AC 439(1) South FATE Som-20 BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935. WM. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital. Crutha & Son, Ltd., The Triangle, Palmers Green. BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935. WM. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital. To the MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you the Annual Report for the year 1935. The year under review was expected to be one in which a Survey Report was submitted, but the Ministry of Health has not required that this should be the case. As, however, five years have now elapsed since a full report was issued on the health conditions of the district, and as those five years have almost exactly coincided with my tenure of office as Medical Officer of Health, I have incorporated several tables setting out the statistics for the previous quinquennium and have also included, where necessary, a brief review of conditions prevailing during that period. With regard to 1935, the vital statistics make very satisfactory reading, indeed the year has been one of the best from a health standpoint for quite a period. The death rate has fallen, the birth rate shows a slight inorease, the zymotic death rate and maternal mortality show marked decreases, while the infectious sickness rate has also declined considerably. The infant mortality is slightly raised, but is still well below that for England and Wales. Apart from the fall in the number of infectious diseases notified, there has also been a very marked decrease in the incidence of non-notifiable infectious diseases within the Borough, particularly with respect to measles. Until figures are available which will show the general sickness rate among all age groups of the population, it is impossible to present a complete picture of the health of any district. This information is long overdue and would be of enormous advantage with regard to such an area as Southgate. At the moment it is only possible to say that, from information available, general sickness within the Borough is maintained at a comparatively low level. 3 The year 1935 saw marked progress in the negotiations which are taking place regarding the extension of the Isolation Hospital and the establishment of a joint hospital district. The end of these negotiations now appears definitely in view, and 1 hope that next year it may be possible to report even more concrete progress. Dr. Tate, the County Medical Officer of Health, has again supplied statistics relating to School Clinics and Public Elementary Schools. Finally, it is once again my privilege 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 courtesy extended to me during the past year. I should also fail in my duty did I not express my grateful thanks to every member of the Public Health Staff for their unfailing co-operation throughout the year. I am, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. May, 1936. PUBLIC HEALTH COMMITTEE at December 31st, 1935. Councillor G. Peverett (Chairman). His Worship the Mayor (Alderman John Joy, J.P.). Councillor A. R. Abercromby. Councillor H. Collar. 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, 1935. His Worship the Mayor (Alderman John Joy, J.P.). Alderman G. B. Massa. Councillor Miss G. E. Appleyard. Councillor W. A. Clarke. Councillor A. E. Lauder. Councillor G. Peverett. Councillor Owen Roberts. Councillor Mrs. E. F. Smith, J.P. (Vice-Chairman). Councillor V. J. Westlake. CO-OPTED MEMBERS. M rs. C. M. A. Vandy (Chairman^. Miss Corry. Mis. A. L. Davy. Dr. L. Westlake. JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1935. SOUTHGATE REPRESENTATIVES. Councillor G. Peverett (Chairman). Councillor H. Collar. Councillor Mis. E. F. Smith, J.P. Councillor V. J. Westlake. TOTTENHAM REPRESENTATIVES. Councillor Mrs. G. E. Morrison. Councillor S. Timms. Councillor A. R. Turner. Councillor R. H. Warren. 5 PUBLIC HEALTH STAFF. *MedicaI 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 (No. 1 District): L. Skeeles, Cert.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 2 District) : H. Hill, M.R.San.I., A.M.Inst.S.E., M.S.I.A., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 3 District): A. E. Gooday, Cert.R. San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. (Appointed 30th April, 1935.). Chief Clerk: P. E. Barber. Clerk : Miss M. Munch. ,, Miss L. Clark. (Appointed 30th April, 1935.) 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. Materniiy and Child Welfare. *Miss D. Donkin, S.R.N., S.C.M., A.R.San.I. (Appointed 30th April, 1935.) Miss B. E. Wellman, S.R.N., S.C.M., A.R.San.I., H.V.—Public Health and General. *Assistant (Maternity Centres): Mrs. A. Thomas. (Resigned 30th June, 1935.) *Part-time Assistant (Maternity Centres) : Mrs. A. M. Blann. (Appointed 11th June, 1935.) Disinfector: A. G. Bates. Temporary Assistant Disinfector : B. Latter. *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, 1935 62,180 Number of inhabited houses (end of 1935) according to Rate Books 17,347 Rateable value (1935) £752,868 Sum represented by a penny rate (1935) . £2,990 There is some evidence to show that Southgate has shared in the national recovery, although, on the whole, there is no appreciable difference in the social conditions of the district. Nutrition continues satisfactory, particularly among the younger element of the population. As before, the Social Service Council carried out its auxiliary services which have proved so valuable. One of the most satisfactory features of the past five years has undoubtedly been the comparatively slight effect which the worldwide depression exerted upon the district. At no time could it be said that our defences were seriously threatened or the standard of nutrition dangerously impaired. Very fortunately, the false economies practised in so many districts were not applied to the social services of Southgate, a policy whose wisdom is now making itself abundantly apparent. Meteorology.—The total rainfall recorded by the Council's rain-gauge in Broomfield Park measured 29.32 inches during 1935, the daily average being 0.08 inches. The greatest fall in 24 hours was on October 3rd, when 0.78 inches were recorded, and the total days on which no rain fell was 194. It will be seen from the following table that the total rainfall and the number of days on which measurable rain fell during 1935 were again considerably higher than during the previous year, although it still cannot be said that 1935 was a "wet" year. It is hoped that more extensive meteorological information will be available next year, following the setting-up of a more adequately equipped station within the district. 7 RAINFALL RECORDED AT BROOMFIELD PARK. Total Rain for month. Number of Wet Days with 0.01 or more ins. 0.04 or more ins. 1934. 1935. 1934. 1935. 1934. 1935. Ins. Ins. Days. Days. Days. Days. Jan. 1.57 1.26 17 14 11 11 Feb. 0.14 2.57 4 15 1 11 Mar. 2.21 0.50 17 6 13 5 April 2.21 2.86 14 20 11 15 May 0.80 1.16 6 8 6 6 June 0.91 3.82 8 19 8 13 July 0.64 0.97 7 6 4 5 Aug. 2.27 2.13 12 7 10 6 Sept. 2.32 3.79 9 19 7 14 Oct. 1.26 3.17 14 13 9 10 Nov. 1.87 4.24 7 23 6 17 Dec. 5.43 2.85 25 21 22 16 Totals. 21.63 29.32 140 171 108 129 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. Male. Female. Live Legitimate 668 352 316 Births Illegitimate 13 9 4 Totals 681 361 320 Birth Rate per 1,000 of the estimated resident population 10.95 Stillbirths 19 14 5 Rate per 1,000 total (live and still) births 27.14 Deaths 561 267 294 Corrected Death Rate per 1,000 of the estimated resident population 8.84 Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. From Puerperal Sepsis 2 2.86 From other Puerperal causes 1 1.43 Total 3 4.29 8 Death rate of infants under one year of age:— All infants per 1,000 live births. 44.05 Legitimate infants per 1,000 legitimate live births 43.41 Illegitimate infants per 1,000 illegitimate live births 76.92 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhœa (under 2 years of age) 2 POPULATION. The Registrar-General's estimate of the population at the middle of 1935 was 62,180, which is an increase of 2,183 over the estimate for 1934. 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 120, as compared with 44 in 1934. The population for the past 5 years has been as follows :— 1931 55,570 1932 57,250 1933 58,820 1934 59,997 1935 62,180 As the birth-rate has fallen from 11.68 to 10.95 during that period, with a more or less stationary death-rate, it will be obvious that the increase of population is almost entirely due to immigration. The last census return showed Southgate to have a comparatively small child population, and there is no evidence which would lead one to believe that this position is tending towards alteration. BIRTHS—BIRTH RATE. The nett total births accredited to the district was 681, an increase of 41 on the preceding year; of these, 361 were males and 320 females (9 males and 4 females being illegitimate). The birthrate was, therefore, 10.95 per 1,000 of the population, as against 10.66 in 1934. The birth-rate for England and Wales for 1935 was 14.7. The total number of births actually registered in the district during the year amounted to 533. 9 MORTALITY. General Mortality and Death Rate.—The nett number of deaths accredited to this district was 561, a decrease of 35 as compared with the previous year. This gives a corrected death-rate of 8.84 per 1,000 of the population, a decrease of 0.89 on the rate for the previous year, which was 9.73. This rate is still appreciably below that for England and Wales (11.7 for 1935). As compared with 1934 there were decreases of 4 deaths from measles, 12 from tuberculosis, 5 from cancer, 19 from pneumonia and 7 from bronchitis; while there were increases of 15 deaths from heart disease, 10 from nephritis and 11 from violence, including suicide. The principal causes of death are shown in Table I on page 13. The following facts appear worthy of special mention:— 1. Once again a slight decrease is shown in the total deaths from cancer. This is extremely encouraging and should, in my opinion, receive due notice and publicity. 2. The number of deaths occurring both from tuberculosis and pneumonia has shown a welcome and appreciable decrease. This also makes pleasant reading, although it must be remembered that the decreases may not be maintained. 3. The increased fatalities among cardiac and nephritic cases occurred largely in elderly residents and were to be anticipated, considering the general age-distribution of the population as a whole. 4. The increase of 11 deaths from violence, including suicide, is definitely disturbing. This is surely a direct condemnation of some part at least of our modern, civilised conditions, and must receive the attention of all right-thinking individuals. 5. As hitherto, no class of deaths was specially attributable to the existence of detrimental conditions, such as type of employment, climate, etc., in Southgate. Infantile Mortality.—There were 30 (1 illegitimate) deaths of infants under 1 year of age, which give an infantile death-rate of 44.05 per 1,000 births registered, as compared with 25 deaths and a rate of 39.06 in the preceding year. The rate for England and Wales for 1935 was 57. It will be seen that the infantile mortality rate rose slightly during 1935, although the rate for Southgate is still considerably lower than that for England and Wales. 10 Table III on page 15 sub-divides the infant deaths according to the weeks or months at which they occurred. 63.3 per cent. of the total deaths occurred during the first month, while 63.1 per cent. of these occurred during the first week. Prematurity accounted for 11 deaths, congenital malformations for 8 and pneumonia for 5. All the infant deaths were investigated. Stillbirths.—Nineteen stillbirths, 1 of which was illegitimate, were accredited to the district for 1935. This is equal to a deathrate of 27.14 per 1,000 total (live and still) births registered, the corresponding figures for 1934 being 23 stillbirths with a rate of 34.69. It is extremely satisfactory to be able to report that the stillbirth rate showed a decline of 7.55 during 1935. 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 4.29 for 1935. This represents 3 maternal deaths, 2 of which occurred outside the district. Last year there were 4 deaths with a corresponding rate of 6.03. Thus the maternal mortality declined by 1.74 during 1935. With such small total numbers it is, of course, dangerous to draw sweeping conclusions, but at least the saving of one maternal life out of four constitutes a modified victory. The part-payment of midwives' fees scheme, outlined in last year's report, is operating very satisfactorily. Each case is carefully scrutinised, no assistance being granted unless it is considered that the confinement can safely take place in the woman's home. (See also page 32.) During 1936, certain additional services were inaugurated, in an attempt to tighten up the defences against maternal morbidity and mortality. These included the provision of sterilized maternity outfits at the Town Hall, the outfits being available free or at cost price at any time of the day or night; the provision of milk for necessitous mothers during the last six instead of the last three months of pregnancy; and the development of a new and more complete dental scheme for ante-natal mothers (further reference to this will be foimd in the section dealing with maternity and child welfare). Steps are also being taken to make the existence of the Antenatal Clinic better known throughout the district, in the hope that the services which are available there and which might do much towards preventing unnecessary suffering and even death, will be utilised still more than is the case as present. 11 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 7 deaths during 1935. This represents a corrected death-rate of 0,11 per 1,000 of the total population, and 1.25 per cent. of the total deaths for the year, at all ages. In 1934 there were 6 deaths, giving a rate of 0.09 and a percentage of 1.00. The figure has slightly increased over that of last year but is still one of the lowest recorded in the district. Mortality of Persons over the age of 65.—It will be seen from Table II, on page 14, that almost 50 per cent. of the total deaths occurring during the year took place in persons over the age of 65. In this connection it is interesting to note that 10 females died at the age of 90 or over, the oldest being 100 years; while 3 males also died within this age period, the oldest being 95. 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 3 deaths from the diseases mentioned above, as follows— Diphtheria, 1 ; diarrhœa, 2. The zymotic death-rate for 1935 was therefore 0.05 per 1,000 of the population, as against 0.13 in 1934, with 8 deaths. It will thus, be seen that the total number of deaths in this category was more than halved, compared with the figure for 1934. 12 Table 1. Causes of Death During the Year 1935. Causes of Death. Male. Female. Total. Rates per 1,000 of population. AU Causes (Civilians only) 267 294 561 1 Typhoid and Paratyphoid Fevers .. .. .. .. 2 Measles .. .. .. .. 3 Scarlet Fever .. .. .. .. 4 Whooping Cough .. .. .. .. 5 Diphtheria .. 1 1 0.02 6 Influenza 4 3 7 0.11 7 Encephalitis Lethargica .. 1 1 0.02 8 Cerebro-Spinal Fever .. .. .. .. 9 Tuberculosis of Respiratory System 15 11 26 0.41 10 Other Tuberculous Diseases 1 .. 1 0.02 11 Syphilis .. .. .. .. 12 General Paralysis of the insane, Tabes Dorsal is 4 .. 