewhat below the average In other words although the death rates from tuberculosis in a district such as Wood Green might be expected to be low, this is not always the case, The reasons are not difficult to find. It must be quite obvious that persons suffering from tuberculosis move into Wood Green from Inner London because of the very fine amenities and the absence of much industrial development The fact that a very few of these patients die and I need scarcely say that the death rate from tuberculosis is declining year by year - must never be taken to impiy that this is a bad area so far as tuberculosis is concerned One must consider above everything else the number of new cases which are recorded in the Borough especially among what might be described as the indigenous population The fact that our death rates from tuberculosis are relatively high however does indicate the urgent need for the adequate housing of all families from which a case of tuberculosis has been reported. So far as the tracing of contacts and the care of actual patients is concerned, the work of our Chest Clinics is particularly important In 1957. the death rate from cancer (2.2 per thousand population) was the fourth highest in Middlesex. In 1956, the rate for Wood Green was the third highest in the County in 1955 the rate was the fourth highest in Middlesex while in 1954 the rate was again the fourth highest in the County. In short, year after year the number of deaths from cancer in Wood Green which varied from 100 in 1954 to 123 in 1956 remained high when compared with figures from other County districts. The reason is again not far to seek. The population of Wood Green is weighted in the over-sixty group and is becoming increasingly weighted as the years go by. This means that more and more Wood Green inhabitants are living to the age when cancer is a major killing disease. Although one cannot describe any cause of death as 7 satisfactory, it is at least pleasing to think that the conditions which prevail within the Borough are such as to promote health and longevity. Unfortunately, we know only too well that a portion of these deaths occur in persons who have only reached late middle life. None the less, the over-all fact remains that, in the absence of any factor which might increase the prevalence of cancer - and no such factor seems to exist - we must assume that the high rates in Wood Green are due to the long life of its citizens. INQUESTS Seventeen inquests were held following the deaths of Wood Green residents during 1957. A further 128 post mortem examinations were carried out without an inquest, 61 of these in the Prince of Wales Hospital, which, by arrangement with the Wood Green Borough Council, provides mortuary services. MATERNAL MORTALITY As in the four previous years no deaths were reported as the result of childbirth, INFANT MORTALITY As already indicated, the infant mortality rate fell from 17.3 in 1956 to 16.8 in 1957. These figures are perhaps seen in more accurate perspective when it is remembered that the number of infants who died during their first year in 1956 was 10, while the corresponding number in 1957 showed an increase of one, the number for that year being 11. In other words, as has been explained, a few infant deaths will raise or lower appreciably the infantile mortality rate for a district with a population such as Wood Green's, bearing in mind that these figures are linked to the number of live births. It will be noted that the number of infant deaths rose from 10 in 1956 to 11 in 1957, although the infant mortality rate fell from 17.3 to 16.8 during the same period. This fall in the infant mortality rate was brought about by the fact that a greater number of births occurred in the Borough during 1957 than in 1956, We also know that all of our infant deaths occurred during the first few weeks of life, indeed, during the first few days of life. In fact, 8 deaths occurred within twenty-four hours of birth. This mortality, known as the neo-natal mortality comprises the type of fatalities which, so far as the work of the local health authority is concerned, are largely non-preventable, Each infant death is, however, very carefully investigated, whether the child dies at home or, as happens in most instances, in hospital. The Council will remember that, in my Annual Report for 1956, I mentioned that we were endeavouring to arrange a post-mortem examination of infants who died before the age of twelve months in as many cases as possible. This is never an easy matter, for very obvious reasons. We are nevertheless 8 continuing our efforts, in the hope that the additional information which post-mortem examinations should give will afford a clearer insight into the causes of death, especially those which should be preventable. The greatest care is also being exercised in the field of ante-natal welfare, since it is now known that a number of infant deaths are due to causes which arise during pregnancy and which lead, if not to a stillbirth, to the early death of the newly-born infant. The infant mortality rate in England and Wales, of infants between the age of six and twelve months has dropped by approximately 92% since the beginning of the century. As a contrast, the mortality of infants immediately after birth has fallen by approximately 30% during the same period. In other words more work is still required to ascertain the true causes of early infant deaths and to ensure that, whenever possible, these causes are not allowed to arise. Onder 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 mths, 6 mths. and under 9 mths 9 mths, and under 12 mths. Total deaths under one yr. Prematurity 3 - - 3 - - - - 3 Congenital Defects 1 - - - 1 - - - - 1 Atelectasis - - - - - - - - - - Gastro-enteritis - - - - - - - - - - Intra-cranial Haemorrhage 1 - - - 1 - - - - 1 Capillary Bronchitis - - - - - - - - - - Asphyxia - - - - - - - - - - Broncho-pneumonia 1 - - - 1 - - - - 1 Other Causes 5 - - - 5 - - - 5 Total 11 - - - 11 - - - - 11 9 GENERAL PROVISION OF HEALTH SERVICES Hospitals The situation in relation to the availability of hospital beds has not altered appreciably from that recorded in my Annual Reports for the last few years. The problem is still most acute as it relates to the provision of beds for the chronic sick, especially the elderly chronic sick. As I stated in my Annual Report for 1956, increased difficulties have tended to arise in the provision of maternity beds. This is specifically the case in so far as the provision of a hospital bed on social rather than medical grounds is concerned. This matter - a very important matter when the existing housing conditions are remembered - has been taken up with the hospitals serving the Borough. It is hoped that the difficulties will at least be alleviated, if not largely removed. The admission to hospital of old people who are suffering from what might be described as the normal infirmities of old age, presents a problem which grows in size and in intensity year by year almost month by month. Unfortunately the situation so far as Wood Green is concerned is by no means clear Geriatric cases from Wood Green are received into St. Michael s Hospital Enfield, the North Middlesex Hospital and on occasions into Chase Farm Hospital. On paper this arrangement may appear adequate. But this is very far from being the case not because of lack of good will on the part of the hospitals concerned but by reason of the increasing demands for geriatric beds not to mention the appalling shortage of staff