BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1959 WM. CLUNIE HARVEY, md.dph Medical Officer of Health. BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1959 WM. CLUNIE HARVEY, m.d.,dp.h. Medical Officer of Health. Borough of Wood Green. With the Compliments of the Medical Officer of Health Town Hall, Wood Green, N..22. Public Health Department, Town Hall, Wood Green, N. 22. June, 1960. To THE MAYOR, ALDERMEN and COUNCILLORS of the BOROUGH OP WOOD GREEN. Mr. Mayor, Ladies and Gentlemen, I beg to present my Annual Report for 1959. It is almost becoming a standard introduction to this Report for me to say that the year under review was more or less uneventful. At the risk of repetition, however,Imust once again state that this was, in fact, the case. I hasten to add, of course, that this does not mean that the Public Health Department was able to go into a state of coma, or to rest on its oars. The same amount of patient, unpublicised work has to be done year after year if the fruits of the past are to be properly garnered and if adequate safeguards are to be laid down for the future. This is the aim towards which the Public Health Department continually works. To deal first of all with the incidence of infectious diseases, 1959 was a particularly happy year in this respect. A full report on this subject will be found in the section which deals specifically with infectious diseases. I will therefore leave any further remarks until I have dealt with this particular problem. The vital statistics for 1959 were satisfactory, although I must once again enter a caveat against placing too much emphasis on the vital statistics which apply to only one year and to a population of approximately forty-eight and a half thousand. None the less, the figures give rise for satisfaction, especially when studied over a period of several years. The death rate was 12.4 compared with 11.3 recorded for 1958, while the birth rate rose from 12.9 in 1958 to 14.2 in 1959. The birth rate was relatively constant from 1955 to 1958, the only significant rise having taken place last year. Once again, there were no deaths from puerperal sepsis. Unfortunately, one case of maternal mortality was recorded,but the cause of death was stated to be due to selfinduced abortion. The infant mortality rate, i.e. the number of infants who died during the first year of life per thousand live births, was 20 5 as against 23.62 in 1958. These matters will, however, be discussed in greater detail in the part of the Report which deals with statistics and social conditions of the Area. Housing still plays a very important part in the programme of Public Health. Indeed, as has been so often said, there can be few aspects of preventive medicine with which a Borough Council such as Wood Green is more intimately concerned. 3 We have already dealt with a large part of our slum clearance programme, and are still continuing this work. The problem of houses in multiple occupation is at present under review throughout the country,as this presents quite a serious problem in many parts. It is already clear, however,that this is not too serious a problem in Wood Green. As the matter is still under careful investigation, however, this would appear to be a matter which would better be reported at a later date. The specific problem of the provision of suitable accommodation for the elderly is dealt with in the section of the Report which deals with the care of the aged. The position with regard to the setting up of smoke control areas in Wood Green is proceeding according to the plan submitted to the Public Health Committee and to the Council and duly agreed. This, of course, is a long term policy, but I think it can be said that Wood Green has not in any way neglected its obvious duties. Food hygiene has once again received considerable attention during the year. The Chief Public Health Inspector and his staff of Public Health Inspectors have carried out many visits to food premises and have investigated all complaints arriving at the Public Health Department. Talks on clean food were given to local organisations throughout the year, stressing particularly the part which members of the public can play in what is undoubtedly a sizeable problem. Although the Borough Council possesses the powers of law enforcement in regard to infringements of the Food Hygiene Regulations and although the Council has taken action in this field when action was required, this only represents a comparatively minor solution to the problem. In the United States of America, they have adopted an excellent slogan "Protect yourself, yourself". This means, of course, that unless and until we all work together to effect much-needed improvement in food hygiene, we cannot expect success. No one would suggest that we should become a nation of priers or snoopers. None the less, it will readily be realised that Public Health Inspectors, with their multifarious duties and small numbers can, with the best will in the world,only devote a limited time to food hygiene. The general public can and should insist on the highest standards at all times and in all places, and should cease to trade with those establishments where conditions are in any way below standard, and should let us know of any conditions which they consider represent a danger to the consumer. If this co-operation was one hundred per cent, there can be little doubt that conditions would improve. This is merely a matter of simple common sense, yet we know that conditions are still tolerated by the general public which should never be allowed to exist and which may never come to our notice. The relations between the Public Health Department and the burgesses of Wood Green have always been good. Our aim is to try and impress upon the public that we are here to help, but that we need their help. The fact that conditions in Wood Green are good, should never be allowed to stand in the way of further progress. We all know that Wood Green is the premier shopping centre in North London; we would also like to think that Wood Green is 4 equally a place in which food hygiene is beyond reproach. But as I have already said, until we can be assured of the fullest co-operation from every burgess in the district,this happy state of affairs will still remain beyond our reach. My remarks this year on health education have been incorporated in Appendix 1, at the end of this Report. It has been very rightly said that a Medical Officer of Health must concern himself with every known factor in his Area which may affect the health of the community. For this reason the Public Health Department has been intimately connected with campaigns to promote clean food to control the spread of infectious diseases, to remedy housing defects, indeed all matters which come within the purview of environmental hygiene. As will also be known, we have associated ourselves with the prevention of accidents in the home, a very urgent and increasing problem, with health education, a function which we share with the Middlesex County Council, and have also keenly watched the very rapid progress made in the field of vaccination and immunisation. But there is one other health hazard which has recently been given considerable prominence and in which the Public Health Department must of necessity be interested. I refer to radiation. Radiation, in other words, the hazards which can arise from the use or disposal of radio-active substances, has presented a problem not only in this country but throughout the civilised world. It has been said that the hazards associated with radioactive substances are not nearly so great as those associated either with accidents on the road or accidents in the home. While this may well be true there is a vast difference between accidents which occur on the road or in the home and accidents or even fatalities due to radiation. We can all see the disastrous results of careless driving, burns, scalds or falls in the home: but radiation still remains a vast complicated and somehow terrifying subject which yet remains beyond the understanding of many, even highly intelligent people. When a child pulls a kettle of water on himself and is scalded we can see the unhappy result: when someone is knocked down by a car, the result is again only too obvious. But the effect of gamma or beta rays or even electrons on our body may not be known for a very long period. We cannot see these rays we cannot smell them, we do not know that they are in the vicinity. Yet we are told that they are highly dangerous either to ourselves or to our progeny. Is it therefore any wonder that the general public are becoming alarmed, are asking to know the full facts and are demanding adequate protection? I have attended a number of conferences which discussed this intriguing subject. On the whole these conferences have produced statements to the effect that the Central Government has the matter well under control, that the public need have no fear, and that adequate steps would be taken if the permissible limits of radio-activity were ever passed,' One has no reason to doubt these statements, or to doubt that the government has set up an 5 efficient system to keep the situation under constant review. There are, however, two aspects of the problem about which many people still feel certain