AC 439 (1) SOUTHGANE BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1933. WM. CLUNIE HARVEY. M.D.. D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital. Crusha Son, Ltd., The Triangle, Palmers Green, .v.1a SOUG 18 BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1933. WM. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital. To the MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE. Mr. Mayor, Ladies and Gentlemen,— I have the honour to present to you the Annual Report for the year 1933. The year under review belongs, as before, to the inter-survey period, and the Report therefore follows the lines of its two immediate predecessors. Several events of major importance occurred during 1933, the most important being the granting of a Charter of Incorporation to the district, with the subsequent birth of the new Borough of Southgate. This, of course, did not affect the integral working of the Public Health Department in any way, but it nevertheless added dignity to the status of those employed by the Council, a fact which was duly appreciated. From a purely Public Health point of view, the outstanding occurrences were the appearance of smallpox in the district in July, and the outbreak of diphtheria towards the latter end of the year. In spite of these unwelcome visitations, the incidence of infectious disease has fallen, and the year has been quite satisfactory in this respect. In addition, several other matters of far-reaching Public Health importance occurred; indeed the year has been one of considerable activity in this direction. Principal among these were the setting up, in March, of a clinic for immunisation against diphtheria; alterations in the management, personnel and structure of the Hospital; the movement for the purification of the water in the Broomfield Park Swimming Lake, and the erection of two new public conveniences. It is probably even more important and gratifying to note that the Council have now under consideration turther schemes for the appointment of an additional Health Visitor, new dental and midwives' schemes, reconstruction of the Destructor, 3 new refuse collection vehicles and ambulances, construction of a laboratory to serve the Hospital and the district as a whole, and the erection of still more conveniences—all matters of considerable importance to Southgate. The birth-rate continues to fall, while the death-rate remains more or less stationary. With the district still undergoing a rapid and extensive phase of development, the population is steadily increasing and new problems continually make their appearance. Mr. L. Skeeles, the Senior Sanitary Inspector, was absent from duty for a period of 15 weeks, but has now happily recovered and resumed his duties. I would like here to take the opportunity of thanking all the members of the Public Health Department for their whole-hearted co-operation throughout the year. The occurrence of four cases of smallpox in one household—an unprecedented event for Southgate— and the diphtheria outbreak in one of the most crowded parts of the district, called for immediate and thorough action. At this and at other times the staff re-acted promptly to the stimulus. It is only on such occasions that one really appreciates intelligent and loyal co-operation, and I am glad to be able to record the existence of such attributes among the staff which I have the honour to control. As hitherto, Dr. Tate, the County Medical Officer of Health, has kindly supplied the statistics relating to School Clinics and Public Elementary Schools. In conclusion, I would like to tender my grateful thanks to the Chairmen and Members of the two Public Health Committees which functioned during 1933, and also to the members of the Urban District and Borough Councils for the help and consideration shown to me during the year under review. I am, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, 1934. Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE at December 31st, 1933. Councillor G. Peverett (Chairman). His Worship the Mayor (Alderman J. Thos. Barber, J.P.). Alderman H. J. Gooding. Councillor H. Collar. Councillor J. Owers. Councillor Mrs. E. F. Smith, J.P. Councillor Mrs. C. M. A. Vandy. Councillor V. J. Westlake. MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1933. Councillor Mrs. C. M. A. Vandy (Chairman). His Worship the Mayor (Alderman J. Thos. Barber, J.P.). Alderman G. B. Massa. Councillor W. A. Clarke. Councillor A. C. Crane. Councillor G. F. Davy. Councillor Mrs. E. L. Evans. Councillor G. Peverett. Councillor Mrs. E. F. Smith, J.P. CO-OPTED MEMBERS. Miss Corry. Mrs. High. Mrs. Seward. Dr. L. Westlake. 5 PUBLIC HEALTH STAFF. * Medical Officer of Health and Medical Superintendent, Isolation Hospital: W. C. Harvey, M.D., Ch.B., D.P.H. (Full Time). * Medical Officer for Maternity Centres: Dorothy M. Catchpool, M.B., B.S., L.R.C.P., M.R.C.S., D.P.H. (Part Time). * Senior Sanitary Inspector (Northern District): L. Skeeles, Cert.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. Sanitary Inspector (Southern District): H. Hill, M.R.San.I., A.M.Inst.S.E., M.S.I.A., Cert.R.San.I., Meat Inspection. Chief Clerk: P. E. Barber. Clerk: Miss M. Munch. * Health Mrs. E. M. Rising, S.R.N., C.M.B., R.S.I., H.V. Visitor s Mrs. D. A. G. Blake, C.M.B., S.I., H.V. * Assistant (Maternity Centres): Mrs. A. Thomas. Disinfector: A. G. Bates. * These Officers' salaries are repaid to the Council, in part, by the Ministry of Health or the County Council. 6 Statistics and Social Conditions of the Area. Area (in acres) 3,597 Registrar-General's estimate of Resident Population, 1933 58,820 Number of inhabited houses (end of 1933) according to Rate Books 15,800 Rateable value (1933) £673,613 Sum represented by a penny rate (1933) £2,772 The social conditions of the district remain more or less unaltered from those of the previous year, although there is some evidence to show that conditions generally are improving in Southgate. The Social Service Council continues to distribute clothing and footwear to deserving recipients and has been the means of securing employment for certain, at least, of the "black-coated" workers resident in the district. A scrutiny of the statistics relating to mortality, infectious disease and infantile mortality would appear to show that Southgate has not suffered to any marked extent from the recent financial depression, although, of course, such statistics can be extremely misleading. If it were possible to secure figures giving the general sickness rate among the whole population, and particularly the children, such figures would yield information of infinitely more value. At present, however, this is not possible. Information obtained from the schools, nevertheless, although not by any means complete, bears out the contention that nutrition is satisfactory among our juvenile population. Anyone comparing the appearance of the children attending our schools and centres with those of areas more hardly hit than our own, could not fail to be impressed by the high standard shown. We have been most fortunate in this respect, and it only remains for us to maintain the level by every means at our disposal. Meteorology.—The total rainfall recorded by the Council's rain-gauge in Broomfield Park measured 16.74 inches during 1933, the daily average being 0.046 inches. The greatest fall in 24 hours was on October 7th, when 0.73 inches were recorded, and the total days on which no rain fell was 220. As will be seen, the total rainfall and daily average were extremely low during 1933. Until a fully-equipped meteorological station is installed, complete statistics regarding sunshine, temperature, wind, etc., will not be available. Such statistics would be extremely useful, and a station of this type is long overdue in Southgate. 7 RAINFALL RECORDED AT BROOMFIELD PARK. Total Rain for month. Number of Wet Days with 0.01 or more. 0.04 or more ins. 1932. 1933. 1932. 1933. 1932. 1933. Ins. Ins. Days. Days. Days. Days. Jan. 1.83 1.75 11 15 11 11 Feb. 0.18 1.39 3 12 2 12 Mar. 1.36 2.41 10 14 10 13 April 2.43 0.98 19 8 17 6 May 3.38 1.62 20 15 12 11 June 0.72 1.74 3 13 3 13 July 1.88 1.40 12 14 9 19 Aug. 1.45 0.57 5 6 5 5 Sept. 1.88 2.06 19 12 14 9 Oct. 5.22 1.43 22 15 21 10 Nov. 1.45 0.93 13 15 3 5 Dec. 0.52 0.46 6 6 10 5 Totals. 22.30 16.74 143 145 117 119 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. Male. Female Live Legitimate 557 270 287 Births Illegitimate 13 7 6 Totals 570 277 293 Birth Rate per 1,000 of the estimated resident population 9.69 Stillbirths 16 10 6 Rate per 1,000 total (live and still) births 27.30 Deaths 591 268 323 Corrected Death Rate per 1,000 of the estimated resi- Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. From Puerperal Sepsis 2 3.41 From other Puerperal causes 0 0.00 Total 2 3.41 8 Death rate of infants under one year of age:— All infants per 1,000 live births 33.33 Legitimate infants per 1,000 legitimate live births 32.31 Illegitimate infants per 1,000 illegitimate live births 76.92 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 0 POPULATION. The Registrar-General's estimate of the population at the middle of 1933 was 58,820. It will thus be seen that there was an increase of 1,570 over the last year's estimate. Actually, there was an excess of 21 deaths over births, a fact which was off-set by the immigration of outside families. There is, moreover, every reason to believe that this condition of affairs will persist for some time. In addition, the increase in population due to enlargement of the Borough boundaries, which will be an accomplished fact by the time this Report appears, will add still more inhabitants to Southgafe. BIRTHS—BIRTH -RATE. The nett total of births accredited to the district was 570, a decrease of 81 on the preceding year; of these, 277 were males and 293 females (7 males and 6 females being illegitimate). The birchrate was, therefore, 9.69 per 1,000 of the population, as against 11.37 in 1932. The average rate for the five years 1929-1933 was 11.14. The birth-rate for England and Wales for 1933 was 14.4. The total number of births actually registered in the district during the year amounted to 327. It is evident from the above figures that the factors making for decline in the birth-rate as detailed in last year's Report still operate. MORTALITY. General Mortality and Death Rate.—The nett number of deaths accredited to this district was 591, an increase of 2 as compared with the previous year. This gives a corrected death-rate of 9.44 per 1,000 of the population, a decrease of 0.23 on the rate for the previous year, which was 9.67. This rate is still appreciably below that for England and Wales (12.3 for 1933). The average rate for the five years 1929-1933 was 9.36. 9 As compared with 1932, there were increases of 13 deaths from influenza, 3 from cancer, 12 from pneumonia and 10 from violence; while there were decreases of 15 deaths from tuberculosis, 16 from heart disease and 4 from bronchitis. The principal causes of death are shown in Table I on page 13. From this we see that:— (1) The number of deaths from tuberculosis has shown a welcome decrease (23 as against 38). (2) The number of deaths from heart disease has also decreased by 16, or 10 per cent. The total number is still large, however, although, as before, the major proportion of deaths occurred as a terminal event in elderly persons. (3) Once again the number of deaths from influenza has increased. There was an increase of no less than 13 in the total during 1933, and it is significant that the number has been actually doubled during the last two years. Influenza must not be treated lightly; if it is, the consequences are apt to be disastrous, and too much emphasis cannot be laid upon this point. Until a specific remedy for influenza is discovered, each case should be watched with the utmost gravity. In the meantime, early diagnosis and adequate treatment, hospitalisation of severe cases (which is available in Southgate) and the intelligent co-operation of the patient hold out the best promise of success. As long as the public fail to realise fully the great danger of this scourge it will continue to take its toll upon human life. Medical skill is useless unless the cases are treated early and unless the doctor's instructions are followed to the letter. If such is done, influenza will lose some at least of its terrors, and it is to be hoped that every care will be taken to ensure that no loopholes are left in the campaign against this disease. (4) Deaths from violence (almost entirely made up of accidents) have increased considerably, although there was one less suicide in the district. This regrettable state of affairs is part and parcel of our complex civilisation, and is one in which the personal factor plays by far the greatest part. (5) There are no classes of death which can be attributed to special detrimental conditions, such as factory employment, type of work, atmospheric conditions, etc., in the district. This is satisfactory and needs little comment. Infantile Mortality.—There were 19 (1 illegitimate) deaths of infants under 1 year of age, which give an infantile death-rate of 33.33 per 1,000 births registered, as compared with 25 deaths and a rate of 38.40 in the preceding year. 10 The average rate for the 5 years 1929-1933 was 40.33. The rate for England and Wales for 1933 was 64. It will be seen that once again the infantile mortality rate has fallen slightly, while the rate for Southgate is considerably lower than that for England and Wales. Table III on page 15 subdivides the infant deaths according to the weeks or months at which they occurred. 63.2 per cent. of the total deaths occurred during the first month, while 58.3 per cent. of these occurred during the first week. Prematurity accounted for 8 deaths, pneumonia for 3, marasmus for 2, and other causes for 6. All the infant deaths were investigated. Stillbirths.—Sixteen stillbirths, none of which was illegitimate, were accredited to the district for 1933. This is equal to a death-rate of 27.30 per 1,000 total (live and still) births registered, the corresponding figures for 1932 being 22 stillbirths and a rate of 32.67. Maternal Mortality.—The maternal mortality rate—i.e., the number of mothers dying as the result of childbirth per 1,000 total (live and still) births—was 3.41 for 1933. This represents 2 maternal deaths, both of which occurred outside the district. Last year there were also 2 deaths with a corresponding rate of 2.96. One of the two deaths took place after abortion and was the subject of an inquest. The problem of the "handy-woman" still continues to receive attention. The new scheme of assisting in the payment of midwives' fees which the Council has under consideration should take us another step towards solving the problem, as it will help those mothers who most require assistance. All maternal deaths continue to be investigated by Dr. Catchpool, who is the Investigating Officer for this district. Mortality of "Toddlers"—i.e., children between the ages of 1 and 5 years. Amongst children of 1 to 5 years of age there were 6 deaths during 1933. This represents a corrected death-rate of 11 0.09 per 1,000 of the total population, and 1.02 per cent. of the total deaths for the year, at all ages. In 1932 there were a similar number of deaths, giving a rate of 0.10 and a percentage of 1.02. The number has remained stationary for the past three years, and is the lowest recorded. Mortality of Persons over the Age of 65.