It is tragic in the extreme to find an elderly person who is either not suffering from any specific disease or who has reached a stage where anything resembling a permanent or even a partial cure is out of the question and to be told that there is no bed available in a hospital for these pitiable cases Such tragedies are very definitely increasing and present what is virtually an insuperable problem The Health Services provided by the County Council in Area No 2 certainly afford as much amelioration as is possible. Health Visitors regularly visit these old people home nurses are available for daily or even more frequent visits while the Home Help Service can also help. But two things must be remembered These measures helpful though they are are only palliative. A time must come when the answer, and the only answer is admission to a hospital or to an Old Persons Home And even here it must never be forgotten that persons can only be admitted to an Old Persons Home if they are able to look after themselves And it is precisely the type of old person who is quite incapable by reason of age and infirmity to fend for themselves which presents the real problem The second point is the fact that the staff available to look after old persons in their own homes is extremely limited while I need scarcely say that there are many other very important duties to be performed. This is particularly so in the case 10 of the Home Help Service where old people can only be catered for when the urgent needs of maternity cases, cases of tuberculosis and urgent illness in the family have been fully covered. Altogether, although the personal health services provided by the County Council are designed, at ieast in part, to reduce the number of cases which might otherwise have to go to hospital they are only able to cope with the aged infirm to an extremely limited extent. What is obviously required is a much fuller geriatric service which will adequately cater for the desperate needs of a Boroughsuch as Wood Green where the population, as I have stated elsewhere is heavily weighted in the older age groups. Such a geriatric service should be able to secure admission to hospital of elderly people before the stage has been reached when rehabilitation is out of the question. This woald permit a much quicker turn-over of beds and would solve at ieast part of our problems. Considerable discussion in which I have played a part has already taken place on this subject. Here again we can only hope that these discussions will bear fruit and that the disturbing state of affairs which exists today will become a nightmare of the past When it is remembered that the lumber of persons over the age of 65 in Middlesex is estimated to rise by 30% in the appreciable future and when it is remembered that Wood Green is particularly unfortunate in this respect the need for immediate action will be more clearly appreciated There is another aspect of the problem of the admission of old people to hospital which urgently demands attention When it is impossible as is so often the case to secure the admission to hospital of an old person who is either very infirm or suffering from some chronic ailment the position of the relatives where there are relatives, becomes extremely difficult,. Quite apart from those old people who are living alone there are many old people who are being looked after in their own homes by relatives The Home Nursing and Home Help Services provided by the County Council are certainly able to help but the strain will always remain with the relatives both by day and by night. When a relative accepts this responsibility in the fullest possible measure and where the infirmity or illness of the elderly-person continues for months and sometimes for years it need scarcely be said that an enormous strain is placed 1 upon the health of those who are doing their best to look after these old persons at home, Veryoften relatives have a breakdown in health sometimes so severe that admission to hospital is required If the geriatric services provided were such that old people could be got into hospital at an early date and if there were even some arrange ment whereby old people could be got into hospital for a short period in order to give the person looking after them a break or even a short holiday this would undoubtedly ease the burden This is yet another matter which is being stressed with the appropriate Regional Hospital Board in an effort to see whether something along these lines can be arranged as a matter of very real urgency. 11 Care of the Aged The remarks which I made in my Annual Report for 1956 regarding care of the aged generally, apply equally today. Here is a field in which so very much can and should be done. As I write this report it is highly probable that the Wood Green Old People s Welfare Committee will be strengthened and able to undertake much wider functions in the very near future. Prom what I know of the Old People s Welfare Committee I am well aware that these extended duties will be eagerly accepted. An attempt is at present being made to endeavour to assess the needs of old people living in the Borough, to place these needs in some order of priority and to take such steps as are practicable to ensure that the needs are met, It need scarcely be said that the Borough Council has always taken the greatest interest in the welfare of its old folk. This is an almost classic example of the way in which a statutory body such as a Borough Council can co-operate with a voluntary committee to improve the lot of those members of the community who are in such dire need of assistance. Much of course, is already being done. The great work carried out by the Old People s Welfare Committee has already been mentioned. One must also remember the magnificent contribution made by the Wood Green Division of the British Red Cross Society and the W.V.S., together with many other bodies not to mention individuals. When ail these efforts have been fully co-ordinated when ouroldpeople can know where to obtain assistance when gaps have been filled and new amenities and services provided, we can honestly say that the problem of the aged is being adequately tackled in Wood Green. Need I stress that the sooner this is done the more can we rest content. Laboratory Facilities Summary of work carried out at Central Public Health Laboratories for the year 1957- Positive Negative Swabs for diphtheria bacilli - 4 Sputa for tubercle bacilli - 8 Throat and nose swabs 8 Faeces 169 Urine 4 Blood - Others 6 Ice Cream 15 Milk 6 Water (Swimming Pool) 3 12 NATIONAL ASSISTANCE ACT, 1918 (National Assistance Amendment Act 1951) SECTION 47 Removal to suitable premises. of persons in need of care and attention, It was not found necessary for the Council to take any action under this Section during 1957 NATIONAL ASSISTANCE ACT, 1918 SECTION 50. - Burial or Cremation of the Dead In accordance with Sec. 50 of this Act, two burials were carried out by the Council during 1957. No burials were carried out during the previous year, 13 SANITARY SERVICES Inspections Public Health Act, 1936 1,049 Housing Act, 1936 203 Rag Flock and Other Pilling Material Act, 1951 6 Pet Animals Act, 1951 7 Factories and Outworkers 208 Food Preparing Premises 351 General Food Premises 711 Shops Act, 1950 116 Smoke Observations 143 Unsound Food 115 Complaints investigated 519 Interviews with owners, etc. 138 Revisits to property under notice 1,519 Infectious Diseases Cases 48 Food Poisoning 3 Special enquiries in connection with