Library BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1963 JANET RUSSELL CAMPBELL, M. B., Ch. B., D.P.H. Medical Officer of Health. WOOD 45 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1963 JANET RUSSELL CAMPBELL, M. B., Ch. B., D.P.H. Medical Officer of Health. MOH Wood green DR Kuck Room. C 317 Public Health Department, Town Hall, Wood Green, N. 22. To THE MAYOR, ALDERMEN and COUNCILLORS of the BOROUGH OP WOOD GREEN. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for 1963. In the vital statistics for 1963 a highly satisfactory feature is the steep drop in the infant mortality rate to 16.75. The birth rate, with 896 live births, was 19.0 per 1,000 of population. The death rate was 12.39, slightly higher than last years figures of 12.23. There were no maternal deaths during 1963. The infantile mortality rate, i.e. the number of infants who died during the first year of life per 1,000 live births fell from 29.5 to 16.75, a very satisfactory record. Two trends referred to in last years report a rising birth rate and an increase in the illegitimate birth rate, are again evidenced this year as is shown in the following tables Birth Rate Illegitimate Birth Rate as % of total live births 1959 13.4 1959 5.33% 1960 13.8 1960 5.05% 1961 14.1 1961 8.10% 1962 13.8 1962 9.12% 1963 14.5 1963 11.05% The number of infectious diseases notified during 1963 was 650 as against 362 last year, This was accounted for largely by the increase in the number of cases of measles. There were 4 deaths from tuberculosis in 1963 all aged over 55, these being the only deaths from notifiable disease. There were no notifications of poliomyelitis nor of diphtheria during the year under review. The last case of poliomyelitis occurred in 1959, five years ago, and the last case of diphtheria 3 in 1947, 16 years ago. Notifications of whooping cough were 77. The pattern of health problems developing today drives home the importance of Health Education as a vital part of local authority Health Services. Two important factors in health education are: (a) Impact on young people - and this must involve co-operation between parents, teachers and medical staff; and (b) Timing. (a) There have recently been produced some excellent films on smoking and on sex education, and several of our Head Teachers have expressed a wish that we should show these films in the schools. As a preliminary to this, meetings have been arranged with parents and staff. This affords the parents particularly an opportunity of seeing the films and of discussing the appropriateness of their use in the schools concerned. Obviously if the parents have full knowledge of the instruction being given in school they will be in a much stronger position to add their influence to that of the teachers and the medical staff and I hope that a greater measure of success may be achieved. (b) The advantage gained by timing in health education was illustrated when, during the recent Aberdeen typhoid epidemic every school in Wood Green, secondary, junior and infants, was visited by a Medical Officer, Health Visitor or Public Health Inspector and a very brief but very downright talk given on the method of spread of typhoid fever, which is the same as that in dysentery and poliomyelitis. The importance of proper hand washing after visiting the toilet and before eating and preparing food was driven home. In every case the children showed a lively interest and the school staff were not only welcoming but very appreciative. At the same time a display of posters, leaflets etc, was staged in the Town Hall. I need hardly emphasise the increasing amount of work falling upon the Public Health Inspectors particularly in the field of smoke control and housing, but it has been a good year of work, thanks to the willing effort of all concerned. With the coming merger of the personal and environmental health services in the new Borough of Haringey, the close and friendly co-operation of the staffs of the Borough and the County Area is particularly fortunate. Particularly is this so in regard to care of the aged and in health education To the great sorrow of his staff and, I am sure, of the Council, Dr. Harvey, after a year s sick leave, resigned his appointment 4 in October. His interest, however, in the staff and in the work of the Council still continues. A further blow to the Department was the death within a few days of his retirement of the Chief Public Health Inspector Mr. McCauley. Mr. McCauley held a very special place in the respect and affection of all members of the staff and of a large section of the public as well. On Dr. Harvey's retirement Dr. Mary Douglas was appointed as my Deputy and I should like to thank her warmly for the generous help she has given me. My grateful thanks are due also to the Chief Public Health Inspector, Mr, James, to Mr. Ingram and indeed to every member of the Health Department. I feel I must also acknowledge with thanks the very friendly co-operation I have received from the other Chief Officers. In conclusion, I would once again thank the Council, particularly the Chairmen and members of the Health & Cleansing and Staff Committees for their unfailing interest and support. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Janet R. Campbell, Medical Officer of Health, 5 BOROUGH OF WOOD GREEN HEALTH AND CLEANSING COMMITTEE Alderman C. D. MOSS (Chairman) Alderman E.E.NICE (lice Chairman) The Mayor, Councillor Mrs. L. A. ANGELL, J. P. Councillor J. S. DOWNIE Alderman J. W. BARNETT Councillor Mrs. D. C. FINDLEY Councillor Mrs. P.M. DINES Councillor B.L.GREENWAY STAFF Medical Officer of Health - William Clunie Harvey, M.D., D.P.H., (Resigned 19.10.63) Medical Officer of Health - Janet Russell Campbell, M. B., Ch. B., D.P.H. (Appointed 19.10.63) Deputy Medical Officer of Health - Mary Curr Douglas, M.B., Ch. B., D. P. H. (Appointed 19.10.63) Chief Public Health Inspector - W. McCauley, Cert. R. San. Inst., and San. Insp. Joint Board, Cert. Meat and Food Inspection. (Died 2.10.63) Chief Public Health Inspector F. James Cert R. San Inst, and San. Insp. Joint Board, Cert Meat & Food Inspection. Cert. R Soc of Health Smoke Inspector (Appointed Chief 15 10 63) Public Health Inspectors - W. E. Goodfellow, Cert. R. San. Assoc. of Scotland, Cert. Meat & Food Inspection and Cert. R. Soc. of Health, Smoke Inspector. (Appointed Deputy 15.10.63) H.J.Bailey, Cert. R. San. Inst. and San, Insp. Joint Board, Cert. Meat and Food Inspection. J. E. Jones, Cert R. San. Inst. and Cert. Meat & Food Inspection. Chief Clerk - P.V. Ingram, M.I.H.E. General Clerks - Mrs. P. C. Rutter (Resigned 31.3.63). P.W. Myers (Resigned 15.2.63). Mrs. E. Maddison (commenced duty 18.3.63). R. Hart (Commenced duty 18.3.63). Miss E. Martin (Commenced duty 22.4.63). R.K, Shelter (Commenced duty 26.8.63). Rodent Operator - J. Harris (Retired 6.12.63). F. Turner (Commenced duty 9.12.63). Disinfector - F. Workman (Resigned 12.7.63). G. East (Commenced 19.7.63, dismissed 24.9.63). H. Terry (Commenced duty 30.9.63). 6 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,606 Population - estimate supplied by the Registrar General 47,060 Number of inhabited houses (end of 1963) according to Rate Books 14,472 Rateable Value (1963) £2,482,243 Sum represented by a penny rate (estimated) £10,270 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Total M F Birth Rate per 1, 000 population 19.04 Live Births- Legitimate 797 422 375 Illegitimate 99 49 50 896 471 425 Still Births - Birth Rate per 1,000 births 14.51 Legitimate 10 5 5 Illegitimate 3 2 1 13 7 6 Deaths 583 286 297 Death Rate per 12.39 1,000 Deaths from Puerperal causes- Nil Rate per 1,000 births Nil Deaths of infants under one year of ageAll infants 15 Rate per 1,000 live births 16.74 Legitimate 15 Rate per 1,000 legitimate live births 16.74 Illegitimate Nil Rate per 1,000 illegitimate live births Nil Deaths from- Tuberculosis 4 Cancer (all ages) 124 Measles (all ages) - Whooping Cough (all ages) - Diarrhoea (under 2 years of age) - Number of births notified 995 Number of births registered in the Borough 190 Birth, Death and Infant Mortality Rates Comparison of National and Local Rates Birth Rate Infant Death Rate Mortality Live Still Rate England and Wales 18,2 17 3 12.2 20.9 Wood Green 19.04 14.51 12.4 16.74 7 POPULATION The mid year estimate of the population supplied by the Registrar General is 47,060 a decrease of 450 from that of the previous year. BIRTHS The number of live births registered during the year was 896 which gives a crude birth rate of 19.04 per 1,000 of population, the corrected birth rate being 20.07. The rate for 1962 was 18.05. There were 13 still births, giving a still birth rate of 14.51 per 1,000 births. In 1962 the still birth rate was 31.2. MORTALITY General Mortality Death Rate. The net number of deaths accredited to the district was 583, two more than in 1962. This gives a crude death rate of 12.39 per 1,000 of population, and a corrected death rate of 13.36 (the rate for 1962 being 12.23). The deaths and death rate for the past five years have been:- Year No. of Deaths Death Rates Wood Green England and Wales 1959 604 12.4 11.6 1960 555 11.5 11.5 1961 538 11.3 12.0 1962 581 12.2 11.9 1963 583 12.4 12.2 The number of deaths in males from diseases of heart and circulation fell from 132 in 1962 to 119 this year. In females also there was a reduction of 14, from 149 to 135. Total deaths in males from cancer of lung and bronchus plus bronchitis were 2 fewer than in the previous year but in females the total was 26, exactly double last year's figure. Mortality of Persons over the age of 85. 396 deaths, or 67.9% of the total deaths during the year occurred in persons over the age of 65 and, of these, 248 were over the age of 75. DEATH FROM LEAD POISONING IN A CHILD AGED 3 YEARS I received notification of this death by 'phone from the General Practitioner and immediately visited the child's Home with the Public Health Inspector in order to carry out an investigation into- (a) the source of the poisoning (b) the presence of any lead poisoning in other members of the household or other persons possibly at risk. 8 (a) Possible sources of lead which were all investigated included materials in the house and also in the immediate environment, i.e., a builders yard where the child played daily and almost exclusively. These were:- (i) Water supply. (ii) Paint on doors, windows, etc. (iii) Paint on cot, toys, etc. (iv) Lead pencils. (v) Cooking utensils. (vi) Contents of several paint tins discarded on a builders dump in the yard. (vii) Analysis ox dust and rubble from the sides and from the bottom of the dump. Reports received on the water supply were completely satisfactory. Paint on toys, cots, etc. did not contain lead. The children had no lead pencils and there were no utensils with lead content. Item (ii). The paint on doors and windows was peeling, and scrapings contained old primer with a high lead content. There were, however, no tooth marks or signs anywhere on the woodwork to indicate that a child had habitually nibbled the paintwork, and the parents had not observed such a habit in any of the children. Item (vi). Two of the paint tins had a high lead content. Item (vii). The dust and rubble from the builders dump also contained a high percentage of lead, Enquiries were made as to any paint spraying processes carried out in the yard but no lead-containing paint had ever been used in such a process and there had been no paint spraying of any sort during the previous year. (b). (i) The family affected lived in a first floor flat and comprised parents, 4 children aged 8 months, 2, 3 and 4, and also a half brother aged 9 who lived near and was in daily association with the family. (ii) Two children aged 2 and 4 who played regularly with this family. (iii) In the flat below, the family consisted of parents and 4 children aged 8 months, 3, 5 and 6 years and a daily foster child aged 2. (iv) In view of the findings at the builders yard, all local General Practitioners were notified and home visits were made by the Health Visitors to all neighbouring families in which children possibly used the yard for play, As a result 16 further children were investigated although none had played regularly in the yard. The outcome of all these investigations showed evidence of lead poisoning in:- (i) 4 children and 1 adult (the mother), (ii) 2 children. (iii) 5 children. (iv) 1 child. 9 With the exception of the child who died none of these showed symptoms of poisoning, and all responded satisfactorily to treatment. As a result of all these foregoing investigations it seemed that the probable source of poisoning was from the discarded paint tins in the builders yard. The tins often filled with rain water and the children, using them to sit on in their games, tipped the water out on the dump. The boy aged 9 - an intelligent responsible lad - remarked that he "stopped the children from drinking the water from the tins" - a significant remark. The children in the ground floor flat (ref.2) played exclusively in their small garden, and never with the other children but the builders dump abutted directly on their garden fence which was very dilapidated and the dust from the dump constantly drifted through into the little garden so that their toys would be repeatedly contaminated by the lead-containing dust and dirt. In group 1 the mother dried all the family washing on a line set up in the builders yard and stretching across in front of the builder s dump. Steps were- taken to prevent access by children to the builders yard and all such yards in the Borough were visited to ensure that no paint tins were discarded where there was open access by the public. In the two families concerned, the entrance to their flats was from an alleyway leading to the builders yard. These families were rehoused immediately. The property concerned was due for demolition and the whole site has now been cleared. The children affected were all treated at St. Ann's Hospital and laboratory investigations were carried out at Great Ormond St. Hospital and Chase Farm Hospital. I should like to thank the Staff at these Hospitals for all their help and co-operation. INQUESTS 28 inquests were held following the deaths of Wood Green residents during 1963. A further 88 post mortem examinations were carried out without an inquest, 74 of these in the Prince of Wales Hospital which, by arrangement with the Wood Green Borough Council, provides mortuary services. MATERNAL MORTALITY No cases of maternal mortality were reported. INFANT MORTALITY There were 15 deaths of infants under one year of age. This gives an infant death rate of 16.74 per 1,000 live births as compared with 21 deaths and a rate of 29.5 in the preceding year. Of the 15 infants who died in Wood Green during 1963, 9 were neo-natal deaths, that is deaths occurring in the first month and all 9 occurred during the first week of life. These very early deaths now constitute the hard core of all infant deaths and are under the most careful scrutiny. 10 STILL-BIRTHS 13 still-births, 10 legitimate and 3 illegitimate were accredited to the Borough for 1963. This is equal to a death rate of 14.51 (live and still-births), the corresponding figures for 1962 being 23 still-births with a rate of 31.2. 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 3 - - - 3 - - - - 3 Congenital Defects 1 - - - 1 - - 1 - 2 Atelectasis - - - - - - - - - - Gastro-enteritis - - - - - - - - - - Intra-cranial Haemorrhage 2 - - 2 - - - - 2 Capillary Bronchitis - - - - - 3 - - - 3 Asphyxia - - - - - - - - - - Broncho-pneumonia - - - - - - - - 1 1 Other Causes 3 - - - 3 1 - - - 4 9 - - - 9 4 - 1 1 15 11 GENERAL PROVISION OF HEALTH SERVICES Care of the Aged The increasing number of elderly people in the community entails a constant increase in the scope and size of the problems relating to the aged. Much of the time and thought of the Medical Officer of Health is spent dealing with such problems and in this field there is particularly close contact between the Health Visitors, Home Nurses, Home Help Organisers, and Public Health Inspectors., The members of the Old People' s Welfare Committee continue to give generously of their time and effort in this service. The Retired Persons Advice Clinic which was initiated last year continues to serve a useful function, It is held at Woodside House on alternate Friday afternoons and is staffed by one of the County Assistant Medical Officers - Dr. Esther Waterhouse together with a member of the nursing staff. The multitude of social problems which adversely affect the health of the elderly make suck an informal consultative clinic a valuable asset in preventive medicine. Laundry Service for Sick Aged Persons In May 1963, a laundry service for aged incontinent persons was set up in