5046-21 M AC 439(0) SOUTHGATETE BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936. WM. CLUNIE HARVEY, M.D., D.P.H.. Medical Officer of Health and Medical Superintendent, Isolation Hospital. Crusha & Son, Ltd., 10, The Triangle, Palmers Green. BOROUGH OF SOUTHGATE. OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936. 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, Cr. Mrss Appleyard and Gentlemen, I have the honour to present to you the Annual Report for the year 1936. The twelve months under review have been satisfactory in almost every respect. In other words, the district has enjoyed a tranquil, and for that reason, relatively uninteresting period. Because of this lack of sensational happenings, and also in view of the fact that much of the material supplied in the Annual Report for 1935 covered the past five years, the information contained in the present Report has been condensed and includes only such data as is required by the Ministry of Health, together with comments upon certain aspects of the Public Health Services which appear to merit special consideration. Thus, particular emphasis has been laid upon housing, and also upon the growth and extension of the Maternity and Child Welfare services within the Borough. As already indicated, the vital statistics for 1936 make extremely satisfactory reading. The death rate has risen very slightly but, as will be seen later, this rise is accounted for by deaths of persons over the age of 60 years; the infantile mortality rate, the toddler mortality rate and the deaths of children of school age and of adolescents, have all declined; the infectious sickness rate establishes a low record for the district; the zymotic death rate has risen, but the rise is due to circumstances over which we had no control; while, for the first time in many years, only one maternal death took place within the Borough. Southgate shared in the widespread measles epidemic during the early part of 1936, but not to a greater extent than did any neighbouring district. It is impossible to compute accurately the actual number of cases which occurred, but there can be no doubt that the total was exceedingly high. 3 The negotiations with regard to the extension of the Isolation Hospital and the establishment of a Joint Hospital District are still proceeding, while the plans of the new hospital are approaching completion. For several years past I have stated that the end of these negotiations appears in view, and there is now every hope that this statement will at last be justified within the near future. The only change in the Public Health Staff during the year was the appointment of a new Health Visitor to take the place of the Health Visitor who resigned in April, 1936. Miss Hart, who secured the appointment, has already proved herself an extremely valuable colleague. Opportunity was also taken during the year to instruct the assistant disinfector, temporarily loaned from the Surveyor's Department, in the driving of a van. The department is now in the position of being able to call upon the services of two qualified van drivers, thus facilitating the work to be carried out. Mention will also be found in the report of the instruction given to several additional members of the department in laboratory technique. As hitherto, Dr. Tate, the County Medical Officer, has supplied statistics regarding School Clinics and Public Elementary Schools within the Borough, information which is most valuable and which is only obtainable through that channel. In conclusion, I should once again like to tender my grateful thanks to the Chairman and Members of the Public Health Committee and to the Members of the Borough Council for the unfailing assistance and courtesy extended to me during the year. To this must be added my grateful thanks to each individual member of the Public Health Staff for their willing co-operation, a co-operation which is none the less welcome for being a virtually accepted fact. I am, Miss Appleyard and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE at December 31st, 1936. Councillor G. Peverett (Chairman). His Worship the Mayor (Alderman Herbert Wauthier, J.P.). Councillor A. R. Abercromby. Councillor W. A. Clarke. Councillor Victor Dover. Councillor T. Mason. Councillor J. Owers. Councillor V. J. Westlake. MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1936. His Worship the Mayor (Alderman Herbert Wauthier, J.P.). Alderman T. Hopper. Alderman G. B. Massa. Councillor Miss G. E. Appleyard (Vice-Chair man). Councillor J. H. Barker. Councillor W. A. Clarke. Councillor A. C. Crane. Councillor G. Peverett. Councillor Owen Roberts. CO-OPTED MEMBERS. Mrs. C. M. A. Vandy (Chairman). Miss H. M. Corry. Mrs. A. L. Davy. Dr. L. Westlake. JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1936. SOUTHGATE REPRESENTATIVES. Councillor G. Peverett (Chairman). Councillor W. A. Clarke. Councillor T. Mason. 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. *Medical Officer of Health and Medical Superintendent, Isolation Hospital: W. C. Harvey, M.D., Ch.B., D.P.H. (Full Time.) *Medical Officer for Maternity Centres: Dorothy M. Catchpool, M.B., B.S., L.E.C.P., M.E.C.S., D.P.H. (Part Time.) *Senior Sanitary Inspector (No. 1 District): L. Skeeles, Cert.E.San.I., M.S.I.A., Cert.E.San.I. Meat Inspection. *Sanitary Inspector (No. 2 District): H. Hill, M.E.San.I., A .M .Inst .S .E., M .S .I.A., Cert .B .San .I. Meat Inspection. *Sanitary Inspector (No. 3 District): A. E. Gooday, Cert.E.San.I., M.S.I.A., Cert.E.San.I. Meat Inspection. Chief Clerk : P. E. Barber. Clerk: Miss M. Munch. ,, Miss L. Clark. Health Visitors: *Mrs. E. M. Eising, S.E.N., S.C.M., E.S.I., H.V. *Mrs. D. A. G. Blake, S.C.M., S.I., H.V. Maternity *Miss D. Donkin, S.R.N., S.C.M, and Child A.E.San.I. (Resigned 9th Welfare. April, 1936.) *Miss E. M. Hart, S.R.N., S.C.M. (Appointed 5th May, 1936.) Miss B. E. Wellman, S.R.N., S.C.M., A.R.San.I., H.V.—Public Health and General. * Part-time Assistant (Maternity Centres): Mrs. A. M. Blann. 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, 1936 64,000 Number of inhabited houses (end of 1936) according to Rate Books 19,252 Rateable Value (1936) £789,167 Sum represented by a penny rate (1936) £3,232 Conditions during 1936 did not vary to any appreciable extent from those of the previous year. The nutritional standard as evidenced by the children attending the welfare centres and also the school children, appears to continue satisfactory. Poverty still exists and with it a certain degree of malnutrition. The milk-inschools scheme and also the various measures undertaken by the Borough Council through the Maternity Department, do much to combat this degree of under-nourishment among the younger members of the population, while the Southgate Social Service Council also plays its part in alleviating those cases of distress which are brought to its notice. There can be little doubt that Southgate's problems in this direction are minor compared with those of many industrial districts, a happy fact for which those who helped to fashion the Southgate of to-day cannot be too highly praised. Our nutritional standard is on the whole extremely satisfactory; we have no serious occupational or industrial factors with which to contend; our amenities are numerous and varied. In short, there is every reason to believe that the coming generation is being given an excellent start in the life which lies ahead. Meteorology.—The total rainfall recorded by the Council's rain-gauge in Broomfield Park measured 25.88 inches during 1936, the daily average being 0.07 inches. The greatest fall in 24 hours occurred on November 11th when 0.92 inches were recorded. The total number of days on which no rain fell was 184. 7 Certain difficulties were encountered in setting up the proposed meteorological station referred to in last year's Annual Report, but the necessary equipment has now been ordered and a suitable site selected for its installation. It is now hoped that the station may be operating within the very near future. RAINFALL RECORDED AT BROOMFIELD PARK. Total Rain for month. Number of 0.01 or more ins Wet Days with 0.04 or more ins. 1936. 1935. 1936. 1935. 1936. 1935. Ins. Ins. Days. Days. Days. Days. Jan. 4.47 1.26 22 14 17 11 Feb. 1.67 2.57 14 15 11 11 Mar. 1.24 0.50 16 6 9 5 April 1.47 2.86 14 20 10 15 May 0.31 1.16 5 8 2 6 June 3.63 3.82 19 19 17 13 July 3.09 0.97 22 6 14 5 Aug. 0.54 2.13 7 7 4 6 Sept. 2.79 3.79 18 19 12 14 Oct. 1.72 3.17 11 13 9 10 Nov. 3.16 4.24 16 23 13 17 Dec. 1.79 2.85 18 21 13 16 Totals 25.88 29.32 182 171 131 129 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. Male. Female. Live Legitimate 620 318 302 Births (Illegitimate 25 12 13 Totals 645 330 315 Birth Rate per 1,000 of the estimated resident population 10.08 Stillbirths 23 14 9 Rate per 1,000 total (live and still) births 34.43 Deaths 631 334 297 Corrected Death Rate per 1,000 of the estimated resident population 9.66 8 Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live and still) births. From Puerperal Sepsis 0 0.00 From other Puerperal causes 1 1.49 Total 1 1.49 Death Rate of infants under one year of age:— All infants per 1,000 live births 43.41 Legitimate infants per 1,000 legitimate live births 43.55 Illegitimate infants per 1,000 illegitimate live births 40.00 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 1 POPULATION. The Registrar-General's estimate of the population at the middle of 1936 was 64,000, an increase of 1,820 over the estimate for 1935. 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 14, as compared with 120 in 1935. The population for the past 5 years has been as follows:— 1932 57,250 1933 58,820 1934 59,997 1935 62,180 1936 64,000 As the birth-rate once again shows a slight decrease, it is still obvious that the increase in population is due to immigration. It will also be obvious that this factor will continue to operate for several years to come. BIRTHS—BIRTH RATE. The nett total births accredited to the district was 645, a decrease of 36 on the preceding year; of these, 330 were males and 9 315 females (12 males and 13 females being illegitimate). The birth-rate was, therefore, 10.08 per 1,000 of the population, as against 10.95 in 1935. The birth-rate for England and Wales for 1936 was 14.8. The total number of births actually registered in the district during the year amounted to 562. MORTALITY. General Mortality and Death Rate.—The nett number of deaths accredited to this district was 631, an increase of 70 as compared with the previous year. This gives a corrected death-rate of 9.66 per 1,000 of the population, an increase of 0.82 on the rate for the previous year, which was 8.84. This rate is still appreciably below that for England and Wales (12.1 for 1936). As compared with 1935, there were increases of 22 deaths from cancer, 13 from heart disease, 11 cerebral haemorrhage, 16 from pneumonia and other respiratory diseases, 10 from tuberculosis and 5 from influenza. There were decreases of 2 deaths from puerperal sepsis, 6 from congenital debility and premature birth and 12 from violence, including suicide. Much more disturbing than the increase in deaths from cancer is the rise in the tuberculosis and respiratory diseases mortality. The deaths from cancer occurred almost entirely in aged persons, and, although death may seldom be a welcome phenomenon, its advent is less tragic in those whose lives have already run the allotted span. Far different is the picture where the victim is young or in the prime of life. There is tragedy in most poignant form, a life cut short by disease which should have been preventable. The increase in deaths from pneumonia and allied respiratory infections can be partly explained by the onset of the influenza epidemic during the latter part of 1936, but no such explanation can be accepted in the case of the tuberculosis mortality. This matter receives further attention later in the Report, and at the moment it need only be stated that the figures regarding tuberculosis mortality and morbidity remain one of the most unsatisfactory features of our vital statistics. 10 It is pleasing to report that no deaths occurred from puerperal sepsis during the year, and that the number of deaths occurring from violence showed a welcome decline. The principal causes of death are shown in Table I on page 13. Table II, on page 14, sets out the distribution of the deaths which occurred during the year according to age groups and sex. From this it will be seen that the age group showing the highest percentage of deaths was the 65 years and over group, with 51.82. Next came the group 45-65 years with 31.22 per cent., after which there was a marked fall to 8.24 per cent. in the age group 25-45. It will also be noted that the age groups containing those individuals from birth to 45 years totalled only 16.96 per cent. of the aggregate deaths. Infantile Mortality.—There were 28 (1 illegitimate) deaths of infants under 1 year of age, which give an infantile death-rate of 43.41 per 1,000 births registered, as compared with 30 deaths and a rate of 44.05 in the preceding year. The rate for England and Wales for 1936 was 59. It will be observed that the infantile mortality rate fell slightly during 1936, and that it is still considerably lower than the figures for England and Wales, which rose from 57 to 59 during the same period. Table 111 on page 15 sub-divides the infant deaths according to the weeks or months at which they occurred. 50 per cent. of the total deaths occurred during the first month, while 85.7 per cent. of these occurred during the first week. Prematurity accounted for 7 deaths, congenital malformations for 4, and pneumonia for 7. All the infant deaths were investigated. Stillbirths.—Twenty-three stillbirths, 1 of which was illegitimate, were accredited to the district for 1936. This is equal to a death-rate of 34.43 per 1,000 total (live and still) births registered, the corresponding figures for 1935 being 19 stillbirths with a rate of 27.14. Maternal Mortality.—The maternal mortality rate—i.e., the number of mothers dying as the result of childbirth per 1000 total (live and still) births,—was 1.49 for 1936. This represents 1 maternal death, which occurred outside the district. Last year there were 3 deaths with a corresponding rate of 4.29. 11 It is especially pleasing to be able to report that only one maternal death took place during the year, although the pleasure is modified by the fact that even this single fatality occurred. The death in question was not due to sepsis and appeared, upon investigation, to have been entirely non-preventable. The fatal issue followed a severe abdominal operation for toxæmia during pregnancy. The steps outlined in last year's Annual Report to increase the facilities available to pregnant women within the Borough and to make the existence of the pre-natal clinic more widely known, are being continued and extended in an endeavour to carry out an adequate campaign against the scourge of maternal mortality. 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 5 deaths during 1936. This represents a corrected death-rate of 0.08 per 1,000 of the total population, and 0.79 per cent. of the total deaths for the year, at all ages. In 1935 there were 7 deaths, giving a rate of 0.11 and a percentage of 1.25. It will thus be seen that the figures show a slight fall. Mortality of Persons over the age of 65.—It will be observed from Table II, on page 14, that slightly more than 50 per cent. of the total deaths occurring during the year took place in persons over the age of 65 (51.82 per cent.). In this connection, it is interesting to note that 10 females died at the age of 90 or over, the oldest being 101 years; while 4 males also died within this age period, the oldest being 94. Zymotic Mortality.—This includes the deaths from the seven principal zymotic diseases, viz. : Smallpox, scarlet fever, diphtheria, typhoid fever, measles, whooping cough and diarrhoea (in children under 2 years of age). There were 7 deaths from the diseases mentioned above, as follows:— Diphtheria, 3; typhoid fever, 2; measles, 1; diarrhoea, 1. The zymotic death-rate for 1936 was therefore 0.11 per 1,000 of the population, as against 0.05 in 1935, with 3 deaths. The figure for 1936 is high by reason of the fact that the deaths of three children who had removed from the district to South Wales were credited to Southgate. These children developed diphtheria several weeks after having left the district for domestic reasons, but they were still counted as residing within the Borough. Had these deaths not been included, the rate would have been practically the same as that for 1935. 12 Table I. Causes of Death During the Year 1936. Causes of Death. Male. Female. Total. Dates per 1,000 of Population. All Causes (Civilians only) 334 297 631 1 Typhoid and Paratyphoid Fevers 2 - 2 0.03 2 Measles .. 1 1 0.01 3 Scarlet Fever .. .. .. .. 4 Whooping Cough .. .. .. .. 5 Diphtheria 2 1 3 0.05 6 Influenza 7 5 12 0.18 7 Encephalitis Lethargica 1 .. 1 0.01 8 Cerebro-Spinal Fever .. .. .. .. 9 Tuberculosis of Respiratory System 15 18 33 0.51 10 Other Tuberculous Diseases 1 3 4 0.06 11 Syphilis 1 .. 1 0.01 12 General Paralysis of the insane, Tabes Dorsalis 3 1 4 0.06 13 Cancer, Malignant Disease 49 54 103 1.58 14 Diabetes 2 4 6 0.09 15 Cerebral Haemorrhage, etc. 9 20 29 0.44 16 Heart Disease 108 78 186 2.85 17 Aneurysm .. 1 1 0.01 18 Other Circulatory Diseases 19 19 38 0.58 19 Bronchitis 8 7 15 0.23 20 Pneumonia (all forms) 16 25 41 0.63 21 Other Respiratory Diseases 7 .. 7 0.11 22 Peptic Ulcer 5 .. 