infectious disease cases 302 Aged and infirm persons 25 Pests Act 540 Clean Air Act 147 Miscellaneous 312 Housing Repairs and Rents Act, 1951 Certificates of Disrepair - Granted 3 Rejected 1 Revocation of Certificates of Disrepair - Revoked 2 Rejected 3 1 Certificate revoked by County Court Number of visits made in connection with above 14 Rent Act 1957. The Rent Act 1957 came into operation in July 1957. It was introduced to amend certain other enactments, including the Housing Repairs and Rents Act. 1954, relating to the control of rents, the right to retain possession of dwellings, to provide a minimum length fornotice to terminate residential lettings and to enable rented houses and flats to be put and kept in repair. It is this latter part of the Act with which we have principally to deal. Applications for Certificates of Disrepair began to come in during August. The procedure for dealing with these applications under the Act is more complicated than under the previous enactments and entails considerably increased work in the Department, both for the inspectorate and for the clerical staff. Number of Applications for Certificates of Disrepair (Form I) 147 Number of Proposals to Issue Certificates of Disrepair (Form J) 107 Number of Certificates of Disrepair issued (Form L) 25 Number of Applications for Certificates of Disrepair rej ected 1 Number of Certificates of Disrepair cancelled 4 Number of Applications for Cancellation rejected 1 Number of visits made in connection with above 176 14 Informal Notices served - Shops Act 1 Complied with 4 Pood and Drugs Act 128 " " 121 Public Health Act 224 " " 262 Housing Act 13 " " 3 Factories Act 0 " " 4 Pests Act 4 " " 8 Statutory Notices served:- Public Health Act 44 " " 50 Housing Act 2 " " 6 Factories Act 0 " " 0 Food & Drugs Act 0 " " 0 Hous ing 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) 237 (b) Number of inspections made for the purpose 1, 252 (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (3) 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. 9 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 265 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 2 (b) Number of dwelling-houses which were rendered fit after service of formal notices- (i) By owners 6 (ii) By Local Authority in default of owners - (2) Proceedings under Public Health Acts:- (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 44 15 (b) Number of dwelling-houses in which defects were remedied after service of formal notices (i) By owners 50 (ii) By Local Authority in default of owners - (3) Proceedings under Sections 11 and 13 of the Housihg 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 2 (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 closingorders were determined, the tenement or room having been rendered fit - In 6 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 Officerorby Housing Departments of outside districts when a Wood Green resident is an applicant 012 their Housing List. Several such visits were made by the Public Health Inspectors during the year. Housing Survey The first phase of the Council's Slum Clearance Scheme in the Winkfield/Acacia/Douglas Roads Area is well advanced. A public enquiry was held in the Old Town Hall in January when objections to the Compulsory Purchase Order covering this phase were heard by an Inspector from the Ministry of Housing & Local Government. After the enquiry, the Ministry s Inspector visited the Area and inspected the property. In May the Minister confirmed the Area with slight modification, which did not affect the Scheme materially. The building of new flats as alternative accommodation for the displaced families was already in progress, and rehousing of the people concerned was commenced as soon as accommodation became available. By the end of the year, this work of rehousing was substantially completed. Air Pollution During 1957 the Council approved in principle the establishment of a Smoke Control Area, and agreed to my suggestions for the method of its introduction, The area decided upon, after careful deliberations, was that 16 part of the Borough that lies along the western boundary. This area consists of - Dwellings 1,214 Shops 34 School buildings 3 Churches 1 Church Halls 1 Golf Clubhouses 1 Sewage works 1 Industrial 2 Libraries 1 The scheme is estimated to involve a total expenditure of approximately £8, 762. 0. 0., apportioned as follows - Council's contribution (30%) £2,628. 12. 0. Exchequer's contribution (40%) £3,504. 16. 0. Owner or occupier scontributions (30%) £2, 628. 12. 0. £8,762. 0. 0. Initial work on this Area was commenced in the latter part of the year. A detailed survey of the Area concerned includes visiting every house or property in the Area,.examining the grates and fireplaces, deciding which are capable of burning coke the extent of adaption or alteration required to those grates in regular use which are not at present capable of burning a smokeless fuel and estimating the cost of the work. This work involves much tact courtesy and enthusians for clean air on the part of the Inspectors and a thorough knowledge of domestic and industrial heating appliances flues and fuels. It also helps to promote good public relations between burgesses and members of face Town Hall staff. Plans have been made for an exhibition of the Solid Smokeless Fuels Federation to be shown In the Area in the latter part of 1958. The ready co-operation of the residents in the Area to accept the Council s programme for a Smoke Control Area is no doubt partly due to the publicity which has already been given to this important facet of Public Health, Rodent Control Two thousand three hundred and thirteen premises were inspected during the year and it was found necessary to carry out treatment in 239 of them. Two thousand two hundred and eightyone dwellinghouses were visited and of these 146 were treated for rat infestation. In addition 27 other premises were treated for the presence of rats. A further 54 dwellinghouses and 12 other premises were treated for mice The Council s tip at White Hart Lane was constantly baited with Warfarin throughout the year. Where there is suspicion or evidence that the rats are coming from defective drains or public sewers the Public Health Inspector is informed a test with the smoke testing machine applied and any necessary action taken. During the year the sewers were treated on two occasions for the control of rats For this purpose the Borough is divided into ten areas each of which has approximately 76 nonholes. The treatment is carried out by two gangs of two men each and the time occupied is just over three weeks. In this connection co operation is sought from the Borough Engineer s and Surveyor s Department, 17 Each of the manholes is baited on two occasions with unpoisoned bait, and on the third occasion poison is added to the bait. Record sheets are kept of each visit and a return made to the Ministry of Agriculture and Fisheries after each treatment. The following is a copy of the results of both treatments: - RODENT OPERATION (1) Twenty-second Maintenance Treatment Apri1/May 1957 and (2) Twenty-third Maintenance Treatment November 1957 Area Number Number of Manholes Manholes Showing Pre- bait take Complete Pre-bait take Complete Poison take Part Poison take (1) (2) (1) (2) (1) (2) 1 69 38 44 17 32 0 34 34 2 67 44 41 24 19 0 41 33 3 71 29 42 12 26 0 23 35 4 74 61 44 42 26 0 54 38 5 67 57 45 24 16 0 52 42 6 67 44 48 27 31 0 44 48 7 75 52 36 26 13 0 44 33 8 62 41 30 10 8 0 41 30 9 57 28 42 0 2 0 18 40 10 63 18 25 8 7 0 18 25 Totals 672 412 397 190 180 0 369 358 Grand Totals 809 370 0 727 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 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. 