—It will be seen from Table II, on page 14, that slightly more than 56 per cent. of the total deaths occurring during the year took place in persons over the age of 65. This percentage is slightly higher than that for last year (54 per cent.). In passing it may be noted that 71 females died at the age of 80 or over, the corresponding figure for the males being 35. Zymotic Mortality.—This includes the deaths from the seven principal zymotic diseases, viz.: Smallpox, scarlet fever, diphtheria, enteric fever, measles, whooping cough, and diarrhoea (in children under 2 years of age). This rate affords useful evidence as to the general health of the district, and any gross defects in such matters as sanitary conditions, overcrowding, housing, etc., would, in all probability, be reflected in it. There were 4 deaths from the diseases mentioned above, as follows:— Diphtheria, 2; whooping cough, 2. The zymotic death-rate for 1933 was therefore 0.06 per 1,000 of the population, as against 0.07 in 1932, with a similar number of deaths. This rate is one of the lowest ever recorded in Southgate. The average rate for the 5 years 1929-1933 was 0.11. 12 Table 1. Causes of Death During the Year 1933. Causes of Death. Male. Female. Total. Rates per 1,000 of Population. All Causes (Civilians only) 268 323 591 1 Typhoid and Paratyphoid Fevers .. .. .. .. 2 Measles .. .. .. .. 3 Scarlet Fever .. .. .. .. 4 Whooping Cough 1 1 2 0.03 6 Diphtheria 2 .. 2 0 .03 6 Influenza 13 24 37 0.59 7 Encephalitis Lethargica .. 1 1 0.02 8 Cerebro-Spinal Fever .. 1 1 0.02 9 Tuberculosis of Respiratory System 13 8 21 0.34 10 Other Tuberculous Diseases ,, 2 2 0.03 11 Syphilis 2 .. 2 0.03 12 General Paralysis of the insane. Tabes Dorsal is 1 .. 1 0.02 13 Cancer, Malignant Disease .. 31 60 91 1.45 14 Diabetes 8 1 9 0.14 15 Cerebral Hiemorrhage, etc. 9 16 25 0.40 16 Heart Disease 65 91 156 2.49 17 Aneurysm 1 1 2 0.03 18 Other Circulatory Diseases.. 14 15 29 0.46 19 Bronchitis 4 6 10 0.16 20 Pneumonia (all forms) 27 10 37 0.59 21 Other Respiratory Diseases 4 1 6 0.08 22 Peptic Ulcer 4 4 8 0.13 23 Diarrhoea, etc. (under 2 years) .. .. .. .. 24 Appendicitis 3 2 5 0.08 26 Cirrhosis of Liver 1 .. 1 0.02 26 Other Diseases of Liver, etc. 1 1 2 0.03 27 Other Digestive Diseases 7 12 19 0.30 28 Acute and Chronic Nephritis 10 6 16 0.26 29 Puerperal Sepsis • • 2 2 0.03 30 Other puerperal Causes .. .. .. .. 31 Congenital Debility, Premature Birth and Malformation, etc. 11 3 14 0.22 32 Senility 2 8 10 0.16 33 Suicide 4 8 12 0.19 34 Other Violence 7 12 19 0.30 35 Other defined Diseases 23 26 49 0.79 36 Causes ill-defined or unknown •• 1 1 0.02 Totals 268 323 591 9.44 13 TABLE II. Deaths from all causes, divided as to sex and certain age groups, and showing a percentage of total deaths and death-rate per 1,000 of population for each group. 1933. Age. MALES. FEMALES. TOTALS. No. % of Total Deaths. Rate per 1,000. No. % of Total Deaths. Rate per 1,000. No. %of Total Deaths. Rate per. 1,000 0— 1 year 14 2.37 0.22 5 0.85 0.08 19 3.22 0.30 1— 5 years 4 0.68 0.06 2 0.34 0.03 6 1.02 0.09 5—15 ,, 3 0.51 0.05 10 1.69 0.16 13 2.20 0.21 15—25 ,, 4 0.68 0.06 8 1.35 0.13 12 2.03 0.19 25—45 ,, 18 3.04 0.29 27 4.57 0.43 45 7.61 0.72 45—65 ,, 85 14.38 1.35 78 13.20 1.25 163 27.58 2.60 65 and over 140 23.69 2.35 193 32.65 3.08 333 56.34 5.33 Totals 268 45.35 4.28 323 54.65 5.16 591 100.0 9.44 14 Table III. Infantile Mortality. 1933. Nett Deaths from stated causes at various periods under 1 Year of Age. Causes of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under 1 Year. All Causes 7 2 3 12 3 3 i 19 1 Smallpox 2 Chickenpox 3 Measles 4 Scarlet Fever 5 Whooping Cough 6 Diphtheria and Croup 7 Erysipelas 8 Tuberculous Meningitis 9 Abdominal Tuberculosis 10 Other Tuberculous Diseases 11 Meningitis (Not Tuberculous) .. .. .. .. .. .. .. 1 .. 1 12 Convulsions .. .. .. .. .. .. 1 .. .. 1 13 Laryngitis 14 Bronchitis 15 Pneumonia .. .. .. .. .. 1 2 .. .. 3 16 Diarrhoea 17 Enteritis 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 23 Atelectasis 1 .. .. .. 1 .. .. .. .. 1 24 Congenital Malformations 1 .. .. .. 1 .. .. .. .. 1 25 Premature Birth 4 1 2 .. 7 1 .. .. .. 8 26 Atrophy, Debility and Marasmus 1 .. 1 .. 2 .. .. .. .. 2 27 Other Causes .. 1 .. .. 1 1 .. .. .. 2 Totals 7 2 3 12 3 3 1 .. 19 15 Table IV. Vital Statistics or Whole District during 1933 and Five Previous Years. Year. Population estimated at Middle of each Year. Nett Births belonging to District. Nett Deaths belonging to the District. At all Ages. Under 1 Year of Age. Number. Rate per 1,000 Population. Number. Rate per 1,000 Population. Number. Rate per 1,000 Nett Births. 1 2 3 4 5 6 7 8 1928 47,040 591 12.57 405 8.1 16 27.07 1929 49,630 557 11.22 534 10.05 27 48.47 1930 51,590 607 11.76 498 9.07 22 36.24 1931 55,460 663 11.68 512 8.67 30 45.24 1932 57,250 651 11.37 589 9.67 25 38.40 1933 58,820 570 9.69 591 9.44 19 33.33 Comparison of the Rates of the Southgate District with those of England and Wales, and London, for the Year 1933. Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births Still Births. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 14.4 0.02 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 7.1 64 118 County Boroughs and Great Towns, including 14.4 0.07 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 9.4 67 132 Smaller Towns (1931 Estim'd Census Populations 25,000—50,000). 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 4.9 56 London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 11.6 59 South gate 9.69 0.27 9.44 0.00 0.00 0.00 0.00 0.03 0.03 0.59 0.00 33.33 16 General Provision of Health Services. Hospitals.—General Hospitals.—The arrangements set out in the Annual Report for 1930 regarding the provision of general and special hospital accommodation for the inhabitants of Southgate remain unaltered. They still appear satisfactory. Provision for Maternity Beds.—The agreement with the Royal Northern Hospital and the Salvation Army Maternity Hospital to admit Southgate mothers at reduced fees, continues to work satisfactorily. As before, the North Middlesex County Hospital is also being utilised by a proportion of our maternity cases. Isolation Hospital.—The previous policy of the Council has been to maintain as high a standard of general equipment at the Isolation Hospital as is possible, and, continuing this policy, a considerable number of improvements and alterations took place during the past year. These included further improvements to roads and paths; ward decorations ; improvements to the Mortuary; provision of new equipment, such as ultra-violet and radiant heat apparatus, bed tables, bed screens, lockers and chairs; repairs to beds and cots, and the provision of a heated waggon to carry food from the kitchen to the wards. In addition, the old school house was converted into a dwelling house for the Medical Superintendent and a path constructed therefrom to the Hospital. At the same time, extra ground was included within the Hospital boundaries, as shown in the accompanying diagram. A laboratory, intended to serve the uses both of the hospital and the district as a whole, was also included as part of the above scheme. When it is in operation, this laboratory should very considerably improve the facilities available for the Hospital, and should supply a service which is never entirely satisfactory unless carried out upon the spot. During the coming year, further improvements are contemplated. These include overhaul of the disinfector; alterations to the heating system of the Cubicle Block; improvements to the garage; construction of a workshop for the porter, and a patients' shelter; further extension of the ultra-violet facilities; erection of a lire escape in the Administration Block, and seven new bedrooms for nurses; new internal telephone system; additional improvements to roads and paths, and other minor alterations and improvements. 17 18 As the Council are aware, we are now receiving the great bulk of Tottenham's infectious cases. The Hospital is thus working continuously at full pressure, and it is therefore necessary to look to the future if the standard of efficiency hitherto aimed at is to be maintained. It is for this reason that the improvements noted above are now being carried out, which improvements should materially assist the smooth-running of the Hospital. When the new bedrooms are completed it is hoped that the nursing staff will be correspondingly supplemented. Further remarks on this subject, together with full details of the year's Clinical work at the Hospital, will be found on pages 60-70. Nursing in the Home.—(a) The Southgate Queen's Nursing Association still continues its excellent work. During 1933 the nurses made a total of 11,564 domiciliary visits. At the Physicotherapeutic Clinic 1,071 patients were treated and the total number of treatments given was 6,200. (b) As before it is not considered necessary to provide a nurse for infectious diseases in the home. Additional Health Visitor.—The time now appears ripe for the addition of a third Health Visitor to the Public Health Staff. The Council will remember that the present Health Visitors devote almost all their time to duties in connection with Maternity and Child Welfare work, and a Health Visitor for purely Public Health services would appear very desirable. Such a Health Visitor could be employed upon work in connection with the visitation of tuberculosis patients, the following up of infectious disease cases discharged from the Isolation Hospital, the home visitation of cases of nonnotifiable infectious disease reported from the schools, the Immunisation Clinic duties and other ancillary but extremely important Public Health measures. A discussion on the subject has already taken place and it is hoped that, by the time this Report is circulated, the new Health Visitor will actually be a member of the Staff. Midwives.—There are 10 midwives practising in the area. They come under the supervision of the County Authority, and none is employed or subsidised by the local Council. Clinics and Treatment Centres.—No change from the arrangements noted in the Report for 1930. A full list of these Clinics will be found in that Report. 19 LABORATORY FACILITIES. Pathological and bacteriological examinations have, as hitherto, been carried out by the Clinical Research Association. The laboratory mentioned in last year's Report has now been constructed and it is hoped to commence work during the first half of 1934. Examination of diphtheria swabs and tubercular sputa will then be carried out in the district, and it should be possible to provide greater facilities for the local practitioners at a much lower cost than hitherto. Until the laboratory is properly established it is intended that Widal and fæces examinations and any other procedure requiring elaborate technique should be undertaken as before by the Clinical Research Association. Bacteriological work for the Hospital will also take place at the new laboratory. Dr. Burns has agreed to act as my deputy for the laboratory work at a small extra remuneration, and I also hope to be able to utilise the services of the new Health Visitor if and when required. During the year 1,347 specimens were sent for examination. The reports received were as follows:— Disease Suspected. Positive. Negative. Total. Diphtheria (Swabs) 215 950 1,165 Typhoid Fever (Blood Tests) 1 13 14 Phthisis (Sputa) 27 141 168 243 1,104 1,347 Bacteriological examination of 3 fæces, 1 vaginal swab, 1 cervix swab, and 2 specimens of cerebro-spinal fluid were also carried out. One test for virulence was made in connection with a protracted case of diphtheria. Arrangements for the examination of water, milk and foodstuffs remain unaltered. Legislation in Force.—No fresh legislation was made during 1933. 20 Institutional Provision for unmarried mothers, illegitimate infants and, homeless children. No change from the arrangements noted in the Report for 1930. Ambulance Facilities.—No change at present from the arrangements noted in the Report for 1930. The Council have decided to purchase two new ambulances, one for general and accident use, and one for infectious diseases services. The two vehicles, both Austin ambulances of the latest pattern, were undoubtedly required, as the present ambulances are no longer entirely satisfactory. It is hoped to have the latter repaired, when they will be retained for use in emergency. The new ambulances are expected early in the present year. Orthopaedic Treatment.—Arrangements are made for treating any orthopædic cases met with in connection with the Maternity and Child Welfare services. One such case occurred during the year requiring institutional treatment, when the Council paid the necessary fees for maintaining a child from a necessitous family at the Royal National Orthopaedic Hospital and, later, at the same Hospital's Convalescent Home. The disease requiring treatment was severe rickets and the total period covered, 17 weeks. As before, the Middlesex County Council undertakes the responsibility when the children reach school age. 21 Maternity and Child Welfare Services. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES during 1933. Number on Registers:— Under 1 year. Over 1 year. Totals. January 1st, 1933 432 579 1011 (1932 791) December 31st, 1933 .. 321 1396 1717 ( ,, 1713) New Cases during 1933 412 294 706 ( ,, 922) 11 of the new cases under 1 year were removals into the district. The remaining 401, therefore, represent 70.35 per cent. of the total births credited to the district. Attendance at Centres, 1933:— Under 1 year. Over 1 year. Totals. Broomfield House 1396 1050 2446 (1932 1969) Bowes Park 1690 1259 2949 ( ,, 2835) New Southgate 943 720 1663 ( ,, 2198) Southgate 1371 1303 2674 ( ,, 2807) Winchmore Hill 2595 1635 4230 ( ,, 3713) Totals 7995 5967 13962 ( ,, 13522) Average 31.35 23.40 54.75 ( ,, 53.03) Number Seen by Doctor:— Under 1 year. Over 1 year. Totals. Broomfield House 575 434 1009 ( 1932 945) Bowes Park 666 480 1146 ( ,, 1077) New Southgate 404 302 706 ( ,, 936) Southgate 520 479 999 ( ,, 1046) Winchmore Hill 861 583 1444 ( ,, 1337) Totals 3026 2278 5304 ( ,, 5341) Average per session 11.87 8.93 20.80 ( ,, 20.94) Percentage of total at tendance seen by Doctor 37.8% 38.2% 38.0% ( ,, 39.5%) 22 Number of Sessions held 255 Talks and Practical Demonstrations in Mothercraft given at Centres 49 Any cases requiring treatment are referred to their own doctors or to hospital. STATISTICS OF ATTENDANCES AND WORK DONE AT ANTE-NATAL CENTRE. Number on Register:— 1932. 