4 0.06 13 Cancer, Malignant Disease 29 52 81 1.28 14 Diabetes 3 5 8 0.13 15 Cerebral Hemorrhage, etc. 8 10 18 0.28 16 Heart Disease 76 97 173 2.72 17 Aneurysm 1 .. 1 0.02 18 Other Circulatory Diseases.. 18 21 39 0.61 19 Bronchitis 5 6 11 0.17 20 Pneumonia (all forms) 18 10 28 0.44 21 Other Respiratory Diseases 2 2 4 0.06 22 Peptic Ulcer 5 3 8 0.13 23 Diarrhoea, etc. (under 2 years) 1 1 2 0.03 24 Appendicitis 1 3 4 0.06 25 Cirrhosis of Liver 1 .. 1 0.02 26 Other Diseases of Liver, etc. 2 2 4 0.06 27 Other Digestive Diseases 8 8 16 0.25 28 Acute and Chronic Nephritis 12 7 19 0.30 29 Puerperal Sepsis .. 2 2 0.03 30 Other Puerperal Causes .. 1 1 0.02 31 Congenital Debility, Premature Birth and Malformation, etc. 13 9 22 0.35 32 Senility 1 3 4 0.06 33 Suicide 5 4 9 0.14 34 Other Violence 13 12 25 0.39 35 Other defined Diseases 21 20 41 0.65 36 Causes ill-defined or unknown .. .. .. .. Totals 267 294 561 8.84 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. 1935. Age. MALES. FEMALES. TOTALS. No. % of Total Deaths. Rate per 1,000. No. % of Total Deaths. Rate per 1,000. No. %of Total Deaths. Rate per. 1,000 0— 1 year 18 3.21 0.28 12 2.14 0.19 30 5.35 0.47 1— 5 years 4 0.71 0.06 3 0.54 0.05 7 1.25 0.11 5—15 ,, 7 1.25 0.11 2 0.35 0.03 9 1.60 0.14 15—25 ,, 7 1.2.5 0.11 8 1.42 0.13 15 2.67 0.24 25—45 ,, 22 3.92 0.35 36 6.42 0.57 58 10.34 0.92 45—65 ,, 80 14.26 1.26 82 14.62 1.29 162 28.88 2.55 65 and over . 129 22.99 2.04 151 26.92 2.37 280 49.91 4.41 Totals 267 47.59 4.21 294 52.41 4.63 561 100.0 8.84 14 Table III. Infantile Mortality. 1935. Nett Deaths from stated causes at various periods under 1 Year of Age. Causes of Death. | Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under 1 Year. All Causes 12 2 2 3 19 3 3 4 1 30 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 .. .. 3 i 5 16 Diarrhœa 17 Enteritis .. .. 1 .. 1 .. .. .. .. 1 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 23 Atelectasis 1 .. .. .. 1 .. .. .. .. 1 24 Congenital Malformations 1 1 .. 1 3 2 2 1 .. 8 25 Premature Birth 8 .. 1 2 11 .. .. .. .. 11 26 Atrophy, Debility and Marasmus 1 .. .. .. 1 1 1 .. .. 3 27 Other Causes .. .. .. .. .. .. .. .. .. .. Totals 12 2 2 3 19 3 3 4 1 30 15 Table IV. Vital Statistics of Whole District during 1935 and Fivr Previous Years. Year. Population estimated at Middle of each Year. Nett Births belonging to District. Nett Deaths belonging to the District. At all Ages Under 1 Year of Age. Number. Rate per 1,000 Population. Number. Rate per 1,000 Population. Number. Rate per 1,000 Nett Births. 1 2 3 4 5 6 7 8 1930 51,590 607 11.76 498 9.07 22 36.24 1931 55,460 663 11.68 512 8.67 30 45.24 1932 57 ,250 651 11.37 589 9.67 25 38.40 1933 58,820 570 9.69 591 9.44 19 33.33 1934 59,997 640 10.66 596 9.73 25 39.06 1935 .. 62,180 681 10.95 561 8.81 30 44.05 Comparison of the Rates of the Southgate District with those of England and Wales, and London, for the Year 1935. 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. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 14.7 0.62 11.7 0.00 0.00 0.03 0.01 0.04 0.08 0.18 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 0.00 0.04 0.01 0.04 0.09 0.16 7.9 62 140 Smaller Towns (1931 Census Populations 25,000—50,000). 14.8 0.64 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.17 3.8 55 London 13.3 0.52 11.4 0.00 0.00 0.00 0.01 0.04 0.06 0.11 11.2 58 Southgate 10.95 0.31 8.84 0.00 0.00 0.00 0.00 0.00 0.02 0.11 2.94 44.05 16 General Provision of Health Services. Hospitals.—General Hospitals.—The arrangements set out in the Annual Report for 1930 regarding the provision of general and special hospital accommodation for the inhabitants of Southgate remain unaltered. They still appear satisfactory. I understand that a suggestion is afoot to enlarge and reconstruct the accommodation available at the Wood Green and Southgate Hospital at an early date. This will undoubtedly prove a boon to the district, as the hospital is carrying out most admirable work which could well be materially extended. Provision for Maternity Beds.—The agreement with the Royal Northern Hospital and the Salvation Army Maternity Hospital to admit Southgate mothers at reduced fees, continues to work satisfactorily. As before, the North Middlesex County Hospital is also being utilised by a proportion of our maternity cases. During 1935, a conference was held between the Authorities of Edmonton, Enfield, Tottenham, Wood Green and Southgate regarding the possibility of establishing a joint Municipal Maternity Home for these areas. As it was understood that the Middlesex County Council is contemplating considerable enlargement of the maternity accommodation available at the North Middlesex County Hospital and that the scale of fees now operating there may be revised, the conference decided not to take any action for the time being. There can be little doubt that there is a growing demand for increased maternity accommodation within this portion of the County of Middlesex, and it is therefore to be hoped that the County Authority will move in the matter very shortly. Isolation Hospital.—Continuing the policy of maintaining an up-to-date, modern institution, further improvements were carried out at the Isolation Hospital during 1935. Several of the wards were re-decorated, while additional ward furniture and equipment was obtained. New furnishings were also purchased for use in the Administrative Block, the amenities being increased by the purchase of a piano and wireless set for the nurses' use. In view of the approaching extensions, it is not proposed to alter the existing hospital to any appreciable extent for the time being, although the present standard will be maintained. 17 The permanent nursing staff was not altered during the past year, but it was necessary on quite a number of occasions to obtain the services of private nurses to cope with extra demands as they arose. The out-door staff also remained unaltered. Some idea of the major additions and improvements undertaken at the Isolation Hospital during the past five years may be gauged from the following details of the work carried out during that period :— Central heating installed throughout the hospital, with the construction of an adequate boiler house and apparatus; construction and furnishing of seven additional nurses' bedrooms and fire escape in Administrative Block; installation of ultra-violet and infra-red apparatus; purchase of new ambulance; equipment of wards with modern furniture; purchase of new surgical equipment, including operating table and blood transfusion apparatus; construction of new incinerator and porter's work-shop; construction of residence for Medical Superintendent; construction and equipment of laboratory; installation of new internal telephone system ; laying down of new "nurses' tennis courts. Apart from these alterations, the following additions to the hospital staff have taken place since 1930 :— Surgical consultant, Night Sister, 2 Ward Sisters, Nurse for special duties, 1 Staff Nurse, 5 Probationers, Assistant Gardener, Assistant Porter. The Hospital is now fully equipped and adequately staffed to meet all reasonable requirements, although, of course, it is realised that the present accommodation is entirely insufficient for the needs of both Tottenham and Southgate. I should not like to let this opportunity pass without expressing my deep appreciation to Mr. Phillips, the Borough Surveyor, for the consistent and invaluable services which he has rendered to the hospital during the past five years of my tenure of office as Medical Superintendent. Without his enthusiasm and co-operation, the results achieved would have been obviously impossible, and I personally owe him a debt of gratitude which I now wish to place on record. Nursing Homes.—There are in the district 4 registered Nursing Homes, as follows :— 1. 73, Palmerston Crescent, Palmers Green. 2. Chase Bank Nursing Home, Avenue Road, Southgate. 3. Onslow House Nursing Home, Chase Road, South- gate. 4. Uvedale Nursing Home, Elmscott Gardens, Winch- more Hill. 18 These Nursing Homes provide facilities for the treatment of medical, surgical and maternity cases, and are under the direct supervision of the Middlesex County Council. Nursing in the Home.—(a) The Southgate Queen's Nursing Association continues its excellent work which is increasing each year, as the extraordinary value which the services provides becomes better known. During 1935, the nurses made a total of 13,661 domiciliary visits (11,232, 1934.) At the Physico-therapeutic Clinic, 1,342 patients were treated, while the total number of treatments given was 7,486. The corresponding figures for 1934 were 1,182 and 6,563 respectively. By the time this report appears, an arrangement will have been completed between the Southgate Borough Council and the Southgate Queen's Nursing Association, whereby the Council will pay an annual sum of £100 to the Nursing Association in respect of services to be rendered to the Borough. These services will include the home nursing of certain infectious diseases, the use of the physico-therapeutic clinic, and other Public Health measures of considerable value. There can be no doubt that these arrangements will prove if very great service to the Borough, and they should mark the inception of an even closer and more cordial co-operation between the Borough Council and the Nursing Association than has hitherto been possible. (b) As previously indicated, home nursing of certain infectious diseases will how be undertaken by the Southgate Queen's Nursing Association at the request of the Borough Council, where such home nursing is considered necessary or desirable. Midwives.—There are 12 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.—The following Clinics and Treatment Centres are available for the inhabitants of the Borough. Maternity and Child Welfare (Southgate Council).—At 31st December, 1935. Infant Welfare Broomfield House Tuesdays 10 a.m.—12 noon. Wesleyan Hall, Bowes Park Tuesdays 2—4 p.m. Baptist Hall, Grove Road Wednesdays 10 a.m.—12 noon. St. Andrew's Hall, Chase Side Wednesdays 2—4 p.m. Wesleyan Hall, Winchmore Hill Thursdays 2—4 p.m. Ante-Natal:— Broomfield House Thursdays 10 a.m.—12 noon. 19 Immunisation (against Diphtheria) Clinic (Southgate Council).— Broomfield House . Thursdays 2—4 p. m. Tuberculosis (Middlesex County Council).—The Dispensaries serving the area are situate at:— 10, Alexandra Road, Hornsey, and Chester Villa, High Road, North Finchley. Venereal Disease Clinic (Middlesex County Council).— Prince of Wales's Hospital, Tottenham. All London General Hospitals are included in the London and Home Counties Joint Scheme for the treatment of Venereal Diseases. School Clinics (Middlesex County Council).—Minor ailment Treatment Clinics provided for Elementary School children in the area :— Winchmore Council School, Highfield Road, Winchmore Hill, and Holly Park Council School, Friern Barnet. Ophthalmic Clinic-. Garfield Road Council School, New Southgate. Dental Clinic : Winchmore Council School, Highfield Road. Orthopaedic Treatment.—Arrangements are made for the treatment of any orthopaedic cases discovered 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 -each school age. Institutional Provision for unmarried mothers, illegitimate infants and homeless children. No change from the arrangements noted in the Report for 1930. Ambulance Facilities.—There are now four ambulances in use within the Borough, two for accident and general purposes, and two for the removal of cases of infectious disease. The service appears adequate to meet the needs of the district, whilst also allowing for "stand-bys" in case of emergency. A revision of the scale of charges operating for the use of the accident ambulances was made during 1935. Very briefly, the existing scale is now as follows:— Removals to Institutions within 5s. for initial journey and the Borough and to the Wood 2s. 6d. for each recurrent Green and Southgate, and journey. North. Middlesex Hospitals 20 Removals to Institutions within 10s. for each journey, ten miles radius of Southgate Town Hall (excluding the two Hospitals indicated above) Removals to Institutions outside 10s. for each journey, plus ten miles radius from South- 9d. per mile in respect of gate Town Hall each mile or part of a mile beyond the ten-mile limit. Double journey charges are made in any of the abovementioned cases where the ambulance is kept waiting at an institution for a period exceeding thirty minutes. Accident cases occurring anywhere within the Borough are removed free of charge. The ambulance service has now been placed under the direct supervision of the Medical Officer of Health. Council Employees.—Thirty-four Council employees were examined at the Town Hall during 1935, either for admittance to the superannuation scheme or before being accepted into the Council's service. Mortuary.—During 1935, 35 bodies were deposited in the Council's mortuary situated at the rear of the Town Hall. LABORATORY FACILITIES. The following tables set out the work carried out at the Council's laboratory and at other laboratories to which material was sent during 1935. As hitherto, the great bulk of the material obtained for examination emanates from the Isolation Hospital. There can be iio doubt that the existence of a laboratory within the Borowrh has facilitated and improved the routine examination of diphtheri t swabs, swabs for hreinolytic streptococci, and sputa. Other specimens, including virulence tests, continue to be sent to the Clinical Research Association and the laboratory of the Prince of Wales's Hospital. Work carried out at the Council s laboratory during 1935 : — 1 Hospital. Borough. 'ositive. Negative. Positive. Negative. Swabs for Diphtheria Bacilli 701 3,069 34 432 Swabs for Hajmolytic Streptococci 5 18 46 Sputa for Tubercle Bacilli 1 13 125 21 Urine 1 — Pleural Fluid — 1 Other Specimens — 1 Total 4,447 This is an increase of 1,631 specimens over the previous year (April 11th to December 31st only). Specimens sent to Clinical Research Association during 1935— Positive. Negative. Total. Swabs for Diphtheria Bacilli 1 8 9 Swabs for Hemolytic Streptococci .. .. .. .. 4 55 59 Blood for Widal Test (Typhoid) 4 3 7 Sputa for Tubercle Bacilli .. — 1 1 9 67 76 In addition, 4 virulence tests (1 positive, 3 negative) in connection with protracted casesi of diphtheria, and 7 examinations of fseces (1 positive, 6 negative) were carried out by the Association. Specimens sent to the laboratory at the Prince of Wales's Hospital during 1935 : — Positive. Negative. Diphtheria swabs for virulence test 8 7 Failing to incubate Diphtheria Bacilli — 7 Fteces .. .. .. .. .. .. — 1 8 15 Total .. 23 BACTERIOLOGICAL EXAMINATION OF MILK. This work was continued during 1935 and is, in my opinion, serving an exceedingly useful purpose. Each milk supply produced in or entering the district was examined quarterly for total bacterial count and bacillus coli content, and twice annually for the presence of tubercle bacilli. Check samples were also taken, following the report of unsatisfactory examinations. All results were transmitted to the Milk Marketing Board. The number of unsatisfactory results obtained has definitely diminished, and there is evidence to show that the retailers are taking cognizance of the 22 reports which are transmitted to them. Up to the present, no consistently unsatisfactory results have been obtained, improvements having been effected in every case, following the transmission of a notice stating the result of the examination. It has been necessary to purchase certain additional apparatus to continue the work of examination in a satisfactory manner, and we are now able at the laboratory to carry out all the routine tests recommended by the Ministry r>f Health. Summary of Work carried out during 1935. Total number of samples examined .. . . .. 