18 INSPECTION AND SUPERVISION OF FOOD (a) Food Premises in the Borough Bakers' Shops 27 Butchers' Shops 38 Cafes and Restaurants 49 Chemists' Shops 15 Confectionery and Sweet Shops 85 Dairies and Milk Shops 39 Pried Fish Shops 11 Wet Fish Shops 12 Greengrocers' Shops 45 Grocers' Shops 89 Public Houses and Off-licences 37 Food 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 Pasteurised Sterilised 16 17 36 Supplementary licences to sell milk from premises which are outside thearea of the Licensing Authority:- Tuberculin Tested Pasteurised Sterilised 11 7 11 Six 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. (c) Food and Drugs Act,1955, Section 16. There are 11 premises registered for the manufacture of Ice Cream in the district and 127 premises registered for retailing Ice Cream. During the year, 58 visits were paid to these premises and 15 samples were submitted for bacteriological examination. These 15 samples were all Grade I. Also 41 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 162. (d) Middlesex County Council Act, 1950 Section II, - Registration of Hawkers of Pood. Twenty-two hawkers of food in the Borough are registered. 19 (e) Meat and Other Foods Condemned The under-mentioned foodstuffs were certified as unfit for human consumption during the year - lbs. Tins Meat 403¼ Meat 108 Pish 188 Pish 7 Dripping 28 Vegetables 76 Fruit 225 619¼ Evaporated Milk 10 Marmalade 1 Bushels Soup 3 Shellfish 1½ Pudding 2 Tomato Juice 1 434 Miscellaneous Items Fruit 3 Condiments 1 Marmalade 1 Jam 5 Pickles 1 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 Throughout the year as in previous years, much attention has been paid to food hygiene, The Public Health Inspectors make frequent visits to food premises within the Borough, primarily to ensure the enforcement of the Food Hygiene Regulations and secondly to advise and educate food handlers in the paramount importance of food hygiene. In all 1,062 visits were made to food premises, as set out below - Dairies and Milk Shops 64 (Registered) Ice Cream Premises 58 (Registered) Stalls (Registered) 35 Butchers 150 Pried Pish Shops 38 Other Food Premises 717 Pull use has again been made of the propaganda material available, including posters from the Ministry of Health. Ministry of Agriculture, Fisheries and Food, the Central Office of Information and the Central Council for Health Education. 20 FACTORIES AND HOMEWORK I. Inspections Premises No. on Register Number of Inspections Written Notices Occupiers prosecuted FACTORIES WITHOUT mechanical power 36 15 - - FACTORIES WITH mechanical power 177 111 - - OTHER PREMISES in which Section 7 is enforced by the local authority 2 2 - - Total 215 128 - - 2. Defects Found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness - 3 - - Overcrowding - . - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary conveniences (a) insufficient - - - - - (b) unsuitable or defective 1 1 - 1 - (C) not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - 1 - - - Total 1 5 - 1 - 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 serve Prosecut ions Wearing apparel making etc. 12 - - - - - Household linen - - - - - - Lace, lace curtains and nets - - - - - - Curtains and furniture hangings - - - - - - Brass and brass articles - - - - - - Artificial Flowers 10 - - - - - Feather sorting - - - - - - Cosaques, Christmas crackers and stockings 42 - - - - - Total 64 - - - - - 21 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 2 samples were taken and sent for analysis. The results were satisfactory. Pet Animals Act, 1951 Under the Act, six 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, Hous ing 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: - 12 maisonettes at Crescent Rise 18 flats at Albert Close Council properties in course of construction at end of year: - 12 flats at Norman Close 28 maisonettes at Crescent Rise Private enterprise properties completed or in course of construction - 5. Swimming Baths The figures of attendances at Western Road and Durnsford Road Baths for the past two years are as follows:- Western Road Baths 1957 1956 Swimming Bath 81,080 69,804 -do- Children (Special sessions) 890 516 Children from Schools 23,664 27,360 Spectators 7,619 7,133 Slipper Baths 39,876 39,894 -do- Old Age Pensioners (free) 2,907 2,794 22 Durnsford Road Open Air Baths 1957 1956 Adults 23, 089 8,446 Children 41,527 25,874 Children from Schools 2,219 1,637 Season Ticket Holder 29,489 22, 298 Spectators - Adults 6,819 5,235 Children 648 626 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. Six 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 1956/57 the total tonnage of refuse collected was 13,254 tons; from this, material salvaged was sold for £1,911. The quantities of salvage were:- Tons Cwts. Qtrs. Paper 138 5 0 Mixed Scrap Iron 15 15 2 Rags 2 14 2 Non-ferrous Metals 14 0 Scrap Tyres 1 6 2 Flock Mattresses 2 17 0 Tins 138 4 2 Bottles 12 7 0 The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths. 23 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES Prom the table of infectious diseases set out on page 34, it will be seen that 1,111 cases of infectious disease were notified during the year, as against 265 in 1956. The Infectious Sickness Rate for the district was therefore 22.44 as compared with 5.29 during the previous year. As I have mentioned on previous occasions however, the Infectious Sickness Rate for any district has lost most of its significance. This rate is almost entirely governed - at least during any normal year - by the fact of the period under review being or not being a year during which measles was prevalent. It need scarcely be said that 1957 was in fact, a measles year, 876 cases being reported as against 27 during 1956, It must be frankly admitted that so far as measles notifications are concerned we merely receive these notifications and do little more, unless we are specifically asked to do so by a general practitioner or by a parent- And this it may be observed is an extremely rare occurrence. In the case of scarlet fever notifications we do of course, control the contacts of food handlers while we still carry out disinfection when and where this, is requested or required. But here again it must be appreciated that what we do now is more,or less infinitesimal compared with what we did not so very many years ago. Indeed in my submission having regard to all the circumstances, the only justification for continuing the notifi cation of the disease which we know as "scarlet fever" is the fact that, at any time the more severe type may arrive back in this country and will then require rigorous supervision The notification of "scarlet fever" seems even more illogical when it is remembered that streptococcal infection of the throat without a rash is not notifiable but is generally assumed to be more or at least equally infectious It must also be borne in mind that many cases of the present mild type of scarlet fever arenever notified at all. Indeed in quite a number of instances it would seem that the existence of the disease is never even suspected So far as the remainder of the table Is concerned it is pleasing to note that the number of cases of dysentery fell from 76 to 32, It must, however be borne in mind that the classification of "dysentery" as set out on notification forms is so wide as