Library BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1958 WM. CLUNIE HARVEY, m.d„ d.p.h. Medical Officer of Health. WOOD 40 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1958 WM. CLUNIE HARVEY, m.d.dp.h Medical Officer of Health. Public Health Department, Town Hall, Wood Green N.22. July, 1959. To THE MAYOR, ALDERMEN and COUNCILLORS Of the BOROUGH OF WOOD GREEN, Mr. Major, Ladies and Gentlemen, I beg to present the Annual Report of 1958, The year 1958 was a placid year Indeed I did not find it necessary to report any untoward occurrences to the Health and Cleansing Committee during the year. The vital statistics for the year are satisfactory The birth rate fell slightly, from 13.2 to 12.9; while the death rate rose from 9.6 to 11.3. The infant death rate, i.e. the number of deaths of infants under one year of age per thousand live births rose from 16.8 to 236 This rise may seem large but has little. significance bearing in mind the comparatively small figures involved These matters will be referred to in greater detail in the body of the Report. So far as infectious diseases were concerned the total number dropped from 1.111 to 651. This of course was very largely due to the marked decline in measles notifications, from 876 to 421 Infectious diseases will also be dealt with in greater detail in the appropriate section of the Report. During 1958 preparations were going on apace to deal with two important aspects of the work of the Public Health Department In the first instance there was the preparation for the two public enquiries which have taken place this year in relation to the clearance areas in Edith Road and the Winkfield Road/Acacia Road areas The second task was the preparatory work which had to be covered before action could be taken to prepare the way for the Wood Green Smoke Control Area No. 1. Although it may be said that these undertakings more properly come into the Report for 1959 much of the work was carried out in 1958 in readiness for action to be taken when appropriate. On January the 18th, 1958, the Health Department moved from its old address at White Hart Lane Old School,where it had been lodged for a number of years, to the more commodious accommodation available in the new Town Hall. The transfer of offices was very smoothly and speedily executed without any untoward disturbance or inconvenience to the public, Needless to say the change to modern well-planned premises, in the same building as the other departments which carry out the work of the Borough Council, was and still is very much appreciated. 3 The value of the liaison which I have been able to develop between my duties as Medical Officer of Health of Wood Green and Area Medical Officer, Area No. 2. County of Middlesex was maintained, indeed intensified during 1958. It would be quite impossible in a Report such as this to elaborate the many ways in which these links have been forged One might, however, mention two specific instances. The closest and most harmonious co-operation has been maintained between the Public Health Department andtheArea Health Office in the important matter of propaganda for vaccination against poliomyelitis. This has proved of quite inestimable value, and has undoubtedly been an extremely potent factor in establishing the fact that the vaccination against polio rate for Wood Green children was shown to be amongst the highest in the county. Although the vaccination rate as applied to the 15-26 age group is not as high as the rate for the younger age groups, it would still appear that the Wood Green rate is at least as high, if not appreciably higher, than that returned by the country as a whole. Here again, the co-operation received from the Borough Council has been in no small measure responsible for this happy result. I wauld again mention the constant interchange of information and views which takes place almost daily between the two Departments under my control. This interchange is, of course, relatively easy, as I am both Medical Officer of Health and Area Medical Officer. But it is a very great pleasure to me to be able to report that the staffs of both Departments work in the closest harmony. Altogether, the part which isbeing played by the Borough Council in promoting the personal health services of the burgesses of Wood Green is by no means inconsiderable. And that is almost certainly an understatement. The work of health education has been carried on throughout the Borough during the year along the lines followed in previous years. A number of talks have been given to local organisations articles have been accepted by the local press and the magazine "Better Health" continues to circulate. Advantage was taken of the Wood Green Carnival to press home the importance of an all-out campaign against flies, and to publicise the current visit of Mass Radiography Unit 6A to the district. More and more emphasis is being placed, and very rightly placed, each year on the risks which accompany the increasing use of radio active materials. It must certainly be admitted that Wood Green isnot a district in which radio-activity is likely to present itself as a serious hazard. None the less, the position remains unsatisfactory. I am personally convinced that at least a proportion of the Public Health staff should be made fully aware, not only of any sources of radio-active waste or fission products which exist within the Borough or in the vicinity; but should also have adequate training in the measures which would have to be taken in an emergency. Neither of these essential safeguards has yet been provided We are certainly told that the most careful watch is being kept hy the Medical Research Council, and that we will at once be informed if and when the general level of radio-activity approaches the danger point. This, of course, is a statement 4 which one would not attempt to contradict. Nevertheless, I still feel that the Public Health Department should be in possession of the fullest possible information, and that responsible members of the staff should know exactly what they have to do should a sudden emergency arise. On numerous occasions I have mentioned the fact that accidents in the home and on the roads now represent a very much more serious problem than do all the known infectious diseases considered together. Accidents on the road do not, of course, fall within the province of the Public Health Department, But we are interested extremely interested in studying and in taking steps to prevent accidents in the home. It is not so long ago, for instance, that a special Home Safety Handbook was published, a handbook which we have found of the greatest use throughout the Borough I have prepared special articles for insertion in the local press while we continually display posters and have leaflets available in our clinics, in the Public Health Department and in the Area Health Office Members of the staff of the Public Health Department and Area Health Office have co-operated in giving talks on the value of home safety especially to mothers with young children and to old people. In this latter connection, an invitation was extended to all Old People s Clubs in Wood Green, offering to send a Health Visitor to one of their meetings, so that the great value of noninflammable clothing materials could be demonstrated We have also co-operated with the hospitals serving Wood Green in this field, The hospitals arenow sending me a list of accidents admitted from the Borough, due especially to burns and scalds. We are thus in a position to visit the homes from which cases come - most of them of course are young children or old persons - and to see whether there is any way in which we can prevent a repetition of the accident which occurred. Altogether, Home Safety is a very good example of the way in which health education can be combined between the Public Health