misgivings. The Radio-active Substances Bill, which is at present going through Parliament, has made provisions for the passing on of essential information especially regarding the disposal of radioactive waste, to local authorities. This is certainly a step in the right direction, but many Medical Officers of Health would still like to see provision made for the training of their staff, or at least a proportion of their staff in all matters pertaining to the use or disposal of radio-active substances. It may be that the Radio-active Substances Bill will cover this point adequately, but that is a matter which still remains to be seen. The second point about which many of us feel certain misgivings is the constant use of the term "re-assurance" when any discussion takes place on radiation. I have little doubt that this word is used in the best possible sense, but none the less when one is constantly told that the public must be re-assured there is still of necessity a doubt left in the public's mind that they are not being given all the facts of the case. Indeed the public should either be told quite clearly that the whole subject of radiation is one which is best left in the hands of those most competent to deal with it or they should be given the fullest possible information and be allowed to judge for themselves. Whether we like it or not the problems of radiation are with us, and are causing a good deal of perturbation among those who take the trouble to think about the problems raised by radiation. And after all who does not fall within this category? The fact that the Royal Commission for Local Government in Greater London sat for many months during 1959 and is expected to make its Report in the Autumn of 1960 may well affect the future of Public Health in a Borough such as Wood Green, It would be unwise to anticipate the contents of this Report but one must envisage the possibility that, some time in the relatively near future such matters as mental health and the operation of the personal health services might well come within the ambit of the Borough Council. Until the Report is received however, it would certainly be injudicious to make any such assumptions. The fact that for the past twelve years. I have been Area Medical Officer for No. 2 Health Area under the Middlesex County Council and that this Area includes the Borough of Wood Green has certainly helped me in establishing the necessary liaison between the environmental health services undertaken by the Borough Council and the personal health services under the control of the County Council. I also hope that this dual appointment has been of use to the Borough Council in integrating work which is of the greatest importance to the burgesses of Wood Green. I cannot close this introduction without making special reference to a subject which has always been very close to my heart, the matter of harmonious co-operation. In Wood Green, it has 6 always been ray pleasure to think that the co operation established between the Public Health Department and other bodies and organisations, not to mention individuals has been close and harmonious. Thus, we have exerted the utmost efforts to promote the closest liaison between the Department and general practitioners, a liaison without which success in the field of Public Health can never be fully attained. We have also co-operated to the full with the Area Health Office, with other branches of the Middlesex County Council such as the Welfare Department, the Children's Department, Pood & Drugs Department, etc., and with the many excellent voluntary organisations within the Borough which are carrying out such wonderful work. I would also refer here to the very happy relations which have always existed between the Public Health Department and the local press. I cannot speak too highly of the wonderful help we have received from the local press on so many occasions, and would pay my humble tribute to the invaluable assistance. The lack of this cordial co-operation, which still seems to exist in some areas has always surprised me. It seems so much easier to co-operate with other people rather than to act in a non-co-operative manner. I am completely satisfied that the extension of this co-operation in Wood Green over the years during which I have acted as Medical Officer of Health for the Borough, has played no little part in achieving results which would otherwise have been impossible. I also like to think that the burgesses of Wood Green know that the Public Health Department exists for one reason only, to help promote better health in the community. I think one can honestly say that this is the case and that no burgess feels that a visit or letter to the Public Health Department will ever be neglected. Accidents in the home a menace which is assuming quite alarming proportions has continued to occupy our attention. I have contributed articles on the subject to the local press while we have mentioned the importance of accidents in the home and the ways in which these accidents can be avoided, at various talks given throughout the year. It will be appreciated, however, that this is a matter which affects the personal health services rather more than the environmental health services. Most of the work has therefore been carried out by members of the Area Health Staff, particularly Health Visitors at clinics. Apart from the display of posters and leaflets a comparatively minor contribution to this enormous subject, we have particularly stressed the importance of the use of non-flammable material. I have been particularly concerned in trying to persuade the makers of nonflammable material to have this material stocked at as many stores in the district as possible. In order to encourage mothers to use non-flammable material for the making of children's frocks, we have had several frocks made by voluntary workers and staff at our clinics, so that the mothers could see how attractive the material is and how it can be made up into suitable dresses, particularly party dresses for their young children. In addition, as I mentioned in last year's Annual Report, we have visited Old 7 People's Clubs to demonstrate the use of non flammable material, since burns in the home most often occur among the very young and the very old. Although this may not seem at first sight to be a subject which could come under the heading of Public Health, it is none the less a vital issue. When one considers what is being done in the field of immunisation and vaccination, and when one remembers the quite apalling number of serious, often fatal accidents which occur in the home due either to burns or to other types of accident one realises that anything we can do to reduce this great and increasing risk will be well worthwhile. In conclusion, I would express my sincerest thanks to the Public Health Committee and to the Borough Council for the continued courtesy and assistance which I have come to expect as Medical Officer of Health, I would also express my grateful thanks to every member of the Public Health Department and in particular to my Deputy, Dr. Janet Campbell, Mr. Wm. McCauley, Chief Public Health Inspector, and to Mr. P. V. Ingram, Chief Clerk. Any Medical Officer of Health is fortunate when he knows that he has a loyal, conscientious and efficient staff. That, I am extremely glad to say, has always been my own position. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. 8 BOROUGH OF WOOD GREEN health and cleansing committee Councillor L. A. VITORIA (Chairman) Oouncillor C.D. MOSS (Vice-Chairman) The Mayor, Alderman, A. VITORIA, J.P., Councillor E. C. HALE Councillor MRS. L. ANGELL Councillor G. CATHLES Councillor J. A. CATON Councillor J. McKENNA STAFF Medical Officer of Health - WILLIAM CLUNIE HARVEY. M.D., D.P.H. Deputy Medical Officer of Health - JANET RUSSELL CAMPBEL, 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 Pood 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 and Cert. R. Soc. of Health, Smoke Inspector; 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, (resigned 7.3.59.); J. E. JONES, Cert. R. San. Inst. and Cert. Meat and Food Inspection (commenced duty 4.5.59.). Chief Clerk.- P. V. INGRAM. General Clerks - Miss J. W. POPE, Shorthand-typist. A. E. O'NEILL (resigned 7.3.59.). R. W, SHADBOLT (commenced duty 20.4.59.). Rodent Operator - J. HARRIS. Disinfector - W. WOODCOCK (resigned 10.9.59.). F. WORKMAN (commenced duty 9.9.59,). 9 statistics and social conditions for the area Area (acres) 1,606 Population - estimate supplied by the Registrar General 48,520 Number of inhabited houses (end of 1957) according to Rate Books 14,617 Rateable Value (1958) £863,205 Sum represented by a penny rate (estimated) £3,326 extracts from vital statistics for the year Total M P Live Births - Legitimate 640 316 330 Birth Rate per 1,000 14.2 Illegitimate 36 17 19 Still Births 15 5 10 Rate per 1,000 Births 22.19 Deaths 604 310 294 Death Rate per 1, 000 12.4 Deaths from Puerperal causes 1 Rate per 1, 000 Births 1.43 Deaths of infants under one year of age:- All infants 14 Rate per 1,000 live births 20.71 Legitimate 12 Rate per 1,000 legitimate live births 18.75 Illegitimate 2 Rate per 1,000 illegitimate live births 55.56 Deaths from: - Tuberculosis 1 Cancer (all ages) 141 Measles (all ages) – Whooping Cough (all ages) – Diarrhoea (under 2 years of age) – Number of Births notified 676 Number of Births registered in the Borough 108 population The mid-year estimate of the population supplied by the Registrar General is 48,520 a decrease of 580 from that of the previous year. births The number of live births registered during the year was 676, which gives a crude birth rate of 14.1 per 1, 000 of population, the corrected birth rate being 14.2. The rate for 1958 was 12.9. There were 15 still-births, giving a still-birth rate of 22.19 per 1,000 births. In 1958 the still-birth rate was 20.5. 