1933. January 1st 64 56 December 31st 57 56 New cases during the year 183 146 The number of new cases during the year represents 24.9% of the total births (live and still-births). Number of sessions held 51 51 Prospective mothers are only examined at the Ante-Natal Centre by appointment. Postcards are sent, prior to each session, inviting the attendance of certain of those on the register. 1932. 1933. Total attendances 786 612 Average per session 15.4 12 Number seen by Doctor 522 441 Average per session 10.2 8.6 Percentage of total attendance seen by Doctor 66.4% 72.0% Percentage of mothers attending Antenatal Centre 27.1% 24.9% Note of any abnormality found is transmitted to the doctor or midwife engaged to attend. TABLE OF VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OF BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. Children:— 1932. 1933. First visits 598 493 Under 1 year of age 1206 In addition to 1246 Over 1 year of age 3547 first visits. 3331 Visits re:— Deaths under 5 years of age 17 21 Stillbirths 15 13 Ophthalmia neonatorum cases 1 23 1932 1933 Ante-natal visits 398 296 Visits re:— Puerperal Fever cases – – Puerperal Pyrexia cases 2 – Special visits (test-feeds, following special cases seen by M.O. at Centres, failing lactation, etc.).. 998 1210 Visits re:— Tuberculosis cases 42 29 Diphtheria Immunisation – 158 Total visits 6824 6797 As hitherto, all notified births are visited by the Health Visitors upon the notifications being received. Any cases requiring special attention are re-visited periodically, and all mothers are given a cordial invitation to attend the Centres if they so desire. These arrangements continue to work satisfactorily. Children Act, 1908.—During 1933 the visits paid in connection with this work were as follows:— Number of registered foster mothers 10 Number of foster children 14 Total visits paid 60 No case of neglect was discovered during the year. Very little trouble is met with in the administration of this Act. Miscellaneous Statistics. 1932. 1933. Births registered in the district 437 327 Attended by Midwives 165 (approx.) 132 Un-notified Births 18 30 Percentage of Births notified 96.3% 90.8% Stillbirths notified 20 9 Stillbirths notified by Midwives 3 1 Stillbirths notified by Doctors 17 8 Stillbirths notified occurring in Institutions : In the district – – Outside the district 12 6 Maternal Deaths 2 2 Infant Deaths:— Under 1 year of age 25 19 Under 1 month (inc. above) 14 12 1 to 5 years of age 6 6 24 Number of Southgate Births in 1932 1933 North Middlesex Hospital Maternity Home 79 44 Infant Mortality amongst children attending Centres 8 3 (2 over, 6 under 1 year.) (1 over, 2 under 1 year.) Number of cases in which milk was granted:—1932. III; 1933, 116. Approximate cost:—1932, £230; 1933, £250. In 7 cases grants of Trufood were made, and in 9 cases grants of Nestles, Vitoleum Cream, etc., were allowed. List of Foods Sold at Centres:— Trufood amounting to £176 (approx.) Horlick's Malted Milk ,, 012s.,, Nestles ,, 0 5s. ,, Vitoleum Cream ,, 3 ,, Dental Treatment.—During 1933, 18 mothers and 62 children were recommended to attend the Dental Clinic at Broomfield House. Of these, 5 mothers and 51 children received treatment. As before, this Clinic is run in co-operation with the Middlesex County Education Authority. The Council have at present under consideration a new dental scheme whereby use will be made of a panel composed of local qualified dentists and also of one or more Dental Hospitals. If this scheme materialises the old arrangements will be considerably altered and, in any event, it is not intended that Broomfield House shall continue to be used as a dental centre. Attendance at Centres of Non-Southgate Mothers.—With the authority of the Committee, 25 mothers, living a short distance beyond the borders of the district, attended various Southgate. centres. A charge of Is. per attendance is made. The number of non-Southgate mothers attending our centres seems to be continually on the increase, and it would now appear necessary to exercise the strictest discrimination in accepting such cases. With the large housing estate springing up on our borders these numbers will probably increase still more, and, while not wishing to deprive any mothers of such advice as the Centres can give, it should be remembered that their own districts are responsible for this service, and also that Southgate mothers must be our primary concern. Voluntary Helpers.—The Voluntary Helpers Committee again rendered excellent assistance to the Maternity and Child Welfare services in the district throughout the year, the work carried out 25 at the Centres being characterised by its unselfishness and regularity. The Committee held its Annual Christmas Party for mothers as usual, and this function once more proved entirely successful. Staff.—Mrs. Thomas, clerical assistant in the Maternity Department, was absent from duty, owing to illness, for three months, but has happily recovered and is now working full time. PUBLIC ELEMENTARY SCHOOLS. Medical Inspection.—The Middlesex County Medical Officer is the Chief School Medical Officer for this district, and organises and supervises the work. The total number of Children in Schools during 1933:— spected at the Elementary Inspected. Requiring Treatment. Entrants 554 79 Intermediates 419 67 Leavers 339 73 — 1312 — 219 Other ages 226 30 Special 2 – — 228 — 30 1540 249 School Clinics.—These are provided by the Middlesex County Council. (a) Minor Ailment Treatment Clinics are in operation at Highfield Road Council School, Winchmore Hill, where sessions are held on Tuesday, Thursday and Friday mornings, and at Holly Park Council School, Friern Barnet, on Monday mornings and Friday afternoons. Total number of children dealt with at the Minor Ailment,' Clinics:— New Cases Attendances . Treated. Not requiring Treatment Winchmore Hill 1412 6445 1339 73 Holly Park 206 646 189 17 1618 7091 1528 90 26 (b) Ophthalmic Clinic.—An ophthalmic clinic is held weekly, on Saturday mornings, at Garfield Road School, and school children are seen by Mr. E. F. King, F.R.C.S., D.O.M.S., Ophthalmic Surgeon. One hundred and ninety-five children attended the clinic and were seen by the Ophthalmic Surgeon during 1933. Spectacles were prescribed and provided for 147 of these. The corresponding figures for 1932 were 185 and 99 respectively. (c) Dental Clinic.—By arrangement with the Borough Council, the County Council holds a dental clinic at Broomfield House, Broomfield Park, where dental treatment of elementary school children, and of expectant and nursing mothers and children below the age of five years referred from the Borough Council's Maternity and Child Welfare Centres, is undertaken by Mr. S. J. Smith, L.D.S., Senior Dental Officer of the County Council. Children attending Bowes Road and Garfield Road Council Schools receive treatment at the clinic at Holly Park Council School. The Dental Officer inspects children in the various schools, and those requiring treatment are referred to the dental clinic, where treatment is provided at a charge of Is. 6d. (remitted in necessitous cases). Two thousand one hundred and eighty-one children were dentally inspected at the Schools during the year as against 3.228 in 1932, while 1,050 attended at the clinics (1932—1,558), where they received treatment for various dental defects. 27 Sanitary Circumstances of the Area. Water.—The water supply of the district, which is almost entirely served by the Metropolitan Water Board, is satisfactory in quality and quantity. The supply is from high-pressure mains. One complaint was received during the summer as to insufficiency in quantity. The cause was purely local, and matters were put right on transmission of the complaint to the Metropolitan Water Board. A few cottages in the Enfield Road are supplied by the Barnet Water Co. Here, also, the supply is quite satisfactory. Swimming Bath.—As might have been expected, the attendance figures at Barrowell Green Open-Air Swimming Bath showed a considerable increase over those of the previous year, although these in turn were also above the average. A Ministry of Health enquiry was held in Southgate during the year on the question of purchasing a site for an open-air bath, and, as the Council are aware, permission to do so was withheld. This Report does not seem to be the proper medium for discussing the pros and cons of an open-air as against a closed-in swimming bath, but, from a Public Health viewpoint, there docs not appear to be any doubt that additional facilities both for swimming and bathing are called for in the district. This need is, of course, accentuated by the closing of the Broomfield Park Swimming Lake referred to below. Whatever the final outcome may be, it is hoped that extra facilities of one kind or another will shortly be available within the Borough. The attendance figures for the last two years, which were as follows, bring out this point very markedly:— 1932. 1933. Men 879 Women 510 45,161 Mixed Bathers, Adults 28,385 Boys 521 41,061 Mixed Bathers, Children 25,610 Season Ticket Holders (attendances) 36,094 45,540 Totals 91,999 131,762 Spectators, Adults 3,555 5,814 Spectators, Children 1,221 2,322 28 Broomfield Park Swimming Lake.—A sample of the water in this lake, which is fed from two other lakes, together with occasional road washings, and is practically stagnant, was taken on February, 3rd 1933, and sent to the Clinical Research Association for chemical analysis. A report was received on the 6th of the same month setting out the results of the analysis and stating that, ' 'the results show the water to be polluted and it cannot be regarded as safe for swimming purposes." Following this report, instructions were issued to take five duplicate samples from different parts of the lake and to send those to the Clinical Research Association and to the Royal Institute of Public Health for chemical and bacteriological analysis. These analyses were considered by a special Committee, who decided, after obtaining the opinion of two eminent authorities, to recommend the Council to close the lake for swimming. This was done, but later the lake was re-opened and instructions were issued to take monthly samples for the purpose of checking the condition of the water. These samples were obtained and I reported the results to a special Public Health Committee held in July. The following is a copy of the report (Sample No. 1 is taken from the batch of five duplicate samples referred to above, and was selected because it was obtained from a similar position to that of Samples 2-—6):— SUMMARY OF ANALYSES OF SAMPLES TAKEN FROM BROOMFIELD PARK SWIMMING LAKE. With one exception the samples were taken from a point opposite the 6ft. mark at a depth of approximately 3ft., and were obtained in the morning, between 8.30 and 10 a.m., after the water had been disturbed by the swimmers. The exception was sample No. 3, which was taken in the early afternoon from the same point, at a depth of approximately 2ft., the water being artificially stirred. The atmospheric conditions prevailing at the time of taking the samples were as follows Sample No. 1. 11/2/33 weather fine—rain a few hours previously. ,, ,, 2. 25/4/33 weather fine—heavy rain during previous 24 hours. ,, ,, 3. 30/5/33 weather fine and warm—strong sunshine— no rain for three days. ,, ,, 4. 22/6/33 weather fine and sunny—temperature moderate—thundery showers during previous few days. ,, ,, 5. 1/7/33 weather fine and sunny—temperature warm—no rain during previous few days. ,, ,, 6. 7/7/33 weather fine and warm—no rain during previous few days. 29 Some time prior to sample No. 4 having been taken a quantity of evil-smelling material was deposited in the lake by some person or persons unknown. The following tables set out the Chemical and Bacteriological analyses:— Chemical Analyses. Sample— Parts per 100,000. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. Chlorine 4.00 4.6 4.45 4.7 4.6 4.5 ,, X 1.647 =Sodium Chloride 6.58 7.57 7.23 7.74 7.57 7.4 Nitrogen as Nitrates Trace Trace 0.02 Trace Nil Nil Saline Ammonia 0.027 0.071 0.025 0.03 0.025 0.05 Albuminoid Ammonia 0.08 0.093 0.085 0.115 0.11 0.115 Oxygen absorbed in 3 hours at 37oC. 0.4 0.32 0.44 0.25 0.65 0.64 Bacteriological Analyses. No. 1. Sample— No. 2. No. 3. No. 4. No. 5. No. 6. Gelatine plates kept for 4 days at 20°C. 10 colonies per c.c.—1, or 10% liquefied gelatine. (Complete liquefaction occurred) Agar plates kept for 24 hours at 37°C. 28 colonies per c.e. 26 92 uncountable. 420 4,000 Bacteria B.Coli in 0.1 o .e. Streptococci in 5 c.c. B. Enteritidis Sporogenes in 5 c.c. B.Coli in 1 c.c. B.Coli in 10 c.e. B.Coli in 0.1 c.c. B.Coli in 1 c.c. B.Coli in 1 c.c. The Analysts' reports were as follows:— Sample No. 1. Chemical. "The figures for the albuminoid ammonia and oxygen absorbed are high and render this water unsuitable for a swimming lake." Bacteriological. "There is no standard for a swimming pool water, but such water should approximate to a drinking water in cleanliness, and as every feature of the examination shows pollution with excremental organisms to a high degree, it should be considered as unsuitable for bathing purposes in its present condition." 30 Sample No. 2. Chemical. "As compared with Certificate Register No. 865 of the 11th February, 1933, the above figures do not greatly differ. The figures for the albuminoid ammonia and oxygen absorbed are high, indicating an excess of organic matter." Bacteriological. "The presence of B. Coli in such a small quantity as 1 c.c. renders the water unsuitable for drinking purposes and by inference also unsatisfactory for bathing and swimming." Sample No. 3. Chemical. ''As compared with Certificate Register No. 2287 of April 25th, 1933, it will be seen that the figures for the albuminoid ammonia and oxygen absorbed are still high, indicating an excess of organic matter." Bacteriological . ''Although there is an improvement compared with the results obtained on the 25th April last, the presence of B. Coli in 10 c.c., together with the large number of organisms growing on gelatine and agar, renders this water unsuitable for drinking purposes, and by inference unsatisfactory for bathing and swimming." Sample No. 4. Chemical. "As compared with Certificate Register No. 3042 of May 30th, 1933, it will be seen that the figures for the saline and albuminoid ammonia have slightly increased. A reduction in these amounts is highly desirable." Bacteriological. "Every feature of this result shows that this water would be unsuitable for use for domestic purposes, and by inference is unsatisfactory for bathing and swimming. This is the least satisfactory result yet obtained." Sample No. 5. Chemical. "The figures for the oxygen absorbed and albuminoid ammonia are high and indicate an excess of organic matter. A reduction in these is highly desirable." 