5 0.08 23 Diarrhoea, etc. (under 2 years) 1 .. 1 0.01 24 Appendicitis 5 2 7 0.11 25 Cirrhosis of Liver 3 .. 3 0.05 26 Other Diseases of Liver, etc. 5 .. 5 0.08 27 Other Digestive Diseases 4 7 11 0.17 28 Acute and Chronic Nephritis 11 6 17 0.26 29 Puerperal Sepsis .. .. .. .. 30 Other Puerperal Causes .. .. 1 0.01 31 Congenital Debility, Premature Birth and Malformation, etc. 10 6 16 0.25 32 Senility 3 3 0.05 33 Suicide 2 2 4 0.06 34 Other Violence 9 9 18 0.28 35 Other defined Diseases 29 24 53 0.81 36 Causes ill-defined or unknown .. .. .. .. Totals 334 297 631 9.66 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. 1936. 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 16 2.54 0.25 12 1.90 0.18 28 4.44 0.43 1— 5 years 2 0.32 0.03 3 0.47 0.05 6 0.79 0.08 5—15 ,, 5 0.79 0.08 2 0.32 0.03 7 1.11 0.11 15—25 ,, 6 0.95 0.09 9 1.43 0.14 15 2.38 0.23 25—45 ,, 23 3.64 0.35 29 4.60 0.44 52 8.24 0.79 45—65 ,, 123 19.49 1.88 74 11.73 1.14 197 31 .22 3.02 65 and over 159 25.20 2.43 168 26.62 2.57 327 51.82 5.00 Totals 334 52.93 5.11 297 47.07 4.55 631 100.0 9.66 14 Table III. Infantile Mortality. 1936. 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 Cautts 12 I 1 .. 14 5 6 3 .. 28 1 Smallpox 2 Chickenpox 3 Measles 4 Scarlet Fever 5 Whooping Cough 6 Diphtheria and Croup ... .. .. .. .. .. .. 1 .. 1 7 Erysipelas 8 Tuberculous Meningitis 9 Abdominal Tuberculosis 10 Other Tuberculous Diseases 11 Meningitis (Not Tuberculous) 12 Convulsions 13 Laryngitis 14 Bronchitis .. .. .. .. .. .. 1 .. .. 1 15 Pneumonia .. .. 1 .. 1 3 2 1 .. 7 16 Diarrhœa 17 Enteritis 18 Gastritis .. .. .. .. .. .. 1 .. .. 1 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 23 Atelectasis 3 3 24 Congenital Malformations 1 .. .. .. 1 1 1 1 .. 4 25 Premature Birth 7 .. .. .. 7 .. .. .. .. 7 26 Atrophy, Debility and Marasmus 27 Other Causes 1 1 .. .. 2 1 1 .. .. 4 Totals 12 1 1 .. 14 5 6 3 .. 28 15 Table IV. Vital Statistics of Whole District during 1936 and Six 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 6 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 8.84 30 44.05 1936 (14,000 645 10.08 631 9.66 28 43.41 Comparison of the Rates of the Southgate District with those of England and Wales, and London, for the Year 1938. 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. Typhoid Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 14.8 0.61 12.1 0.01 0.00 0.07 0.01 0.05 0.07 0.14 5.9 59 122 County Boroughs and Great Towns, including London 14.9 0.67 12.3 0.01 0.00 0.09 0.01 0.06 0.08 0.14 8.2 63 143 Smaller Towns (1931 Census Populations 25,000—50,000). 15.0 0.64 11.5 0.00 0.00 0.04 0.01 0.04 0 05 0.15 3.4 55 London 13.6 0.53 12.5 0.01 0.00 0 14 0.01 0 06 0.05 0.14 14.4 66 Southgate 10.08 0.36 9.66 0 03 0.00 0.01 0.00 0.00 0.05 0.18 0.01 43.41 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. The suggestion outlined in last year's Report regarding the enlargement of the accommodation available at the Wood Green and Southgate Hospital has now reached a further stage, and plans are being prepared to carry the scheme into being. This ia most satisfactory and should considerably improve the medical and surgical facilities available to the inhabitants of Southgate. In this connection, it may be noted that the Borough Council is contemplating making an increased grant to the hospital in question in recognition of the work which it is performing on behalf of the Borough. 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. The County Authorities have not yet carried out the expected additions to the accommodation for maternity cases at the North Middlesex County Hospital. This is in many ways regrettable as 6uch accommodation is urgently required, the urgency increasing as time progresses. Isolation Hospital.—The following improvements were carried out at the Isolation Hospital during 1936:— Re-decoration of wards; purchase of additional ward furnishings and equipment; purchase of new furniture for Administrative Block; opening of two tennis courts and puttiing green for use of staff. During the present year, further improvements are contemplated. These will include the usual re-decorations and replacements, the provision of running water (modern type surgical basins) in all the wards, the installation of a signal system in the Cubicle Block, the purchase of the latest type of insulated food 17 trolley, the provision. of a bed-pan sterilizer and special stainless steel equipment, the purchase of the most modern type of oxygentent and intubation set, together with several other improvements designed to maintain the efficiency and up-to-date character of the hospital. The permanent nursing, domestic and out-door staff remained unaltered during 1936. As before, additional nursing staff was obtained when occasion demanded. Mention of the hospital brings immediately to mind the serious loss sustained during the year in the unfortunate death of Mr. Robert Phillips, Borough Engineer and Surveyor. It was only last year that I made mention in this Report of the invaluable services which Mr. Phillips rendered to the hospital, services so great that it will be difficult to find their equal. Every member of the staff felt keenly the loss of Mr. Phillips, and it seems particularly tragic that he was not spared to see the consummation of the many years of unselfish work which he put into the design and planning of the hospital extensions. Nursing Homes.—There are in the district 6 registered Nursing Homes, as against 4 in 1936. They are 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. 5. 116, Aldermans Hill, Palmers Green. 6. 2, Downes Court, Winchmore Hill. 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. The arrangements with the Queen's Nursing Association outlined in last year's Report, whereby the Borough Council were to pay an annual sum to the Nursing Association in respect of services to be rendered within the Borough, have now 18 been completed and are operating in a very satisfactory manner. Special cases requiring nursing in their own homes are referred to the Nursing Association, who carry out the necessary treatment, the Council's Health Visitor acting as liaison officer. These services have been invaluable in several cases and appear to be much appreciated by the recipients. The following table sets out the work carried out under this heading : — Diseases Treated. Cases. Visits. Pneumonia 34 394 Influenza 22 149 Measles 8 90 Measles and Pneumonia 1 19 Mumps 2 19 Complications of Pregnancy 13 166 Ophthalmia Neonatorum 1 26 Miscellaneous Complaints (children under 5) 66 407 147 1,270 The inauguration of this service was a definite step in a forward direction. It meant a closer co-operation between the Nursing Association and the Public Health Department, a cooperation which is most desirable from every viewpoint. It also resulted in the alleviation of considerable suffering and distress, and brought help to poor families who might otherwise have had to make shift without the necessary assistance. Our only difficulty now is to find those cases requiring assistance, so that help can be supplied where it is most needed. With this end in view, I intend to address a communication to all the medical practitioners in the district, reminding them of the available facilities and requesting their co-operation. In addition to the work outlined above, the Southgate Queen's Nursing Association continued to supply its usual excellent services, which are still rapidly extending, to the lasting benefit of the inhabitants of Southgate. During 1936, the nurses made a total of 13,446 domiciliary visits (13,661, 1935). At the Physico-therapeutic Clinic, 1,509 patients were treated, while the total number of treatments given was 8,450. The corresponding figures for 1935 were 1,342 and 7,486 respectively. 19 X-ray facilities are now available at the Physico-therapeutic Clinic, while the same facilities can be transported to the patients' own homes. This is a most useful service which deserves even more recognition than it is at present receiving. As an instance of the progressive character of the Nursing Association, it might also be mentioned that maternity and midwifery cases are now accepted, a branch of the Association's work which may be very greatly extended within the near future. It is my privilege, as Medical Officer of Health of Southgate, to act as a member of the Executive Committee of the Southgate Queen's Nursing Association. I am thus able to keep in close touch with the Association's activities and can vouch personally for the fact that the Association is now playing a well-nigh indispensable part in the social services of the Borough. (b) As indicated in the Report for 1935, home nursing of certain infectious diseases is now being 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 9 midwives practising in the area. These come under the supervision of the County Authority, and none is employed or subsidised by the local Council. The passing of the Midwives Act, 1936, necessitated considerable discussion as to the position which Southgate would adopt under the national scheme. After due deliberation, the Council decided to apply for supervisory powers, this being done in September, 1936. In December, the Ministry of Health informed the Council that the number of midwives' cases undertaken within the Borough was so small that such powers could not be granted. This decision meant that all the powers under the Midwives Act were delegated to the County Council, the Borough Council remaining practically in the same position as hitherto. The County Council are now preparing their scheme, and have already consulted the Borough Council as to the steps which the latter proposed to adopt had they been granted supervisory powers. It is too soon yet to state what the result of the County Council's deliberations will be, but it is highly probable that the work will be placed in the hands of a local voluntary organisation. One thing at least is certain. The County Council's Scheme will affect the Borough Council's activities, particularly with regard to the operation of the 20 present assisted midwives' scheme. Apart from that, the number of official midwives in the district and the treatment meted out to those others not accepted as such, will remain outside the Borough Council's jurisdiction, unless or until any amendments in the present Act are brought into force. 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, 1936. Infant Welfare:— Methodist Hall, The Bourne Mondays 2—4 p.m. Broomfield House Tuesdays 10 a.m.—12 noon. Methodist Hall, Bowes Park Tuesdays 2—4 p.m. Baptist Hall, Grove Road Wednesdays 10 a.m.—12 noon. Community Hall, Southgate Wednesdays 2—4p.m. Methodist Hall, Winchmore Hill Thursdays 2—4 p.m. Pre-Natal:— Broomfield House Thursdays 10 a.m.—12 noon. Immunisation (against Diphtheria) Clinic (Southgate Council).— Broomfield House Thursdays 2—4 p.m. and, by rota, at Public Elementary Schools within the Borough. 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, Oakwood Council School, Chase Road, Southgate, and Holly Park Council School, Friern Barnet. 21 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 reach school age. Institutional Provision for umnarried mothers, illegitimate infants and homeless children. No change from the arrangements noted in the Report for 1930. Ambulance Facilities.—The details set out in last year's Report regarding ambulance facilities available within the Borough remain as there stated, with two alterations, both intended to improve the existing service. Accident cases are now removed free of charge if the "accident" occurs anywhere within the Borough. Previous to this decision, such cases were only removed without cost if the "accident" occurred in the street. This new procedure has obviated certain cases of hardship, and appears to be operating in a satisfactory manner. All "accidents" must be certified by the Medical Officer of Health. The second alteration to the facilities set out in last year's Report consists of the provision of electrically heated blankets and resuscitating apparatus in all ambulances, instead of the accident ambulance only as hitherto. All cases in which there is doubt as to the exact charge incurred are referred to the Medical Officer of Health before being dealt with by the Treasurer's Department. All cases where the services of the ambulance are asked for to remove cases resident outside the Borough or to undertake long journeys, are also referred to the Medical Officer of Health. Council Employees.—Fifteen Council employees were examined at the Town Hall during 1936, either for admittance to the superannuation scheme or before being accepted into the Council's service. 22 Mortuary.—During 1936, 31 bodies were deposited in the Council's mortuary situated at the rear of the Town Hall. The present mortuary was considered inadequate for its present purpose and plans have been prepared for the erection of an up-todate. suitably equipped structure, containing post mortem room, body store and viewing room. This building will occupy a site at the rear of the Town Hall, convenient of access yet suitablyscreened from the road. Its provision has been a long-felt need and will mark yet another step in the Public Health progress of the Borough. 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 1936. Once again, the provision of a laboratory within the Borough has proved of definite value. The scope of the laboratory is gradually being extended, particularly in the direction of milk examinations. We may now look forward to the day when the new hospital will be constructed, with a larger and more completely equipped laboratory. When that day arrives, it is sincerely to be hoped that the facilities provided may be available to the Borough of Southgate as a whole, as well as to the Joint Hospital itself. Opportunity has been taken during the year to train an additional Sanitary Inspector and the Chief Clerk of the Public Health Department in the technique of laboratory work. This places us in a more secure position as regards stand-bys during holiday or illness periods. Work carried out at the Council's laboratory during 1936:— Hospital. Borough. Positive. Negative. Positive. Negative. Swabs for Diphtheria Bacilli 462 3,027 17 340 Swabs for Haemolytic Streptococci — — 11 29 Sputa for Tubercle Bacilli — 1 17 143 Total 4,047 (Total, 1935—4,447). 23 Specimens sent to Clinical Research Association during 1936- Positive. Negative. Total. Swabs for Diphtheria Bacilli - 1 1 Swabs for Hæmolytic Streptococci - 1 1 Blood for Widal Test (Typhoid) 7 20 27 Faeces 6 25 31 Sputa for Tubercle Bacilli 1 - 1 14 47 61 In addition, 4 specimens of cerebro-spinal fluid and 1 of exudate were examined by the Association. Specimens sent to the laboratory at the Prince of Wales's Hospital during 1936 :— Positive. Negative. Diphtheria swabs for virulence test 8 2 Failing to incubate Diphtheria Bacilli - 8 8 10 Total 18 BACTERIOLOGICAL EXAMINATION OF MILK. The work carried out at the laboratory in connection with milk has followed closely upon the lines of the previous year, except that certain pieces of new equipment have been purchased which allow of more accurate results being obtained. In view of the passing of the Milk (Designations) Order, 1936, the routine will be further altered during 1937. Additional tests are now required, and arrangements are being made to carry these tests into effect. Summary of Work carried out during 1936. Total number of samples examined 224 Samples examined for total bacterial count 224 Samples examined for presence of bacillus coli 224 Samples examined for presence of tubercle bacilli 115 Samples of Non-designated Milks, including Raw Milk, Pasteurised (Non-designated) Milk, Sterilised Milk and Irradiated Milk, examined 111 24 Percentage of satisfactory results as regards total bacterial count 97.2%. Percentage of satisfactory results as regards b. coli content 91.8% Average bacterial count 34,597 Samples of Designated Milks examined 113 Certified Milk 7 Grade A (Tuberculin Tested) Milk 8 Grade A Milk 2 Grade A (Pasteurised) Milk 3 Tuberculin Tested (Certified) 13 Tuberculin Tested 18 Tuberculin Tested (Pasteurised) 5 Accredited 5 Pasteurised Milk 52 Certified Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 15,185 Grade A (Tuberculin Tested) Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 21,500 Grade A Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 30,900 Grade A (Pasteurised) Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 15,396 Tuberculin Tested (Certified) Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 34,868 Tuberculin Tested Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 33,159 Tuberculin Tested (Pasteurised) Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 19,094 Accredited Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 22,875 Pasteurised Milk. Percentage of samples satisfactory in every respect 100% Average bacterial count 28,658 No tubercle bacilli were found in any of the 115 samples examined. 25 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 Wash houses 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 ot Home Office, 17. 1. 1912. 17. 1. 1912. Parts VIII and IX. 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, and V. 15. 8. 1913. The Southgate Urban District Council Act, 1913, amended by Southgate Urban (Local Act) Order, 1926. BYE-LAWS AND REGULATIONS. 25. 9. 1923. Bye-laws with respect to Chase Side Recreation Ground. 13. 7. 1928. Bye-laws 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. Bye-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. 7. 