C.I. AC 439(1) SOUT HEATE SOUG 19 M. BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934. Wm. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital. Crusha & Son, Ltd., The Triangle, Palmers Green. BOROUGH OF SOUTHGATE. PUBLIC HEALTH DEPARTMENT. Telephone Palmers Green 0023. TOWN HALL. PALMERS GREEN, N.13. With the Compliments of the MEDICAL OFFICER OF HEALTH. BOROUGH OF SOUTHGATE. Wh. 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 1934. The year under review immediately precedes that in which the quinquennial report is submitted, and for this reason the information contained in the present Report is strictly limited to necessary requirements. The vital statistics for 1934 present little that is outstanding. The birth and death rates have not materially altered, while the Infantile Mortality figures are also more or less unchanged. There has been a rise in the number of cases of infectious diseases notified, but no more than one would expect following the low figures of the past few years. It will be appreciated that, with the comparatively small numbers dealt with in Southgate, minor increases or decreases become more obvious than would be the case in a larger district. Apart from notifiable infectious diseases, a very large increase took place in the number of measles cases notified during the first quarter of the year, Southgate being affected in the nation-wide epidemic. An interesting feature of the year's work has been the equipping and operation of a laboratory at the Isolation Hospital for the use of the Hospital and the Borough as a whole. This has proved of great service and has also effected a considerable economy in the cost of bacteriological examinations. As before, Dr. Tate, the County Medical Officer of Health, has kindly supplied the statistics relating to School Clinics and Public Elementary Schools. 3 In conclusion, I would like to tender my grateful thanks to the Chairman and Members of the Public Health Committee and to the Members of the Borough Council for the help and consideration shown me during the year under review. I woidd also express my personal thanks to each member of the Public Health staff for their loyal co-operation throughout the year. I am, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. May, 1935. 4 PUBLIC HEALTH COMMITTEE at December 31st, 1934. Councillor G. Peverett (Chairman). His Worship the Mayor (Alderman W. H. Pullinger, J.P.). Councillor H. Collar. Councillor A. C. Crane. Councillor Victor Dover. Councillor J. Owers. Councillor Mrs. E. F. Smith, J.P. Councillor V. J. Westlake. MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1934. His Worship the Mayor (Alderman W. H. Pullinger, J.P.). Alderman G. B. Massa. Councillor Miss G. E. Appleyard. Councillor W. A. Clarke. Councillor Mrs. E. L. Evans. Councillor A. E. Lauder. Councillor G. Peverett. Councillor Owen Roberts. Councillor Mrs. E. F. Smith, J.P. (Vice-Chairman). CO-OPTED MEMBERS. Mrs. C. M. A. Vandy (Chairman). Miss Corry. Mrs. High. 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 Visitors: *Mrs. E. M. Rising, S.R.N., S.C.M., R.S.I., H.V. *Mrs. D. A. G. Blake, S.C.M., S.I., H.V. Maternity and Child Welfare. Miss B. E. Wellman, S.R.N., S.C.M., A.R.San. I., H.V. (Appointed March 27th, 1934)—Public Health and General. * Assistant (Maternity Centres) : Mrs. A. Thomas. Disinfector : A. G. Bates. Temporary Assistant Disinfector : B. Latter (commenced duties November, 1934). * 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) 3,764 Registrar-General's estimate of Resident Population, 1934 59,997 Number of inhabited houses (end of 1934) according to Rate Books 16,806 Rateable value (1934) £707,126 Sum represented by a penny rate (1934) £2,946 There is no evidence to show that the social conditions of the district have materially altered from those set out during the past few years. The Social Service Council continues its valuable auxiliary work and the standard of nutrition amongst the children still reveals a satisfactorily high standard. Meteorology.—The total rainfall recorded by the Council's rain-gauge in Broomfield Park measured 21.63 inches during 1934, the daily average being 0.059 inches. The greatest fall in 24 hours was on November 9th, when 0.77 inches were recorded, and the total days on which no rain fell was 225. As will be seen, the total rainfall and daily averages were again very low during 1934. It is perhaps interesting to note that, although the total rainfall for the year 1934 was appreciably greater than that for 1933, the number of days upon which measurable rain fell during 1934 was 5 less than during the previous year. Once again I would emphasise the necessity for the provision of a fully equipped meteorological station. Until such a station is provided, complete records as to sunshine, temperature, wind, etc., in addition to rainfall, will not be available and this long-felt need will remain unmet. 7 RAINFALL RECORDED AT BROOMFIELD PARK. Total Rain for month. Number of 0.01 or more ins, Wet Days with 0.04 or more ins. 1934. 1933. 1934. 1933. 1934. 1933. Ins. Ins. Days. Days. Days. Days. Jan. 1.57 1.75 17 15 11 11 Feb. 0.14 1.39 4 12 1 12 Mar. 2.21 2.41 17 14 13 13 April 2.21 0.98 14 8 11 6 May 0.80 1.62 6 15 6 11 June 0.91 1.74 8 13 8 13 July 0.64 1.40 7 14 4 19 Aug. 2.27 0.57 12 6 10 5 Sept. 2.32 2.06 9 12 7 9 Oct. 1.26 1.43 14 15 9 10 Nov. 1.87 0.93 7 15 6 5 Dec. 5.43 0.46 25 6 22 5 Totals. 21.63 16.74 140 145 108 119 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. Male. Female. Live /Legitimate 619 330 289 Births (Illegitimate 21 13 8 Totals 640 343 297 Birth Rate per 1,000 of the estimated resident population 10.66 Stillbirths 23 12 11 Rate per 1,000 total (live and still) births 34.69 Deaths 596 272 324 Corrected Death Rate per 1,000 of the estimated resident population 9.73 Deaths irom puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. From Puerperal Sepsis 4 6.03 From other Puerperal causes 0 0.00 Total 4 6.03 8 Death rate of infants under one year of age:— All infants per 1,000 live births 39.06 Legitimate infants per 1,000 legitimate live births 33.92 Illegitimate infants per 1,000 illegitimate live births 190.47 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 1 POPULATION. By reason of the Middlesex Review Order, 1934, various alterations were made to the boundaries whereby an additional 167 acres were included within the Borough, as from April 1st, 1934. The Registrar-General's revised estimate of the population at that time was 59,250. The Registrar-General's estimate of the population at the middle of 1934 was 59,997, which is an increase of 1,177 over the estimate for 1933. This is taken as the population of the Borough for the purposes of this Report. The natural increase of the population by excess of births over deaths was 44, as compared with an excess of 21 deaths over the total births during 1933. BIRTHS—BIRTH RATE. The nett total of births accredited to the district was 640, an increase of 70 on the preceding year; of these, 343 were males and 297 females (13 males and 8 females being illegitimate). The birthrate was, therefore, 10.66 per 1,000 of the population, as against 9.69 in 1933. The birth-rate for England and Wales for 1934 was 14.8. The total number of births actually registered in the district during the year amounted to 395. As will be seen, the birth-rate shows a slight increase on last year's figure although it is still low. MORTALITY. General Mortality and Death Rate.—The nett number of deaths accredited to this district was 596, an increase of 5 as compared with the previous year. 9 This gives a collected death-rate of 9.73 per 1,000 of the population, an increase of 0.29 on the rate for the previous year, which was 9.44. This rate is still appreciably below that for England and Wales (11.8 for 1934). As compared with 1933, there were increases of 4 deaths from measles, 15 from pulmonary tuberculosis, 14 from circulatory diseases, 10 from pneumonia and 2 from puerperal sepsis; while there were decreases of 29 deaths from influenza, 5 from cancer and 7 from suicide. The principal causes of death are shown in Table I on page 13. From this table the following facts emerge— (1) The number of deaths from pulmonary tuberculosis has once again risen from 23 to 39. In this connection the fact that more intimate supervision of cases by the new Health Visitor is now possible takes on increasing importance, as it is obvious that this disease must on no account be treated lightly. (2) The number of deaths from influenza has shown a very welcome decrease (8 as against 37 in 1933). This is gratifying and it now only remains to be seen whether or not the improvement will be sustained. (3) For the first time in several years the number of deaths from cancer has decreased. The decrease is small (5) but the very fact that the number has not risen is in itself worthy of comment. Here again one can only hope that early advice and treatment are beginning to play their part and that the public will take heart from the returns and realise that cancer is definitely curable. (4) Once again it can be said of Southgate that there are no classes of death which can be attributed to special detrimental conditions, such as type of employment, atmospheric conditions, etc. In a rapidly developing district such as Southgate this must be regarded as eminently satisfactory. Infantile Mortality. -There were 25 (4 illegitimate) deaths of infants under 1 year of age, which give an infantile death-rate of 39.06 per 1,000 births registered, as compared with 19 deaths and a rate of 33.33 in the preceding year. The rate for England and Wales for 1934 was 59. It will be seen that the infantile mortality rate has risen slightly, although the rate for Southgate remains considerably lower than that for England and Wales. 10 Table III on page 15 subdivides the infant deaths according to the weeks or months at which they occurred. 68.0 per cent, of the total deaths occurred during the first month, while 76.4 per cent, of these occurred during the first week. Prematurity accounted for 8 deaths and pneumonia for 5. All the infant deaths were investigated. Stillbirths.—Twenty-three stillbirths, 2 of which were illegitimate, were accredited to the district for 1934. This is equal to a death-rate of 34.69 per 1,000 total (live and still) births registered, the corresponding figures for 1933 being 16 stillbirths with a rate of 27.30. 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 6.03 for 1934. This represents 4 maternal deaths, 3 of which occurred outside the district. Last year there were 2 deaths with a corresponding rate of 3.41. It will be seen that, while the Maternal Death Rate has risen by almost 100 per cent., the number of deaths only showed an increase of 2. This illustrates the danger of drawing conclusions from such small numbers. One of the four deaths took place after therapeutic abortion, while in another case the patient was a Christian Scientist who declined certain prescribed medical treatment. A scheme of part-payment of midwives' fees in necessitous cases was instituted during the year. These payments are only made in cases where the confinement can be safely carried out at home and full reports are required from the midwife in attendance. Compensation is also paid to midwives if the case has ultimately to be removed to hospital. The scheme is operating satisfactorily and it is hoped, by its means, to obtain a more efficient maternity service for necessitous women within the Borough. Additional services are contemplated during the incoming year. 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 1934. This represents a corrected death-rate of 0.09 per 1,000 of the total population, and 1.00 per cent, of the total deaths for the year, at all ages. In 1933 there were a similar number of deaths, giving a rate of 0.09 and a percentage of 1.02. The number has remained stationary for the past four years, and is the lowest recorded. 11 Mortality of Persons over the age of 65.