Department and the Area Health Office, i.e. be tween the Borough Council and the County Council, Accidents in the home represent a menace about which we must never be complacent. It is surely illogical that we should be spending millions of pounds and using a large number of staff to deal with the question of vaccination against poliomyelitis, immunisation against diphtheria and vaccination against smallpox, all three of which diseases do not account for more than a few hundred deaths every year throughout the country: yet, although there are many thousands of deaths annually from accidents in the home not to mention the countless number of non-fatal injuries, we still seem to accept this fact as more or less inevitable. I would conclude by thanking the Health and Cleansing Committee and the Borough Council for their sustained support and encouragement, which means a great deal to a medical officer of health and to apublic health department as a whole. I would also express my sincere thanks to the staff of the Public Health Department. I would Bake particular reference once again to the able assistance and devotion to duty rendered by my Deputy, Dr. J.R. Campbell, Mr. McCauley,Chief Public Health Inspector, and Mr. P. V. Ingrain, 5 ray Chief Clerk. I am very glad to think,however,that every member of my Department has given generously of his or her service throughcut the year, I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health, 6 BOROUGH OF WOOD GREEN HEALTH AND CLEANSING COMMITTEE Councillor L.A. VITORIA (Chairman) Councillor MRS. L.A. ANGELL (Yice-Chairman) The Mayor Councillor C. W. BUCKBY, J.P Councillor C. D. MOSS Alderman J. W. BARNETT Councillor E. C. HALE Councillor G. CATHLE3S Councillor E. E. NICE STAFF *Medical Officer of Health - WILLIAM CLONIE HARVEY- M. D D.P.H. Deputy Medical Officer of Health - JANET RUSSELL 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 Fbod 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. O'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. 7 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,606 Population - estimate supplied by the Registrar General 49,100 Number of inhabited houses (end of 1957) according to Rate Books 14,617 Rateable Value 1958) £813,668 Sum represented by a penny rate (estimated) £3,302 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Total M F Live Births - Legitimate 598 321 277 Birth Rate per 1,000 12.9 Illegitimate 37 23 14 Still Births 13 7 6 Rate per 1,000 Births 20.5 Deaths 573 288 285 Death Rate per 1,000 11.3 Deaths from Puerperal causes 1 Rate per 1,000 Births 1.57 Deaths of infants under one year of age:- All infants 15 Rate per 1,000 live births 23.62 Legitimate 14 Rate per 1,000 legitimate live births 23.41 Illegitimate 1 Rate per 1,000 illegitimate live births 27.09 Deaths from:- Tuberculosis 4 Cancer (all ages) 129 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) - Number of Births notified 635 Number of Births registered in the Borough 143 POPULATION The mid year estimate of the population supplied by the Registrar General is 49 100 a decrease of 400 from that of the previous year BIRTHS The number of live births registered during the year was 635, which gives a crude birth rate of 12.9 per 1,000 of population, the corrected birth rate being the same figure The rate for 1957 was 13.2. There were 13 still-births, giving a stillbirth rate of 20.5 per 1.000 births In 1957 the still-birth rate was 16.79. 8 DEATHS The number of deaths credited to Wood Green after the necessary adjustments have been made for outward and inward transfers was 573 giving a crude death rate of 11.3 per thousand of population and a corrected death rate of 11.7. The Total number of deaths for the previous year was 485, when the death rate was 9.6. Of the total of 573 no fewer than 395 occurred at ages over 65, while 135 deaths occurred at ages of 80 and over and ten a,t ages over 90. Prom the table which sets out the causes of death during 1958 (page 36) it will be seen that deaths due to diseases of the heart and circulation made up slightly more than 50%ofthe total deaths recorded during the year. This repeats the findings of the past few years. The continued appearance in our mortality statistics of deaths from coronary occlusion together with other diseases of the heart and circulation, especially among males during what should be the prime of life, is most disturbing. Various reasons have been advanced to explain these catastrophes, although no single explanation would seem to meet the case. The increasing stress and strain of modern life together with errors of diet have both been accused, althouth there may very well be some other factor or factors which have not yet come to light. Whatever the cause, this is obviously a matter which calls for the most pro found study. For the same reason the increase in deaths from cancer of the lung provides another avenue which should be explored, must be explored as a matter of urgency. Although one cannot say that there are any specific factors peculiar to Wood Green which encourage coronary thrombosis or lung cancer, it is clearly evident that health education has an important part to play in providing the necessary advice and guidance, at least along general lines. INQUESTS Thirty three inquests were held following the deaths of Wood Green residents diring 1958. A further 150 post mortem examinations were carried out without an inquest, 62 of these in the Prince of Wales Hospital which, by arrangement with the Wood Green Borough Council, provides mortuary services. MATERNAL MORTALITY One death was reported under this heading as the result of self-induced abortion. INFANT MORTALITY There were 15 deaths of infants under one year of age, giving an infant mortality rate of 23.62 per thousand live births. This is an increase over 1957 when the number of infant deaths was 11 which gave an infant mortality rate of 16.8. Of the 15 infant deaths six occurred within the first twenty-four hours, nine during the first week and 11 during the first four weeks of life. The corresponding total figure for these three groups in 1957 was 9 also 11. Although it would be wrong to say that the death of any infant cannot be prevented it is a known fact that deaths up to the age of one month depend upon a variety of dVcumstances, many of which are at the moment, almost outwith our control. A great deal of work is being done in trying to reduce neo-natal mortality, and we all look forward to the day when the neo-natal mortality rate will have dropped as sensationally as the death rate of infants during the latter eleven months of their first year. Meantime,, every infant death continues to be very carefully scrutinised in an effort to discover any factor or factors which might have contributed to the tragic fatality. STILL-BIRTHS As with infant, mortality, a great deal of work is being carried on throughout the country, in an endeavour to itemise the various causes which lead to still-birth and to remove those factors which contribute. Although many still births cannot under present circumstances be prevented we are none the less certain that the still birth rate can and should be materially reduced. The Following table shows 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 mths. 6 mths. and under 9 mths. 9 mths and under 12 mths Total deaths under one yr. Prematurity 4 - - - 4 - - - - 4 Congenital Defects 3 - - - 3 - - - - 3 Atelectasis - - - - - - - - - - Gastro enteritis - - - - - - - - - - Intra- cranial Haemorrhage - - - - - - - - - - Capillary Bronchitis - - - - . - - - - - Asphyxia - - - - - 1 - - 1 Broncho-pneumonia 1 - 1 - 2 - - - - 2 Other Causes 1 - - 1 2 1 - 1 1 5 Total 9 - 1 1 11 1 1 1 1 15 10 GENERAL PROVISION OF HEALTH SERVICES Hospitals The remarks contained in my Annual Report for 1957 relating to the provision of health services remain substantially