Wood Green to serve also the Borough of Southgate and the Urban District of Friern Barnet. The whole of the work is carried out at the laundry attached to the CoupciP s Swimming Bath in Western Road. I am pleased to report that the arrangements made have worked admirably, that the service provided has been a success, and, furthermore, that I am satisfied it has supplied the solution to a very difficult problem. In the chiropody service also there is some progress to report. We have obtained the additional services of a part-time chiropodist on the area staff and are now able to hold 4 sessions of chiropody per week at Stuart Villa. Additional time has also been made available for home treatment. Hospitals The General Hospital services available to the people of Wood Green continue as in previous years. The appointment last year of a Geriatrician has certainly eased some of the difficulties in the hospital admission of elderly patients. The outstanding shortage is in maternity bed accommodation and this whole question is at present under review. 12 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 is as follows:- Positive Negative Swabs for Diphtheria bacilli _ 2 Sputa for Tubercle bacilli - 1 Throat and nose swabs 15 Faeces 329 Urine 5 Water (Swimming Pool) 1 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 1963. NATIONAL ASSISTANCE ACT, 1948 SECTION 50:- Burial or Cremation of the Dead. There were 3 burials carried out under this Section during 1963. 13 SANITARY SERVICES Inspections Public Health Acts 700 Housing Act, 1957 and 1961 300 Rag Flock and Other Filling Material Act, 1951 - Pet Animals Act, 1951 9 Factories and Outworkers 1ll Food Preparing Premises 586 General Food Premises 874 Shops Act, 1950 102 Smoke Observations 20 Unsound Food 145 Complaints Investigated 426 Interviews with Owners, etc. 220 Revisits to property under notice 631 Infectious Diseases Cases 90 Special enquiries in connection with infectious disease cases 211 Aged and infirm persons 20 Pests Act 197 Clean Air Act 6 Miscellaneous 203 Food Poisoning 12 Smoke Control Area 4 117 Smoke Control Area 5 967 Smoke Control Area 6 790 Informal Notices Served Shops Act 16 Complied with 14 Food and Drugs Act 20 " " 18 Public Health Act 216 " " 206 Housing Acts, 1957/1961 19 " " 4 Factories Act 3 " " 3 W.G.U.D.C. Act 5 " " 1 Statutory Notices Served Public Health Act, 138 Complied with 112 Housing Act 3 " " 8 Shops Act 1 " " 1 Rent Act, 1957 The number of applications for Certificates of Disrepair has shown no appreciable change this year. Set out below is a table showing the number of applications received as compared with the previous year:- 1962 1963 Number of applications for Certificates of Disrepair (Form I) 6 6 Number of Proposals to Issue Certificates of Disrepair (Form J) 4 2 Number of Certificates of Disrepair issued (Form L) 4 2 14 1962 1963 Number of applications for Certificates of Disrepair rejected - Number of Certificates of Disrepair cancelled 1 1 Number of applications for Cancellation rejected - 1 Number of visits made in connection with above 15 17 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) 364 (b) Number of inspections made for the purpose 1,000 (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 216 3. Action under Statutory Powers during the year:- (1) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1957:- (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) Proceedings under Public Health Acts:- (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 138 (b) Number of dwelling-houses in which defects were remedied after service of formal notices (i) By owners 112 (ii) By Local Authority in default of owners - 15 (3) Proceedings under Sections 11 and 13 of the Housing Act, 1957:- (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, 1957:- (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 no instance was it found necessary for legal proceedings to be taken. Housing Applications We have continued to receive many letters from private doctors in support of housing applications. These are very carefully considered with the Housing Officer and extra points are awarded according to the circumstances. Unfortunately, only too often an award of even maximum points cannot produce new housing accommodation, but a great deal of care and thought goes into this side of our work. Smoke Control Areas Work in the formation of smoke control areas under the Clean Air Act 1956 continues. The Council's Smoke Control Order No. 5 came into operation on 1st October, 1963. This Order relates to an area of 184 acres in extent and comprises 1,772 premises in the Mayes Road, Station Road, area. At the close of the year, the Council submitted for approval by the Minister of Housing and Local Government Smoke Control Order No. 6 relating to an area embracing 1,659 premises in the Noel Park Estate. It is proposed that the Order come into operation on the 1st October, 1964. Rodent Control During the year 265 dwellings in the Borough were treated for rat infestation, entailing 1,614 visits. In addition 13 business premises were treated for the presence of rats. A further 53 dwellings and 6 other premises were treated for mice and a total of 79 visits were made. The Council's refuse tip at White Hart Lane was constantly baited with an anti-coagulant bait and several supervisory visits were made to the adjoining Council allotments for evidence of the presence of rats. 16 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 super vised by the Alexandra Palace Trustees. 