—It will be seen from Table II, on page 14, that 53.69 per cent, of the total deaths occurring during the year took place in persons over the age of 65. This percentage is slightly lower than that for last year (56.34 per cent.). In passing, it may be noted that 79 females died at the age of 80 or over (1 of whom attained the great age of 98 years), the corresponding figure for the males being 39. 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). There were 8 deaths from the diseases mentioned above, as follows— Diphtheria, 3; measles, 4; diarrhoea, 1. The zymotic death-rate for 1934 was therefore 0.13 per 1,000 of the population, as against 0.06 in 1933, with 4 deaths. 12 Table 1. Causes of Death During the Yeab 1934. Causes of Death. Male. Female. Total. Kates per 1,000 of Population. A11 Causes (Civilians only) 272 324 596 1 Typhoid and Paratyphoid Fevers. .. .. .. .. 2 Measles 3 1 4 0.07 3 Scarlet Fever .. .. .. .. 4 Whooping Cough .. .. .. .. 5 Diphtheria 3 .. 3 0.05 6 Influenza 3 5 8 0.13 7 Encephalitis Lethargica 1 .. 1 0.02 8 Cerebro-Spinal Fever .. .. .. .. 9 Tuberculosis of Respiratory System 21 15 36 0.59 10 Other Tuberculous Diseases 2 1 3 0.05 11 Syphilis .. .. .. .. 12 General Paralysis of the insane, Tabes Dorsalis 2 .. 2 0.03 13 Cancer, Malignant Disease 28 58 86 1.40 14 Diabetes 3 4 7 0.11 15 Cerebral Hemorrhage, etc. 4 16 20 0.32 16 Heart Disease 80 78 158 2.58 17 Aneurysm .. .. .. .. 18 Other Circulatory Diseases 19 24 43 0.70 19 Bronchitis 9 9 18 0.29 20 Pneumonia (all forms) 20 27 47 0.77 21 Other Respiratory Diseases 1 2 3 0.05 22 Peptic Ulcer 4 1 5 0.08 23 Diarrhoea, etc. (under 2 years) 1 .. 1 0.02 24 Appendicitis .. 2 2 0.03 25 Cirrhosis of Liver 2 1 3 0.05 26 Other Diseases of Liver, etc. .. 3 3 0.05 27 Other Digestive Diseases 8 9 17 0.28 28 Acute and Chronic Nephritis 3 6 9 0.15 29 Puerperal Sepsis .. 4 4 0.07 30 Other Puerperal Causes .. .. .. .. 31 Congenital Debility, Premature Birth and Malformation, etc. 6 10 16 0.26 32 Senility 1 7 8 0.13 33 Suicide 2 3 5 0.08 34 Other Violence 11 7 18 0.29 35 Other defined Diseases 35 31 66 1.08 36 Causes ill-defined or unknown .. .. .. .. Totals 272 324 596 9.73 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. 1934. MALES. FEMALES. TOTALS. Age. 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 11 1.84 0.18 14 2.35 0.23 25 4.19 0.41 1— 5 years 3 0.50 0.05 3 0.50 0.05 6 1.00 0.10 5—15 ,, 7 1 .18 0.11 3 0.50 0.05 10 1.68 0.16 15—25 ,, 8 1.34 0.13 7 1.18 0.11 15 2.52 0.24 25—45 ,, 28 4.70 0.46 32 5.37 0.52 60 10.07 0.98 45—65 ,, 94 15.78 1.53 66 11.07 1.08 160 26.85 2.61 65 and over 122 20.47 2.00 198 33.22 3.23 320 53.69 5.23 Totals 273 45.81 4.46 323 54.19 5.27 596 100.0 9.73 14 Table III. Infantile Mortality. 1934. Nett Deaths from stated causes at various periods under 1 Year of Age. Causks 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 13 1 1 — 2 17 2 4 i i 25 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) 12 Convulsions 13 Laryngitis 14 Bronchitis 15 Pneumonia 1 .. .. 1 2 1 2 .. .. 5 16 Diarrhcwa 17 Enteritis .. 1 .. .. 1 1 .. .. 2 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 23 Atelectasis 1 .. .. .. 1 .. .. .. .. 1 24 Congenital Malformations .. .. .. 1 1 .. 1 .. .. 2 25 Premature Birth 7 .. 1 .. 8 .. .. .. .. 8 26 Atrophy, Debility and Marasmus .. .. .. .. .. 1 .. .. .. 1 27 Other Causes 1 .. .. .. 1 .. .. 1 1 3 Totals 13 1 1 2 17 2 4 1 1 25 15 Comparison of the Rates of the Southgate District with those of England and Wales, and London, for the Year 1934. 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 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 5.5 59 121 County Boroughs and Great Towns, including 14.7 0.00 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 7.4 63 132 Smaller Towns (1931 Jistim'd Census Populations 25,000—50,000). 15.0 0.67 11.3 0.00 0.00 0.07 0.02 0.04 0.09 0.14 3.6 53 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 12.6 67 Southgate 10.66 0.38 9.73 0.00 0.00 0.07 0.00 0.00 0.05 0.13 1.56 39.06 16 Table IV. Vital Statistics of Whole District during 1934 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. Bate per 1,000 Nett Births. 1 2 3 4 5 6 7 8 1929 49,030 657 11.22 534 10.05 27 48.47 1930 61,590 607 11.76 498 9.07 22 36.24 1931 56,460 663 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 1934 59,997 640 10.66 596 9.73 25 39.06 General Provision of Health Services. Hospitals .—General Hospitals.—The arrangement 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. I'rorision fur 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.—Improvements have been carried out at the Isolation Hospital during the year as follows : Addition of seven bedrooms and fire escape facilities to Administration Block; construction of new incinerator and porter's workshop; extension of ultra-violet light facilities; installation of new internal telephone system; improvements to garage; re-decoration to wards; improvements to roads and paths; overhaul of disinfector, and several important additions to the hospital equipment. In addition, 1.4(5 acres of additional land were taken into cultivation, thus continuing the progressive policy of the past few years. Further improvements are contemplated during the incoming year. The nursing staff has been increased to cope with the record volume of work now being met with at the hosiptal. Instead of 14 the total now stands at 20, 1 new staff nurse and 5 extra probationers having been engaged. A staff nurse has also been transferred from the wards to special duties in connection with the office, stores and laboratory, thus filling a long-felt need. Further additions are contemplated in the near future, while extra private nurses are obtained as and when necessary. Apart from the nursing staff, a non-resident assistant porter and a non-resident assistant gardener were engaged during the ,year, while the domestic staff was also increased owing to extra work. The discussions regarding the extension of the hospital are still proceeding, and it is hoped that 1935 will see the fruition of pinny years of long and arduous negotiations. 17 Nursing in the Home.—(a) The Southgate Queen's Nursing Association still continues its excellent work. During 1934 the nurses made a total of 11,292 domiciliary visits. At the Physicotherapeutic Clinic, 1,182 patients were treated and the total number of treatments given was 6,563. The nursing headquarters of the Association have now been transferred to " Osidge," Chase Side, where more commodious premises are available for the staff. It is hoped that in the future even more close co-operation will take place between the Nursing Association and the Public Health Department than has been the case in the past; and that some official recognition may be given by the Borough Council to the excellent work performed. (b) As before, it has not been considered necessary to provide a nurse for infectious diseases in the home, especially in view of the appointment of the new Health Visitor. Additional Health Visitor.—The new Health Visitor, mentioned in last year's Report, commenced her duties in May, 1934, and already the appointment has shown itself to have been more than amply justified. Work previously undertaken in a rather perfunctory manner owing to lack of staff is now satisfactorily supervised, while new avenues of service have been opened. Owing to the new regime instituted at the Isolation Hospital for the treatment of scarlet fever cases, to be described later in the Report, the services of the Health Visitor will be required to a greater extent than ever before. Miss Wellman, who received the position, has proved herself to be a competent and conscientious worker and I cannot speak too highly of her services. Midwives.—There are 6 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. It was hoped that a new Child Welfare Clinic might have been opened on the North Circular 18 Road, but this scheme had to be abandoned. In place of this, a new Centre is contemplated for the Council's Housing Estate in Southgate. There can be little doubt that such a Centre would prove a valuable addition to the Maternity and Child Welfare services of the district. As previously mentioned, laboratory work was begun at the Council's laboratory situated at the Isolation Hospital on April 11th, 1934. The work is carried out by the Medical Officer of Health assisted by Mr. Hill, Sanitary Inspector, and by Dr. Burns acting as Deputy for the Medical Officer of Health. The facilities afforded have proved of inestimable service in expediting the results of bacteriological examinations, while a considerable saving has been effected in the total costs. Practitioners in the district also make use of the laboratory for examination of pathological specimens, etc., and every encouragement is given them to do so. Apart from the examination of swabs and sputa, samples of milk are regularly examined for total bacterial counts, presence of b. coli and b. tuberculosis. This work has proved illuminative and the results are being submitted to the Milk Marketing Board at monthly intervals. A modern electrically-driven centrifuge was obtained to assist in this work. Other specimens are sent to the Clinical Research Association or to the laboratory of the Prince of Wales's Hospital for examination, and animal virulence tests are also performed when required by these two bodies. The report of the year's work in this connection is as follows— LABORATORY FACILITIES. During the first three months of the year, 596 specimens were sent to the Clinical Research Association for examination. The reports received were as follows— Disease Suspected. Positive. Negative. Total. Diphtheria (Swabs) 109 401 510 Typhoid Fever (Blood Tests) 0 6 6 Phthisis (Sputa) 12 68 80 121 475 596 19 Bacteriological examination of 3 specimens of cerebro-spinat fluid were also carried out. One test for virulence was made in connection with a protracted case of diphtheria. Work carried out at the Council's laboratory from April 11th to December 31st, 1934 :— Hospital. Borough. Positive. Negative. Positive. Negative. Swabs for Diphtheria bacilli 628 1.917 23 164 Swabs, direct examinations 1 0 2 0 Sputa for tubercle bacilli 0 2 14 56 629 1,919 39 220 2,548 259 In addition to the above, bacteriological examinations of the following were made :— Vaginal swabs 2 Pleural effusion 1 Vesicular mole 1 Intestinal secretion 1 Urine 1 Water samples 3 BACTERIOLOGICAL EXAMINATION OF MILK. The bacteriological examination of the milk supplied in the district commenced in August as a preliminary to the scheme of examinations for the ensuing year, when it is intended to examine each supply produced in or entering the district four times annually for total bacterial count and bacillus coli content, and twice annually for the presence of tubercle bacilli. During the year, 20 samples of all grades of milk were examined and the results notified to the retailers. 1. Non-Designated Milk. (a) Total Bacterial Count.—The informal standard adopted is 200,000 organisms per cubic centimetre, and samples containing more than that number are considered to be unsatisfactory. Of the 15 samples procured, 14, or 93.3 per cent, were satisfactory. The 20 average bacterial count of the 14 satisfactory samples was 44,616 per cubic centimetre. The average count of the sample below the standard was 508,000 bacteria per cubic centimetre. (6) Coliform Bacilli.—The standard adopted is that coliform bacilli should not be found in a smaller quantity of milk than onetenth of a cubic centimetre; in effect this means that there should not be more than 10 such organisms present in 1 cubic centimetre of milk. The value of this examination is considered to be very great as it is a definite indication of excremental contamination. Of the 15 samples examined, 8, or 53.3 per cent., were found to be satisfactory. The condition of the samples as regards coliform bacilli is shown in the following table :— Coliform Bacilli. No. of Samples. Not found in ) c.c. or less 3 satisfactory Present in 1 c c. but not in less - " " .1 c.c. " " 5 " " .01 c.c. " " 7 unsatisfactory (c) Tubercle Bacilli.—12 samples of milk were examined for the presence of tubercle bacilli, all of which gave negative results. (d) Summary.—Of the 15 samples examined, 8, or 53.3 per cent., were satisfactory in every respect as regards total bacterial count and bacillus coli content. 