unaltered, although, on the whole, the position is more satisfactory. Thus, very little difficulty has been encountered in the admission of maternity cases to hospital, either on social or cm medical grounds. The admission of infectious diseases cases, either to Coppetts Wood or St. Ann's Hospital, together with the admission of acute medical or surgical cases to general hospitals, also presented no real problems. Unfortunately, the obstacles in the way of the admission of the type of cases commonly known as the "elderly chronic sick" have not been duly overcome. While the admission of elderly patients to the North Middlesex Hospital and Chase Farm Hospital, Enfield, has been somewhat easier we still look forward to the setting up of a true geriatric service at the North Middlesex Hospital, a service which will undoubtedly be of the greatest value to the Borough of Wood Green. I never fail to raise our needs at the various Committees to which I have the privilege of belonging. As I have said so often before, Wood Green is in an unfortunate position. The difficulty lies in the fact that the North Middlesex Hospital and Chase Farm Hospital, Enfield. cover a very much wider area than does the Borough of Wood Green. In short there is no hospital to which general practitioners in Wood Green can apply knowing that that hospital is concerned purely with the elderly population of the Borough. I would once again say, however, that the position has eased, and that the establishment of a geriatric service at our largest hospital, the North Middlesex Hospital, will ease the position still further. The whole subject of geriatrics should not, of course, be confined to the admission of the elderly chronic sick to hospital. Much more can and should be done in this most important field. For instance, all possible steps should be taken to ensure that the health of our old people is maintained at the highest practicable level, so that admission to hospital can at least be postponed. Here, the setting up of geriatric clinics may prove the answer. At the moment, this lies within the province of the County Council, which is very carefully watching the situation, so that action can be taken as and when this action seems to be required. Much work can also be done in the rehabilitation of elderly persons admitted to hospital. The aim should surely be to return these patients to their homes in such a condition that they are able to fend for themselves and cease to become what is very often an intolerable burden on the authorities. I would also mention the important part which our Home Helps and Home Nurses are playing. In this connection, Area No. 2 recently set up a Night Home Help Service. This Service is designed to provide a Home Help who will sit up with a seriously ill elderly person, and thus give relatives who are almost exhausted, the opportunity of well-earned rest. This Service was very widely publicised and is already being used almost to the maximum. 11 Care of the Aged In September of this year, Mr. Stately was appointed as fulltime Secretary of the Wood Green Old People's Welfare Committee. This is certainly a step forward, and I am pleased to say that the very closest liaison exists between my Department and the work carried out by the Secretary of the Old People's Welfare Committee As Medical Officer of Health I cannot speak too highly of the work of the Wood Green Old People's Welfare Committee. which is doing a great deal to provide amenities and services which cannot be provided by a statutory authority. As Medical Officer of Health and Area Medical Officer I endeavour, in every way possible to link the statutory services of which I am in control, with the work of the Old People's Welfare Committee On the other hand, I am only too sensible that the Old People's Welfare Committee has been able, in many ways, to assist these statutory services by providing those little extras which do so much to lighten the burdens of old age. Although this does not strictly speaking belong to the Report for 1958, the fact that the Minister of Health has extended the chiropody provisions represents another advance is viiat must now be regarded as a continuous struggle. Old age with its many, varied problems is something a community must accepts something we should cheerfully accept as a willing obligation Until this gigantic problem, for it is truly gigantic, is recog nised on a national level our Borough will, I am sure, continue to make its own contribution to the welfare and happiness of our old people. Laboratory Facilities Summary of work carried out at Central Public Health Laboratories for the year 1958:- Positive Negative Swabs for diphtheria bacilli - 4 Sputa for tubercle bacilli - 6 Throat and nose swabs 191 Faeces 301 Urine 4 Blood 2 Others 7 Rectal Swabs 70 Ice Cream 6 Milk 6 Water (Swimming Pool) 4 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 1958. NATIONAL ASSISTANCE ACT, 1918 SECTION 50.:- Burial or Cremation of the Dead„ No burials were carried out by the Council under this Section of the Act during the year 1958 Two burials were carried out during the previous year. 13 SANITARY SERVICES Inspections Public Health Act, 1936 873 Housing Act, 1936 110 Rag Flock and Other Filling Material Act 1951 Pet Animals Act, 1951 8 Factories and Outworkers 179 Food Preparing Premises 293 General Food Premises 534 Shops Acts 1950 439 Smoke Observations 174 Unsound Food 107 Complaints investigated 492 Interviews with owners etc. 149 Revisits to property under notice 1,144 Infectious Diseases Cases 132 Food Poisoning . 7 Special enquiries in connection with infectious disease cases 189 Aged and infirm persons 18 Pests Act 537 Clean Air Act . 1,112 Miscellaneous 764 Rent Act l957. 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 for notice 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 have continued to come in, the numbers being set out below:- Number of Applications for Certificates of Disrepair (Form I) 126 Number of Proposals to Issue Certificates of Disrepair (Form J) 150 Number of Certificates of Disrepair issued (Form L) 61 Number of Applications for Certificates of Disrepair rejected 3 Number of Certificates of Disrepair cancelled 7 Number of Applications for Cancellation rejected 2 Number of visits made in connection with above 376 Informal Notices served:- Shops Act 7 Complied with 20 Food and Drugs Act 4 " " 23 Public Health Act 236 " " 229 Housing Act - " " Factories Act 8 " " 8 Pests Act " " 14 Statutory Notices served:- Public Health Act 57 Complied with 51 Housing Act " " Factories Act " " Pood & Drugs Act " " 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) 235 (b) Number of inspections made for the purpose 983 (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 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 229 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 (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 57 (b) Number of dwelling houses in which defects were remedied after service of formal notices (i) By owners 51 (ii) By Local Authority in default of owners - 15 (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 - (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 8 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. Housing Surveys Edith Road Proposed Clearance Area. The eleven houses in this road were inspected in detail during the year. Eight of them were found to be unfit for human habitation and could not be made fit at a reasonable cost and the best means of dealing with them is by demolition. I have been informed that a Public Enquiry is to be held on the 4th January 1959 when objections to the Compulsory Purchase Order made by the Council will be heard by an Inspector from the Ministry of Housing and Local Government. The demolition of the properties in Phase I of the Council's Slum Clearance Scheme of the Winkfield