17 INSPECTION AND SUPERVISION OF FOOD (a) Food premises in the Borough Bakers' Shops 25 Butchers' Shops 35 Cafes and Restaurants 37 Chemists' Shops 16 Confectionery and Sweet Shops 76 Dairies and Milk Shops 36 Pried Pish Shops 9 Wet Pish Shops 5 Greengrocers' Shops 57 Grocers' Shops 70 Public Houses and Off-Licences 39 Pood Factories 12 (b) Food and Drugs Act, 1955, Section 16. There are 11 premises registered for the manufacture of Ice Cream in the district and 151 premises registered for retailing Ice Cream. Luring the year 40 visits were paid to these premises. Also 47 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 102. (c) Middlesex County Council Act, 1950 Section II. - Registration of Hawkers of Pood. 31 hawkers of food in the Borough are registered. (d) Meat and Other Foods Condemned The under-mentioned foodstuffs were certified as unfit for human consumption during the year:- Meat 1,057 lb. Meat 441 tins Pish 30 lb. Fish 137 tins Fruit 873 tins MISCELLANEOUS ITEMS- Vegetables 667 tins Jam etc. 51 pkts/jars Evaporated & Mayonnaise 3 " Condensed Milk 183 tins Pickles & Onions 108 " Cream 67 tins Mincemeat 13 " Milk Pudding 22 tins Fruit Juices 14 " Soup 170 tins Puddings 13 " Spaghetti 37 tins Meat 70 " Beans 132 tins Fish 63 " Others 153 " After examination by the Public Health Inspector condemned food is collected by this Department's van; it is then removed 18 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. (e) 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 Pood Hygiene Regulations, and secondly to advise and educate food handlers in the paramount importance of food hygiene. In all 1,460 visits were made to food premises, as set out below:- Dairies and Milk Shops 50 Butchers 241 Ice Cream Premises 40 Pried Fish Shops 30 (Registered) Stalls (Registered) 80 Other Food Premises 1,019 Full use has again been made of the propaganda material available, including posters from the Ministry of Health, Ministry of Agriculture, Fisheries and Food, the Central Office of Information and the Central Council for Health Education. 19 FACTORIES AND HOMEWORK I. Inspections Premises No. on Register Number of Inspections Written Notices Occupiers Prosecuted FACTORIES WITHOUT mechanical power 30 53 - - FACTORIES WITH mechanical power 181 192 - - OTHER PREMISES in which Section 7 is enforced by the local authority 6 6 - - Total 217 251 - - 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 - - - - - (b) unsuitable or defective - - - - - (c) not separates for sexes Other offences against the Act (not including offences lating to outwork) - - - - - Total - - - - - 3. Outwork Particulars 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 53 - - - - - Artificial flowers 9 - - - - - Curtains 2 - - - - - Toys 15 - - - - - Brushes 1 - - - - - Button carding 4 - - - - - Cardboard boxes 1 - - - - - Hand made-scourers 1 - - - - - Total 86 - - - - - 20 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. Three samples of feathers were submitted for laboratory examination and were found to be satisfactory. Pet Animals Act, 1951 Under the Act, seven licences were renewed during the year after the premises had been inspected and found to be satisfactory, and one new application for licence was granted. 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- 52 flats Commerce Road, Redevelopment Stage I 52 flats Winkfield and Acacia Roads, Stage II 167 dwellings Cheshunt Housing Estate. Council properties in course of construction at end of year - 66 dwellings Winkfield& Acacia Roads,Stages III & IV 168 flats Commerce Road Redevelopment Stage II 33 dwellings Cheshunt Housing Estate. Private enterprise properties completed or in course of construction - 86 flats, 1 house. Swimming Baths The figures of attendances at Western Road and Durnsford Road Baths for the past two years are as follows:- Western Road Baths 1962/3 1963/4 Swimming Bath 86,947 91,031 -do- Children (Special sessions) - - Children from Schools 36,647 44,680 Spectators 8,047 8,600 Slipper Baths 31,239 27,352 -do- Old Age Pensioners (free) 3,909 4,398 Steam Bath 417 230 21 Durnsford Road Open Air Baths 1962/3 1963/4 Adults 15,865 19,925 Children 31,441 33,923 Season Tickets issued 565 663 * (Attendances of season ticket holders no longer recorded). 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 our Swimming Baths being a means of providing health-giving exercises in the open air. The incidence of Plantar warts (verrucas) among school children continues to be a matter of concern. 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 provide a means of allowing the virus which causes verrucas to pass from one child to another. I am doing all I can to get the co-operation of teachers and parents in obviating the spread of this infection and the Baths Manager and I have the situation constantly under review. 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. Eight 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 1962/63 the total tonnage of refuse collected was 11, 702 tons; the income from salvage material amounted to £2.880. The steam raised by the incineration of the refuse is used for space and water heating at Western Road Baths. 22 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES The following table sets out the infectious diseases notified as compared with notifications received during 1962:- 1963 1962 Scarlet Fever 17 21 Diphtheria - - Cerebro-Spinal Fever - - Enteric or Typhoid Fever - Paratyphoid Fever - - Erysipelas 1 2 Pneumonia 20 17 Acute Poliomyelitis - - Acute Encephalitis - - Puerperal Pyrexia - - Pulmonary Tuberculosis 23 21 Non-Pulmonary Tuberculosis 2 3 Malaria - - Measles 429 232 Whooping Cough 77 16 Ophthalmia Neonatorum - - Dysentery 78 49 Food Poisoning 3 - Smallpox - - Meningoccocal Infection - 1 650 362 From the table set out above the following facts emerge'- 1. Scarlet Fever notifications totalled 17 in 1963, a drop of 4 on the 1962 figures. 