C 11 AC-439 (1) Soth Gate Soug 22 M. BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937. Crusha & Son, Ltd., Tottenham, Enfield, Palmers Green and Wood Green. WM. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent. Isolation Hospital. BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937. 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. Mb. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1937. Once again, the twelve months under review have been satisfactory, and there is little outstanding to report. As in recent years, information contained in the present Report includes the data required by the Ministry of Health, together with such comments as appear necessary or desirable. It has already been stated that the year 1937 was satisfactory from a Public Health standpoint. The Death Rate shows no material alteration from the low level of recent years, the Infantile Mortality Rate has fallen slightly and is still well below that for England and Wales, while the Infectious Sickness Rate is one of the lowest yet recorded in the district. The various steps taken to augment the Public Health Services of the Borough and to keep them up-to-date will be found set out in the body of the Report, together with those proposals suggested for the immediate future. Two alterations were effected in the personnel of the Public Health Staff during the year. A new Health Visitor, Miss M. Maddock, was appointed to take the place of Mrs. Blake, who resigned in October, 1937. A change was necessitated in the clerical staff owing to the resignation of the junior typist. This position was filled by the transfer of a typist from the Town Clerk's Department. 3 Dr. J. Tate, the County Medical Officer and School Medical Officer, has once again supplied statistics regarding School Clinics and Public Elementary Schools within the Borough. This information is most valuable and is only obtainable from that source. In conclusion, I wish to tender my thanks to the Chairman and Members of the Public Health Committee and of the Council, and also to my Staff for the valuable co-operation and assistance received throughout the year. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE at December 31st, 1937. Councillor G. Peverett (Chairman). His Worship the Mayor (Alderman G. B. Massa, J.P.). Councillor A. R. Abercromby. Councillor W. A. Clarke. Councillor Victor Dover. Councillor J. Owers. Councillor Mrs. C. M. A. Tandy. Councillor V. J. Westlake. MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1937. Councillor Mrs. C. M. A. Tandy (Chairman). Councillor Miss G. E. Appleyard (Vice-Chairman). His Worship the Mayor (Alderman G. B. Masea, J.P.). . Councillor J. H. Barker. Councillor W. A. Clarke. Councillor A. C. Crane. Councillor R. B. Dearie. Councillor A. E. Lauder. Councillor G. Peverett. CO-OPTED MEMBERS. Miss H. M. Corry. Mrs. A. L. Davy. Mrs. Victor Dover. Dr. L. Westlake. JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1937. 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. Alderman R. H. Warren. 5 PUBLIC HEALTH STAFF. * Medical Offioer of Health and Medical Superintendent, Isolation Hospital: W. C. Harvey, M.D., Ch.B., D.P.H. (Full Time.) *Medical Officer for Maternity Centres : Dorothy M. Catchpool, M.B., B.S., L.R.C.P., M.R.C.S., D.P.H. (Part Time.) *Senior Sanitary Inspector (No. 1 District) : L. Skeeles, Cert.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 2 District): H. Hill, M.R.San.I., A.M.Inst.S.E., M.S.I.A., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 3 District): A. E. Gooday, Cert.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. Chief Clerk: P. E. Barber . Clerk: Miss M. Munch. ” Miss L.Clark. (Resigned Aug. 31st). ” Miss K. Stoten (Appointed Oct. 1st). Health Visitors:*Mrs. E. M. Rising, S.R.N., S.C.M..) R.S.I., H.Y. *Miss E. M. Hart, S.R.N., S.C.M. Maternity and Child Welfare. *Mrs. D. A. G. Blake, S.C.M., S.I., H.V. (Resigned October 31st) *Miss M. Maddock, S.R.N., S.C.M.. H.V. (Appointed 1st November.) 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, 1937 66,230 Number of inhabited houses (end of 1937) according to Rate Books 19.588 Rateable Value (1937) £826,867 Sum represented by a penny rate (1937) £3,410 General conditions in Southgate have shown no material alteration from those outlined in some detail in the Reports of recent years. The comments which appeared therein regarding nutrition, unemployment, special environmental factors, etc., still hold good, and no useful purpose would seem to be served by repeating them here. Meteorology.—The total rainfall recorded by the Council's rain-gauge in Proomfield Park measured 28.83 inches during 1937, the daily average being 0.078 inches. The greatest fall in 24 hours occurred on December 13th when 0.79 inches were recorded. The total number of days on which no rain fell was 184. RAINFALL RECORDED AT BROOMFIELD PARK. Total Rain for month. Number of Wet Days with 0.01 or more ins. 0.04 or more ins. 1936 Ins. 1937. Ins. 1936. Days. 1937. Days. 1936. Days. 1937. Days. Jan. 4.47 3.82 22 23 17 17 Feb. 1.67 4.35 14 23 11 19 Mar. 1.24 2.49 16 19 9 13 April 1.47 3.04 14 15 10 13 May 0.31 2.72 5 15 2 12 June 3.63 1.89 19 13 17 9 July 3.09 0.58 22 10 14 7 Aug. 0.54 1.15 7 7 4 4 Sept. 2.79 1.59 18 14 12 13 Oct. 1.72 2.25 11 11 9 8 Nov. 3.16 1.43 16 9 13 7 Dec. 1.79 3.52 18 22 13 9 Totals. 25.88 28.83 182 181 131 131 7 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. Male. Female. Live Legitimate 634 316 318 Births Illegitimate 24 6 18 Totals 658 322 336 Birth Rate per 1,000 of the estimated resident population 9.93 Stillbirths 18 11 7 Rate per 1.000 total (live and still) births 26.63 Deaths 716 346 370 Corrected Death Rate per 1,000 of the estimated resident population. 10.59 Deaths from puerperal causes:— From Puerperal sepsis Rate per 1,000 total Deaths. (live and still) births. 0 0.00 From other Puerperal causes 3 4.44 Total 3 4.44 Death Rate of infants under one year of age:— All infants per 1.000 live births 42.55 Legitimate infants per 1.000 legitimate live births . . 42.58 Illegitimate infants per 1,000 illegitimate live births. . 41.66 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 4 POPULATION. The Registrar-General's estimate of the population at the middle of 1937, was 66,230, an increase of 2,230 over the estimate for 1936. This is taken as the population of the Borough for the purposes of this report. 8 The number of deaths exceeded the number of births by 58, as compared with an excess of births over deaths of 14 in 1936. The population for the past 5 years has been as follows:— 1933 58,820 1934 59,997 1935 62,180 1936 64,000 1937 66,230 BIRTHS—BIRTH RATE. The nett total births accredited to the district was 658, an increase of 13 on the preceding year; of these, 322 were males and 336 females (6 males and 18 females being illegitimate). The birth-rate was, therefore, 9.93 per 1,000 of the population, as against 10.08 in 1936. The birth-rate for England and Wales for 1937 was 14.9. The total number of births actually registered in the district during the year amounted to 628. MORTALITY General Mortality and Death Rate.—The nett number of deaths accredited to this district was 716, an increase of 85 as compared with the previous year. This gives a corrected death-rate of 10.59 per 1,000 of the population, an increase of 0.93 on the rate for the previous year, which was 9.66. This rate is still appreciably below that for England and Wales (12.4 for 1937). As compared with 1936, there were increases of 22 deaths from cancer, 34 from heart disease and other circulatory diseases, 15 from influenza, 6 from bronchitis, 2 from puerperal causes, and 14 from suicide and other forms of violence. There were decreases of 9 deaths from tuberculosis, 3 from diphtheria, 2 from typhoid fever, 5 from appendicitis, and 5 from nephritis. It may also be noted that the deaths of males increased by 12, while the deaths of females increased by 73 over those recorded in 1936. 9 The most noteworthy features of the mortality statistics for 1937 were the increased number of deaths from influenza and suicide and other forms of violence, and a welcome decrease in the tuberculosis mortality rate. The increases in the deaths from cancer and heart disease are of no special epidemiological significance, mostly occurring as they did among members of the oldest age group. The increase in the deaths from puerperal causes, and the decrease in the case of diphtheria represent variations in such small totals that any conclusions which might be drawn from them would almost certainly be erroneous. The increased influenza death rate was, of course, due to the epidemic which continued well into 1937. With regard to the alarming increase in the deaths from suicide and other forms of violence, the remarks which I made in several previous reports carry still more significance. This increase is a tragic index of our so-called modern civilisation. The remedy is difficult to find, particularly by a Public Health Authority, but the matter is rapidly becoming one of first-class national importance. The principle 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 58.80. Next came the group 45-65 years with 26.95 per cent., after which there was a marked fall to 7.68 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 14.25 per cent. of the aggregate deaths. It is somewhat of a coincidence that the distribution of deaths for the year 1937 was almost exactly similar to that for 1936. One would expect considerable similarity in a population such as Southgate's, but to find almost parallel figures is remarkable. Infantile Mortality.