Road/Acacia Road/Douglas Road Area is now in operation and is well advanced. Inspections of the properties in Phase II of this Scheme have been completed and a Compulsory Purchase Order made by the Council. Smoke Control The detailed inspection in the proposed Smoke Control Area No. 1 which commenced in the latter part of 1957 was completed in June 1958. In all a total of 1,258 premises were visited. Of these, 1,214 were dwellinghouses. It was found that approximately 600 dwellings would require some adaptation or replacement of fire grates so that the occupiers could burn solid smokeless 16 fuels in order to avoid contravening the Act. Application was duly made to the Minister of Housing and Local Government for the Wood Green (No. 1) Smoke Control Order 1958 This Order was duly confirmed on the 1st January 1959, the Order coming into effect on the 1st July 1959. So that as much publicity as possible could be given to this matter an exhibition on smoke control and a display of solid smokeless fuel appliances was held at Rhodes Avenue School, which is situated within the Area. Brochures were prepared defining the curtilage of the Area and the requirements of the Act. These, together with other relevant literature, were sent to owners and occupiers of every premise within the Area. The ready co-operation of both owners and occupiers in such a worthwhile venture is most pleasing. In the meantime plans are in hand for a second smoke control order. Rodent Control One thousand four hundred and twenty-nine premises were inspected during the year and it was found necessary to carry out treatment in 200 of them. One thousand three hundred and four dwellinghouses were visited and of these 140 were treated for rat infestation. In addition 13 other premises were treated for the presence of rats. A further 41 dwell inghouses and 6 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 manholes. 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 and Surveyor s Department. 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 Fineries after each treatment. The following is a copy of the results of both treatments:- 17 RODENT OPERATION (1) Twenty-fourth Maintenance Treatment April/May 1958 and (2) Twenty-fifth Maintenance Treatment October/November 1958 Number of Manholes Manholes Showing Pre-bait take Complete Pre-bait take Complete Poison take Part Poison take April/ May 672 385 233 0 375 Oct/ Nov. 672 372 177 0 352 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, irtiilst that at Alexandra Palace is supervised by the Alexandra Palace Trustees. 18 INSPECTION AND SUPERVISION OF FOOD (a) Food Premises in the Borough Bakers' Shops 27 Butchers' Shops 37 Cafes and Restaurants 49 Chemists' Shops 17 Confectionery and Sweet Shops 85 Dairies and Milk Shops 38 Fried Fish Shops 11 Wet Fish Shops 12 Greengrocers' Shops 45 Grocers Shops 87 Public Houses and Off-Licences 39 Food Factories 9 (b) Milk Supply The following licences for the sale of milk under special designations have been granted to the 38 premises registered for the sale of milk in the Borough:- Tuberculin Tested Pasteurised Sterilised 18 25 38 Supplementary licences to sell milk from premises which are outside the area of the Licensing Authority:- Tuberculin Tested Pasteurised Sterilised 12 13 17 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 I60 There are 11 premises registered for the manufacture of Ice Cream in the district and 134 premises registered for retailing Ice Cream. During the year,33 visits were paid to these premises and 6 samples were submitted for bacteriological examination. These 6 samples were all Grade I. Also 42 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 168. (d) Middlesex County Council Act, l950. Section II. - Registration of Hawkers of Pood Twenty three 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 434½ Meat 90 Fish 49 Fish 1 Potatoes 224 Vegetables 22 Fruit 61 7 07½ Evaporated Milk 1 Marmalade - Bushels Soup 1 Shellfish 1½ Pudding Tomato Juice - 176 Miscellaneous Items Red Cabbage 42 Blackcurrants 1 Sandwich Spread 1 Marmalade 1 Sauce 2 After examination tay 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 810 visits were made to food premises, as set out below:- Dairies and Milk Shops 61 Butchers 168 (Registered) Ice Cream Premises 33 Fried Fish Shops 23 (Registered) Stalls (Registered) 23 Other Food Premises 502 Full usehasagain 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 1. Inspections Premises No.on ster Number of Inspections Written Notices Occupiers prosecuted FACTORIES WITHOUT mechanical power 36 10 8 - FACTORIES WITH mechanical power 179 103 - - OTHER PREMISES in which Section7 is enforced by the local authority 2 2 - - Total 217 115 8 - 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 4 4 - - - Overcrowding - - - - - -Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary conveniences (a) insufficient 1 1 - - - (b) unsuitable or defective 2 2 - 1 - (c) not separate for sexes 1 1 - 2 - Other offences against the Act (not Including offences relating to outwork) - - - 1 - Total 8 8 - 4 - 3. Outwork No. of outworkers in August list No. or cases of default in sending lists to Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel: making etc. 12 - - - - - Household linen - - - - - - Lace,lace curtains and nets - - - - - - Curtains and furniture hangings - - - - - - Brass and brass articles - - - - - - Artificial Flowers 8 - - - - - Feather sorting - - - - - - Cosaques, Christmas crackers and stockings 42 - - - - - Total 62 - - - - - 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. 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 existinglicences 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:- 1 house - Torrington Gardens 28 maisonettes at Crescent Rise 12 flats at Norman Close Council properties in course of construction at end of year:- 6 flats 3 maisonettes Alexandra Park Road Private enterprise properties completed or in course of construction - 11 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 1958 Swimming Bath 81,080 88,529 -do- Children (Special sessions) 890 627 Children from Schools 23,664 21,729 Spectators 7,619 9,371 Slipper Baths 39,876 37,310 -do- Old Age Pensioners (free) 2,907 2,927 22 Durnsford Road Open Air Baths 1957 1958 Adults 23,089 15,025 Children 41,527 39,291 Children from Schools 2,219 1,455 Season Ticket Holders 29,489 31,583 Spectators - Adults 6, 819 5,712 Children 648 617 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 1957/58 the total tonnage of refuse collected was 11,975 tons; from this.material salvaged was sold for £3,413. The quantities of salvage were:- Tons Cwts. Qtrs. Paper 159 3 - Mixed Scrap Iron 45 - 2 Rags 7 17 3 Non-Ferrous Metals 2 6 - Scrap Tyres - - - Flock Mattresses 15 14 2 Tins 369 9 - Bottles 49 7 - 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 The drop In the number of Infectious diseases notified during the year was due almost entirely to the low incidence of measles 1958 not being a "measles year" Indeed apart from the decrease in measles notifications the infectious diseases notifications for 1958 showed no material difference from those recorded during the previous year I can add very little to the paragraphs contained in my Report for 1957 which dealt with the notification of infectious diseases and with the question of epidemiology as a socialogical entity I am still of the opinion that the present system of notification should be reviewed in its entirety in the light of present knowledge and experience Two facts are becoming increasingly obvious Although it is very right that we should continue at least for the time being to receive notification of even the milder type of infectious diseases it would seem that there is at least a proportion of dead wood which could profitably be removed What is more important much more important certain diseases some of them