1934. Bye-laws with respect to nuisances in connection with the removal of offensive or noxious matters in the Borough. 26 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 in the Borough. 24. 9. 1935. Bye-laws with respect to petroleum filling stations in the Borough. 24. 9. 1935. Regulations as to pleasure grounds. 20. 3. 1936. Bye-laws as to nuisances. 19. 8. 1936. Rules as to allotment gardens. 23. 10. 1936. Bye-laws for the good rule and government of the Borough. 11. 12. 1936. Bye-laws as to pleasure grounds. Arrangements have been made for the adoption of bye-laws with respect to hairdressing and massage establishments during 1937. 27 Maternity and Child Welfare Services. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1936. Number on Registers :— Under 1 year. Over 1 year. Totals. 1935. January 1st, 1936 297 633 930 923 December 31st, 1936 418 1,553 1,971 1,595 New cases during 1936— Southgate 527 341 868 709 East Barnet 74 22 96 51 of the Southgate new cases under 1 year were "removals" into the district. The remaining 476, therefore, represent 73.80 per cent. of the total births credited to the district. Attendances at Centres, 1936:— Under 1 year. Over 1 year. Totals. 1935. Broomfield House 1,371 828 2,199 2,568 Bowes Park 1,398 985 2,383 2,453 New Southgate 1,632 1,479 3,111 2,017 Southgate (Jan. 1—Feb. 26 only) 472 383 855 4,479 Winchmore Hill 2,042 1,855 3,897 4,288 Community Hall (Mar. 4— Dec. 30 only) 1,066 1,762 2,828 - The Bourne (Mar. 2—Dec. 28 only) 1,548 811 2,359 - Totals 9,529 8,103 17,632 15,805 Average 32.19 27.37 59.56 61.98 28 Number Seen by Doctor:— Under 1 year. Over 1 year. Totals. 1935. Broomfield House 539 402 941 1,092 Bowes Park 524 434 958 974 New Southgate 577 527 1,104 846 Southgate (Jan. 1—Feb. 26 only) 148 111 259 1,410 Winchmore Hill 652 650 1,302 1,394 Community Hall (Mar. 4— Dec. 30 only) 345 519 864 - The Bourne (Mar. 2—Dec. 28 only) 499 314 813 - Totals 3,284 2,957 6,241 5,716 Average per session 11.09 9.99 21.08 22.41 Percentage of total attendance seen by Doctor 34.4% 36.5% 35.4% 36.2% Number of Sessions held .. .. .. 296 Talks and Practical Demonstrations in Mothercraft given at Centres 39 Any cases requiring treatment are referred to their own doctors or to hospital. STATISTICS OF ATTENDANCES AND WORK DONE AT PRE-NATAL CENTRE. Number on Register :— 1936. 1935. January 1st 54 71 December 31st 69 54 New cases during the year 194 182 The number of new cases during the year represents 29.04% of the total births (live and stillbirths). Number of sessions held 52 51 Prospective mothers are only examined at the Pre-Natal Centre by appointment. 29 Postcards are sent, prior to each session, inviting the attendance of certain of those on the register. 1936. 1935. Total attendances 669 666 Average per session 12.86 13.06 Number seen by Doctor 630 603 Average per session 12.11 11.82 Percentage of total attendance seen by Doctor 94.1% 90.5% Percentage of mothers attending Antenatal Centre 29.04% 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:— 1936. 1935. First visits 416 496 Under 1 year of age 1,162—In addition to— 1,480 Over 1 year of age 3,256— first visits. — 3,023 Visits re:— Deaths under 5 years of age 13 22 Stillbirths 9 14 Ophthalmia neonatorum cases 3 - Pre-natal visits 392 464 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.) 1,150 1,190 Total visits 6,403 6,691 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 operate in a satisfactory manner 30 As will be seen from the statistics set out in the previous few pages, the work of the Clinics has continued unabated throughout the year. The opening of the new Clinic at The Bourne has increased the available facilities, and it is already evident that there is a substantial demand for the services provided. The number of attendances made at the Centres has increased by almost 2,000. On the other hand, the number of domicilliary visits paid has fallen. This is accounted for by the fact that, during a considerable portion of the year, one of the Health Visitors was absent owing to sickness; while, during yet another portion of the year, the work of the Department had to be carried on without the services of the third Health Visitor. The fullest advantage is still not yet taken of the facilities available at the Pre-natal Clinic. In this connection, it may be stated that arrangements have now been completed with the Middlesex County Council whereby cases entering the North Middlesex County Hospital for confinement will be referred to the Council's Pre-natal Clinic for supervision. This is an excellent arrangement and provides a much closer liaison between the hospital at which the confinement may be expected to take place and the Council's officers, than was hitherto possible. It is anticipated that the numbers at the Clinic will rise following the inception of this scheme, a satisfactory feature in itself, but not in any way so important as the co-ordination to which reference has already been made. 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 12 Number of foster children 13 Total visits paid 156 No case of neglect was discovered during the year. Miscellaneous Statistics. 1936. 1935. Births registered in the district 562 533 Attended by Midwives 131 135 Un-notified Births 18 18 Percentage of Births notified 96.8% 96.6% Stillbirths notified 18 18 Stillbirths notified by Midwives 5 - Stillbirths notified by Doctors 13 18 Stillbirths notified occurring in Institutions: In the district 2 - Outside the district 6 5 31  1936. 1935. Maternal Deaths 1 3 Infant Deaths:— Under 1 year of age 28 30 Under 1 month (inc. above) 14 19 1 to 5 years of age 5 7 Number of Southgate Births in North Middlesex Hospital Maternity Home 94 84 Infant Mortality amongst children attending Centres 14 4 (4 over, 10 under 1 year.) (2 over, 2 under 1 year.) Number of cases in which milk was granted:—1934, 117; 1935, 225; 1936, 241. Approximate cost:—1934, £248; 1935, £731; 1936, £776. Grants of Trufood were made in 10 cases, Cow and Gate in 10 cases, and Allenbury's in 9 cases; while grants of cod liver oil emulsion and cod liver oil and malt were allowed in 81 and 68 cases respectively. List of Foods Sold at Centres. £ Trufood, amounting to 150 (approximate) Cow & Gate, amounting to 103 ,, Dental Treatment.— The arrangements outlined in last year's Report have operated in a satisfactory manner. There is every evidence to show that Southgate mothers and children are receiving adequate treatment at the Eastman Dental Clinic, and I see no reason to alter the existing conditions. Number of "Council" patients attending Clinic, 1936. . 42 Cost of such cases £60 16 6 Part Payment of Midwives' Scheme.— Forty-five applications were dealt with under this scheme during 1936. 38 awards were made, totalling £67 0s. 0d.; 1 compensation grant of £1 1s. Od. was made to a midwife in respect of a patient sent to hospital. 7 applications were refused as the family income was above the approved scale. A slight alteration in the existing scale of assistance is contemplated in the near future. This will extend the scale and ease the burden oh those parents with small families. As the Middlesex 32 County Council will operate the provisions of the new Midwives Act, it is very probable that this part of the Council's work will be taken over. As the scale which they propose to adopt is at least as generous as our own, it would appear that Southgate mothers will not suffer in any way following the change-over. Attendance at Centres of Non-Southgate Mothers.—As the Hertfordshire County Council are contemplating the construction of a Welfare Centre in East Barnet at an early date, we may look forward to the time when we will no longer be required to treat large numbers of non-Southgate mothers at our Centres. Following the rapid erection of houses on our borders, these numbers have been increasing month by month until the position has become wellnigh impossible. Southgate has agreed to accept East Barnet mothers until such time as the East Barnet Centre is available, always provided that this can be done without jeopardising the services available to our own inhabitants. The Committee has given this matter its careful consideration from time to time and will doubtless oontinue to do so until the position is finally re-adjusted. The following table sets out the number of non-Southgate mothers who attended the various Centres during the year. East Barnet District. The Bourne 74 Broomfield House - Bowes Park - New Southgate 38 Community Hall 11 Winchmore Hill - Pre-Natal 10 Voluntary Helpers.— The Voluntary Helpers' Committee again carried out most useful work in connection with the Centres within the Borough throughout the year. Their Annual Christmas Party was an unqualified success, but it must not be thought that the holding of this party is the sum total of the Voluntary Helpers' activities. Their usefulness is apparent in many other directions, and the Maternity and Child Welfare services undoubtedly owe them the deepest debt of gratitude. General.—One of the most interesting features of the past six years' work has been the growth and extension of the Maternity and Child Welfare services within the Borough. Some idea of the 33 expansion of these services may be gathered from a perusal of the alterations and additions which have been made to the available facilities since 1931. These include :— Extension of milk grants to mothers during second three months of pregnancy and to children over the age of three years, together with expansion of Council's scale for necessitous families; granting of free milk to all cases, instead of free and half price as previously; institution of assisted midwives' scheme and expansion of same; reorganisation of dental scheme; making of arrangements with Salvation Army Mothers' Hospital, Clapton, and Royal Northern Hospital, for reception of maternity cases from within the Borough; provision of maternity sets free or at cost price; opening of new Centre at The Bourne and removal of another Centre to newer and more commodious premises at the Community Hall; engagement of additional Health Visitor; making of grants to mothers in an endeavour to eliminate the danger of handywomen; provision of Home Helps; provision of artificial sunlight facilities at the Southgate Queen's Nursing Association's premises, for children attending Welfare Centres; institution of scheme for removal of tonsils and adenoids; co-operation with North Middlesex County Hospital for examination of pregnant women at Prenatal Clinic; offer of immunisation against diphtheria to all children attending Welfare Centres. It is extremely difficult to computate the effect which these services have had upon the health of the mothers and children of Southgate. Their value cannot be estimated from a study of mere statistics. The number of maternal deaths within the district has been so small that it can hardly be expected that this will materially be reduced; the infantile mortality is so satisfactory that one could scarcely anticipate a further reduction. For any conception of the advantages conferred upon the district by the unceasing vigilance of the Maternity and Child Welfare Committee, one must look to the mothers and children themselves. The healthy appearance of the mothers, infants and toddlers attending the Centres, a fact which must be apparent to anyone visiting the Clinics; the high nutritional standard of the child population of the Borough as a whole; the low sickness and morbidity rates; and above all, the splendid standard of physique exhibited by our school children —those are the living memorials to the Committee's continued endeavours. There can be little doubt that the Maternity and Child Welfare Committee is making a magnificent contribution to 34 the welfare of Southgate, and there can be even less doubt that the effects of those efforts will become more and more apparent as the years pass by. The future of Southgate may well be said to lie within the Committee's hands. The policy adopted has been progressive and, in the right sense of the word, generous. Such being the case, one can look forward to the future with a complete sense of equanimity. Further extensions of the Maternity and Child Welfare services are contemplated in the near future. Thus, the milk grants and midwives scales are receiving further attention, with a view to their revision and extension. Premises are being sought for the erection of a new and up-to-date Maternity and Child Welfare Clinic in the southern portion of the district, an area which has not been adequately served for some time. An attempt is also being made to establish at least one creche within the Borough and to persuade the Middlesex County Council that the provision of a nursery school is extremely advisable. These are but further stepping-stones in the path of progress. The Maternity and Child Welfare services can never stand still. As their responsibilities increase, their horizon must continue to extend. As I have endeavoured to indicate, we have much upon which to congratulate ourselves. Even more work lies before us in the immediate future. PUBLIC ELEMENTARY SCHOOLS. The arrangements for co-operation between the County School Medical service and the Public Health Department remain as outlined in last year's Annual Report. Several visits were paid to elementary schools following multiple cases of infectious disease, while immunisation was also carried out at two schools ill the district. One visit was paid to a secondary school for the purpose of giving a lecture on Public Health to the senior scholars. This talk will be repeated during 1937. 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 1936 was as follows :— 35  Inspected. Requiring Treatment. Entrants 669 62 Intermediates 376 33 Leavers 459 61 1,504 156 Other ages 161 26 Special 4 - 165 26 1,669 182 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, at Oakwood Council School, Southgate, on Tuesday 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 1936 was as follows :— New Cases. Attendances. Treated. Not requiring Treatment. Winchmore Hill 1,175 3,894 1,103 72 Oakwood 393 1,044 388 5 Holly Park 241 582 176 65 1,809 5,520 1,667 142 (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 nine children attended the clinic and were seen by the Ophthalmic Surgeon during 1936. Spectacles were prescribed and provided for 146 of these. The corresponding figures for 1935 were 220 and 128 respectively. (e) Dental Clinic.— Dental treatment of school children is carried out by Mrs. A. M. Ferry, L.D.S., one of the County 36 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). Two thousand one hundred and ninety-five children were dentally inspected at the schools during the year, as against 1,227 in 1935, while 1,519 attended at the clinics (1935, 998) where they received treatment for various dental defects. 37 Sanitary Circumstances of the Area. Water.— The circumstances as to the water supply of the district remain as set out in the report for 1934, and continue satisfactory. Swimming Bath.— The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows :— 1935. 1936. Mixed Bathers, Adults 39,870 21,688 Mixed Bathers, Children 39,369 24,174 Season Ticket Holders (attendances) 18,202 15,497 Totals 97,441 61,359 Spectators, Adults 3,425 2,414 Spectators, Children 1,308 1,000 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.— Comparatively few complaints have been received regarding unpleasant odours from neighbouring sewage farms. The smell emanating from the East Barnet Sewage Farm still continues, however, and no alteration in the existing circumstances can be expected until the reconstruction scheme at present being carried out has been completed. Drainage and Sewerage. -The arrangements for drainage, sewerage, and sewage disposal remain materially as set out in the Report for 1930. The flooding of the sewers in the north-west portion of the district which occurred during June, 1936, was definitely disturbing, as is also the periodical flooding which occurs in other parts of the Borough. The rainfall during the preceding period was certainly phenomenal, but one does not like to think that such an occurrence might repeat itself in the near future. The potentialities for harm following such flooding are enormous, quite apart from the inconvenience caused to the inhabitants of the neighbourhood affected. For this reason it is to be hoped that the drainage and sewerage of 38 the district will receive the Council's serious and immediate attention, and that any existing defects in the general arrangements will be rectified at a very early date. It is pleasing to report that the Council has decided to hire a mechanical street gully cleanser. This apparatus was long overdue and will be a welcome addition to the Public Health utilities of the district. Cesspools.—The number of cesspools remaining in the district is 18. These continue to be cleansed periodically by a contracting firm which carries out the work in an unexceptionable manner. Roads.—There are now more than 81 miles of roads in the district, made up as follows :— County Roads 12.39 miles. Arterial Roads 1.89 ,, District Roads 52.01 ,, 66.29 ,, Private Roads 15.03 ,, 81.32 ,, Public Conveniences.— The new conveniences mentioned in last year's Annual Report continue to operate satisfactorily, good use being apparently made of them. The lack of a suitable convenience in the New Southgate portion of the district is still making itself felt. Following representations to the Public Health Committee, the hours of opening were extended in respect of the North Circular Road convenience. This has considerably extended the usefulness of the convenience, whose site makes it imperative that it should remain open to a later hour than is necessary in the case of more isolated conveniences. Collection and Disposal of Refuse.