2. Designated Milk. Five samples of Pasteurised Milk sold under licence within the terms of the Milk (Special Designations) Order, 1923, were examined. As regards total bacterial count and bacillus coli content all were satisfactory. The five samples were also examined for the presence of tubercle bacilli with negative results. Legislation in Force.—Additions to the legislation in force in the district have been made during 1.934 as follows— Bye-laws for the Good Rule and Government of the Borough and for the Suppression of Nuisances—adopted March 27th, 1934. 21 Bye-law with respect to means of Escape from Fire in certain Factories and Workshops in the Borough of Southgate—adopted April 24th, 1934. Bye-law under the Public Health (Smoke Abatement) Act, 1926, for Regulating the Emission of Smoke from certain Buildings in the Borough of Southgate—adopted April 24th, 1934. Bye-laws with respect to Cleansing of Earthclosets, Privies, Ashpits and Cesspools in the Borough of Southgate—adopted July 24th, 1934. Bye-laws with respect to Nuisances in connection with the Removal of Offensive or Noxious Matters in the Borough of Southgate—adopted July 24th, 1934. Bye-laws with respect to Houses Intended or Used for Occupation by the Working Classes and Let in Lodgings or Occupied by Members of more than one Family in the Borough of Southgate—adopted September 25th, 1934. The report of the work carried out under the Smoke Abatement Bye-law will be found on page Institutional Provision for unmarried mothers, illegitimate infants and homeless children. No change from the arrangements noted in the Report for 1930. Ambulance Facilities.—The two ambulances mentioned in last year's Report have now been purchased and are in commission, the old vehicles being retained as very useful " standbys." A revision of the ambulance charges operating within the Borough will be made during 1935, with a view to obviating any hardship to any person requiring such services. The ambulance service will also be placed under the direct supervision of the Medical Officer of Health. Otherwise, no change has been made in the arrangements set out in the Report for 1930. Orthopaedic Treatment.—Arrangements are made for the treatment of any orthopaedic cases met with in connection with the Maternity and Child Welfare services. No such cases were met with during the year. As before, the Middlesex County Council undertakes the responsibility when the children reach school age. Maternity and Child Welfare Services. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1934. Number on Registers:— Under 1 year. Over 1 vear. Totals. January 1st, 1934 287 599 886 (1933 1101) December 31st, 1934 754 838 1595 ( ,, 1717) New Cases during 1934 473 236 709 ( ,, 706) 20 of the new cases under 1 year were "removals" into the district. The remaining 453, therefore, represent 70.78 per cent, of the total births credited to the district. Attendances at Centres, 1934:— Under 1 year. Over 1 year. s. Broomfield House 1158 851 2009 (1933 2446) Bowes Park 1203 1051 2254 ( ,, 2949) New Southgate 1122 754 1876 ( ,, 1663) Southgate 1339 1184 2523 ( „ 2674) Winchmore Hill 2419 1621 4040 ( „ 4230) Totals 7241 5461 12702 ( ,, 13962) Average 28.39 21.41 49.81 ( ,, 54.75) Number Seen by Doctor:— Under 1 year. Over 1 year. Totals. Broomfield House 474 444 918 (1933 1009) Bowes Park 458 500 958 ( ,, 1146) New Southgate 490 314 804 ( ,, 706) Southgate 530 490 1020 ( ,, 999) Winchmore Hill 780 591 1371 ( ,, 1444) Totals 2732 2339 5071 ( ,, 5304) Average per session 10.71 9.17 19.88 ( ,, 20.80) Percentage of total attendance seen by Doctor 37.7% 42.8% 39.9% ( ,, 38.0%) 23 Number of Sessions held 255 Talks and Practical Demonstrations in Mothercraft given at Centres 47 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:— 1933. 1934. January 1st 56 53 December 31st 56 52 New cases during the year 146 177 The number of new cases during the year represents 26.7% 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. 1933. 1934. Total attendances 612 635 Average per session 12 12.45 Number seen by Doctor 441 512 A\erage per session 8.6 10.03 Percentage of total attendance seen by Doctor 72.0% 80.6% Percentage of mothers attending Antenatal Centre 24.9% 26.7% 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:— 1933. 1934. First visits 493 561 Under 1 year of age 1246) In addition to /1285 Over 1 year of age 3331) first visits. (3578 Visits re:— Deaths under 5 years of age21 21 Stillbirths 13 19 Ophthalmia neonatorum cases — 1 24 1933. 1934. Ante-natal visits 296 406 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.) 1210 1173 Visits re:— Tuberculosis cases 29 9 Diphtheria Immunisation 158 58 Total visits 6797 7113 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. Owing to the increasing work of the Centres, the services of an additional Health Visitor will be required in the near future. It is anticipated that* such an appointment will have been made by the time this Report is circulated. Children Acts, 1908-32.—The passing of the Children and Young Persons Act, 1932, has thrown a much greater responsibility upon the Council in respect of this most important work. The various regulations of the Act have been complied with and the work allocated between the Maternity and Child Welfare Health Visitors and the Health Visitor appointed for general Public Health purposes. Foster-children under the age of 5 years are superintended by the former, while those over 5 come under the jurisdiction of the latter. Apart from minor faults, mainly in the direction of tardy notification of the receipt of foster children, little difficulty has been met with in the administration of this Act. During 1934 the visits paid in connection with this work were as follows :— Number of registered foster mothers 9 Number of foster children 11 Total visits paid 23 No case of neglect was discovered during the year. 25 Miscellaneous Statistics. 1933. 1934. Births registered in the district 327 395 Attended by Midwives 132 (approx.) 123 Un-notified Births 30 25 Percentage of Births notified . 90.8% 93.7% Stillbirths notified 9 19 Stillbirths notified by Midwives 1 4 Stillbirths notified by Doctors 8 15 Stillbirths notified occurring in Institutions: In the district — — Outside the district 6 7 Maternal Deaths 2 4 Infant Deaths:— Under 1 year of age 19 25 Under 1 month (inc. above) 12 17 1 to 5 years of age 6 6 Number of Southgate Births in Noith Middlesex Hospital Maternity Home 44 87 Infant Mortality amongst children attending Centres 3 10 (1 over, (4 over, 2 under 6 under 1 year.) 1 year.) Number of cases in which milk was granted:—1933, 116; 1934, 117. Approximate cost 1933, £250; 1934, £248. In 4 cases grants of Trufood were made, and in 4 cases grants of cod liver oil emulsion or Vitroleum Cream were allowed. Trufood sold at Centres amounted to £173 (approx.). Dental Treatment.—As suggested in last year's Report, the arrangement between the liorough Council and the Middlesex County Education Authority for the treatment of mothers and children at the Dental Clinic at Broomfield House was terminated in June, 1934. After careful consideration of various schemes, the Maternity and Child Welfare Committee decided to make use of the Eastman Dental Clinic, and arrangements have now been completed whereby Southgate mothers and children will be treated at that Clinic, where the work is of an exceedingly high standard. The final financial arrangements are still under discussion. During 1934 no dental treatments were carried out at the Broomfield House Clinic. No particulars are yet available of the mothers and children who were sent to the Eastman Dental Clinic. 2.0 Part Payment of Midwives' Scheme.—Thirty-eight applications were dealt with under this scheme during 1934. 31 awards were made totalling £52 2s. Od.; 1 compensation grant of £1 Is. Od. was made to a midwife in respect of a patient sent to a hospital; and 6 applications were refused as the family income was above the scale. Attendance at Centres of Non-Southgate Mothers.—With the authority of the Committee, 51 mothers, living a short distance beyond the borders of the district, attended various Southgate Centres. A charge of Is. per attendance is made. It will be observed that this number shows no sign of decreasing, but no mothers are allowed to attend Centres unless the officers are satisfied that such attendances will not disturb the routine of the Clinics. During the year an arrangement was come to with the Hertfordshire County Council whereby the County Council pays 10s. per mother per year for the attendance at Southgate Clinics of mothers residing in the East Barnet area. Unsuccessful attempts were made to enter into similar agreements with other neighbouring Authorities. Voluntary Helpers.—The Voluntary Helpers' Committee again rendered excellent assistance to the Maternity and Child Welfare services in the district, the work carried out during 1934 at the Centres being characterised by its unselfishness and regularity. The Committee held its customary Annual Christmas Party for mothers, the function once again proving eminently successful. General. —The year under review has been an important one from the point of view of Maternity and Child Welfare. During this time the scheme for the part payment of midwives was instituted, together with new and, it is hoped, more satisfactory arrangements for dental treatment. Towards the end of the year, too late for its effects to be felt in 1934, a revision of the scheme which provides free or half-price milk to necessitous children was carried out. The results of this will be that many more families will benefit while a considerable number of children between the ages of 3 and 5 will be included. It is also proposed to extend the facilities for receiving milk, under certain conditions, to expectant mothers during the last six months of pregnancy instead of the final three months as was previously the case. Further advances are scheduled for the near future, among such being an arrangement for the removal of tonsils and adenoids in children under the age of 5 at the North Middlesex County 27 Hospital, the possible supply of sterilised maternity outfits, and suggested co-operation between the Queen's Nursing Association and the Council regarding the setting up of a rota of home-helps and a supervised midwives' scheme. A visit was paid to Southgate during the year by a Ministry of Health Official, who made a thorough inspection of the Maternity and Child Welfare services of the district. The subsequent report from the Ministry expressed satisfaction as to the work performed and suggested several minor additions to the scheme, these having since been carried out. 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 inspected at the Elementary Schools during 1934 was as follows— Inspected. Requiring Treatment. Entrants 583 91 Intermediates 315 47 Leavers 230 42 1128 180 Other ages 104 23 Special 2 1 106 24 1234 204 The various schools in the district were inspected throughout the year for the presence of any sanitary defects. In addition, any doubtful cases of infectious disease met with by the Assistant County School Medical Officer during routine inspections were reported to the Public Health Department with a note as to the conditions found. Extending this most desirable spirit of cooperation, several schools in which localised outbreaks of infectious disease occurred were visited in company with the Assistant School Medical Officer, and classes of children examined for possible "carriers" or missed cases. Finally, as reported elsewhere, arrangements have been made with the Middlesex County Education Authority whereby immunisation against diphtheria can be carried out at any school in the district. By these means the singular position in which Southgate is placed by virtue of the fact that school medical inspections are not performed by its own officers is to a certain degree mitigated. 28 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. The total number of children dealt with at the Minor Ailments Clinics was as follows— New Cases. Attendances. Treated. Not requiring Treatment. Winchmore Hill 1342 5663 1201 141 Holly Park 278 671 251 27 1620 6334 1452 168 (b) Ophthalmic Clinic.