BOROUGH OF WOOD GREEN feft *' - Medical Officer of Health for the Year JANET R. CAMPBELL, m.b., ch.b., d.p.h Medical Officer of Health 1 WOOD 46 BOROUGH OF WOOD GREEN ANNUAL REPORT of the Medical Officer of Health for the Year 1964 JANET R. CAMPBELL, m.b., ch.b., d.p.h Medical Officer of Health BOROUGH OF WOOD GREEN with the compliments of the Medical officer of Health From Hall, Wood Green, N.22. 1 1 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF WOOD GREEN Mr. Mayor, Ladies and Gentlemen I have the honour to present the Annual Report for the year 1964. This will be my last annual report and the last report for the Borough of Wood Green. On an occasion such as this—in a sense a farewell to the Borough of Wood Green as a Borough—one is irresistably drawn to look back over the years so far as the health records go and this takes us to 1889. Over these 76 years the advance in knowledge and understanding of infections, the saving of infant life and the greatly increased life span are achievements which must have seemed beyond the dreams of the Medical Officers of Health of these early days. I have done a series of graphs to illustrate some of these advances and together with explanatory notes they are to be found on pages 35 to 37 at the end of this report. To return to this year's report, although substantially complete a few items, e.g. number of illegitimate births, etc.. are not yet to hand from the Registrar General. In 1964 there was a slight regression in the birth rate which had risen consistently each year from 1958 to 1963. This year, with 856 live births, the rate per 1,000 population was 18.4 against 19.0 last year. The crude death rate was 12.79 compared with 12.39 in 1963. The corrected death rate for 1964 cannot yet be estimated. Again there were no maternal deaths, the last such death occurring in 1959. The infant mortality rate, i.e. the number of infants who died during the first year of life per 1,000 live births, rose from 16.75 to 24.53. The chief factor in this higher death rate was the unusually high number of infant deaths,-8-from bronchitis and pneumonia. The number of infectious diseases notified was 426 compared with 650 last year. Measles notifications were 311 against 429 and dysentery notifications 14 against 78 in 1963. 1 Again in 1964 there were no notifications of diphtheria, which now puts the last such notification at a distance of 17 years. Notifications of whooping cough were 41. Tetanus Immunisation of Borough Staff One of the most satisfactory features of our work in 1964 was the immunisation against tetanus of 87 of the outdoor staff of the Borough, including the Parks, Building, Roads, Sewers and Refuse Collection and Disposal Staffs. This is the first opportunity of such protection that these groups have had and I am particularly pleased that so many have availed themselves of it. My thanks are due to the County Medical Officer for permission to use the facilities and staff of our clinics for this purpose. Health Education Our scheme to hold meetings with parents and staff associations has made good progress. At these meetings we have shown various films for discussion with parents and teachers, and subsequently the School Medical Officers have attended at the schools for the showing of the films and have been available for questions and discussion. This seems to be a reasonable line of progress and has met with a good reception. Once again my warm thanks are due to my Deputy, Dr. Mary Douglas and to Mr. F. James, Chief Public Health Inspector, and also to Mr. W. E. Goodfellow, Deputy Chief Public Health Inspector and Mr. P. V. Ingram, Chief Clerk, and indeed to every member of staff of the Department for all their help and cooperation Finally I should like to thank the Council and particularly the Chairmen and members of the Public Health and Staff Committees for their unfailing support and encouragement which I have greatly appreciated. I am, Mr. Mayor, Ladies and Gentlemen Your Obedient Servant JANET R. CAMPBELL Medical Officer of Health Town Hall Wood Green, N.22 February, 1965 2 HEALTH AND CLEANSING COMMITTEE Alderman C. D. Moss (Chairman) Councillor Mrs. L. A. Angell (Vice-Chairman) The Mayor, Councillor M. Skudder, B.Sc., J.P Alderman J. W. Barnett Councillor Mrs. P. M. Dines Councillor J. S. Downie Councillor Mrs. D. C. Findley Councillor B. L. Greenway STAFF Medical Officer of Health—Janet Russell Campbell, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health—Mary Curr Douglas, M.B., Ch.B., D.P.H. Chief Public Health Inspector—F. James, Cert.R.San. Inst., and San. Insp. Joint Board, Cert. Meat and Food Inspection, Cert.R. Soc. of Health, Smoke Inspector. Deputy Chief Public Health Inspector —W. E. Good fellow, Cert. R.San.Assoc. of Scotland, Cert. Meat and Food Inspection and' Cert.R.Soc. of Health, Smoke Inspector Public Health Inspectors—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 and Food Inspection L. A. Deamer, Public Health Inspector's Cert. 6? Cert. Meat and Food Inspection (appointed 11.6.64) Trainee Public Health Inspector—R. K. Shelter Chief Clerk—P. V. Ingram, M.I.H.E General Clerks—Mrs. E. Maddison (resigned 26.6.64) Mrs. E. Anderson (appointed 29.6.64 resigned 18.9.64) Miss J. V. Barrett (appointed 21.9.64) R. Hart Miss E. Martin (resigned 26.6.64) Miss V. J. Smee (appointed 13.7.64) Rodent Operator—F. Turner Disinfector—H. Terry 3 STATISTICS AND SOCIAL CONDITIONS FOR THE AREA Area (acres) 1,606 Population—estimate supplied by the Registrar General 46,520 Number of inhabited