—There were 28 (1 illegitimate) deaths of infants under 1 year of age, which give an infantile death-rate of 42.55 per 1,000 births registered, as compared with 28 deaths and & rate of 43.41 in the preceding year. The rate for England and Wales for 1937 was 58. It will be seen that the infant mortality rate once again fell slightly during the year, and that it is still well below that for England and Wales. 10 Table III on page 15 sub-divides the infant deaths according to the weeks or months at which they occurred. 67.86 per cent. of the total deaths occurred during the first month, while 68.42 per cent. of these occurred during the first week. Prematurity accounted for 9 deaths, congenital malformations for 6, pneumonia for 4, and enteritis for 4. All the infant deaths were investigated. Stillbirths.—Eighteen stillbirths, none of which was illegitimate, were accredited to the district for 1937. This is equal to a death-rate of 26.63 per 1,000 total (live and still) births registered, the corresponding figures for 1936 being 23 stillbirths with a rate of 34.43. The decrease shown in the stillbirth rate is very welcome, as is also the fact that the figure of 18 is one of the lowest recorded in Southgate for a number of years. Maternal Mortality.—The maternal mortality rate—i.e., the number of mothers dying as the result of childbirth per 1,000 total (live and still) births—was 4.44 for 1937. This represents 3 maternal deaths all of which occurred outside the district. Last year there was one death with a corresponding rate of 1.49. As noted elsewhere in this report, it would be unwise to attempt to draw any important conclusions from these figures. One additional maternal death raises our maternal mortality rate quite out of proportion to the causal circumstances. It is also significant to note that all the deaths occurred outside the district. We must nevertheless take every precaution to ensure the safety of our expectant mothers, as only in this way can these tragedies be prevented. 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 4 deaths during 1937. This represents a corrected death-rate of 0.06 per 1,000 of the total population, and 0.56 per cent. of the total deaths for the year, at all ages. In 1936 there were 5 deaths, giving a rate of 0.08 and a percentage of 0.79. 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 appreciably more than 50 per cent. of the total deaths occurring during the year took place in 11 persons over the age of 65 (58.80 per cent.). In this connection, it is interesting to note that 8 females died at the age of 90 or over, the oldest being 96 years; while 5 males also died within this age period, the oldest being 95. Zymotic Mortality.—This includes the deaths from the seven principal zymotic diseases, viz. : Smallpox, scarlet fever, diphtheria, typhoid fever, measles, whooping cough and diarrhoea (in children under 2 years of age). There were 4 deaths in this category, all from diarrhoea. The zymotic death-rate for 1937 was therefore 0.06 per 1,000 of the population, as against 0.11 in 1936, with 7 deaths. 12 Table 1. Causes of Death During the Year 1937. Causes of Death. Male. Female. Total. Rates per 1,000 of Population. All Causes (Civilians only) 346 370 716 1 Typhoid and Paratyphoid Fevers .. .. .. .. 2 Measles .. .. .. .. 3 Scarlet Fever .. .. .. .. 4 Whooping Cough .. .. .. .. 5 Diphtheria .. .. .. .. 6 Influenza 9 18 27 0.40 7 Encephalitis Lethargica .. .. .. .. 8 Cerebro-Spinal Fever .. .. .. .. 9 Tuberculosis of Respiratory System 17 8 25 0.37 10 Other Tuberculous Diseases 1 2 3 0.04 11 Syphilis .. .. .. .. 12 General Paralysis of the insane, Tabes Dorsalis 2 1 3 0.04 13 Cancer, Malignant Disease 59 66 125 1.85 14 Diabetes 4 6 10 0.15 15 Cerebral Hemorrhage, etc. 8 24 32 0.48 16 Heart Disease 99 103 202 3.00 17 Aneurysm 2 .. 2 0.03 18 Other Circulatory Diseases 23 32 55 0.82 19 Bronchitis 10 11 21 0.31 20 Pneumonia (all forms) 19 21 40 0.59 21 Other Respiratory Diseases 4 2 6 0.08 22 Peptic Ulcer 5 3 8 0.12 23 Diarrhoea, etc. (under 2 years) 1 3 4 0.06 24 Appendicitis .. 2 2 0.03 25 Cirrhosis of Liver 2 1 3 0.04 26 Other Diseases of Liver, etc. 1 2 3 0.04 27 Other Digestive Diseases 7 3 10 0.15 28 Acute and Chronic Nephritis 5 7 12 0.18 29 Puerperal Sepsis .. .. .. 30 Other Puerperal Causes .. 3 3 0.04 31 Congenital Debility, Premature Birth and Malformation, etc. 10 9 19 0.28 32 Senility 1 2 3 0.04 33 Suicide 5 8 13 0.19 34 Other Violence 13 10 23 0.34 35 Other defined Diseases 39 23 62 0.92 36 Causes ill-defined or unknown .. .. .. Totals 346 370 716 10.59 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. 1937. 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 13 1.82 0.19 15 2.09 0.23 28 3.91 0.42 1— 5 years 2 0.23 0.03 2 0.28 0.03 4 0.56 0.06 5—15 „ 3 0.42 0.04 3 0.42 0.04 6 0.84 0.08 15—25 „ 4 0.56 0.06 5 0.70 0.07 9 1 .26 0.13 25—45 „ 27 3.77 0.40 28 3.91 0.42 55 7.68 0.82 45—65 „ 115 16.06 1.70 78 10.89 1.15 193 26.95 2.85 65 and over 182 25.42 2.69 239 33.38 3.54 421 58.80 6.23 Totals 346 48.33 5.11 370 51.67 5.48 716 100.0 10.59 14 Table III. Infantile Mortality. 1937. Nett Deaths from stated causes at various periods under 1 Year of Age. Causes of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. | 9—12 Months. Total Deaths under 1 Year. All Causes 13 5 .. 1 19 3 2 3 1 28 1 Smallpox 2 Chickenpox 3 Measles 4 Scarlet Fever 5 Whooping Cough 6 Diphtheria and Croup 7 Erysipelas 8 Tuberculous Meningitis 9 Abdominal Tuberculosis 10 Other Tuberculous Diseases 11 Meningitis (Not Tuberculous) 12 Convulsions 13 Laryngitis 14 Bronchitis .. .. .. .. .. .. .. 1 .. 1 15 Pneumonia .. 1 .. .. 1 1 1 .. 1 4 16 Diarrhoea 17 Enteritis .. 1 .. 1 2 1 .. 1 .. 4 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 1 .. .. .. 1 .. .. .. .. 1 22 Want of Attention and Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 23 Atelectasis 24 Congenital Malformations 3 1 .. .. 4 1 1 .. .. 6 25 Premature Birth 7 2 .. .. 9 .. .. .. .. 9 26 Atrophy, Debility and Marasmus 27 Other Causes .. .. .. .. .. .. .. 1 .. 1 Totals 13 5 .. 1 19 3 2 3 1 28 15 Table IV. Vital Statistics of Whole District during 1937 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 5 6 7 8 1931 1932 56,460 57,250 663 651 11.68 11.37 512 589 8,67 9.67 30 25 45.24 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 64,000 645 10.08 631 9.66 28 43.41 1937 66,230 658 9.93 716 10.59 28 42.55 Comparison of the Rates of the Southoate District with those of England and Wales, and London, for the Year 1937. 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 14.9 0.60 12.4 0.00 0.00 0.02 0.01 0.04 0.07 0 45 5.2 58 125 County Boroughs and Great Towns, including London 14.9 0.67 12.5 0.01 0.00 0.03 0.01 0.04 0.08 0.39 7.9 62 148 Smaller Towns (1931 Census Populations 25,000—50,000). 15.3 0.64 11.9 0.00 0.00 0.02 0.01 0.03 0.05 0.42 3.2 55 London 13.3 0.54 12.3 0.00 0.00 0.01 0.01 0.06 0.05 0.28 120 60 Southgate 9.93 0.26 10.59 0.00 0.00 0.00 0.00 0.00 0.00 0.40 5.92 42.55 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 proposed enlargement of the Wood Green and Southgate Hospital referred to in last year's Annual Report has not yet become an accomplished fact, but it may be that, within the next twelve months, these enlargements will see their inception. Provision for Maternity Beds.—The agreement with the Royal Northern Hospital and the Salvation Army Maternity Hospital to admit Southgate mother's 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. When the re-building scheme at the North Middlesex County Hospital has been completed, the accommodation for maternity oases will be considerably extended. Thus, a long-felt need will be met. The question of providing a Borough Maternity Hospital for Southgate residents has been one in which I have taken considerable interest for some time. There can be little doubt that such an institution would be a valuable asset to the maternity services of the district. There can be even less doubt that the cost of providing the service would be high. So long as the population of the Borough is being adequately catered for in the matter of maternity beds, it is extremely doubtful if such an expenditure could be justified. Moreover, with an extended North Middlesex County Hospital, it would appear that liberal maternity bed provision will, in fact, be made. In the circumstances, therefore, it would seem wise to postpone consideration of this question for the time being, but I trust that the matter may be kept in mind for possible, future action. Isolation Hospital.