— The system of refuse collection detailed in the Annual Report for 1935 remains unaltered, with the exception of certain minor, operative details. The system still appears to meet the needs of the district in ah adequate manner, although the future is not being lost sight of. Additional vehicles and apparatus are being obtained, to cope with the increasing demands on the service. The time does not yet seem to have arrived when the refuse destruction plant itself requires 39 extension, but, with the rapid growth of the district, it is unlikely that this extension can be indefinitely postponed, unless some alteration in the hours or system of working is instituted. Minor complaints continue to be received and are dealt with by the Surveyor's Department. Not a single complaint was received during 1936 as to fly or cricket nuisance around the destructor, or, for that matter, in any other portion of the district. This is extremely satisfactory, but may be attributed, in great part at least, to the inclement weather experienced during the summer of 1936. Arrangements are still ready to cope at short notice with any recurrence of the cricket nuisance which marked the summer and autumn of the previous year. The following is a brief summary of the work carried out during the year :— No. of days worked—Hired Horses 226 Pagefield Containers 1,114 ,, ,, ,, Freighters 621 ,, ,, ,, Hired Lorries 70 No. of Loads to Destructor 7,448 Total Weight to Destructor 15,613 tons. No. of Loads to Shoots 466 Total W eight to Shoots 560 tons. Smoke Abatement.— The following is a summary of the work carried out during 1936 under the Smoke Abatement Act, 1926 :— One hundred and forty-seven observations were made on chimneys within the Borough. One contravention of the Bye-law was noted during the year. Notice of the offetice was served and the matter reported to the Pubic Health Committee. The offender was warned. 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 from these sources are now showing a rapid decrease as the district becomes more fully developed. Very few complaints were received during 1936 as to ponds, but several complaints regarding the improper use of pieces of waste ground were dealt with. These complaints are not 40 momentous in themselves, although they cause the Public Health Department no little inconvenience. It is very difficult to obtain a permanent abatement of the nuisance, while continued vigilance is required to ensure that the instructions issued by the Department are carried out. The matter is very often one for the Police rather than the Public Health Department, but we have co-operated so far as lies within our powers upon several occasions. 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.— All the schools within the district continue to receive periodical inspection from the Sanitary Inspectors. No serious defects were discovered during 1936. It is understood that Cockfosters Church of England School will shortly be closed and that the pupils will be transferred to other schools in the neighbourhood. This is a progressive measure, as the school premises in question have long outlived their period of usefulness. One new school was opened in the district during the year—De Bohu'n School in Green Road. This is a modern, well-planned structure and ranks as one of the best of its kind within the County. Rag Flock Acts, 1911 and 1928. —There are no premises in the district manufacturing, selling or using Rag Flock aocording to the Acts. 41 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). Seven 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, 10 for Pasteurised Milk, 4 for Grade A Pasteurised Milk, and 2 for Accredited Milk were granted during the year. No milk, other than that contained in sealed bottles, is retailed from any general shop in the district. With certain minor exceptions, the standard of milk sold within the Borough is satisfactory. There is evidence to show that improvement is still taking place, and, although it has just been stated that the standard is satisfactory, there is still room for such improvement. Perfection is impossible at the present moment, but any standard which shows considerable deviation from the optimum should be considered highly undesirable. The fact that six Southgate residents contracted typhoid fever during the year following the consumption of raw, unpasteurised milk at one or other of three seaside resorts, points to the vital necessity of safeguarding the nation's milk supplies, a subject which the Public Health Committee has had under consideration upon several occasions. Until the country's supplies are rendered safe, the danger will exist, and at any time and at any place where raw milk is consumed in bulk a repetition of the recent epidemic may occur. It should also be noted that this applies equally to the possibility of sporadic oases of tuberculous infection occurring from the same source. Several Corporations are considering the advisability of seeking powers to make the pasteurisation of all milk 42 supplies entering their district, compulsory. This would appear an entering their districts, compulsory. This would appear an exceedingly wise step under existing conditions, although it is merely shifting a national responsibility on to the shoulders of the Local Authorities. Infringements.— The following infringements were discovered and rectified during the year:— 1. Milk (Special Designations) Order, 1923— Selling Pasteurised Milk without licence 1 2. Milk and Dairies Order, 1926— Retailing milk without being registered as Retail Purveyor 3 Veterinary Examination of Cows.— This was undertaken, as before, by the Middlesex County Council. Inspection of Cowsheds, Dairies and Milkshops.— The cowsheds, dairies and milkshops in the district were regularly inspected throughout the year, the conditions found therein being satisfactory. As noted in last year's Annual Report, the examination of milk samples undertaken at the Council's laboratory provides an extremely valuable check upon such inspections. Meat.— There are no public abattoirs in the district. Butchers' shops are visited frequently, while slaughterhouses are kept under strict control. As will be seen from the table appearing below, the total number of carcases examined during the year has shown an enormous increase, no less than 300 per cent. over that of 1935. As a corollary, the number of visits paid to slaughterhouses has also risen by more than 400, the total visits paid during 1936 being more than double those made two years previously. When it is remembered that these visits are not fleeting in character, but entail the spending of a considerable amount of time in the slaughterhouse, and that they must often be paid after office hours and during weekends, it will be realised that this work places a definite onus upon the Sanitary Inspectors. The work must be carried out, however, as it is of the utmost importance. 43 The following is a summary of the work carried out during 1936:— Total number of carcases examined, 17,825. Bovines, 78; Sheep and Lambs, 7,298; Calves, 382; Pigs, 10,067. (1935. Bovines, 84; Sheep and Lambs, 3,691; Calves, 112; Pigs, 2,105. Total, 5,992.) As a result of these examinations, 376 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. 19 separate portions affected with Tuberculosis 1,563 2 ,, ,, ,, ,, Abscesses 18 1 ,, portion ,, ,, Bruising 40 1,621 Calves. 1 separate portion affected with Immaturity 64 Sheep Carcases. 1 separate portion affected with Cirrhosis 2 1 ,, ,, ,, ,, Abscesses 6 6 ,, portions ,, ,, Distoma 14 22 Pig Carcases. 294 separate portions affected with Tuberculosis 3,288 5 ,, ,, ,, ,, Pneumonia .. 26 39 ,, ,, ,, ,, Cirrhosis 200 1 ,, portion ,, ,, Acue Septicaemia 110 6 ,, portions ,, ,, Swine Erysipelas 605 4,229 5,936 (53 cwts.) 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:— 44 Animals. All Diseased Conditions. Tuberculosis. Slightly Affected. Extensively Affected. Slightly Affected. Extensively Affected. No. % No. % No. % No. % Bovines— 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 1936 17 21.79 5 6.41 14 17 .94 5 6.41 Sheep— 1934 2 0.05 - - - - - - 1935 4 0.10 - - - - - - 1936 8 0.10 - - - - - - Calves— 1934 - - - - - - - - 1935 - - 1 0.80 - - - - 1936 - - 1 0.26 - - - - Pigs— 1934 9 1.32 - - 6 0.88 - - 1935 71 3.37 4 0.19 57 2.70 3 0.14 1936 331 3.27 14 0.13 287 2.85 7 0.06 Although the list of diseases found in the animals slaughtered and the total amount of meat, etc., surrendered may appear formidable at first glance, these figures must be considered in the light of the number of carcases examined during the year. The percentage of unsound meat is relatively exceedingly small, and should be taken as ah indication of the high quality of Southgate's supplies. Infringements.— The following infringements were discovered and dealt with during the year:— 1. Slaughter of Animals Act, 1933. Animals being killed without being first effectually stunned with a mechanically operated instrument 2 Other Foods. —The bakehouses, fish, fruit and grocers' shops situated within the district continue to be kept under observation. The remarks which I made in last year's Annual Report regarding the lack of adequate legislation controlling these premises still apply. Much as we should like to effect still further improvements in existing conditions, our hands are tied by the antiquated legal machinery at present provided. Seven boxes (98 lbs.) of kippers and 84 lbs. cod fillets were voluntarily surrendered during the year. 45 Shops Act, 1934.— A summary of the work carried out under this Act will be found set out, together with the details relating to the sanitary inspection of the area. This will reveal the fact that extra work has been thrown upon the shoulders of the Sanitary Inspectors and Health Visitor. Again it must be stated that this work is of great importance since it safeguards, not only the interests of the employees working in the premises concerned, but also the interests of the general public as a whole, particularly where shops retailing foodstuffs and perishable goods are concerned. Still further and more frequent inspection of shops will be required when the proposed bye-laws with respect to hair-dressing establishments comes into force. 46 Sale of Food and Drugs Act. The duties under the Food and Drugs Act are administered by the Middlesex County Council. The following particulars of samples taken in the district during the past year were supplied by the courtesy of the Chief Officer of the Public Control Department:— Articles. Samples Taken. Found Adulterated. Milk 92 2 Butter 2 - Cinnamon 1 - Hake 5 - Lemon Sole 4 1 Sausages 4 - Cocoa 1 - Mustard 1 - Gin 1 - Rum 1 1 Whisky 2 - Meat Paste 1 - Sugar 1 - 116 4 47 ANNUAL REPORT, 1936 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 1936 1935 1936 Factories (including Factory Laundries) 546 415 22 31 .. Workshops (including Workshop Laundries) 358 251 36 21 .. Workplaces (other than Outworkers' premises. included in Part 3 of this Report) 40 18 16 .. .. Total 950 684 74 52 .. 2.—DEFECTS FOUND. Particulars Number of Defects Found. Remedied. Referred to H.M. Inspector. No. of Prosecu tions. 1935 1936 1935 1936 Nuisances under the Public Health Acts:—* Want of Cleanliness 82 39 81 39 .. .. Want of Ventilation 1 1 1 1 .. .. Overcrowding .. .. .. .. .. .. Want of Drainage of Floors 1 .. 1 .. .. .. Other Nuisances 23 13 23 11 .. .. † Sanitary Accommodation Insufficient 2 .. 2 .. .. .. Unsuitable or Defective 22 11 21 10 .. .. 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 64 133 61 .. .. *Including those specified in Sections 2,3,7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. † Section 22 of the Public Health Acts (Amendment) Act, 1890, was adopted in 1890. 48 49 3.—Home Work. Nature of Work. Outworkers' Lists, Section 107. Prosecutions. Outwork in Unwholesome Premises, Sec 108 Outwork in Infected Premises. Sees. 109 & 110. Lists received from Employers. Notices served on Occ'prs as to keeping or sending Lists. Failing to keep or permit inspection of lists. Failing to send lists. Twice in the year. Once in the year. Instances. Notices Served Prosecutions. Instances. Orders Made. (S.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 .. 16 .. .. .. .. .. .. .. .. .. .. .. .. 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. (1) No. (2) Class. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) .. Bakehouses 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 1 Laundries 2 Other Workshops 199 Reports of action taken sent to H.M. Inspector 1 Total Number of workshops on Register 206 Other .. Underground Bakehouses (s.101):- Certificates granted during the year .. In use at the end of the year .. SANITARY INSPECTION OF AREA. The various tables set out in the following pages detail the work of sanitary inspection carried out within the Borough during 1936. These tables are of no little interest, and from them several important facts emerge. The housing inspections have risen by almost 1,000, very largely due to the additional work entailed under the Housing Act, 1936. As previously indicated, visits to slaughterhouses have increased by more than 400. Factory and workshops visits have decreased by slightly more than 200, in itself an eminently satisfactory feature when it is remembered that the decrease is due to the absence of re-visits necessitated in former years by the continued lack of cleanliness. Finally, visits paid in connection with infectious diseases have risen by no fewer than 1,400. This latter rise is due, partly to the more frequent visits paid by the Health Visitor following information received regarding notifiable and non-notifiable infectious diseases, and partly to the very large number of measles cases which occurred within the Borough during the winter and spring of last year. The total number of inspections carried out during the year has risen by more than 3,000. This need not be taken to imply that the district requires more inspection by reason of depreciation and other undesirable elements, the increased total being explainable upon the grounds already stated. The total number of informal notices served has decreased by more than 600, while the statutory notices remain at the same low level as 1935 (8). This is quite a satisfactory feature of the sanitary work, and illustrates the fact that, by tactful and persuasive means, it is possible to achieve results without having recourse to more stringent, coercive methods. Inspections. 1934. 1935. 1936. Housing inspections and re-inspections 5,915 4,419 5,323 Slaughterhouse visits and inspections 488 660 1,086 Factories and workshops (including bakehouses) visits and inspections 1,108 1,033 772 Dairies, cowsheds, milkshops and other food shops, visits and inspections 2,231 3,327 2,977 Various complaints, inspections and reinspections 1,529 1,660 1,476 Dustbins, inspections and re-inspections 1,146 1,672 2,076 Infectious Disease visits and re-visits 2,459 2,664 4,080 Other inspections (Rent Acts—Rats and Mice Destruction Act—Ditches and Ponds -— Accumulations — Non-notifiable Diseases, etc.— Drain inspections and tests—Smoke observations) 7,286 9,603 10,379 Total 22,162 25,038 28,169 50 Service of Notices. Total informal sanitary notices served 1,572 2,122 1,433 Total informal dustbin notices served 257 298 357 Total informal notices served 1,829 2,420 1,790 Total informal notices complied with 1,790 2,500 1,792 Total statutory notices served 30 8 9 Total statutory notices complied with 30 8 8 Total notices carried forward 198 117 116 Sanitary Improvements.— The following is a summary of the sanitary improvements effected, and the defects remedied:— Housing. Premises cleansed 54 Ceiling plaster repaired 206 Ceilings washed and distempered 1,359 Wall plaster repaired 213 Walls redecorated 1,090 Dampness remedied 250 Floors repaired or relaid 106 Ventilation under floors improved 32 Roofs repaired 330 Eaves gutters repaired or renewed 131 Rainwater pipes repaired or renewed 104 Yards repaired or repaved 63 Window frames repaired or renewed 179 Sashcords provided 330 Doors and frames repaired or renewed 54 Brickwork repointed or repaired 159 Cooking ranges repaired or renewed 67 Firegrates repaired or renewed 44 New sinks provided 53 Waste pipes repaired or renewed 82 Internal steps and staircases repaired 21 Food stores repaired 3 Internal woodwork repaired 69 Lighting and ventilation improved 4 Water supply—Draw taps fixed on main service 4 Water storage cisterns cleansed 10 New storage cisterns provided 3 Defective pipes repaired 87 Washing coppers repaired or renewed 26 Coal sheds repaired 11 51 Drainage. Inspection chambers repaired 49 New inspection chambers provided 49 Drains examined and tested 303 Drains repaired 45 New drains laid 29 Drains unstopped or trapped 127 New gullies provided 39 Gully grates provided 37 Choked gullies cleansed 89 Vent shafts and soil pipes repaired or renewed 27 F.A.I.'s repaired or renewed 40 Sanitary Accommodation. W.C. pans renewed 61 W .C. seats repaired or renewed 57 New flushing cisterns provided 15 W.C. cisterns repaired 56 W.C. flush pipes repaired or renewed 25 W.C. cone joints repaired or renewed 90 W.C. structures repaired 32 New W.C.'s provided 3 Refuse Receptacles. Dustbins renewed (by owners) 373 Dustbins renewed (by Council—in default) — Cowsheds and Dairies. Cowsheds cleansed and limewashed 2 Dairies cleansed and limewashed 2 Accumulations of manure removed 5 Slaughterhouses. Cleansed and limewashed 4 Structures repaired 2 Bakehouses. Cleansed and limewashed 23 Structure repaired 1 W.C.'s repaired 1 W.C.'s cleansed and limewashed 7 52 Factories and Workshops. Notices posted 14 Walls cleansed and limewashed 26 Ceilings cleansed and limewashed 24 Floors repaired 4 W.C. pans provided 11 W.C. cisterns repaired or renewed 8 W.C. cone joints repaired or renewed 20 W.C.'s cleansed and limewashed 14 Shops. Walls cleansed 14 Floors cleansed 6 Accumulations removed 22 Yards repaired, paved or drained 2 W.C.'s cleansed 18 W.C.'s repaired or renewed 3 Notices posted 126 Miscellaneous. Cesspools emptied and cleansed 19 Cesspools abolished 11 Accumulations of refuse and manure removed 54 Nuisances from keeping of animals abated 5 Foul ditches, ponds and stagnant water abated 4 Moveable dwellings (vans and tents) removed 11 Smoke nuisances abated 16 House-to-House Inspection.