10 deaths The net number of deaths accredited to the district was 604, 31 more than in 1958. This gives a crude death rate of 12.4 per 1,000 of the population and a corrected death rate of 11.9. Prom the table which sets out the causes of death for 1959 (page 39), it will once again be seen that diseases of the heart and circulation made up by far the greatest single cause of death. This is in keeping with the national situation, and is a most disturbing feature of modern life. The causes of coronary occlusion the disease with which we are particularly concerned are complex and not yet fully understood. It was formerly thought that the stresses and strains associated with life today was the main factor. Nowadays, although this factor is still believed to play a significant part, the role of essential fatty acids in producing atherometa or plaques in the tiny coronary arteries which feed the heart, are also considered to have great significance. Much work is being done in this field in order to establish more clearly the precise causes of coronary diseases and the steps which can be taken to reduce the apalling loss of life which occurs in middle and late middle age, especially among males. Once again, deaths from cancer of the lung and cancer of the bronchus are still very high, another fact which gives rise to much anxiety. So much has been said and written on this subject that it would appear unnecessary to dwell on the factors which may be contributing to this unhappy rise. One certainly cannot say that there are any specific factors existing in Wood Green which encourage coronary thrombosis or lung cancer. But as I said in. my Report for 1958, it is quite clear that health education has an important part to play in providing advice and guidance which will help to reduce the two most serious types of fatality which our generation has to face. inquests Thirty-two inquests were held following the deaths of Wood Green residents during 1959. A further 165 post mortem examinations were carried out without an inquest, 75 of these in the Prince of Wales Hospital which, by arrangement with the Wood Green Borough Council, provides mortuary services. maternal mortality One maternal death was reported during 1959. As mentioned in the introduction to this Report, this death was due to selfinduced abortion. infant mortality There were 14 deaths of infants under one year of age,which gives an infant death rate of 20 5 per 1, 000 live births as 11 pared with 15 deaths and a rate of 23, 62 in the preceding year, Among the 14 infants who died in Wood Green during 1959 before they had reached the age of twelve months, 12 were under the age of one month. Of these 9 failed to survive one week. Although these figures are satisfactory, at least when one considers the comparable position not so many years ago, we must still strive, are indeed striving to discover the precise factors which produce these infant deaths. To this end. every infant death is accordingly scrutinised and examined in all its aspects. still-births Fifteen still-births, 13 legitimate and 2 illegitimate were accredited to the Borough for 1959. This is equal to a death rate of 22,19 per 1, 000 births, the corresponding figures for 1958 being 13 still-births with a rate of 20.5. The following table shows causes of death at various ages under one year - tinder 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 6 _ _ _ 6 _ _ _ _ 6 Congenital Defects 1 _ _ _ 1 _ _ _ _ 1 Atelectasis _ _ _ _ _ _ _ _ _ _ Gastro-enteritis _ _ _ _ _ _ _ _ _ _ Intra-cranial Haemorrhage _ _ _ _ _ _ _ _ _ _ Capillary Bronchitis _ _ _ _ _ 3 _ _ _ 3 Asphyxia _ _ _ _ _ _ _ _ _ _ Broncho-pneumonia _ 1 _ 1 2 _ _ _ _ 2 Other Causes 2 _ _ _ 2 _ _ _ _ 2 Total 9 1 _ 1 11 3 _ _ _ 14 12 general provision of health services Hospitals There is little I can add to the remarks which I made last year in regard to the Hospital Services available to the Burgesses of Wood Green. The position in regard to the Medical Officer of Health, however, so far as admissions to hospitals are concerned, is still not entirely clear either to patients or even to certain members of the medical profession. Briefly, the Medical Officer of Health has no power to admit a person to hospital, except in special circumstances. We can certainly arrange for the admission of a case of infectious disease to hospital where admission to hospital is required. As this eventuality seldom arises, unless in cases of overcrowding or where both breadwinners go out to work, this is a problem which presents no difficulties. I should however, like to express my thanks to Coppetts Wood Hospital South Lodge Hospital and St. Ann's Hospital for the help which they invariably provide in arranging for a case to be taken into hospital when asked to do so. The other step which can be taken by a Medical Officer of Health is for the admission to hospital of patients who are in need of care and attention, but may be a danger to themselves or to other persons and who refuse admission to hospital. Such action is taken under Section 47 of the National Assistance Amendment Act 1951. Fortunately as action under this Act is by no means a pleasant procedure and seldom yields satisfactory results, we have so far always been able to deal with the matter in other ways. Tact and persuasion can do a lot and have invariably enabled us to secure the consent of even the most stubborn patient who up till then has adamantly refused the care and attention required in hospital. There still seems to be a very live belief, however that the Medical Officer of Health can arrange for the admission of cases to hospital in any circumstances. That is far from being the case. The duty of arranging the removal to hospital of a patient lies fairly and squarely with the family doctor, and not with the local authority. I have, however been able to help in many cases by supporting the general practitioner with removal to hospital, especially in the case of the chronic sick, usually difficult to arrange. I can only do so however when the family doctor has made an application for the removal of a patient to a specific hospital and has been told that this removal could not be affected. I then add my weight and have as I have just said secured the co-operation of the hospital concerned in almost every case with which I deal. I am always only too happy to take this action as although it is not a duty of the Medical Officer of Health to arrange for the admission of a patient to hospital, other than those already mentioned we obviously cannot dissociate ourselves from such an important aspect of preventive medicine. This of course 13 is one of the drawbacks produced by the National Health Act 1948 when hospitals previously under the control of local authorities were brought under the direction of Regional Hospital Boards. Previous to 1948, our relations with local authority hospitals were close and cordial. I must add, of course, that my own relations with the staff of surrounding hospitals leave nothing to be desired. But there must come a time when the present generation of Medical Officers of Health have passed, and when, presumably, the gap between the local authorities and the hospitals serving their districts is not so close as it still is today One can only hope that this day is still distant, but it is a possibility which one cannot avoid. Care of the Aged It would indeed be a truism to say that care of the aged is assuming a significance which demands the most urgent attention. In a district such as Wood Green, with its aging population - the fact that 70% of total deaths occurred in persons over the age of 65 is evidence of this situation - care of the aged assumes particular importance. The Public Health Department is always prepared to help in every way possible, while, of course, the Area Health Office is intimately associated through its Health Visitors Home Helps and Home Nursing Service, with aged persons. I personally have looked forward eagerly to the day when the Old People' s Centre in Wood Green would be functioning. In this connection, I have for some time been considering the possibility of setting up an Old Persons Clinic in Wood Green, a project for which the Old People's Centre might be ideally suited. Old Persons' Clinics at which advice can be given and even certain medical examinations carried out, have already proved their worth, especially when run in conjunction with an established geriatric service. I am of opinion that this type of project calls for careful consideration, although I do not yet know whether or not the Old People s Centre could be used for such a purpose. This, however, is a matter which would naturally require discussion and consultations at a later date. In the