-—An ophthalmic clinic is held weekly, on Wednesday 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-four children attended the clinic and were seen by the Ophthalmic Surgeon during 1934. Spectacles were prescribed and provided for 128 of these. The corresponding figures for 1933 were 195 and 147 respectively. (c) Dental Clinic.-—For several years past, arrangements existed between the Middlesex County and the Southgate Borough Councils whereby the Dental Clinic for elementary school children, expectant .and nursing mothers and children below the age of five years was held at Broomfield House, Broomfield Park. As indicated elsewhere in this report, these arrangements were terminated in June, 1934. The Clinic was accordingly transferred to the Winchmore Council School, Highfield Road, where dental treatment of school children only is now carried out by Miss A. M. Munro, L.D.S., one of the County Council's Assistant Dental Officers. Children attending Bowes Road and Garfield Road Council Schools continue to 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). One thousand five hundred and fifty-one children were dentally inspected at the Schools during the year as against 2,181 in 1933, while 1,032 attended at the clinics (1933—1,050), where they received treatment for various dental defects. 29 Sanitary Circumstances of the Area. Water.-—The water supply of the district, which is almost entirely served by the Metropolitan Water Board, remains satisfactory in quality and quantity. The supply is from high-pressure mains. One cottage in Bramley Road and a number of houses in the transferred area at Cockfosters are supplied by the Barnet Water Co. Here, also, the supply is quite satisfactory. Nine cottages at Cockfosters still obtain their water supplies from two deep wells. Samples of the water from these wells were submitted during the year to chemical- examination with satisfactorv results. Swimming Bath—The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows: 1933. 1934. Men 45,161 39,678 Women Mixed Bathers, Adults Boys Mixed Bathers, Children 41,061 35,008 Season Ticket Holders (attendances) 45,540 29,946 Totals 131,762 104,632 Spectators, Adults 5,814 4,012 Spectators, Children 2,322 1,736 Following complaints as to the condition of the water in the Bath, a mechanical cleansing apparatus is being installed. Broomfield Park Swimming Lake.—This lake is now being used again for swimming purposes following its being supplied with water from the artesian well sunk in Broomfield Park. Rivers and Streams.—Complaints are still being received regarding the East Barnet Sewage Farm and Refuse Dump. So far as can be ascertained the matter is in very much the same position as when the Report for 1933 was issued, little progress having been unfortunately made during the interval. Enquiries have, however, elicited the fact that the work of reconstructing the East Barnet Sewage Farm will shortly be commenced. 30 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. Four miles of additional sewage sewers and four miles of surface-water sewers were laid to serve various building estates in the district during 1934. Closet Accommodation.—Conditions satisfactory and as set out in the Report for 1933. Cesspools.—Following the inclusion of the Cockfosters area within the Borough of Southgate there are now 28 cesspools in the district. These are cleansed weekly by a contracting firm and there is every evidence to show that the work is being carried out in the most efficient and least obnoxious manner. Roads.—There are now almost 78 miles of roads in the district, made up as follows— County Roads 12.39 miles. Arterial Roads 1.89 ,, District Roads 48.79 ,, 60.07 " Private Roads 14.86 ,, 77.93 ,, Public Conveniences.—The Council's underground convenience at The Triangle, Palmers Green, continues its useful services, while the convenience at Enfield West and Southgate Stations mentioned in last year's Report are also proving extremely valuable. The Public Convenience at Winchmore Hill will be opened during 1935, while it is hoped that the convenience to be built adjoining the Employment Exchange in Palmers Green will also be completed before the end of the year. Collection and Disposal of Refuse.—The arrangements mentioned in last year's Report for the extension and modernisation of the Refuse Destructor are nearing completion and 1935 should see the new plant in operation. It was very unfortunate that during the latter part of 1934 the destructor was partly out of action when the weather was extremely mild. Because of this fact, the system of controlled tipping which had to be adopted was insufficient to prevent a plague of flies, which rapidly spread to the neighbouring dwelling-houses. Everything possible was done at the destructor and in the houses affected to minimise the nuisance, which abated as the weather grew colder. 31 The new refuse collection vehicles outlined in last year's Report are in commission and are proving satisfactory. Several minor alterations in the system of refuse collection were put into force during the year, particularly a twice weekly system of refuse collection for traders, but in the main the arrangements are exactly similar to those outlined in the Report for 1930. 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 387 ,, ,, ,, Pagefield Containers 740 ,, ,, ,, Electrical Vehicles 588 ,, ,, ,, Freighters 493 ,, ,, ,, Hired Lorries 20 No. of Loads to Destructor 7,400 Total Weight to Destructor Est. 11,839 tons. No. of Loads to Shoots 536 Total Weight to Shoots Est. 1,352 tons. Smoke Abatement.—The Council adopted bye-laws under the Smoke Abatement Act, 1926, in April, 1934, and the necessary action was taken during the remainder of the year to ensure that the provisions contained therein were enforced. The following is a summary of the work performed. One hundred and thirty-one observations of six industrial chimneys in the Borough were made. A large number of ti.ese observations followed complaints regarding the emission of smoke from the chimneys of one factory in the district. During the period when the chimneys of this factory were under observation, the maximum period for the emission of black smoke, subsequently fixed in the bye-law dealing with this matter, was exceeded on 10 occasions. Since the adoption of the bye-law one contravention only has been noted. The owners of the premises were notified and the nuisance has been abated. There are no chimneys in the district connected to exempted furnaces. Since the adoption of the bye-law fortnightly observations of all chimneys in the Borough have been made. No legal action has so far been found necessary. 32 Ponds and Rubbish Dumps.—Complaints regarding smells from ponds and nuisances from rubbish dumps still continue to be received. This is inevitable in an area such as Southgate, with its rapidly-changing phases of development. The large ponds situated between Highfield Road and Laburnum Grove have now practically disappeared, having been almost completely filled in with material of a suitable nature for such a purpose. As the district develops, the number of ponds and dumping-grounds will be very greatly diminished and, meantime, careful supervision remains the obvious remedy against any potential nuisance. Common Lodging Houses, Houses -let -in -lodgings, etc.— Very little difficulty has been met with in administering the byelaws governing these types of premises, but the requirements continue to receive constant supervision. Schools.—As previously noted, the various schools in the district continue to receive periodic visits of inspection. The condition of the Chase Road Church School was reported to the Public Health Committee, by whom the matter was in turn reported to the School Managers, the Middlesex County Education Authority and the Board of Education. Various conferences have taken place regarding the necessity for improving the existing conditions and it is expected that the alterations suggested to the Managers will be carried out in the main during the coming year. Rag Flock Acts, 1911 and 1928. —There are no premises in the district manufacturing, selling or using Rag Flock according to the Acts. 33 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). Eleven 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. Three supplementary licences for Certified Milk, 5 for Grade A (Tuberculin Tested) Milk, 1 for Grade A Milk, 3 for Pasteurised Milk, and 1 for Grade A Pasteurised Milk were granted during the year. Once again it is pleasing 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.—The cowsheds, dairies and milkshops in the district were inspected regularly throughout the year, and were found to be in a satisfactory condition. As reported in the paragraph dealing with the work of the new laboratory, bacteriological examinations of milk samples are now being carried out in Southgate. This, in my opinion, constitutes a most vital additional safeguard to the milk supply of the district. 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 4,618 carcases was examined, as follows— Bullocks, 54; Sheep and Lambs, 3,805; Calves, 79; Pigs, 680. 34 As a result of these examinations, 32 separate diseased or unsound conditions were discovered and the carcases or organs dealt with. Details of these conditions are as follows— Weight Bovine Carcases. in lbs. 19 separate portions affected with Tuberculosis .. 561 1 ,, ,, ,, ,, Distoma .. 14 575 Sheep Carcases. 2 separate portions affected with Pneumonia . . 6 Pig Carcases. 6 separate portions affected with Tuberculosis .. 56 3 ,, ,, ,, ,, Pneumonia .. 13 1 ,, ,, ,, ,, Cirrhosis 5 74 Total weight of unsound meat dealt with 655 (5cwts. 3qrs. 11 lbs.) 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. Tubcreulosis. Slightly A fleeted. Extensively Affected. Slightly Affected. Extensively Affected. No. % No. % No. % No. % Bo vines— 1933 18 24.32 2 2.70 7 9.4") 2 2.70 1934 15 27.77 1 1.85 13 24.07 1 1 85 Sheep— 1933 3 0.08 1 0.02 — — — — 1934 2 0.05 — — — — — Calces— 1933 1934 Pigs— 1933 10 1.82 — — 3 0.53 — — 1934 9 1.32 — — (5 0.88 — — Other Foods.—The bakehouses, fish, fruit and grocers' shops in the district are kept under observation. 15½ lbs, chilled salmon, 1½doz. escallops, 4 boxes filleted haddock, 1 box kippers and 3 boxes mixed fish were voluntarily surrendered during the year. 35 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 101 3 Butter 4 — Hake 19 9 Lemon Sole 2 1 Meat ] — Minced Beef 2 — Gin 1 — Whisky 2 — 132 13 36 ANNUAL REPORT, 1934 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 Inspections. Written Notices. Prosecu tions. 1933 1934 1933 1934 Factories (including Factory Laundries) 345 588 36 34 .. Workshops(including Workshop Laundries) 346 455 25 38 .. Workplaces (other than Outworkers' premises, included in Part 3 of this Report) 48 65 10 7 .. Total 757 1108 71 79 .. 2.—DEFECTS FOUND. Particulars. Number of Defects Found. Remedied. Referred to H.M. Inspector. No. of Prosecu tions. 1933 1934 1933 1934 Nuisances under the Public Health Acts:—* Want of Cleanliness 80 82 85 82 .. .. Want of Ventilation .. .. .. .. .. .. Overcrowding .. .. .. .. .. .. Want of Drainage of Floors .. .. .. .. .. .. Other Nuisances 26 2 29 2 .. .. †Sanitary Accommodation Insufficient .. .. Unsuitable or Defective 20 41 25 40 .. .. Not separate for sexes 1 .... 1 .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of Underground Bakehouses (8. 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 127 125 140 124 .. .. *Including those specified in Sections 2,3,7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. † Section 22 of the Public Health Acts (Amendment) Act, 1890, was adopted in 1890. 37 38 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 Failing to keep or permit inspection of lists. Failing to send 1 ists. Twice in the year. Outworkers Once in the year. Outworkers. Instances. Notices Served Prosecutions. Instances. Orders Made. (S.110) Prosecutions. (S.109-110) Lists. Contractors . Workmen. Lists. Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel — (1) Making, etc. 6 •• 26 .. .. .. .. .. .. .. .. .. .. .. •• 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. No. Class. (1) (2) (1) (2) Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factorv 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 under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector .. 1 Laundries 3 Other Workshops 104 Reports of action taken sent to H. M. Inspector 1 Total Number of workshops on Register 212 Other .. Underground Bakehouses (s. 101):— Certificates granted during the year .. .. SANITARY INSPECTION OF AREA. The number of inspections carried out during 1934 has once again shown an increase over those of previous years. It must be remembered, of course, that many of the visits paid by the new Health Visitor are included in the lists, while the work carried out by a workman whose services were obtained temporarily from the Surveyor's Department, primarily for the purpose of disinfestation, are also included. There can be no doubt, however, that the presence of the additional staff has allowed much important work, hitherto inadequately dealt with, to be more thoroughly performed. As an example of this, the inspection and supervision of hairdressers' shops, ice-cream vendors and establishments mainly employing young women has been regularly and systematically carried out. The work of disinfestation will be referred to in more detail later in the Report. Inspections. 1933. 1934. Housing inspections and re-inspections 3,841 5,915 Slaughterhouse visits and inspections 586 488 Factories and workshops (including bakehouses) visits and inspections 757 1,108 Dairies, cowsheds, milkshops and other food shops, visits and inspections 1,447 2,231 Various complaints, inspections and re-inspections 1,355 1,529 Dustbins, inspections and re-inspections 1,363 1,146 Infectious Disease visits and re-visits 1,086 2,459 Other inspections (Rents Acts—Rats and Mice Destruction Act—Ditches and Ponds— Accumulations—Non-notifiable Diseases, etc.—Drain inspections and tests—Smoke observations) 4,443 7,286 Total 14,878 22,162 Service of Notices. Total informal sanitary notices served 1,063 1,572 Total informal dustbin notices served 270 257 Total informal notices served 1,333 1,829 Total informal notices complied with 1,377 1,790 Total statutory notices served 37 30 Total statutory notices complied with 47 30 Total notices carried forward 159 198 39 Sanitary Improvements.—The following is a summary of the sanitary improvements effected, and the defects remedied:— Housing. Premises cleansed 138 Ceiling plaster repaired 380 Ceilings washed and distempered 1,034 Wall plaster repaired 613 Walls redecorated 1,476 Dampness remedied 195 Floors repaired or relaid 156 Ventilation under floors improved 25 Roofs repaired 272 Eaves gutters repaired or renewed 218 Rainwater pipes repaired or renewed 191 Yards repaired or repaved 144 Window frames repaired or renewed 212 Sashcords provided 573 Doors and frames repaired or renewed 101 Brickwork repointed or repaired 170 Cooking ranges repaired or renewed 74 Firegrates repaired or renewed 54 New sinks provided 56 Waste pipes repaired or renewed 120 Internal steps and staircases repaired 33 Food stores repaired 3 Internal woodwork repaired 157 Lighting and ventilation improved 5 Water supply—Draw taps fixed on main service 10 Water storage cisterns cleansed 5 New storage cisterns provided 6 Defective pipes repaired 30 Overcrowding abated 3 Washing coppers repaired or renewed 67 Verminous premises cleared of vermin 34 Verminous rooms cleared of vermin 59 Drainage. Inspection chambers repaired 60 New inspection chambers provided 17 Drains examined and tested 383 Drains repaired 60 New drains laid 44 Drains unstopped or trapped 210 New gullies provided 37 Gully grates provided 16 Choked gullies cleansed 107 Vent shafts and soil pipes repaired or renewed 31 F. A.I.s repaired or renewed 99 40 Sanitary Accommodation. W.C. pans renewed 104 W.C. seats repaired or renewed 53 New flushing cisterns provided 52 W.C. cisterns repaired 81 W. C. flush pipes repaired or renewed 49 W.C. cone joints repaired or renewed 106 W.C. structure repaired 50 Refuse Receptacles. Dustbins renewed (by owTners) 390 Dustbins renewed (by Council—in default) 0 Cowsheds and Dairies. Cowsheds cleansed and limewashed 7 Cowsheds floors repaired 1 Cowsheds walls repaired 1 Dairies cleansed and limewashed 4 Dairies walls repaired 1 Dairies floors repaired 2 Accumulations of manure removed 6 S laugh ter houses. Cleansed and limewashed 5 Roofs repaired 1 Bakehouses. Cleansed and limewashed 14 Floors repaired 3 Roofs repaired 1 Walls repaired 4 W.C.s repaired 3 W.C.s cleansed and limewashed 5 Factories and Workshops. Notices posted 101 Walls cleansed and limewashed 43 Ceilings cleansed and limewashed 39 W.C. cisterns repaired or renewed 4 W.C. cone joints repaired or renewed 7 W.C.'s cleansed and limewashed 30 Roofs repaired 2 Food Shops. Shop floors cleansed 8 Accumulations removed 41 Yards repaired, paved or drained 21 W.C.s cleansed 13 W.C.s repaired or renewed 21 41 Miscellaneous. Cesspools emptied and cleansed 8 Accumulations of refuse and manure removed 64 Nuisances from keeping of animals abated 16 Foul ditches, ponds and stagnant water abated 11 Moveable dwellings (vans and tents) removed 40 Smoke nuisances abated 9 Dustbins.—Special inspections, following upon information supplied 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, 264 premises were visited in this connection, 209 verbal notices, 47 preliminary notices and 2 statutory notices being served. These special inspections alone resulted in the provision of 250 new bins, which included a number of bins supplied following notices served during 1933. Premises under Periodical Inspection.—The following premises are kept under periodical inspection. As hitherto, the inspections revealed the fact that they were being satisfactorily administered. Description of Premises. No. in District. Dairies and Milkshops 33 Cowsheds 3 Bakehouses 15 Dining Rooms 23 Slaughterhouses 5 Fried Fish Shops 10 Factories and Workshops 197 Public House Conveniences 21 Total 307 HOUSING. Number of New Houses Erected during the Year 1934:— (a) Total (including numbers given separately under (b) 838 (b) With State assistance under the Housing Acts:— (i) By the Local Authority Nil (ii) By other bodies or persons Nil 42 House -to -House Inspection.—The Housing Schedule remains as last year but will receive further revision during 1935. Seven hundred and seventeen houses were inspected and recorded under the Housing Acts, as follows— No. of Houses Scheduled. No. Inspected. No.l. Northern District. 1933. 1934. Annual List 121 56 121 Biennial List 35 — 35 Quinquennial List 751 172 190 No. 2. Southern District. Annual List 150 150 150 Biennial List 74 22 52 Quinquennial List 717 243 169 Total 1,848 643 717 Non-Scheduled Houses.—In addition to the above, 1,151 non-scheduled houses were inspected for housing defects, mostly upon the complaint of the occupiers, as follows— 1933. 1934. North-East Ward 59 188 North-West Ward 26 536 Middle Ward 61 154 South Ward 98 273 Total 244 1,151 1. Inspection of Dwelling-houses during the year:— 1933. 1934. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,281 1,868 (6) Number of inspections made for the purpose 1,455 1,953 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 643 717 (b) Number of inspections made for the purpose 794 775 43 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 Nil (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 786 1,348 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 693 1,017 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 B.—Proceedings under Public Health Acts:— (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 38 30 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 48 30 (b) By local authority in default of owners Nil Nil 41 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 1933. 1934. D.—Proceedinqs under Section 20 of the Housinq Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Nil E.—Proceedinqs under Section 3 of the Housinq 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:— (a) By owners Nil Nil (b) 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 45 (2) Number of Dwelling-houses in respect of which Closing Orders were determined, the Dwelling-houses having been rendered fit Nil 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 voluntarily by owners 15 29 (6) Number of Dwelling-houses demolished voluntarily by owners 16 21 Since the last Report was issued, the Ministry of Health has accepted the statement of the Southgate Borough Council that there are no "slums" or "slum property" in the district. While eminently satisfactory, this does not mean that housing inspection must in any way be neglected, or that additional Council houses should not be built. There is still need for such accommodation at a low rental, whether flats or otherwise, a need which may be revealed in a much clearer light if and when the new proposed Housing Act comes into being. Overcrowding.—Three cases of overcrowding in a mild form were reported during 1934. 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, one application was received from an occupier for a certificate to the effect that his house was not in a reasonable state of repair. A special inspection was made, following which a certificate was granted. In addition to the above, four 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 four cases. Rats and Mice Destruction Act.—This Act is administered in the Southgate area by the Middlesex County Council. Numerous complaints were again received during the year as to 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. 46 Prevalence of and Control over Infectious and Other Diseases. From Table V, on page 62, it will be seen that 332 cases of infectious diseases were notified during the year, as against 249 in 1933, an increase of 83. These 332 cases represent infection in 299 houses. As previously mentioned, the increase in numbers was anticipated following a period of low infectivity, quite apart from the growth in population of the Borough, which also had an appreciable effect upon the total figures. The ward distribution of the cases of infectious disease notified during the year was as follows:— South Ward 135 Middle Ward 74 North-West Ward 69 North-East Ward 54 If the approximate population of the wards as set out be taken as 33 per cent., 30 per cent., 9 per cent, and 28 per cent, respectively of the total population of the Borough, it will be seen that the South and North-West Wards showed a relatively high incidence of infectious disease, while the North-Hast and Middle Wards were correspondingly low. When one considers the relatively high child population of the first two wards this is only to be expected. The infectious Sickness Rate of the district for 1934 was 5.5 as against 4.2 in 1933 and 4.3 in 1932. The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 253 premises. During such inspections, 74 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. Two hundred and twenty-seven cases were removed to the Isolation Hospital at Tottenhall Road. Of these, 125 were suffering from scarlet fever, 5 from scarlet fever and diphtheria, 3 from scarlet fever and measles, 35 from diphtheria, 7 from diphtheria and measles, 7 from erysipelas, 1 from pneumonia, 1 from whooping 47 cough and pneumonia, 2 from puerperal pyrexia, 1 from meningitis, 22 from measles, 1 from German measles, 1 from post-measles mastoid, 1 from otorrhoea, 1 from tonsillitis, 1 from parotitis, while 9 were observation cases and 4 were diphtheria "carriers." Small-pox.—No cases of small-pox occurred in the district during 1934. Several ' 'contacts'' were reported from other districts, these persons being visited and kept under strict supervision. Vaccination.—No primary vaccinations or revaccinations under the Public Health (Smallpox Prevention) Regulations, 1917, were required during 1934. Scarlet Fever.