non infectious might well be added to the list of diseases which are at present reported to the Public Health Department. This is not of course a matter which has only local significance but rather falls within the description of a national problem If the Public Health Depart ment and the Borough Council are concerned with all matters which affect the health of the inhabitants of the Borough and this has been clearly established then it surely follows logically that we should have the fullest possible information not only of conditions which are likely to affect health but of diseases which are materially influencing not only the health and welfare but the lives of young and old Thus although we know at any time at least with some degree of accuracy how many cases of scarlet fever or measles are occurring in the district we normally have to wait until the receipt of a death certificate before we are made aware of cases of such diseases as cancer acute fatal rheumatism and heart disease Yet we are perfectly well aware that scarlet fever is an extremely mild disease today while in the case of measles as I have said before we need do little more than act as a post office When one considers the question of poliomyelitis and multiple sclerosis perhaps the commonest of all nervous diseases in this country today an interesting fact emerges We know that multiple sclerosis is directly responsible for approximately 800 deaths every year while poliomyelitis usually accounts for something between 200 and 300 annual deaths It is certainly a fact that we know a great deal about acute anterior poliomyelitis while our knowledge of the aetiology and treatment of multiple sclerosis still presents a very great problem I merely give this comparison to show that diseases which are not necessarily infectious in the commonly accepted sense of the term should not merely because of their non infectious nature remain unknown in the community Even if we still have to wait until research and modern science have provided us with the weapons with which to deal with such diseases as coronary thrombosis teukaemia multiple sclerosis cancer to mention only some of the more serious disorders in this category we would still like to have some approximate. idea of the magnitude 24 of the problem so that we can study it more fully It is by no means certain of course that this study would bring forth the much needed answers but we would at least have the satisfaction of trying to establish whether or not there was any factor in the district which had significance After all, the sum total of the facts ascertained in many districts might eventually be scientifically related to the vast amount of medical research which is taking place in so many hospitals and laboratories. It is certainly a fact that the infectious diseases picture presented today is radically different from what it was only a few decades ago One has only to look at the use which is being made of the older type of isolation hospital to realise this today Yet the pattern of notification has altered very little One appreciates that this is a gigantic problem with many ramifications But it surely represents a problem which can and should be vigor ously tackled on a national level In other words the horizon of the term epidemiology has widened almost beyond recognition Diphtheria For the eleventh year in succession no case of diphtheria was notified in the Borough The last death took place approximately twenty years ago Our campaign of immunisation against diphtheria has been carried on throughout the year along the general lines set out in my Annual Report for 1957 We are still continuing to give separate protection against diphtheria and pertussis (whooping cough) in the belief that the protection afforded by vaccination against poliomyelitis is not yet sufficiently advanced to remove the poss ible danger of provocation poliomyelitis I am very pleased to be able to report that Wood Green mothers have freely accepted our advice and are attending with their infants as often as is neces sary at clinics or at their own doctors surgeries to have their children protected against diphtheria and pertussis separately and also vaccinated against smallpox As the necessary number of visits including vaccination against poliomyelitis does not entail more than one visit each month to a clinic or to the family doctor it can scarcely be said that an intolerable burden is being placed on the shoulders of mother or children! Detailed records kept in the Area Health Office show that 91% of Wood Green children who had reached the age of two years by the end of 1958 had been fully protected against diphtheria These figures are eminently satisfactory and speak for themselves Indeed they represent levels of immunisation which not so many years ago would have been considered virtually unattainable They obviously redound to the credit and intelligence of our mothers who appreciate to the full the advantages which protection against such diseases as diphtheria pertussis (whooping cough) poliomyelitis and smallpox will impart to their infants Scarlet Fever Seventy-seven cases of scarlet fever were notified during the year as compared with 22 cases in 1957 and 17 cases in 1956, 25 A small outbreak of scarlet fever occurred at the beginning of the year, It was confined mainly to one school in the district The circumstances were such that I thought it expedient to investigate. on the assumption that there might have been carriers or missed cases still attending school Accordingly nose and throat swabs were taken from children in the classes concerned Fortyfive children were swabbed of these eight produced a positive growth Three of the cultures showed the organism responsible for scarlet fever These three children were excluded from school, and I am happy to relate that there were no further cases reported from this school at that time The Public Health Inspectors also visited all the homes of children absent from this school at that time in an endeavour to find any further missed cases This involved making 92 calls, many of these in the evening As a result of these calls, one further case came to light. Two months later a second minor outbreak occurred in another school The same action was taken five children were excluded, with the result that there was at once a decline in the incidence of scarlet fever It must again be noted that the character of scarlet fever is extremely mild in the cases now being met with Indeed it is no longer considered necessary to exclude contacts of scarlet fever from school though this procedure may have to be amended at any time if the more virulent type of scarlet fever makes its appearance Poliomyelitis Two cases of paralytic poliomyelitis were notified during the year as against four cases of paralytic poliomyelitis and two cases of non paralytic poliomyelitis in 1956 The first occurred in May in a girl aged two Although paralytic, this was a very mild case and the patient made good progress and a successful recovery The second case I regret to say was truly tragic This case occurred in November in a man of 33 After an illness of very short duration the patient died I have reported to the Public Health Committee from time to time on the scheme of vaccination against poliomyelitis which is now in force within the Borough as part of the County Council s immunisation and vaccination programme This scheme operated with remarkable smoothness during the year It is not possible in this report to detail the number of Wood Green children who have been given either one two or three injections against poliomyelitis as these figures are not yet available As soon as the numbers have been tabulated however I will report the year s totals to the Public Health Commltteo At the moment it can be said that the percentage of children up to the age of 15 who have been