houses (end of 1964) according to Rate Books 14,472 Rateable Value (1964) £2,518,825 Sum represented by a penny rate (estimated) £10,494 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Total Live Births 856 Birth rate per 1,000 population 18.4 Still Births 13 Still birth rate per 1,000 births 15.19 M F Deaths 311 284 595 Death rate per 1,000 population 12.79 Deaths from Puerperal causes Nil Rate per 1,000 births Nil Deaths of infants under 1 years of age— All infants 21 Rate per 1,000 live births 24.53 Deaths from— Tuberculosis 2 Cancer (all ages) 121 Measles (all ages) Whooping cough (all ages) Diarrhoea (under 2 years of age) Number of births notified 856 Number of births registered in the Borough 202 4 POPULATION The mid year estimate of the population supplied by the Registrar General is 46,520, a decrease of 540 from that of the previous year. BIRTHS The number of live births registered during the year was 856 which gives a crude birth rate of 18.4 per 1,000 of population. The crude rate for 1963 was 19.04. There were 13 still births, giving a still birth rate of 15.19 per 1,00 births, live and still ; in 1963 the still birth rate was 14.51. MORTALITY General Mortality and Death Rate The net number of deaths accredited to the district was 595, 12 more than in 1963. This gives a crude death rate of 12.79 per 1,000 of population, compared with a crude rate of 12.39 on 1963 The deaths and death rate for the past five years have been - Death Rates Tear A(o. of Deaths Wood Green England & Wales 1960 555 11.5 11.5 1961 538 11.3 12.0 U962 581 12.2 11.9 1963 583 12.4 12.2 19'64 595 12.8 — The number of deaths in males from diseases of heart and circulation rose from 119 in 1963 to 128 this year. In females also there was a rise of 15 from 135 to 150. Total deaths in males from cancer of lung and bronchus plus bronchitis were 76, 22 more than in the previous year and in females the total was 16, 10 less than last year's figure. Mortality of Persons over the age of 65 399 deaths, or 67.1'%, of the total deaths during the year occurred in persons over the age of 65 and', of these, 259 were over the age of 75. INQUESTS 18 inquests were held following the deaths of Wood Green residents during 1964. A further 88 post mortem examinations were carried out without an inquest. 5 MATERNAL MORTALITY No cases of maternal mortality were reported. INFANT MORTALITY There were 21 deaths of infants under 1 year of age. This gives an infant death rate of 24.53 per 1,000 live births as compared with 15 deaths and a rate of 16.74 in the preceding year. Of the 21 infants who died in Wood Green during 1964, 11 were neo-natal deaths, that is deaths occurring in the first month and, of these, 8 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. The following table shows causes of deaths at various ages under year:— Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 mths 3 mths and under 6 mths 6 mths and under 9 mths y mens and under 12 mths Total deaths under 1 year Prematurity 6 - - - 6 - - - - 6 Congenital Defects - 1 - - 1 2 1 1 - 5 Atelectasis 1 - - - 1 - - - - 1 Gastroenteritis - - - - - - - - - - Intracranial Haemorrhage - - - - - - - - - - Capillary Bronchitis - - - - - 2 2 1 - 5 Asphyxia - - - - - - - - - - Broncho-pneumonia - - - - - - - 1 - 1 Other causes 1 1 - i 3 - - - - 3 8 2 - 1 11 4 3 3 - 21 STILL BIRTHS Thirteen still births were accredited to the Borough for 1964. This is equal to a death rate of 14.96 per 1,000 births, live and still, the corresponding figures for 1963 being 13 still births with a rate of 14.51. 6 GENERAL PROVISION OF HEALTH SERVICES Care of the Aged Fortunately the residents of Wood Green continue to live, as a rule, to a ripe old age—and in most cases to an active and happy old age. There are, however, a considerable number of elderly people who are lonely and out of touch with the services which are provided to help them and it is towards these people that our efforts are especially directed. The Old People's Welfare Committee are continually expanding their services and the centre at Woodside House and at the Old Folk's Club, Station Road, are of inestimable benefit. The Work Centre for the elderly at Shropshire Hall is very fully used and I think it could be said to make life worth living for many of the lonely people who attend. The Elderly Persons Advice Clinic continues to be held fortnightly at Woodside House and I hope it may be possible to expand this service using more than one centre, in order to cut down travelling as far as possible. These Advice Clinics are attended by Dr. Douglas, together with Mrs. Barr, a member of the Nursing Staff. Laundry Service for Aged Incontinent Persons This service was set up in Wood Green in 1963 to serve the Boroughs of Wood Green and Southgate and the Urban District of Friern Barnet. It is an excellent example of co-operation between three local authorities, all of whom have this service closely at heart. With the coming changes other arrangements have had to be made, and as from the 1st March, laundry for Southgate and Friern Barnet will be dealt with elsewhere and that for Wood Green at Hornsey Disinfection Station. I am grateful to the three Councils and to the officers, particularly of the Engineer's Department in Wood Green who have made this scheme work so smoothly and efficiently and also to Mrs. Mitchell, the Area Home Help Organiser, for the extra work she has willingly put into this service. Chiropody Service Chiropody sessions continue to be held at Stuart Villa and domiciliary visits are made as necessary. Hospitals The general hospital services available to the people of Wood Green continue in the main as in previous years. 