246 Samples examined for total bacterial count .. .. 244 Samples examined for presence of bacillus coli .. .. 244 Samples examined for presence of tubercle bacilli . . 126 Samples of Non-designated Milks, including Raw Milk, Pasteurised (Non-designated) Milk, Sterilised Milk and Irradiated Milk, examined . . .. . . 145 Percentage of satisfactory results as regards total bacterial count .. .. .. .. .. .. 100% Percentage of satisfactory results as regards b. coli content 86.8% Average bacterial count .. . . .. .. 37,122 Samples of Designated Milks examined .. .. 99 (Certified Milk .. .. .. .. 20 Grade A (Tuberculin Tested) Milk .. 28 Grade A Milk .. .. .. .. 4 Grade A (Pasteurised) Milk .. 8 Pasteurised Milk . . . . .. 39) Certified Milk. Percentage of samples satisfactory in every respect.. 95% Average bacterial count .. .. .. .. 10,701 Grade A (Tuberculin Tested) Milk. Percentage of samples satisfactory in every respect.. 96.4% Average bacterial count .. .. .. .. 23,804 Grade A Milk. Percentage of samples satisfactory in every respect.. 100% Average bacterial count .. .. .. .. 15,836 Grade A (Pasteurised) Milk. Percentage of samples satisfactory in every respect.. 100% Average bacterial count .. .. .. .. 8,917 Pasteurised Milk. Percentage of samples satisfactory in every respect.. 94.8% Average bacterial count .. .. .. .. 29,785 No tubercle bacilli were found in any of the 126 samples examined for this purpose. 23 LEGISLATION IN FORCE IN THE DISTRICT. LOCAL AND ADOPTIVE ACTS. The Infectious Diseases (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890, except Part 4. Museums and Gymnasiums Act, 1891, so far as relates to Museums. Baths and Washhouses Acts, 1846-1899. Public Health Acts Amendment Act, 1907:— 1. 4. 1912. Parts II (except Section 28), III, IV (except Section 66), V and VI. 17. 1. 1912. Section 81 in Part VII—as amended by Order of Home Office, 17. 1. 1912. 17. 1. 1912. Parts VIII and XI. 1. 4. 1912. Part X. 25. 11. 1919. Small Dwellings Acquisition Act, 1899. 17. 12. 1923. Private Street Works Act, 1892. 12. 4. 1926. Public Health Act, 1925, Parts II, III, IV, ahd V. 15. 8. 1913. The Southgate Urban District Council Act, 1913, amended bv Southgate Urban (Local Act) Order, 1926. BYE-LAWS AND REGULATIONS. 25. 1. 1887. Bye-laws with respect to common lodging houses. 5. 7. 1923. Rules with respect to allotments. 25. 9. 1923. Bye-laws with respect to Chase Side Recreation Ground. 22. 2. 1927. Bye-laws with respect to bowling greens. 22. 5. 1928. Bye-laws with respect to golf course. 13. 7. 1928. Byelaws with respect to new streets and buildings. 15. 1. 1929. Bye-laws with respect to slaughter-houses. 25. 5. 1932. Bye-laws with respect to the regulation of advertisements. 27. 3. 1934. Bve-laws for the good rule and government of the Borough and for the suppression of nuisances. 24. 4. 1934. Bye-law with respect to means of escape from fire in certain factories and workshops in the Borough. 24. 4. 1934. Bye-law under the Public Health (Smoke Abatement) Act, 1926, for regulating the emission of smoke from certain buildings in the Borough. 24. 7. 1934. Bye-laws with respect to cleansing of earth-closets, privies, ashpits and cesspools in the Borough. 24 24. 7. 1934. Bye-laws with respect to nuisances in connection with the removal of offensive or noxious matters in the Borough. 25. 9. 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. 26. 2. 1935. Bye-laws for the good rule and government of the Borough and for the prevention and suppression of nuisances. 1. 3. 1935. Bye-laws with respect to pleasure grounds ill the Borough. 21. 9. 1935. Bye-laws with respect to petroleum filling stations in the Borough. 25 Maternity and Child Welfare Services. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1935. Number on Registers:— Under Over 1 year. 1 year. Totals. January 1st, 1935 315 608 923 (1934 886) December 31st, 1935 839 926 1765 ( ,, 1595) New Cases during 1935 527 317 844 ( ,, 709) 24 of the new cases under 1 year were "removals" into th district. The remaining 503, therefore, represent 73.86 per cent of the total births credited to the district. Attendances at Centres, 1935:— Under 1 year. Over 1 year. Totals. Broomfield House 1681 887 2568 (1934 2009) Bowes Park 1403 1050 2453 ( ,, 2254) New Southgate 1136 881 2017 ( ,, 1876) Southgate 2574 1905 4479 ( ,, 2523) Winchmore Hill 2352 1936 4288 ( ,, 4040) Totals 9146 6659 15805 ( „ 12702) Average 35.87 26.11 61.98 ( ,, 49.81) Number Seen by Doctor:— Under 1 year. Over 1 year. Totals. Broomfield House 631 461 1092 (1934 918) Bowes Park 527 447 974 ( ,, 958) New Southgate 482 364 846 ( ,, 804) Southgate 787 623 1410 ( ,, 1020) Winchmore Hill 728 666 1394 ( ,, 1371) Totals 3155 2561 5716 ( ,, 5071) Average per session 12.36 10.05 22.41 ( ,, 19.88) Percentage of total attendance seen by Doctor 34.5% 38.4% 36.2% ( „ 39.9%) 26 Number of Sessions held 255 Talks and Practical Demonstrations in Mothercraft given at Centres 46 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:— 1934. 1935. January 1st 53 71 December 31st 52 54 New cases during the year 177 182 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. 1934. 1935. Total attendances 635 666 Average per session 12.45 13.06 Number seen by Doctor 512 603 Average per session 10.03 11.82 Percentage of total attendance seen by Doctor 80.6% 90.5% Percentage of mothers attending Antenatal Centre 26.7% 26.0% 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:— 1934. 1935. First visits 561 496 Under 1 year of age. 1285—In addition to—1480 Over 1 year of age 3578— first visits. —3023 27 Visits re:— Deaths under 5 years of age 21 22 Stillbirths 19 14 Ophthalmia neonatorum cases 1 — Ante-natal visits 406 464 Visits re:— Puerperal Fever cases — 2 Puerperal Pyrexia cases 2 — Special visits (test-feeds, following special cases seen by M.O. at Centres, failing lactation, etc.) 1173 1190 Visits re:— Tuberculosis cases 9 — Diphtheria Immunisation 58 — Total visits 7113 6691 As hitherto, the vast majority of notified births are visited by the Health Visitors upon the notification being received. Any cases requiring special attention are revisited periodically, and mothers are given a cordial invitation to attend the Centres if they so desire. These arrangements continue to work satisfactorily. It is particularly pleasing to report that the percentage of children attending the Welfare Centres has been maintained at a very satisfactory level during the past few years, although the figure, excellent as it is, could still be increased with advantage to the Borough. These figures have been among the most gratifying features of the recent years' work, and not only redound very greatly to the credit of the Maternity and Child Welfare Department, but should also exercise a very considerable and beneficial effect upon the health of the community in the immediate future. The proportion of cases attending the ante-natal clinic is still too low, but, as already indicated, steps are being taken to bring the facilities available at the clinic more prominently before the general public. The following table sets out the percentage of children attending the Centres as new cases since 1926, the position being also shown in graphical form. It will be seen that the total of 503 in respect of attendances of children under the age of 1 year during 1935, constitutes a new record for the district. 28 29 The services of an additional Health Visitor, foreshadowed in the Report for 1934, have now been obtained, the time of this official being already fully occupied. Owing to the resignation of the clerk to the Maternity and Child Welfare Department and the appointment of a part-time assistant in her place, the great bulk of the clerical work in connection with Maternity and Child Welfare is now being carried out in the Public Health Department. As this work is materially increasing, it is quite possible that additional assistance may become necessary within the near future. Children Acts, 1908-32.— The following is a summary of the work carried out under these Acts during the past year:— Number of registered foster mothers 11 Number of foster children 12 Total visits paid 143 No case of neglect was discovered during the year. Miscellaneous Statistics. 1934. 1935. Births registered in the district 395 533 Attended by Midwives 123 135 Un-notified Births 25 18 Percentage of Births notified 93.7% 96.6% Stillbirths notified 19 18 Stillbirths notified by Midwives 4 — Stillbirths notified by Doctors 15 18 Stillbirths notified occurring in Institutions: In the district - - Outside the district 7 5 Maternal Deaths 4 3 Infant Deaths:— Under 1 year of age 25 30 Under 1 month (inc. above) 17 19 1 to 5 years of age 6 7 Number of Southgate Births in North Middlesex Hospital Maternity Home 87 84 Infant Mortality amongst children attending Centres 10 4 (4 over, 6 under 1 year.) (2 over, 2 under 1 year.) 30 Number of cases in which milk was granted:—1933, 116; 1934, 117; 1935, 225. Approximate cost:—1933, £250; 1934, £248; 1935, £731. In 17 cases, grants of Trufood were made, while grants of cod liver oil emulsion and cod liver oil and malt were allowed in 57 and 23 cases respectively. List of Foods Sold at Centres. £ Trufood, amounting to 187 (approximate) Cow & Gate, amounting to 17 ,, Cod liver oil emulsion, amounting to 17 ,, Cod liver oil and malt, amounting to 9 ,, Dental Treatment.—After prolonged negotiations, an agreement was concluded with the Eastman Dental Clinic whereby that Clinic undertook the treatment of ante-natal women, and children under the age of 5, sent to them from the Maternity and Child Welfare Department. A scale of fees was drawn up and agreed to by both parties. This scale was based upon the scheme for the provision of milk to necessitous cases, the amount payable by the patients being in proportion to their means, and the Borough Council being responsible for collecting that proportion of the fee payable by the patient. In addition to the cases for whom the Borough Council have made themselves responsible, the Eastman Dental Clinic also agreed to treat patients who could afford to pay a certain limited amount for treatment, at their usual hospital scale of charges. These patients will also be sent with a covering note from the Maternity and Child Welfare Department, in order that no unauthorised person may take advantage of this scale of charges. An arrangement has also been made whereby the necessary fares will be met in necessitous cases. The agreement referred to above was not definitely concluded until 1936, but the Eastman Dental Clinic also treated our patients throughout the previous year. The following table sets out the number of patients attending the Clinic, and the approximate number of treatments given. It will be understood that, with the new agreement in force, it will now be possible to supply much more comprehensive figures. No. of "Council" patients attending Clinic, 1935 8 No. of completed treatments 2 Cost of such completed cases £5 4 0 31 Part Payment of Midwives' Scheme.—Fifty-seven applications were dealt with under this scheme during 1935. 44 awards were made, totalling £81 14s. Od.; 2 compensation grants of £1 Is. Od. were made to a midwife in respect of patients sent to hospital. 11 applications were refused as the family income was above the approved scale. From the figures set out above, it will be seen that this scheme is extending, as its usefulness and applicability become tetter known throughout the district. Attendance at Centres of Non-Southgate Mothers.—With the authority of the Committee, 8 mothers (excluding those from Hertfordshire referred to below), living a short distance beyond the borders of the district, attended various Southgate Centres. A charge of Is. per attendance is made in respect of each visit paid. As hitherto, the attendance of non-Southgate mothers at Southgate Centres is not encouraged, as the work of the Centres is sufficiently heavy to occupy the entire time of the officers concerned, without the additional burden of dealing with mothers from outside our boundaries. In addition to this time factor, the complication of visiting or not visiting mothers outside the district has led the Committee to prohibit the attendance of such mothers, unless under exceptional circumstances. Arrangements have been made with the Hertfordshire County Council whereby mothers living a short distance over the Southgate boundary in the East Barnet District are permitted to attend Centres in Southgate. The Hertfordshire County Council pays the Southgate Council 10s. per annum in respect of each mother. A total of 53 mothers availed themselves of this privilege during 1935. Voluntary Helpers.—The Voluntary Helpers' Committee once again rendered its customary excellent assistance to the Maternity and Child Welfare services of the district, the work being characterised, as before, by the high standard of its efficiency. The Annual Christmas Party for mothers was held as usual, and repeated its previous successes. General.—As hitherto indicated, the year 1935 has been characterised by a considerable extension in the activities of the Maternity and Child Welfare Department. Attendances at the Centres have been maintained or increased, the services of an additional Health Visitor are now available, while the facilities afforded to the mothers and children within the Borough have been materially implemented. 32 This is a healthy and satisfactory state of affairs and should be followed by corresponding improvement in the well-being of the mothers and children of Southgate. In this connection, it might here be noted that, by the time this Report is issued, the Child Welfare Clinic formerly situated in St. Andrew's Church Hall will have been removed to The Bourne, Southgate, while an entirely new Clinic will be operating at the Community Hall, Southgate. Thus, a portion of the district whose wants have not been entirely met in the past will receive much more satisfactory attention, the new Clinics being suitably distributed and very well equipped for their purpose. Having taken this step, the facilities available in New Southgate might now be reviewed, with a view to a corresponding improvement. The remaining Centres within the district appear to be eminently satisfactory for immediate requirements. PUBLIC ELEMENTARY SCHOOLS. As before, the Public Health Department has worked in conjunction with the County School Medical service with respect to the discovery of "carriers," missed cases of infectious diseases, etc., several conjoined visits having been paid to schools in the district by the Assistant School Medical Officer and myself for such purposes. Immunisation has also been carried out in the schools, as noted elsewhere in the report, an average of two schools being visited in this connection each year. 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 1935 was as follows:— Inspected. Requiring Treatment. Entrants 641 48 Intermediates 312 32 Leavers 228 25 1181 105 Other ages 183 23 Special 8 3 191 26 1372 131 33 School Clinics.