—The following improvements were carried out at the Isolation Hospital during 1937:— Re-decoration of wards; purchase of additional furniture and equipment, including oxygen tent, several steam bed-pan 17 sterilizers, stainless steel equipment, and intubation set; repairs to boiler plant and laundry equipment; provision of modern type surgical basins in all wards; installation of signal system in Cubicle Block; purchase of latest type of insulated food trolley. Additional alterations and improvements are contemplated during the present year, such being designed to maintain the hospital in an up-to-date and efficient condition. The permanent nursing, domestic and out-door staff remained unaltered during 1937. As before, additional nursing staff was obtained when occasion demanded. It is with the greatest regret that I still do not find myself in a position to report that a start has been made with the proposed hospital extensions. Several conferences have taken place at the Ministry of Health and with the Tottenham Borough Council representatives. The delays which occurred have been unavoidable so far as we are concerned, but I most sincerely trust that we are now approaching the end of our difficulties. While it might not be true to state that additional beds are specifically required for Southgate purposes, it is a very definite fact that the improved facilities available at an enlarged hospital would very greatly benefit the inhabitants of the Borough. The conception of the use of an Isolation Hospital has been completely revolutionised within recent times. The original claims made for such an institution have rightly been discarded, and in their place a wider outlook regarding the potentialities both of prevention and treatment has arisen. Unfortunately, the limited accommodation and staff at present available have so far prevented the fullest use being made of what should be an institution of prime Public Health importance. Amalgamation with a neighbouring authority should solve these difficulties and furnish the means of providing what are fast becoming essential services, at reasonable cost. Nursing Homes.—There are in the district 6 registered Nursing Homes, the same number as during 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. 18 These Nursing Homes provide facilities for the treatment oi 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 has continued the work set out in last year's Annual Report, and, as the figures set out in the following table will show, has increased the scope of the services provided. The Council's arrangement with the Nursing Association is working admirably, and has now become an established factor in the public health services of the Borough. Table of Work carried out by the Southgate Queen's Nursing Association under the Borough Council's Scheme:— Diseases Treated. Cases. Visits. Pneumonia 25 242 Influenza 49 352 Measles 1 14 Children under 5 (notifiable) 3 45 ” ” (not notifiable) 62 373 Complications of Pregnancy 13 182 Hospital cases 65 995 Other notifiable 2 9 220 2,212 (1936) 147 1,270 In addition to the work outlined above, the Southgate Queen's Nursing Association supplied, as heretofore, its usual efficient general services, which also continue to show a very definite increase. The following table sets out the work carried out by the Queen's Nursing Association during 1937, so far as its own activities are concerned. 1937. 1936. Domiciliary Nursing Visits 15,574 13,446 Patients attending Physiotherapeutic Clinic 1,614 1,509 Treatments given 8,701 8,450 The Southgate Queen's Nursing Association undertakes the recognised midwifery service in the Borough, under the auspices of the Middlesex County Council. While the Borough Council takes no 19 part in conducting this scheme, it is intimately concerned both in operation and results, and it is pleasing to be able to report that the most cordial co-operation exists between the Nursing Association and the Maternity Department. This co-operation is vital in the interest of all concerned, and every effort is made to ensure its continuance. It was my privilege as Medical Officer of Health to attend a number of the Nursing Association's Executive Committee meetings during the year, it being thus possible to keep in close touch with the work of the Association. (6) As indicated above, home nursing of certain infectious diseases is 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. The scheme is working in a very satisfactory manner. Midwives.—There are 10 midwives practising in the area. These come under the supervision of the County Authority, and none is employed or subsidised by the local Council. It has already been stated that the Southgate Queen's Nursing Association undertakes the midwifery work within the Borough, under the jurisdiction of the Middlesex County Council. It has also been stated that the scheme appears to be working in a smooth and efficient manner, and that we on our side are co-operating as and when required. There have been obvious difficulties to surmount, but this is not a matter1 upon which a.ny comment is required in the Report of Southgate's Medical Officer of Health. The County Council is the responsible authority, and it merely rests with us to make such representations regarding the well-being of Southgate mothers as we may think proper. Up to the present, it has only been necessary to indicate to the Queen's Nursing Association the lines upon which co-operation appears most desirable. Our suggestions have invariably met with a sympathetic reception, and at the moment it would seem that the matter might well be allowed to rest at that point. Clinics and Treatment Centres.—The following Clinics and Treatment Centres are available for the inhabitants of the Borough : 20 Maternity and Child Welfare (Southgate Council).—At 31st December, 1937. Infant Welfare:— Methodist Hall. The Bourne Mondays 2—4p.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—4p.m. Pre-Natal:— Broomfield House Thursdays 10 a.m.—12 noon. Immunisation (against Diphtheria) Clinic (Southgate Council).— Broomfield House Thursdays 2—4p.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, De Bohun Council School, Southgate, and Holly Park Council School, Friern Barnet. Ophthalmic Clinic: Garfield Road Council School, New Southgate. Dental Clinic: Winchmore Council School, Highfield Road. Orthopædic Treatment.—Arrangements are made for the treatment of any orthopædic 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 sohool age. 21 Institutional Provision for unmarried mothers, illegitimate infants and homeless children. No change from the arrangements noted in the Report for 1930. Ambulance Facilities.—The details set out in the Annual Report for 1935 regarding ambulance facilities available within the Borough, together with the alterations commented upon in last year's Annual Report, hold good. All cases of doubt are referred to the Medical Officer of Health, and the Borough Council would appear to have much upon which to congratulate itself with regard to the operation of its ambulance service. Council Employees.—Twelve Council employees were examined at the Town Hall during 1937, either for admittance to the superannuation scheme or before being accepted into the Council's service. Mortuary.—During 1937, 43 bodies were deposited in the Council's mortuary situated at the rear of the Town Hall. A valuable addition to the Public Health services of the Borough was made towards the end of 1937, when the new mortuary premises situated at the rear of the Town Hall were completed. These premises consist of a body store capable of housing five bodies, a fully-equipped post-mortem room, and a suitably-decorated viewing room. Full publicity regarding the mortuary facilities was supplied to the local Press, while all general practioners within the Borough were circulatd, informing them of the existence of those facilities and offering their use. wherever such a regrettable necessity arose. This invitation has been accepted on numerous occasions, and it would already appear that the mortuary is fulfilling a very definite and valuable purpose. 