—One hundred and sixty-five cases of scarlet fever were notified during the year, as against 91 in 1933. The ward distribution was as follows:— South Ward 82 Middle Ward 32 North-West Ward 28 North-East Ward 23 Sixteen "secondary'' cases occurred in houses from which previous cases had been notified. In each instance the primary case had been removed to hospital. One "return'' case occurred. The incidence of the disease was spread fairly evenly over the twelve months, but minor peaks occurred in May and October. The type of disease met with was definitely mild and no deaths occurred. One hundred and twenty-five cases were removed to the Isolation Hospital, representing 75.7 per cent, of the total number of cases notified. Arrangements are being made whereby the period of detention in hospital of scarlet fever cases will be reduced from 4½ weeks to 3 weeks, following the administration of serum to all cases. It is anticipated that this measure will relieve the demands upon the scarlet fever accommodation at the hospital and thus lessen the congestion. Apart from this, every endeavour is still made to ensure that cases which can be suitably isolated and treated at home are retained there. Diphtheria.—Forty-four cases of diphtheria (40 faucial, 3 nasal, and ???faucial and nasal) were notified during 1934, as against 23 the previous year. Seven of these were secondary cases. 48 The ward distribution was as follows:— South Ward 10 Middle Ward 8 North-West Ward 19 North-East Ward 7 Forty-two cases (95.4 per cent, of the total cases notified) were removed to hospital. The type of disease met with was definitely severe, and three deaths occurred. The greatest incidence occurred in the first quarter of the year, and a notable feature during that period was the association of diphtheria with measles, seven such cases being admitted to hospital. There can be little doubt that the co-existence of the severe measles epidemic which visited Southgate during the early part of 1935 had not a little to do with the increased incidence and marked severity of diphtheria within the Borough, by reason of the lowered resistance of the children, together with the intensification of "droplet" infection brought about by the measles catarrh. The dates of notification were as follows:— 1st day 1 2nd ,, 9 3rd ,, 8 4th ,, 9 5th ,, 5 6th ,, 4 7th ,, 2 8th ,, 1 9th ,, 2 ? „ 3 The fatal cases occurred in patients notified on the second, sixth and seventh days of disease respectively. This is definitely unsatisfactory, particularly in view of the extensive propaganda instituted against diphtheria within the Borough, and reveals the fact that these efforts must be continued. Practically speaking, every death from diphtheria is a preventable tragedy, and until the fact is borne home upon everyone concerned that we are at present dealing with a particularly virulent type of infection, the risk of these most regrettable fatalities will remain an ever-present menace. Swabs are taken of all home contacts and of all cases fourteen days after their discharge from hospital. As. hitherto, Diphtheria Antitoxin is kept in stock at the Public Health Department and issued to all medical practitioners on application. -19 Immunisation.—Three hundred and twenty-three persons attended for immunisation at the weekly clinic held in Broomfield House or at the schools visited, during 1934. After prolonged negotiations, permission was obtained from the Middlesex Education Committee, as the Local Education Authority, to visit schools in the district after school hours for the purpose of immunisation. Advantage was taken of this facility to visit Tottenhall Road School and Highfield Road School, invitations being issued to all parents to bring their children for immunisation. In addition to these visits, the work carried out at the clinic in Broomfield House was continued as before. The following tables set out the work performed during the year. Results of Schick Tests. 1-5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total. Negatives 1 (1.3%) 17 (9.9%) 17 (27.8%) 11 (68.7%) 46 Positives:— Mild — 60 (35.4%) 24 (39.3%) 3 (18.8%) 87 Moderate — 52 (30.7%) 12 (19.6%) 1 (6.25%) 65 Marked — 38 (22.47%) 8 (13.3%) 1 (6.25%) 47 Nil 150 44 5 199 Not tested 76 (98.7%) 2 (1.6%) — — 78 Completed Cases (To 31.12.34 from commence ment of scheme) 147 201 102 6 456 No. of persons who have attended for immunisation since commencement of scheme (including Schick negatives, uncompleted cases and defaulters 1,063 Results of Schick Test after Three Months (1934). Negatives 428 Positives 28 456 Further Results of Positives (28)— After 4th injection:— Negatives 25 Positives 3 After 5th injection:- Negatives 3 Positives Nil Number of Cases failing to complete Immunisation (1934) 69 Before three injections 22 after three injections 37 50 Reactions after Injections(193.). 1-5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total. Mild 1 2 — 2 5 Moderate — 2 3 — 5 Severe — — — — — 1 4 3 2 10 In addition to the figures set out above there is evidence that a number of families are seeking immunisation at the hands of their family physicians. Two children developed clinical diphtheria during the course of their immunisation, but before immunity could be established. In each case the attack was extremely mild and no complications ensued. Arrangements have been made to visit two further schools for the purpose of immunisation during 1935. The cost of immunisation works out at approximately 2s. 6d. per person immunised. Supervision of Cases discharged from Isolation Hospital. —Following the appointment of the new Health Visitor for general Public Health services it has been possible to arrange a systematic visitation of all cases of infectious disease after discharge from the Isolation Hospital. This has proved of great service and is, in my opinion, a valuable addition to the preventative measures undertaken by the Council. Not only is it possible to give valuable advice to cases who might otherwise abstain from seeking medical attention, but, in addition, the visits paid by the Health Visitor have also resulted in subsequent visits by medical attendants, which might not otherwise have occurred. The work of supervision has also enabled us to check the effect of treatment in the Isolation Hospital, and I am happy to state that the information so received has been most satisfactory. This work will be extended during the incoming year when the period of detention in hospital of scarlet fever cases is reduced. Typhoid Fever (including Paratyphoid).—No cases of typhoid fever or paratyphoid were notified during the year. One case occurred during 1933. Puerperal Fever and Puerperal Pyrexia.—Two cases of puerperal fever and 2 of puerperal pyrexia were notified in Southgate during the year as against 1 and 5 in 1933. 51 It was not found necessary to make use of the services of the Council's gynaecologist during the year for any cases occurring within the Borough. Erysipelas.—Twenty cases of erysipelas were notified during the year, a similar number being notified in 1933. There were two deaths, one of which occurred in an adult of 53 years of age who was a patient in the Passmore Edwards Hospital, Wood Green. The other was that of an adult of 65 years who had been treated at her own home. Seven cases in all were removed to the Isolation Hospital. Pneumonia.—Forty-one cases of pneumonia were notified in Southgate during the year, as against 57 in 1933. There were 47 deaths, this number including all deaths which occurred in hospitals outside the district, a number of which were secondary cases and therefore non-notifiable. Several cases were removed to the North Middlesex County and other Hospitals. Tuberculosis.—The number of cases of pulmonary tuberculosis notified during the year under the Public Health (Tuberculosis) Regulations, 1912, was 52, while the number of cases of non-pulmonary tuberculosis notified was 5. In addition to these notified cases, 24 patients were entered on the register (21 pulmonary and 3 non-pulmonary) who were new residents in the district but had been previously notified elsewhere. The corresponding figures for 1933 were: Pulmonary cases, 38; non-pulmonary cases, 7. There were 39 deaths, 36 from pulmonary and 3 from nonpulmonary tuberculosis. Of these, 3 had not been previously notified (1 being the subject of a Coroner's inquest)—a ratio of 7.7 per cent., as against 15.8 per cent, in 1930. 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 19. Non -Notifiable Infectious Diseases.—During the year, information was received from the head teachers of various schools in the district regarding the occurrence of 650 cases of measles, 197 of German measles, 94 of whooping cough, 61 of mumps, 4 of influenza, and 44 of chickenpox among elementary school children. These children were attended to by the County Council School Authorities. 52 There were 4 deaths from measles. It will be obvious from a study of the figures set out below that Southgate had its full share of the widespread 1934 epidemic of measles and German measles. The incidence of the other diseases mentioned was considerably less than during 1933. The complete list is as follows:— 1933. 1934 Measles 27 650 Whooping Cough 134 94 Mumps 118 61 Influenza 27 4 Chickenpox 50 44 German Measles — - 197 Total 356 1,050 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 cancer has now been added to the list of diseases receiving free disinfection. The following Tables summarise the work carried out during the year:— Disinfection in connection with Notifiable Diseases. Number of rooms fumigated 569 Number of articles disinfected by steam 2,942 Number of articles destroyed 222 Disinfection in connection with Non-notifiable Diseases. Disinfection of rooms and bedding, on request, after cases of nonnotifiable disease (charge of 5s.):— Number of rooms fumigated 141 Number of articles disinfected by steam 919 Amount received in respect thereof £6 10s. Od. 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, 333 books were so disinfected. 53 ISOLATION HOSPITAL. The number of patients treated in the Hospital during the year has once again reached a, new record. Six hundred and twenty-two patients were treated (including those patients in Hospital on January 1st. 1934). this being the first time in the history of the Hospital that the number has exceeded 600. As before, the bulk of the patients were admitted from Tottenham, with which Authority the agreement set out in last year's Annual Report still holds. The agreement whereby patients from the Friern Barnet Urban District were admitted to the Isolation Hospital was terminated by mutual arrangement on September 30th. This agreement was originally instituted in 1902 and apparently gave satisfaction throughout its entire existence. The Hospital will, of course, be available still for Friern Barnet patients should that Authority desire for any reason to make use of its accommodation, always provided that such accommodation is available at the time. A feature of the year's work has been the comparatively large number of diphtheria cases admitted. As will readily be realised, the admission of such a large number of diphtheria patients, many of whom were very acutely ill, meant a definite increase in the work of the Hospital. As in previous years, the variety of diseases treated was also numerous, this adding its quota to the nursing and administrative problems. Number of cases admitted to Hospital:— Southgate 227 Tottenham 308 Friern Barnet 32 Wood Green 1 Edmonton 2 Middlesex County Council 1 571 Two of the patients admitted from Wood Green and Edmonton were treated in the Hospital at their own request and as paying patients. The second case from Edmonton was admitted in error and transferred to the Edmonton and Enfield Joint Isolation Hospital so soon as the mistake was discovered. The Middlesex County Council's case was a member of the staff at the North Middlesex County Hospital, for whom the County Council accepted responsibility. 