meantime the Public Health Department and the Area Health Office are continuing their efforts to alleviate distress and ill-health among the aged. It is quite obvious that much remains to be done. Housing for the aged - and Wood Green is already making its contribution - admission of the chronic sick to hospital, an adequate service of Home Helps, by no means an easy matter, the provision of Home Nurses, visits from Health Visitors and Public Health Inspectors - these are the obvious ways in which we can be of practical help. I would make it clear, however,that care of the aged is a problem intimately associated with public health and preventive medicine and that we are always ready and willing to be of assistance at any time and in any way. 14 Laboratory Facilities As in past years, the Central Public Health Laboratory Service has been of the greatest assistance to us, not only the Central Laboratory at Colindale, but also the Laboratory housed in Coppetts Wood Hospital, where Mr, McGimpsey is the Bacteriologist. I gratefully acknowledge the assistance afforded throughout the year, and the close co-operation which has continued for so many years between the Public Health Department and the Laboratory Service. Summary of the work carried out at the Central Public Health Laboratory for the year as follows - Positive Negative Swabs for diphtheria bacilli – – Sputa for tubercle bacilli – 8 Throat and nose swabs 67 Faeces 279 Urine 1 Blood 2 Others 4 Ice Cream 12 Milk 12 Water (Swimming Pool) 4 NATIONAL ASSISTANCE ACT, 1948 (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 1959. NATIONAL ASSISTANCE ACT, 1948 SECTION 50.Burial or Cremation of the Dead„ The burial was carried out by the Council of a still-born child found at the rear of Brabant Road. There were no burials carried out under this Section during 1958. 15 SANITARY SERVICES Inspections Public Health Act, 1936 554 Housing Act, 1936 244 Rag Flock and Other Filling Material Act, 1951 - Pet Animals Act, 1951 11 Factories and Outworkers 220 Food Preparing Premises 157 General Food Premises 620 Shops Act, 1950 107 Smoke Observations 130 Unsound Food 116 Complaints Investigated 421 Interviews with Owners, etc. 147 Revisits to property under notice 792 Infectious Diseases Cases 89 Special enquiries in connection with infectious disease cases 49 Aged and infirm persons 10 Pests Act 277 Clean Air Act 1,952 Miscellaneous 261 Informal Notices Served Shops Act 3 Complied with 5 Food and Drugs Act 18 " " 14 Public Health Act 223 " " 195 Housing Act – " " 1 Factories Act 16 " " 9 Pests Act – " " – Statutory Notices Served Public Health Act 44 Complied with 54 Housing Act - " " - Factories Act 1 " " 1 Food and Drugs Act 2 " " 2 Rent Act 1957 The number of applications for Certificates of Disrepair has shown a marked decline during the year. Set out below is a table showing the number of applications received as compared with the previous year: - 1958 1959 Number of Applications for Certificates of Disrepair (Form I) 126 23 Number of Proposals to Issue Certificates of Disrepair (Form J) 150 21 Number of Certificates of Disrepair issued (Form L) 61 6  1958 1959 Number of Applications for Certificates of Disrepair rejected 3 Number of Certificates of Disrepair cancelled 7 11 Number of Applications for Cancellation rejected 2 3 Number of visits made in connection with above 376 97 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) 223 (b) Number of inspections made for the purpose 798 (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 196 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 - (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 (2) Proceedings under Public Health Acts:- (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 44 (b) Number of dwelling-houses in which defects were remedied after service of formal notices (i) By owners 54 (ii) By Local Authority in default of owners 17 (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 2 (b) Number of dwelling-houses demolished in pursuance of demolition orders - (H) 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 1 (b) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 1 In no instance was it found necessary for legal proceedings to be taken. Housing Applications The task of visiting housing applicants and the preparation of reports on their living conditions has been discontinued,with the exception of certain cases where information is required by the Councils 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 CLEARANCE AREA The Public Enquiry was held by the Ministry of Housing and Local Government at the Town Hall Wood Green on the 4th January 1959 to hear objections to the Edith Road Clearance Area. The Ministry Inspector conducting the Enquiry visited the Area and we learnt later in the year that the whole of the Area had been confirmed by the Minister. WINKFIELD ROAD/ACACIA ROAD CLEARANCE AREA SECOND PHASE Detailed inspections were completed in respect of properties affected by the Second Phase of this Scheme and reports were submitted to the Health and Cleansing Committee in November 1958, This involved three adjacent areas comprising in all 65 houses which were deemed to be unfit for human habitation, These houses were occupied by 117 families - 275 persons in all. A Public Enquiry was held at the Town Hall Wood Green, on the 4th June 1959 in connection with these Areas, and later the Inspector conducting the Enquiry visited the Area In due course the Ministry informed us that the Area had been confirmed with modifications. 18 The site of Phase I of the Council's Clearance Scheme of Winkfield Road/Acacia Road Compulsory Purchase Order has been cleared, and building operations have commenced. COMMERCE ROAD REDEVELOPMENT PLAN During the year detailed surveys were carried out of properties in the Commerce Road Redevelopment Area and lists of principal defects were prepared and an Official Representation was made to the Council. This was accepted and the Order was entitled "Wood Green (Commerce Road Area No. 1) Declaration of Unfitness Order 1959" and submitted to the Ministry of Housing and Local Government. Clean Air Act 1956 SMOKE CONTROL AREAS A marked turning point in the control of air pollution in the Borough was reached on 1st July 1959 when the Wood Green No.1 Smoke Control Order relating to 1,214 dwellings and 44 other premises in the Alexandra Park district came into operation. Thus a positive start was made to bring an end to the burning of bituminous coal on domestic firegrates in the Borough. Before this step was taken, there were emitted from the domestic chimneys in Smoke Control Area No. 1 some 30 tons of smoke per annum, always at a low level and largely at that time of the year when meteorological conditions produce natural fogs, which, when containing smoke, menace public health. Work in the formation of smoke control areas continued, and in December the Wood Green No. 2 Smoke Control Order was made by the Council and submitted for the approval of the Minister of Housing and Local Government. This Order embraces 1,215 dwellings in an area of 250 acres abutting Snoke Control Area No, 1, and it was proposed that the operative date for the Order be 1st October 1960. It was agreed that an area of 200 acres, abutting Smoke Control Areas Nos. 1 and 2 and containing approximately 1,458 dwellings be surveyed with a view to making it a smoke control area on 1st October 1961. When completed, this phase of the smoke control area programme will have brought to an end the burning of bituminous coal in 27% (estimate) of the houses in the Borough. MEASUREMENT OP AIR POLLUTION A scheme for the measurement of air pollution in the Borough commenced in October 1959. 19 STANDARD DEPOSIT GAUGE THE VOLUMETRIC APPARATUS The apparatus for this purpose consists of:- (a) A standard deposit gauge standing on the roof of the link block of the Town Hall. The container is removed monthly and the contents, which are too coarse to be held in suspension in the atmosphere, are analysed at the Trinity Grammar School Laboratory. (b) A combined smoke and sulpher dioxide recorder, in a second floor room at the Town Hall. The daily assessment of smoke and sulpher dioxide is carried out by the Public Health Inspectors. In view of the short time these measurements have taken place, it is not possible to comment on the trend or the degree of air pollution in the Borough. The reports are sent to the Department of Scientific and Industrial Research at present carrying out a national survey of air pollution. Mr. James attended the International Clean Air Conference at Seymour Hall in London, W. 1., during October. He submitted a full and concise report on this Conference to the Health Committee in November. Mr. Goodfellow was successful in obtaining the Certificate of the Royal Society of Health for Smoke Inspectors. Rodent Control During the year, 159 dwellinghouses in the Borough were treated for rat infestation: this entailed 1,361 visits. In addition 20 other premises were treated for the presence of rats, entailing 95 visits. A further 55 dwellinghouses and 8 other premises required treatment for mice and a total of 469 visits were made in dealing with these. 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 70 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. 