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 1937. Work at the laboratory continues to increase, and it is hoped that, when the hospital extensions have been completed, arrangements will be made whereby the hospital laboratory can be used for general Borough purposes. There can be no doubt that the existence of a laboratory within the district is an inestimable advantage. One cannot easily set these advantages out in print, but they are none the less tangible and important. 22 Work carried out at the Council's laboratory during 1937:— Hospital. Borough. Positive. Negative. Positive. Negative. Swabs for Diphtheria Bacilli 710 3,207 20 397 Swabs for Haemolytic Streptococci - - - 5 Sputa for Tubercle Bacilli 1 2 10 148 Faeces for Tubercle Bacilli - 1 - Breast Milk — — — 2 Total 4,503 (Total, 1936—4,047). Specimens sent to Clinical Research Association during 1937:— Positive. Negative. Total. Swabs for Diphtheria Bacilli — 1 1 Swabs for Meningococci — 2 2 Swabs for Haemolytic Streptococci - 4 4 Blood for Widal Test (Typhoid) 2 15 17 Faeces 6 25 31 Rectal Swabs 1 3 4 Pus — 1 1 Cerebro-spinal Fluid 1 1 2 10 52 62 Specimens sent to laboratory at the Prince of Wales's Hospital during 1937:— Positive. Negative. Diphtheria swabs for virulence test 16 9 Failing to incubate Diphtheria Bacilli — 9 Rectal Swabs 3 8 19 26 Total 45 BACTERIOLOGICAL EXAMINATION OF MILK. The work carried out at the laboratory in connection with the examination of milk samples has followed along the lines of pre- 23 vious years, with certain extensions necessitated by virtue of the passing of the Milk (Special Designations) Order, 1936. A summary of the work carried out during 1937 appears below, and from the figures there set out, it will be seen that the position is relatively satisfactory. When, however, it is realised that two samples of raw milk prior to pasteurisation revealed the presence of the bacillus tuberculosis, it will be seen, first, that the investigations are very well worth while, and second, that pasteurisation of milk supplies is at present, a very definite necessity. Summary of Work carried out during 1937. Total number of samples examined 204 Samples examined for total bacterial count 152 Samples submitted to reductase test 52 Samples examined for presence of bacillus coli 130 Samples examined for presence of tubercle bacilli 106 Samples of Non -designated Milks, including Raw Milk, Pasteurised (Non-designated) Milk, Sterilized Milk and Irradiated Milk, examined 104 Percentage of satisfactory results, as regards total bacterial count 98.1% Percentage of satisfactory results, as regards b. coli content 94.2% Average bacterial count 31,863 Samples of Designated Milks examined 100 Tuberculin Tested (Certified) 24 Tuberculin Tested 16 Tuberculin Tested (Pasteurised) 8 Accredited 12 Pasteurised 40 Fifty-two samples of raw, designated milks were submitted to the methylene blue (reductase) test with the following results:— Percentage found satisfactory. Tuberculin Tested (Certified) 100% Tuberculin Tested 93.2% Accredited 91.6% 24 Forty-eight samples of designated milks treated by heat were examined for total bacterial content, as follows: Tuberculin Tested (Pasteurised). Percentage of samples found satisfactory in every respect 87.5% Average bacterial count 18,111 Pasteurised Milk. Percentage of samples found satisfactory in every respect 97.5% Average bacterial count31,275 Tubercle bacilli were found to be present in two samples of raw milk, examined prior to pasteurisation. No tubercle bacilli were present in any of the remaining 104 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 IV. Public Health Acts Amendment Act, 1907.— 1. 4. 1912. Parts II (except Section 28), IV, V and VI. 17. 1. 1912. Section 81 in Part VII—as amended by Order of Home Office, 17. 1. 1912. 17. 1. 1912. Parts VIII and IX. 1. 4. ,1912. Part X. 25. 11. 1919. Small Dwellings Acquisition Acts, 1899-1923. 17. 12. 1923. Private Street Works Act, 1892. 12. 4. 1926. Public Health Act, 1925, Part II. 15. 8. 1913. The Southgate Urban District Council Act, 1913, amended by Southgate Urban (Local Act) Order, 1926. Various Middlesex County Council Acts. 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. 1. 6. 1937. Bye-laws with respect to hairdressing establishments. 19. 11. 1937. Bye-laws as to establishments for massage or special treatment. 27 Maternity and Child Welfare Services. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1937. Number on Registers:— Under Over 1 year. 1 year. Totals. 1936. January 1st, 1937 447 609 1,056 930 December 31st, 1937 991 956 1,947 1,971 New cases during 1937— Southgate 544 350 894 868 East Barnet 46 17 63 96 38 of the Southgate new cases under 1 year were "removals'' into the district. The remaining 506, therefore, represent 76.90 per cent, of the total births credited to the district. Attendances at Centres, 1937:— Under 1 year. Over 1 year. Totals. 1936. Broomfield House 1,402 901 2,303 2,199 Bowes Park 1,983 1,640 3,623 2,383 New Southgate 1,901 1,585 3,486 3,111 Southgate (Jan. 1—Feb. 26, 1936) - - - 855 Winchmore Hill 2,147 1,647 3,794 3,897 Community Hall 1,307 2,101 3,408 2,828 The Bourne 1,869 1,057 2,926 2,359 Totals 10,609 8,931 19,540 17,632 Average 35.13 29.57 64.70 59.56 28 Number Seen by Doctor:— Under 1 year. Over 1 year. Totals. 1936. Broomfield House 498 440 938 941 Bowes Park 666 608 1,274 958 New Southgate 593 575 1,168 1,104 Southgate (Jan. 1—Feb. 26, 1936) - - - 259 Winchmore Hill 703 648 1,351 1,302 Community Hall 435 623 1,058 864 The Bourne 641 466 1,107 813 Totals 3,536 3,360 6,896 6,241 Average per session 11.71 11.12 22.83 21.08 Percentage of total attendance seen by Doctor33.3% 37.6% 35.3% 35.4% Number of Sessions held (1937) 302 Talks and Practical Demonstrations in Mothercraft given at Centres (1937) 42 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. 1937. January 1st 54 69 December 31st 69 121 New cases during the year 194 245 The number of new cases during the year represents 36.13% 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. Postcards are sent, prior to each session, inviting the attendance of certain of those on the register. 29 1936. 1937. Total attendances 669 841 Average per session 12.86 16.49 Number seen by Doctor 630 788 Average per session 12.11 15.45 Percentage of total attendance seen by Doctor 94.1% 93.7% Percentage of mothers attending Prenatal Centre 29.04% 36.13% 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. 1937. First visits 416 444 Under 1 year of age 1,162 In addition tofirst visits. 1,629 Over 1 year of age 3,256— 2,821 Visits re:— Deaths under 5 years of age 13 9 Stillbirths Ophthalmia Neonatorum 9 5 cases 3 — Pre-natal visits 392 493 Visits re:— Puerperal Fever cases — — Puerperal Pyrexia cases 2 9 Special visits (test-feeds, following special cases seen by M.O. at Centres, failing lactation, etc.) 1,150 841 Total visits 6,403 6,251 It will be noted from the figures set out in the previous pages that the work of the clinics once again shows an increase over that of previous years. Attendance at the various Centres have increased by almost 2,000, while the average percentage attendance at the Clinics has also shown a slight and welcome increase. A pleasant feature of the year's work has been the extended use made of the Pre-natal Clinic. This is apparently due to the closer cooperation existing between the Maternity Department and the North Middlesex County Hospital, a co-operation which is extremely valuable from every standpoint. Various attempts were made throughout the year to bring the Clinic facilities more closely to the notice of the burgesses. One hundred per cent, attendances of Southgate mothers is, of course, an impossibility, but so long as the available services are not known to or used by any family in Southgate who might benefit therefrom, maximum efficiency cannot be anticipated. 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 10 Number of foster children 12 Total visits paid 150 Work in connection with the Children Acts was considerably heavier during 1937 than in any previous year, although the number of foster children in the district and the supervising visits paid actually show a slight decrease. Following numerous complaints, one house used for the reception of foster children was voluntarily closed. It should be stated here that no exception waS taken by the Department to the premises or to the management thereof. A second very unpleasant case occurred, in which it was necessary to have one child removed to hospital and to take immediate steps to ensure that no further children should be sent to the home concerned. At one time it appeared that proceedings might have to be taken, but this was not done. Apart from the two cases noted above, no complaint or case of neglect was met with during the year. Miscellaneous Statistics. 1936. 