to have limited practical significance Cases of poliomyelitis rose very slightly from 5 to 6 a satisfactory outcome in view of the fact that poliomyelitis was reasonably widespread throughout the country during 1957. Whenever I study infectious diseases tables I am more than ever convinced that our whole system of notification should be completely overhauled. At the moment we receive notifications of diseases such as measles, where we act virtually as a post office only erysipelas which has little or no clinical import these days puerperal pyrexia which may very well be due merely to constipation or a slight cold during the puerperium malaria whose significance entirely escapes me and several, other diseases which, although admittedly infectious have extremely little communal or epidemiological significance. One must admit that 24 the collection of information is always valuable. But when the collection of this information means that other work must either be neglected or pushed aside, when the cost involved might very well be devoted to other, more important projects, it would seem that the time has come to act. And there is yet another aspect of the problem to consider. The diseases which I have just mentioned are no longer killing agents, with the possible exception of pertussis (whooping cough) in very young children, and paralytic poliomyelitis. Even here, the death rate is not at all high. Yet the death rate for such diseases as coronary thrombosis and lung cancer is steadily rising among important age groups in the population, while the aggregation of diseases commonly grouped under the term 'rheumatism' continues to take heavy toll, not perhaps of life, but of well-being and the ability to carry on a useful even abearable existence. But in none of these instances is notification required.This would surely seem a fruitful field in which the modern epidemiologist might play a truly significant part. D i phther ia For the tenth year in succession, no case of diphtheria was notified in the Borough. The last death took place approximately nineteen years ago. The remarks set out in my Annual Report for 1956 relating to immunisation apply equally today. We have now implemented the suggestions which I set out in my report for 1956, replacing immunisation against diphtheria and pertussis (whooping cough) combined immunisation - by immunisation against diphtheria and vaccination against pertussis (whooping cough) separately. It must be admitted that our new system calls for more visits to clinics or to private doctors by mothers who wish their infants protected against diphtheria and pertussis (whooping cough} as well as being vaccinated against smallpox. Although we are keeping very careful records.it is not yet possible to state the exact impact which the change-over from combined inoculations to separate inoculations has had. Our own belief, however,, is that mothers are accepting the advice given at our clinics, to the effect that a few additional visits are much more than compensated by the very full measure of protection afforded their children. In this connection, the Council will be interested to know that 85% of Wood Green children who attained the age of two years by the end of 1955, had been immunised against diphtheria. By the end of 1957,the latest figures available, this percentage had risen to 88%. It is hoped that when vaccination against poliomyelitis assumes the proportions which immunisation against diphtheriahas now reached, it will be safe to resumeonce more protection against diphtheria and pertussis (whooping cough) by the combined method. Indeed, one might even hope that a triple or even quadruple antigen will eventually be available, affording protection against diphtheria, pertussis (whooping cough) and possible tetanus, in a single series of inoculations. 25 A very careful time-table, set out below, was drawn up in 1957 to allow us to offer immunisation and vaccination to mothers at properly spaced intervals. This time-table has been working very well:- Months of age 1st No injections. 2nd Pertussis vaccine - first dose. 3rd " " - second dose. 4th No injections. 5th Smallpox vaccination. 9th Formol diphtheria toxoid (F. T.) - first dose. 10th " " " " second dose. 12th Pertussis vaccine - third dose. 5 th year Formol diphtheria toxoid (F.T.) 1st reinforcing dose. 10th year Formol diphtheria toxoid (F.T.) 2nd reinforcing dose. Scarlet Fever Twenty-two cases of scarlet fever were notified during the year, as against 17 cases in 1956 and 26 cases in 1955. It must again be stressed that the character of scarlet fever has altered materially, so much so that the disease is now mild in almost every case, no complications or sequelae having been reported. We must always bear in mind, however, the possibility of the more serious type of scarlet fever returning. To be perfectly frank, this is the sole reason which I can see for scarlet fever continuing to appear among the list of notifiable infectious diseases. In view of the extremely mild character of the cases of this disease now being met, it is no longer considered necessary to exclude contacts of scarlet fever from school. Here again, of course, this procedure would have to be amended if a different type of scarlet fever made its appearance. Pollomyelitis Pour cases of paralytic poliomyelitis and two cases of nonparalytic poliomyelitis were notified during the year,as against four paralytic cases and one non-paralytic case during 1956 - January - Boy aged 6 - non-paralytic February - Girl aged 13 - paralytic July - Boy aged 7½ - paralytic July - Boy aged 5 - paralytic July - Boy aged 2 - paralytic August - Boy aged 5 - non-paralytic In all cases a good recovery was made. As can be seen from the above list, three of the six cases reported during the year occurred in July, At the same time, four cases were reported from the adjoining part of the Borough of Southgate,thus involving a total of seven children developing poliomyelitis within a period of a few weeks in the Alexandra Bowes Ward and in the adjoining portion of Southgate. At the time, it looked as though we might be at the onset of an outbreak or even an epidemic. The strictest measures of hygiene were therefore undertaken in all the schools concerned, while a 26 most careful watch was kept on all known contacts. Fortunately, only one more case of poliomyelitis was reported from this part of the Borough, and one from the corresponding part of Southgate during the year. The most careful enquiries did not bring to light any connection between the individual cases. The Council will be aware of the programme of vaccination against poliomyelitis which continued throughout 1957. The Council will also be aware of the interruptions which have taken place in our schedule of inoculations, owing to the hold-up in vaccine which occurred early in 1958. Although this is a matter which more properly belongs to the Annual Report for 1958,it can be said that vaccine is now being made available in increasing quantities. During 1957 approximately 1,080 Wood Green children were given two injections of poliomyelitis vaccine. At the end of the year some 280 children had received a first injection and should have been given their second injection during the early months of 1958, No American vaccine was officially available in this country during 1957. It will be appreciated that this figure must be approximate, as we have very limited information relating to children who attend boarding schools outside Wood Green who received their