7 The acute shortage is in maternity beds, and the scheme for "planned early discharge" must inevitably continue until the shortage is met. In all these cases a very careful investigation is made to ensure that the home is a suitable one to which the mothers may safely return 48 hours after her confinement in hospital. Laboratory Facilities I would again record my appreciation and thanks to the staff of the Public Health Laboratory Service at Cblindale and at Goppetts Wood Hospital for their unfailing assistance during the year. I feel that we are very highly privileged in having available their expert advice to call upon at any time. Summary of the work carried out at the Central Public Health Laboratory for the year is as follows Positive Negative Swabs for Diphtheria Bacilli l Sputa for Tubercle Bacilli 2 Throat and Nose Swabs 25 Faeces 224 Blood 1 Urine 1 Others 10 Water (swimming pool) 2 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 1964. NATIONAL ASSISTANCE ACT, 1948 Section 50—Burial or Cremation of the Dead There were no burials carried out under this section during 1964. 8 SANITARY SERVICES Inspections Public Health Act, 1936 913 Public Health Act, 1961 53 Housing Act, 1957 93 Housing Act, 1961 261 Rag Flock and Other Filling Material Act, 1951 1 Pet Animals Act, 1951 33 Factories and Outworkers 80 Food Preparing Premises 276 General Food Premises 603 Shops Act, 1950 6 Offices, Shops and Railway Premises Act, 1963 361 Smoke Observations 82 Unsound Food 178 Complaints investigated 576 Interviews with owners, etc. 288 Revisits to property under notice 1,240 Infectious Diseases cases 42 Special enquiries in connection with infectious diseases cases 247 Aged and infirm persons 36 Prevention of Damage by Pests Act 280 Clean Air Act, 1956 1ll Noise Abatement Act 72 Wood Green Urban District Council Act, 1920 122 Rent Act 11957 20 Food poisoning 4 Miscellaneous 621 Smoke Control Area 4 2 'Smoke Control Area 5 231 Smoke Control Area 6 676 Smoke Control Area 7 567 Smoke Control Area 8 111 Informal Notices Served Complied with Shops Act 3 1 Food and Drugs Act 14 14 Public Health Act, 1936 220 187 Public Health Act, 1961 25 20 Housing Act, 1957 3 6 Housing Act, 1961 12 9 Factories Acts 4 3 W G.U.D.C. Act 19 17 9 Statutory Notices Served Complied with Public Health Act, 1936 31 46 Housing Act, 1957 — 5 Housing Act, 1961 8 6 Food and Drugs Act 3 3 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:— 1963 1964 Number of applications for Certificates of Disrepair (Form I) 6 15 Number of proposals to issue Certificates of Disrepair (Form J) 2 12 Number of Certificates of Disrepair issued (Form L) 2 7 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 17 20 Housing Statistics 1. Inspection of dwelling-houses during the year:— (II) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 365 (b) Number of inspections made for the purpose 1,320 (2) Number of dwelling-houses found to be in a state so dangerous and 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 10 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 245 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 31 (b) Number of dwelling-houses in which defects were remedied after service of formal Notices: (i) by owners 51 (ii) by local authority in default of owners (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. 11 HOUSING ACT, 1961 Houses in Multiple Occupation During the year 123 houses were inspected of which 43 were found to be unsatisfactory in the light of the standard set by the Council. Forty-five informal notices and eight statutory notices requiring compliance with the Council's standards were served. Thirty-three informal notices and four statutory notices were complied with. Below is a summary of the improvements carried out:— Houses inspected 123 Houses satisfactory 80 Houses not satisfactory 43 Informal notices served 45 Informal Notices complied with 33 Statutory Notices served 8 Statutory Notices complied with 4 Space heating provided 3 W.C.'s provided 11 Baths provided 6 Sinks provided 2 Hot water heaters provided 57 Cold water supplies installed 8 Cooking facilities provided 1 Overcrowded abated (lettings) 9 Defects of management remedied 4 Notices not complied with as houses not now in multiple occupation 13 Thirteen houses in respect of which notices had been served were subsequently found to be no longer in multiple occupation. HOUSING ACT, 1961 Statutory Notices were served under Section 19 concerning seven overcrowded houses limiting the number of persons permitted to live in the houses. Six of these notices were effective; the number of occupants being reduced to the numbers specified on the Notices. HOUSING ACT, 1957, SECTION 43 A public enquiry was held at the Town Hall on the 23rd June, 1964, in respect of Clearance Orders made to secure the demolition of the under-mentioned houses. The Orders were subsequently confirmed by the Ministry of Housing and Local Government. 