2. It is now 16 years since the last case of diphtheria was notofied in the Borough and 24 years since this was a cause of death. 3. Measles notifications rose from 232 in 1962 to 429 this year, 4. Pertussis notifications were 77. 5. The incidence of food poisoning and dysentery rose from a combined total of 49 in 1962 to 81 in 1963. All cases of dysentery and food poisoning, particularly Salmonella typh-murium infections, are carefully investigated and are fully followed up wherever the source of infection may lie 6. No cases of poliomyelitis were notified in 1963. 7. 25 cases of tuberculosis were notified during 1963, one more than in 1962. 23 A broad classification of the cases of tuberculosis notified during the past five years in relation to employment was:- 1959 1960 1961 1962 1963 Clerical 4 5 5 1 3 Manual Labour 10 2 1 3 8 Housewives 3 3 3 4 3 Factory Workers 8 11 2 4 - Children 3 3 1 3 1 Professional Classes 3 1 1 4 - Domestic Service 1 - - - - Nurses - 1 - - - Shop Assistants 3 1 1 - - Armed Forces .. 1 - - - - Retired Persons 3 1 3 2 3 Unclassified .. 5 2 9 3 3 43 30 25 24 21 Our scheme for the B. C.G. vaccination of school children is actively continuing and is working extremely well. This work is undertaken by the School Health Services. IMMUNISATION AND VACCINATION IN THE CONTROL OF INFECTIOUS DISEASE I wish especially to mention a recent service made available in Wood Green Whereby Tetanus Immunisation has been offered to the outdoor staff employed by the Council. (Although this strictly belongs to the 1964 report, I make no apology for mentioning it here). Absence of immunity to Tetanus carries with it two hazards. The first, death from Tetanus, may occur when the infection is not even suspected e. g. from the prick of a rose thorn. The much commoner hazard, however, is severe reaction and shock from the giving of Anti-Tetanus Serum, particularly if this is repeated. Certain employments more than others carry with them the risk of Tetanus wound infection and any injury under these conditions will demand the giving of anti-tetanus serum. The only means of avoiding both the danger of contracting tetanus and the danger of serum reaction is by Tetanus Immunisation, In those so protected injury calls for simply a small boost dose of toxoid and there is no need for administration of serum. Tetanus Immunisation was first made available through local health authorities in 1960, and since then has been offered each year to all our infants, pre-school and schol children. Accordingly by now most young people up to the age of 18 have had the opportunity of this protection and have widely availed themselves of it. This, however, leaves almost the entire adult population 24 unprotected, including certain groups particularly at risk. Such groups employed by local authorities include parks, building, roads, sewer and refuse collection and disposal staff An effort has been made in Wood Green this year to put matters right in this respect, and all such staff have been offered tetanus immunisation. There has been a very good initial response and it is hoped that it may be possible to continue this measure as a local authority service. The changing pattern of infectious disease over the last few years leaves no room for doubt as to the efficacy of immunisation as a means of control. It is interesting to consider the age range of our present population who are so protected from various infectious diseases. Smallpox. The population at all ages have had the opportunity of smallpox vaccination. The response of the adult population is directly related to any occurrence of smallpox in the vicinity. As regards the child populztion, however, fortunately the response is consistent and high. Every month, each Health Visitor records the vaccination state of all children currently reaching the age of 2. In the majority of cases a vaccination record card is available and, if not, a home visit is paid so that records are accurate. In Wood Green the percentage of children at 2 years who have been successfully vaccinated has risen from 53% in 1955, when this method of follow-up was commenced, to 87. 1% for 1963. Diphtheria. A very high percentage of the population'from infancy to adults aged 38 to 40 years have received diphtheria immunisation. Diphtheria immunisation was carried out to some extent in the late 1930s, but it was in 1940 that a campaign was launched in Middlesex offering immunisation to all children up to school-leaving age There was an immediate, massive response with soon afterwards a spectacular drop in the cases of diphtheria The response over the years has continued at a high level and the primary protection is continued with "boost" injections to maintain continuing immunity. It follows that in our present population adults up to the age of 38 or 40 come within the range of the protected group. In Wood Green during 1963, 93, 2% of children reaching the age of 2years had been immunised. This compares with a percentage of 83% in 1955. The system of follow-up used is the same as that in smallpox vaccination. Whooping Cough. Our main concern in this disease is to protect the very young children in whom the condition can still be fatal. Immunisation, therefore, commences at 2 to 3 months. Protection is thus given over the first few years of life, but since in older children the