—These are provided by the Middlesex County Council. (a.) Minor Ailment Treatment Clinics are in operation at Winchmore Council School, Highfield Road, Winchmore Hill, where sessions are held on Tuesday, Thursday and Friday mornings, and at Holly Park Council School, Friern Barnet, on Monday and Wednesday mornings. The total number of children dealt with at the Minor Ailments Clinics during 1935 was as follows:— New Cases. Attendances. Treated. Not requiring Treatment. Winchmore Hill 1417 5210 1341 76 Holly Park 312 627 290 22 1729 5837 1631 98 (b) Ophthalmic Clinic.—An ophthalmic clinic is held weekly on Wednesday mornings, at Garfield Road School, school children being seen by Mr. E. F. King, F.R.C.S., D.O.M.S., Ophthalmic Surgeon. Two hundred and twenty children attended the clinic and were seen by the Ophthalmic Surgeon during 1935. Spectacles were prescribed and provided for 128 of these. The corresponding figures for 1934 were 194 and 128 respectively. (c) Dental Clinic.—Dental treatment of school children is carried out by Miss A. M. Munro, L.D.S., one of the County Council's Assistant Dental Officers at the Winchmore Council School, Highfield Road. 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 1s. 6d. (remitted in necessitous cases). One thousand two hundred and twenty-seven children were dentally inspected at the Schools during the year, as against 1,551 in 1934, while 998 attended at the clinics (1934, 1,032) where they received treatment for various dental defects. 34 PRIVATE SCHOOLS. Several visits were paid to private schools within the Borough, following the notification of multiple cases of infectious disease. In one instance, the majority of the scholars attending were "Dick" tested, while a large series of swabs were examined for the presence of hemolytic streptococci, in an attempt to control a small, localised focus of scarlet fever. The result of the "Dick" tests revealed the presence of almost 100 per cent, positive reactors. The children who were found to be carrying hsemolytic streptococci were excluded until 3 negative swabs had been obtained, after which the outbreak very quickly subsided. 35 Sanitary Circumstances of the Area. Water.—The circumstances as to the water supply of the district are as set out in the report for 1934, and remain satisfactory. Swimming Bath.—The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows:— 1934. 1935. Mixed Bathers, Adults 39,678 39,870 Mixed Bathers, Children 35,008 39,369 Season Ticket Holders (attendances) 29,946 18,202 Totals 104,632 97,441 Spectators, Adults 4,012 3,425 Spectators, Children 1,736 1,308 A sample of the water in the swimming bath was sent for chemical and bacteriological analysis during 1935. An eminently satisfactory report was received, the report concluding with the following words: "No exception can be taken to the use of this water for swimming bath purposes. Bacteriologically it is comparable to a potable water." Broomfield Park Swimming Lake.—This lake continues to be used for swimming purposes, the supply of water from the artesian well being satisfactory in quality and in quantity. Rivers and Streams.—The condition with regard to the East Barnet Sewage Farm and Refuse Dump shows no material alteration. We still await the happy day when the reconstruction scheme will be completed, and the nuisance, which has so long troubled the district, become largely a spectre of the past. Drainage and Sewerage.—The arrangements for drainage, sewerage, and sewage disposal remain materially as set out in the Report for 1930. Since 1930, 11 miles of additional sewage sewers and 11 miles of surface-water sewers have been constructed within the district. 36 Cesspools.—The number of cesspools remaining in the district is 24. These continue to be cleansed periodically by a contracting firm which carries out the work in an unexceptionable manner. Roads.—There are now almost 80 miles of roads in the district, made up as follows:— County Roads 12.39 miles. Arterial Roads 1.89 ,, District Roads 49.45 ,, 63.73 ,, Private Roads 16.14 ,, 79.87 ,, Since 1930, 13.55 miles of additional roads have been constructed within the Borough. Public Conveniences.—In addition to the Council's underground convenience operating at The Triangle, Palmers Green, and the conveniences situated at Enfield West and Southgate Tube Stations, public conveniences are now available within the district at Fords Grove, Winchmore Hill, and the North Circular Road, Palmers Green. The new conveniences have filled a definite want, but there still appears to be a demand for an additional convenience at New Southgate. Until such a convenience is constructed, the district cannot be said to be adequately served in this respect. During the year, arrangements were entered into with the owners to reconstruct the public convenience attached to the "Fox Hotel," Palmers Green. The Council maintain and light this convenience, which has proved very useful in the past. Collection and Disposal of Refuse.—The Refuse Destructor, which was reconstructed during 1934, has been in operation throughout the past year and appears capable of dealing adequately with the refuse of the Borough. Unfortunately, a severe plague of crickets was encountered at and around the destructor during the latter part of 1935, the outbreak causing great inconvenience to the inhabitants of the surrounding houses. Steps were taken by the Surveyor's Department and the Public Health Department to combat the nuisance. These steps included work inside the destructor itself, which aimed at destroying the crickets and also minimising their spread. Measures were also carried out in the 37 houses affected, to discourage the entry of crickets into the actual premises and to destroy them if and when they were discovered therein. These measures controlled the outbreak, although it was several months before normal conditions could be resumed. Special assistance had to be obtained to carry out this work, the approximate cost of the operations totalling £294. A commercial firm, which claims to deal specially with the cricket problem, has been consulted in the hope of preventing a recurrence of the nuisance during 1936. The position is being carefully watched, and, if necessary, a prepared plan can be put into immediate operation. Several complaints as to flies were received from householders around the destructor during the year, but it was possible to check this nuisance by the removal of a great bulk of the material suitable for fly incubation. Adequate measures to deal with the flies inside the houses were also carried out, the complaints ceasing after a very short time. The system of refuse collection as outlined in the Report for last year remains practically unaltered, with the exception of certain operative details, and appears to be working satisfactorily. Minor complaints continue to be received and are 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 166 ,, Pagefield Containers 1,111 ,, ,, ,, Electrical Vehicles 61 ,, ,, ,, Freighters 595 ,, ,, ,, Hired Lorries 79 No. of Loads to Destructor 7,120 Total Weight to Destructor (Estimated) 13,212 tons. No. of Loads to Shoots 413 Total Weight to Shoots (Estimated) 840 tons. Smoke Abatement.—The following is a summary of the work carried out during 1935 under the Smoke Abatement Act, 1926:— One hundred and fifty-eight observations were made, 152 on chimneys within the Borough and 6 on chimneys on the border of an adjoining district. No contraventions of the Bye-law were noted during the year. 38 There are no chimneys in the district connected to exempted furnaces. Fortnightly observations of all chimneys in the Borough continue to be made. Ponds and Rubbish Dumps.—Complaints regarding nuisance from ponds and rubbish dumps are still received from time to time, but are decreasing. As might be expected considering the rapid extension of building within the district, complaints from these sources have materially diminished during the past five years, as the district continues to lose its last few remaining rural identities. 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 hitherto, all the schools within the district receive periodical visits of inspection from the Sanitary Inspectors. Apart from two schools, the conditions found were, on the whole, satisfactory, only a few minor defects being reported. In the case of the two exceptions—Chase Road and Cockfosters Schools—both of which are church schools, plans have been submitted for reconstruction. It is anticipated that such reconstruction will bring the schools up to a reasonable standard from a health point of view. Rag Flock Acts, 1911 and 1928.—There are no premises in the district manufacturing, selling or using Rag Flock according to the Acts. 39 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). Eight additional retailers were registered during the year under this Act. Under the Milk (Special Designations) Order, 1923, 7 Dealers' Licences to sell Certified Milk, 17 to sell Pasteurised Milk, 6 to sell Grade A (Tuberculin Tested) Milk, 4 to sell Grade A Pasteurised Milk and 1 to sell Grade A Milk were granted during the year. One Pasteuriser's Licence in respect of a pasteurising and bottling establishment was granted. Five supplementary licences for Certified Milk, 7 for Grade A (Tuberculin. Tested) Milk, 1 for Grade A Milk, 9 for Pasteurised Milk and 4 for Grade A Pasteurised Milk were granted during the year. It is again important and pleasing to note that no milk, other than that contained in sealed bottles, is retailed from any general shop in the district. As reported on page 22, the standard of milk sold within the district is satisfactory and has shown a definite improvement within the last few months. Infringements.—The following infringements were discovered and rectified during the year:— 1. Milk (Special Designations) Order, 1923— Selling Pasteurised Milk without licence 2 Selling Grade A Pasteurised Milk without licence 1 2. Milk and Dairies Order, 1926— Retailing milk without being registered as Retail Purveyor 6 Veterinary Examination of Cows.—This was undertaken, as before, by the Middlesex County Council. 40 Inspection of Cowsheds, Dairies and Milkshops.—The cowsheds, dairies and milkshops in the district were regularly inspected throughout the year, the conditions found therein being satisfactory. The bacteriological examination of milk undertaken at the Council's laboratory provides an additional and valuable check upon such inspections, faulty methods of production and distribution being capable of detection in this way. Meat.—There are no public abattoirs in the district. Butchers' shops are visited frequently, while slaughterhouses are kept under strict control. Considerably more slaughtering was carried out in the district last year than hitherto, largely owing to the increased business carried on by one particular firm. In addition, a second firm removed from its former premises to a reconstructed building, which has been passed as entirely satisfactory for the purpose. The work of supervising the slaughtering of animals places considerable responsibility upon the shoulders of the Sanitary Inspectors and also occupies an appreciable portion of their time. It will be realised that this work is of very considerable importance, and it is pleasing to report that, although strict supervision is maintained, the relations existing between the Public Health officials and the firms carrying out the slaughtering have up to the present been cordial. The following is a summary of the work carried out during 1935:— Total number of carcases examined, 5,992. Bullocks, 84; Sheep and Lambs, 3,691; Calves, 112; Pigs, 2,105. (1934: Bullocks, 54; Sheep and Lambs, 3,805; Calves, 79; Pigs, 680. Total, 4,618.) As a result of these examinations, 104 separate diseased or unsound conditions were discovered, the carcases or organs receiving the necessary attention. Details of these conditions are as follows:— Weight in lbs. Bovine Carcases. 18 separate portions affected with Tuberculosis 1,279 1 ,, ,, ,, ,, Distoma 14 1 ,, ,, ,, ,, Abscesses 12 3 ,, ,, ,, ,, Bruising 262 1,557 41 Calves. 1 separate portion affected with Immaturity 56 Sheep Carcases. 3 separate portions affected with Pneumonia .. 12 1 ,, ,, ,, ,, Abscesses 42 54 Pig Carcases. 59 separate portions affected with Tuberculosis 1,021 2 ,, ,, ,, ,, Pneumonia 7 7 ,, ,, ,, ,, Cirrhosis 37 1 ,, ,, ,, ,, Ecchinococcus 3 2 ,, ,, ,, ,, Pleurisy 8 1 ,, ,, ,, ,, Fatty Degeneration 8 1 ,, ,, ,, ,, Swine Erysipelas 90 2 ,, ,, ,, ,, Necrosis 10 1,184 2,851 (25cwts. lqr. 231bs.) The incidence of disease in the different food animals inspected during the past year as compared with the previous two years is shown in the following table:— Animals. All Diseased Conditions. Tuberculosis. Slightly Affected. Extensively Affected. Slightly Affected. Extensively Affected. No. % No. % No. % No. % Bovines— 1933 18 24.32 2 2.70 7 9.45 2 2.70 1934 15 27.77 1 1.85 13 24.07 1 1.85 1935 19 22.50 4 4.76 16 19.04 2 2.38 Sheep— 1933 3 0.08 1 0.02 — — — — 1934 2 0.05 - - - - - - 1935 4 0.10 - - - - - - Calves— 1933 - - - - - - - - 1934 - - - - - - - - 1935 — — 1 0.80 — — — — Pigs— 1933 10 1.82 — — 3 0.53 — — 1934 9 1.32 — — 6 0.88 — — 1935 71 3.37 4 0.19 57 2.70 3 0.14 42 Infringements.—The following infringements were discovered and dealt with during the year:— 1. Meat Regulations, 1924. Carcases inflated by mouth 1 2. Slaughter of Animals Act, 1933. Animals being killed without being first effectually stunned with a mechanically operated instrument 1 Other Foods.—The bakehouses, fish, fruit and grocers' shops situated within the district continue to be kept under observation. In this connection, the lack of adequate legislation controlling those premises in which foodstuffs are retailed for human consumption might be noted. Too great a margin of latitude is still allowed, although on the whole Southgate is particularly fortunate in its class of shops. Three stones of mackerel and 10 tins of apricots were voluntarily surrendered during the year. Shops Act, 1934.—This Act came into operation on December 30th, 1934, and has placed considerably more responsibility upon the Local Authority. A much more detailed inspection of such establishments is now necessary with respect to working hours and conditions, condition of premises, lavatory accommodation, etc., these inspections being undertaken by the Sanitary Inspectors and Miss Wellman, Health Visitor, who have been appointed Shops Inspectors under the Act. A summary of the work carried out during the year will be found set out with the details relating to the sanitary inspection of the area. It can be definitely stated that, with the exception of certain minor infringements of the Act which are inevitable among so many shops, the inspections revealed a satisfactory standard of efficiency. 43 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:— Samples Found Articles. Taken. Adulterated. Milk 104 1 Cream Pastry 3 — Arrowroot 1 — Hake 3 — Lemon Sole 3 2 Sausages 8 3 Minced Beef 1 — Mustard 1 — Gin 1 - Rum 1 1 Whisky 4 1 130 8 44 ANNUAL REPORT, 1935 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. 1935 1934 1935 1934 Factories (including Factory Laundries) 546 588 22 34 .. Workshops (includ ing Workshop Laundries) 358 455 36 38 .. Workplaces (other than Outworkers premises, included in Part 3 of this Report) 46 65 16 7 .. Total 950 1108 74 79 .. 2.—DEFECTS FOUND. Particulars. Number of Defects Found. Remedied. Referred to H.M. Inspector. No. of Prosecu tions. 1935 1934 1935 1934 Nuisances under the Public Health Acts:—* Want of Cleanliness 82 82 81 82 .. .. Want of Ventilation 1 .. 