31 Bacteriological. "The results obtained are better than those from the sample submitted on the 22nd June, 1933, but they are still not satisfactory considered as a drinking water, and, therefore, by inference not of a good quality for bathing and swimming purposes." Sample No. 6. Chemical. "As compared with certificate Register No. 3705—i.e., Sample No. 5—the figures for the saline ammonia have increased. There is an excessive amount of organic matter still present as shown by the high figures for the albuminoid ammonia and oxygen absorbed. A reduction in these is highly desirable." Bacteriological. "The results of this examination are not so satisfactory as the last sample submitted on 1st July, 1933." The following facts emerge from a study of the above reports :— 1. The saline ammonia, albuminoid ammonia and oxygen absorbed figures have remained at a dangerously high level throughout, and are now showing a definite increase. 2. The Bacteriological Analyses are now even less satisfactory than they were in February. 3. The samples have been taken irrespective of weather conditions, which, apart from the fact that no rain was present when the actual samples were being taken, have varied within considerable limits, especially as to conditions, prevailing during the previous few days. 4. The conditions found in Sample No. 4, following upon the deposit of the unknown material in the lake, are present in an approximately similar degree in Sample No. 6. Having carefully considered the facts, collectively and individually, I am of opinion that the lake should now be closed for swimming. Following the reception of this report, the lake was closed for swimming and has remained so up to the present. The Council has carefully considered schemes for purifying the water. Chlorination appears to be entirely out of the question, but a modified process, that of chloramination, was only abandoned 32 after an exhaustive enquiry into its possibilities. At the present moment an artesian well is being sunk in Broomfield Park, and it is hoped that the volume of water then available will render the lake suitable for swimming. At any rate, there can be no doubt that the water so obtained will prove of considerable service in the park generally. Rivers and Streams.—Complaints regarding the East Barnet Valley Sewage Farm and Refuse Dump were somewhat fewer last year than during 1932, but there is still no reason to believe that the nuisance has been materially abated. The Southgate Urban District Council asked permission to send a deputation to the Minister of Health on this subject, but were informed that such a deputation would serve no useful purpose and that the East Barnet Valley Urban District Council were proceeding with the scheme of reconstruction previously reported. A deputation, however, did visit the Lee Conservancy Board on the same matter and were assured by that body that strict measures were being undertaken to prevent pollution of Pymmes Brook by any sewage effluent. There the matter has rested, but conditions are still far from satisfactory, and ' we still look forward to the day when this nuisance will be a thing of the past. Drainage and Sewerage.—The main arrangements for drainage, sewerage and sewage disposal were given in detail in the Report for 1930, and have not been materially altered. During 1933 several improvements and alterations were once more made in various parts of the district. A length of the northern main sewer (almost a mile) was relaid to deal with additional sewage in that area. Three miles of sewage sewers and three miles of surface-water sewers were also laid to serve various building estates in the district. Closet Accommodation.—Water-closets are in use throughout the whole district and are connected with the Council's sewers. There is still one earth closet in the district, which is seldom, if ever, used. Cesspools.—The cesspools mentioned in last year's Report still remain. These serve 25 cottages in the most thinly-populated parts of the district. One other cesspool is being constructed to serve a hut now used as a Boys' Club. Although unsatisfactory in principle, the difficulties in making connection with a sewer are so great that any other alternative appears impracticable. The work has not yet been completed and close watch is being maintained to see that the Public Health requirements are amply fulfilled. 33 The arrangements for supervising and controlling these cesspools are as given in last year's Report. When the new area at Cockfosters is taken over further cesspools will require to be dealt with. Roads.—There are now nearly 70 miles of roads in the district, made up as follows:— County Roads 10.13 miles. Arterial Roads 1.83 ,, District Roads 48.04 ,, 60.00 ,, Private Roads 9.84 ,, 69.84 ,, Public Conveniences.—The Council's underground convenience at The Triangle, Palmers Green, continues its useful services. The conveniences at Enfield West and Southgate Stations mentioned in last year's Report are now open and proving extremely valuable. The erection of a Public Convenience for Winchmore Hill has not yet been accomplished, but negotiations are proceeding to obtain the necessary sanction. Negotiations are also proceeding to obtain a suitable site for a convenience which will serve the southern portion of the district, and also those persons attending the Labour Exchange. Collection and Disposal of Refuse.—The arrangements in force are unaltered from those detailed in the Report for 1930, and amplified in last year's Report. The Cleansing Committee have under consideration a scheme of reorganisation at the Refuse Destructor whereby the plant will be brought thoroughly up to date and made capable of dealing adequately with the rapidly-increasing bulk of daily refuse. A scheme of waste paper collection is also being considered. In addition, extra refuse collection vehicles are to be purchased. These were urgently required and should make for increased efficiency. There can be little doubt that this branch of Public Health work is of enormous importance. It is futile to try to continue with methods of collection and disposal which are either inadequate or inefficient, and money spent in this direction will bear fruit, not only in the improved appearance, but also in the added safeguards to the health of the district. 34 Several complaints were received during the year with reference mainly to the non-collection of refuse or to the alleged carelessness of the men employed. These were dealt with by the Surveyor's Department. The following is a brief summary of the work carried out during the year:— No. of Days Worked—Hired Horses 674 ,, ,, ,, ,, Electrical Vehicles 905 ,, ,, ,, ,, Freighters 606 Demonstration Vehicles 64 No. of Loads taken to Destructor 6,964 Total Weight taken to Destructor 11,998 tons. No. of Loads taken to other shoots 368 Total Weight taken to other shoots 781 tons. Trade Refuse.—The sum of £186 was obtained for the removal of trade refuse during the year. Smoke Abatement.—Two complaints as to the emission of black smoke were received during the year. In the first case, the factory concerned was situated just without our border and, although our Sanitary Inspector took observations, the complaint was necessarily passed on to the Medical Officer of Health of the district concerned. We received an assurance that the matter would receive attention, and were also informed by the factory owners that new machinery to remove the nuisance was being installed. The second complaint was investigated, and observation proved that a certain amount of black and other smoke was being emitted. The factory owners were interviewed and promised to take every step to abate the nuisance. The premises are still being kept under observation and more stringent action will be taken if necessary. The Council have had under consideration the adoption of byelaws under the Smoke Abatement Act, 1926; when these are adopted, action will be easier, and for this reason the possession of such bye-laws would appear highly desirable. Ponds and Rubbish Dumps.—Complaints regarding smells from ponds and nuisances from rubbish dumps were fewer last year than previously, but these matters still require careful supervision. Common Lodging Houses, Houses -let -in -lodgings, etc.— As hitherto, we have experienced very little difficulty in administering the bye-laws governing these types of premises. Owing to the fact that more and more large houses are being let off in flats, 35 the houses-let-in-lodgings question is becoming increasingly pertinent in Southgate. Vigilant watch is being kept on all such converted premises and every endeavour made to abate nuisances as they occur. Schools.—The schools in the district are visited from time to time. A thorough inspection of all the schools in the district was made during the year, after which the school authorities were communicated with and asked to remedy the defects discovered. As the result of this, the following improvements were carried out:— 1. A number of defective W.C.'s were repaired and put in order at various schools. 2. Improved and more adequate flushing apparatus was provided to the W.C.'s at one school in place of a defective system. 3. Garfield Road School.—Work on the conversion of the present trough closets to pedestal wash-down W.C.'s will probably be carried out during the summer vacation. 4. Chase Road C.E. School.—Certain alterations considered necessary at this school were recommended to the Managers. Efforts are being made to meet these requirements. The majority of the Schools are now generally satisfactory, but several of the older premises still leave much to be desired. The Boys' School at Cockfosters will be included in the Southgate area when the alteration in the boundary comes into force and it is understood that this school will require attention. The Southgate Girls' School, a very old building unsuitable to present-day needs, was closed during 1933, the scholars being transferred to the new Oakwood School in Chase Road. Rag Flock Acts, 1911 and 1928.—There are no premises in the district manufacturing, selling or using Rag Flock according to the Acts. 36 Inspection and Supervision of Food. Milk Supply.—No registration of retailers or producers has had to be refused under the provisions of the Milk and Dairies (Amendment) Act, 1922 (Milk and Dairies Order, 1926). Four additional retailers were registered during the year under this Act. Under the Milk (Special Designations) Order, 1923, 5 Dealers' Licences to sell Certified Milk, 15 to sell Pasteurised Milk, 5 to sell Grade A (Tuberculin Tested) Milk, and 1 to sell Grade A Pasteurised Milk were granted during the year. One Pasteuriser's Licence in respect of a pasteurising and bottling establishment was granted. Four supplementary licences for Certified Milk, 5 for Grade A (Tuberculin Tested) Milk, 1 for Grade A Milk, 5 for Pasteurised Milk, and 2 for Grade A Pasteurised Milk were granted during the year. It is very satisfactory to note that no milk, other than that contained in sealed bottles, is retailed from any general shop in the district. Veterinary Examination of Cows.—This was undertaken as before by the Middlesex County Council. Inspection of Cowsheds, Dairies and Milkshops.—As hitherto, the cowsheds, dairies and milkshops in the district were inspected regularly throughout the year, and were found to be in a satisfactory condition. The dairy to which objection was raised during 1932 has now been abolished, and the new premises opened comply with all regulations. Meat.—There are no public abattoirs in the district. Butchers' shops are visited frequently, and slaughterhouses are kept under strict control. During the year a total of 4,232 carcases was examined, as followas:— Bullocks, 74; Sheep and Lambs, 3,578; Calves, 33; Pigs, 547. 37 As a result of these examinations, 31 separate diseased or unsound conditions were discovered and the carcases or organs dealt with. Details of these conditions are as follows:— Bovine Carcases. Weight in lbs. 9 separate portions affected with Tuberculosis 1,028 3 ,, ,, ,, ,, Distoma 40 3 ,, ,, ,, ,, Cirrhosis 56 1 ,, ,, ,, ,, Multiple Abscesses 20 1,144 Sheep Carcases. 1 Separate portion affected with Emaciation 64 1 ,, ,, ,, ,, Distoma 2 1 ,, ,, ,, ,, Pneumonia 3 69 Pig Carcases. 3 separate portions affected with Tuberculosis 25 3 ,, ,, ,, ,, Pneumonia 12 2 ,, ,, ,, ,, Bruising 21 2 ,, ,, ,, ,, Cirrhosis 5 63 Total weight of unsound meat dealt with 1,276 (11cwts. 1qr. 161bs.) The incidence of disease in the different food animals inspected during the past year as compared with the previous year is shown in the following table :— Animals. All Diseased Conditions. Tuberculosis. Slightly Affected. Extensively Affected. Slightly Affected. Extensively Affected. No. % No. % No. % No. % Bovines— 1932 4 7.84 – – – – – – 1933 18 24.32 2 2.70 7 9.45 2 2.70 Sheep— . 1932 2 0.06 – – – – – – 1933 3 0.08 1 0.02 – – – – Calves— 1932 – – – – – – – – 1933 – – – – – – – – Pigs— 1932 9 2.80 – – 6 1.86 – – 1933 10 1.82 – – 3 0.53 – – Other Foods.—The bakehouses, fish, fruit and grocers' shops in the district are kept under observation. Three tins of prawns and 11 stone 31bs. of crabs were voluntarily surrendered during the year. 38 Sale of Food and Drugs Act. The duties under the Food and Drugs Act are administered by the Middlesex County Council. The following particulars of samples taken in the district during the past year were supplied by the courtesy of the Chief Officer of the Public Control Department:— Articles. Samples Taken. Found Adulterated. Milk 104 2 Milk, Sterilised 4 — Butter 2 — Chocolate 1 — Hake 12 4 Sole 3 1 Lemon Sole 4 2 Minced Beef 1 — Sausages 2 — 133 9 39 ANNUAL REPORT, 1933. On the Administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Laundries, Workplaces and Homework. 1—INSPECTION, Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of (1) Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries). 345 36 .. Workshops (including Workshop Laundries) 346 25 .. Workplaces (other than Outworkers' premises, included in Part 3 of this Report) 48 10 .. Total 757 71 .. 2—DEFECTS FOUND. Particulars. Number of Defeots. Found. Remedied. Referred toH.