inoculations in other parts of the country. It is also much too soon to estimate the effect which the programme of vaccinations will have on the incidence of poliomyelitis; or, indeed, whether a third inoculation will still be required. This is a matter which must rest with the future although we are all sanguine of the benefits which we hope will accrue. Measles As noted elsewhere, 876 cases of measles were notified during the year,, as against 27 cases in 1956. These facts indicate that 1957 was a "measles year". Once again, the disease itself was mild in the extreme, only 17 cases requiring to be admitted to hospital. Pertussis (Whooping Cough) Ninety-five cases of pertussis (whooping cough) were noti fied during the year, as against 37 in 1956. As noted elsewhere, we are continuing our policy of offering immunisation against pertussis (whooping cough). Again, as noted elsewhere, these injections are being given quite apart from immunisation against diphtheria. As pertussis (whooping cough) is most serious during the first six months of life, our programme is aimed at protecting children as soon as practicable after birth, having due regard to the need for vaccination against smallpox during the same period. Food Poisoning(including Sonne Dysentery) One might almost say that the figures relating to the incidence of food poisoning (including sonne dysentery) reported in the Borough over the past few years indicate that this type of infection can now be regarded as virtually endemic in the resident population. Having regard to the increasing number of food 27 poisoning outbreaks which are being recorded each year throughout the country,even when the much more accurate system of recording is taken into account, it must be realised that the commoner organisms which cause food poisoning, especially the salmonella group seem to have established themselves throughout the population, especially the urban population of these Islands. Fortunately we can at least say that the simpler non-fatal form of foodpoisoning has now taken the place of such diseases of the gastrointestinal tract as cholera and the enteric fever group.In other words, killing diseases which formerly swept the population in vast, over-whelming waves, have now been replaced by comparatively mild attacks of food poisoning caused by germs apparently introduced within recent years to this country. This, of course, is highly satisfactory when the picture less than 100 years ago in regard to such diseases as cholera and typhoid fever is placed against the food poisoning and dysentery situation as we know it today But this is only part of the story. So long as outbreaks or even individual cases of food poisoning are occurring so long must it be recognised that these attacks are neither haphazard nor the result of some unfortunate coincidence- Food poisoning is the logical result of faulty methods in the preparation handling selling and cooking of food The fact that the number of outbreaks of food poisoning, however small these outbreaks may be which are reported each year from England and Wales is very much higher than medical officers would like to see continues to give rise to concern. As I have just said, it means that conditions are being allowed to exist which act to the prejudice of the public and which place the health and sometimes even th® life of our people in jeopardy.lt would be dangerous to argue that food poisoning today is mild, that drastic action is not required that an illness seldom lasting more than a few days need cause no one much concern That is surely a policy of stark despair. This country which has a history second to none in the realm of promoting health should not rest on its laurels until our reputation in the world of food hygiene has been completely re-established. In Wood Green, with our limited number of Public Health Inspectors, all of whom have many other duties to perform we do our best by periodic visits, selected inspections advice and guidance and, where necessary, legal action to improve the standard of food hygiene in food premises operating within the Borough. This is a never-ending task as it must be admitted that we are still far from approaching that ideal which au of us so fervently desire The Public Health Department also takes as many opportunities as possible to address local organisations on the matter of clean food what part the housewlft? can play in this great effort what attitude the ordinary ratepayer should adopt It is impossible to say what impact these talks very often accompanied by one or more sound films have But it is hoped that the cumulative effect will eventually be felt I am very happy to be able to report that during 1957 1 was invited by the Secretary of the Northern Hospital Group to visit the kitchens at the Wood Green & Southgate Hospital. Such visits are of the greatest importance, establishing that cordial 28 ship which is so essential between the Public Health Services and local hospitals. It also gives the Medical Officer of Health the opportunity of seeing at first-hand conditions which prevail in hospital kitchens and, when invited to do so, to make suggestions. In all, five cases of food poisoning and 32 cases of dysentery were reported in 1957, as against 18 and 76 respectively during the previous year, I must again stress that these figures are of very little value except for purposes of comparison, as we know that many cases of food poisoning and dysentery never come to our notice. Many of the cases of dysentery reported occurred among Boy Scouts using Scout Park as a transit camp. On the 6th August we were informed that a Swiss boy had been admitted to hospital suffering from diarrhoea. Within the next forty-eight hours a further nine boys were admitted to Coppetts Wood Hospital. Laboratory examinations showed these boys to be suffering from sonne dysentery. Faece specimens were immediately taken from all the remaining boys in the Swiss troop. Ten of these specimens were reported positive As a result seven more boys were treated in hospital. Arrangements were made to visit the Camp at least once daily in order to issue the necessary advice and to supervise the hygiene, with particular emphasis on hand-washing. A plentiful supply of disinfectant was provided All the boys in the troop were also given treatment designed to destroy the organisms which they might be presumed to be carrying The entire troop including those boys and young men who had been treated in hospital and who had made a rapid and complete recovery were allowed to leave on the 13th August. I wrote to the Medical Officer of the Swiss Canton in which the boys resided, supplying full details of what had happened and what had been done. I subsequently received a courteous reply thanking us for our attention and for the information contained in my letter. Paratyphoid Fever No cases of paratyphoid were reported in 1957, Puerperal Pyrexia Two cases of puerperal pyrexia were notified during the year. Both cases made an uneventful recovery. Small pox No case of smallpox occurred during 1957. The year 1957, however, did see the occurrence of three cases of smallpox in the neighbouring Borough of Tottenham, This produced 28 Wood Green contacts, none of them fortunately, close contacts of the Tottenham cases. It was,however, necessary to keep these contacts under the closest surveillance and to ensure that should ®. case arise the necessary steps to prevent spread of the disease could be taken without delay It was also necessary to request the services