— The number of houses inspected under the Housing Schedules has risen somewhat during the year. As will be seen from the Table set out below, some further amendments have been made to these various Schedules. In such a district as Southgate, it would be unwise to maintain the Schedules in a static condition. The face of the district is continually changing, and it is therefore necessary to readjust our outlook from time to time with regard to the desirability of official visits at regular intervals. 53 Six hundred and fifty-six houses were inspected and recorded under the Housing Acts, as follows:— District No. 1. No. of Houses Scheduled. No. 1936. Inspected. 1935. Annual List 65 65 65 Biennial List 26 14 - Quinquennial List 637 125 201 District No. 2. Annual List 182 182 120 Biennial List 103 47 22 Quinquennial List 599 111 39 District No. 3. Annual List 86 86 86 Biennial List 26 26 - Quinquennial List 268 - 68 Total 1,992 656 601 Non-Scheduled Houses.— In addition to the above, 860 non-scheduled houses were inspected for housing defects and insanitary conditions, mostly upon complaint of the occupiers, as follows:— 1936 1935. North-East Ward 143 264 North-West Ward 215 314 Middle Ward 164 108 South Ward 338 273 Total 860 959 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, 440 premises were visited in this connection, 223 verbal notices, 101 preliminary notices and 4 statutory notices being served. These special inspections alone resulted in the provision of 324 new bins, which included a number of bins supplied following notices served during 1935. 54 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 48 Cowsheds 2 Bakehouses 18 Dining Rooms 43 Slaughterhouses 5 Fish Shops 21 Factories and Workshops 193 Public House Conveniences 22 Grocers 111 Greengrocers 46 Butchers 52 Confectioners 22 Total 583 (1935—324) HOUSING. Contained in the appendix to this Report will be found two special reports submitted to the Public Health Committee regarding the work carried out under the housing survey during the year. The relatively satisfactory condition which pertains in Southgate has already been reported to the Council, and needs little further stressing at this juncture. It may suffice to state here that, since the last report was issued upon the housing situation, still further abatement of overcrowding has taken place. In February, 1936, we were faced with 62 cases of overcrowding within the Borough, an extremely low figure and one which gave us little anxiety. By September of the same year this figure had fallen to 38, revealing a situation which cannot surely be improved upon, if it can even be equalled throughout the country. As the housing problem has occupied a considerable proportion of the Committee's and of the Council's attention during the year, I should like to submit a short statement as to the development of municipal enterprise within the Borough during the period which has elapsed since the War. Prior to the War, the Council had erected 82 houses, the housing schemes being small and scattered throughout the district. The onset of the War interrupted the Council's housing activities, 55 and work was suspended until hostilities had terminated. In 1919, the threads were gathered up and steps taken to develop the land which had been purchased for housing prior to the War. The work was carried out by what has been aptly termed "semi-direct labour," and it is interesting to note that the Southgate Urban District Council earned the distinction of being the first Local Authority to complete a house in any of the post-war housing schemes. In 1919, the erection of 94 houses was begun in Carpenter Gardens, work being completed by 1921. After an intervening period of 3 years, further schemes were embarked upon in Trent Gardens and Hood Avenue. By the end of 1926, 61 houses had been erected in the former scheme and 89 in the latter. Thus, a total of 244 houses were built in Southgate between the years 1919 and 1926, no small achievement, indeed an enterprise of which the district might well be proud. Moreover, the first steps had now been taken to establish a definite Council housing estate. In spite of this, however, the housing position still remained acute. The next step was a letter addressed to the local Press by the Chairman of the Public Health Committee calling the district's, and particularly the Churches' attention to the serious lack of available houses at an economic rent. This challenge was taken up and several public meetings, under the auspices of the local Churches, were held. Following these meetings, the Council undertook to erect a suitable number of additional Council houses, while the Church Army Housing Estate also put into operation a plan for removing necessitous families from the congested areas of London to a specially designed estate at Barrow Close. Another noteworthy feature of the same period was the inception of the Church Housing Advisory Committee. This Committee, composed jointly of representatives of the Church Army Housing Estate and of the local Council, administered certain funds, the object of which was, and still is, to assist necessitous families in paying their rents. There can be little doubt that the activities of this Committee have been a God-send to many poor families in the district, and no praise can be too high for the work which its members have performed. Mention might also be made here of an anonymous gift of £2,000 made prior to the inception of the Church Housing Advisory Committee's fund, and given for the same purpose. This gift was put to excellent use, and may be regarded as the first step in the local endeavours to assist necessitous families to meet the demands which their rentals made upon exceedingly slender incomes. It will thus be seen that, during the few years following 1926. serious attempts were made to meet the housing needs of the 56 moment. Apart from the role which the Urban District Council played in fostering semi-municipal enterprise, the fact that a further 287 Council houses were erected during the years which elapsed between 1926 and 1930, shows that the Local Authority was alive to the serious nature of the problem and was determined to overcome it. It will not be necessary to point out that the period in question was critical and fraught with innumerable difficulties. The national housing problem was appalling, while the general nutritional standard had fallen to a dangerously low level. People were still living under deplorable conditions, and money, which should have been spent in the purchase of necessary foodstuffs, was being dissipated in the payment of uneconomic and in many cases, exorbitant rents. Any summary of the development of municipal housing enterprise in Southgate would be incomplete without a reference to the institution of the local housing bonds, in 1920, the proceeds of which were used to build the Council's houses. Considerable difficulty was experienced in obtaining the necessary funds, but the Council persisted in its endeavours, and the number of houses eventually built is eloquent testimony to the success of those efforts. Reference must also be made to the number of loans granted to families under the Small Dwellings Acquisition Acts, 1899-1923, and the Housing Acts of 1923, 1925 and 1935, for the purpose of purchasing houses. Since the inception of these loans in 1923, no fewer than 1,575 families have been so assisted, the total sum lent being £955,474. This sphere of the Council's activities has proved exceedingly valuable and has helped many families to realise their ambition without placing themselves in a dangerous position. Following the activities already noted, a period of relative quiescence intervened. Conditions improved somewhat throughout the country, unemployment declined, and money became more plentiful. In spite of this, the housing problem cried aloud for solution Large numbers of families were still living very little above the border-line of poverty, while rents were being demanded and paid which precluded any margin for additional and muchneeded nourishment. In addition, the vast problem of overcrowding still remained, although possibly, and certainly in many places, of which Southgate was fortunately one, in a modified form. This situation received attention, and the Housing Act, 1936, was passed in an endeavour to face the issue. What happened in Southgate has already been mentioned, and it only remains to add the further steps which the Council decided to adopt. 57 Forty-four flats have already been erected adjoining the Council's Estate to cope with the increasing demand for Council houses. In 1936, a further resolution was adopted to erect 10 sixroomed Council houses, 40 five-roomed houses, 16 three-roomed flats and 8 bungalows for aged persons (this latter proposal will in all probability require modification, although the accommodation will still be provided). The Public Health Department co-operated in this work by suggesting to the Council the number of rooms required in individual houses to abate the existing degree of overcrowding, and also by making suggestion as to the minimum floor space of such rooms. Mention must also be made of the Community Hall which was opened in a position adjoining the Council Housing Estate in 1935, and which has proved an unqualified success. There are not many such amenities provided in England, and Southgate can feel proud that the Council sponsored and made possible such an admirable enterprise. It can thus be stated that Southgate has contributed its quota towards the solution of one of the greatest national problems which this country has at any time been asked to face. We are now inan enviable position, and I do not think we have any reason to fear the approaching future. An official of the Ministry paid a recent visit to the Public Health Department and seemed to be of the opinion that we had met the housing needs of the district in an adequate manner. This official made various useful suggestions which were handed on to the appropriate Committees, most important among which was the question of graduated rents. Although we now appear to have a sufficiency of Council houses available for our citizens, it is still a moot point as to the capabilities of those citizens to meet the required rents. Above everything else, our purpose must be to provide accommodation for those persons who are unable to obtain suitable premises at a rental within the capacity of their slender incomes. A system of graduated rents might solve this difficulty, and it is for the Council to decide whether such a system would be advantageous. I am of the definite opinion that a thorough investigation should be made of the problem, and that the system should be adopted if there is the slightest evidence to show that the nutrition of any families within the Borough is suffering because they are required to expend too large a portion of their income upon rent. In my judgment, this constitutes an even more serious question than does overcrowding, important as this problem undoubtedly is. The latter condition certainly encourages disease, but the former problem, uneconomic 58 rents, is an infinitely greater source of danger. When it is remembered that a third of the family income is often expended in rent, the gravity of the position will be realised. We have done much, and we have a great deal for which to thank the pioneers of those earlier and extremely difficult days. Our problems are comparatively simple, and, unlike those of less fortunate communities, they do admit of solution. It must be admitted that our position still falls short of the ideal. Although the degree of legal overcrowding in Southgate is certainly minimal, families are still living in premises which were never intended to accommodate the present number of inhabitants. This is a field which might repay investigation, as it does not appear to have received adequate attention from responsible authorities in the past. Number of New Houses Erected during the Year 1936:— (a) Total (including numbers given separately under (b)) 977 (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 :— 1936. 1935. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,516 1,560 (b) Number of inspections made for the purpose 1,624 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 656 601 (b) Number of inspections made for the purpose 719 677 (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 59 (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 1,433 1,315 (5) Number of Dwelling-houses closed voluntarily by owners 35 39 (6) Number of Dwelling-houses demolished voluntarily by owners 25 42 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 1,317 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 (2) Number of Dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil Nil (b) By local authority in default of owners Nil Nil B.—Proceedings under Public Health Acts:— (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 9 8 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— 60 (a) by owners 8 8 (b) 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 Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Nil 4. Housing Act, 1935—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 38 (2) Number of families dwelling therein 38 (3) Number of persons dwelling therein 267 (b) Number of new cases of overcrowding reported during the year 62 (c) (1) Number of cases of overcrowding relieved during the year 24 (2) Number of persons concerned in such cases 152½ (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil 61 As already noted, the overcrowding problem in Southgate cannot be considered abnormal, although its very existence must always be deplored. Only 34 oases existed at the end of 1936, and of these, 19 occurred in the Church Army Housing Estate at Barrow Close. The Church Army Housing authorities are being communicated with and have promised to take every possible step to abate the existing conditions. Fortunately, none of the cases can be regarded as serious meantime, but, with the presumptive increase in the families concerned, the nuisance will tend to magnify itself within the next few years. I hope to be able to submit a further report to the Council some time during the present year, setting out the steps which are being taken to cope with the problem in that particular Estate. The provisions of the additional Council houses referred to should go a long way towards solving the problem, while the same scheme should provide means of abating the remaining, isolated cases of overcrowding scattered throughout the Borough. 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.— Numerous complaints continue to be received regarding nuisance from rats and mice, particularly the former. Each case is investigated and advice supplied. At the same time, the complaint is transmitted to the proper authority, the Middlesex County Council. 62 Prevalence of and Control over Infectious and Other Diseases. From Table V, on page 87, it will be seen that 199 oases of infectious disease were notified during the year, as against 270 in 1935 and 332 in 1934, a decrease of 71 from the previous year and no less than 133 from the total of two years ago. These 199 cases represent infection in 189 houses. It will thus be realised that the number of cases of infectious disease Notified during 193& has once again shown a substantial decrease. Indeed, not since 1927 has the total number of cases of infectious disease notified during any one year been less than 200. When it is remembered that the population of Southgate was approximately 43,000 during that particular year, the significance of this fact will become apparent. The remarks which I made in last year's Annual Report regarding the necessity for consolidating our present happy position with regard to infectious disease, still carry the same force. We can scarcely expect to continue in such a favourable position, which actually contains a potential element of danger. Our child population is obviously growing up in an extremely sheltered environment. The opportunities which they possess of exercising their powers of natural immunity are thereby greatly curtailed, and we must therefore do everything in our power to stimulate a state of artificial immunity while the present inter-epidemic period persists. This particularly applies to diphtheria, which has been almost absent from the Borough during the past year. The means of protection are to our hand. To withhold those powers or even to adopt a non-committal, neutral attitude would be nothing short of criminal folly. The ward distribution of the cases of infectious disease notified during the year was as follows— 1935. 