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of Cleanliness 80 85 .. .. Want of Ventilation .. .. .. .. Overcrowding .. .. .. .. Want of Drainage of Floors .. .. .. .. Other Nuisances 26 29 .. .. † Sanitary Accommodation Insufficient .. .. .. .. Unsuitable or Defective 20 25 .. .. Not separate for sexes 1 1 .. .. Offences under the Factory and Workshops Act:— Illegal occupation of Underground Bakehouses (s. 101) .. .. .. .. Breach of special sanitary requirements for Bakehouses (ss. 97 to 100) .. .. .. .. Other Offences .. .. .. .. (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 127 140 .. .. *Including those specified in Sections 2,3,7 and 8 of the Factory and Workshops Act as remediable under the Public Health Acts. † Section 22 of the Public Health Acts (Amendment) Act, 1890, was adopted in 1890. 40 41 3.—Home work. Nature of Work. Outworkers' Lists, Section 107. Prosecutions. Outwork in Unwholesome Premises, Sec. 108 Outwork in Infected Premises. Sees. 109 & 110. Lists received from Employers. Notices served on Occ'prs as to keeping or sending Lists. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Twice in the year. Outworkers Lists. Once in the year. Outworkers. Instances. Notices Served Prosecutions . Instances. Orders Made. (8.110) Prosecutions. (8.109-110) Contractors . Workmen. Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) bearing Apparel — (1) Making, etc. 7 .. 31 .. .. .. .. .. .. .. .. .. .. .. .. 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. (1) No. (2) Class. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) .. Bakehouses 15 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not I under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 1 Laundries 2 Reports of action taken sent to H.M. Inspector 1 Other Workshops 162 Total Number of workshops on Register 179 Other .. Underground Bakehouses (s. 101):— Certificates granted during the year .. In use at the end of the year .. SANITARY INSPECTION OF AREA. As will be seen from the Tables set out below, the number of inspections carried out during 1933 has considerably increased, in spite of the fact that the Senior Sanitary Inspector was absent from duty for a period of 15 weeks. The Tables referred to have also been amplified this year to allow of more detailed information being given. The various matters contained therein are reported to the Public Health Committee each month. During 1933 a slight revision was made in the Sanitary areas of the district, with a view to more evenly distributing the work of the two Inspectors. Inspections. 1933. Housing inspections and re-inspections (1932—4,211) 3,841 Slaughterhouse visits and inspections ( .. 417) 586 Factories and workshops (including bakehouses) visits and inspections ( „ 880) 757 Dairies, cowsheds, milkshops and other food shops, visits and inspections ( ,, 1,411) 1,447 Various complaints, inspections and reinspections ( „ 1,424) 1,355 Dustbins, inspections and re-inspections ( ,, 1,354) 1,363 Infectious Disease visits and re-visits ( ,, 1,292) 1,086 Other inspections (Rents Acts-—Rats and Mice Destruction Act—Ditches and Ponds — Accumulations — Non-notifiable Diseases, etc.—Drain inspections and tests—Smoke observations) ( ,, 2,003) 4,443 Total (1932—12,992) 14,878 Service of Notices. Total informal sanitary notices served (1932— 928) 1,063 Total informal dustbin notices served ( ,, 301) 270 Total informal notices served ( ,, 1,229) 1,333 Total informal notices complied with ( ,, 1,053) 1,377 Total statutory notices served ( ,, 33) 37 Total statutory notices complied with ( ,, 23) 47 Total notices carried forward ( ,, 203) 159 42 Sanitary Improvements.—The following is a summary of the sanitary improvements effected, and the defects remedied:— 1932. 1933. Premises cleansed 86 96 Ceilings repaired and distempered 1,230 1,491 Wall plaster repaired 400 220 Walls redecorated 910 1,079 Dampness remedied 247 272 Ventilation under floors improved 14 16 Floors repaired or relaid 86 90 Roofs repaired 194 250 Eaves, guttering and rainwater pipes repaired or renewed 165 279 Yards repaired or repaved 93 116 Brickwork repointed or repaired 67 119 Windows and doors repaired or renewed 391 472 Coppers repaired or renewed 32 46 Cooking ranges repaired or renewed 82 104 Draw taps fixed on main water service 11 16 Water storage cisterns cleaned or covered 4 14 Drains unstopped, trapped, etc. 93 94 Inspection chambers provided or repaired 40 64 Drains reconstructed or repaired 47 61 Drains examined or tested 373 359 New trapped gullies fixed 17 26 Waste pipes repaired or renewed 79 107 Soil pipes or venti lating shafts repaired or renewed 27 35 New sinks fixed 63 69 Flushing cisterns repaired or renewed 56 79 W.C.'s repaired and improved 111 166 Fresh air inlets repaired or renewed 34 101 Cesspools abolished—drains connected to sewer 0 0 Cesspools emptied and cleansed 5 8 Accumulations of refuse removed 55 83 Nuisances from keeping of animals abated 4 3 Foul ditches, ponds and stagnant water abated 1 1 Moveable dwellings (caravans or tents) removed 1 12 Overcrowding abated 4 5 Smoke nuisances abated 3 16 Dustbins renewed (by owners) 340 346 Dustbins renewed (by Council, in default) 0 0 Other nuisances remedied 38 76 Miscellaneous repairs executed 147 104 Total 4,640 6,495 43 Dustbins.—Special inspections, following upon information given by the Dustmen, continue to be made in all parts of the district and amongst all classes of property with the object of effecting the replacement of defective dustbins. Altogether 286 premises were visited in this connection; 192 verbal notices, 45 preliminary notices and 6 statutory notices were served. These special inspections alone resulted in the provision of 242 new bins, which included a number of bins supplied following notices served during 1932. Premises under Periodical Inspection.—The following premises are kept under periodical inspection. As before, the inspections showed that they were being satisfactorily administered. Description of Premises. No. in District. Dairies and Milkshops 33 Cowsheds 3 Bakehouses 15 Dining Rooms 21 Slaughterhouses 5 Fried Fish Shops 9 Factories and Workshops 179 Public House Conveniences 20 Total 285 HOUSING. Number of New Houses Erected during the Year 1933 (a) Total (including numbers given separately under (b)) 550 (b) With State assistance under the Housing Acts:— (i) By the Local Authority Nil (ii) By other bodies or persons Nil House-to-House Inspection.—The Housing Schedule was revised during 1933 and brought up to date. The effect of this revision was to transfer certain houses from the biennial and quinquennial to the annual and biennial lists, and to add several houses, which had not previously appeared in the schedule, to the quinquennial list. In some other cases houses which had been demolished were removed from the list. The revised schedule appears in the Table below. Six hundred and forty-three houses were inspected and recorded under the Housing Acts, as follows:—  No. of House. Scheduled. No. Inspected. No. I. Northern District. 1932. 1933. Annual List 121 120 56 Biennial List 35 35 — Quinquennial List 751 134 172 No. 2. Southern District. Annual List 150 83 150 Biennial List 74 74 22 Quinquennial List 717 311 243 Total 1,848 757 643 Non-Scheduled Houses.—In addition to the above, 244 nonscheduled houses were inspected for housing defects, mostly upon the complaint of the occupiers, as follows:— 1932. 1933. North-eastWard 70 59 North-west Ward 44 26 Middle Ward 55 61 South Ward 93 98 Total 262 244 1. Inspection of Dwelling-houses during the year:— 1932. 1933. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,019 1,281 (b) Number of inspections made for the purpose 1,102 1,455 (2) (a) Number of Dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 757 643 (b) Number of inspections made for the purpose 840 794 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 2 45 1932 1933. (4) Number of Dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 718 786 2. Remedy of Defects during the year without Service of formal Notices:— Number of Dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 570 693 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of Dwelling-houses in respect of which notices were served requiring repairs Nil Nil (2) Number of Dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil Nil (b) By local authority in default of owners Nil Nil n.—Proceedings under rub he Health Acts:— (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied33 38 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 23 48 (b) By local authorities in default of owners Nil Nil C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of Dwelling-houses in respect of which Demolition Orders were made Nil Nil (2) Number of Dwelling-houses demolished in pursuance of Demolition Orders Nil Nil 46 D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made Nil Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Nil E.—Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of Dwelling-houses in respect of which notices were served requiring repairs Nil Nil (2) Number of Dwelling-houses which were rendered fit after service of formal notices: (а) By owners Nil Nil (б) By local authority in default of owners Nil Nil (3) Number of Dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil Nil F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 :— (1) Number of Dwelling-houses in respect of which Closing Orders were made Nil Nil (2) Number of Dwelling-houses in respect of which Closing Orders were determined, the Dwelling-houses having been rendered fit 1 Nil (3) Number of Dwelling-houses in respect of which Demolition Orders were made Nil Nil (4) Number of Dwelling-houses demolished in pursuance of Demolition Orders Nil Nil (5) Number of Dwelling-houses closed tarily by owners 13 15 (6) Number of Dwelling-houses demolished voluntarily by owners 16 16 47 Southgate was in the fortunate position of being able to report to the Ministry of Health during 1933 that no inhabited premises existed in the district which could be classified as "slum property." For the Council's information I herewith append the Report on this matter which was submitted to the Public Health Committee in June:— ''There can be no doubt that the general standard of housing in Southgate is satisfactory and Well above the average. There are, however, several small blocks of property which are considerably below the general level. These are situated as follows:— South Ward Park Cottages. Curtis Road. Part of High Road, New Southgate. South portion of Palmers Road. Lee Street. Albert Street. South Road. Green Brae, Tottenhall Road. North-East Ward Barrow Close. Portion of Highfield Road. Salisbury Cottages, Hoppers Road. North-West Ward Elgin Cottages, Avenue Road. Ivy Road. Hillside Grove. "Of these properties the worst are those in Ivy Road, Green Brae, Salisbury Cottages, Curtis Road, Palmers Road and Park Cottages. All these properties are inspected annually and in each case we are able, mainly under Section 17 of the Housing Act, 1930, and Section 91 of the Public Health Act, 1875, to obtain the repairs necessary to put the houses into a condition suitable for occupation. The only possible exception is No. 4, Salisbury Cottages, and even here the house hardly comes within the purview of slum property. There is, moreover, a strong possibility that the house may be closed voluntarily. "After careful consideration, I cannot say that there is any property in the district which definitely comes under the category of a 'slum.' In other words, we have always been able, up to the present, to have the existing faults remedied and improvements carried out at a reasonable cost. I would accordingly recommend that the reply to the Ministry regarding our programme for the next five years be to the effect that we have no areas, or even houses, in such a condition as to require compulsory demolition or the enforcement of a Closing Order; and that we are keeping pace with modern conditions and improvements under the statutory powers at our disposal. 48 "While this is the reply which I would suggest, I still consider that the Council should press forward with their scheme for providing at least 50 new houses, and that we should inform the Ministry of the Council's determination to do so. If this were done, it might be possible to arrange for voluntary closing of certain houses in the district, with the subsequent re-housing on these tenants in Council houses." Since this report was issued the house referred to in paragraph 2 has been vacated. I need hardly reiterate the fact that, although "slums" are absent from Southgate, no effort will be spared to maintain the existing standard of housing and to effect improvements whenever and wherever such are necessary. In this connection, I would repeat my please of last year for more and still more Council houses. The question of uneconomic rents is still with us, pregnant with difficulties, and demanding immediate solution. The Council should not rest until it is satisfied that the urgent need for houses whose rents are within the slender means of the more necessitous families is met, and adequately met. Every shilling spent in rent means less nourishment for some unfortunate family, and we should remember that starvation is quite as effective in a mansion as in a two-roomed cottage. Everything considered, I know of no problem which cries out for solution more than does this one, and I therefore trust that it will receive the attention which it requires. Overcrowding.—Five cases of overcrowding in a mild form were reported this year. It was possible in all instances to effect material improvement in the conditions under which the families lived. Rent Restrictions Acts.—Under the provisions of these Acts, 9 applications were received from occupiers for certificates to the effect that their houses were not in a reasonable state of repair. Special inspections were made in each case, and 9 certificates were granted. In addition to the above, 3 applications were received from owners of premises for certificates that the necessary work to put the premises into a reasonable state of repair had been executed. Certificates were granted in all three cases. 49 Rats and Mice Destruction Act.—This Act is administered in the Southgate area by the Middlesex County Council. As before, many complaints were received during the year of the presence of rats in various parts of the district. These complaints were all investigated in the first instance by the Sanitary staff and handed over to the Rat Destruction Officer when necessary. Nuisances from Rubbish Heaps and Ponds. -Several complaints were received as to the presence of flies, etc., in and around rubbish heaps and ponds. These places are kept under observation and steps taken to prevent breeding. It is with great pleasure that I have to report a high distinction gained by Mr. Hill, Sanitary Inspector for the Southern District, who won the Ollett Gold Medal for the best paper read before the Sanitary Inspectors' Association during 1932. 