22 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-sixth Maintenance Treatment April/May 1959 and (2) Twenty-seventh Maintenance Treatment October/November 1959 Number of Manholes Manholes Showing Pre-bait take Complete Pre-bait take Complete Poison take Part Poison take 27th Apl./ 20th May 672 348 164 0 334 19th Oct./ 13 th Nov. 672 427 266 0 342 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, 23 INSPECTION AND SUPERVISION OF FOOD (a) Food Premises in the Borough Bakers' Shops 23 Butchers' Shops 38 Cafes and Restaurants 52 Chemists' Shops 18 Confectionery and Sweet Shops 84 Dairies and Milk Shops 38 Pried Fish Shops 11 Wet Pish Shops 11 Greengrocers' Shops 45 Grocers' Shops 87 Public Houses and Off-Licences 39 Pood 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 17 23 38 Supplementary Licences to sell milk from premises which are outside the area of the Licensing Authority:- Tuberculin Tested Pasteurised Sterilised 9 10 13 Twelve 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 147 premises registered for retailing Ice Cream. During the year 48 visits were paid to these premises and 12 samples were submitted for bacteriological examination. These 12 samples were all Grade I. Also 44 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 148. (d) Middlesex County Council Act, 1950. Section II. - Registration of Hawkers of Food. Twenty-six hawkers of food in the Borough are registered. 24 (e) Meat and Other Foods Condemned The under-mentioned foodstuffs were certified as unfit for human consumption during the year:- lbs. Meat 890½ Tins Meat 255 Pish 15 Vegetables 99 Fruit 83 Evaporated Milk 8 Soup 4 Tomato Juice 21 Tomatoes 47 532 MISCELLANEOUS ITEMS - Sauce 2 Chutney 2 Pickles 8 Raisins 1 Blackcurrants 1 Sterilised Milk 1 Clear Consomme 1 Sugar Strands 1 Liquid Egg Colour 1 After examination by the Public Health Inspector condemned food is collected by this Departments van, 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 776 visits were made to food premises, as set out below:- Dairies and Milk Shops (Registered) 74 Butchers 148 Ice Cream Premises 48 (Registered) Fried Fish Shops 21 Stalls (Registered) 49 Other Food Premises 436 Full use has again been made of the propaganda material available, including posters from the Ministry of Health, Ministry of Agriculture, Fisheries and Pood, the Central Officer of Information and the Central Council for Health Education. 25 FACTORIES AND HOMEWORK I. Inspections Premises No. on Register Number of Inspections Written Notices Occupiers prosecuted FACTORIES WITHOUT mechanical power 30 20 - - FACTORIES WITH mechanical power 179 196 1 - OTHER PREMISES In which Section 7 is enforced by the local authority 2 2 _ - Total 211 218 1 - 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 - - - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary conveniences (a) insufficient 1 1 - 1 - (b) unsuitable or defective 2 1 - 2 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - - - - - Total 3 2 - 3 - 3. Outwork No. of outworkers in August list No. of cases of default in sending lists to Council No. of prosecutions for failure to supply lists No. of Instances of work in unwholesome premises Notices served Prosecutions Wearing apparel making etc. 1 - - - - - Household linen - - - - - - Lace,lace curtains and nets - - - - - - Curtains and furniture hangings - - - - - - Toy painting 50 - - - - - Artificial Flowers 1 - - - - - Feather sorting - - - - - - Cosaques,Christmas crackers and stockings 12 - - - - - Total 64 - - - - - 26 Water Supply The whole Borough is in the area supplied by the Metropolitan Water Board and every house has a constant supply Rag Flock and Other Filling Materials, Act,1951. Three premises in the Borough are registered under the above Act. 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. Housing The Borough Surveyor has kindly supplied me with the following figures showing the number of dwellings which have been erected or rebuilt during the year. Council dwellings completed:- 6 flats and 3 maisonettes at Alexandra Park Road Council properties in course of construction at end of year:- 4 maisonettes Trinity Road 36 maisonettes and 18 flats Winkfield and Acacia Roads 6 houses Devonshire Hill Lane Private enterprise properties completed or in course of construction - 19 Swimming Baths The figures of attendances at Western Road and Durnsford Road Baths for the past two years are as follows:- Western Road Baths 1958 1959 Swimming Bath 88,529 93,417 -do- Children (Special sessions) 627 643 Children from Schools 21,729 26,099 Spectators 9,371 9,057 Slipper Baths 37,310 36,939 -do- Old Age Pensioners (free) 2 927 3,263 27 Durnsford Road Open Air Baths 1958 1959 Adults 15,025 45,742 Children 39,291 81,930 Children from Schools 1,455 1,742 Season Ticket Holders 31,583 46,131 Spectators - Adults 5,712 11,227 Children 617 895 Samples of water were taken from both baths. The results of the tests were uniformly satisfactory. There is nothing I can add to the remarks which I have made in previous Annual Reports relating to the use of our Swimming Baths. This was especially noticeable last summer, when full advantage was taken of the excellent weather. During the summer months, Durnsford Road Swimming Bath not only proved itself a first-class amenity, but what is even more important, showed itself to be a means of providing health-giving exercise; in the open air. One matter which has been exercising me, particularly as District School Medical Officer has been the increasing incidence of plantar warts (verrucas) among schoolchildren. Although it is quite obvious that swimming baths are by no means the only way in which verrucas can be spread, it is equally obvious that the wet surrounds of swimming baths, either open-air or closed, provide an excellent means of allowing the virus which causes verrucas to pass from one child to another. In order to try to obviate this particular means of spreading verrucas. I addressed the letter set out below to the Superintendent of our swimming baths:- "I have been worried for some considerable time about the matter of the exclusion of children from the Swimming Baths who are a danger to other children - and even to adults - by reason of the spread of infectious diseases. I am thinking particularly of that great nuisance, the plantar wart or, as it is usually known,the verruca, even when the wart is covered by adhesive plaster. As we are all aware, adhesive plaster has a nasty habit of coming off in water. "We know that these warts can be and are being spread to quite an extent on swimming bath surrounds. The reason is very simple. Swimming bath surrounds are one of the few places where large numbers of children persistently walk for fairly long periods with bare feet, If a child with a verruca walks on a swimming bath surround with bare feet, the virus which causes a verruca can be left behind on the surround and may be picked up by any child who follows shortly afterwards. As you will see, it is not the swimming bath itself which has anything whatsoever to do with the spread of verrucas; it is simply and solely the fact that children do use the surrounds in bare feet. 28 "If we could be sure that children with verrucas on the sole of the foot were excluded from swimming baths, I am perfectly certain that the incidence of verrucas would very considerably diminish. As you may be aware, I have tried, by articles in the press, by letters to head teachers, by talks to parents, etc., to instil into everyone concerned the vital importance of ensuring that children do not visit swimming baths when they are suffering from a verruca. Unfortunately, in spite of all we have done, some parent s are still sufficiently careless as to allow their children to visit our swimming baths, knowing perfectly well that they have a verruca. And it is here that we would very much like your continued help. "I know how very helpful you have been in the past. Indeed, I am more than delighted at the number of times the Public Health Department has been telephoned, enquiring as to whether or not a particular child should be excluded, either because of a verruca or for any other reason. This always gives us very great pleasure, as it is a clear sign of the co-operation which is so essential and which we all desire so much. Please do not hesitate to exclude any child from the swimming bath when, in your opinion, this could be justified on health grounds. A telephone message to the Public Health Department will then clear the matter up, if any difficulty still remains. "I would assure you that I am always prepared to take responsibility for advising you on exclusions, and that you may ask for ray advice or the advice of my Department at any time whatsoever. "It is not, of course, verrucas only which may cause the exclusion of a child from a swimming bath. Children with sores on the feet and body - impetigo or any other skin infection which is contagious - heavy infestation which can actually be seen (fortunately this is extremely rare indeed) or any other condition which is apparent or which is admitted and which might be liable to spread infection in the swimming bath, should be excluded. And here again I am not thinking so much of people swimming in the water as to their mixing together on the surrounds or while sun-bathing. "It is not really