disease tends to be mild, the regular immunisation of older groups is not considered necessary Poliomyelitis. Polio vaccine was introduced in 1956 and led to a wide initial public response which later fluctuated Probably 80% or more of young people up to the age of 24 years have been vaccinated against poliomyelitis. Older people up to the age of 50 years and over in our present population have also had the opportunity of this protection although the percentage in this group will be considerably lower. B.C.G. Vaccination Against Tuberculosis. In 1957 B. C. G. Vaccination was first offered to all school children aged 13 years, i.e. prior to leaving school. This offer is made annually to all schools both maintained and private schools. Thus young people now between the ages of 13 and 22 years have all had the opportunity of receiving B.C.G. Vaccination in school, and in Wood Green between 70 and 75% have taken advantage of it. The consent rate for 1963 in Wood Green was 75. 2%. Typhoid. A comparatively small percentage of the population are protected against Typhoid Fever. A growing number of our school children, however, are so protected prior to foreign travel, and it may be that the general public will profit by their example and also seek this safeguard before travelling abroad. DISINFECTION AND DIS INFESTATION The number of articles dealt with at the Disinfection Station was as follows:- Articles disinfected 25 Articles destroyed 48 17 rooms were disinfected on account of infectious disease. 6 premises were disinfested on account of the presence of vermin, which involved the disinfestation of 21 rooms. 69 premises were treated for infestations of cockroaches, wasps, ants, flies, bluebottles, fleas, beetles and maggots, woodworm, woodlice, moths, bees and silverfish. 74 Library books were brought to the Department during the year for disinfection on account of being in contact with cases of infectious disease. 26 APPENDIX 1 TABLE I Vital Statistics of Wood Green 194 2 - 1963 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 Illegitmate No. Rate per 1 000 Illegitimate births No, Rate per 1 000 Population (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 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 50.3 537 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 1960 48,160 724 15.0 46 22 30.4 - - 555 11.5 1961 47,750 753 15.7 61 17 26.8 2 32.8 548 11.5 1962 47,510 811 17.07 74 21 29.5 1 13.16 581 12.23 1963 47,060 896 19.04 99 15 16.74 - - 583 12.39 27 TABLE II INFECTIOUS DISEASES FOR THE PAST 25 YEARS Year Diphtheria Scarlet Fever Enteric or Typhoid Fever Pulmonary Tuberculosis NonPulmonary Tuberculosis Measles Pertussis Polio myelitis †N *D †N *D †N *D †N *D †N *D †N *D †N *D †N *D 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 1960 - - 38 - - - 27 1 3 - 21 - 72 - - - 1961 - - 15 - - - 19 2 6 1 763 - 13 - - - 1962 - - 21 - - 4 21 - 3 1 232 - 16 - - - 1963 - - 17 - - - 23 - 2 - 429 - 77 - - - †N Notifications *D - Deaths 28 TABLE III INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1963 Cases Notified in whole Borough Total Cases Notified in each Ward Total Cases removed to Hospital or Sanatorium Total Deaths At Ages - Years Notifiable Disease All Ages Under 1 year 1 to 5 years 5 to 10 years I 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 AlexandraBowes Town Hall Noel Park Scarlet Fever 17 - 6 7 2 1 - - - 1 - - 4 6 7 1 - Diphtheria - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - - - Para-typhoid Fever - - - - - - - - - - - - - - - - - Erysipelas 1 - - - - - - - - - - 1 - 1 - 1 - Pneumonia 20 2 3 - 1 - 1 4 3 3 1 2 8 8 4 7 62 Acute Poliomyelitis - - - - - - - - - - - - - - - - - Polio-Encephalitis - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - - - - - - - - - - Pulm Tuberculosis 23 - - 1 - - 1 2 3 3 5 4 11 7 5 5 3 Non-Pulm. Tuberculosis Malaria 2 - - - - - - - - - 2 - 2 - - - 1 Chickenpox - - - - - - - - - - - - - - - - - Measles 429 16 298 98 9 6 1 1 - - - - 92 88 249 1 - Whooping Cough 77 5 50 17 3 1 - - 1 - - - 25 17 35 5 - Opthalmia Neonatorum - - - - - - - - 1 - - - - - - - - Dysentery 78 5 33 13 4 3 3 5 2 4 3 3 36 25 17 10 - Food Poisoning 3 1 1 - - - - 1 - - - - 1 2 - - - Meningoccocal Infection - - - - - - - - - - - - - - - Totals 650 29 391 135 19 11 6 13 9 11 10 10 179 154 317~^ 30 66 29 TABLE IV Causes of death during the year 1963 Causes of Death Male Female Tuberculosis, respiratory 2 1 Tuberculosis, other - 1 Syphilitic disease - 1 Diphtheria - - Whooping Cough - - Meningococcal infections - - Acute Poliomyelitis - - Measles - - Other infective and parasitic diseases - 3 Malignant neoplasm, stomach 11 7 Malignant neoplasm, lung, bronchus 26 9 Malignant neoplasm, uterus - 6 Malignant neoplasm, breast - 9 Other malignant and lymphatic neoplasms 23 33 Leukaemia aleukaemia 7 3 Diabetes - 2 Vascular lesions of nervous system 23 32 Coronary disease, angina 75 44 Hypertension with heart disease 2 3 Other heart diseases 14 32 Other circulatory disease 5 24 Influenza - 2 Pneumonia 26 36 Bronchitis 28 17 Other diseases of respiratory system 1 - Ulcer of stomach and duodenum 2 1 Gastritis, enteritis and diarrhoea • - Nephritis and Nephrosis 1 1 Hyperplasia of prostate 3 - Pregnancy, childbirth, abortion - 1 Congenital malformations 2 - Other defined and ill-defined diseases 20 17 Motor vehicle accidents 3 - All other accidents 6 7 Suicide 6 2 Homicide and operations of war - - Total 286 297 30 TABLE IV A Males Causes of Death All Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis,respiratory 2 - - - - - - - 1 1 Tuberculosis, other - - - - - - - - - - - Syphilitic