1936. South Ward 101 48 Middle Ward 63 63 North-West Ward 43 43 North-East Ward 63 45 It will be observed that the figures for the South and NorthEast Wards have shown a marked diminution, while the figures for the Middle and North-West Wards were, by a strange coincidence, exactly the same as those for the previous year. The fall in the 63 South Ward figure is somewhat surprising, but is at the same time encouraging. That particular Ward is still the most thickly populated portion of the district, with the highest child population. The fact that it does not show by any means the highest proportion of infectious disease may be taken as some indication that the mechanism of protection is operating in a satisfactory manner. A particularly interesting feature regarding the orientation of the infectious disease notifications is brought out in the case of the Council Housing Estate and the Church Army Housing Estate in Barrow Close. Out of the total of 199 cases notified during the year, only 11 (scarlet fever 2, puerperal pyrexia 1, diphtheria 1, pneumonia 4, tuberculosis 3) occurred in the Council's Housing Estate. Needless to say, this figure is extremely satisfactory. Even more satisfactory are the returns from the Church Army Housing Estate, where only 1 case of notifiable infectious disease, a case of pulmonary tuberculosis, occurred during the year. It is figures such as these which give encouragement to the members of Public Health Departments. The Council must also feel great satisfaction in the fact that the two largest municipal or semi-municipal housing estates within the Borough have remained so free from infectious disease. The Infectious Sickness Rate for the district for 1936 was 3.1 as against 4.3 in 1935 and 5.5 in 1934. This figure (3.1) is the lowest which I can find as having been recorded for Southgate, the next lowest being the rate for 1923, which was 3.4. The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 151 premises. During such inspections, 41 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 eleven cases were removed to the Isolation Hospital at Tottenhall Road. Of these, 46 were admitted suffering from scarlet fever, 11 from diphtheria, 3 from erysipelas, 8 from typhoid fever, 1 from puerperal pyrexia, 1 from post scarlatinal endocarditis, 16 from measles, 4 from measles and bronchopneumonia, 1 from measles and meningitis, 1 from rubella (German measles), 1 from whooping cough, 1 from croup, 7 from tonsillitis, 64 and 1 from quinsy. Seven observation cases, 1 diphtheria carrier and 1 baby with mother 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 1936. 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 1936. Scarlet Fever.— Seventy-four cases of scarlet fever were notified during the year, as against 133 in 1935. This total (74) is the second lowest ever recorded in Southgate, the lowest being 42 in 1927, when the population of the district was 43,000. The average for the last 10 vears is 103.8. The ward distribution was as follows :— 1935. 1936. South Ward 41 18 Middle Ward 25 22 North-West Ward 17 18 North-East Ward 41 16 Nine "secondary" cases occurred in houses from which previous cases had been notified. In five of these instances the primary case had been removed to hospital. Not a single "return" case occurred during the year. Five of the cases occurring during the year were "imported," two from a holiday resort, one from a hospital outside the district, and two from neighbouring districts. The incidence of scarlet fever was spread evenly over the 12 months. No particular peak was displayed, as might have been expected with such a comparatively small number of cases. The type of disease met with was again mild, no deaths taking place during the year. 65 46 cases were removed to the Isolation Hospital, representing 62.2 per cent. of the total number of cases notified. The procedure with regard to the visiting of schools and the supervision of cases after discharge from hospital remains as outlined in detail in last year's Annual Report. Only one addition has been made to the routine then set out. This consists of the visiting of all cases approximately 12 months after their discharge from hospital. The table set out immediately following this paragraph summarises the results of these visits, together with the results of the examinations made immediately after the patients' return to their homes. From this it will be seen that the position remains extremely satisfactory. It is now obvious that the administration of serum and the discharge of patients after 3 weeks in hospital is proving its worth. On the Hospital side, the complications have materially fallen, while the patients appear to regain their strength much more quickly. On the Public Health side, the fact that no serious complication has occurred after discharge from hospital, together with the fact that not a single "return" case was met with during the year, would make it appear that the system is sound and worthy of continuance. Total number of persons discharged during 1935 71 Number of persons visited after 1 year 64 (7 removed from district.) Number of persons remaining perfectly well throughout the year 61 (2 patients had complained of slight rheumatism ; 1 had been under hospital treatment for glandular infection, probably unconnected with the original attack of scarlet fever.) Total number of persons discharged during 1936 40 Persons in whom no abnormalities attributable to the original attack were discovered after 14 days 33 Patients developing rhinorrhoea 3 ,, ,, slight adenitis 1 ,, ,, transient albuminuria 1 ,, not examined 2 In all cases exhibiting abnormalities, complete recovery was made after a short period. 66 Diphtheria.— Twelve cases of diphtheria were notified during 1936, as against 25 during 1935, and 44 during 1934. None of these cases was secondary. This total (12) is the second lowest ever recorded in Southgate, the lowest being 8 in 1932 when the population was still only 57,000. The average for the past 10 years is 31.5. The ward distribution was as follows :— 1935. 1936. South Ward 10 2 Middle Ward 5 2 North-West Ward 7 7 North-East Ward 3 1 Eleven cases (91.7 per cent. of the total notified) were removed to hospital. The type of disease met with was comparatively mild and no deaths occurred from cases notified within the Borough. Unfortunately, three patients, all members of one family which had removed from the district to South Wales, were reported as having died from diphtheria. Although this family had moved from the district some time previously, the deaths were still accredited to Southgate. The occurrence of such a tragedy points to the continued need for strict supervision and control of this disease. The dates of notification were as follows:— 1st day 1 2nd ,, 2 3rd ,, 0 4th ,, 3 5th ,, 2 6th ,, 2 7th ,, 1 8th ,, 0 9th ,, 0 15th ,, 1 As hitherto, swabs were taken of all home contacts and of all cases fourteen days after their discharge from hospital. Diphtheria Antitoxin is kept in stock at the Public Health Department and issued to all medical practitioners on application. Immunisation. —Three hundred and nineteen persons attended for immunisation during 1936 at the weekly clinic held in Broomfield House or at the schools visited during the year, as compared with a total of 415 for the previous year. The schools selected 67 during the past year were Hazelwood Lane and St. Pauls, 123 and 44 children attending at each school respectively. The method of offering immunisation at the schools continues to attract the majority of parents. All the elementary schools within the Borough will have been visited by the end of 1937, when I hope to commence the cycle once again. It will be seen from the tables set out below that the figures of those attending for immunisation fell somewhat during the past year. This was almost entirely due to the fact that one of the two schools chosen for immunisation was comparatively small (St. Paul's), as against the corresponding school selected during 1935 (Bowes Road). When one considers that immunisation is a branch of the Public Health services which holds out infinite hope of protection, the total number of cases immunised can still only be considered as definitely unsatisfactory. It must now be realised that the existence of risks following immunisation is infinitesimal and can be almost disregarded. In spite of this, far too many parents are still fearful of the process or are completely apathetic. It is difficult to give further publicity to immunisation without creating an exaggerated sense of fear, but the time must come when we shall have to weigh this sense of fear, in many ways wholesome and natural, against the loss of a child's life, in every way tragic and unnatural. 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 - 19 8 11 38 12.1% Positives:— Mild - 28 5 5 38 12.1% Moderate - 66 5 1 72 23.1% Marked - 36 6 - 42 13.4% Nil 130 16 6 152 Not tested 123 - - - 123 39.3% Total for year 313 Completed Cases (To 31.12.36 from commencement of scheme 434 452 179 9 1,074 68 Number of persons who have attended for immunisation since commencement of scheme (including Schick negatives, uncompleted cases and defaulters) 1,797 Results of Schick Test after Three Months (1936). Negatives 335 Positives 34 369 Further Results of the 34 "Positives" — After 4th injection :— Negatives 29 Positives 5 After 5th injection:— Negatives 5 Positives Nil Number of Cases failing to complete Immunisation (1936) 29 Before three injections 13 After three injections 16 Total number of visits paid to schools and Clinic for purposes of immunisation (1936) 1,697 Total number of visits paid to schools and Clinic for purposes of immunisation since inception of scheme 8,430 Number of cases to be completed in 1937 81 Reactions after Injections (1936). 1 -5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total. Mild 1 - - - 1 Moderate - 3 - - 3 Severe - - - - - 1 3 - - 4 So far as can be ascertained, not a single child immunised against diphtheria during 1936 developed clinical diphtheria. Typhoid Fever (including Paratyphoid).—Eight cases of typhoid fever and two of paratyphoid B fever were notified during the year. In six of these cases, the infection was contracted during the widespread epidemic in the Bournemouth district which 69 occurred during the summer months. In another case, the infection was contracted during a cruise. The source of infection in two of the remaining cases, one of which unfortunately proved fatal, remained doubtful, but in all probability arose outside the Borough. The last case also resulted in a fatal issue, and in this instance no evidence as to the original source of infection was obtained. The patient died before the diagnosis was even established. Apart from the two fatal cases, the remaining cases made a complete recovery, although several were seriously ill on admission to hospital. All the cases, with the exception of the two fatal cases, one of which was removed to a hospital outside the district and the other of which died at home, were treated in the Southgate Isolation Hospital. Two cases occurred during 1935. Puerperal Fever and Puerperal Pyrexia.—Two cases of puerperal pyrexia were notified during the year, as against three cases of puerperal fever and eight of puerperal pyrexia during 1935. One case was removed to the Isolation Hospital. These figures show a welcome decline in the incidence of these two diseases, a decline which is even more pleasantly marked in the death rate. In this connection, 1 again feel constrained to issue the warning that it is unsafe to draw conclusions from such small totals. It was not necessary to call upon the services of Mr. Read, the Council's consulting gynaecologist, during the year. Erysipelas.—Seven cases of erysipelas were notified during the year as against 23 in 1935 and 20 in 1934. No deaths occurred. Three cases were removed to the Isolation Hospital. Erysipelas has shared to a marked degree in the general decline in infectious disease. As this disease is particularly trying to elderly patients, the fall is especially welcome. Pneumonia.—Thirty-four cases of pneumonia were notified during 1936, as against 24 in 1935 and 41 in 1934. 70 These case? were distributed as follows :— Children. Adults. Acute Primary Lobar Pneumonia 9 15 Broncho-pneumonia 5 1 Influenzal Pneumonia - 4 The rise in the incidence of pneumonia during 1936 is almost certainly attributable to the initial phase of the influenzal epidemic which was beginning to make its presence felt during the latter weeks of the year. In this connection, it is interesting to note that no fewer than eight of the patients affected were 65 years or over, six of them being over the age of 70. Pneumonia is essentially a disease of the two extremes of life, broncho-pneumonia being much more common in infancy, and lobar pneumonia in middle and particularly late life. Both types of pneumonia require the most careful attention, a fact which will be obvious when it is realised that approximately 17 per cent. of the total number of cases of infectious diseases notified during the year were attributable to this disease. As hitherto, a considerable proportion of the cases notified were removed to the North Middlesex County and other hospitals. Tuberculosis.— Forty-seven cases of pulmonary and eleven cases of non-pulmonary tuberculosis were notified during the year under the Public Health (Tuberculosis) Regulations, 1912, the corresponding figures for 1935 being, pulmonary cases, 42 : nonpulmonary cases, 7. 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. Thirty-seven deaths occurred, 33 from pulmonary and 4 from non-pulmonary tuberculosis. Seven of these cases had not previously been notified, a ratio of 18.9 per cent. as against 11.1 per cent. in 1935. As will be seen, the notifications of tuberculosis increased during 1936, while the deaths also showed a considerable rise. The poignant tragedy of tuberculosis is exemplified when the age groups of those cases notified are studied. For 1936, the table is as follows :— 1 to 5 years 1 5 to 15 years 4 15 to 20 years 7 20 to 35 ,, 26 35 to 45 ,, 10 45 years and over 10 71 It will thus be seen that tuberculosis, a chronic yet incapacitating and often fatal disease, strikes most at those in early adolescence or in the prime of life. Once again, the necessity for sparing no effort in preventing its onset must be stressed. For every ounce of help afforded an unfortunate sufferer after the disease has shown itself, many pounds of assistance could and should be given before. This help, of course, must come, in part at least, from the supervising authority, the Middlesex County Council. The Southgate Borough Council can only exercise its general powers as a Public Health and Housing authority, in an endeavour to ensure that housing conditions within the Borough are such as will not encourage the spread of the disease. That apart, we can merely try to mitigate the suffering of the affected patients who reside in the district, and do what lies within our power to minimise the spread of the disease to others. Our position is not a particularly happy one, but we should not rest until every avenue of approach has been explored. In considering the incidence and also the mortality of tuberculosis within the Borough, it must, however, be remembered that several cases occurred in families already possessing a tuberculous history who had moved into the district for health reasons. Southgate may not, strictly speaking, be a health resort, but its amenities attract this unfortunate type of family from the more congested areas of inner London. 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 23. Non-Notifiable Infectious Diseases.