of the smallpox consultant for the Area on one occasion. I would take the opportunity here of expressing my sincere thanks to the Public Health Inspectors, who did a great deal of 29 useful work during this period in tracing contacts and keeping a watch on the houses from which contacts had been reported. The occurrence of definite contacts of a disease such as smallpox requires urgent and immediate attention. Nothing can be left to chance.no gaps must be left in our defences. Fortunately, as I have already stated - and this was very largely due to the excellent way in which the limited outbreak in Tottenham was handled - the smallpox interlude passed without incident. During this period we persuaded 79 persons, either definite contacts or members of households in which contacts were living, to be vaccinated. The incidence of the Tottenham smallpox cases shows all too clearly that the risk of smallpox is still with us. When one remembers that the state of vaccination in Great Britain as a whole is anything but satisfactory, the danger will be more clearly appreciated. It is not so many years ago that the percentage of infants being vaccinated in Word Green was less than 10. By the end of 1955, we knew that over 54% of Wood Green children reaching the age of 2 years were protected against smallpox by vaccination. By the end of 1957 this figure had risen to the level of 65%. This is, of course, almost entirely due to the constant advice given to parents attending our clinics hy our Assistant Medical Officers and Health Visitors, who by their efforts and by their persuasion have encouraged mothers to take the fullest advantage of the vaccination facilities now provided at all our clinics. Tuberculosis Forty-seven cases of tuberculosis (40 pulmonary and 7 nonpulmonaiy) were notified during the year, as against 63 in 1956. Of the 47 cases, 22 were transferred fronf other districts, 25 being new cases. A broad classification of the cases notified during the past five years in relation to employment was - 1953 1954 1955 1956 1957 Clerical 12 16 12 5 4 Manual Labour 23 14 17 7 3 Housewives 11 20 8 3 3 Factory Workers 4 7 - 5 3 Children 4 5 5 5 1 Professional classes 4 1 2 3 3 Domestic Service - - 2 - 1 Nurses - - 1 - - Shop Assistants 2 8 4 1 2 Armed Forces - - 2 - - Retired Persons 3 2 2 2 - Unclassified 8 8 1 6 5 71 81 56 37 25 30 The number of cases on the register at the end of the year was as follows: - Pulmonary - 315 males Non-pulmonary - 13 males 251 females 41 females Total 566 54 It must again be stressed that the totals which make up the tables set out above are not sufficiently large to warrant any significent conclusions being drawn. The figures merely allow us to keep an eye on trends,so that we can take any action or suggest any action which might be considered necessary. The scheme for the B.C. G. vaccination of children in the 13 age group, referred to in my Annual Report for 1956, is making excellent progress. This work is, of course, carried out by Middlesex County Council staff, as part of the school health services provided by the local health authority in Wood Green. No difficulties have been encountered in administering or in carrying out the B.C.G. scheme, which undoubtedly marks a very definite step in the protection of our susceptible adolescents against tuberculosis. Mass Radiography Unit 6A did not visit Wood Green during 1957. Arrangements have however, been made for the Unit to visit the Borough- during the early Autumn of 1958. DISINFECTION AND D J S FESTATI ON The number of articles dealt with at the Disinfection Station was as follows - Articles disinfected 145 Articles destroyed 65 20 rooms were disinfected on account of infectious disease. 15 premises were disinfested on account of the presence of vermin, which involved the disinfestation of 38 rooms, 45 premises were treated for infestations of cockroaches, wasps, ants, flies, bluebottles, fleas, beetles, bees and moths. 95 library books were brought to the Department during the year for disinfection. 31 32 APPENDIX 1 TABLE 1 Vital Statistics of Wood Green: 1937-57 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) 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, 700 624 11.8 25 21 34 2 83 594 11.7 a nd 50, 700 1940 46,230 605 13.1 42 23 39 3 71 737 15.9 3 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 1957 49, 500 655 13.2 28 11 16.8 1 35.7 585 9.6 33 INFECTIOUS DISEASESTOV^HE PAST 25 YEARS Year Diphtheria Scarlet Fever Enteric Fever Pulmonary Tuberculosis Nonpulmonary Tuberculosis Measles Pertussis Poliomyelitis /N *D /N *D /N *D /N *D /N *D /N *D /N *D /N *D 1933 24 1 192 - - - 57 26 9 6 - 1 1 - 1934 31 3 292 1 - 56 32 12 3 1 2 1 - 1935 39 4 201 1 4 - 47 23 5 1 - - 1 - 1936 99 12 98 - 5 - 51 46 8 5 2 2 2 - 1937 46 3 72 1 2 - 49 24 8 2 1 5 2 - 1938 63 2 92 - 1 - 59 21 10 7 3 - 1 - 1939 24 1 63 - - 45 26 6 2 - 1 2 - 1940 26 - 61 - 7 . 55 22 10 4 89 - 24 2 - - 1941 42 - 51 - 2 - 57 26 7 4 401 2 192 1 1 - 1942 22 - 87 - - - 69 30 4 4 361 2 95 1 1 - 1943 26 - 155 - - - 43 22 3 3 356 - 106 1 - - 1944 9 - 51 - - . 44 20 5 4 232 - 134 1 1 - 1945 2 - 62 - 2 - 56 27 7 4 172 - 117 - 2 - 1946 7 - 73 - 1 - 76 22 10 3 346 - 89 - - 1 1947 10 - 46 - - - 52 17 10 5 410 2 171 - 2 - 1948 - - 69 - . - 65 21 9 5 408 - 174 - 5 1 1949 - - 71 - 2 - 68 19 9 - 678 - 46 - 6 1 1950 - - 99 - 1 57 10 6 2 421 - 376 1 4 - 1951 - - 196 - 1 - 50 13 5 2 434 - 127 1 1 - 1952 - - 93 - - - 36 5 4 1 449 - 89 - 3 - 1953 - - 66 - - - 64 5 7 2 778 - 202 - 6 2 1954 - - 61 - - - 73 6 8 1 29 - 80 - 1 - 1955 - 26 - - - 51 6 5 1 635 - 28 1 4 - 1956 - - 17 - - - 30 1 7 1 27 - 37 - 5 - 1957 - - 22 - - - 26 6 5 1 876 - 95 - 6 - /N Notifications *D - Deaths 34 TABLE Infectious Diseases Notified during the year 1957 Notifiable Disease Cases Notified in Whole Borough Total Cases Notified in each Ward Total Cases removed to Hospital or Sanatorium Total Deaths Ail Ages At Ages - Years Under 1 year 1 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years 20 to 25 years 25 to 35 years 35 to 45 years 45 to 55 years 55 to 65 years 65 and upwards Alexandra Bowes Town Hall Noel Park Scarlet Fever 22 - 6 14 2 - - - - - - - 10 4 8 9 - Diphtheria - - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - - - Para-typhoid Fever . - - - - - - - - - - - - - - - - Erysipelas 2 - - - - - - - 1 - - 1 1 - 1 - - Pneumonia 39 1 2 2 - 1 - 1 3 9 11 9 16 5 18 24 26 Acute Poliomyelitis 6 - 1 3 1 - - - 1 - - 3 - 3 6 - Polio-Encephalitis - - - - - - - - - - - - - - Puerperal Pyrexia 2 - - - - _ - 2 - - - - - - 2 - - Pulm Tuberculosis , 26 - 1 - - 5 3 3 5 6 3 - 9 7 10 26 6 Non-Pulm. Tuberculosis 5 - 1 - - - - 1 2 1 - - - 2 3 6 1 Malaria - - - - - - - - - - - - - - - - - Chickenpox 1 - - - - - 1 - - - - - 1 - - 1 - Measles 876 16 345 493 14 3 1 1 3 - - - 218 277 381 17 - Whooping Cough 95 10 39 43 3 - - - - - - - 33 34 28 6 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - Dysentery 32 - 1 4 14 5 1 - 4 2 1 - 23 5 4 21 - Food Pois ning 5 - - - - - 1 - 2 1 - 1 2 1 2 - - Totals 1 111 27 396 559 34 14 7 8 21 19 15 11 316 335 460 116 33 TABLE IV Causes of death during the year 1957 Causes of Death Male Female Tuberculosis, respiratory 4 2 Tuberculosis, other 1 - Syphilitic disease - - Diphtheria - - Whooping Cough - - Meningococcal infections - - Acute Poliomyelitis - - Measles - - Other infective and parasitic diseases - 2 Malignant neoplasm, stomach 8 4 Malignant neoplasm, lung, bronchus 24 1 Malignant neoplasm, uterus - 2 Malignant neoplasm, breast - 8 Other malignant and lymphatic neoplasms 34 26 Leukaemia, aleukaemia 4 2 Diabetes - 1 Vascular lesions of nervous system 21 39 Coronary disease- angina 55 33 Hypertension with heart disease 4 5 Other heart diseases 22 37 Other circulatory disease 11 10 Influenza 2 - Pneumonia 17 9 Bronchitis 21 7 Other diseases of respiratory system 2 1 Ulcer of stomach and duodenum 4 - Gastritis enteritis and diarrhoea - 1 Nephritis and nephrosis 3 3 Hyperplasia of prostate 3 - Pregnancy, childbirth, abortion - - Congenital malformations 4 1 Other defined and ill-defined diseases 19 13 Motor vehicle accidents.. 