vaccinated against poliomyelitis is most gratifying and must be one of the best reported in the county Indeed the first figures issued showed that the percentage of these children in Area No 2 who were vaccinated against poliomyelitis was actually the highest in the county This again is a tribute to the foresight of the parents who have not hesitated to take advantage of the facilities 26 provided. The response to the offer of vaccination against poliomyelitis among the 15 - 26 age group was not so high, although here again our preliminary survey tends to show that the rate was and still is considerably higher than that reported from the country as a whole. We all know that the policy of vaccination against poliomyelisit has been altered from time to time and that it has not yet been entirely stabilised Many people feel for instance that a fourth inoculation will be required before full protection can be guaranteed It is certainly known that the third injection is vital that without this third injection given following a mini mum of seven months after the second injection no one is fully protected In view of the changing picture I intend to keep the Public Health Committee fully informed of variations in policy and progress made Wood Green co-operated with the Central Public Health Labor atory at Colindale in collecting and sending for examination every week the stools of selected infants This was part of an extensive enquiry into the possible existence of carriers of the poliomyelitis virus No virus was discovered among all the specimens sent for examination Measles As noted elsewhere 421 cases of measles were notified during the year as against 876 in 1957 As I have mentioned in earlier reports measles epidemics fall fairly consistently into a twoyear cycle Although 1958 was not in the two year cycle, measles figures were comparatively high In 1957. which was "a measles year" the epidemic occurred very early in the year so that when in the last quarter of 1958 the figures started to soar rapidly we had once again almost completed the two-year cycle The outbreak which occurred in the early part of 1957 gave us the highest figures for Wood Green since measles became a noti fiable disease in 1940 It was therefore not surprising that the subsequent outbreak at the end of 1958 was of a more confined nature and that by the end of 1958 it had practically subsided Measles like so many of the other so called children's complaints has lost much of its virulence Indeed there has not been a death in this Borough from measles since 1947 Of the total 421 cases that occurred this year, only eight were removed to hospital Such removal is generally made for purely social reasons Pertussis (Whooping Cough) Forty cases of whooping cough were notified during the year as against 95 in 1957 The policy of offering immunisation against pertussis to the mothers of young children both through their family doctor and the welfare clinics is still being maintained These injections are given quite apart from the immunisation against diphtheria. This disease is most serious during the first six months of life and in consequence the immunisation programme is projected towards protecting all children as soon after birth as is practicable 27 bearing in mind the need for vaccination against smallpox during the first months of life. Food Poisoning (including Sonne Dysentery) This year only one case of food poisoning was brought to the attention of this Department- It would not be correct to say, however, that this was the only case which occurred in Wood Green during the year for many cases of food poisoning, including Sonne Dysentery, are of such a minor nature that the family doctor does not notify me of their occurrence. Indeed. many cases are so mild that they are not even brought to the notice of the family doctor. Forty cases of Sonne Dysentery were reported during the year. On the whole I consider the over all picture relating both to food poisoning and Sonne Dysentery to be good though there is no room for complacency, since one never knows when, through the carelessness or neglect of some food handler, we may be dealing with a serious outbreak. During the year, what appeared to be a true outbreak of suspected food poisoning in a works canteen was brought to my notice. In all, 35 persons were affected. The illness in each case was brief, between five and twenty-one hours. Most of the persons affected were known to have eaten steak pie. Unfortunately none of this or any other foodstuffs served in the canteen on the day in question were available at the time of my being informed, so that it was not possible for specimens of the food to be sant for laboratory examination. The Public Health Inspector concerned interviewed the affected persons on the staff and all the members of the canteen staff. Specimens were obtained from a number of the persons affected These specimens, together with specimens submitted by members of the canteen staff, were sent to Coppetts Wood Laboratory for investigation The results in every case were negative. The medical histories of the canteen staff were carefully investigated with a view to ascertaining whether any had suffered from diarrhoea, bails, septic cuts or sore noses. No such connection was established The canteen in question is clean and well run, while the manageress is competent and has a sound knowledge of food hygiene. Paratyphoid Fever No cases of paratyphoid fever were reported in 1958. Puerperal Pyrexia One case of puerperal pyrexia was notified during the year. The patient made an uneventful recovery. Smal1pox No case of smallpox occurred in Wood Green during 1958. Indeed I was not even asked to see any doubtful rashes. I am glad to be able to report that the number of mothers seeking vaccination for their infants at the Child Welfare Clinic in Wood Green is still on the increase. As Area Medical Officer, I have communicated with 28 general practitioners again asking them to advocate vaccination as strongly as possible. The percentage of children in Wood Green who reached the age of two at the end of 1958 vaccinated against smallpox was 74%. Tuberculos is Seventy-five cases of tuberculosis (66 pulmonary and 9 nonpulmonary) were notified during the year, as against 47 in 1957, Of the 75 cases, 42 were transferred from other districts, 33 being new cases. A broad classification of the cases notified during the past five years in relation to employment was:- 1954 1955 1956 1957 1958 Clerical 16 12 5 4 5 Manual Labour 14 17 7 3 2 Housewives 20 8 3 3 9 Factory workers 7 - 5 3 2 Children 5 5 5 1 - Professional classes 1 2 3 3 2 Domestic Service - 2 - 1 1 Nurses - 1 . . - Shop Assistants 8 4 1 2 3 Armed Forces - 2 - . 