50 Prevalence of and Control over Infectious and Other Diseases. The two outstanding events of the year as regards infectious diseases were the small outbreak of smallpox in July and the diphtheria outbreak in October-November. In spite of these occurrences, 1933 was very satisfactory from an infectious diseases standpoint. From Table V, on page 71, it will be seen that 249 cases of infectious diseases were notified during the year, as against 239 in 1932. The average for the five years 1929-1933 was 303. These 249 cases represent infection in 226 houses. The figure of 249 is 10 more than last year, the increase being accounted for by the greater population. When one comes to consider the-Infectious Sickness Rate of the district, i.e., the number of persons per 1,000 of population suffering from any notifiable infectious disease during the year, the comparison becomes clearer. This rate is a fairly good index of the health standard of the community in relation to its resistance against infectious disease, and, happily, the figure for Southgate is low. The Infectious Sickness Rate for 1933 was 4.2 as against 4.3 in 1932 and 4.5 in 1931. The figure of 4.2 is one of the lowest ever recorded in Southgate. and shows that a steady increase in population does not necessarily bring with it an increase in the incidence of infectious diseases. The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 157 premises. During such inspections, 48 houses were found to contain sanitary defects, consisting chiefly, as previously, of defective water-closets, dampness and want of cleansing. These defects have all been remedied. No case of overcrowding was met with in any of the houses inspected in connection with cases of infectious disease. One hundred and twenty-six cases were removed to the Isolation Hospital at Total enhall Road. Of these, 70 were suffering from scarlet fever, 22 from diphtheria, 1 from paratyphoid fever, 7 from erysipelas, 1 from pneumonia and whooping cough, and 1 from puerperal fever, while 9 were observation cases and 15 were "diphtheria carriers." Smallpox.—For the first time in more than a quarter of a century smallpox showed itself in Southgate. Four cases occurred in one family residing in Lower Park Road, New Southgate, the 51 history of the outbreak being very illuminating. The first case was that of a young woman, usually resident in Camberwell, who, on feeling unwell, came to stay with her mother in Southgate. Prior to the diagnosis of smallpox being made, this girl infected her sister, niece and brother-in-law, only two members of the household, the father and mother, remaining unaffected. It is very significant that these latter two persons were the only ones in the house who had been previously vaccinated. The cases were removed to Long Reach Hospital, where they all made a rapid and complete recovery. Immediately following notification of the first case, steps were taken to have all the other members of the household examined and vaccinated, while endeavours were made to trace all contacts. The examination of the other occupants of the house revealed the further three cases reported above, and the search for contacts was therefore extended. Thirty-five contacts in all were discovered, immediate and remote, and it is very gratifying to be able to report that, without exception, they all accepted vaccination. Close watch was kept upon them, but no further cases occurred. I think it should be placed on record that every assistance was given by the family affected and the contacts to those making the investigation, while all the instructions issued were faithfully carried out, a fact which undoubtedly helped in so strictly limiting the number of cases. Surrounding Authorities were immediately notified, in the usual way, of all contacts resident in their districts. Vaccination.—No primary vaccinations or revaccinations under the Public Health (Smallpox Prevention) Regulations, 1917, were required during 1933. Scarlet Fever.—Ninety-one cases of scarlet fever were notified during the year, as against 100 in 1932. This figure is well below the average for the last five years (108) and is the lowest recorded since 1926, in spite of the increase in population. It must be remembered, of course, that this is an inter-epidemic period so far as Southgate is concerned, but the consistently low figure for scarlet fever during the past few years is very satifsactory. There were no deaths during 1933. None of the cases notified was "imported," while 14 were "secondary" cases occurring in houses from which previous cases had been notified. In only three cases had the original patient been isolated at home. There were two "return" cases from houses to which previous cases had returned after discharge from the Isolation Hospital, although in one case there was another very probable source of infection. 52 Nineteen of the cases notified were over the age of 16, one being a nurse from Grovelands Hospital. The remainder (72) were children, 13 of them being under school age. Of the remaining 59. 37 attended elementary schools in the district, 5, secondary schools, 9, private schools and 8, schools outside the district. The case-distribution into wards was as follows:— North-West Ward, 14 (9 in the Council Housing Estate). North-East Ward, 18. Middle Ward, 31. South Ward, 28. The highest incidence during the year took place in April and November, when 14 cases were notified. Seventy cases were removed to the Isolation Hospital, representing 76.9 per cent, of the total number of cases notified. Diphtheria.—Twenty-three cases of diphtheria (19 faucial, 2 faucial and laryngeal, 1 nasal and faucial, and 1 nasal) were notified during 1933 as against eight the previous year. Although this is a comparatively large increase, the figure is below the average for the past five years (31.8), and is low for a district with a population such as Southgate's. In addition, the figure would have been very much lower had it not been for the localised outbreak which occurred in the North-West Ward during the latter part of October and November, when no less than 17 cases occurred. This outbreak, although numerically unimportant, requires special consideration. The first case was notified on October 20th and the last on November 28th, the weekly incidence during that period being 1, 3, nil, 6, 3, 2, 2. The cases were confined with one exception to the northern portion of the North-West Ward in and around the Council's Housing Estate, 6 cases actually occurring within the Housing Estate itself, although there had not been a single case of diphtheria in that portion of the district for over a year. Two deaths took place, one, a child aged 5, and the other a child aged 3. Apart from these two cases, the type of disease met with was comparatively mild, all the other patients making a good recovery under treatment. As soon as the outbreak commenced, steps were taken to investigate its possible source and also to check its spread. The first 3 cases occurred in a family in which the children were attending a school outside the district, but in all the others (with the one exception noted above, when the case occurred in the North-East Ward), one or more of the children in the household affected attended Oakwood School. The milk supply in all cases was investigated and it was found that the supply came from varied sources (7 to be exact), thereby eliminating the possibility of a milk-borne epidemic. In spite of this, the workmen handling 53 or distributing milk in the three farms situated within the district were swabbed, with uniformly negative results. All the members of the households affected and all contacts were swabbed, while I personally attended Oakwood School and examined several hundred children. Those with enlarged tonsils or adenoids and any defect of the nose were swabbed, it being felt that there was more likelihood of carriers occurring among that type of child. By this means, no less than 11 carriers were discovered and isolated, while 4 other carriers were notified by private practitioners. It is possible, of course, that several of these persons may have suffered from diphtheria at some earlier date, but there was no clinical evidence or history to prove this theory. Finally, warnings and instructions were issued through the medium of the local Press, ' 'Better Health,'' the Welfare Centres and the Health Visitors, while a vigorous campaign advising immunisation was started. These measures were undertaken, not for any "panic" purposes, but in the hope that they would bring a realisation of the dangers of diphtheria before the inhabitants of Southgate. As already noted, the outbreak gradually subsided, the cases occurring in the latter part of November being exceedingly mild. The following particulars relate to the cases notified during the year:— Number of cases notified, 23. (Adults, 5; Children, 18.) Number of cases removed to Hospital, 22. (95.7 per cent.) Distribution into Wards:— North-West Ward, 13. North-East Ward, 2. South, 3. Middle, 5. Carriers discovered, 19. (Adults, 2—oldest 48 years; Children, 17—youngest 3 years.) With such a comparatively small number of annual cases, it is quite easy to swab all the members of the household affected together with intimate contacts. This is now being done. Fifteen of the carriers were removed to Hospital until three negative swabs had been obtained. The remainder were isolated at home, the swabs being taken by the family doctor or by the Public Health Department. Day of Disease on which the Cases were Notified. 1st Nil 2nd 5 3rd 7 4th 3 5th 4 6th 1 7th Nil 8th 1 ? 2 (probably 7 days or over) 54 This condition of affairs is by no means satisfactory, especially when it.is known that the second of the two deaths which occurred took place in a child unnotified until the fifth day of disease. In almost every case the fault lay in the unfortunate failure of the parents to recognise the clinical signs and symptoms of diphtheria until the patient had been ill for several days. Further information on the subject has been disseminated, and it is hoped that a more speedy recognition of the disease will be met with in future. As hitherto, Diphtheria Antitoxin is kept in stock at the Public Health Department and issued to all medical practitioners on application. This facility is utilised extensively, and it is quite obvious from the demands made upon the supply at the Town Hall that the local practitioners are not waiting for the result of a swab in doubtful cases, but are injecting anti-toxin immediately as a precautionary measure. This, of course, is only as it should be. Immunisation.—A considerable advance in the campaign against infectious disease was made during 1933 by the inauguration of a Clinic for Immunisation against diphtheria. The first session of the Clinic, which is held on Thursday afternoons from 2—4 in Broomfield House, took place on March 5th, and altogether 49 sessions were held. Seven hundred and forty new cases attended during these sessions, together with 1,760 re-visits, making a total of 2,500 visits. It was found necessary to hold extra sessions during the period covering the diphtheria outbreak, three such being held per week for four weeks at Oakwood School, Chase Road School and Broomfield House respectively. I would like here to thank the Head Teachers of Oakwood and Chase Road Schools for the great assistance accorded to my staff and myself during this time. It was at their suggestion that I visited the schools, and there is no doubt that the work of immunisation was greatly facilitated by so doing. Next year I hope to obtain similar permission to attend other schools in the district, as 1 consider this work too valuable to be discontinued. Full particulars of the work of the Clinic are set out below, but, this being the first year of its existence, a few general remarks may not be out of place. The staff of the Clinic consists of myself as Medical Officer, a nurse from the Isolation Hospital, and the Junior Clerk from the Public Health Department. No expense is incurred in the way of salaries or use of rooms. The method of procedure is to perform a Schick Test on all children over the age of 5, it being considered unnecessary to do so in children under that age owing to the overwhelming number of positive reactions found. Those with a positive reaction (and all children under 5) receive three weekly injections of 1 cubic centimetre of Toxoid-Antitoxin mixture (T.A.M.) in alternate arms. Three months later they 55 receive a further Schick Test. If the test is still positive a fourth injection is given and a further test made after three months, as before. Up to the present, this has proved sufficient in all cases. Careful records are kept and filed for reference. Children under 12 months are considered too young for immunisation, but apart from this, the earlier the age at which the injections are given the better is the result. Very few reactions were met with among the patients attending the Clinic (35 out of approximately 1,500 injections given), while even in these cases all untoward symptoms had disappeared within a few days. In only 3 cases was the reaction in any way severe. One of the great stumbling-blocks to such a scheme as this, is the number of patients who, for one cause or another, fail to complete the course. We have met with the usual number in Southgate, but the Health Visitors have been extremely valuable in rounding up the absentees and we are gradually completing the blanks in our records. The following are the statistics relating to the Clinic to date:— Number of sessions held 49 Number of new cases 740 (44 adults, 696 children) Number of re-visits 1,760 Total number of attendances 2,500 Highest number of new cases dealt with at one session 140 Highest number of total visits at one session 223 Results of Schick Test Divided According to Age Group. Positive (including pseudo-negative):— 1—5. 5—10. 10—15. 15 and over. Slight - (0%) 77 (27.7%) 69 (33.5%) 6 (13.7%) Normal 1 (12.5%) 70 (25.3%) 38 (18.5%) 5 (11.4%) Marked 7 (87.5%) 82 (29.7%) 41 (19.9%) 4 (9%) Negative (including pseudo-positive):— 1—5. 5—10. 10—15. 15 and over. - (0%) 48 (17.3%) 58 (28.1%) 29 (65.9%) This Table shows what might be expected in a population such as Southgate's. The proportion of "Schick-negatives" increases with the age of the cases tested, until it reaches a maximum of well over 50 per cent, in the adults. It should be pointed out here that the 8 children Schick-tested in the 1—5 age group were done as a control, and prove the futility of carrying out this test on any large scale among very young children. 50 Completed Cases. 1—5. 5—10. 10—15. 15 and over. Total Number of cases completing course up to 31-12-33 7 33 4 1 45 Result of re-Sehick test after three months.—Positive, 8; Negative, 37. Result of further re-Schick in the 8 positive cases three months after fourth injection.—Positive, nil; Negative, 5; Still to be tested, 3. Reactions after Injections. 1—5. 5—10. 10—15. 