12 Acacia Road 28, 30, 32, 34, 36, 38, 40 Coburg Road 74, 76, 78 Elm Cottages 1, 2, 3, 4, 5, 6 Finsbury Cottages 1, 2, 3, 4, 5, 6, 7, 8, 9 Lordship Cottages 1, 2, 3, 4, 5 River Park Road 23, 24, 25 Wellesley Road 1,2,3,4,5,6,7,8,9,10,11,12,13, 14, 15, 16 Western Road 17, 19, 21, 23, 25, 27, 29 White Hart Lane 58, 59, 60 White Hart Lane 88, 90, 92 HOUSING APPLICATIONS The staff of the Public Health Department work in close liaison with that of the Housing Department. I, myself, have frequent meetings with Mr. Simpson, Housing Officer, to review and discuss cases regarding medical priority. The Public Health Inspectors also are often called upon to visit housing applicants in order to make a report on their living conditions. SMOKE CONTROL During the year the 6th Smoke Control Order controlling an area comprising part of the Noel Park Estate and premises in the vicinity of Wood Green Underground Station, became operative. Towards the end of the year, two further Smoke Control Orders were made. The first to control, subject to Ministerial approval, a further part of the Noel Park Estate, and the second to control premises in the Ewart Grove and Williams Grove area on the 1 st November, 1965. Since the Council will not exist to make further Smoke Control Orders, it is perhaps fitting at this stage to summarise below the progress made to date:— Summary of Progress as to December, 1964 No. of acres No of premises covered by covered by Smoke Control Percentage of Smoke Control Percentage of Orders confirmed acres of the Orders confirmed premises in the or awaiting Borough or awaiting Borough decision so covered decision at present covered 1,186 73.9 12,371 76.9 Estimated consequential Estimated consequential reduction in the burning of reduction in Bituminous Coal Smoke Pollution TONS TONS 10,500 3,67 13 NATIONAL SURVEY OF AIR POLLUTION At the request of the Department of Scientific and Industrial Research the Council agreed to participate in this survey and set up a measurement station at the Town Hall in October, 1959. Two further stations were added in January, 1962, one at Lordship Lane Secondary Modern School and one at Bounds Green Secondary Modern School. That at Lordship School was transferred to Wood' side School in November, 1962.* Without the willing co-operation of staff and pupils at these schools the survey of air pollution in the Borough could not have been complete and I unhesitatingly express my sincere thanks for their valued assistance. The tables below show the readings taken during the whole of this period. TOWN HALL Sulphur—Micrograms Cu/Metre 1959 I960 1961 1962 1963 1964 January — 220 214 195 345 200 February — 192 177 13'2 395 140 March — 120 220 223 168 220 April — 134 123 85 114 150 May — 92 63 59 64 84 June — 60 83 62 85 74 July — 37 65 64 59 80 August — 54 46 51 50 51 September — 80 93 73 76 77 October 103 134 142 168 142 140 November 172 H89 223 264 270 300 December 177 237 327 470 237 302 TOWN HALL Smoke—Micrograms Cu/Metre 1959 1960 1961 1962 1963 1964 January — 220 169 119 201 160 February — 220 131 123 219 100 March — 130 160 158 '713 100 April — 77 63 44 55 45 May — 63 40 39 30 26 June — 94 35 23 25 2'8 July — 29 27 22 17 18 August — 35 22 21 26 20 September — 55 239 39 128 76 October 90 140 9(2 112 140 81 November 240 190 172 189 190 180 December 170 267 215 264 117 140 14 Sulphur—Micrograms Cu/Metre Lordship Lane/Woodside Bounds Green 1962 1963 1964 1962 1963 1964 January 2139 378 142 191 — 130 February 196 355 171 191 380 163 March 244 168 242 260 168 231 April 109 50 181 88 160 156 May 100 39 97 100 60 91 June 89 — 81 65 100 81 July 123 41 80 71 61 8! August — — 61 — 76 63 September — Ill 100 101 101 84 October —. 211 182 188 150 181 November 262* 300 301 259 271 270 December 475 259 257 — 269 242 Smoke —Micrograms Cu/Metre Lordship Lane/Woodside Bou nds G reen 1962 1963 1964 1962 1963 1964 January 169 183 151 101 — 130 February 111 197 .100 89 189 124 March 178 60 1518 124 60 119 April 62 32 49 51 70 64 May 40 19 28 40 63 45 June 20 — 41 18 50 41 July 23 14 20 16 22 39 August — — 33 — 31 27 September — 50 102 42 142 71 October — 100 '82 89 171 111 November 180* 161 111 177 220 186 December 256 121 121 — 117 140 RODENT CONTROL The treatment of the Council sewers against rats was continued; the 33rd and 34th poisoned bait treatment was carried out without pre baiting As a result of notification, 342 premises were inspected' for the presence of rats and mice. At 75 of these premises minor mouse infestations and 267 minor common rat infestations were found. In the course of a survey of properties 1,559 visits were made revealing 8 minor and 2 major common rat infestations. The total number of treatments carried out during the period was 352. The Council's refuse tip and destructor works were baited at intervals and several supervisory visits were made to the Council allotments adjoining the tip for evidence of the presence of rats. 15 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 of Alexandra Palace is supervised by the Alexandra Palace Trustees. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The purpose of this Act is to make fresh provisions for the securing of health, safety and welfare of persons employed to work in Offices, Shops and certain Railway Premises. On and after the 1st May, 1964, persons employing or intending to employ persons in offices, shops or certain railway premises, were required to register the premises with the local authority for the area in which the premises were situated or, in certain cases, with H.M. Inspector of Factories. For the purpose of carrying out their powers and d'uties under the Act, the Wood Green Borough Council established a register of premises, subject to registration with them, and appointed their Public Health Inspectors as Inspectors for the purpose of the Act. The register is maintained in the Department of the Medical Officer of Health Measures were taken to publicise the coming into operation of the