1 .. .. .. Overcrowding .. .. .. .. .. .. Want of Drainage of Floors 1 1 .. .. Other Nuisances 23 2 23 2 .. .. †Sanitary Insufficient 2 .. 2 .. .. .. Unsuitable or Defective 22 41 21 40 .. .. dation Not separate for sexes 4 .. 4 .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of Underground Bakehouses (s. 101) .. .. .. .. .. .. Breach of special sanitary requirements for Bakehouses (ss. 97 to 100) .. .. .. .. .. .. Other Offences .. (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 135 125 133 124 • • .. *Including those specified in Sections 2,3,7 and 8 of the Factory and Workshop Act as remediable under the Publio Health Acts. †Section 22 of the Public Health Acts (Amendment) Act, 1890, was opted in 1890. 45 46 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 keep ing or sending Lists. Failing to keep or permit inspection of lists. Falling to send lists. Twice In the year. Once in the year. Instances. Notices Served Prosecutions . Instances. Orders Made. (8.110) Prosecutions. (8.109-110) Lists. Outworkers Lists. Outworkers. Contractors . Workmen. Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel — (1) Making, etc. 6 .. 25 .. .. .. .. .. .. .. .. .. .. .. .. 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. (1) No. (2) Class. (1) (2) Matters notified to H.M. Inspector of Factories:— Bakehouses 5 Failure to affix Abstract of the Factory and Workshop Act (s. 133) .. Action taken in matters refrred by H.M inspector as |Notified by H.M. Inspector . 3 Laundries 2 remediable under the Public Health Acts, but not Other Workshops 193 under the Factory and Workshop Act (s. 5) Reports of action taken sent to H.M. Inspector 3 Total Number of workshops on Register 200 Other .. Underground Bakehouses (s. 101):— Certificates granted during the year .. In use at the end of the year .. SANITARY INSPECTION OF AREA. The number of inspections carried out during 1935 again shows an increase over those of previous years, being a record for the district. This was to be anticipated when it is remembered that the services of an additional Sanitary Inspector were obtained during the year. The visits paid by the Health Visitor for Public Health purposes and the workman whose services were obtained from the Surveyor's Department are also included in the total. Following the appointment of the new Sanitary Inspector in April, 1935, the sanitary districts of the Borough were reorganised, the district being split into three instead of two, as hitherto. I would like to take this opportunity of expressing my appreciation of the work of the Sanitary Inspectors throughout the year, an appreciation which includes the services rendered by Mr. Gooday, the most recent addition to the staff. This appreciation is not in respect of the number of visits paid, which may mean much or little, but rather by reason of the quality of the work performed. Inspections. 1933. 1934. 1935. Housing inspections and re-inspections 3,841 5,915 4,419 Slaughterhouse visits and inspections 586 488 660 Factories and workshops (including bakehouses) visits and inspections 757 1,108 1,033 Dairies, cowsheds, milkshops and other food shops, visits and inspections 1,447 2,231 3,327 Various complaints, inspections and re- inspections 1,355 1,529 1,660 Dustbins, inspections and re-inspections 1,363 1,146 1,672 Infectious Disease visits and re-visits 1,086 2,459 2,664 Other inspections (Rent Acts—Rats and Mice Destruction Act—Ditches and Ponds — Accumulations — Non-notifiable Diseases, etc.—Drain inspections and tests—Smoke observations) 4,443 7,286 9,603 Total 14,878 22,162 25,038 Service of Notices. Total informal sanitary notices served 1,063 1,572 2,122 Total informal dustbin notices served 270 257 298 Total informal notices served 1,333 1,829 2,420 47 Total informal notices complied with 1,377 1,790 2,500 Total statutory notices served 37 30 8 Total statutory notices complied with 47 30 8 Total notices carried forward 59 198 117 Sanitary Improvements.—The following is a summary of the sanitary improvements effected, and the defects remedied:— Housing. Premises cleansed 62 Ceiling plaster repaired 360 Ceilings washed and distempered 1,481 Wall plaster repaired 567 Walls redecorated 1,229 Dampness remedied 184 Floors repaired or relaid 237 Ventilation under floors improved 27 Roofs repaired 321 Eaves gutters repaired or renewed 182 Rainwater pipes repaired or renewed 129 Yards repaired or repaved 100 Window frames repaired or renewed 229 Sashcords provided 485 Doors and frames repaired or renewed 125 Brickwork repointed or repaired 163 Cooking ranges repaired or renewed 56 Firegrates repaired or renewed 57 New sinks provided 37 WTaste pipes repaired or renewed 87 Internal steps and staircases repaired 42 Food stores repaired 5 Internal woodwork repaired 177 Lighting and ventilation improved 3 Water supply—Draw taps fixed on main service 7 Water storage cisterns cleansed 9 New storage cisterns provided 3 Defective pipes repaired 16 Overcrowding abated 5 Washing coppers repaired or renewed 52 Verminous premises cleared of vermin 68 Verminous rooms cleared of vermin 130 Coal sheds repaired 4 48 Drainage. Inspection chambers repaired 60 New inspection chambers provided 55 Drains examined and tested 185 Drains repaired 75 New drains laid 65 Drains unstopped or trapped 228 New gullies provided 46 Gully grates provided 47 Choked gullies cleansed 45 Vent shafts and soil pipes repaired or renewed 27 F.A.I.s repaired or renewed 129 Sanitary Accommodation. W. C. pans renewed 89 W.C. seats repaired or renewed 92 New flushing cisterns provided 34 W. C. cisterns repaired 92 W.C. flush pipes repaired or renewed 38 W.C. cone joints repaired or renewed 110 W.C. structure repaired 36 New W.C.s provided 8 Refuse Receptacles. Dustbins renewed (by owners) 413 Dustbins renewed (by Council—in default) 0 Cowsheds and Dairies. Cowsheds cleansed and limewashed 2 Dairies cleansed and limewashed 4 Accumulations of manure removed 2 Slaughterhouses. Cleansed and limewashed 4 Structure repaired 2 Bakehouses. Cleansed and limewashed 9 Structure repaired 2 W.C.s repaired 1 W.C.s cleansed and limewashed 3 Factories and Workshops. Notices posted 119 Walls cleansed and limewashed 32 Ceilings cleansed and limewashed 23 49 W.C. cisterns repaired or renewed 14 W.C. cone joints repaired or renewed 12 W.C.s cleansed and limewashed 77 Roofs repaired 8 Shops. Walls cleansed 10 Floors cleansed 14 Accumulations removed 48 Yards repaired, paved or drained 16 W.C.s cleansed 53 W.C.s repaired or renewed 58 Notices posted 139 House-to-House Inspection.—Following the apportionment of the Borough into three sanitary districts, the Housing Schedule was altered. In addition to the transfer of the necessary houses to the third district, several minor alterations were made, the result showing no increase in the total number of houses scheduled for inspection, but rather a decrease in the period between inspections. Six hundred and one houses were inspected and recorded under the Housing Acts, as follows:— District No. 1. No. of Houses No. Inspected. Scheduled. 1934. 1935. Annual List 65 65 65 Biennial List 9 9 — Quinquennial List 687 177 201 District No. 2. Annual List 120 120 120 Biennial List 74 54 22 Quinquennial List 511 148 39 District No. 3. Annual List 86 86 86 Biennial List 26 26 — Quinquennial List 270 32 68 Total 1,848 717 601 Non-Scheduled Houses.—In addition to the above, 959 non-scheduled houses were inspected for housing defects and insanitary conditions, mostly upon complaint of the occupiers, us follows:— 50 1934. 1935. North-East Ward 188 264 North-West Ward 536 314 Middle Ward 154 108 South Ward 273 273 Total 1,151 959 Miscellaneous. Cesspools emptied and cleansed 9 Cesspools abolished 4 Accumulations of refuse and manure removed 63 Nuisances from keeping of animals abated 4 Foul ditches, ponds and stagnant water abated 10 Moveable dwellings (vans and tents) removed 30 Smoke nuisances abated 9 Dustbins.—Special inspections, following 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, 400 premises were visited in this connection, 195 verbal notices, 76 preliminary notices and 15 statutory notices being served. These special inspections alone resulted in the provision of 278 new bins, which included a number of bins supplied following notices served during 1934. 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 34 Cowsheds 2 Bakehouses 18 Dining Rooms 42 Slaughterhouses 5 Fried Fish Shops 9 Factories and Workshops 193 Public House Conveniences 21 Total 324 51 HOUSING. Number of New Houses Erected during the Year 1935:— (a) Total (including numbers given separately under (b)) 900 (b) With State assistance under the Housing Acts:— (i) By the Local Authority Nil (ii) By other bodies or persons Nil 1. Inspection of Dwelling-houses during the year:— 1934. 1935. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,868 1,560 (b) Number of inspections made for the purpose 1,953 1,631 (2) (a) Number of Dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 717 601 (b) Number of inspections made for the purpose 775 677 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 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 1,348 1,315 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 1,017 1,298 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 52 (2) Number of Dwelling-houses which were rendered fit after service of formal notices:— (а) 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 30 8 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 30 8 (б) By local authority in default of owners Nil Nil C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of Dwelling-houses in respect of which Demolition Orders were made Nil Nil (2) Number of Dwelling-houses demolished in pursuance of Demolition Orders Nil Nil D.—Proceedings under Section 20 of the Housinq Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made Nil Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Nil E.—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:— (а) By owners Nil Nil (б) By local authority in default of owners Nil Nil 53 (3) Number of Dwelling-houses in respect oi which Closing Orders became operative in pursuance of declarations byowners of intention to close Nil Nil F.—Proceedings under Sections 11,14 and 15 of the Housing Act, 1925:— (1) Number of Dwelling-houses in respect of which Closing Orders were made Nil Nil (2) Number of Dwelling-houses in respect of which Closing Orders were determined, the Dwelling-houses having been rendered fit Nil Nil (3) Number of Dwelling-houses in respect of which Demoliti on Orders were made Nil Nil (4) Number of Dwelling-houses demolished in pursuance of Demolition Orders Nil Nil (5) Number of Dwelling-houses closed tarily by owners 29 39 (6) Number of Dwelling-houses demolished voluntarily by owners 21 42 The housing survey of the district, made necessary because of the passing of the Housing Act, 1935, was begun before the end of last year and has now been completed. Properly speaking, this is a matter which should be dealt with in the report for 1936, and it may suffice to state here that the standard of housing discovered was remarkably high, while the incidence of overcrowding was correspondingly low. It does not appear that the Borough Council will be called upon to carry out any extensive measures to remedy existing conditions, but, nevertheless, the survey will undoubtedly show that more accommodation is required at rents within the means of those persons unfortunate enough to possess the slenderest incomes, i.e., those individuals who most require assistance in the direction of adequate accommodation. I cannot too strongly emphasise the need for more Council houses at the earliest opportunity. It should be quite possible in a district such as Southgate to meet all the needs of the inhabitants with regard to housing, and until this is done the Borough will not rest upon a safe and sure health foundation. Those people who can afford to buy their own houses or to pay high rentals should be satisfied through the medium of private enterprise. That portion of the community, however, which cannot possibly afford such expenditure continues 54 to look to the Local Authority for adequate and inexpensive accommodation. Until this demand is met in its entirety, the Borough Council cannot be said to have fulfilled its moral and legal obligations as a Public Health Authority. Overcrowding.—Five cases of overcrowding in a comparatively mild form were reported during 1935. The position as regards Southgate will, of course, be fully investigated under the housing survey. It can be stated here that over 60 cases of overcrowding have made themselves apparent under this survey, and that action will be taken during the incoming year to remedy this Public Health menace. Rent Restrictions Acts.—Under the provisions of these Acts two applications were received from occupiers for certificates to the effect that their houses were not in a reasonable state of repair. Special inspections were made, following which certificates were granted. Rats and Mice Destruction Act.—This Act is administered in the Borough of Southgate by the Middlesex County Council. Numerous complaints were again received as to the presence of rats in various parts of the district, complaints which will doubtless continue to be received until the district is fully developed. Information as to suitable means of eradication is always supplied by the Sanitary Inspectors when required, in addition to which the complaints are transmitted to the Rat Destruction Officer for this area. 55 Prevalence of and Control over Infectious and Other Diseases. From Table V, oil page 79, it will be seen that 270 cases of infectious diseases were notified during the year, as against 332 in 1934, a decrease of 62. These 270 cases represent infection in 252 houses. It will be observed that the number of cases of infectious disease notified during 1935 has shown a definite decrease from that of the previous year. Southgate is now enjoying a period during which the incidence of infectious disease is at a relatively low level. Everything possible should be done to safeguard the population against a reversal of these conditions, but it must be remembered that, in such an urbanised community as North Middlesex, it is too much to hope that this happy state of affairs will continue indefinitely. It should be our aim to protect the community by such measures as active immunisation, improvement in housing, attention to nutrition, and general control of infectious disease, using all the powers vested in the Local Authority, in the hope that the population will thereby be placed in a more favourable position to withstand outbreaks of infectious disease, and also ill the hope that natural immunity will take its course and afford a sufficient margin of additional protection. The ward distribution of the cases of infectious disease notified during the year was as follows:— 1934. 1935. South Ward 135 101 Middle Ward 74 63 North-West Ward 69 43 North-East Ward 54 63 When compared with the notifications received during 1934, it will be seen that the figures for the South and North-West Wards show a definite proportionate decrease, that for the Middle Ward is slightly down, while the figure for North-East Ward is correspondingly increased. The reason for the increase in the last-named ward was the occurrence of a small localised outbreak of scarlet fever during the early portion of the year. The infectious Sickness Rate for the district for 1935 was 4.3, as against 5.5 in 1934 and 4.2 in 1933. From the graph set out on page 57, it will be seen that the figure of 4.3 is one of the most satisfactory recorded during the past 10 years, lower figures having only been obtained for the years 1931 and 1933. 