1 Retired Persons 2 2 2 - - Unclassified 8 1 6 5 8 81 56 37 25 33 The number of cases on the register at the end of the year was as follows - Pulmonary - 331 males Non pulmonary - 15 males 262 females 48 females Total 593 63 It will be seen that the number of cases of tuberculosis notified during the past five years has dropped considerably, from 81 to 33. These figures have a limited significance in view of the short period covered and the low totals involved, They are, however, useful as a basis of comparison. The death rate from tuberculosis for Wood Green has dropped from 0.12 per thousand of the population in 1957,. when we were the fourth highest in the County, to 0 08 per thousand of the population; the seventh highest in the County, and only slightly higher than the County rate of 0 07. The B.C. G. vaccination scheme for schoolchildren in the thirteen-year-old age group referred to in earlier reports is still making excellent progress. Although this work is in point of fact part of the school health services provided by the Middlesex County Council as the Local Health Authority for Wood Green, I felt that it warranted further mention here as a very definite 29 step taken in the protection of the youth of the Borough against tuberculosis. Indeed as I write this Report, information has been received that the scheme is now to be extended both to younger children and to older adolescents. We welcome this extension, and are already taking steps to put the new proposals into operation. Mass Radiography Once again, after a period of two years. Mass Radiography Unit 6A visited Wood Green Between the 15th and 25th September fourteen sessions were held for the purpose of X-raying members of the public. Leaflets prepared by the Unit giving details of the visit were distributed by the Public Health Department through theusual channels, Ihe fullest use possible was made of the various media available to us for publicising this worthwhile service. As I mentioned in my introductory remarks, advantage was taken of the Council s carnival parade to enter one of the Unit s vehicles with a told appealing slogan prominently displayed on its side. This vehicle took the third prize in its class. This is the first time, I understand that a vehicle of the Mass Radiography Service has ever been successfully entered for anything of a like nature. Facilities were again offered us by the Wood Green Horticultural Society at their Annual Show for a stand from which leaflets and information could be distributed. Several hundred inflated balloons were distributed to children in the Horticultural Show grounds informing the public of the current visit of the Mass Radiography Unit to Wood Green. The Unit was again sited on Spouters Corner, the response being highly satisfactory, especially when it is remembered that fewer public sessions were held than on the previous visit., and that at this time articles appeared in certain sections of the press pointing out the possible hazards of radiography, Since then, of course, the Adrian Committee s reassuring report has been published This Committee was appointed in 1956 under Lord Adrian, O.M F.R.S. M.D. F.R.C.P. to review the present practice in diagnostic radiography, radiology and the use of radio-therapy in non malignant conditions. The findings of this Committee show that mass radiography. properly conducted, makes negligible contribution to the total radiation to which the popu lation is daily exposed and that its general use should therefore not be curtailed. Indeed the Committee states "In particular the value of mass miniature radiography is so great that it must not be curtailed without great cause. It is also pointed out that in 1957 mass X-ray led to the discovery of nearly 18,000 cases of respiratory tuberculosis cases alone together with 63,000 other abnormalities- The report goes on to say that a person who has had ten mass X ray examinations over a number of years would have his chances of developing leukaemia in any year increased if at all from fifty to at most fifty one chances in a million The Committee were satisfied that the somatic risk at these levels is on any interpretation far outweighed by the benefits of mass miniature radiography With this heartening report now before the public s eye, we hope that subsequent visits of Unit 6A to this Borough will have even greater support Mrs E, Waters, Secretary of the Unit has informed me that the Unit was again very pleased with the response they enjoyed in Wood Green and with the assistance they received from the Public Health Department We now look forward to a subsequent visit in the early autumn of 1960 30 ANALYSIS OF MASS RADIOGRAPHY SURVEY GROUP PULMONARY TUBERCULOSIS Number examined Recalled for Large Film 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 1,235 31 20 4 5 - 3 1 1 - - 9 Female 1,774 35 25 2 6 - 2 - 2 - 3 7 ORGANISED GROUPS Male 205 2 2 - - - - 1 - - - - Female 170 2 1 - - - - - 1 - •• - TOTAL Male 1,440 33 22 4 5 - 3 2 1 - - 9 Female 1,944 37 26 2 6 - 2 - 3 - 3 7 TOTAL 3,384 70 48 6 11 - 5 2 4 - 3 16 31 Other Abnormalities Discovered Include:- Male Female Total Bronchiectasis 1 1 2 Emphysema 1 - 1 Pulmonary Fibrosis (non T.B.) 2 1 3 Sarcoidosis 1 - 1 Pleural Thickening 3 - 3 Elevation of Diaphragm 1 1 2 Pneumonia - 1 1 Benign Tumours of Lung and Mediastinum:- Mediastinal Cyst 1 1 Pericardial Cyst 1 1 Retrosternal Thyroid 1 1 DISINFECTION AND DISINFESTATION The number of articles dealt with at the Disinfection Station was as follows: - Articles disinfected 168 Articles destroyed 97 20 rooms were disinfected on account of infectious disease. 11 premises were disinfested on account of the presence of vermin, which involved the disinfestation of 32 rooms. 29 premises were treated for infestations of cockroaches, wasps, ants, flies, bluebottles, fleas, beetles, bees, moths, lice and silver fish. 103 library books were brought to the Department during the year for disinfection. 32 APPENDIX I TABLE I Vital Statistics of Wood Green 1938-58 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) 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 1957 49,500 655 13,2 28 11 16.8 1 35 7 585 9.6 1958 49,100 635 12.9 37 13 26,62 1 27 09 573 11.3 33 TABLE II INFECTIOUS DISEASES FOR THE PAST 25 YEARS Year Diphtheria Scarlet Fever Enteric or Typhoid Fever Pulmonary Tuberculosis Nonpulmonary Tuberculosis Measles Pertussis Poliomyelitis † N *D †n *D †N *d †N *D †N *D †N *D †n *D †N *D 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 _ 1958 - - 77 - 1 - 29 5 3 - 421 - 40 - 2 1 †N - Notifications *D - Deaths 34 TABLE III Infectious Diseases Notified during the year 1958 Notifiable Disease Cases Notified in Whole Borough Total Cases Notified in each Ward Total Cases removed to Hospital or Sanatorium Total Deaths At Ages - Years All Ages Under 1 year 1 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years 20 to 25 years 25 to 35 years 35 to 45 years 45 to 55 years 55 to 65 years 65 and upwards Alexandra Bowes Town Hall Noel Park Scarlet Fever 77 - 16 50 7 2 - 2 - - - - 40 16 21 23 - Diphtheria - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - Enteric or Typhoid Fever 1 - - - - - - - - - - 1 - 1 - 1 - Para-typhoid Fever - - - - - - - - - - - - - - - - - Erysipelas 1 - - - - - - - 1 - - - 1 - - - - Pneumonia 34 2 2 2 1 - - 2 1 3 2 19 14 7 13 24 34 Acute Poliomyelitis(P) 2 - 1 - - - - 1 - - - - 1 1 - 2 1 Polio-Encephalitis - - - - - - - - - - - - - - - - - Puerperal Pyrexia 1 - - - - - 1 - - - - - - - 1 - - Pulm Tuberculosis 30 - - 2 4 8 3 6 5 2 14 6 10 13 4 Non-Puln Tuberculosis 3 - - - - - - 1 2 ° - - 3 - - 1 - Malaria - - - - - - - - - - - - - - - - - Measles 421 7 184 215 12 2 - 1 - - - - 84 117 220 8 - Whooping Cough 40 4 10 24 2 = - - - - - - 7 7 26 4 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - Dysentery 40 4 15 10 1 1 - 1 7 - - 1 14 19 7 5 - Food Poisoning 1 - - - - - - - - 1 - - 1 - - 1 - Totals 650 17 228 301 23 7 5 16 14 10 7 23 179 174 298 82 39 35 TABLE IV Causes of death during the year 1958 Causes of Death Male Female Tuberculosis, respiratory 3 1 Tuberculosis, other - - Syphilitic disease 2 - Diphtheria - - Whooping Cough - - Meningococcal infections - - Acute Poliomyelitis 1 - Measles - - Other infective and parasitic diseases - 1 Malignant neoplasm stomach 9 7 Malignant neoplasm lung bronchus. 30 10 Malignant neoplasm uterus - 15 Malignant neoplasm breast - 6 Other Malignant and lymphatic neoplasms 22 30 Leukaemia aleukaemia 1 - Diabetes - 2 Vascular lesions of nervous system 27 45 Coronary disease angina 60 39 Hypertension with heart disease 3 3 Other heart diseases 21 43 Other circulatory disease 15 14 Influenza - - Pneumonia 19 15 Bronchitis 20 10 Other diseases of respiratory system 5 3 Ulcer of stomach and duodenum 4 1 Gastritis enteritis and diarrhoea 1 3 Nephritis and nephrosis 1 3 Hyperplasia of prostate 2 - Pregnancy, childbirth abortion - 1 Congenital malformations 3 1 Other defined and ill defined diseases 18 20 Motor vehicle accidents 6 2 All other accidents 12 4 Suicide 3 5 Homicide and operations or war Totals 288 285 36 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 3 - - - - - - 1 - - 2 - Tuberculosis, other - - - - - - - - - - - - Syphilitic disease 2 - - - - - - - - 1 - 1 Dyphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal Infections - - - - - - - - - - - - Acute Poliomyelitis 1 - - - - - A - - - - - Measles - - - - - - - - - - - - Other Infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasm, stomach 9 - - - - - - - 1 1 3 4 Malignant neoplasm lung, bronchus 30 - - - - - - - 7 8 8 7 Malignant neoplasm breast - - - - - - - - - - - - Other malignant and lymphatic neoplasms ». 