Act and the registration forms were delivered to all premises known to be subject to registration. Steps were taken to ensure that, as far as possible, premises were duly registered. Three hundred and sixty-one visits were subsequently made and the number of premises is set out in the following tables:— A. Registration and General Inspections Class of premises No. of premises registered during the year Total No. of registered premises at end of year No. of registered premises receiving a general inspection during the year Offices 190 1190 8 Retail Shops 398 398 69 Wholesale Shops, Warehouses 31 31 4 Catering Establishments, open to the Public, Canteens 44 44 9 Fuel Storage Depots 1 1 — 16 B. Analysis of Persons Employed in Registered Premises by Workplace No. of persons Class of Workplace employed Offices 2,191 Retail Shops 2,638 Wholesale Depts., Warehouses 3 31 Catering Establishments open to the Public 421 Canteens 90 Fuel Storage Depots 16 Total Males 3,570 Total Females 2,1,17 Total 5,687 C. Exemptions Three applications for exemption from the requirements relating to space, temperature and sanitary conveniences were received during the year. In each case exemption was refused. INSPECTION AND SUPERVISION OF FOOD (a) Food Premises in the Borough Bakers' Shops 26 Butchers' Shops 33 Cafes and Restaurants 38 Chemists Shops 17 Confectionery and Sweet Shops 74 Dairies and Milk Shops 27 Fried Fish Shops 8 Wet Fish Shops 5 Greengrocers' Shops 46 Grocers' Shops 72 Public Houses and Off Licences 41 Food Factories 10 (b) Food and Drugs Act 1955, Section 16 There are 13 premises registered for the manufacture of ice cream in the district and 154 premises registered for retailing ice cream. During the year 12 visits were paid to these premises. Also 49 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 6. 17 (c) Middlesex County Council Act 1950 Section II—Registration of Hawkers of Food 33 hawkers of food in the Borough are registered. (d) Meat and Other Foods Condemned The undermentioned foodstuffs were certified as unfit for human consumption during the year:— Meat 1,001 lb Fish 16 lb Miscellaneous Items pkts./jars tins Jam, etc. 51 Meat 347 Pickles and Onions 80 Fish 66 Mincemeat 1 Fruit 600 Fruit Juices 66 Vegetables 507 Puddings 13 Milks, etc. 106 Meat 117 Cream 21 Fish 71 Milk Puddings 28 Others 317 Soup 200 Beans 98 tins After examination by the Public Health Inspector condemned food is collected by this Department's 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 this Department's Office 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 Food Hygiene Regulations, and secondly to advise and educate food handlers in the paramount importance of food hygiene. In all, 897 visits were made to food premises as set out below Dairies and Milk Shops 25 Butchers' 121 Ice-cream Premises 12 Fried Fish Shops 16 (Registered1) Stalls (Registered) 36 Other Food Premises 669 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. 18 FACTORIES AND HOMEWORK 1. INSPECTIONS Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 1 1 - - Factories with mechanical power 166 80 - - Other premises in which Section 7 is enforced by the local authority Total 5 172 18 99 - 4- 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 - 5 - 6 - (c) not separate for sexes - 1 - 1 - Other offences against the Act - - - - - (not including offences relating to outwork) - - - - - T otal - 6 - 7 - 19 20 3. OUTWORK Particulars Number of Outworkers in August List Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel 63 — — — — — Artificial flowers 9 — — — — — Curtains 2 — — — — — Toys 27 — — — — — Button carding 4 — — — — — Christmas crackers 2 — — — — — Total 107 — — — — 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. One sample of feathers and down and one sample of down were submitted for laboratory examination and found to be satisfactory. Pet Animals Act 1951 Under the Act 8 licences were renewed1 during the year after the premises had been inspected and found to be satisfactory, and two new applications for licences were granted. Establishments for Massage or Special Treatment Five existing licences under the Middlesex 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— 25 flats—Winkfield and Acacia Roads, Stages III and IV 33 dwellings—Cheshunt Housing Estate Council properties in course of construction at end of year— 41 dwellings—Winkfield and Acacia Roads, Stages III and IV 168 flats—Commerce Road, Redevelopment Stage II 12 maisonettes and hostel block at Edith Road Private enterprise properties completed or in course of construction—30 flats, 1 house. 21 Swimming Baths The figures of attendance at Western Road and Durnsford Road Baths for the past two years are as follows :— Western Road Baths 1963 /Dec., 1964 Swimming Bath 91,031 83,454 Children from Schools 44,680 33,174 Spectators 8,600 8,734 Slipper Baths 27,352 17,521 Slipper Baths, Old Aged Pensioners (free) 4,398 3,205 Steam Bath 230 184 Durnsford Road Open Air Baths Adults 19,925 32,898 Children 33,923 54,249 Children from Schools 970 922 Season Tickets issued* 663 422 *(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. 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 1963-64 the total tonnage of refuse collected was 13,368 tons ; the income from salvaged material amounted to £3,152. 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 picture regarding infectious diseases for 1964 is very satisfactory. It will be seen from the tables on pages 27 and 28 that :— 1. Scarlet Fever notifications totalled 30, i.e. 13 more than last year. 2. There were again no cases of Diphtheria—the last notification was 17 years ago. 3. Measles notifications fell from 429 to 311. 