—As will be seen from the list of cases of non-notifiable infectious diseases received from the various schools within the Borough, the number of measles cases rose very considerably during the year. This supplies evidence as to the share which Southgate took in the national epidemic of last winter. Unfortunately, as indicated in last year's Annual Report, the information received cannot be termed accurate. Not being our own Education Authority, we are dependent upon teachers' reports as to the number of cases of nonnotifiable infectious diseases occurring at the various schools. This 72 is distinctly unsatisfactory, especially as the information is usually received too late to be of the slightest value. I reported last year that 10-12 days occasionally elapsed between the child being absent from school and the notification being received at the Public Health Department. I have gone into the figures in more detail this year, and find that this interval is sometimes very much more prolonged than then indicated. The following table sets out the period after which notification was received regarding various cases of non-notifiable infectious disease. The total number of cases represents a consecutive batch of 150 notifications:— Notifications received:— 1 to 5 days after onset of illness 23 5 to 10 38 10 to 20 55 20 to 30 ,, ,, 19 30 to 40 8 40 and over ,, ,, ,, 7 150 It will be seen that the interval elapsing between onset of disease and notification is extremely variable. It must be realised, of course, that this may be due to the fact that the illness was not reported at the school until the child returned after convalescence. On the other hand, one would expect that attendance officers or school nurses could obtain this information and could transmit it either direct to the Public Health Department or to the Head Teachers of the schools concerned, when it could be sent to -us. Neighbouring districts, which operate their own school medical service, obtain this information in detailed form at least once each week. When it is remembered that Southgate possesses a follow-up system more complete than that which obtains in many other districts, the fact that we are deprived of this information is particularly regrettable. The type of measles case occurring within the Borough during 1936 was not particularly severe, although one death occurred in a child under 5 years of age. When the epidemic was making itself apparent, I wrote to all the doctors in the district inviting them to send suitable cases to the Isolation Hospital, and also informing them that nursing facilities were available through the Borough Council's Southgate Queen's Nursing Scheme. These facilities were gratefully received, and 20 cases were admitted to the Isolation Hospital. In addition, the Queen's Nurses made 109 visits to 73 homes in which a case of measles or whooping-cough was being nursed. The death which occurred took place in a house in which there were no school children. As the parent of the child had not attended the Welfare Centre for some time, no information was obtained as to the occurrence of the case until it was too late to be of any assistance. It is gratifying to note that no deaths occurred among the cases admitted to hospital, although some were gravely ill upon admission, while all cases attended by the Queen's Nurses also made a satisfactory recovery. Thus, at a very early date the Council's provision for such an emergency justified itself to the hilt. The following list sets out the information received from the schools regarding cases of non-notifiable infectious disease, during the year. 1934. 1935. 1936. Measles 650 7 511 Whooping Cough 94 83 70 Mumps 61 182 116 Ringworm — — 1 Influenza 4 9 9 Pneumonia — — 1 Bronchitis — — 5 Chickenpox 44 69 251 German Measles 197 1 3 Total .. 1,050 351 967 As already noted there was one death from measles. Notifiable Diseases occurring amongst School Children.— The arrangements remain unaltered from those detailed in last year's Report. Disinfection and Disinfestation.—The arrangements for disinfection and disinfestation remain unaltered. The following table summarises the work carried out during the year: — (1) Disinfection in connection with Notifiable Infectious Diseases: Number of rooms fumigated 266 Number of school class-rooms (Private, Elementary and Secondary) fumigated 58 Number of articles disinfected by steam 2,144 Number of articles destroyed 81 74 (2) Disinfection in conenction with Non-Notifiable Infectious and Non -Infectious Diseases'.— (a) Disinfection of rooms and bedding, without charge, after certain cases of Non-Notifiable Disease:— Number of rooms fumigated 180 Number of articles disinfected by steam 1,099 Number of articles destroyed 415 (b) Disinfection of rooms and bedding, on request, after cases of Non -Notifiable Disease (charge 5s.):— Number of rooms fumigated 47 Number of articles disinfected by steam 639 Amount received in respect thereof £11 15s. (3) Disinfestation:— Eradication of Bed Bugs:— (i) Number of premises found to be infested: (a) Council Houses 7 (b) Church Army Housing Estate 24 (c) Other Houses 80 All these premises were disinfested. Total number of rooms disinfested.. 384 Total number of articles disinfested 164 (ii) Methods employed: Owners of infested premises requested to strip walls and remove woodwork from wall surfaces; spraying with "Ris" insecticide and fumigation with sulphur, repeated where necessary; removal of bedding, as required, for steam disinfection. (iii) Methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses: Premises occupied by intending tenants, together with the contents thereof, are inspected by the Sanitary Inspectors prior to removal to Council houses, while, in cases where the incoming tenant resides outside the Borough, a report is obtained from the Medical Officer of Health of the district concerned. No case requiring the disinfestation of incoming tenant's belongings occurred during 1936. Any Council house found to be infested after vacation by an outgoing tenant is disinfested by the Surveyor's Department before being reoccupied. 75 (iv) With the exception of the stripping of walls and the removal of woodwork, as noted above, the work of disinfestation is carried out by the Local Authority. 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, 267 books were so disinfected. The school and other books found in homes where cases of notifiable infectious disease have occurred, are disinfected. Arrangements are now being made whereby the books found in homes where cases of non-notifiable infectious disease are discovered will be treated in a similar manner, provided the discovery is made at a sufficiently early date to allow of disinfection being of any service. Individual school books from class-rooms from which a case of notifiable infectious disease has been notified, are also removed and disinfected. ISOLATION HOSPITAL. The number of patients treated in hospital during 1936 was 565, as against 616 during 1935 and 622 in 1934 (This number comprises the patients admitted during the year, together with those in hospital on 1st January, 1936). It will be seen that this number again shows a decrease, the hospital being slightly quieter during 1936 than during either of the two preceding years. The decreased number of patients was offset by the increased severity of the cases being admitted, this being particularly noticeable with respect to the diphtheria admissions; and also by the large number of measles cases admitted during the epidemic of last winter and spring. The total decrease is entirely explained by the drop in scarlet fever admissions (256 to 159). This decrease would have been still more marked had the number of measles cases admitted to the hospital (88 as against 19 in 1935) not risen appreciably. The following table sets out the number of patients admitted to the hospital during 1936, and the areas from which those patients were admitted: — 1936. (1935.) Southgate Ill (163) Tottenham 394 (390) Middlesex County Council 5 76 It will be observed that the only fall is shown in the number of patients admitted from our own Borough. The diseases for which the 510 patients were admitted during 1936 were as follows:— Scarlet Fever 163 Diphtheria 156—Faucial 138 Nasal 9 Laryngeal 4 Faucial & Nasal 5 Diphtheria "Carrier" 4 Diphtheria and Chicken-pox 2 Diphtheria and Bronchitis 1 Scarlet Fever and Burns 2 Scarlet Fever and Polio-encephalitis 1 Scarlet Fever and Diphtheria 2 Scarlet Fever and Diphtheria ' 'Carrier'' 3 Scarlet Fever and Sinusitis 1 Scarlet Fever and Broncho-pneumonia 3 Scarlet Fever and Acute Bronchitis 2 Scarlet Fever and Endocarditis 1 Scarlet Fever and Emphysema 1 Scarlet Fever and Adenitis 1 Measles 28 Measles and Otitis Media 1 Measles and Bronchitis 3 Measles and Endocarditis 1 Measles and Pneumonia 47 Measles, Whooping-cough and Pneumonia 5 Whooping-cough 4 Whooping-cough and Otitis Media 1 Whooping - cough, Mumps and Nephritis 1 Broncho-pneumonia 1 Bronchitis 1 Typhoid Fever 9 Puerperal Fever 5 Baby with mother 2 Erysipelas 19 Erysipelas and Nasal Diphtheria 1 77 Erysipelas, Rhinorrhoea and Tonsillitis 1 Acute Exfoliative Dermatitis 1 Cellulitis of Leg 2 Quinsy and Septic Rash 1 Septicaemia and Cancrum Oris 1 Rubella (German Measles) 1 Teething Rash 1 Food Rash 1 Tonsillitis and Gland Abscess 1 Tonsillitis 19 Acute Nephritis 1 Urticaria 2 Simple Croup 2 Albuminuria following Scarlet Fever 1 Impetigo 1 Influenza 1 Fracture of Toe 1 510 Several of the above patients were admitted for observation purposes, while in 52 cases the original diagnosis was amended after admission to the Isolation Hospital (50 during 1935). The following list sets out the full details regarding the amended diagnoses: — Laryngeal Diphtheria to Simple Croup 1 Diphtheria to Tonsillitis 14 Laryngeal Diphtheria to Tonsillitis 1 Diphtheria to Diphtheria "Carrier" 2 Diphtheria to Scarlet Fever and Diphtheria 1 Diphtheria to Tonsillitis and Gland Abscess 1 Scarlet Fever to Food Rash 1 Scarlet Fever to Teething Rash 1 Scarlet Fever to Tonsillitis 2 Scarlet Fever to Scarlet Fever and Pneumonia 1 Scarlet Fever to Bronchitis 1 Scarlet Fever to Scarlet Fever and Diphtheria ' 'Carrier'' 3 Scarlet Fever to Scarlet Fever and Polioencephalitis 1 Scarlet Fever to Measles 1 Scarlet Fever to Diphtheria ' 'Carrier'' 1 78 Scarlet Fever to Urticaria 2 Scarlet Fever to Impetigo 1 Scarlet Fever to German Measles 1 Scarlet Fever to Septicaemia and Cancrum Oris 1 Scarlet Fever and ? Mastoid to Scarlet Fever and Adenitis 1 Scarlet Fever and Diphtheria to Scarlet Fever 1 ? Scarlet Fever to Quinsy and Septic Rash 1 Erysipelas to Cellulitis of Leg 2 Erysipelas to Acute Exfoliative Dermatitis 1 Erysipelas to Erysipelas and Nasal Diphtheria 1 Measles and Bronchitis to Measles 1 Measles and Bronchitis to Bronchitis 1 Measles and Whooping-Cough to Measles, Whooping-Cough and Pneumonia 1 Measles and Pneumonia to Measles, Whooping-Cough and Pneumonia 1 German Measles to Scarlet Fever 1 Meningitis to Measles and Broncho- Pneumonia 1 Typhoid Fever to Nephritis 1 Typhoid Fever to Broncho-Pneumonia 1 Total 52 Number of Patients in Isolation Hospital on any one day during each Month:— Greatest Number. Lowest Number. January 60 45 February 59 47 March 58 49 April 59 29 May 41 33 June 38 29 July 57 41 August 57 40 September 54 40 October 50 36 November 42 31 December 51 39 79 Complications.—The complications met with during 1936 were as follows:— Scarlet Fever.—(Total of 189 cases treated during the year). Right Otorrhoea 4 Left Otorrhoea 2 Double Otorrhoea 1 Abscess 1 8 The complication rate for scarlet fever during 1936 is the lowest yet recorded at the hospital (4.2 per cent, against 6.6 per cent in 1935, the previous low record). This is extremely satisfactory, but it must be remembered that the type of case being admitted was distinctly mild and that most of the cases were admitted during the very early stages of the illness. In addition, the wards were exceptionally quiet during the major portion of the year. In spite of these facts, I am of opinion that the administration of serum to all cases on admission is now exercising a beneficial effect, and to this, in part at least, must be ascribed the compartively small number of complications which occurred in the scarlet fever wards. Diphtheria.—Apart from the 6 fatal cases met with during the year, only 16 complications occurred among the remaining 176 cases of diphtheria receiving treatment. This gives a complication rate of 9.17, the lowest figure obtained since I began to calculate the complication rate for diphtheria after taking over the duties of Medical Superintendent to the Isolation Hospital. The figure for the previous year was 15.1 per cent. The complications met with were as follows:— Palatal Paralysis 5 Ocular Paralysis 1 Palatal, Ocular and Pharyngeal Paralysis 1 Ocular and Pharyngeal Paralysis 1 Palatal and Pharyngeal Paralysis 1 Mild Endocarditis 2 Rhinorrhoea 1 Abscess of Glands 1 Tonsillitis and Abscess of Buttock 1 Left Otorrhoea 1 Nephritis 1 16 80 As will be seen, the number of complications met with has fallen to an appreciable extent during the past year, a point which is exceeding pleasing when one remembers the unusual severity of the diphtheria cases being admitted during that period. It is also pleasing to note that the complications yielded to treatment and that the patients concerned were able to be discharged in a fit condition, although sometimes after a very protracted convalescence. Only one complication occurred among the remaining 183 non-fatal cases of measles, whooping-cough, erysipelas, typhoid fever, etc., treated in the hospital during 1936. Deaths.—Twenty deaths took place during the year, as against 17 in 1935. These deaths occurred from the following diseases:— Diphtheria 6 Measles and Broncho-Pneumonia 8 Whooping-Cough and Broncho-Pneumonia 2 Septicaemia and Cancrum Oris 1 Broncho-Pneumonia and Scarlet Fever 1 Polio-encephalitis and Scarlet Fever 1 Puerperal Sepsis 1 20 Five patients died within 24 hours of admission to hospital, several surviving only a few hours. It will be seen that 50 per cent. of these deaths occurred from some form of pulmonary infection, in every case but one, bronchopneumonia following measles or whooping-cough. This is explained by the fact that only the most severe cases of measles and whoopingcough were admitted to the Isolation Hospital during the epidemic of 1936, several of the patients being practically moribund on admission. The death rate from diphtheria, 3.3 per cent., is again low, and is strictly comparable to the complication rate. Two patients died from concurrent diseases during treatment for scarlet fever, but in each case the infection bringing about the fatal issue was present before the onset of the scarlet fever, and was the direct cause of death. 81 General Treatment.—There have been no radical alterations in the treatment carried out at the Isolation Hospital during the year. As previously indicated, the serum treatment for scarlet fever has been continued, with satisfactory results. Certain minor modifications in the treatment of severe cases of diphtheria have been introduced, particularly with a view to reducing or preventing cardiac complications. It is too soon yet to be able to report upon the effect of these modifications, which have followed recent investigations into the treatment of diphtheria, but 1 have every hope that they will bear out the claims of their sponsors. The artificial light apparatus is still being used in selected cases and continues its usefulness. Every opportunity is taken to try out the latest recommended forms of treatment, serum or otherwise. The results are not always as satisfactory as one might wish, but the treatment of acute infectious disease is never static and must be reviewed from time to time in the light of modern scientific discoveries. Operations.—The following operations were performed during the year:— Appendicectomy (Measles) 1 Tracheotomy (Diphtheria) 2 Tonsillectomy (Diphtheria "Carriers") 4 7 In addition to these operations, numerous incisions for gland abscesses were performed, while the usual number of additional minor operations were carried cut during the treatment of patients admitted from General Hospitals with concurrent surgical conditions. Dr. Macdonald, Consulting Surgeon to the Hospital, performed all the operations during the year. His work in this respect has been invaluable, and in at least two cases he was instrumental in saving the patient's life. Dr. Maodonald's consultative visits (112) have been equally valuable. He is always at the Hospital's services, and I cannot thank him too much for the valuable assistance which he renders, night and day, throughout the year. 82 Discharge Procedure.—The discharge procedure detailed in the Report for 1933 has remained unaltered, with the addition noted in last year's Annual Report. Period of Isolation in Hospital.—The average period of isolation in hospital was as follows:— Scarlet Fever.—22.6 days (longest, 52 days—otorrhoea; shortest, 12 days—admitted after acute stage of disease had terminated). Average duration, 1935—25.6 days. Diphtheria.—59.6 days (longest, 125 days—various paralyses ; shortest, 25 hours—died). Average duration, 1935—56.8 days. It is interesting to note that the average period of isolation for scarlet fever patients has decreased from 35.4 days in 1934, to 22.6 days during last year. This is directly attributable to the serum administration treatment. It is particularly pleasing to be able to report that the decrease in the detention period has not been accompanied by any untoward effects. Indeed, rather the reverse has held, while the return-case rate has actually diminished. Staff.-(a) Illness.—The following illnesses occurred among the Staff during the past year:— Erysipelas, Rhinorrhoea and Tonsillitis (Nurse) 1 Diphtheria (Nurse) 1 Influenza (Nurse) 1 Fracture of Toe (Maid) 1 It will be seen that the health of the staff was satisfactory, the number of nurses and maids requiring to be warded during the year being minimal. The nurse who contracted diphtheria was not a member of the permanent staff, being merely a temporary addition during a particularly busy period. She was thus not able to obtain the protection against diphtheria which our own nurses are afforded. 83 (b) Immunisation.—Immunisation against diphtheria is still being carried out among members of the nursing and administrative staff. (c) Lectures.—The information regarding lectures set out in last year's Annual Report still holds good. Cross-Infection —Although two cases were admitted to the diphtheria ward incubating other diseases (measles and scarlet fever) and one to the scarlet fever ward (measles), not a single case of cross-infection occurred in the hospital throughout the year. This is particularly encouraging, and I should like to congratulate the staff upon achieving such a result. Return Cases.—Only one "return case," i.e., a case of scarlet fever occurring in a home within 28 days after the return to the home of a case of that disease from the Isolation Hospital, occurred among the 181 cases discharged from hospital during the year. This gives a Return Case Rate of .55 per cent., one of the lowest ever recorded at the hospital. Transfers to and from other Hospitals.