56 57 The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 228 premises. During such inspections, 24 houses were found to contain sanitary defects, consisting chiefly, as previously, of defective water-closets, dampness and want of cleansing. These defects have all been remedied. No case of overcrowding was met with in any of the houses inspected in connection with cases of infectious disease. One hundred and sixty-three cases were removed to the Isolation Hospital at Tottenhall Road. Of these, 98 were admitted suffering from scarlet fever, 23 from diphtheria, 9 from erysipelas, 2 from paratyphoid B fever, 2 from puerperal fever, 2 from puerperal pyrexia, 1 from otorrhcea following scarlet fever, 4 from tonsillitis, 1 from pneumonia, 1 from whooping cough, bronchitis and pneumonia, 1 from measles, 2 from rubella (German measles), 1 from bronchitis and croup, 1 from whooping cough, and 1 from acute thyroidism; while 2 observation cases, 10 diphtheria " carriers," and two babies with mothers were also admitted. (As will be seen from the portion of the Report dealing with the work of the Isolation Hospital, the original diagnosis had to be amended on several occasions. Small-pox.—No cases of small-pox occurred in the district during 1935. The number of "contacts" reported from other districts has fallen to a remarkable degree within the past few years, it being now a rare occurrence to receive notification of the existence within the Borough of such contacts. Vaccination.—No primary vaccinations or re-vaccinations under the Public Health (Smallpox Prevention) Regulations, 1917, were required during 1935. Scarlet Fever.—One hundred and thirty-three cases of scarlet fever were notified during the year, as against 165 in 1934. The ward distribution was as follows:— 1934. 1935. South Ward 82 41 Middle Ward 32 25 North-West Ward 28 17 North-East Ward 23 41 58 Five "secondary" cases occurred in houses from which previous cases had been notified. In three of these instances the primary case had been removed to hospital. One "return" case occurred. Two of the cases occurring during the year were "imported," one from a holiday resort and one from a hospital outside the district. The incidence of the disease was once again spread fairly evenly over the 12 months, the only peak being displayed in June, following the occurrence of a restricted outbreak in a private school in Winchmore Hill. (See page 35.) As reported elsewhere in this Report, schools are visited upon the reception of notification of multiple cases, particularly where children of approximately the same age are affected. A search is then made for missed cases and possible "carriers," swabs being examined for the presence of hemolytic streptococci, and individual exclusion being carried out where considered necessary. It is again pleasant to report that the type of disease met with was, on the whole, mild, no deaths taking place during the twelve months. Ninety-eight cases were removed to the Isolation Hospital, representing 73.7 per cent. of the total number of cases notified. During the course of the year, the following circular letter was sent to all doctors practising in the district:— "Admission of Scarlet Fever Cases to Hospital. "Of late years, a very large proportion of the cases of scarlet fever notified within the Borough of Southgate have been admitted to the Isolation Hospital, the percentage being usually in the neighbourhood of 90 or over. The admission of such a large percentage of scarlet fever cases to hospital is not entirely in accordance with modern Public Health teaching, more especially when the general type of population met with in Southgate is taken into consideration. "It has been proved that the hospitalisation of such cases does not in any way reduce the incidence of the disease, while the risk of cross-infection and minor complications such as rhinorrhoea, adenitis, secondary rashes, impetiginous eruptions, etc., is considerably increased. This is due to the fact that scarlet fever may be caused by a variety of streptococci, 59 at least five in number, and that cases which are admitted with infection due to one strain can very easily contract a secondary infection from a different and possibly more virulent strain then present in the ward. "For those reasons it would appear very desirable to advise home treatment in the case of children suffering from scarlet fever when the disease is mild or even moderate, and when the home conditions are satisfactory and permit of suitable attention and isolation. I need not stress the point that there are many homes in Southgate which ideally fulfil these conditions. "Cases of severe infection and cases in which the home conditions are not suitable by reason of inadequate isolation, financial stringency, occupation of breadwinner or other member of the family, and any further circumstances demanding special consideration will, of course, be gladly admitted to the Isolation Hospital on request. "Free Supply of Anti-Scarlatinal Serum. "As the serum treatment of scarlet fever appears to hold out the prospect of best results, especially in severe or moderately severe cases (although all patients appear to benefit from such treatment), concentrated anti-scarlatinal serum will be supplied, free of charge, to any practitioner for the treatment of cases isolated at home. This serum can be administered intramuscularly, intraperitoneally or intravenously as required. Needless to say, the usual contraindications against the exhibition of serum hold good." The number of cases sent to hospital began to show a decrease after this letter had been circulated, and it is now obvious that only those patients for whom hospitalisation is definitely required are being sent to hospital. This is very satisfactory and allows us to reserve additional accommodation at the Isolation Hospital for other diseases which call more urgently for such treatment. Following the institution of the three weeks' treatment at the Isolation Hospital, in conjunction with the administration of serum to all cases irrespective of severity (see page 74), every case leavihg the Isolation Hospital is now instructed to attend at the Town Hall approximately 14 days after discharge, when their physical condition and urine are examined for the presence of any abnormalities. In addition to this examination, the patients are visited in 60 their homes by the Health Visitor immediately after discharge, these visits continuing so long as they appear to be required. The following Table sets out the result of the observations which have been made upon these patients:— Total number of persons discharged during 1935 71 Persons in whom no abnormalities attributable to the original attack were discovered after 14 days 63 Patients developing rhinorrhœa 5 ,, ,, mild rheumatism 1 ,, ,, transient albuminuria 1 ,, not examined 1 In every case, the abnormality which developed was slight and of no serious import. All had disappeared by the end of the third week, the patients being then in a satisfactory physical condition. One child developed whooping-cough shortly after discharge from hospital. It was not necessary to re-admit any of the patients to hospital, with the exception of the child who developed whoopingcough. These patients are now being examined approximately twelve months after their attack of scarlet fever. So far, no illeffects have been evidenced, following the original infection. I consider this work to be definitely valuable and worthy of continuation over a prolonged period. It is yielding most useful information, not only as regards the effect produced by the treatment given in the Isolation Hospital, but also as regards the general after-effects of attacks of scarlet fever of varying intensity and type. In addition, it allows us to exercise more careful supervision over patients discharged from hospital, and should thus minimise the danger of "return cases." In this connection, it is interesting to note that the only "return case" met with during 1935 occurred in the mother of a child who had developed symptoms of whooping-cough within a few days of admission to hospital and who had been discharged after a prolonged stay in hospital, at the parents' own request. Diphtheria.—Twenty-five cases of diphtheria were notified during 1935, as against 44 during the previous year. None of these cases was secondary. 61 The ward distribution was as follows:— 1934. 1935. South Ward 10 10 Middle Ward 8 5 North-West Ward 19 7 North-East Ward 7 3 Twenty-three cases (92.0 per cent. of the total notified) were removed to hospital. The type of disease met with was hot so severe as that encountered during the previous year, but one death occurred in a patient notified towards the end of 1934. Eleven cases were reported in January, the remainder being spread evenly over the 12 months. No particular portion of the district was affected more than another. The dates of notification were as follows:— 1st day 0 2nd ,, 4 3rd ,, 3 4th ,, 6 5th ,, 6 6th ,, 2 7th ,, 2 8th „ 0 9th ,, 0 ? ,, 2 The fatal case occurred in a patient notified on the third day of disease. Swabs were 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. Immunisation.—Four hundred and fifteen persons attended for immunisation during 1935 at the weekly clinic held in Broomfield House or at the schools visited during the year, this figure including 27 cases from East Barnet Urban District and 11 from Friern Barnet, payment being received from the responsible Authorities for the treatment of those children. (Total for 1934, 323.) The schools selected during the past year were Garfield Road and Bowes Road, 92 and 144 children attending at each school 62 respectively. There can be little doubt that the method of offering immunisation at the schools affords much better results than those obtained from the weekly clinic at Broomfield House. The work can be carried out more expeditiously upon the school premises, while defaulters are also very much fewer. In spite of these facts, I consider it advisable to continue the ad hoc clinic, as otherwise, parents would be compelled to wait for immunisation until the particular school which their children attended was visited, while, in addition, infants under five—the most important subjects for immunisation—might easily be neglected. 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 — 14 16 9 39 9.4% Positives:— Mild — 36 25 6 67 16.2% Moderate — 56 30 3 89 21.4% Marked — 44 15 4 63 15.2% Nil 136 70 13 219 Not tested 157 — — — 157 37.8% Total for year 415 Completed Cases 264 (To 31.12.35 from commencement of scheme) 285 148 8 705 Number of persons who have attended for immunisation since commencement of scheme (including Schick negatives, uncompleted cases and defaulters) 1,478 Results of Schick Test after Three Months (1935). Negatives 236 Positives 13 249 63 Further Results of the 13 "Positives''— After 4th injection:— Negatives 12 Positives 1 After 5th injection:— Negatives 1 Positives Nil Number of Cases failing to complete Immunisation (1935) 43 Before three injections 18 After three injections 25 Total number of visits paid to schools and Clinic for purposes of immunisation (1935) 1,930 Total number of visits paid to schools and Clinic for purposes of immunisation since inception of scheme 6,733 Number of cases to be completed in 1936 166 Reactions after Injections (1935). 1-5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total. Mild 1 — — 1 2 Moderate — — — 2 2 Severe — — — 1 1 1 — — 4 5 One child developed clinical diphtheria during 1935, after having been immunised. This child was not seen by a doctor until the eighth day, and the famliy practitioner himself expressed the opinion that the child would probably have died had immunisation not been previously carried out. The case of a second family is interesting. There were two children in this family, one immunised and one not immunised. The immunised child escaped diphtheria although he carried diphtheria bacilli in his nose. The non-immunised child developed clinical diphtheria and had to be admitted to hospital. Typhoid Fever (including Paratyphoid).—Two cases of paratyphoid B fever were notified during the year. In each case the infection was traceable to a source outside the district. Both cases were admitted to hospital and made satisfactory progress. No cases occurred during 1934. 64 Puerperal Fever and Puerperal Pyrexia.—Three cases of puerperal fever and 8 cases of puerperal pyrexia were notified during the year, as against 2 and 2 in 1934. These figures, although small in themselves, are definitely alarming, as they show a very considerable increase in the incidence of these two diseases. It would certainly be dangerous to draw sweeping conclusions from the figures applicable to one year, and it will be necessary to wait for a longer period before we can definitely say that puerperal infection is on the increase in Southgate. If such were the case, drastic measures would be called for to reduce the incidence without further delay. The services of the Council's consulting gynaecologist, Mr. Head, were required three times during the year, twice for cases occurring in private nursing homes and once for a case admitted to the Isolation Hospital. These cases all made satisfactory recovery and I should like to take this opportunity of thanking Mr. Read for his services, which are invariably rendered with great promptitude, and prove of the very greatest value. Erysipelas.—Twenty-three cases of erysipelas were notified during the year as against 20 in 1934. One death occurred. Nine cases were removed to the Isolation Hospital. Pneumonia.—Twenty-four cases of pneumonia were notified during 1935, as against 41 in 1934 and 57 in 1933. It will thus be seen that the figures have shown a progressive decrease during the past three years, not the least satisfactory feature of our vital statistics. So long as the present system of notifying only acute primary lobar and acute influenzal pneumonias persists, it will not be possible to obtain a true picture of the incidence of pneumonia in any class of the population. Some drastic revision of the present regulations is definitely called for, which will allow a more comprehensive notification of all the types of pneumonia met with in the different age groups of the population. Twentyeight deaths occurred, this number, as before, incorporating all deaths from this cause and therefore including secondary cases, which were non-notifiable. A. considerable proportion of the cases were removed to the North Middlesex County and other Hospitals, one fatal case being admitted as a matter of urgency to the Isolation Hospital. 65 Tuberculosis.—Forty-two cases of pulmonary and seven cases of non-pulmonary tuberculosis were notified during the year under the Public Health (Tuberculosis) Regulations, 1912, the corresponding figures for 1934 being, pulmonary oasies, 521; non-pulmonary cases, 5. In addition to these notified cases, 19 patients were entered in the register (15 pulmonary, 4 non-pulmonary), these cases being new residents in the district, previously notified elsewhere. Twenty-seven deaths occurred, 26 from pulmonary and 1 from non-pulmonary tuberculosis. Three of these cases had not previously been notified, a ratio of 11.1 per cent. as against 7.7 per cent. in 1934. As mentioned elsewhere in this Report, it will be seen that the number of deaths from tuberculosis has shown a welcome decline, while the number of notifications has also fallen. 