1937. Births registered in the district 562 628 Attended by Midwives 131 113 Un-notified Births 18 17 Percentage of Births notified 96.8% 97.3% Stillbirths notified 18 12 Stillbirths notified by Midwives 5 2 31 Stillbirths notified by Doctors 13 10 Stillbirths notified occurring in Institutions : In the district 2 5 Outside the district 6 4 Maternal Deaths 1 3 Infant Deaths:— Under 1 year of age 28 28 Under 1 month (inc. above) 14 19 1 to 5 years of age 5 4 Number of Southgate Births in North Middlesex Hospital Maternity Home 94 113 Infant Mortality amongst children attending Centres 14 6 (4 over, (2 over, 10 under 4 under 1 year.) 1 year.) Number of cases in which milk was granted:— 1935, 225; 1936, 241; 1937, 305. Approximate cost:—1935, £731; 1936. £776; 1937, £964. Grants of Trufood were made in 12 cases, Cow and Gate in 16 cases, Allenbury's in 27 cases; Nestle's in 8 cases; Ostermilk in 2 cases; and Parrish's Food in 2 cases; while grants of cod liver oil emulsion, cod liver oil and malt, and syrup minadex were allowed in 63, 74 and 14 cases respectively. Number of children under 1 year of age granted free milk during 1937 158 Percentage of total live births 24.07 List of Foods Soi.d at Centres. £ Trufood, amounting to 91 (approximate) Cow & Gate, amounting to 89 ,, Dental Treatment.—The arrangements outlined in the Annua Report for 1935- continue to operate in a satisfactory manner. Some slight difficulty has been encountered in persuading mothers to attend personally, and to take their children to the Eastman Dental Clinic, by reason of the travelling expenses involved. It is anticipated that this difficulty will very shortly be overcome by the provision of free transport. Number of "Council" patients attending Clinic. 1937 29 Cost of such cases £32 32 Part Payment of Midwives' Scheme.—Thirty-six applications were dealt with under this scheme from January 1st until September 30th, when the Middlesex County Council became responsible for the provision of midwives. The total expenditure in this connection was £77 0s. Od. As noted elsewhere in this Report, the Borough Council is nc) longer responsible for providing financial assistance in connection with midwifery service. Home Help Scheme.—A scheme for the provision of Home Helps to households where a confinement had taken place was instituted on June 22nd, 1937 (see appendix for special report). The following table details the work carried out under the scheme from that date until the end of the year: Number of Home Helps provided free of charge—25. 2 for 21 days 22 for 14 days. 1 for 13 days. Number of Home Helps provided at a charge of Is. per day—3. 1 for 19 days. 2 for 14 days. Number of Home Helps provided at a charge of 5s. per day—2. 1 for 14 days 1 for 3 days. Total cost of operating the Scheme during 1937—£100 18s. Average number of Home Helps on Council's roll—10. There can be little doubt that this scheme has been of very great advantage and that it has provided much-needed ,assistance to necessitous families. There is also every evidence to believe that, as the facilities become better known, the scheme will assume increasing popularity. Certain minor administrative difficulties were encountered during the early stages, necessitating slight alterations to the scheme, but. the machinery is now working smoothly. It may be necessary at a later date to make further amendments, but there does not appear to be any need at" the moment to alter the regulations as they 'now stand. Attendance at Centres of Non-Southgate Mothers.— Members of the Council will remember that the above matter occasioned considerable concern during 1936. Following negotiations with the Hertfordshire County Council, the attendance of mothers from the East Barnet Urban District was finally stopped at the end of September, 1937. 33 The following table sets out the number of non-Southgate mothers who attended the various Centres during the year: East Barnet District The Bourne 91 Broomfield House — Bowes Park — New Southgate 51 Community Hall 15 Winchmore Hill — Pre-Natal 7 Voluntary Helpers.—The Voluntary Helpers' Committee continued its excellent work during the year. The voluntary Helpers must be congratulated upon the quality of the services which they render, and it is pleasing to report that these services were officially recognised at a function held in the Town Hall during December, 1937. General.—The scheme mentioned in last year's Annual Report for the provision of an additional ad hoc combined Maternity Centre and Day Nursery within the Borough has not yet materialised. Members of the Committee spent considerable time in inspecting premises of a similar nature recently constructed in and around London, but certain difficulties encountered have delayed the execution of the scheme. While the provision both of a modern Maternity and Child Welfare Centre and of an adequate Day Nursery appears highly desirable, these are not matters which should be decided at a moment's notice. It is, however, anticipated that a definite decision will shortly be reached. It is somewhat regrettable that the arrangement whereby the Borough Council will share a combined School and Maternity and Child Welfare Centre with the Middlesex County Council has also not been completed. When provided, this Centre should prove of very great service to the Bowes Park and New Southgate areas, and it is to be hoped that the County Council will see their way clear to commence building operations at a very early date. Elsewhere in this Report I have stated that our outlook towards Infectious Diseases must, never be static, but, should continue to advance with the times. This remark applies with even greater force to Maternity and Child Welfare, in many respects the foundation of modern preventive medicine. We must be continually prepared to harness scientific knowledge to our use, and to examine and re-adjust our perspective in the light, of modern knowledge. 34 In a district such as Southgate, Maternity and Child Welfare must play a major part in the Public Health programme. What was sufficient yesterday will probably not be sufficient to-day, and will certainly be insufficient to-morrow. We cannot hope to maintain an efficient service upon the outlay of previous years. Such a policy would inevitably weaken our resistance, and would moreover be followed by a completely disproportionate rise in expenditure. Our defences should be impregnable, for upon those defences rests the security and well-being of our future population. PUBLIC ELEMENTARY SCHOOLS. The arrangements for co-operation between the County School Medical service and the Public Health Department remain as outlined in the Annual Report for 1935. Several visits were paid to elementary schools following the report of multiple cases of infectious disease, while immunisation was also carried out at two schools in the district. One visit was again paid to a secondary school for the purpose of giving a lecture on Public Health to th^ senior scholars in connection with Health Week. 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 1937 was as follows :— Requiring Inspected. Treatment. Entrants 929 179 Intermediates 776 139 Leavers 485 87 2,190 405 Other ages 325 56 Special4 — 329 56 2,519 461 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 35 sessions are held on Tuesday, Thursday and Friday mornings, at De Bohun Council School, Southgate, on Tuesday mornings, and at Holly Park Council School, Friern Barnet, on Monday and Wednesday mornings. The total number of children attending Southgate Schools dealt with at the Minor Ailments Clinics during 1937 was as follows:— Not New Atten- Treated. requiring Cases. dances. Treatment. Winchmore Hill 1,317 3,897 1,244 73 De Bohun 446 1,536 446 Holly Park 301 620 263 38 2,064 6,053 1,953 111 (6) Ophthalmic Cliv/ic.—An ophthalmic clinic is held twice weekly, on Monday mornings and Thursday afternoons, 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 fortyeight children attended the clinic and were seen by the Ophthalmic Surgeon during 1937. Spectacles were prescribed and provided for 148 of these. The corresponding figures for 1936 were 209 and 146 respectively. (c) Dental Clinic.—Dental treatment of school children is carried out by Mrs. A. M. Ferry, L.D.S., one of the County Council's Assistant Dental Officers at the Winchmore Council School, Highfield Road. Children attending Bowes Road and Garfield Road Council Schools continue to receive treatment at the clinic at Holly Park Council School. The Dental Officer inspects children in the various schools, and those requiring treatment are referred to the dental clinic where treatment is provided at a charge of Is. 6d. (remitted in necessitous cases). Two thousand and eigthy-three children were dentally inspected at the schools during the year, as against 2,195 in 1936, while 1,894 attended at the clinics (1936, 1,519) where they received treatment for various dental defects. 