4. Pertussis notifications were 41, 9 less than in 1963. 5. There were no outbreaks of dysentery this year and the total notifications were 14 compared with 78 last year. 6. Again no cases of poliomyelitis were notified. 7. Sixteen cases of tuberculosis were notified comoared with 25 last year. A broad classification of the cases of tuberculosis notified during the past five years in relation to employment was :— 1960 1961 1962 1963 1964 Clerical 5 5 1 3 1 Manual Labour 2 1 3 8 2 Housewives 3 3 4 3 5 Factory workers 11 2 4 — 2 Children 3 1 3 1 — Professional classes 1 1 4 — — Domestic service — — — — 3 Nurses 1 — — — — Shop assistants 1 1 — — — Armed Forces — — — — — Retired persons 1 3 2 3 3 Unclassified 2 9 3 3 — 30 25 24 21 16 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. 23 IMMUNISATION AND VACCINATION IN THE CONTROL OF INFECTIOUS DISEASE The following tables gives a rough estimate of the extent to which the population of Wood Green is protected by immunisation from the various infectious diseases. This is based on our knowledge of the rate of immunisation obtaining in children from infancy to 15 years of age covering the period from 1935 to the present date. (The figures do not, however, take account of movements of population into or out of the Borough except as regards children under the age of 2). Disease Age range of population of Wood Green estimated to possess useful protection conferred by vaccination or immunisation Diphtheria From infancy to approximate age 40. During 1964 90.9% of children reaching the age of 2 years had been immunised Whooping cough From infancy to age 40 Tetanus From infancy to age 20, plus 87 of staff of Wood Green Borough Council Smallpox From infancy to approximately 10 years very fully protected and to perhaps 15 or 20 years fairly fully protected. Varying number in ages beyond this. During 1964 79% of children reaching the age of 2 years had been successfully vaccinated Poliomyelitis From infancy to age 25 very full protected and also to a lesser extent up to age 50 or over Tuberculosis Ages 13 to 24 very fully protected. This is the group who have received B.C.G. vaccination in school. The consent rate to B.C.G. vaccination for 1964 was 79% Measles Several children aged 1 to 2 years were vaccinated during 1964 under the research scheme of the Medical Research Council. 1965 is expected to be an epidemic year for measles and this will test the efficacy of the vaccine in those children whose parents volunteered to take part in the trial 24 DISINFECTION AND DISINFESTATTON The number of articles dealt with at the Disinfection Station was as follows :—- Articles disinfected 100 Articles destroyed 47 Sixty rooms were disinfected on account of infectious disease. Six premises were disinfected on account of the presence of vermin which involved the disinfestation of 21 rooms. Seventy-nine premises were treated for infestations of cockroaches, wasps, ants, flies, bluebottles, fleas, beetles and maggots, woodworm, woodlice, moths, bees and silverfish. Forty-seven library books were brought to the Department during the year for disinfection on account of being in contact with cases of infectious disease. 25 26 APPENDIX I TABLE I Vital Statistics of Wood Green 1943—1964 Year Population estimated to middle of each year Net births belonging to the district Net deaths belonging to the district Under one year of age At all ages Total number Rate per 1,000 population Illegitimate number Total number Rate per 1,000 live births Illegitimate number Rate per 1,000 Illegitimate births Number Rate per 1,000 population (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 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 49,500 655 113.2 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 1964 46,520 856 18.4 - 21 24.53 — — 595 12.79 27 TABLE II Infectious diseases for the past 25 years Year Diphtheria Scarlet Fever Enteric or Typhoid Fever Pulmonary Tuberculosis NonPulmonary Tuberculosis Measles Pertussis Poliomyelitis †N *D †N *D †N *D †N *D †N *D †N *D †N *D †N *D 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 5 232 — 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 — 19;53 — — 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 — — — 76 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 I960 — — 38 — — — 27 1 3 — 21 — 72 — — — 1961 — — 15 — — — 19 2 6 1 763 — 13 — — — 1962 — — 21 — — — 21 — 3 1 232 — 16 — — — 11963 — — 17 — — — 23 — 2 — 429 — 77 — — — 1964 — — 30 — — — 13 — 3 — 311 — 41 — — — *N—Notifications *D—Deaths 28 TABLE III Infectious Diseases Notified During the Year 1964 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 B'owes Town Hall Noel Park Scarlet Fever 30 - 13 10 4 — 1 2 — — — — 9 14 7 4 — Diphtheria — — - — — — — — — — — — — — — — — Cerebro Spinal Fever — — — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — Para—typhoid Fever — — — — — — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — — — — — — Pneumonia 11 — 2 1 — — — 1 1 3 1 2 1 3 7 2 — Acute Poliomyelitis — — — — — — — — — — — — — — — — — Polio Encephalitis —. — — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — — — — — — — — — — Pulm. Tuberculosis 13 — — — — — 2 5 1 3 — 2 4 5 4 2 2 Non—Pulm. Tuberculosis 3 — — — — — — 1 — 1 — 1 1 1 1 1 — Malaria — — — — — — — — — — — — — — — — — Chickenpox — — — — — — — — — — — — — — — — — Measles 311 21 183 101 6 — — — — — — — 72 150 89 5 — Whooping Cough 41 10 25 6 — — — — — — — — 11 18 12 1 — Opthalmia Neonatorum — — — — — — — — — — — — — — — — — Dysentery 14 — 4 3 2 1 4 — — — — — 7 3 4 1 — Food Poisoning 3 — — — — — 1 1 1 — — — 2 1 — 1 — Meningoccal Infection — — — — — — — — — — — — — — — — — Totals 426 31 227 121 12 1 8 10 3 7 1 5 107 195 124 17 2 TABLE IV Causes of Death during the year 1964 Causes of Death Male Female Tuberculosis, respiratory 1 1 Tuberculosis, other — — Syphilitic disease — — Diphtheria — — Whooping Cough — — Meningococcal infections — — Acute Poliomyelitis — — Measles - - Other infective and parasitic diseases — — Malignant neoplasm, stomach 13 10 Malignant neoplasm, lung, bronchus 46 2 Malignant neoplasm, uterus — 14 Malignant neoplasm, breast — 3 Other malignant and lymphatic neoplasms 23 30 Leukaemia aleukaemia 2 2 Diabetes — — Vascular lesions of nervous system 35 48 Coronary disease, angina 50 29 Hypertension with heart disease 18 25 Other heart diseases 16 24 Other circulatory disease 9 24 Influenza — — Pneumonia 27 22 Bronchitis 30 14 Other diseases of respiratory system 1 1 Ulcer of stomach and duodenum 3 2 Gastritis, enteritis and diarrhoea — — Nephritis and Nephrosis 3 5 Hyperplasia of prostate — - Pregnancy, childbirth, abortion — — Congenital malformations 8 5 Other defined and ill-defined diseases 11 13 Motor vehicle accidents 6 2 All other accidents 4 5 Suicide 5 3 Homicide and operations of war - — Total 311 284 29 TABLE IVA 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 1 - - - - - 1 - - - - Tuberculosis, other - - - - - - - - - - - Syphilitic disease - - - - - - - - - - - Diphtheria - - - - - - - - - - - Whooping cough - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - Measles - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - Malignant neoplasm stomach 13 - - - - - - 1 1 3 8 Malignant neoplasm lung, bronchus 46 - - - - - 1 5 19 9 12 Malignant neoplasm breast - - - - - - - - - - - Other malignant and lymphatic neoplasms 23 - - - - 1 1 2 5 8 6 Leukaemia, aleukæmia 2 - - - - - - - 1 1 — Diabetes - - - - - - - - - - - Vascular lesions of nervous system 35 - - - - - - - 18 9 8 Coronary disease, angina 50 - - - - - 3 4 16 14 13 Hypertension with heart disease 18 - - - - - - 2 1 4 11 Other heart diseases 16 - - - - - 1 — 4 7 4 Other circulatory diseases 9 - - - - - - - - 4 5 Influenza - - - - - - - - - - - Pneumonia 27 1 - - — — 1 2 1 4 18 Bronchitis 30 3 - - - - - 3 5 12 7 Other diseases of respiratory system 1 - - - - - 1 - - - - Ulcer of stomach and duodenum 3 - - - - - - - - 2 1 Carried forward 274 4 — - - 1 9 19 71 77 94 30 TABLE IVA—Males—cont 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 274 4 — — — 1 9 19 71 77 94 Gastritis, Enteritis and Diarrhoea — — — — — — — — — — — Nephritis and Nephrosis 3 — — — — — — — — — 3 Hyperplasia of prostate — — — — — — — — — — — Congenital malformations 8 7 1 — — — — — — — — Other defined and ill defined diseases 11 3 — — 1 — — 1 — 4 2 Motor vehicle accidents 6 — — 1 — 1 1 — 1 — 2 All other accidents 4 — — — — 1 — — 1 — 2 Suicide 5 —. — — — — 2 — 1 2 — Homicide and operations of war — — — — — — — — — — — Totals 311 14 1 1 1 3 12 20 74 83 103 TABLE IVB 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 1 75 and over Tuberculosis, respiratory 1 - - - - - 1 - - - - Tuberculosis, other - - - - - - - - - - - Syphilitic disease - - - - - - - - - - - Diphtheria - - - - - - - - - - - Whooping Cough - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - Measles - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - Malignant neoplasm stomach 10 - - - - - - 1 2 2 5 Malignant neoplasm lung, bronchus 2 - - - - - - - 1 - 1 Carried forward 13 — — - — — 1 1 3 2 6 31 TABLE IVB—Females—cont 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 1 75 and over Brought forward 13 — — — — — 1 1 3 2 6 Malignant neoplasm breast 14 — — — — 1 — 4 2 4 3 Malignant neoplasm uterus 3 — — — — — — — 1 1 1 Other malignant and Lymphatic neoplasms 30 — — — — — — 4 5 12 9 Leukaemia, aleukaemia 2 — — — — — — 1 1 — — Diabetes — — — — — — — — — — — Vascular lesions of nervous system 48 — — — 1 — 1 2 8 11 25 Coronary disease angina 29 — — — — — — 1 4 4 20 Hypertension with heart disease 25 — — — — — — 1 2 2 20 Other heart diseases 24 — — — — — — — 4 6 14 Otiher circulatory diseases 24 — — — — — — 1 1 4 18 Influenza — — — — — — — — — — — Pneumonia 22 — — — — — — — — 2 20 Bronchitis 14 2 — — — — — — 1 3 8 Other diseases of respiratory system 1 — — — — — — — — 1 Ulcer of stomach and Duodenum 2 — — — — — — — — 1 1 Gastritis, Enteritis and Diarrhoea — — — — — — — — — — — Nephritis and Nephrosis 5 — — — — 1 — 1 — — 3 Pregnancy, childbirth, abortion — — — — — — — — — — — Congenital malformations 5 5 — — — — — — — — — Other defined and ill defined diseases 13 — — — — — — 1 4 3 5 Motor vehicle accidents 2 — 1 — — — — — — — 1 All other accidents 5 — — 1 1 — — — — 1 2 Suicide 3 — — — — — 1 — 2 — — Homicide and operations of war — — — — — — — — — — — Totals 284 7 1 1 2 2 3 17 38 57 156 32 TABLE V TUBERCULOSIS Tuberculosis Register Pulmonary Non Pulmonary T otals M. F. M. F. Number of cases on Register at end of 1963 296 216 22 41 575 New cases notified during 1964 7 6 2 1 16 Transfers from other districts 7 9 — — 16 Number of cases removed from Register 26 21 3 2 52 Number of cases on Register at end of 1964 284 210 21 40 555 NEW CASES AND MORTALITY DURING 1964 New Cases Deaths Respiratory Non Respiratory Respiratory NonRespiratory M F M F M F M F 00 — — — — — — — — 1 — — — — — — — — 5 — — — — — — — — 15 2 1 — — — — — — 