possible to detail all the types of infections or even non-infectious illnesses which may necessitate exclusion. But once again, the Public Health Department will give you advice at any time. In this connection, I was particularly glad to receive an enquiry from an attendant at one of our swimming baths. The attendant had noted that a child had arrived for swimming at a time when the schools were in session. She asked the child why he was not at school, and was informed that his sister was suffering from Sonne Dysentery. Very properly the attendant telephoned the Public Health Department, when we verified that she was perfectly correct in not allowing this child to enter the swimming bath. I merely give this as an example of the excellent co-operation which has been 29 in existence for so very long and which we feel quite sure will continue. "While writing, might I mention the annual subject of making quite sure that children do not remain too long in the swimming bath, even when no cases of polio have been reported in the neighbourhood. As you well know exhaustion is one of the most potent factors in turning what might very well be a mild case of polio into a serious illness, even a great disaster, I would therefore be very glad if as always, you will have no hesitation in restricting the time during which children remain in the bath. If you have any difficulty in enforcing this order - or, indeed, any order at all - I would once again state that we will give you all the help within our power." "P.S. It would be quite impossible to prepare a notice which would draw all the pertinent facts relating to exclusion from swimming baths to the attention of parents and children, I feel that any such notice would have to be condensed. I have therefore drafted a brief statement, which I very strongly feel should be prominently displayed at the swimming bath. I would be most grateful to have your opinion on the wording, size of notice, position where it should be displayed etc. Please do not hesitate to make any criticisms or suggestions. These I am quite sure, would be really valuable." NOTICE CHILDREN WITH ANY SKIN INFECTION OR WITH A VERRUCA ON THE SOLE OF THE FOOT WILL NOT BE ADMITTED TO THE SWIMMING POOL. W. C. HARVEY, Medical Officer of Health 30 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 quired. 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 1958/59 the total tonnage of refuse collected was 11,663 tons, from this, material salvaged was sold for £2,176. The quantities of salvage were; - Tons Cwts. Qtrs. Paper 62 16 2 Mixed Scrap Iron 50 18 3 Rags 5 3 2 Non-Ferrous Metals 2 10 - Scrap Tyres 1 3 - Flock Mattresses 14 18 - Tins 373 12 2 Bottles 18 5 2 The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths. 31 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 40, it will be seen that 360 cases of infectious diseases were notified during the year as against 651 in 1958. The fall in the number of infectious diseases during the year was due almost entirely to the fact that 1959 was not a "measles year". As regards the infectious diseases picture as a whole, I cannot do better than to quote in full the report which I made to the meeting of the Health and Cleansing Committee held on the 26th February 1960:- "The following table sets out the notifiable infectious diseases for the years 1959 and 1958:- 1959 1958 Scarlet Fever 28 77 Diphtheria - - Cerebro-Spinal Fever - - Enteric or Typhoid Fever - 1 Paratyphoid Fever 3 - Erysipelas 1 1 Pneumonia 46 34 Acute Poliomyelitis 7 2 Acute Encephalitis 1 - Puerperal Pyrexia - 1 Pulmonary Tuberculosis 42 30 Non-pulmonary Tuberculosis 3 3 Malaria - - Measles 169 421 Whooping Cough 16 40 Ophthalmia Neonatorum - - Dysentery 35 40 Food Poisoning 9 1 Smallpox - - 360 651 "After a rise in the number of scarlet fever notifications during 1958, in 1959 the number again fell to a low figure comparable to the small number of cases notified since 1954. "Most of the cases of measles notified during 1958 were in the latter quarter of the year. whereas those for 1959 were mainly within the first month or two being the end of the 1958 measles outbreak. The nature of the illness was extremely mild. The need for removal to hospital was virtually confined to those cases removed for domestic reasons. "Once more there was a very low incidence of whooping cough (pertussis). Although statistical evidence is not available, 32 I am personally convinced that the campaign for the protection of Wood Green children by inoculation against this disease is having a beneficial effect. "The total number of cases of pneumonia notified during 1959 was slightly higher than those notified during 1958 and this can in part be attributed to the very cold wet weather experienced during the early part of the year. The majority of cases occurred among elderly persons. Pneumonia is, however, no longer a serious illness. The introduction of modem antibiotics has removed many of the terrors of this disease,except in the very old and very young. We will, of course, have to contend with the occasional case of virus pneumonia, against which the antibiotics are virtually powerless. Fortunately, however, these cases are comparatively rare. "The incidence of food poisoning and dysentery during the year remains relatively static. As I have remarked before, however, we know that the notifications of food poisoning and dysentery sent to the Public Health Department by no means account for all the cases which occur, "There were seven cases of Poliomyelitis notified during 1959 (4 non-paralytic and 3 paralytic) compared with two cases of paralytic poliomyelitis in 1958. As the Committee are aware from my previous reports, one of the cases in 1959, in fact the last case reported to me, was a man of 25, who unfortunately died after an illness of very short duration. The others, I am pleased to say, have all recovered. Two of the children have been left with a slight weakness, which will in time be reduced with modern therapy. Among the persons affected, those who had had one or two inoculations against poliomyelitis suffered from an extremely mild attack and in every case where injections had been administered, the person suffered from nonparalytic poliomyelitis. "The figures relating to tuberculosis in 1959, although higher than in 1958, are still considerably lower than, let us say for instance, in 1954 when the figure was 81. It is very difficult to make a definite statement on either the rise or decline in the tuberculosis notifications within the Borough, having regard to the small numbers involved. None the less, it would appear that Wood Green is sharing in the nation-wide improvement and that the number of yearly notifications in Wood Green gives no cause for dissatisfaction. "It is hoped that it will be possible to arrange for a further visit of the Mass Radiography Unit 6A to the Borough some time later this year. "Altogether the infectious disease picture during 1959 is most satisfactory. "in concluding this review of infectious diseases,I should make mention of the immunisation and vaccination programme 33 which the Area Health staff and family doctors carry out in Wood Green. Inoculation against diphtheria, pertussis and tetanus is now available at the two clinics in Wood Green. The use of the new "treble antigen" began on the 1st January 1960 and is already proving extremely popular with mothers. Less visits are now required either to a clinic or to the family doctor, while protection against tetanus is now also available. As several cases of tetanus have occurred in North London within recent months - one in fact was a Wood Green child this appears to be a logical addition to our protective armament. "The latest figures for Wood Green children show that 87.8% of children up to the age of two years were protected against diphtheria by the end of 1959, while approximately the same number were protected against pertussis. The figures for protection against tetanus are, of course, not yet available. I think it would be fair to say that these figures, although good, still leave much to be desired. "Vaccination against smallpox is also available at both clinics and our latest figures show that 78.7% of children up to the age of two years were vaccinated against smallpox by the end of 1959. Although this figure is quite high, it still leaves much to be desired in a community such as ours. It must be remembered, however, that not so many years ago little more than 20 to 25% of children were so protected. It is hoped to make considerable improvements on the average during 1960. "Our scheme for vaccination against poliomyelitis among children and adults is comprehensive. Vaccination against poliomyelitis is available at both Wood Green clinics, whilst special clinics have been arranged on Saturday mornings to cope with young adults up to the age of 26. We know that approximately 90% of children up to the age of 15 were protected against poliomyelitis by vaccination by the end of 1959. The figures relating to the 15 - 26 age group is not fully known since many young adults were protected at their place of work or in the City. We have, however, reason to believe that at least 50% of adults in this age group have been protected by vaccination. Here I think it can be claimed with some confidence that these