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 21. Non-Notifiable Infectious Diseases.—The arrangements for receiving information regarding non-infectious diseases from the head teachers of the various elementary schools in the district remain unaltered. This information is exceedingly valuable, particularly in view of the visits now paid to such cases by our Health Visitor, and more especially still, in view of the new arrangements with regard to home nursing which have been entered into with the Southgate Queen's Nursing Association. The information would be of even greater value if it were more promptly transmitted, some of the cases being only reported some 10—12 days and even longer after the child has been absent from school. Much of the value is thus negatived. Importance is added to this question when it is remembered that, apart from information obtained at the Child Welfare Clinics, we depend upon school notifications for discovering younger cases, i.e., those most requiring attention, in homes where a child of school age has 66 already been affected. Opportunity has since been taken to inform the teachers that the information should be supplied at as early a date as possible. The following list sets out the information received during the year. 1933. 1934. 1935. Measles 27 650 7 Whooping Cough 134 94 83 Mumps 118 61 182 Influenza 27 4 9 Chickenpox 50 44 69 German Measles — 197 1 Total 356 1,050 351 There were no deaths from measles. From this table it will be seen that the number of notifications has fallen very considerably during 1935, as compared with the previous year. 1935 was an inter-epidemic period and there can be little doubt that the figures for 1936 will show a definite increase. With this in mind, steps have already been taken to prepare for and guard against the expected measles epidemic in which Southgate will doubtless share. Notifiable Diseases occurring amongst School Children.— The arrangements remain unaltered from those detailed in last year's Report. Disinfection and Disinfestation.—With the addition of cancer as a disease for which free disinfection is allowed, the arrangements for disinfection and disinfestation remain as set out in the Report for 1930. The following table summarises the work carried out during the year. Disinfection in connection with Notifiable Diseases:— Number of rooms fumigated 401 Number of articles disinfected by steam 3,087 Number of articles destroyed 166 Disinfection in connection with Non-notifiable Diseases. 67 Disinfection of rooms and bedding, on request, after cases of non-notifiable disease (charge, of 5s.):— Number of rooms fumigated 7 Number of articles disinfected by steam 156 Amount received in respect thereof £7 5s. Od. Disinfection of Books.—The arrangements indicated 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, 141 books were so disinfected. ISOLATION HOSPITAL. The number of patients treated in hospital during 1935 was 616, as against 622 during 1934. (This number comprises the patients admitted during the year, together with those in hospital on 1st January, 1935.) As will be seen, the number shows a slight drop, although actually the h umber of patient days was increased, owing to the abnormal number of diphtheria cases treated during the year. As in previous years, the bulk of the patients were admitted from Tottenham. The following table sets out the number of patients admitted to the hospital during 1935, and the areas from which those patients were admitted. 1935. (1934.) Southgate 163 (227) Tottenham 390 (308) Edmonton 3 ( 2) Friern Barnet — ( 32) Wood Green — ( 1) Middlesex County Council — ( 1) 556 (571) As this may be the last year in which the hospital is operated on its present basis, the following figures might be of interest as showing the increased use of the hospital which has taken place within the last 10 years:— 1925.—103 cases admitted (average number in hospital on any one day, 8.7; highest, 16; lowest, 2). 1929.—254 cases admitted (average number in hospital on any one day, 20.5; highest, 40; lowest, 1). 68 1931.—217 cases admitted (average number in hospital on any one day, 22.3; highest, 34; lowest, 9). 1932.—255 cases admitted (average number in hospital on any one day, 24.0; highest, 62; lowest, 9). 1933.—500 cases admitted (average number in hospital on any one day, 47.4; highest, 65; lowest, 30). 1934.—571 cases admitted (average number in hospital on any one day, 55.5; highest, 67; lowest, 41). 1935.—556 cases admitted (average number in hospital on any one day; 53.0; highest, 68; lowest, 38). In addition to the greater numbers, the variety of diseases treated and the severity of the cases admitted have also increased in a corresponding manner. This has necessitated a much greater measure of control, both from a medical and from a nursing standpoint. The diseases for which the 556 patients were admitted during 1935 were as follows:— Scarlet Fever 256 Diphtheria 160—Faucial 144 Nasal 7 Nasal & Faucial 3 Laryngeal 3 Laryngeal & Faucial 2 Laryngeal & Nasal 1 Diphtheria "Carriers" 13 Scarlet Fever and Diphtheria 8 Scarlet Fever and Diphtheria “Carrier” 4 Scarlet Fever and Burns 2 Scarlet Fever and Chicken-pox 1 Scarlet Fever and Chicken-pox contact 2 Scarlet Fever and Whooping-cough 2 Scarlet Fever and Measles 1 Scarlet Fever and Ringworm 1 Scarlet Fever and German Measles 2 Scarlet Fever and Adenitis 1 69 Scarlet Fever and Bronchitis .. 1 Scarlet Fever and Congenital Heart Disease 1 Scarlet Fever, Congenital Heart Disease and Diphtheria ''Carrier'' 1 Scarlet Fever and Polio-encephalitis 1 Scarlet Fever and Endocarditis 1 Diphtheria and Chicken-pox 2 Diphtheria and Measles 1 Diphtheria and Mumps 2 Diphtheria and Whooping-cough 1 Diphtheria and Broncho-pneumonia 1 Typhoid Fever 1 Paratyphoid B Fever 3 Erysipelas 24 Puerperal Fever 4 Baby with Mother 2 Whooping-cough and Pneumonia 5 AVhooping-cough, Pneumonia and Mumps 1 Whooping-cough and Bronchitis 2 Lobar Pneumonia 1 Measles 10 Measles and Broncho-pneumonia 5 Measles, Asthma and Eczema 1 Measles and Eczema 1 Measles and Nephritis 1 Measles and Mastoid Abscess 1 Rubella (German Measles) 3 Appendix Abscess 1 Cellulitis of Leg 1 Tonsillitis 11 Acute Thyroidism 1 Bronchitis 1 Pleurisy 1 Mumps 2 Mumps and Gastritis 1 Simple Croup 3 Chicken-pox, Broncho-pneumonia arc Fractured Skull 1 Chicken-pox and Tuberculosis of Spine 1 Iodine Rash 1 Non-infectious Rash 1 556 70 Seven of the above patients were admitted for observation purposes, while in 50 cases the original diagnosis had to be amended after admission, the cases affected being either sent home, transferred to a General Hospital when the disease was found to be non-infectious, or treated in the Isolation Hospital. The following list sets out the full details regarding the amended diagnosis:— Diphtheria to Diphtheria "Carrier" 8 Diphtheria to Tonsillitis 7 Diphtheria to Acute Thyroidism 1 Diphtheria to Simple Croup 3 Diphtheria to Diphtheria and Scarlet Fever 3 Diphtheria to Scarlet Fever and Diphtheria ' 'Carrier'' 1 Diphtheria to Mumps 2 Scarlet Fever to Tonsillitis 4 Scarlet Fever and Diphtheria to Scarlet Fever 1 Scarlet Fever to Scarlet Fever and pox 1 Scarlet Fever to Scarlet Fever and ing-cough 1 Scarlet Fever to Measles 2 Scarlet Fever to German Measles 4 Scarlet Fever to Scarlet Fever and Diphtheria "Carrier" 6 Scarlet Fever to Scarlet Fever and Measles 1 Whooping-cough to Bronchitis 1 Erysipelas to Cellulitis of Leg 1 Typhoid Fever to Appendix Abscess I Measles to Iodine Rash 1 Scarlet Fever to Non-infectious Rash 1 Total 50 Number of Patients in Isolation Hospital on any one day during each Month:— Greatest Number. Lowest Number. January 68 55 February 68 56 March 61 50 April 60 41 May 55 38 June 59 47 71 July 51 41 August 50 41 September 57 46 October 62 47 November 61 52 December 59 52 Complications.—The complications met with during 1935 were as follows:— Scarlet Fever.—(Total of 285 cases treated during the year.) Rheumatism 3(1 very slight) Otorrhœa 8 (right 4, left 3, double 1) Adenitis 5 Rhinorrhœa 2 Late Albuminuria 1 Total 19 The pencentage of complications met with during the year shows a definite decrease from the figures which obtained for the past three years, although these in turn were low, and seems to support the fact that the new serum treatment put into operation is exercising a benficial effect, not only in diminishing the average stay in hospital but also in reducing complications. It must also be remembered that every complication, however slight, is included in this list, and that all yielded satisfactorily to treatment. Once again, of course, it would not be safe to draw final conclusions from these figures, which cover too short a period and were not controlled by a parallel series of cases to which no serum had been administered. It is interesting to note from the table of complications, that most of the complications met with were of the "septic" type, thus bearing out the known fact that antitoxin has least effect in preventing this type of complication, its greatest value lying in the power to reduce toxicity and thus minimise the later, more serious after-effects. In addition to the complications set out above, one patient developed a secondary rash. Diphtheria.—Apart from the 6 fatal cases met with during the year, 29 complications occurred amongst the 184 cases treated during 1935. 72 These were as follows:— Palatal Paralysis 12 Palatal, Ocular and Pharyngeal Paralysis 1 Palatal and Pharyngeal Paralysis 4 Ocular Paralysis 1 Mild Endocarditis 2 Late Endocarditis 1 Otorrhœa 6 (right 3, left 2, double 1) Otorrhcea and Rhinorrhœa 1 Nephritis 1 Peronychia 1 Total 29 This complication rate is very similar to that which obtained for 1934, but is, if anything, rather higher. This is explained by the fact that the type of' diphtheria admitted was definitely more severe than has been the case for the past few years, with the exception of last year when the complication rate was also high. The complications responded excellently to treatment in every case. In this connection it must, be remembered that the incidence of late paralysis in diphtheria is in some ways satisfactory, as it means that patients who might otherwise have died have survived to the period when paralysis occurs and when ultimate recovery can be hopefully expected. Deaths.—Seventeen deaths occurred during the year, as against 19 in 1934. The deaths occurred from the following diseases:— Diphtheria 6 Scarlet Fever and Mastoid Abscess 1 Scarlet Fever and Congenital Heart Disease 1 Scarlet Fever and Polio-encephalitis 1 Erysipelas 3 Whooping-cough and Broncho-pneumonia 3 Mea sles and Broncho-pneumonia 1 Lobar Pneumonia 1 Three patients died within 24 hours of admission to hospital, one surviving less than 4 hours. The death-rate from diphtheria was just under 3.3, remarkably satisfactory considering the type of disease for which the patients were admitted, and one of the lowest ever recorded at the hospital. 73 General Treatment.—The greatest change in the treatment carried out during the year lay in the introduction of the serum treatment for scarlet fever, a report on the anticipated advantages of which was set out in Appendix 3 of the Annual Report for 1934. As indicatd elsewhere in this Report, the use of serum in the treatment of all cases admitted to hospital and the isolation of these cases for three weeks is, in my opinion, a definitely progressive step. Not only do the complications tend to be diminished, but, what is even more important, the danger of cross-infection appears to be lessened, as is evidenced by the figures set out on page 72, while the "return case" rate is not increased. The patients certainly seem to be happier when allowed on full diet and out of bed within ten days of admission, while the fact that no untoward late effects are to be expected is shown by the result of the visits paid to the homes by the Health Visitor after the patients' discharge from hospital, and by the "clearance" examinations carried out at the Town Hall. (It might be of interest to note here that my colleague, Dr. Kirkhope, the Medical Officer of Health for Tottenham, has come to the same conclusion as myself after a study of the patients discharged to his own area.) Thus, from all aspects, the serum treatment of scarlet fever in conjunction with the three weeks' detention period, appears worthy of a further extended trial in its present form. Incidentally, it has not been necessary to use the intraperitoneal or the intravenous method of injecting the serum, the intramuscular method having been sufficient in all cases up to the present. Finally, the prejudice of some parents to the early discharge of their children is being slowly overcome, very little difficulty being now met with in this connection. Glucose, iodine in milk, alkaline mixtures and adrenalin injections, in addition to large doses of serum administered intravenously and intramuscularly, are now being used in the treatment of hypertoxic diphtherias. This combination has so far yielded satisfactory results and is being given an extended trial. The form of treatment adopted with regard to the remaining diseases admitted to hospital has remained more or less unaltered, except where newer and more concentrated brands of serum have been used in the treatment of certain infections. The ultra-violet and infra-red apparatus continues to serve a valuable purpose and has been made use of as hitherto throughout the year. 74 Operations.—The following operations were performed during the year:— Appendicectomy (Scarlet Fever) 1 Mastoidectomy (Scarlet Fever, 1; Measles, 1) 2 Blood Transfusion (Mastoid Abscess) 1 Myringotomy (Scarlet Fever) 1 Tonsillectomy (Diphtheria "Carriers," 2; Scarlet Fever, 1) 3 8 In addition to these operations, numerous incisions for gland abscesses (mostly present on admission) were performed, while several minor operations were also carried out for the treatment of surgical conditions occurring in patients admitted from General Hospitals. The majority of these operations were performed by Dr. Macdonald, Consulting Surgeon to the Hospital. The services of Specialist Consultants were also obtained when necessary, one of the major operations being so performed. In addition to his operative work, Dr. Macdonald paid 107 visits to the hospital at my request for consultative purposes. I would like to take this opportunity of thanking Dr. Macdonald for his never-failing assistance, which is of the utmost value to the hospital. Discharge Procedure.—The discharge procedure detailed in the Report for 1933 has remained unaltered, except that negative nose and throat swabs are now obtained from all patients before their discharge from hospital, no matter what was the nature of the disease for which they had been admitted. Period of Isolation in Hospital.—The average period of isolation in hospital was as follows:— Scarlet Fever.—25.6 days (longest, 97 days—right otorrhœa and tonsillectomy; shortest, 8 days—left against advice). Average duration, 1934—35.4 days. Diphtheria.—56.8 days (longest, 130 days—persistently positive swabs; shortest, 3 hours—died). Average duration, 1934—46.6 days. 75 It will be seen from the foregoing figures that the average stay of the scarlet fever patients treated in hospital decreased by almost 10 days, following the introduction of the new regime. The added severity of the diphtheria cases admitted to hospital is illustrated by the increase in the detention period for that disease, also approximately 10 days. Staff.