54 The figures for 1933 were:— Southgate 126 Tottenham 322 Friern Barnet 50 Wood Green 1 Edmonton 1 500 The diseases for which the 571 patients were admitted were as follows:— Scarlet Fever 245 Diphtheria 177— -Faucial 158 Nasal 9 Nasal & Faucial 3 Laryngeal 4 • Laryngeal & Faucial 1 Larvngea: & Nasal 1 Aural & Nasal 1 Diphtheria "Carriers" 5 Scarlet Fever and Diphtheria 16 Scarlet Fever and Diphtheria ' 'Carrier'' 1 Scarlet Fever and Burns 1 Scarlet Fever and Chickenpox Scarlet Fever and Whooping Cough 1 Scarlet Fever and Mastoid 1 Scarlet Fever and Measles 4 Diphtheria and Chickenpox Diphtheria and Measles 8 Late Diphtheritic Paralysis 1 Typhoid Fever 1 Chicken-pox 1 Erysipelas 14 Puerperal Fever 3 Puerperal Pyrexia 1 Baby with Mother 1 55 Whooping Cough 1 Whooping Cough and Pneumonia 3 Whooping Cough and Bronchitis 2 Pneumonia 1 Pneumonia and Erysipelas 1 Influenza 4 Measles 35 Measles and Mastoid 2 Measles and Broncho-Pneumonia 3 Measles and Whooping Cough 1 Measles and Bronchitis 1 Measles, Whooping Cough and Broncho-Pneumonia 1 Rubella Meningitis following Measles 1 Influenzal Meningitis 1 Abscess of ha nd 1 Cellulitis Tonsillitis 10 Ludwig's Angina 1 Acute Rheumatism 1 Colitis 1 Bronchitis 1 Simple Dermatitis Impetigo 1 Asthma 1 Vincent's Angina 1 Simple Croup 1 Rhinorrhoea 1 Simple Otorrhoea 1 571 Several of the above cases were admitted for observation purposes, while, in 22 other cases the original diagnosis was amended after admission, the patients being transferred to a General Hospital or sent home when the non-infectious nature of their illness became apparent. In one case (abscess of hand) the patient was too ill to be moved and died in Hospital. 56 Number of Patients in Isolation Hospital during each Month :— Greatest Number. Lowest Number. January 59 48 February 60 45 March 67 47 April 62 52 May 61 46 June 56 41 July 64 42 August 64 48 September 63 53 October 63 49 November 64 49 December 67 56 Complications.—The complications met with during 1934 were as follows— Scarlet Fever.—(Total of 274 cases treated during the year.) Rheumatism 4 Otorrhoea 12 (right 9, left 2, double 1.) Rhinorrhoea 2 Adenitis 3 Nephritis and Otorrhoea 1 Endocarditis 2 Total 24 The percentage of complications is practically identical with the figure obtained for the last two years, the most prominent feature being once again the incidence of otorrhoea. The type of complication was for the most part mild and responded adequately to treatment. In addition to these complications, one patient developed a secondary rash. Diphtheria.—Apart from the 8 fatal cases met with, 25 complications occurred amongst the 203 cases treated during the year. These were as follows— Palatal Paralysis 11 Palatal, Ocular and Pharyngeal Paralysis 2 Paralysis of Palate and Muscles of Limbs 1 Peripheral Neuritis 1 57 Otorrhoea 7 (right 1. left 5, double 1) Palatal Paralysis and left Otorrhoea 1 Endocarditis (mild) 2 Total 25 The number of complications is slightly higher than in previous years. This is due to the fact that the type of case admitted was considerably more severe than previously. The complications responded quickly and satisfactorily to treatment, and it was possible to discharge the patients in a sound physical condition. Deaths.—Nineteen deaths (3 adults and 16 children) occurred during the year, 8 from diphtheria, 1 from influenzal meningitis, 1 from meningitis following measles, 1 from myocarditis following acute tonsillit is, 2 from measles and diphtheria, 3 from measles and broncho-pneumonia, 2 from septicaemia, and 1 from bronchopneumonia. Five of the patients died within 24 hours of admission, one case surviving only 4 hours. General Treatment.—The treatment carried out at the Hospital during the year followed, in the main, the lines laid down in previous Reports, with the exception that larger doses of serum were administered to diphtheria patients, while serum was more extensively used in the treatment of scarlet fever patients. In addition, steps were taken to counteract the possibility of severe paralysis or fatal cardiac failure in diphtheria by the administration of glucose and adrenalin. I hope during the incoming year to amplify this treatment by the adoption of an even later technique, while direct laryngoscopy and suction are also being adopted in the treatment of laryngeal diphtheria. As mentioned in an earlier portion of the Report, a modified method for treating scarlet fever patients is being adopted. A report submitted on this question will be found in appendix 3 of this Report. The ultra-violet and infra-red apparatus once more proved its usefulness during the year. The following tables set out the work performed— 58 Ultra-Violet Radiation. Adenitis following Scarlet Fever 3 Debility following Scarlet Fever 2 Debility following Diphtheria and Scarlet Fever 1 Rhinorrhoea 2 Otorrhoea 2 Impetigo 2 Peronychia 3 Eczema 1 Dermatitis 1 17 Infra-Red Radiation. Dermatitis 2 Debility following Scarlet Fever 2 Rhinorrhoea 1 5 The results obtained from this form of treatment have been satisfactory, particularly in the case of glands and malnutrition. It is now possible to make more use of the lamps as the wards are all being supplied with the requisite connections. Operations.—Dr. Macdonald, who was appointed Consultative Surgeon to the Hospital during the year, has paid numerous visits for the purpose of consultations and minor operations. Many of the cases admitted (particularly those from General Hospitals) required surgical attention, and this was supplied. In addition, 1 tonsillectomy was performed and several myringotomies. Three tracheotomies were also performed. No mastoid operations were required during the year. Discharge Procedure.—The procedure outlined in last year's Report has remained unaltered except that negative nose swabs for Klebs Loeffler bacilli are now required from all patients discharged from the Scarlet Fever Block. Period of Isolation in Hospital.—The average time of isolation in Hospital was as follows— Scarlet Fever—35.4 days (longest, 123 days—persistent otorrhoea). Average duration, 1933—36.5 days. Diphtheria—46.6 days (longest, 98 days—persistent diphtheria bacilli in throat; shortest, 1 day—died). Average duration, 1933—47.4 days. 59 Staff.—Apart from minor ailments such as colds, etc., the following illnesses occurred among the staff during 1934— Scarlet Fever 3 Diphtheria 1 Diphtheria Carrier 1 Tonsillitis 3 Influenza 2 Appendicitis 2 The two cases of appendicitis were immediately removed to a General Hospital for operative treatment, while the remainder of the patients were treated in our own Hospital. Apart from two of the cases of scarlet fever which occurred in laundresses, the remaining cases of scarlet fever and diphtheria occurred in nurses who had only just commenced their training. Steps are taken to immunise the nursing staff against diphtheria, scarlet fever, typhoid fever and colds, but, owing to the very heavy calls upon their services during the year, it has not vet been possible to complete this work. As previously mentioned, the nursing, domestic and gardening staff have been increased during the year. In addition, private nurses continue to be engaged as and when required. Courses of lectures are given to the probationer nurses as detailed in previous Reports. Cross Infection.—During the height of the measles epidemic early in 1934, several cases were admitted to Hospital incubating the disease who later developed typical signs of measles. After considerable difficulty, protective measles serum was obtained from the London County Council and administered to the contacts in the wards affected. By this means only two further cases occurred, which cases proved exceedingly mild. The use of this serum is obviously of the greatest importance, and I am taking steps to ensure that a further supply will be available should the need arise again in the future. Several cases of children with diphtheria bacilli in their noses occurred in the scarlet fever wards, but no children developed diphtheria and all the noses cleared up quickly on treatment. Owing to the fact that quite a considerable number of cases were admitted with a wrong diagnosis, children who had previously suffered from mild scarlet fever were in several cases admitted to the diphtheria ward. These children were removed as soon as the error was detected, but in some cases the children had remained in the ward for several hours. This resulted in one case of scarlet 60 fever occurring in the diphtheria ward. When the percentage of wrong diagnoses is taken into account this single case is, in my opinion, a remarkable tribute to the watchfulness of the nursing staff. In two instances children were admitted to the diphtheria ward incubating whooping cough. The cases were removed as soon as the symptoms of whooping cough appeared and no secondary cases occurred. Visiting.—The arrangements for visiting patients remain unaltered and appear satisfactory. Transfers to and from Other Hospitals.—The following transfers occurred during the year:— From the Prince of Wales's Hospital 18 cases. „ North Middlesex County Hospital 6 „ „ Wood Green and Southgate Hospital 1 case. To the Prince of Wales's Hospital 1 case. ,, North Middlesex County Hospital 5 cases. ,, Wellhouse Hospital 1 case. ,, Charing Cross Hospital 1 ,, ,, Wood Green and Southgate Hospital 1 ,, I would again like to pay tribute to the courtesy of the Medical Superintendent of the North Middlesex County Hospital who invariably receives patients requiring General Hospital treatment. These cases are for the most part made up of patients admitted to the Hospital with a wrong diagnosis. Laboratory.—Details of the Laboratory work carried out in connection with the Hospital will be found on pag; 19. General Remarks.—It gives me great pleasure to express my gratitude to the Matron of the Hospital, Miss West, and to the members of the nursing staff for the consistent services which they rendered throughout the whole of 1934. As will be seen from the previous records, the year's work was exceptionally arduous and necessitated whole-hearted co-operation from everyone concernded in the running of the Hospital. This co-operation was forthcoming and did not a little to lighten the burden of the work. I would also like to thank my Deputy, Dr. Burns, together with Dr. Macdonald, for the innumerable services which they rendered during the year. 61 62 Diseases. At all ages Under 1 year 1 to 2 2 to 3 3 to 4 4 to 5 5 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, 1934. Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 44 .. 3 .. 1 .. 18 10 3 6 .. 2 1 3 Scarlet Fever 165 .. 3 4 9 8 71 36 7 10 4 2 .. .. Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. .. .. .. .. 1 1 .. .. 4 Puerperal Pyrexia 2 .. .. .. .. .. .. .. .. 1 1 .. .. Erysipelas 20 .. .. .. .. .. .. .. .. 1 2 12 5 2 Ophthalmia Neonatorum 1 1 .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 41 2 2 4 1 1 3 .. 1 5 3 12 7 17 Tuberculosis— Pulmonary 52 .. .. .. .. .. 1 .. 8 21 11 11 .. 36 Non-Pulmonary 3 .. 2 .. .. .. .. .. 1 1 .. 1 .. 3 Totals 332 3 10 8 11 9 99 46 20 51 22 40 13 95 63 Ophthalmia Neonatorum, 1934. TABLE VII. 1 Notified. Cases. 1 At Home. Treated. Nil In Hospital. 1 Vision Unimpaired . Nil Vision Impaired . Nil Total Blindness. Nil Deaths Table VI. Cases of Infectious Disease Notified each Month of the Year, 1934. Notifiable Diseases. Smallpox. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Puerperal Pyrexia. Acute Poliomyelitis. Encephalitis Lethargica. Cerebro-spinal Meningitis. Malaria. Ophthalmia Neonatorum. Pneumonia. Tuberculosis Totals. Pulmonary. NonP ulmonary January .. 20 4 .. 3 .. 1 .. .. .. .. .. 11 7 .. 46 February .. 8 9 .. 3 .. .. .. .. .. .. .. 7 5 .. 32 March .. 10 10 .. 4 2 .. .. .. .. .. .. 6 4 .. 36 April .. 14 1 .. 2 .. 1 .. .. .. .. .. 1 4 1 24 May .. .. 13 7 .. 4 .. .. .. .. .. .. 1 6 7 1 39 June .. .. 1 .. .. .. .. .. .. .. .. .. 3 3 .. 12 July .. .. 13 4 .. 1 .. .. .. .. .. .. .. 2 3 1 24 August .. 2 1 .. 1 .. .. .. .. .. .. .. 1 6 1 12 September .. 14 1 .. .. .. .. .. .. .. .. .. .. 4 .. 19 October .. 23 3 .. 1 .. .. .. .. .. .. .. 1 5 1 34 November .. 19 .. .. .. .. .. .. .. .. .. 1 4 .. 24 December .. 24 3 .. 1 .. .. .. .. .. .. .. 2 .. .. 30 Totals .. 165 44 .. 20 2 2 .. .. .. .. 