36 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. The Ministry of Health now requires that information relating to any infection which might be water-borne should be transmitted to the responsible water authority, in. our case the Metropolitan Water Board. This is being done. Swimming Bath.—The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows :— 1936. 1937. Mixed Bathers, Adults 21,688 22.922 Mixed Bathers, Children 24,174 23,925 Season Ticket Holders (attendances) 15,497 15,278 Totals 61,359 62,125 Spectators, Adults 2,414 2,895 Spectators, Children 1,000 1,019 Broomfield Park Swimming Lake.—Further samples of the water from this lake were taken in October and December of last year, the appropriate reports being submitted to the Public Health Committee. The steps taken following the reception of these reports will be dealt with in the Annual Report for 1938. as they properly belong to that period. It need only be stated here that the Public Health Committee considered the analyses unsatisfactory, and that recommendation was made that the lake be closed for swimming. Rivers and Streams.—Very few complaints have been received regarding unpleasant odours from neighbouring sewage farms. Drainage and Sewerage.—The arrangements for drainage, sewerage, and sewage disposal remain materially as set out in the Report for 1930. In a district such as Southgate, this work must proceed at a fast pace, in order that the development of the district may receive proper attention. 37 The mechanical street gully cleanser mentioned in last year's Annual Report continues to be hired under contract, and has proved its usefulness beyond question. 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.—There are now three public conveniences within the Borough, situated as follows: North Circular Road, Palmers Green; The Triangle, Palmers Green; Fords Grove, Winchmore Hill. In addition to the above, there are available to the public conveniences provided by the London Passenger Transport Board at Southgate and Enfield West Underground stations. Once again, I should like to plead the necessity for establishing a public convenience to serve the New Southgate area. Collection and Disposal of Refuse.—The system of refuse collection detailed in the Annual Report for 1935 remains unaltered, with the exception of certain operative details. Minor complaints continue to be received and are dealt with by the Surveyor's Department. It is anticipated that a separate collection of garden refuse at a small charge will shortly be instituted. Once again it is pleasing to report that the district was free from any serious fly or cricket nuisance during the year. Individual complaints are occasionally sent in and receive immediate attention 38 The following is a brief summary of the work carried out during the year:— No of days worked—Hired Horses 264 „ „ ,, ,, ,, Pagefield Containers 1,198 ,, ,, ,, Freighters 564 ,, ,, ,, Hired Lorries 63 No. of Loads to Destructor 7,706 Total Weight to Destructor 16,410 tons. No. of Loads to Shoots 119 Total Weight to Shoots 212 tons. Smoke Abatement.—The following is a summary of the work carried out during 1937 under the Smoke Abatement Act, 1926:— One hundred and sixty-eight observations were made on chimneys within the Borough. No contraventions of the Bye-law were noted during the year. 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.—Few complaints were received during 1937 with regard to the above matter, although waste pieces of land continue to be used as dumping places for undesirable rubbish. As the district develops, these spots decrease in number. Undesirable ponds have now almost vanished from the face of Southgate, and we shall all look forward to the day when it will be possible to make the same statement with respect to that type of vacant land which is seldom an amenity and more often than not a- decided public health nuisance. Common Lodging Houses, Houses-let-in-lodgings, etc.— Very little difficulty has been met with in administering the byelaws governing these types of premises, but the requirements continue to receive constant supervision. Schools.—The school mentioned in last year's Annual Report as due to be closed, has now ceased to be used. It cannot yet be said that all schools within the Borough are satisfactory from a Public Health point of view, but undoubted improvements have been carried out during recent years. Rag Flock Acts, 1911 and 1928.—There are no premises in the district manufacturing, selling or using Rag Flock according to the Acts. 39 Inspection and Supervision of Food. Milk Supply.—No registration of retailers or producers has had to be refused under the provisions of the Milk and Daries (Amendment) Act, 1922 (Milk and Dairies Order, 1926). Six additional retailers were registered during the year under this Act. Under the Milk (Special Designations) Order, 1936, 18 Dealers' Licences to sell Pasteurised Milk, 8 to sell Tuberculin Ttested Milk and 1 to sell Accredited Milk were granted during the year. One Pasteuriser's licence in respect of a pasteurising and bottling establishment was granted. Ten supplementary licences for Pasturised Milk, 7 for Tuberculin Tested 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. The standard of milk sold in the Borough continues satisfactory, with certain, comparatively minor exceptions. It is most unfortunate that the Government has not. yet. seen fit to introduce legislation making the pasteurisation of all milk supplied within any district compulsory. Until that is done, or until the question of eradicating tuberculosis from the heards of this country is tackled, anything approaching perfection will be impossible. As the eradication of tuberculosis would entail enormous expenditure spread over a period of many years, pasteurisation would appear to hold out the only immediate solution to the present, problem. Milk, one of our ideal foodstuffs from the nutritional point of view, is still rightly under suspicion. To remove that suspicion, the public must 'be assured of a safe supply. Pasteurisation, carried out efficiently and under strict supervision, will achieve this object. Without pasteurisation, our hands still remain firmly and most unpleasantly tied. Infringements.—The following infringements were discovered and rectified during the year:— Milk and Dairies Order, 1926. Retailing milk without being registered as Retail Purveyor, 6. 40 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 the Annual Report for 1935, the examination of milk samples undertaken at the Councils 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. The table appearing below indicates that the total number of carcases examined during the year has once again shown a substantial increase over that of the previous year. Meat inspection, with which is included inspection of slaughterhouses, is now a most important aspect of the Public Health activities of the Borough. The significance of the woirk need scarcely be stressed. The following is a summary of the work carried out during 1937:— Total number of carcases examined, 22,794. Bovines, 240; Sheep and Lambs, 7,133, Calves, 87; Pigs, 15,334. (1936. Bovines, 78; Sheep and Lambs, 7,298; Calves, 382; Pigs, 10,067. Total 17,825). As a result of these examinations, 386 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 1,044 1 ,, portion ,, ,, Actinomycosis 35 1,079 Calves. Nil. Sheep Carcases. 6 separate portions affected with Distoma 11 11 41 Pig Carcases. 337 separate portions affected with Tuberculosis 3,753 1 ,, portion ,, ,, Dropsy and Emaciation 96 14 ,, portions ,, ,, Cirrhosis 87 1 ,, portion ,, ,, Localised Septicaemia 34 5 ,, portions ,, ,, Swine Erysipelas 451 1 ,, portion ,, ,, Fatty Degeneration 2 4,423 5,513 (49 cwts. 25 1bs.) The incidence of disease in the different food animals inspected during the past year as compared with the previous three years, is shown in the following table:— Animals. All Diseased Conditions. Tuberculosis. Slightly Affected. Extensively Affected. Slightly Affected. Extensively Affected. No. °/ /o No. 0/ /o No. 0/ /o 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 17.91 5 6.41 1937 18 7.08 2 0.83 17 7.08 2 0.83 Sheep— 1934 2 0.05 - - - - - - 1935 4 0.10 - - - - - - 1936 8 0.10 - - - - - - 1937 6 0.08 - - - - - - Calves— 1934 - - - - - - - - 1935 — — 1 0.80 — — — — 1936 — — 1 0.26 — — — — 1937 - - - - - - - - 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 1937 345 2.25 14 0.09 331 2.15 6 0.03 42 It will be noted with pleasure that the incidence of disease has shown a definite decrease in every respect. The percentage of unsound meat has been low for many years, but it is doubtful if any district in Great Britain could show a better standard than that set out for 1937 in the table on the previous page. Infringements.