—(a) Illness.—In addition to the usual minor ailments met with during the year, the following illnesses occurred among the staff:— Scarlet Fever (Nurse) 1 Gastritis (Nurse)1 Influenza (Nurse) 1 German Measles (Nurse) 1 Pleurisy (Nurse)1 Erysipelas (Maid) 1 Quinsy (Ambulance Driver) 1 7 The nurse who developed scarlet fever did so following a severe vaccination reaction, only a few days after commencing duties in the hospital. (6) Immunisation.—Immunisation against diphtheria, typhoid fever, scarlet fever and colds is still being carried out, but, as before, the work is hampered because of the continued high pressure under which the staff is operating. (c) Lectures.—Lectures continue to be given to probationer nurses by the Matron, Mr. Hill, Sanitary Inspector, and myself as Medical Superintendent. This work is somewhat discouraging for those who undertake it, as the personnel continually changes, so that only a percentage of those who commence the course ever finish it. When the proposed extensions are finally accomplished it is greatly to be hoped that the new hospital will be recognised as a full training school, when a more extended course of lectures can be given to a greater number of nurses. At the present moment, with the hospital continuing more or less full throughout the year, the younger nurses are placed under a very severe strain. It is therefore not surprising that they find the course of lectures and the necessary study rather difficult and irksome. Personally, I am actually surprised and rather gratified that so many finish the course and pass the examination. 76 Cross-Infection.—The following cases of cross-infection occurred during the year:— Scarlet Fever in Diphtheria Ward 1 Positive Nasal Diphtheria Swab in Scarlet Fever Ward 2 Total 3 When one considers the large number of cases admitted to the hospital under a mistaken diagnosis, and the fact that several children were admitted to both the scarlet fever and diphtheria wards incubating a second disease which developed during their stay in hospital, I think these figures might be taken as extremely satisfactory. The number of positive diphtheria swabs discovered in the scarlet fever ward fell very considerably during the past year, a fact which can be attributed, at least in part, to the earlier discharge of the patients. Altogether, 1935 probably showed the lowest incidence of cross-infection which the hospital can produce. Fortunately, no cases of measles were imported into any of the wards, one of the greatest problems of Isolation Hospital administration being thus eliminated for one year. Transfers to and from other Hospitals.—The following transfers occurred during the year:— From the Prince of Wales's Hospital 37 cases (Staff 5) ,, North Middlesex County Hospital 7 ,, ,, Chase Bank Nursing Home 2 ,, ,, Grovelands Hospital 1 case ,, Jewish Hospital for Incurables, Tottenham 1 ,, ,, Wood Green and Southgate Hospital 1 ,, Total 49 77 To the Prince of Wales's Hospital 8 cases ,, North Middlesex County Hospital 10 ,, Total 18 Visiting.—The arrangements for visiting patients remain unaltered and still appear satisfactory. Laboratory.—Details of the Laboratory work carried out in connection with the Hospital will be found on page 21. Miscellaneous.—(l) The eldest patient treated in the Hospital during the year was a male aged 78 suffering from erysipelas; the youngest was a child aged seven weeks, also suffering from erysipelas. (2) The main feature of the year's work has been the average severity of the cases admitted and the large variety of diseases treated. Each year appears to throw an increased responsibility upon the shoulders of the nursing staff, but each year they rise to the occasion and give of their best in the work which lies before them. I should not like to let this opportunity pass without once again expressing my gratitude to Miss West, Matron, and to every member of the nursing and administrative staff for the help which they afforded me during the year. Without their cordial co-operation and assistance the whole structure would fall to pieces. That this help has been forthcoming is surely evidenced in the few pages of statistics which have just been submitted. I should also like to thank my deputy, Dr. Burns, who once again rendered invaluable services too numerous to mention, during the year. 78 62 Table V. NOTIFIED CASES OF INFECTIOUS DISEASES,1935. 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. Smallpox - - - - - - - - - - - - - - Diphtheria 25 - - 2 - 1 10 4 1 4 1 2 - 1 Scarlet Fever 133 - 1 3 8 8 65 18 7 19 3 1 - - Typhoid Fever 3 - - - - - 1 - - 1 1 - - - Puerperal Fever - - - - - - - - - 3 - - - Puerperal Pyrexia - - - - - - - - - 6 2 - - 3 Erysipelas - - - - - - - - 1 2 3 11 6 1 Ophthalmia Neonatorum - - - - - - - - - - - - - - Encephalitis Lethargica 1 - - - - - - - - 1 - - - 1 Acute Poliomyelitis 1 - - - - - - - 1 - - - - - Cerebro spinal Meningitis - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - Pneumonia 24 3 - - - - 5 1 - 3 1 6 5 28 Tuberculosis— Pulmonary 42 - - - - - 3 1 3 12 12 10 1 26 Non-Pulmonary 7 - - - - 2 1 - 2 1 1 - - 1 Totals 270 3 1 5 8 11 85 24 15 52 24 30 ' 12 61 80 Ophthalmia Neonatorum, 1935. TABLE VII. Nil Notified . Nil At Home. Treated. Cases. Nil In Hospital . Nil Vision Unimpaired. Nil Vision Impaired. Nil Total Blindness. Nil Deaths Table VI. Cases of Infectious Disease Notified each Month of the Year, 1935. 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. NonPulmonary January - 23 11 - 2 - - - - - - - 2 2 1 41 February - 15 5 - 3 1 - - - - - - 3 6 - 33 March - 19 2 - 1 - 1 - - - - - 3 3 1 31 April - 8 - - 2 - - - - - - - 2 3 l 16 May - 8 - - 5 - 3 - - - - - 3 4 l 26 June - 11 1 - 2 - - - - - - - - 5 l 20 July - 11 - - - - - - - - - - 1 4 1 17 August - 3 4 - 2 - - - - - - - 2 4 - 16 September - - 1 - 2 - - 1 - - - - 2 3 1 15 October - 8 - - 1 - 2 - 1 - - - 2 4 - 19 November - 15 1 - 1 - 1 - - - - - 4 2 - 24 December - 7 - - 2 - 1 - - - - - - 2 - 12 Totals 133 25 3 23 3 8 1 1 - - - 24 42 7 270 TABLE VIII. Tuberculosis, 1935. Age Periods. *New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 yr. - - - - - - - - 1-5 years — — 2 — — — — — 5-10 „ 2 — 1 1 — — — — 10-15 ,, 1 1 — 2 1 — 1 — 15-20 ,, 3 3 2 - - - - - 20-25 ,, 2 4 — — — 2 — — 25-35 ,, 11 4 — 1 2 5 — — 35-45 ,, 7 7 1 1 5 2 — — 45-55 ,, 4 1 — — 3 1 — — 55-65 ,, 4 2 — — 3 1 — — 65 and over 1 — — — 1 — — — Totals 35 22 6 5 15 11 1 — REGISTER OF CASES. Pulmonary. NonPulmonary. Total. M. F. M. F. Cases on Register, 1/1/35 112 73 20 19 224 Cases notified for first time, 1935 27 15 6 1 49 Cases restored to Register 2 — — 1 3 Other Cases added 5 8 - 3 16 Cases removed from Register 38 19 7 5 69 Remaining on Register, 31/12/35 108 77 19 19 223 *These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the District. 81 APPENDIX. 1. Health Publicity. The customary attempt was made during 1935 to carry out adequate and continuous health publicity by means of talks, distribution of suitable pamphlets where and when necessary, topical articles in the local Press and the circulation of the Southgate edition of "Better Health," many of whose introductory articles also appeared in the Press. Continuing the policy of previous years, it was not thought advisable to hold a Health Week or Baby Show in Southgate, although the latter function was at one time suggested. I personally consider the work of continuous health propaganda most valuable, this being a branch of the Public Health services which is now coming to be appreciated at its proper value. Ignorance, not deliberate neglect, is still our greatest obstacle, and only by persistent education and contact can this difficulty be overcome. 2. Insulin. As stated in the report for 1934, a supply of insulin, free of charge, has been provided for four necessitous patients residing in the district, the supply ranging from 20 to 60 units per day. During the past year, the supply to three of the patients was discontinued, upon the reports of the medical practitioners in charge of the cases that the patients no longer required insulin. No new cases requiring assistance were reported during this period. A total of approximately 19,200 units of insulin, costing £6 0s. 0d., was distributed during 1935. Periodical reports continue to be transmitted to the Ministry of Health. 3. Report on Cricket and Fly Nuisance in the Neighbourhood of the Refuse Destructor, submitted to the Public Health Committee, 10th September, 1935. "Since the last meeting of the Public Health Committee several complaints regarding nuisances from flies and crickets have been received from householders residing in the neighbourhood of the Refuse Destructor. 82 "With regard to the complaints of flies the following steps were taken in an endeavour to abate the nuisance:— (а) Certain material at the Refuse Destructor which was considered to be a potential breeding ground for these insects was disposed of to a Contractor. (b) After representations, an accumulation of manure situated on the premises of Messrs. Carter Page, Nurserymen, was adequately covered in and an assurance received that future accumulations would receive similar treatment. (c) Periodical inspections of all allotments in the Borough, particularly those in the vicinity of the Destructor have been arranged with a view to requiring all accumulations of manure, etc., to be adequately covered in. (In this connection I would suggest that a pamphlet be distributed to all allotment holders setting out the danger of the fly nuisance and the suggested precautions to be taken.) (d) Certain houses in which the fly nuisance was particularly bad were sprayed. "At the time of writing this report there is no evidence to show that any immediate danger exists from flies, while the removal of the material already referred to would appear to have eliminated the most obvious breeding ground. At the same time, however, it must be realised that the danger is of sufficient magnitude to necessitate every step being taken to prevent any breeding taking place on a large scale. "With regard to the cricket nuisance a visit was paid to the Refuse Destructor on Tuesday, August 13th, by a Medical Officer of the Ministry of Health and an entomologist from the Natural History Museum when various suggestions were made as to the possible abatement of the nuisance. These suggestions included alterations to the fences separating the Destructor from Carpenter Gardens, the use of crude oil on the dump, the possible use of some form of hydrocyanic acid gas for the purpose of extermination, and the secure battening down of the dump and trimming of the edges, together with preventative measures within the houses affected such as had previously been undertaken. "Following these discussions, the fence separating the houses in Carpenter Gardens from the Refuse Destructor was strengthened at ground level and the services of an unemployed man were 83 obtained to carry out the measures in the houses necessary to discourage the entry of the crickets, this man working under the control of the Public Health Department. (These duties had been previously undertaken by the workman loaned to the Public Health Department by the Surveyor's Department.) "At the moment 96 houses are being visited and being supplied with pyrethrum powder, 20 of these being regularly sprayed inside in addition. The fences surrounding the dump have also been sprayed and numbers of crickets have been killed at these points. It is also interesting to note that residents in Barrowell Green report having seen crickets drop from clinker carts leaving the Destructor. That the crickets are still present in the houses is evidenced by the fact that approximately 30 crickets were found in the pyrethrum powder provided at the rear of Xos. 19 to 27 Carpenter Gardens on a visit paid on Monday afternoon, September 9th. "While the colder mornings and evenings should tend to discourage the breeding of crickets it should be remembered that when fires are lit in the houses and "warm spots" thus created, the crickets will almost certainly migrate towards the warmth and so prolong the nuisance. "Under the circumstances I am of opinion that drastic measures, such as those previously outlined, should be undertaken with a view to preventing the further breeding of crickets within the Destructor premises, and that meantime the preventative, although merely palliative, measures within the houses themselves should be continued. "Up to the present approximately £80 has been spent on pyrethrum powder, while the wages of the unemployed man amount to £2—£2 10s. Od. per week" 4. Extract from Preliminary Report on Procedure under Housing Act, 1935, submitted to the Public Health Committee, 7th November, 1935. "I have had several conferences with the Sanitary Inspectors on this question, and after prolonged discussion have decided to recommend the inspection of all the property within the Borough 84 which, in the opinion of the Sanitary Inspectors, might be suspected of showing any overcrowding. If this course were adopted the following houses would require inspection:— No. 1 District 1,693 No. 2 District 2,054 No. 3 District 3,699 Total 7,446 "No arbitrary house value was decided upon in compiling this list, which was rather arrived at through the personal knowledge of the Sanitary Inspectors. "From the experience of other Authorities which have already commenced the work of completing Schedule A, it has been found that one enumerator can deal with approximately 250 houses per week, and that one clerk is required to deal with the information obtained by six enumerators. Taking the number of houses to be inspected in Southgate as 7,500, and allowing five weeks for the completion of the work under Schedule A, it will be seen that approximately eight enumerators would be required, together with one clerk who could be assisted by the normal Public Health staff. The work under Schedule B could probably be completed by the Sanitary Inspectors with the assistance of one clerk, within a period of four weeks. "The expense ehtailed in this work, assuming that each temporary assistant would receive 3 guineas per week (the sum paid by the Rating and Valuation Officer for similar work), and also allowing for the necessary office equipment and stationery, would therefore be:— £ s. d. 8 enumerators at 3 guineas per week for a period of 5 weeks (Schedule A) 126 0 0 1 clerk at 3 guineas per week for a period of 5 weeks (Schedule A) 15 15 0 1 clerk at 3 guineas per week for a period of 4 weeks (Schedule B) 12 12 0 Cabinet, binders and necessary forms, etc. (Schedules A and B) 21 0 0 Total £175 7 0 85 "As the above-mentioned total is almost entirely composed of wages, and as the work could be done by " black-coated " unemployed, the Committee might consider treating this matter as a means of providing relief for the unemployed. "The enumerators would require authority from the Council to make the necessary inspections. "Following the completion of Schedules A and B, Local Authorities must consider the general housing position of their district with a view to the abatement and prevention of any overcrowding and the setting up of redevelopment areas where necessary. As these matters depend entirely upon the conditions revealed by the housing survey, I propose to defer consideration of them until the necessary information has been obtained." 86