—The following transfers occurred during the year:— From the Prince of Wales's Hospital 19 cases ,, North Middlesex County Hospital 8 ,, ,, Wood Green and Southgate Hospital 1 case Total 28 cases To the North Middlesex County Hospital 3 cases ,, Hornsey, Finchley and Wood Green Isolation Hospital 1 case Total 4 cases Visiting.—The arrangements for visiting patients remain unaltered and still appear satisfactory. Difficulty is occasionally encountered in dealing with visitors, but so far, the privileges granted by the Committee have never had to be refused. 84 Laboratory.—Details of the Laboratory work carried out in connection with the Hospital will be found on page 23. Miscellaneous.—(I) The. oldest patient treated in the Hospital during the year was a male aged 76 years suffering from scarlet fever and severe emphysema; the youngest was a baby aged 7 days admitted with its mother, who was suffering from puerperal fever. (2) One of the main features of the year's work was the large number of complicated and uncomplicated cases of measles (88) admitted during the year. This is more than four times the number admitted during 1935, and was due to the prevalence of the widespread epidemic during the winter and spring of last year. As already indicated, quite a number of these patients were desperately ill, and their continued nursing placed an additional strain upon the members of the nursing staff. During the height of the epidemic, wards 2 and 2a had to be reserved specially for the reception of measles cases. A second feature of the year's work was the influx into the hospital of 7 cases of typhoid and paratyphoid fever within a few weeks, each of the cases having contracted the disease in or around Bournemouth. Although several of the patients were extremely ill on admission, all made a satisfactory recovery. (3) In an attempt to gain the latest information regarding the construction and equipment of modern Isolation Hospitals, the Chairman of the Public Health and Joint Hospital Committees, Mr. Brown, Architectural Assistant, and the Medical Officer of Health, visited Coventry, Barking and Wakefield and inspected the Municipal Hospitals for infectious disease situated in those areas. These visits proved of immense value. A full report was submitted to the Public Health Committee and to the Joint Hospital Committee early in 1937. (4) 1 should like to take this opportunity of thanking Miss West, Matron, and every member of the nursing, domestic and out-door staff for the help which they afforded me during the year. The administration of an Isolation Hospital depends almost entirely upon team work, and it gives me great pleasure to think that 1 have had the cordial co-operation of the staff throughout the entire year. The results which they achieved are evidenced in the bare statistics set out in the preceding pages. No statistics, however, can pay tribute to their unfailing devotion to duty, to their willingness to serve their patients at any hour of the day or night, 85 and to then cheerfulness and dependability during every period of emergency. 1 should also like to thank my Deputy, Dr. A. S. Burns, for the numerous services which he rendered to the Hospital and to myself during the year. Finally, I should like to express my most sincere appreciation to the members of the Joint Hospital Committee for the unvarying courtesy and assistance received throughout the course of the year. After a long period of hospital administration, I have a very keen realisation of the help which a Committee can afford its officials, and it is with no desire to exaggerate that 1 state that the encouragement, which I have received from the Joint Hospital Committee has been unequalled within my experience. 86 Table V. Notified Cases of Infectious Diseases, 1936. 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 12 .. 1 1 1 .. 3 1 .. 4 1 .. .. 3 Scarlet Fever 74 .. 1 1 5 2 36 11 2 16 .. .. .. .. Typhoid Fever 10 .. .. .. .. .. 1 2 4 2 .. 1 .. 2 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Pyrexia 2 .. .. .. .. .. .. .. .. 2 .. .. .. .. Erysipelas 7 .. .. .. .. .. .. .. .. .. .. 5 2 .. Ophthalmia Neonatorum 2 2 .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Acute Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebrospinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 34 3 .. .. 2 2 3 1 1 2 2 10 8 41 Tuberculosis— Pulmonary 47 .. .. .. .. .. .. .. 7 23 7 8 2 33 Non-Pulmonary 11 .. 1 .. .. .. 1 3 .. 3 3 .. .. 4 Totals 199 5 3 2 8 4 44 18 14 52 13 24 12 84 87 88 Ophthalmia Neonatorum, 1936. TABLE VII. 2 Notified. Cases. Nil At Home. Treated. Nil In Hospital. 2 Vision Unimpaired. Nil Vision Impaired. Nil Total Blindness. Nil Deaths Table VI. Cases of Infectious Disease Notified each Month of the Year, 1936. Notifiable Diseases. Smallpox. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Puerperal Pyrexia. Acute Poliomyelitis. Encephalitis Lethargica. Cerebrospinal Meningitis. Malaria. Ophthalmia Neonatorum. Pneumonia. Tuberculosis Totals. Pulmonary. Non. Pulmonary January .. 7 1 .. 1 .. .. .. .. .. .. .. 8 5 2 24 February .. 7 .. .. .. .. .. .. .. .. .. .. 6 2 1 16 March .. 12 1 .. 1 .. .. .. .. .. .. .. 11 8 1 34 April .. 4 2 .. 1 .. .. .. .. .. .. .. 1 2 .. 10 May .. 15 1 1 2 .. .. .. .. .. .. .. .. 2 1 22 June .. 3 .. .. 1 .. .. .. .. .. .. .. .. 1 2 7 July .. 5 1 1 .. .. .. .. .. .. .. .. 1 5 1 14 August .. 4 .. 4 .. .. .. .. .. .. .. 1 .. 6 2 17 September .. .. 1 3 .. .. .. .. .. .. .. .. .. 4 .. 13 October .. 1 .. 1 1 .. 1 .. .. .. .. .. 3 5 .. 12 November .. 7 3 .. .. .. .. .. .. .. 1 2 5 1 19 December .. 4 2 .. .. .. 1 .. .. .. .. .. 2 2 .. 11 Totals .. 74 12 10 7 .. 2 .. .. .. .. 2 34 47 11 199 TABLE VIII Tuberculosis, 1936. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary . M. F. M. F. M. F. M. F. Under 1 yr. - - - - - - — — 1-5 years — — 1 - — — —- — 5-10 ,, - - 1 1 — — — — 10-15 ,, — - 1 3 — — — — 15-20 „ 4 5 — - — 2 — — 20-25 ,, 5 6 1 1 1 4 — — 25-35 ,, 9 11 — 3 4 3 — — 35-45 „ 6 4 1 2 3 4 1 2 45-55 ,, 3 2 — — 3 2 — 1 55-65 „ 2 1 — — 4 3 — — 65 and over 1 1 - - - - - — Totals 32 30 5 10 15 18 1 3 REGISTER OF CASES. Non- Pulmonary. Pulmonary. Total. M. F. M, F. Cases on Register, 1/1/36 108 77 19 19 223 Cases notified for first time, 1936 23 24 5 6 58 Cases restored to Register 1 1 - 2 4 Other Cases added 8 5 - 2 15 Cases removed from Register . 25 26 - 5 56 Remaining on Register, 31/12/36 115 81 24 24 244 *These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the District. 89 APPENDIX. 1. Health Publicity. The measures adopted to stimulate an interest in matters connected with Public Health were carried out along similar lines to those of previous years. Various talks were given to organisations in the district, articles were printed in the local Press, while the Southgate edition of "Better Health" continued to circulate. It is difficult to estimate the value of this propaganda, but it should of necessity play a prominent part in any progressive Public Health administration. The main policy has been directed towards improving the knowledge of the burgesses upon basic Public Health principles, stressing those of most practical importance but avoiding any attempt at creating an atmosphere of panic. For the latter reason, certain display posters offered to the Borough Council were not accepted. I am not entirely satisfied that we are wise in eliminating every attempt to produce an atmosphere of danger among our thinking population. If we pursue such a policy to its logical conclusion, our position may be comfortable, but it will lie none the less dangerous. As 1 have mentioned elsewhere, fear is a natural and sometimes an extremely valuable phenomenon, which may have wholesome and decidedly salutary effects. The avoidable' death of child or adult, on the other hand, means an inevitable tragedy, all the more pitiful if life is cut short during the first few years. Ignorance and apathy are still our greatest enemies, and, in my opinion, any reasonable methods adopted to surmount these obstacles would be fully justified by the results. As hitherto, it was not thought advisable to hold any local Health Week or similar concentrated health crusade, although plans are being prepared for such a function during 1937. 2. Circular Letters. The following circular letters were issued during year: — (a) Letter to doctors re Pre-Natal Clinic. (b) Letter to midwives re Pre-Natal Clinic. (c) Letter to Council tenants re Pre-Natal Clinic. (d) Letter to fathers of children attending Infaht Welfare Clinics calling a Fathers' Meeting. 90 (e) Letter to Head Teachers of all schools within th Borough offering to supply leaflets re measles fo distribution amongst scholars. 3. Special Reports. (i) Report on Housing Survey. " I beg to submit the following report on the work carried out (submitted to Public Health Committee, 5th March, 1936) unde the Housing Act, 1935: — Number of houses visited under Schedule A 9,841 Number of houses inspected under Schedule B (included in above) 295 Number found uncrowded 9,779 Number found overcrowded 62 Percentage of overcrowding 0.62% The cases of overcrowding were distributed as follows:— Sanitary District No. 1 13 ,, ,, No. 2 14 No. 3 35 Total 62 The cost of the scheme was as follows:— £ s. d. Stationery (including filing cabinet) 17 15 5 8 enumerators for 4 weeks at £3 3s. (less 1 week's sickness) 97 13 0 1 clerk who assisted in the measuring of rooms for 12 weeks, 5 days at £3 3s 40 8 6 £155 16 11 The result of the survey shows a remarkably low incidence of overcrowding, while it is also noteworthy that very few complaints were received from the houses visited regarding defects which the occupier considered should be remedied. (The enumerators were instructed to ask in every case whether a visit from a Sanitary Inspector were desired.) "Before the 1st of June the Council must consider and report to the Ministry of Health what action they intend to take with regard to overcrowding. Very briefly, the Council, apart from 91 any re-development or re-conditioning schemes which they might authorise, can adopt the following alternatives:— (a) Serve a notice on all owners of overcrowded premises to abate overcrowding. (b) Issue temporary licences covering a period of 12 months which will allow the tenants to continue under existing conditions, the position to be reviewed at the end of that period. "In view of the high standard of housing and low percentage of overcrowding which the survey has revealed, it does not appear feasible to consider any re-development or any re-conditioning scheme. In my opinion, the Council should take all possible steps to abate every case of overcrowding within the Borough, especially as it should be quite possible to achieve this highly desirable object, considering the small numbers with which we have to deal. In this connection it might be of interest to note that 37 of the 62 cases of overcrowding met with, were found in the Church Army Housing Estate at Barrow Close and in Council property. In view of these facts, the case for the construction of additional Council houses or flats at an early date is very greatly strengthened." (ii) Report on Overcrowding within the Borough. "A survey of the overcrowding existing within the Borough (submitted to Public Health Committee, 2nd October, 1936) shows that, at the present moment, there are 38 such cases, as against 62 in February of this year, when the initial survey was made. The following table sets out the incidence of overcrowding as divided between Council property, Church Army Housing Estate and the remainder of the district. Table I. September, 1936. February, 1936. Council Property 6 10 Church Army Housing Estate 19 27 Remainder of District 13 25 38 62 "As will be seen, the overcrowding had already diminished by more than 33 1/3 per cent., due to the sorting out of the various 92 families concerned, following upon the survey. It will also be seen that abatement has occurred in each of the three categories. "It is of interest to note that 17 of the 38 cases referred to above would not have been classed as overcrowded under the standards laid down prior to the passing of the Housing Act, 1935. "Table II sets out the overcrowding position as regards number of rooms, number in family, etc.: — Table II. Address. No. of Rooms No. of Over 10 Persons Under 10 Persons in Excess Rooms Required. 2, Park Cottages, N. 11 4 5 1 ½ 4 rooms of adequate size. 6, Trevecca Terr., N.11 , 1 2 1 ½ 2 71, High Road, N.11 3 6 — 1 4 19, Lower Park Road, N.11 2 4 — 1 3 8, Palmers Road., N.11 2 2 2 i 2 rooms of adequate size. 34, Shrewsbury Road, N.11 2 4 - 1 3 43, Addison Av., N.14 5 7 3 ½ 5 rooms of adequate size. 5, Eastpole Cotts., Bramley Rd.N.l4 4 7 4 4 5 rooms of adequate size. 14, Council Cotts. Chase Rd., N.14 . 4 7 - 1½ 4 rooms of adequate size. 19, Council Cotts. Chase Rd., N.14 4 6 - ½ 4 rooms of adequate size. 109, Cowper Gardens,N.14 5 6 5 ½ 5 rooms of adequate size. 9, Walkers Cotts., High St.,N.14 4 8 3 2½ 5 76, Ivy Road, N.14 4 6 3 1 4 rooms of adequate size. 7, Barrow Close, N.21 4 5 4 1 „ „ 9, ,, 4 5 4 1 „ „ 11, ,, 4 7 1 1½ „ „ 25, ,, 4 7 1 1½ „ „ 93 Address. No. of Rooms No. of Over 10 Persons Under 10 Persons in Excess Rooms Required. 35, Barrow Close N.21 4 6 4 2 5 37, ,, ,, 4 5 6 2 5 41, „ „ 4 8 — 2 5 45, „ „ 4 6 4 2 5 49, „ „ 4 6 2 1 4 rooms of adequate size. 55, ,, ,, 4 7 1 1½ „ „ 16, „ „ 5 7 3 1 5 rooms of adequate size. 18, „ „ 5 7 2 ½ „ „ 24, ,, ,, 4 6 6 3 5 28, „ „ 4 7 2 1 5 34, ,, ,, 3 5 2 1½ 4—Has single lady lodge1 here occupying 1 room. 42, „ „ 4 7 2 2 5 44, „ „ 4 6 2 1 4 rooms of adequate size. 46, ,, ,, 4 5 3 ½ „ „ 60, „ „ 4 6 1 ½ „ „ 3, Devonshire Rd., N.13 3 6 — 1 4 895, Green Lanes, N.21 5 10 2 1 6 9, Russell Road, N.13 3 5 1 ½ 4 24, „ „ 3 6 — 1 4 217, Tottenhall Road, N.13 4 6 1 1 4 rooms of adequate size. Town Hall, Caretaker' s premise 4 s 7 2 ½ 5 (N.B.—For the purpose of the Act, any bedroom space over 110 sq. ft. is excluded from consideration. Any room which can be used for sleeping purposes is, however, included.) I 94 If the above table is analysed, the following facts appear:— (a) Degree of Overcrowding Present. Premises overcrowded by ½ an adult 11 ,, ,, 1 adult 14 ,, ,, 1½ adults 5 „ „ 2 ,, 5 „ „ 2½ „ 1 „ „ 3 „ 1 „ „ 4 „ 1 ,, ,, more than 4 adults 0 (b) Adjustments Required to Abate Overcrowding. Same number of rooms, but of adequate size, required 18 1 extra room required 20 More than 1 extra room required 0 (c) Extent of Premises Required to Abate Overcrowding (provided. adjustment is made by re-distributing existing cases). 1 roomed premises 0 2 „ „ 2 3 ,, ,, 2 4 „ ,, 19 5 ,, ,, 14 6 ,, ,, 1 Premises of more than 6 rooms 0 "From the above tables, it will be seen that more than 50 per cent. of the overcrowding is in respect of ½ an adult or 1 adult, which is, of course, satisfactory, in that the existing overcrowding is minimal. It will also be seen that in no case is more than 1 additional room required to abate the overcrowding, while in approximately 50 per cent. of the cases (18 out of 38), all that is required is the same number of rooms of adequate size. "Finally, and of most importance from the point of view of future action, it will be seen that, in the great majority of cases, houses containing 4 and 5 rooms which can be used as sleeping apartments, are required. It can, of course, presumably be assumed that still further improvement of existing conditions will be obtained by a re-distribution of the families concerned within the properties at present available, but this information, i.e. the ultimate accommodation required, will 'necessarily influence the Council's final scheme. 95 "The Ministry of Health has already been informed of the immediate position, which must be considered extremely satisfactory in a district containing approximately 17,500 inhabited houses. As the Committee will be aware, overcrowding under this Act does not become a technical offence until January 1st. 1937, but before this date, the Council should formulate some scheme to provide alternate accommodation for at least a proportion of the overcrowded cases. It does not, however, appear necessary to provide accommodation in respect of all the cases, as re-adjustment will doubtless solve a part of the problem." (iii) Scheme for Provision of Home Helps. Two Reports upon the institution of a scheme of Home Helps to assist in the home after a confinement, were also submitted to the Council in November and December, 1936. 4. Anti-Air-Raid Precautions. A Committee was set up to deal with this important question, and held its first meeting in December, 1936. No good purpose would he served at the moment in detailing the scheme which has since been prepared, as the details and even certain of the more important general principles still remain to be settled. Several members of the Public Health and Hospital staffs have already attended courses in Anti-Air-Raid Precautions, while arrangements have been made for several members of the staff to attend one or other of the Home Office Instructional Schools. If and when the scheme is put into operation, it will undoubtedly place considerable responsibilities upon the members of the Public Health Staff, but the Council can rest assured that the individuals concerned will do everything which lies within their power to carry out the work allocated to them. 5. Insulin. As in previous years, a supply of insulin, free of charge, has been provided for necessitous patients residing in the Borough. One such patient received a total of 8,800 units, at a cost of £2 15s. 0d. No new cases were reported during the year. Periodical reports are forwarded to the Ministry of Health. 96