—The following infringements were discovered and dealt with during the year:— 1. Slaughter of Animals Act, 1933. Animals being killed without being first effectively 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. 57 lbs. oif halibut and 141bs. of mackerel were voluntarily surrendered during the year. Shops Act, 1934.—A summary of the work carried out under this Act is detailed in the section relating to the sanitary inspection of the area. It will once again be seen that this Act necessitated considerable supervision on the part of the Sanitary Inspectors, a supervision which is essential from many points of view. The administration of the bye-laws with respect to hairdressing and massage establishments, while not strictly speaking coming under the Shops Act, is of a comparable nature. These duties are being performed by Miss Wellman, who has spent considerable time in their execution. 43 Sale of Food and Drugs Act. The duties under the Food and Drugs Act are administered by the Middlesex County Council. The following particulars of samples taken in the district during the past year were supplied by the courtesy of the Chief Officer of the Public Control Department:— Articles. Sample Found Taken. Adulterated. Milk 104 - Milk, condensed 1 — Milk, sterilized 1 - Butter 1 - Cream 3 - Cream Pastries 1 — Gin 2 — Hake 3 Lamb's Liver 2 1 Lemon Sole 5 — Sardines 1 — Sheep's Liver 3 1 Sild 1 — Vinegar 1 — Whisky 9 1 138 3 One butcher was prosecuted for selling Pig's liver as Sheep's liver. 44 ANNUAL REPORT, 1937 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. 1937 1936 Written Notices. 1937 1936 Prosecu tions. Factories (including Factory Laundries) 550 415 26 31 .. Workshops (including Workshop Laundries) 259 251 29 21 .. Workplaces (other than Outworkers' premises, included in Part 3 of this Report) 10 18 1 .. .. Total 819 684 56 52 .. 2—DEFECTS FOUND. Particulars Number of Defects Found. Remedied. Referred to H.M. Inspector. No. of Prosecu tion 1937 1936 1937 1936 Nuisances under the Public Health Acts:—* Want of Cleanliness 70 39 70 39 .. .. Want of Ventilation .. 1 .. 1 .. .. Overcrowding 2 .. .. .. 2 .. Want of Drainage of Floors .. .. .. .. .. .. Other Nuisances 19 13 21 11 .. .. † Sanitary Accommodation Insufficient 2 .. 1 .. .. .. Unsuitable or Defective 14 11 15 10 .. .. Not separate for sexes 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 107 64 107 61 2 . . *Including those specified in Sections 2,3,7 and 8 of the Factory and Workshop Act as remediable under the Publio Health Acts. † Section 22 of the Public Health Acts (Amendment) Act, 1890, was adopted in 1890. 45 46 3.—HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Prosecutions. Outwork in Unwholesome Premises, Sec 108. Outwork in Infected Premises. Sees. 109 & 110. Lists received from Employers. Notices served on Occ'prs as to keeping or sending Failing to keep or permit inspection of lists. Failing to send lists. Twice in the year. On ce in the year. Instances. Notices Served Prosecutions. Instances. Orders Made. (S.110) Prosecutions. (8.109-100) Lists. Outworkers Lists. Outworkers. Contractors . Workmen. Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel — (1) Making, etc. 6 .. 25 - 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. No. Class. (1) | (2) (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) Notifled by H.M. Inspector . 4 Laundries 2 Reorts of action taken sent H.M. Inspector 3 Other Workshops 197 Total Number of workshops on Register 204 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 on the following pages detail the work of sanitary inspection carried out within the Borough during 1937. From these tables, the following facts emerge: 1. The total number of inspections has increased, from 22,162 in 1934, to 30,780 in 1937. A tabulated list of inspections may be made to convey much or little, but such a steady increase as is shown in the figures for the past few years denotes a proportionate increase in the work of sanitary inspection within the Borough. This, of course, is merely what one would expect in a developing district such as Southgate. 2. It will be noted that the number of premises under periodical inspection has increased during the past year from. 583 to 619. When it is realised that the corresponding figure for 1935' was 324, it will be appreciated that this aspect of public health has necessitated increased supervision. 3. The total number of informal notices has slightly increased, but has not varied greatly from the average of the past few years. The number of statutory notices is once again low. 4. The inspection of factories and' workshopsi and also of shops shows a slight increase, but not more than one would anticipate from the steady addition of new premises to the district. Inspections. 1935. 1936. 1937. Housing inspections and re-inspections 4,419 5,323 3,862 Slaughterhouse visits and inspections 660 1,086 1,154 Factories and workshops (including bakehouses) visits and inspections 1,033 772 819 Dairies, cowsheds, milkshops and other food shops, visits and inspections 3,327 2,977 3,378 Various complaints, inspections and re- inspections 1,660 1,476 994 Dustbins, inspections and re-inspections 1,672 2,076 1,901 Infectious Disease visits and re-visits 2,664 4.080 3,436 Other inspections (Rent Act—Rats and Mice Destruction Act—Ditches and Ponds —Accumulations — Non-notifiable Diseases, etc.—Drain inspections and tests—Smoke observations) .. 9,603 10,379 15,236 Total 25,038 28.169 30,780 47 Service of Notices. Total informal sanitary notices served 2.122 1,433 1,568 Total informal dustbin notices served 298 357 383 Total informal notices served 2,420 1,790 1,951 Total informal notices complied with 2.500 1.792 1,755 Total statutory notices served 8 9 10 Total statutory notices complied with 8 8 11 Total notices carried forward 117 116 177 Sanitary Improvements.—The following is a summary of the sanitary improvements effected, and the defects remedied:— Housing. Premises cleansed 37 Ceiling plaster repaired 201 Ceilings washed and distempered 1,188 Wall plaster repaired 342 Walls redecorated 958 Dampness remedied 223 Floors repaired or relaid 117 Ventilation under floors improved 71 Roofs repaired 263 Eaves gutters repaired or renewed 113 Rainwater pipes repaired or renewed 77 Yards repaired or repaved 91 Window frames repaired or renewed 172 Sash-cords provided 277 Doors and frames repaired or renewed 92 Brickwork repointed or repaired 170 Cooking ranges repaired or renewed 49 Firegrates repaired or renewed 43 New sinks provided 62 Waste pipes repaired or renewed 129 Internal steps and staircases repaired 31 Food stores repaired 4 Internal woodwork repaired 75 Lighting and ventilation improved 4 Water supply—Draw taps fixed on main service 16 Water storage cisterns cleansed 9 New storage cisterns provided 17 Defective pipes repaired 36 Washing coppers repaired or renewed 38 Coal sheds repaired 14 48 Drainage. Inspection chambers repaired 47 New inspection chambers provided 34 Drains examined and tested 369 Drains repaired 62 New drains laid 32 Drains unstopped or trapped 158 New gullies provided 37 Gully grates provided 49 Choked gullies cleansed 150 Vent shafts and soil pipes repaired or renewed 35 F.A.I.'s repaired or renewed 46 Sanitary Accommodation. W.C. pans renewed 60 W.C. seats repaired or renewed 70 New flushing cisterns provided 27 W.C. cisterns repaired 74 W.C. flush pipes repaired or renewed 44 W.C. cone joints repaired or renewed 70 W.C. structures repaired 33 New W.C.'s provided 2 Refuse Receptacles. Dustbins renewed (by owners) 413 Dustbins renewed (by Council—in default) — Cowsheds and Dairies. Cowsheds cleansed and limewashed 1 Dairies cleansed and limewashed 4 Slaughterhouses. Cleansed and limewashed 2 Structures repaired 2 Bakehouses. Cleansed and limewashed 13 Structure repaired 1 W.C.'s repaired 3 W.C.'s cleansed and limewashed 5 Notices posted 2 49 Factories and Workshops. Walls cleansed and limewashed 24 Ceilings cleansed and limewashed 24 Roofs repaired 2 Floors repaired 2 W.C. pans provided 2 W.C. cisterns repaired or renewed 4 W.C. cone joints repaired or renewed 5 W.C.'s cleansed and limewashed 48 Notices posted 9 Shops. Walls cleansed 5 Floors cleansed 11 Accumulations removed 29 Yards repaired, paved or drained 3 W.C.'s cleansed 23 W.C.'s repaired or renewed 8 New W.C.'s provided 1 Notices posted 200 Miscellaneous. Cesspools emptied and cleansed 12 Accumulations of refuse and manure removed 61 Foul ditches, ponds and stagnant water abated 4 Moveable dwellings (vans and tents) removed 4 Smoke nuisances abated 11 House -to -Houselnspection.—The number of houses inspected under the Housing Schedules has again risen somewhat during the year. Slight amendment was necessary in respect of the various Schedules, due to the fact that certain houses, closed for a period of years, were re-constructed and thereafter re-opened. 