22 - - - - - - 1 4 6 2 9 Leukaemia, aleukaemia 1 - - - 1 - - - - - - - Diabetes - - - - - - - - - - => Vascular lesions of nervous system 27 - - - - - - - 3 9 4 11 Coronary disease, angina 60 - - - - - 1 1 9 16 17 16 Hypertension with heart disease 3 - - . - - - - 1 2 0 - Other heart diseases 21 - - - - - - - - 3 10 8 Other circulatory diseases 15 - - - - - - - -- 4 11 Influenza - - - - - - - - - - - - Pneumonia 19 1 - - - - - - 2 2 6 8 Bronchitis 20 - - - - - - - 2 4 10 4 Other diseases of respiratory system 5 - - - - - 1 1 - 2 1 - Ulcer of stomach and duodenum 4 - - - - - - - - 1 1 2 Gastritis, Enteritis and Diarrhoea. 1 - - - - - - - - - - 1 Nephritis and nephrosis 1 - - - - - - - - 1 - - Hyperplasia of prostate 2 - - - - - - - - - - 2 Totals carried forward 246 1 - - 1 - 3 4 29 56 68 84 37 38 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 246 1 - - 1 - 3 4 29 56 68 84 Congenital malformations 3 3 - - - - - - - - - - Other defined and illdefined diseases 18 2 - - - . - - 2 1 4 9 Motor vehicle accidents 6 - - - - 3 2 - - - - - All other accidents 12 3 - - - - 1 - - 3 2 3 Suicide 3 - - - - 1 1 - - - - 1 Homicide and operations of war - - - - - - - - - - - - Totals 288 9 - - 2 4 7 4 31 60 74 97 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 J 75 and over Tuberculosis, respiratory 1 - - - - - - - - - - 1 Tuberculosis. other - - - - - - - - - - - - Syphitilic disease - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal infections Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases 1 - - - - - - - - - - 1 Malignant neoplasm stomach 7 - - - - - - - 1 - 4 2 Malignant neoplasm lung bronchus 10 - - - - - - - 1 2 3 4 Malignant neoplasm breast 15 - - - - - - - 4 2 3 6 Malignant neoplasm uterus 6 - - - - - - - - 2 2 2 Other malignant and lymphatic neoplasms 30 - - - - - 1 2 4 3 6 14 Leukaemia, aleukaemia - - - - - - - - - - - - Diabetes 2 - - - - - - - - - 1 1 Vascular lesions of nervous system 45 - - - - - - 4 5 11 13 12 Coronary disease, angina 39 2 - - - - - 1 3 3 14 16 Hypertension with heart disease 3 - - - - - 1 - - - 1 1 Other heart diseases 43 - - - - - - - - - 18 25 Other circulatory diseases 14 - - - - - - - - - 7 7 Influenza 1 - - - - - - - - - 1 - Pneumonia 15 1 - - - - - - - 2 7 5 Bronchitis 10 - - - - - - - - - 6 4 Other diseases of respir atory system, 3 1 - - - - - 1 - - 1 - Ulcer of stomach and duodenum „i 1 - - - - - - - - - - 1 Gastritis. Enteritis and Diarrhoea 3 - - - - - - - - - - 3 Nephritis and nephrosis 3 - - - - - - - - - 1 2 Totals carried forward 252 4 - - - - 2 8 18 25 86 109 39 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 252 4 - - - - 2 8 18 25 86 109 Pregnancy Childbirth Abortion 1 - - - - - 1 - - - - - Congenital malformations Other defined and ill- 1 1 - - - - - - - - - - defined diseases 20 - - - - - - - 1 3 9 7 Motor vehicle accidents 2 - - - - - - - 1 - - 1 All other accidents, 4 2 - - - 1 - - - - 1 - Suicide 5 - - - - 1 1 1 - 1 1 - Homicide and operations of war - - - - - - - - - - - - Totals 285 7 - - - 2 4 9 20 29 97 117 40 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary NonPulmonary Total M. P. M. P. No, of cases on Register at end of 1957 315 251 13 41 620 New cases notified during 1958 17 13 - 3 33 Transfers from other Districts 18 18 2 45 42 No, of cases removed from Register 29 22 - - 51 No of cases on Register at end of 1958 331 262 15 48 644 New Cases and Mortality during 1958 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 - - - - - - - - 5 - - - - - - - - 15 1 3 - - - - - - 25 5 5 - 1 - - - - 35 - 3 - 1 1 - - - 45 5 1 - 1 - 1 - - 55 3 2 - - - - - - 65 and upwards 1 1 - - 2 - - - Totals 15 15 - 3 3 1 - - Above includes transfers (42) from other districts, 41 APPENDIX 2 Miseellaneous (a) Letter to Doctors Letters on the following subjects were circulated to Wood Green practitioners in 1958 some under my signature as Medical Officer of Health and others either as Area Medical Officer or District School Medical Officer 6th January - Prompt notification of Infectious Disease to Public Health Department. January - Change of Address (new Town Hall). 10th January - Poliomyelitis Vaccination - Extended Scheme. 24th January - Poliomyelitis Vaccination - Vaccine for "green card* registrations 18th March - Home Helps and Cancer Cases. 18th March Old People in need of Admission to Hospital. Institution or Old People's Homes 27th March Easter Holiday Arrangements - Home Nurses. Midwives„ &c. 31st March - Second letter re Old People in need of Admission to Hospital etc, 24th April - Poliomyelitis Vaccination - Availability of Vaccine 6th May - " " " " " 20th May - " " " " " May - Case of Poliomyelitis. 26th June - Admission of Aged Sick to Hospital. 20th August - Poliomyelitis Vaccination - Extension of Scheme. November-Case of Poliomyelitis I would once again emphasize that the closest liaison is maintained between general practitioners and the Public Health Department It is a most pleasing thought that the relationship between my colleagues in general practice and the Public Health Departmeit is so very cordial Without this co operation lit need scarcely be said that maximum results in the field of health can never be expected By reason of the fact that I am a member of the Medical Advisory Committee of the Northern Group of Hospitals a member of the Medical Advisory Committee of Friern Hospital and a member of the North Middlesex Liaison Committee my contacts not only with general practitioners but with consultant and other hospital staffs can be readily maintained I find that attendance at these Committees is extremely useful since it allows me to gain an inside knowledge into the working of other branches of the medical profession, and also permits a free interchange of views (b) Medical Examinations During the year 34 medical examinations were carried out Thirteen of these were in respect of entrants to the Council's employ for acceptance into the Superannuation Scheme 4 in respect of workmen already in the Council's employ for acceptance into the Superannuation Scheme and 27 in respect of workmen for acceptance 42 into the Sickness Pay Scheme. In addition. 16 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. June - Report on Preliminary Survey of Proposed Smoke Control Area No. 1 and estimated cost of works necessary. October - Annual Conference of the Association of Public Health Inspectors. 16th to 19th September, 43 44 APPENDIX 3 Legal Proceedings during 1958 Statutory Nuisance, Public Health Act. 1936 - Edith Road Statutory Nuisance, Public Health Act, 1936 - Ranelagh Road (11) Statutory Nuisance, Public Health Act, 1936 - Ranelagh Road (13) Statutory Nuisance, Public Health Act, 1936 - Ranelagh Road (15) Failure to comply with Nuisance order - Edith Road Failure to comply with Nuisance order - Edith Road Statutory Nuisance. Public Health Act, 1936 - High Road Selling food not of the substance Amended Food and Drugs Act, 1955 Statutory Nuisance, Public Health Act, 1936 Order to abate nuisance Costs £2, 2. 0. Order to abate nuisance Costs £1. 1. 0 Order to abate nuisance Costs 10s. 6d. Order to abate nuisance Costs 10s. 6d. Fine £5 Costs £3. 3. 0. Fined £1 per day - total £30 Costs £5. 5. 0. Order to abate nuisance Fine £5 Costs £2. 2. 0. Fine £5 Costs £2. 2. 0. Costs £3. 3. 0.