15 and over. Total. Mild 1 10 10 2 23 Moderate 2 3 1 3 9 Severe — — 1 2 3 Total 3 13 12 7 35 Number of cases failing to complete course of immunisation=68. Many of these cases are expected to attend early in 1934, and in several instances satisfactory explanations such as removal from the district, commencement of work, continuance of treatment with own doctor, were forthcoming. The remainder are being followed up in the hope that they will eventually be persuaded to present themselves again. Seventeen children failed to attend after the original Schick Test in spite of repeated reminders. Schools and Centres Attended by the Children Immunised Schools. Oakwood 264 Chase Road 98 Bowes Road 47 Tottenhall Road 38 St. Paul's 18 Hazelwood Lane 14 Garfield Road 14 Southgate County 5 Minchenden County 5 Highfield Road 1 Other Schools (including Private Schools and Colleges and Schools situate outside the district) 35 539 57 Maternity and Child Welfare Clinics. Southgate 63 Bowes Park 20 New Southgate 16 Broomfield House 13 Winchmore Hill 7 119 Thirty-eight children under the age of 5 were brought to the Clinic who did not attend any Southgate Centre. Of the 44 adults who attended the Clinic, 14 were members of the Isolation Hospital Nursing Staff, while 3 were maids at the same institution. Twenty-four children under the age of 2 years were immunised, 4 of these being 12 months old. The eldest person being immunised was 51 years of age. During the time of the diphtheria outbreak many parents sought immunisation for their children from their private physicians. The Public Health Department offered any assistance required in the way of procuring material, performing the Schick Test, etc., and in several instances this help was accepted. Typhoid Fever (including Paratyphoid).—One case of paratyphoid fever was notified during the year, as against 3 in the preceding year. The patient was removed to the Isolation Hospital and made a good recovery. Puerperal Fever and Puerperal Pyrexia. One case of puerperal fever and 5 of puerperal pyrexia were notified during the year as against 2 and 4 in 1932. It was not found necessary to make use of the services of the Council's gynæcologist during the year. Hospital Treatment for Infectious Diseases.—Steps are still being taken to admit to hospital only those cases requiring hospital treatment, as against isolation, and to limit the period of hospitalisation so far as is consistent with safety. (It is now well recognised that Isolation Hospitals do not limit the spread of infectious diseases to any noticeable extent, and our beds must therefore be kept for cases requiring medical and nursing attention if such is not available at home.) As before, every encouragement is given to local practitioners to send in complicated cases of measles, whooping cough and similar non-notifiable diseases. 58 Erysipelas.—Twenty cases of erysipelas were notified during the year, as against 16 in 1932. There were two deaths, one of which occurred in an adult of 62 years of age, who was removed to the Isolation Hospital. The other was that of an adult of 58 years who was a patient in the North Middlesex County Hospital. Seven cases in all were removed to the Isolation Hospital. Pneumonia.—Fifty-seven cases of pneumonia were notified during the year, as against 53 in 1932. There were 37 deaths. Several cases were removed to the North Middlesex County and other Hospitals. Ten of the cases notified occurred in persons over the age of 65 and 4 in children under five, these figures being exactly similar to the numbers recorded for the same age-groups last year. Tuberculosis.—The number of cases of pulmonary tuberculosis notified during the year under the Public Health (Tuberculosis) Regulations, 1912, was 38, while the number of cases of non-pulmonary tuberculosis notified was 7. In addition to these notified cases, 11 patients were entered on the register (10 pulmonary and 1 non-pulmonary), who were new residents in the district, but had been previously notified elsewhere. The corresponding figures for 1932 were: Pulmonary cases, 43; non-pulmonary cases, 8. As already noted, these figures show a considerable improvement over those of last year. Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1925, Section 62. (Compulsory removal to hospital of persons suffering from pulmonary tuberculosis.) It was not necessary to take any action during the year in connection with the above. Laboratory Facilities.—See page 20. Non-Notifiable Infectious Diseases.—During the year, information was received from the head teachers of various schools in the district regarding the occurrence of 27 cases of measles, 134, of whooping cough, 118, of mumps, 27, of influenza, and 50, of chickenpox among elementary school children. These children were attended to by the County Council School Authorities. It will be seen that the figures for measles show a decrease in comparison with those of last year, viz., 27 as against 236), although the figures for the remaining diseases are higher. 59 The complete list is as follows:— 1932. 1933. Measles 236 27 Whooping Cough 75 134 Mumps 39 118 Influenza 17 27 Chicken-pox 39 50 German Measles 7 — Total 413 356 Notifiable Diseases occurring amongst School Children.— The arrangements remain unaltered from those detailed in last year's Report. Disinfection and Disinfestation.—The methods in use for disinfection and disinfestation remain as detailed in the Report for 1930, except that, as reported last year, cancer has now been added to the list of diseases receiving disinfection free. The following Tables summarise the work carried out during the year:— Disinfection in connection with Notifiable Diseases. Number of rooms fumigated 502 Number of articles disinfected by steam 2,486 Number of articles destroyed 192 Disinfection in connection with Non-notifiable Diseases. Disinfection of rooms and bedding, on request, after cases of no7inotifiable disease (charge of 5s.):— Number of rooms fumigated 80 Number of articles disinfected by steam 1,112 Amount received in respect there of £8 5s. 0d. Disinfection of Books.—The arrangements mentioned in the Report for 1930 regarding the disinfection of books issued through the Middlesex County Council libraries in the district remain unaltered. During the year, 366 books were so disinfected. ISOLATION HOSPITAL. The year 1933 has been a momentous one in the history of the Isolation Hospital. In the first place, the number of patients treated (541) is a record, and shows the increased use to which the Hospital was put during the year. Again, a decision was reached regarding the immediate future use of the Hospital which may have 60 a very important bearing upon its ultimate fate. After prolonged discussions and conferences an agreement was drawn up between the Southgate and Tottenham Urban District Councils whereby Tottenham patients will be admitted to the Isolation Hospital at a specified charge for a period of ten years, or until the Middlesex County Council or the Ministry of Health make other arrangements. The question of further extensions to the Hospital was left over until the County policy is finally stabilised, but the matter was fully discussed and an agreement in principle arrived at on both sides. The agreement referred to above was ratified by the Southgate Borough Council and is now in operation. The sequel to the arrangement has shown itself in the vast increase in the number of patients treated. As will be seen from the Table set out on page 64, the lowest number of patients in hospital on any one day was 30, as against 9' the previous year, whereas on many occasions the number was 60 or over. In spite of this, it has only been necessary to refuse admittance to Tottenham patients on a few occasions, and then only when it was understood that accommodation could be obtained elsewhere. As hitherto, the bulk of the patients admitted consisted of scarlet fever cases, with diphtheria showing a considerable increase over the previous few years. Apart from these two complaints, 107 patients suffering from other infectious or apparently infectious diseases were admitted. The Isolation Block known as Wards 2 and 2A was utilised on several occasions as an overflow from the cubicles, as we wished to ensure that adequate accommodation was available for serious diseases such as complicated measles and whooping cough, rather than that such accommodation should be filled up with comparatively mild cases of scarlet fever. In this connection, it is of some importance to note that in no instance was a case suffering from an infectious disease other than scarlet fever or diphtheria refused admission from any of the three Authorities which the Hospital serves. With the increase in Hospital work it was considered advisable to carry out two further and very necessary innovations, namely, to build a house for the Medical Superintendent in the Hospital grounds, and to construct a laboratory. The first of these is now an accomplished fact, while the second is well on the way to completion. I took up residence in my new quarters in Wolves Lane on December 6th, 1933, and intend, under the new regime, to pay a minimum of two visits to the Hospital per day, and more if required. Residence so near the Hospital will undoubtedly mean closer and more intimate contact—a contact which is now absolutely essential. Details concerning the laboratory will be found under the appropriate heading. 61 From the Table setting out the various diseases treated in the Hospital it will be seen that every endeavour was made to meet the various demands of the three Authorities whose patients were admitted. No patient suffering from an infectious disease of any kind was refused admission if accommodation was available, while the Hospital also received doubtful cases for observation on many occasions. Such a multiplicity of cases naturally increased the work and responsibility of the nursing staff, especially when one remembers that a considerable percentage of the patients were gravely ill on admission. During 1933, 500 cases were admitted, this number being almost double that for 1932, which was 255. As far as can be ascertained, the number 500 constituted the highest figure for patients treated in the Isolation Hospital during any one year. The cases were distributed as follows:— Southgate 126 Tottenham 322 Friern Barnet 50 Wood Green 1 Edmonton 1 Total 500 The two cases from Wood Green and Edmonton were admitted in error. The Edmonton patient was transferred to the Enfield and Edmonton Joint Isolation Hospital as soon as the mistake was observed. The Wood Green patient, who was admitted from the Prince of Wales's Hospital, was too ill to be moved, and died the following day. The figures for 1932 were:— Southgate 120 Tottenham 70 Friern Barnet 65 Total 255 The diseases for which the 500 patients were admitted were as follows:— Scarlet Fever 230 Diphtheria 143—Faucial 109 Nasal 23 Nasal & Faucial 1 Laryngeal 5 Laryngeal & Faucial 5 62 Diphtheria Carriers 20 Typhoid Fever 1 Paratyphoid Fever 1 Puerperal Fever 2 Baby with Mother 1 Baby born in Hospital 1 Erysipelas 28 Erysipelas and Cellulitis of leg 1 Erysipelas and Arthritis 1 Erysipelas and Double Mastoid 1 Measles.. 3 Measles and Pneumonia 2 Rubella 4 Whooping Cough 2 Whooping Cough and Pneumonia 10 Whooping Cough, Pneumonia and Burns 1 Whooping Cough and Bronchitis 4 Scarlet Fever and Whooping Cough 2 Scarlet Fever and Measles 2 Scarlet Fever arid Pulmonary Tuberculosis 1 Scarlet Fever and Urticaria 1 Scarlet Fever and Rubella 1 Scarlet Fever and Diphtheria 2 Scarlet Fever and Chicken-pox 1 Post-Scarlatinal Nephritis and Endocarditis 1 Diphtheria, Eczema of head and Nephritis 1 Diphtheria and Specific Arthritis 1 Pneumococcal Meningitis 1 Encephalitis Lethargica 1 Tonsillitis 17 Septicaemia 1 Cellulitis of leg 2 Acute Rheumatism 2 Simple Croup 1 Influenza 1 Hilus Tuberculosis 1 Non-infectious Rashes 4 500 Eight of the above cases were admitted for observation purposes, while in 26 other cases the original diagnosis was amended after admission, the patients being transferred to another hospital, or sent home when the non-infectious nature of their illness became apparent. 63 Number of Patients in Isolation Hospital during each Month:— Greatest Number. Lowest Number. January 40 30 February 42 33 March 40 33 April 45 34 May 50 37 June 53 40 July 59 45 August 53 36 September 61 40 October 62 49 November 65 54 December 62 49 Complications.—The complications met with during 1933 were again, for the most part, mild. Scarlet Fever.—(Total of 260 cases treated during the year.) The percentage was practically the same as last year (26 of 260 cases as against 15 of 152 cases), the most notable feature being the high incidence of otorrhcea among the complications. In one case, a mastoid operation was required after several weeks' convalescence. The remainder of the cases cleared up excellently under treatment. Adenitis 1 Rheumatism and Adenitis 1 Rheumatism 2 Otorrhcea 13 (right 8, left 2 double 3) Albuminuria and Right Otorrhcea 1 Transient Albuminuria 4 Rhinorrhcea 1 Nephritis 1 Impetigo 1 Ethonoidal Sinusitis 1 Total 26 Diphtheria.—Apart from 8 cases of fatal acute myocarditis, 13 complications occurred amone the 149 cases of dinhtheria treated during the the year. These were as follows:— Endocarditis (mild) 1 Otorrhœa 3 (right 2, left 1) Palatal Paralysis 4 Tonsilitis 1 Transient Albuminuria 4 64 In addition, 3 cases developed secondary rashes. All the cases did well and were discharged in a sound physical condition. Only 4 complications occurred among the remaining patients treated during the year. Deaths.—Seventeen deaths (2 adults and 15 children) occurred during the year, 8 from diphtheria, 3 from erysipelas, 4 from whooping cough and broncho-pneumonia, 1 from measles and broncho-pneumonia, and 1 from pneumococcal meningitis. Twelve of these cases were admitted from Tottenham, 1 from Friern Barnet, 3 from Southgate, and 1 from Wood Green. Six of the patients died within 24 hours of admission, and all were seriously ill when taken into hospital. General Treatment.—The treatment carried out at the Isolation Hospital during the year was, in the main, similar to that previously noted in these Reports, with one important addition. In April, 1933, a combined ultra-violet and infra-red apparatus was obtained which has already proved its usefulness. Certain members of the nursing staff were instructed as to its use, and selected cases were chosen for radiation. Twenty-two patients have been treated up to the end of the year, for the following diseases:— Ultra-Violet Light. Adenitis following Scarlet Fever 6 Abscesses in thigh following Puerperal Fever 1 General Debility (after Whooping Cough) 5 Sinuses in arm 2 Otorrhcea 2 16 Infra-Red Radiation. Impetigo 2 Eczema 1 Rhinorrhcea 2 5 The results have been very satisfactory with the exception of the otorrhcea, which did not seem materially affected. It is hoped that we will be able to extend the treatment considerably in the present year. Operations.