Disease - - - - - - - - - - - Diphtheria - - - - - - - - - - - Whooping Cough - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - Measles - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - Malignant neoplasm stomach 11 - - - - - 1 3 1 3 3 Malignant neoplasm lung, bronchus 26 - - - - - 1 5 11 5 4 Malignant neoplasm breast - - - - - - - - - - - Other malignant and lymphatic neoplasms 23 - - - 1 - - 2 7 8 5 Leukaemia, aleukaemia 7 - - 2 1 - - 1 1 2 - Diabetes = - - => - =» = - - = - Vascular lesions of nervous system 23 - - - - 1 - 1 5 5 11 Coronary disease, angina 75 - - - - - 2 8 27 17 21 Hypertension with heart disease 2 - - - - - - 1 - - 1 Other heart diseases 14 - - - - - 1 2 1 6 4 Other circulatory diseases 5 - - - - - - 2 - 3 Influenza - - - - - - - Pneumonia 26 2 - = - - - 1 3 5 15 Bronchitis 28 - - - - - - 1 6 13 8 Other diseases of respiratory system 1 - - - - - - - - 1 - Ulcer of stomach and duodenum 2 - - - - - - - 1 1 - Gastritis, Enteritis and Diarrhoea - - - - - - - - - - - Nephritis and Nephrosis 1 - - - - - - - 1 - - Hyperplasia of prostate 3 - - - - - - - - 1 2 Totals carried forward 249 2 - 2 2 1 5 25 66 68 78 31 TABLE IVA (Cont'd) Males Causes of Death All Ages Under 1 1 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 249 2 - 2 2 1 5 25 66 68 78 Congenital malformations 2 2 - - - - - - - - - Other defined and illdefined diseases 20 5 1 - - - 1 - - 5 8 Motor vehicle accidents 3 - - - 1 - - - - 1 1 All other accidents 6 - - - 1 - 1 - 1 3 Suicide 6 - - 1 - 1 3 - 1 - Homicide and operations of war - - - - - - - - - - - Totals 286 9 1 2 4 2 7 29 66 76 90 32 TABLE IV B Females Causes of Death All Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 and over Tuberculosis, respiratory 1 - - - - - - - 1 - - Tuberculosis, other 1 - - - - - - - - - 1 Syphilitic disease 1 - - - - - - - 1 - - Diphtheria - - - - - - - - - - - Whooping Cough - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - Measles - - - - - - - - - - - Other infective and parasitic diseases 3 2 - 1 - - - - - - - Malignant neoplasm, stomach 7 - - - - - - - 1 4 2 Malignant neoplasm, lung, bronchus 9 - - - - - - - 3 4 2 Malignant neoplasm, breast 9 - - - - - - 1 3 4 1 Malignant neoplasm uterus 6 - - - - - 1 - 3 - 2 Other malignant and Lymphatic neoplasms 33 - - - 1 - 1 3 5 10 13 Leukaemia, aleukaemia 3 - - - - - - 1 - 1 1 Diabetes 2 - - - - - - - - 2 - Vascular lesions of nervous system 32 - - - - - - 1 2 9 20 Coronary disease angina 44 - - - - - - 2 6 14 22 Hypertension with heart disease 3 - - - - - - - - 1 2 Other heart diseases 32 - - - 1 - 2 2 3 4 20 Other circulatory diseases 24 - - - - - - - 2 6 16 Influenza 2 - - - - - - - - - 2 Pneumonia 36 1 - - - - - 1 1 5 28 Bronchitis 17 - - - - - - - 1 5 11 Other diseases of respiratory system 3 - - - - - - - 2 1 - Ulcer of stomach and Duodenum 1 - - - - - - - - - 1 Gastritis, Enteritis and Diarrhoea - - - - - - - - - - - Nephritis and Nephrosis 1 - - - - - - - 1 - - Totals carried forward 270 3 - 1 2 - 4 11 35 70 144 33 TABLE IVB (Cont'd. ) Females Causes of Death All Ages Under 1 1 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 270 3 - 1 2 - 4 11 35 70 144 Pregnancy, childbirth abortion 1 - - - 1 - - - - - - Congenital malformations - - - - - - - - - - - Other defined and illdefined diseases 17 3 - - 1 - 1 - 1 1 10 Motor vehicle accidents - - - - - - - - - - _ All other accidents 7 - 1 - - - - 1 - 1 4 Suicide 2 - - - - - 1 - 1 - - Homicide and operations of war - - - - - - - - - - - Totals 297 6 1 1 4 - 6 12 37 72 158 34 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary NonPulmonary Total M. F. M. F. No. of cases on Register at end of 1962 303 222 17 45 587 New cases notified during 1963 12 11 2 - 25 Transfers from other Districts 10 7 3 1 21 No. of cases removed from Register 29 24 - 5 58 No. of cases on Register at end of 1963 296 216 22 41 575 New Cases arid Mortality during 1963 Age Periods New Cases Deaths Respiratory Non Respiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 00 - - - - - - - - 1 - 1 - - - - - - 5 - 1 1 - - - - - 15 1 3 - 1 - - - - 25 6 3 1 1 - - - - 35 6 4 1 - - - - - 45 5 1 - - - - - 55 4 1 1 - - 1 - - 65 and upwards 1 2 - - 2 = - 1 Totals 23 16 4 2 2 1 - 1 Above includes transfers (21) from other districts. 35 APPENDIX II (a) Letters to Doctors Letters on the following subjects were circulated to Wood Green practitioners in 1963, some under signature of Medical Officer of Health, others either as Area Medical Officer or District School Medical Officer: - 28th February - Smallpox Vaccination and Tetanus Immunisation 29th March - Dysentery Notifications 29th March - Collection of Laboratory Specimens 28th May - - ditto - 16th July - - ditto - 19th July - Lead Poisoning 11th October - Vaccination and Immunisation - Publicity Campaign 13th December - Collection of Laboratory Specimens 30th December - Incidence of Congenital Malformation (b) Medical Examinations During 1963, 58 medical examinations were carried out -25 of these were in respect of entrants to the Council's employ for acceptance into the Superannuation Scheme, 15 in respect of work men already in the Council s employ for acceptance into the Superannuation Scheme, and 18 in respect of workmen for acceptance into the Sickness Pay Scheme. In addition, 43 medical reports were issued relating to employees absent from duty for more than a short period through sickness. These reports were obtained from the family doctor or from a hospital. In this connection it is a pleasure to acknowledge the courtesy and co-operation which I have invariably received from the General Practitioners in Wood Green. 36