figures are as good as any in England or Wales. We are now, of course, offering vaccination to all adults up to the age of 40. "Our publicity scheme in relation to all types of immunisation and vaccination is very complete in Wood Green. This includes primary vaccination or immunisation in addition to reinforcing injections given at schools. I think it could be said that we do more in this direction than most other areas in Middlesex. Indeed some of my colleagues seem to think we do too much. None the less, I am firmly convinced that publicity plays a very important part in health education and is partly responsible for the good results we can show in Wood 34 Green. We also work in the closest harmony with general practitioners. I have made it a practice to keep general practitioners informed of the latest developments in this field. I also try to ensure that we are also working along the same lines. I am very happy to say that these efforts appear to be successful." One or two other points regarding infectious diseases might be mentioned. For the twelfth year in succession no case of diphtheria was notified in the Borough. The last death took place approximately 20 years ago. We must not, however,allow ourselves to be lulled into any sense of false security by such a happy statement. Only this year, a number of cases of diphtheria occurred in a Borough not many miles from Wood Green. This limited outbreak was particularly interesting from two aspects. In the first place, it was found that those few children who had been immunised and who still developed diphtheria, developed the disease in a mild form, recovered quickly and with no ill-effects. On the other hand, the single death which occurred took place in a child who had not been immunised at any time. In other words, the value of immunisation was strengthened since although only a few cases were involved, it was clearly shown that the few children who developed diphtheria after immunisation came to no harm, but merely suffered a comparatively minor illness. The second lesson to be learnt from this outbreak of diphtheria - and it was not the only outbreak of diphtheria which occurred in England and Wales during 1959 - points to the fact that the organism which causes diphtheria still exists and is quite able to strike. In short although it may be true to state that many recently qualified general practitioners have never seen a case of diphtheria, our campaign of immunisation must be continued relentlessly. The fact that approximately 88% of Wood Green children up to the age of two years were protected against diphtheria by immunisation at the end of 1959 is highly encouraging though it still leaves much to be desired in a community such as this. 35 Tuberculosis For your further information, I set out below a broad classification of the cases of tuberculosis notified during the past five years in relation to employment:- 1955 1956 1957 1958 1959 Clerical 12 5 4 5 4 Manual Labour 17 7 3 2 10 Housewives 8 3 3 9 3 Factory workers - 5 3 2 8 Children 5 5 1 - 3 Professional classes 2 3 3 2 3 Domestic Service 2 - 1 1 1 Nurses 1 - - - - Shop Assistants 4 1 2 3 3 Armed Forces 2 - - 1 - Retired Persons 2 2 - - 3 Unclassified 1 6 5 8 5 56 37 25 33 43 The number of cases on the register at the end of the year was 681 as set out in table on page 46. Our scheme for the B.C.G. vaccination of Wood Green schoolchildren continues and is working very well. As I explained in my Annual Report for 1958, of course, this work is undertaken by the School Health Service. Satisfactory as the infectious diseases picture is, not only in Wood Green but throughout the country as a whole, few Medical Officers of Health are entirely happy on the question of notification. Notification is, and must remain an essential part of our defence mechanism against the spread of infectious diseases. But times change, and infectious diseases with them. Recommendations have been made by the Public Health Committee of the British Medical Association and by the Society of Medical Officers of Health, relating to suggested changes in the general pattern of notification designed to bring our procedure into line with modern conditions. As this matter is being taken up and will presumably be considered by the Ministry of Health in due course, there would seem to be little point in discussing it further here. I would merely mention, once again, the anomaly which exists in regard to scarlet fever. As has been said, it is thoroughly illogical that a legal distinction continues to be drawn between a streptococcal infection which includes a rash, i.e. scarlet fever, and a streptococcal infection which does not include a rash. It may be that until everyone concerned is completely satisfied that the present mild form of scarlet fever is here to stay - and this is by no 36 means certain - notification should continue.. On the other hand, one cannot see why notification should be necessary so long as scarlet fever retains its present mild form, since steps could be very quickly taken to reintroduce notification of scarlet fever if and when there was any indication that its virulence had changed. In the meantime, we continue to carry out the instructions which govern the notification of infectious diseases so far as lies within our power. The fact that quite a number of especially mild cases of scarlet fever never seem to come to our notice, and the fact that an even greater number of cases of food poisoning and dysentery never even reach the doctor" s surgery does not seem to have made any appreciable impact upon the occurrence or spread of these diseases. DISINFECTION AND DIS INFESTATION The number of articles dealt with at the Disinfection Station was as follows:- Articles disinfected 76 Articles destroyed 30 22 rooms were disinfected on account of infectious disease. 16 premises were disinfested on account of the presence of vermin, which involved the disinfestation of 32 rooms. 158 premises were treated for infestations of cockroaches, wasps, ants, flies, bluebottles, fleas, beetles, bees., moths, lice, silver fish, maggots and woodworm. 68 library books were brought to the Department during the year for disinfection. The Council's bedding van, after a useful life of twelve years, has been replaced by a new vehicle fitted with an insectproof partition between the cabin and the body of the van. The floor is made of impervious material. 37 8£ APPENDIX 1 TABLE 1 Vital Statistics of Wood Green 1939-59 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) 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 - 631 119 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 1959 48,520 640 14.1 36 14 20.71 2 55.56 604 12.4 68 TABLE II INFECTIOUS DISEASES FOR THE PAST 25 YEARS Year Diphtheria Scarlet Pever 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 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 1959 - - 28 - - - 30 1 3 - 169 - 16 - 7 1 / - Notifications *D - Deaths 40 TABLE ill Infectious Diseases Notified during the year 1959 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 Pever 28 5 21 1 1 - - - - - - 8 8 12 16 - Diphtheria - - - - - - - - - - " - - - - - Cerebro-Spinal Pever - - - - - - - - - - - - - - - - - Enteric or Typhoid Pever - - - - - - - - - - - - - - - - - Para-typhoid Pever 3 - - 1 " 1 - - - 1 - - 2 - 1 3 - Erysipelas 1 - - - - - - - - 1 - - - 1 - - - Pneumonia 46 1 - 4 1 - - 3 2 6 12 17 9 14 23 23 33 Acute Poliomyelitis 7 - - 4 1 - 1 1 - - - - - 5 2 7 1 Acute Encephalitis 1 - - - - - - 1 - - - - - 1 - 1 - Puerperal Pyrexia - - - - - - - - - - - - - - - - - Pulm. Tuberculosis 42 - - 1 1 1 6 7 6 8 7 6 18 13 11 13 1 Non-Pulm. Tuberculosis 3 - - - - - 1 1 - - 1 - 3 - 2 - Malaria - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - Measles 169 6 92 65 2 2 - 2 - - - 61 60 48 6 - Whooping Cough 16 1 9 5 - 1 - - - - - - 2 14 - 4 - Opthalmia Neonatorum - - - - - - - - - - - - - - - - - Dysentery 35 1 11 9 3 - 1 4 5 - 1 - 17 11 7 3 - Pood Poisoning 9 1 - 2 - - 1 1 2 - - 2 2 1 6 3 Totals 360 10 117 112 9 6 9 20 16 16 19 26 119 131 110 81 35 TABLE IV Causes of death during the year 1959 Causes of Death Male Female Tuberculosis, respiratory 1 Tuberculosis, other - - Syphilitic disease 1 1 Diphtheria - - Whooping Cough - - Meningococcal infections - - Acute Poliomyelitis 1 - Measles - - Other infective and parasitic diseases - - Malignant neoplasm, stomach 9 6 Malignant neoplasm, lung, bronchus 27 8 Malignant neoplasm, uterus - 6 Malignant neoplasm, breast - 16 Other Malignant and lymphatic neoplasms 37 32 Leukaemia, aleukaemia - 4 Diabetes 1 1 Vascular lesions of nervous system 29 40 Coronary disease, angina 69 35 Hypertension with heart disease 4 6 Other heart diseases 26 37 Other circulatory disease 18 19 Influenza 3 2 Pneumonia 18 15 Bronchitis 24 11 Other diseases of respiratory system 2 4 Ulcer of stomach and duodenum 6 2 Gastritis, enteritis and diarrhoea., 2 1 Nephritis and nephrosis 1 - Hyperplasia of prostate 2 - Pregnancy, childbirth, abortion - 1 Congenital mal formations 2 1 Other defined and ill-defined diseases 17 28 Motor vehicle accidents 3 3 All other accidents 7 9 Suicide 1 5 Homicide and operations of war - Total 310 294 41 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 - - - - - - - - - - - - Tuberculosis, other - - - - - - - - - - - - Syphilitic disease 1 - - - - - - - - - - 1 Diphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal Infections - - - - - - - - - - - - Acute Poliomyelitis 1 - - - - - 1 - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasm stomach 9 - - - - - - - 1 1 2 5 Malignant neoplasm lung, bronchus 27 - - - - - - 1 5 6 3 12 Malignant neoplasm breast - - - - - - - - - - - - Other malignant and lymphatic neoplasms 37 - - - - - - 1 4 4 6 22 Leukaemia, aleukaemia - - - - - - - - - - - - Diabetes 1 - - - - - - - - - - 1 Vascular lesions of nervous system 29 - - - - - - 1 1 8 11 8 Coronary disease, angina 69 - - - - - - - 9 10 13 37 Hypertension with heart disease 4 - - - - - - - 1 - 1 2 Other heart diseases 26 - - - - - - 1 - 3 15 7 Other circulatory diseases 18 - - - - - - - - 4 9 5 Influenza 3 - - 1 - - - - - - - 2 Pneumonia 18 1 - - - - - 1 2 6 8 - Bronchitis.. 