1 41 52 5 332 TABLE VIII. Tuberculosis, 1934. Age Periods. *New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 yr. - - 1 - - - - - 1-5 years 1 - - 1 - - 1 1 5-10 - 1 - 1 - - - - 10-15 „ - - - 1 - - - - 15-20 „ 4 6 - 2 1 1 - - 20-25 „ 6 5 - 1 1 2 - - 25-35 „ 13 11 - - 4 7 - - 35-45 „ 10 3 - - 3 3 - - 45-55 „ 6 2 - 1 4 - 1 - 55-65 „ 3 2 - - 5 2 - - 65 and over - - - - 3 - - - Totals 43 30 1 7 21 15 2 1 REGISTER OF CASES. Pulmonary. NonPulmonary. Total M. F. M. F. Cases on Register, 1/1/34 108 77 23 25 233 Cases notified for first time, 1934 31 21 1 4 57 Cases restored to Register 1 1 - — 2 Other Cases added 11 8 — 3 22 Cases removed from Register 39 34 4 13 90 Remaining on Register, 31/12/34 112 73 20 19 224 *These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the District. 64 APPENDIX. 1. Health Publicity. As hitherto, an attempt has been made by means of talks, distribution of pamphlets, articles in the Press, local edition of "Better Health," etc., to carry out a continuous policy of Health Propaganda in the district. Bearing this in mind, it was not considered necessary to hold a Health Week in Southgate during 1934. 2. Insulin. The supply of free Insulin was extended during the year and four patients are now receiving such a supply from the Council, the daily amount varying in each case from 30 to 60 units. As before, progress reports obtained from the private practitioner or from the Hospital dealing with the case are transmitted quarterly to the Ministry of Health. 3. Report on the Treatment of Scarlet Fever Cases, submitted to the Public Health Committee, November, 1934. "I would like to bring the above matter to the attention of the Committee as it is one of no little epidemiological importance. While it largely involves the question of detention of patients in Hospital and might therefore be presumed to come within the purview of the Hospital Sub-Committee, the matter is really of wider significance, inasmuch as the whole outlook on Scarlet Fever as it affects Southgate requires to be reviewed. "At the present moment there are three schools of thought regarding the treatment of scarlet fever. Very briefly, the opinions held are as follows :— (1) That scarlet fever is of so mild a type nowadays that the vast majority of cases can be safely left at home, with or without domiciliary supervision. (2) That scarlet fever, while usually mild, occasionally brings in its train such disastrous consequences that hospital treatment is called for in most cases, which treatment and isolation should be carried out for a period of 4-5 weeks in simple, uncomplicated cases. (3) That the complications of scarlet fever may be so serious that every case should have anti-scarlatinal serum injected to prevent their onset; and that if such is done isolation in hospital should not, in ordinary cases, be for a longer period than three weeks. 65 "As the Committee are no doubt aware, it has been the practice in Southgate to follow the second method of procedure, i.e., to admit to hospital 70-90 per cent. of all cases notified, to detain them for at least four weeks and to give serum only in cases of moderate or great severity. "In view of the changing outlook towards scarlet fever adopted by many authorities, and also in view of the very large demand upon our scarlet fever beds in Hospital, I have given this matter considerable thought and have made certain investigations. I have visited two of the foremost exponents of serum treatment in scarlet fever and saw their work in the hospital wards. I also consulted the Medical Officer of Health, Tottenham, and following these interviews, together with the perusal of several recent authoritative statements on the subject, I consider that it would be wise to change our policy and to give serum in all cases admitted to Hospital. ''The advantages of serum administration, as held and, I consider, proved by its sponsors, are as follows:— (1) There is a rapid fall of temperature, oedema of the pharynx subsides very quickly and the patients so treated speedily experience a feeling of well-being. (2) Complications are very considerably reduced, as are also cross-infections in the wards, both points of vital importance. (3) Because of the practical elimination of kidney damage patients can be put on full diet as soon as the temperature settles (usually within 48-72 hours), and can be got up in the second week of disease. Nutrition and muscle tone are thereby sustained, two very important factors in convalescence. (4) Patients can normally be discharged from hospital with safety at the end of three weeks. (5) Desquamation is considerably reduced. (This is only important from the standpoint of parental anxiety.) ''It will thus be seen that patients treated by serum make a much speedier recovery than those untreated and are considerably less subject to the complications which almost alone make scarlet fever a serious disease. "Regarding the administration of serum, there are three ways in which this can be carried out— (1) Intramuscularly. (2) Intraperitoneally. (3) Intravenously. 66 "The first method is attended by little or no risk, the second very occasionally gives rise to reactions, while the third very often upsets the patient. Bearing these facts in mind, I would recommend the injection of serum intramuscularly in mild or moderately severe cases, reserving the intraperitoneal method for severe cases where a speedy reaction of the serum is desired, and the intravenous method for desperate cases. ''The usual dose of serum would be 10 cubic centimetres for children and 20 cubic centimetres for adults. The cost of the material would, of course, be more than offset by the shortening of the period of detention in hospital. ' 'To carry this method into practice two further lines of action would be necessary. In the first place, it would be essential to have a careful "follow up" system of seeing patients approximately 14 days after their discharge from hospital. There should be no difficulty in carrying this out as we virtually do so at present. In the second place, it would be very desirable to have some method of removing the patients after they were allowed up, from the ward to which they were admitted into a convalescent block. This also could be done, although it would be very much easier had we more accommodation. "It should be noted that the three weeks' discharge period only applies to mild and uncomplicated cases. As the complication rate is cut down by the serum-treatment method, however, one would hope that the majority of cases would be able to go at the end of that time. Again, it should be remembered that this early discharge has nothing to do with the "Milne" method of treatment formerly undertaken at the Hospital. It is the administration of serum and that alone which makes the early discharge possible. "Bearing all the facts of the case in mind, I think we would be coming into step with the most modern technique in the treatment of scarlet fever were we to adopt this procedure. Its exponents can show magnificent results after several years' trial, and I feel that we should at least put it into operation for a period of not less than twelve months. 4. Report of the Investigation on the Delivery of Bread within the Borough of Southgate, submitted to the Public Health Committee, July 1934. Fourteen bakehouses and 20 bakers' shops were visited in the course of the investigation and 78 roundsmen were interviewed. Twenty-three general shops where bread is sold were also visited. 67 Statement of the inspections made in the compilation of this Report. Number of Master Bakers interviewed 9 (None of these produce wrapped bread and none are willing to do so.) Number of firms producing bread for wholesale and retail purposes and delivering in the Borough 6 Number of firms producing for retail purposes and delivering 3 Number of firms retailing (not producing) and delivering 3 Number of firms producing only (not delivering) 2 Number of firms retailing (not delivering) 1 Number of firms outside the Borough found delivering bread into the Borough 13 Number of different types of loaves sold 28 Number of barrows examined (4 types) 52 (Satisfactory 49, unsatisfactory 3.) In two of the three cases classified as ''unsatisfactory'' the barrows were being used temporarily. In one case the bread was exposed on top of the barrow and in the other the bread was deposited on straw. Four days after complaining of this, another, satisfactory barrow was in use. The third unsatisfactory barrow had no shelves. Number of motor vans examined (all satisfactory) 12 Number of horse-drawn carts (3 types), (all satisfactory) 9 Number of tricycles and bicycles 5 (Two of these were covered and 3 uncovered.) With the exceptions noted above the types of distributing vehicles used were modern and satisfactory. Number of roundsmen examined 78 (Wearing overalls, 24; not wearing overalls, 54.) Twenty-two had clean hands, 47 moderately clean hands and 9 dirty hands. On two occasions a roundsman was seen carrying a basket containing bread, over his shoulder. The bread was touching his coat— no overall being worn. Roundsmen were seen smoking on three occasions. General stores supplying bread in the Borough 13 Number selling wrapped bread only 2 Number selling wrapped and unwrapped bread 8 Number selling unwrapped bread only 13 68 The bread was exhibited for sale on the counter, on biscuit tins, in front of the counter, on sweet bottles, in the window and on shelves. In several cases it was stored under the counter. The condition of the shops was satisfactory as to cleanliness. Prom the aforementioned visits the following facts were obtained:— 1. Bread is sold wrapped, but there is no apparent demand. 2. The local bakers are unwilling to wrap bread on account of:— (a) No demand. In two instances wrapped bread was discontinued owing to lack of demand. (b) Provision of necessary machinery and cost of wrapping with increased cost of loaf. (c) Unsatisfactory keeping qualities of the wrapped bread due to wrapping while warm. (d) Various types of loaves making wrapping of all bread an uneconomic proposition (17 types). The following table gives the particulars of wrapped bread sold. Number of firms selling wrapped bread—8. 60% of bread sold by 4 of these firms is stated to be wrapped. 50% „ „ 1 „ „ „ „ 30% „ „ 1 „ „ „ „ 12% „ „ 1 „ „ „ „ 10% „ „ 1 „ „ „ „ Additional charges are made by three firms for wrapped bread. 3. The roundsmen are permitted to wear overalls, but none are provided for them. 4. On 15 occasions bread was left on doorsteps. On 9 such occasions the bread was unwrapped and on 6 it was wrapped (4 in bags and 2 in paper). Remarks of the Medical Officer of Health appended to the above Report. "It is gratifying to note that the delivery of bread within the Borough is, on the whole, carried out in a satisfactory manner. There are, however, certain elements which are not entirely in accordance with modern hygiene. 69 "In several instances bread was found left on doorsteps and window-sills unwrapped. In other cases roundsmen were found smoking during the delivery of bread, and on occasions their hands were seen to be dirty. It was also noted that the wearing of overalls by roundsmen was rather the exception than the rule. The types of vehicles used were, on the whole, satisfactory, but some of these vehicles were found to be uncovered, thus exposing the bread to atmospheric pollution. ''The facts relating to wrapped bread are illuminating. It would appear that wrapped bread can be obtained if desired, although its universal provision does not yet seem practicable. ''If the defects in the system of distribution noted above were corrected, I am of opinion that the universal wrapping of bread, while in itself very desirable, and to be encouraged, does not constitute a Public Health necessity. If the bread is adequately protected from atmospheric pollution and the roundsmen made to maintain a reasonable state of cleanliness, especially as to hands, the chances of the bread becoming infected would appear to be comparatively slight." As directed by the Committee, the Medical Officer of Health communicated with all bread distributors in the Borough, asking them to take all possible steps in the interests of Public Health to obviate the defects in the distribution of bread referred to in the report. 70