—Quite a large number of patients requiring surgical treatment were admitted during the year. The conditions present included discharging sinuses following injury, abscesses, 65 empyema and acute arthritis. These conditions occurred in patients who had been admitted from the North Middlesex or Prince of Wales's Hospitals either for observation or suffering from some infectious disease. In addition, several of the patients who developed adenitis following scarlet fever required minor operative treatment, while 4 tracheotomies were performed together with several paracenteses and Wilde's incisions. One mastoid operation was found necessary. The tracheotomies were, unfortunately, unsuccessful in averting a fatal issue, but the remaining operative treatment proved exceedingly beneficial in every case. Apart from the actual operations, a considerable amount of work in the way of dressings, artificial light treatment, irrigation, etc., was carried out, with excellent results. As before, Dr. Macdonald undertook the great bulk of the surgical work required and never failed to respond immediately to the calls made upon his services, either for operative or consultation purposes. A throat and nose surgeon from London was obtained to perform one of the tracheotomies, and several visits were made by other West End consultants. It is hoped in the present year to appoint Dr. Macdonald as Consultative Surgeon to the Hospital at a fixed remuneration, thus stabilising a position which has been rather nebulous, although in practice very satisfactory, in the past. Discharge Procedure.—The practice governing the discharge of diphtheria patients has been amended, and now 3 instead of 2 negative swabs are necessary before any such patients leave the hospital, unless by arrangement with the district from which they were admitted. A "trial-period" disclosed the fact that several patients gave a positive swab after two negatives and it was therefore thought that the more rigorous standard would admit of less error. Patients with persistent diphtheria bacilli in the nose, throat or ear are given special treatment in an endeavour to shorten the period of carrying, and virulence tests are performed when required. When possible, scarlet fever cases are discharged from the Cubicle and Isolation Blocks, but in all cases the strictest care is exercised to prevent infection being carried outside the hospital. In this connection, a scheme whereby home contacts will be offered a protective dose of anti-scarlatinal serum is being considered. Period of Isolation in Hospital.—The average time of isolation in hospital was as follows:— Scarlet Fever—36.5 days (longest, 73 days; shortest, 11 days—desquamating on admission). Average duration, 1932—37.4 days. 66 Diphtheria—47.4 days (longest, 98 days—persistent diphtheria bacilli in throat; shortest, 1 day—died.) Average duration, 1932—49 days. Cases Treated in the Cubicle Block during 1933 (including Cases in Hospital on January 1st, 1933):— Erysipelas 31 Erysipelas and Arthritis 1 Erysipelas and Fracture of Base of Skull 1 Erysipelas and Cellulitis of leg 1 Erysipelas and Double Mastoid 1 Puerperal Fever Baby with Mother 1 Baby born in Hospital 1 Typhoid Fever 1 Paratyphoid Fever 1 Measles 3 Measles and Pneumonia 2 Whooping Cough 2 Whooping Cough and Pneumonia 10 Whooping Cough and Bronchitis 4 Whooping Cough, Pneumonia and Burns 1 Rubella 4 Pneumococcal Meningitis 1 Diphtheria 1 Diphtheria Carriers 2 Diphtheria, Eczema of head and Endocarditis 1 Diphtheria and Specific Arthritis 1 Scarlet Fever 5 Scarlet Fever and Diphtheria 2 Scarlet Fever and Measles 2 Scarlet Fever and Chickenpox 3 Scarlet Fever and Whooping Cough 2 Scarlet Fever and Urticaria 1 Scarlet Fever and Rubella 1 Scarlet Fever and Pulmonary Tuberculosis 1 Post-Scarlatinal Nephritis and Endocarditis 1 Encephalitis Lethargica 1 Tonsilitis 17 Cellulitis of leg 2 Septicaemia 1 Simple Laryngeal Croup 1 Sub-Acute Rheumatism 2 Influenza 1 Hilus Tuberculosis 1 Non-infectious Rashes 5 Total 121 67 As will be seen, the Cubicle Block was extensively used during the year, the number of patients treated therein being greatly in excess of the figure for 1932, which was 77. In point of fact, the eight cubicles were almost invariably full, and the only pity is that still more are not available. As I stated in last year's Report, we could well do with double the number, especially when one considers the diverse nature of the diseases being admitted. Staff.—The health of the nursing staff was fairly good throughout the year, although a comparatively large number of minor ailments was met with. In addition to colds, "hospital throats" and other transient complaints, one member of the staff developed Rubella, two, sub-acute rheumatism, and one, severe tonsillitis. The fact that the staff has been working at full pressure throughout the year, coupled with the very severe and septic cases requiring treatment, undoubtedly accounts for the increase in sickness. It was necessary to appoint temporary nurses at various times owing to depletion of the regular staff through the illnesses mentioned above. The Public Health Committee are at the moment contemplating an increase to the present staff accommodation, and when this is accomplished it is hoped that the number of the staff will also receive consideration with a view to a proportionate increment. The only increase to the present staff of the Hospital during 1933 was that of an additional porter—a much-needed appointment—and there can be no doubt that the nursing staff, both day and night, requires further recruitment. With the whole of the hospital continually in use, the work of supervision and treatment is definitely increased, and I therefore trust that the Council will give this matter their most serious consideration. The junior nurses still continue to receive courses of lectures in anatomy, physiology, general hygiene and nursing. The constant coming and going of nurses is very trying to those who give the instruction and has meant that, this year, no nurses entered for the examination. The staff is now more stabilised, however, and it is hoped that several nurses will enter during 1934. One nurse who received her preliminary training at our hospital returned as a staff nurse after completing the course at Plaistow Fever Hospital, and has proved very satisfactory. Another nurse left to take her general training at the Royal Free Hospital. Cross Infection.—During the year 4 children were admitted suffering from an infectious disease and later developed symptoms of another infection having a longer incubation period. In 2 of these 68 cases (whooping cough and chickenpox) no further cases occurred, but in the other two instances, 2 cases of rubella (German measles) and 3 of chickenpox followed. Prompt measures, such as isolation of the infected cases, segregation of susceptibles, and quarantine, were undertaken, but the harm has usually been done before these measures can be put into operation. Strict enquiries are always made as to possible contact with further infection at the time of admittance to hospital, but too often the parents themselves are unaware of this possibility, the children having been exposed at school and shown no symptoms. One child was admitted to the diphtheria ward certified diphtheria and later desquamated. All the children in that ward who had not previously suffered from scarlet fever were given a protective dose of 2.5 c.c. anti-scarlatinal serum. No further cases occurred. Visiting.—The arrangements for visiting patients remain unaltered and are working satisfactorily. Before the appointment of the additional porter it was found necessary to have an extra man on duty at the hospital on Sunday afternoons during the visiting hour, owing to the abnormally large number of visitors attending. This practice has now been discontinued. Transfers to and from Other Hospitals.—Fourteen patients and eight members of the staff were admitted from the Prince of Wales's Hospital during the year, and three from the North Middlesex County Hospital. Four patients were transferred after the expiry of infection to the North Middlesex County Hospital for surgical treatment, and one to the Prince of Wales's Hospital for the same purpose. One nurse was admitted with scarlet fever from Grovelands Hospital of Recovery. The North Middlesex County Hospital invariably receives any non-infectious patients requiring operative or other surgical treatment very willingly, and I would like to take this opportunity of thanking the Medical Superintendent for his many courtesies. General Remarks.—The youngest patient treated during the year was a child of three months suffering from whooping cough and broncho -pneumonia. 69 For the first time in its history a birth took place in the hospital. This occurred in the case of a scarlet fever patient admitted during the last month of her pregnancy. The mother and child both made excellent progress and were discharged in a very satisfactory condition. In conclusion, I would like to add a note of sincere appreciation for the work carried out during the year by the nursing and domestic staff, ably headed by Miss Beatrice West, the Matron. It has been no easy time, but never once did the staff fail to realise the extra responsibilities thrown upon their shoulders, nor to respond willingly and conscientiously to the calls made upon their time and services. In addition, I would also thank Dr. Burns for his valuable services as deputy, and Dr. Macdonald for his assistance on the surgical side. 70 Diseases. At all ages Under 1 year 1 to 2 2 to 3 3 to 4 4 to 5 6 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Deaths Table V. Notified Cases of Infectious Diseases, 1933. Smallpox 4 1 .. .. .. .. .. .. 1 2 .. .. .. .. Diphtheria 23 .. .. 1 5 .. 9 4 .. 1 .. 3 .. 2 Scarlet Fever 91 .. 1 3 5 3 43 13 11 11 .. .. .. .. Typhoid Fever 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. Puerperal Fever 1 .. .. .. .. .. .. .. .. .. 1 .. .. 2 Puerperal Pyrexia 5 .. .. .. .. .. .. .. .. 5 .. .. .. .. Erysipelas 20 .. .. .. .. .. .. 1 .. 2 2 12 3 2 Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Poliomyelitis 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. Cerebro spinal Meningitis 1 1 .. .. .. .. .. .. .. .. .. .. .. .. Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 57 1 .. 1 1 1 4 1 2 11 9 16 10 37 Tuberculosis— Pulmonary 38 .. .. .. .. .. .. 1 1 17 7 10 2 21 Non-Pulmonary 7 .. .. .. 2 2 1 1 .. 1 .. .. .. 2 Totals 249 3 1 5 13 6 57 22 15 51 19 42 15 66 71 Table VI. Cases of Infectious Disease Notified each Month of the Year, 1933. Notifiable Diseases. Smallpox. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Puerperal Pyrexia. Acute Poliomyelitis. Encephalitis Lethargica. Cerebrospinal Meningitis. Malaria. Ophthalmia Neonatorum. Pneumonia. Tuberculosis Totals. Pulmonary. NonPulmonary January .. 5 .. .. 4 .. 1 .. .. .. .. .. 17 .. 1 28 February .. 5 .. .. 3 .. 1 .. .. .. .. .. 10 4 .. 23 March .. 4 .. .. 4 .. 1 .. .. 1 .. .. 9 3 .. 22 April .. 14 2 .. 1 .. 1 .. .. .. .. .. 3 4 1 26 May .. 11 .. .. 1 .. .. .. .. .. .. .. 3 3 .. 18 June .. 8 2 .. .. .. .. .. .. .. .. .. 2 3 .. 15 July 4 5 1 .. .. .. 1 1 .. .. .. .. 1 4 2 19 August .. 2 .. .. 2 .. .. .. .. .. .. .. 2 6 1 13 September .. 6 .. .. .. .. .. .. .. .. .. .. 1 3 1 11 October .. 7 4 1 1 .. .. .. 3 .. 16 November 14 12 .. 3 i .. .. .. .. .. .. 3 4 1 38 December .. 10 2 .. 1 .. .. .. .. .. .. .. 6 1 .. 20 Totals 4 91 23 1 20 l 5 1 .. 1 .. .. 67 38 7 249 almia Neonatorum, 1933. TABLE VII. Nil Notified. Cases. Nil At Home. Treated. Nil In Hospital. Nil Vision Unimpaired. Nil Vision Impaired. Nil Total Blindness. Nil Deaths 72 TABLE VIII. Tuberculosis, 1933. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary M. F. M. F. M. F. M. F. Under 1 yr. — — — — — — — — 1-5 years — — 2 2 1 — — — 5-10 — — 1 — — — — 1 10-15 ,, 1 — 1 — — — — 1 15-20 ,, 1 1 1 — — 1 — — 20-25 ,, 2 2 — — — 1 — — 25-35 ,, 10 8 1 — 4 2 — — 35-45 ,, 3 7 — — 1 2 — — 45-55 ,, 7 3 — — 2 2 — — 55-65 ,, 4 — — — 2 — — — 65 and over 2 — — — 3 — — — Totals 30 21 6 2 13 8 — 2 REGISTER OF CASES. Pulmonary. NonPulmonary. Total. M. F. M. F. Cases on Register, 1/1/33 92 68 19 25 205 Cases notified for first time, 1933 22 16 5 2 45 Cases restored to Register 2 1 — — 3 Other Cases added 6 4 1 — 11 Cases removed from Register 14 12 2 2 30 Remaining on Register, 31/12/33 108 77 23 25 233 These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the District. 73 APPENDIX. 1. Health Publicity. As hitherto, an attempt was made throughout the year to stimulate public interest in matters appertaining to health. With the exception of a few months' lapse owing to lack of advertisement support (a matter of which I was not informed until it was almost too late), the magazine, "Better Health," circulated as in previous years, and is, from the comments which I hear, very acceptable to those whom it reaches. The various local newspapers printed the Southgate material, either in part or full, on many occasions, which served to widen the appeal very considerably. Talks on Immunisation, Vaccination and other health subjects were given in several parts of the district, while articles on matters of Public Health interest were printed in the local Press. Leaflets were always on display in the Public Health Department and at the Maternity and Child Welfare Centres, and suitable material was also sent to the schools. Opportunity was taken of the Charter Celebrations in September to hold a modified ' 'Health Week,'' the main theme being Immunisation against Diphtheria. During this week (September 20th-26th) talks were given at the various Centres and at several schools; health films were shown in three local cinemas; health posters were displayed; visits were arranged to various dairies; the Centres were open to inspection by the general public; health literature was distributed at the Centres and schools in conjunction with the Middlesex County Library, and a public lecture was arranged under the auspices of the Southgate branch of the St. John Ambulance Brigade at Bowes Road Schools. The total cost of this Health Week was almost negligible, yet the interest shown proved considerable. Once again I wish to pay tribute to the continued assistance given by the Press. Material is never refused and a means is thereby made available of informing the public immediately of matters which vitally affect their welfare. 2. Insulin. The sanction of the Ministry of Health was received during the year to supply 30 units of Insulin per day to a necessitous diabetic patient. The material is being supplied through the Prince of Wales's Hospital and progress reports are transmitted quarterly to the Ministry of Health. 74