3 2 All other accidents 1 6 Suicide 1 2 Homicide and operations of war - - Totals 268 217 35 TABLE IVA Ma 1 es 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 4 - - - - - - - 1 1 _ 2 Tuberculosis, other 1 - 1 - - - - - - - - - Syphilitic disease - - - - - - - - - - - - Dyphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal Infections - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasm stomach 8 - - - - - - 1 2 1 2 2 Malignant neoplasm lung, bronchus 24 - - - - - - 2 4 4 11 3 Malignant neoplasm breast - - - - - - - - - - - - Other malignant and lymphatic neoplasms 34 - - - - 1 1 - 2 7 11 12 Leukaemia aleukaemia . 4 - - - - - - - - 1 2 1 Diabetes - - - - - - - - - - - - Vascular lesions of nervous system 21 - - - - - - 1 3 5 6 6 Coronary disease angina 55 - - - - - - 1 8 5 20 21 Hypertension with heart disease 4 - - - - 1 - - - - 2 1 Other heart diseases 22 1 - - - 1 - - 3 2 10 5 Other circulatory disease 11 - - - - - - - 1 4 4 2 Influenza 2 - - - - - - - 1 - - 1 Pneumonia 17 - - - - - - 1 1 8 7 Bronchitis 21 1 1 - - - - 1 - 8 4 6 Other disease of respiratory system 2 - - - - - - - - 1 - 1 Ulcer of stomach and duodenum 4 - - - - - - 1 - - 2 1 Gastritis Enteritis and Diarrhoea - - - - - - - - - - - - Nephritis and nephrosis - - - - - - - - - 2 - 1 Hyperplasia of prostate 3 - - - - - - - - - 1 2 Totals carried forward 237 2 2 - - 3 1 7 26 42 83 74 36 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 237 2 2 - - 3 1 7 26 42 83 74 Congenital malformations 4 3 1 - - - - - - - - - Other defined and illdefined diseases 19 3 - - - - - - 4 3 4 5 Motor vehicle accidents 3 - - - 1 - - - 1 - 1 All other accidents 1 - - - - - - - 1 - - - Suicide 1 - - - - - - 1 - - - Homicide and operations of war - - - - - - - - - - - - Totals 265 8 3 - - 4 1 7 32 46 87 80 37 TABLE IVB Females Causes cf Death All Ages Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis, respiratory 2 - - - - - - 2 - - - - Tuberculosis, other - - - - - - - - - - - - SSyphilitic disease - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases 2 - - - - - - 1 1 - - - Malignant neoplasm, stomach 4 - - - - - - - - 2 1 1 Malignant neoplasm lung bronchus 1 - - - - - - - - - 1 - Malignant neoplasm breast 8 - - - - - - - 1 2 4 1 Malignant neoplasm uterus 2 - - - - - - - - 2 - Other malignant and lymphatic neoplasms 26 - - - - - - - 5 3 8 10 Leukaemia aieukaemia 2 - - - - - - - - - 1 1 Diabetes 1 - - - - - - - - 1 - Vascular lesions of nervous system 39 - - - - - - - 3 5 15 16 Coronary disease angina 33 - - - - - - - - 2 10 21 Hypertension with heart disease 5 - - - - - - - - - - 5 Other heart diseases .. 37 - - - - - - - 2 6 10 19 Other circulatory disease 10 - - - - - - - - 3 2 5 Influenza - - - - - - - - - - - - Pneumonia 9 - - - 1 - 1 - - 2 - 5 Bronchitis 7 - - - - - - - - 1 2 4 Other disease of resplr' atory system 1 - - - - - - - - - - 1 Ulcer of stomach and duodenum - - - - - - - - - - - - Gastritis, Enteritis and Diarrhoea 1 - - - - - - - - - - 1 Nephritis and nephrosis 3 - - - - - - - - 2 - 1 Totals carried forward 193 - - - 1 - - 3 12 26 57 91 38 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 193 - - - 1 - 1 3 12 28 57 91 Pregnancy, Childbirth Abortion - - - - - - - - - - - - Congenital malformations 1 1 - - - - - - - - - - Other defined and illdefined diseases 13 2 - - - - - 2 1 1 4 3 Motor vehicle accidents 2 - - - - - 1 - - 1 - - All other accidents 6 - - - - - - - - - 2 4 Suicide 2 - - - - - - - 2 - - - Homicide and operations of war - - - - - - - - - - - - Totals .. .. 217 3 - 1 - 2 5 15 30 63 98 39 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary NonPulmonary Total M. F. M. F. No. of cases on Register at end of 1956 308 247 12 40 607 New cases notified during 1957 12 8 2 3 25 Transfers from other Districts 12 8 1 1 22 No. of cases removed from Register 17 12 2 3 34 No. of cases on Register at end of 1957 315 251 13 41 620 New Cases and Mortality during 1957 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 - - - 1 - - 1 - 5 - - - - - - - - 15 5 5 - - - - - - 25 6 5 1 - - - - - 35 4 4 1 2 - 2 - - 45 6 2 1 - 1 - - - 55 2 - - 1 1 - - - 65 and upwards 1 - - - 2 - - - Totals 24 16 3 4 4 2 1 - Above includes transfers (22) from other districts. 40 APPENDIX 2 Miscellaneous (a) Letters to Doctors Letters on the following subjects were circulated to Wood Green practitioners during 1957, some being sent under my 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 extremely difficult to divide one1 s responsibility in such a vital matter as that of health, I have included all the topics covered; - February - Notification to all doctors of two cases of poliomyelitis. Suspension of combined immunisation against diphtheria and pertussis. Resumption of combined method of immunisation. March - Supplies of Antitoxins and Antigens. Regulations as to Infectious Diseases (revised 1957). April - Collection of Specimens during Holiday Periods. Case of ? Poliomyelitis. June - Influenza. Smallpox. July - Poliomyelitis and Smallpox. Poliomyelitis cases in Wood Green and Southgate. Notification of Poliomyelitis cases. August - Asian ' Flu. Diagnosis of Asian ' Flu and specimens. September - Asian ' Flu. October - Asian Flu Epidemic. November - Collection of Laboratory Specimens during Christmas. The remarks set out in my Annual Report for 1956 relating to the value of close co-operation with general practitioners holds as firmly today as it did then, I am still veiy happy to think that the relationship of the Public Health Department with the family doctor is close and cordial, and that this cordial bond is playing a truly significant part in maintaining the health of the district. (b) Medical Examinations During the year 52 medical examinations were carried out. Nine of these were in respect of entrants to the Council s employ for acceptance into the Superannuation Scheme, 20 in respect of workmen already in the Council's employ for acceptance into the Superannuation Scheme and 23 in respect of workmen for acceptance into the Sickness Pay Scheme. In addition, 37 medical reports were issued relating to employees absent from duty through sickness. (c)Additional Reports to Public Health Committee May - Congress of the Royal Society of Health, 30th April to 3rd May. Statement on the Implementation of the Clean Air Act in Middlesex - Smoke Control Areas. 41 APPENDIX 3 Legal Proceedings during 1957 Statutory nuisance. Public Health Order to abate nuisance - Act, 1936 - Mayes Road Costs £3. 3. 0. Statutory nuisance, Public Health Work completed - Costs Act, 1936 - Commerce Road £1. 1. 0, Statutory nuisance,, Public Health Work completed - Costs Act, 1936 - Clarence Road £1. 1. 0. Statutory nuisance. Public Health Work completed - Costs Act, 1936 - Dagmar Road £1. 1. 0. Statutory nuisance Public Health Order to abate nuisance- Act, 1936 - Bounds Green Road Costs £1. 1. 0. Statutory nuisance, Public Health Order to abate nuisance- Act, 1936 - Parkhurst Road Costs £5. 5. 0, 42 Printed and Published by Wood Green Borough Council Town Hall N 22