24 2 - - - - - - 2 3 4 13 Other diseases of respira tory system 2 - - - - - - - - 1 1 - Ulcer of stomach and duodenum 6 - - - - - - - - 1 2 3 Gastritis, Enteritis and Diarrhoea.. 2 - - - - - - - - - - 2 Nephritis and nephrosis 1 - - - - - - - - - - 1 Hyperplasia of prostate 2 - - - - - - - - - - 2 Totals carried forward 280 3 - 1 - - 1 5 25 47 75 123 42 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 280 3 - 1 - - 1 4 25 47 75 123 Congenital malformations 2 2 - - - - - - - - - - Other defined and illdefined diseases 17 4 - - - - - 1 1 6 3 2 Motor vehicle accidents 3 - - - - - 1 - - 1 - 1 All other accidents 7 - - - - - - - 3 - 3 1 Suicide 1 - - - - - 1 - - - - - Homicide and operations of war - - - - - - - - - - - - Totals 310 9 - 1 - - 3 6 29 54 81 127 43 TABLE IVB Females Causes of Death All Ages Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis, respiratory 1 - - - - - - 1 - - - - Tuberculosis, other - - - - - - - - - - - - Syphilitic disease 1 - - - - - - - - - - 1 Diphtheria - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - Measles - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - Malignant neoplasm, stomach 6 - - - - - - - 2 2 1 1 Malignant neoplasm, lung, bronchus 8 - - - - - - 1 2 1 4 Maglignant neoplasm breast 16 - - - - - - 1 3 2 3 7 Malignant neoplasm uterus 6 - - - - - - - - - 3 3 Other malignant and lymphatic neoplasms 32 - - - - - - 3 2 9 14 4 Leukaemia, aleukaemia 4 - - - - - - - 1 1 - 2 Diabetes 1 - - - - - - - - - 1 - Vascular lesions of nervous system 40 - - - - - - 1 2 3 14 20 Coronary disease, angina 35 - - - - - - 1 5 8 5 16 Hypertension with heart disease 6 - - - - - - - - 2 1 3 Other heart diseases 37 - - - - - - 1 - 3 8 25 Other circulatory diseases 19 - - - - - - - - - 1 18 Influenza 2 - - - - - - - - - - 2 Pneumonia 15 - - - - - - 2 1 5 7 - Bronchitis 11 1 - - - - - - - 1 2 7 Other diseases of respiratory system 4 - - - - - - - - - 2 2 Ulcer of stomach and Duodenum 2 - - - - - - 1 - - 1 - Gastritis,Enteritis and Diarrhoea 1 - - - - - - - - - - 1 Nephritis and nephrosis - - - - - - - - - - - - Totals carried forward 247 1 - - - - - 12 18 37 63 116 44 TABLE 1VB (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 247 1 - - - - - 12 18 37 63 116 Pregnancy, Childbirth Abortion 1 - - - - - 1 - - - - - Congenital mal formations 1 1 - - - - - - - - - - Other defined and illdefined diseases 28 4 - - - - - - 2 2 3 17 Motor vehicle accidents 3 - - 1 - - - 1 - 1 - - All other accidents 9 - - - - - - - 2 - 1 6 Suicide 5 - - - - - - 2 1 1 - 1 Homicide and operations of war - - - - - - - - - - - - Totals 294 6 - 1 - - 1 15 23 41 67 140 45 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary NonPulmonary Total M. P. M. F. No. of cases on Register at end of 1958 331 262 15 48 656 New cases notified during 1959 24 15 1 3 43 Transfers from other Districts 6 11 - - 17 No, of cases removed from Register 19 12 1 3 35 No. of cases on Register at end of 1959 342 272 15 48 681 New Cases and Mortality during 1959 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. P. M. P. P. 0 - - - - - - - - 1 - - - - - - - - 5 2 - - - - - - - 15 4 12 - - - - - - 25 4 6 - 1 - - - - 35 6 2 1 " - 1 - - 45 6 3 - - - - - - 55 4 2 - 1 - - - - 65 and upwards 4 1 - 1 - - - - Totals 30 26 1 3 - 1 - - Above includes transfers (42)from other districts. 46 APPENDIX I Health Education We are proud, and I think very rightly proud, of the work which is being carried out in Wood Green in the field of health education. The cost of health education in Wood Green has been infinitesimal, when compared with that of most other public services. Although the effect which health education has had on the occurrence of disease and, what is more important still, on the promotion of health is difficult to gauge, I have not the slightest doubt that our programme of health education has contributed in no small measure to the health and well-being of Wood Green. As will be known, of course, we share the duties of health education with the Middlesex County Council part being carried out by the Public Health Department and part by the staff of the Area Health Office, This is a particularly good example of the benefit which accrues through the Medical Officer of Health being Area Medical Officer for the same Area. I am able to correlate the work, to ensure an even distribution, to make use of those officers best qualified and best able to carry out any particular function of health education. The April issue of the journal "The Medical Officer" contained a most interesting article by a Medical Officer of Health in which the order of preference of various sections of the community in regard to health education was set out. The survey carried out showed that the most popular means of propaganda were television programmes, closely followed by films. At the bottom of the list - and I was not at all surprised at this - came the distribution of pamphlets, a means of health education about which I have had increasing doubts. I was also interested to see that, of the eleven means of health education listed, exhibitions came ninth in the list. Here again, this is what one might expect, since exhibitions unless they deal with an urgent, topical problem, have singularly little effect upon the public. For this purpose it is hoped to purchase our own projector during 1960, In conclusion this brief report on health education, I would make special mention of the great assistance afforded by the Borough Council in promoting the display of propaganda material relating to vaccination against poliomyelitis. Without the help of the Borough Council it is extremely doubtful whether we could have obtained sufficient sites to make known the fact that vaccination against poliomyelitis was being carried out throughout the district, and that this was a matter in which everyone must of necessity be interested. It would indeed be true to say that cooperation in projects such as this is absolutely essential. 47 APPENDIX 2 Miscellaneous (a) Letters to Doctors Letters on the following subjects were circulated to Wood Green practitioners in 1959, some under my signature as Medical Officer of Health and others either as Area Medical Officer or District School Medical Officer :- January 16th - Old Persons' Welfare - Assistance in the Home, etc. February 26th - List of useful addresses and telephone numbers April - Laboratory Collections - Easter Holiday. April 20th - Polio Vaccine - temporary shortage of vaccine. May - Laboratory Collections - Whitsun. June 5th - Poliomyelitis - occurrence of cases in Islington and vaccination sessions. June 15th - Poliomyelitis - continuance of Islington outbreak - vaccine in single dose containers. July 13th - Poliomyelitis - cases in Wood Green, July 16th - Poliomyelitis - limited outbreak in Wood Green and vaccination. July 22nd - Further cases of Poliomyelitis. July 23rd - Poliomyelitis - further information re Wood Green cases. July 27th - Further case of Polio, July 29th - Polio Vaccine and Penicillin Sensitivity- August 4th - Poliomyelitis - Vaccination of Contacts. September 24th - Polio Vaccination - Expectant Mothers. November 12th Immunisation and Vaccination Programme. December 4th - Notification of cases of dysentery. December 10th - Laboratory Collections of specimens - Christmas Holiday. 48 (b) Medical Examinations During the year 60 medical examinations were carried out, 12 of these were in respect of entrants to the Council's employ for acceptance into the Superannuation Scheme, 14 in respect of workmen already in the Council' s employ for acceptance into the Superannuation Scheme and 34 in respect of workmen for acceptance into the Sickness Pay Scheme. In addition, 26 medical reports were issued relating to employees absent from duty through sickness. These reports were obtained from the family doctor with whom we have the most happy relations. (c) Additional Reports to Health Committee January - Conference of The National Society for Clean Air 1958. February - Report on Preliminary Survey.of Proposed Smoke Control Area No. 2 and Estimated Cost of Necessary Works and Programme of Further Smoke Control Areas. Report on Mechanical Coal Handling Plant, Palace Gates Siding. May - Measurement of Air Pollution. Royal Society of Health Congress. August and - Health Services Handbook. October October - Fluoridation of Water Supplies. November - Proposed Smoke Control Area No. 2. Annual Conference of The Association of Public Health Inspectors. International Clean Air Conference. 49