25 3 6 1 — — — — — 35 2 4 — — 1 1 — — 45 3 3 1 — — — — — 55 1 1 — — — — — — 65 and upwards 3 — — 1 — — — — Totals 14 15 2 1 1 1 — — 33 MASS RADIOGRAPHY—WOOD GREEN, 1964 Once again after a period of two years Mass Radiography Unit 6A visited Wood Green at the close of the year. There were four public sessions and leaflets prepared by the Unit giving details of the visits were distributed by the Public Health Department through the usual channels. The fullest use possible was made of the various media available to us publicising this worthwhile service. Set out below is a table of attendances. The analysis of the survey was not available to me at the time of going to press Mrs. E. Waters, Secretary of the Unit, has informed me that the Unit was again very pleased with the response they enjoyed in Wood Green, and with the assistance they received from the Public Health Department. Male Female Total Barratt & Co. Ltd. 183 391 574 Caxton Chocolate Co. Ltd. 70 73 143 Spouters Corner 481 567 1,048 Bury Road (Marks & Spencer Ltd. and other firms) 44 182 226 Total Number X-rayed 778 1,213 1,991 Requiring further investigation 10 17 27 34 INCIDENCE AND DEATHS FROM DIPHTHERIA Although the death rate was comparatively small in relation to the large number of cases, diphtheria is a crippling disease and leaves a trail of damage to heart, etc., in its wake. The dramatic fall which started in 1939 was the result of a tremendous immunisation campaign which grew in momentum until by 1945 practically every child up to school leaving age had been immunised. It is a matter of great satisfaction that in this Borough even to-day there is no falling off in the immunisation rate for diphtheria. INFANT AND EARLY NEO-NATAL MORTALITY These rates over the years are completely comparable since they are in all cases rates per 1,000 births. The graph shows that out of 1,000 babies born now, 100 are saved who would have died just over 60 years ago. The remarkable feature of the graph is the contrast between the almost dramatic fall in the total infant mortality rate, and the relatively small reduction in loss of life during the first 7 days of life. The " hard core " of deaths is accounted for by congenital defects, birth injury and prematurity. Intensive research is proceeding into factors, e.g. drugs, virus infections etc. which could produce damage to the developing child, particularly during the first three months of pregnancy. There is a clear case for strict control of all drugs administered to women of child-bearing age and for the giving of Gamma globulin to every expectant mother exposed to a virus infection. In addition a great effort must be made to obtain hospital admission for every mother starting in premature labour so that the child so greatly at risk shall have special skill immediately at hand, and means available to provide an atmosphere of the right temperature and humidity. PERCENTAGE OF TOTAL ANNUAL DEATHS OCCURRING UNDER THE AGE OF 1 YEAR RECORDED AT 5 YEAR INTERVALS This graph shows that up to the year 1900 approximately 40 out of 100 deaths occurring in Wood Green, i.e. 2 out of 5, were in infants not yet aged 1 year. Over the last 10 years between 2 and 3 only out of 100 deaths in the Borough are of babies under a year and 65-70 out of 100 deaths are now of people over the age of 65. The killing diseases of infancy then were chiefly the diarrhoeal diseases and pneumonia which were no respectors of class or person. Few families of any size had not suffered such a loss. A factor not shown in this graph is the present phenomenally low death rate between the ages of 1 and 65. This means that, having survived the first year of life, there is now a very great expectation of living to 65 years or more. In the early days not only was there a high infantile death rate, but the loss of young lives from tuberculosis and other infections meant that possibly only half the babies born lived to maturity. Of tremendous importance to the nation is this survival to maturity of over 90% of children born in contrast to the survival of only approximately 50% up to 1900. When one considers that Sir Winston Churchill, born 90 years ago, was a premature infant and greatly “ at risk ”, one realises how many great men and women must have been lost to the nation and to the world by this tragic loss of young life. Surely it is a heartening thought that, whatever potential for greatness exists in the nation, it now has the opportunity to mature and declare itself. APPENDIX II (a) Letters to Doctors Letters on the following subjects were circulated to Wood Green Practitioners in 1964 under my signature either as Medical Officer of Health or as Area Medical Officer. March, 1964 Collection of Laboratory Specimens 4th May, 1964 Incontinence Pads 2nd July, 1964 Tetanus Immunisation of Staff 29th July, 1964 Collection of Laboratory Specimens 14th Sept., 1964 Greater London Boroughs 14th Sept., 1964 Home Nursing, Midwifery and Home Help Services (b) Medical Examinations During 1964, 49 medical examinations were carried out in respect of the new entrants to the Council's service. In addition to these medical examinations, a considerable number of medical reports were obtained from family dbctors and hospital consultants concerning employees absent from duty through sickness for more than a short period. Once again, it is a pleasure to acknowledge the courtesy and co-operation which I received on all occasions from the General Practitioners in Wood Green. E G Ellis & Sons Willow Street ChingforD - E4