50 Six hundred and ninety-six houses were inspected and recorded under the Housing Acts, as follows:— District No. 1. No. of houses Scheduled. No. Inspected. 1936. 1937. Annual List 65 65 65 Biennial List 26 14 12 Quinquennial List 637 125 128 District No. 2. Annual List 190 182 190 Biennial List 103 47 56 Quinquennial List 599 111 114 District No. 3. Annual List 86 86 86 Biennial List 26 26 — Quinquennial List 268 — 105 Total 2,000 656 696 Non-Scheduled Houses.—In addition to the above, 885 non-scheduled houses were inspected for housing defects and insanitary conditions, mostly upon complaint of the occupiers, as follows:— 1936. 1937. North-East Ward 143 138 North-West Ward 215 114 Middle Ward 164 182 South Ward 338 451 Total 860 885 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, 432 premises were visited in this connection, 184 verbal notices, 163 preliminary notices and 6 statutory notices being served. These special inspections alone resulted in the provision of 344 new bins, which included a number of bins supplied following notices served during 1936. 51 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 38 Cowsheds 2 Bakehouses 19 Dining Rooms 44 Slaughterhouses 5 Fish Shops 23 Factories and Workshops 204 Public House Conveniences 24 Grocers 124 Greengrocers 50 Butchers 55 Confectioners 31 Total 619 (1936—583) ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. As a result of the adoption of portions of the Middlesex County Council Act, 1934, it became necessary for the proprietors of certain establishments for Massage or Special Treatment within the Borough to obtain licences from the Council. The licences operated from October 1st, 1937, and during the remainder of the year 9 such licences were issued. HOUSING. From the figures relating to overcrowding, it will be seen that the position in Southgate is still comparatively satisfactory. That it is not entirely satisfactory is obvious from the fact that overcrowding still exists. It need scarcely be mentioned again that the provision by the Council of 74 additional houses and flats should go far towards solving the problem, and should reduce existing overcrowding to the irreducible minimum. At the risk of repetition, I feel that I must once again stress the importance of providing houses for those families who most require them, at economic rents. Whether a system of graduated rents be put into operation, or whether such unfortunate families be 52 subsidised in some other manner, the fact remains that accommodation at an economic rental should at all costs be provided for those families who are at present compelled to spend money on rent which would be far better utilised in the provision of clothing and nourishment for their members. It is very pleasant to be able to state that the vast majority of our population live under conditions which cannot, be classed as overcrowded. If even a small percentage of these families are depriving their children of necessities in order to obtain the privilege of living under such conditions, then the position cannot, in any sense of the term, be described as satisfactory. Overcrowding is not a serious problem in Southgate, from a sociological or epidemiological standpoint; it is even doubtful if it ever will be. The question of uneconomic rents, however, falls into a, very different category, and should receive the immediate and careful consideration of the Council. Number of New Houses Erected during the Year 1937:— (a) Total (including numbers given separately under (b)) 1.065 (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. 1937. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1.516 1,581 (b) Number of inspections made for the purpose 1,624 1,680 (2) (a) Number of Dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 656 696 (b) Number of inspections made for the purpose 719 795 (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 53 1936. 1937. (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 1.465 (5) Number of Dwelling-houses closed tarily by owners 35 16 (6) Number of Dwelling-houses demolished voluntarily by owners 25 22 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 1.283 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (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 10 54 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 8 11 (b) by owners, after legal proceedings Nil 2 (c) By local authority in default of owners Nil Nil C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (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 12 of the Housing Act, 1936:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made Nil Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Nil 4. Housing Act, 1936 (Part IV)—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 32 (2) Number of families dwelling therein 32 (3) Number of persons dwelling therein 226½ (b) Number of new cases of overcrowding reported during the year 4 (c) (1) Number of cases of overcrowding relieved during the year 10 (2) Number of persons concerned in such cases 69½ (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 55 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil Rent Restrictions Acts.—Under the provisions of these Acts, one application was received from an occupier for a certificate to the effect that his house was not in a reasonable state of repair. A special inspection was made, following which a certificate was granted. One application was received from an owner of property for the removal of a certificate previously given to the occupier. After re-inspection of the premises the application was granted, certain necessary repairs having been carried out. 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. 56 Prevalence of and Control over Infectious and Other Diseases. From1 Table V, on page 78, it will be seen that 217 causes of infectious disease were notified during the year, as against 199 in 1936 and 270 in 1935, an increase of 18 over the previous year, but 53 less than the total of two years ago. These' 217 oases represent infection in 211 houses. The infectious Sickness Rate for the district was 3.3 as against 3.1 during 1936 and 4.3 during 1935. From these figures it will be apparent that the low rate for the past few years has continued. At the time of writing this Report, however, it is already evident that we are leaving the trough and that the figure for 1938 will show a. definite rise. As I pointed out in last year's Annual Report, this position is inevitable. No matter what precautions are taken in the way of adequate housing, sanitation, environmental hygiene, etc., infection will still occur. Years of relative immunity against infectious! disease have left us with a comparatively unprotected population. Short of complete, artificial immunity against all major infectious diseases, at present merely a Utopian dream, that population remains open to risk. Fortunately, the general measures to which I have already referred should play their part, not in eliminating infectious disease from our midst, but in raising the thresh hold of resistence of those attacked, thus producing a milder type of infection. The ward distribution of the cases of infectious disease notified during the year was as follows— 1936. 1937. South Ward 48 60 Middle Ward 63 57 North-West Ward 43 42 North-East Ward 45 58 The above figures show very little deviation,1 from those of the past few years, a remark which applies equally to the ward distribution of individual infectious disease, set out, on the following pages. The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 182 premises. During such inspections, 21 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. 57 No case of overcrowding was met with in any of the houses inspected in connection with cases of infectious disease. It is interesting to note that, of the 217 cases of notifiable infectious disease reported during the year, only 21 occurred in Council property, as follows : Scarlet fever 6 Diphtheria 2 Erysipelas 2 Dysentery 1 Pneumonia 6 Tuberculosis 4 No cases were reported from the Church Army Housing Estate at Barrow Close. One hundred and five cases were removed to the Isolation Hospital at Tbttenhall Road. Of these, 46 were admitted suffering from scarlet fever, 1 from scarlet fever and chicken pox, 8 from diphtheria, 17 from erysipelas, 1 from typhoid fever, 1 from puerperal pyrexia, 5 from pneumonia, 3 from influenza, 2 from whooping cough and pneumonia, 1 from whooping cough and otorrhoea, 1 from whooping cough and ?mastoid, 1 from measles and pneumonia, 1 from German measles and hematuria, ] from mumps, and 5 from tonsillitis. Nine observation oases and 2 babies with mothers were also admitted. (As will be seen from the portion of the Report dealing with the work of the Isolation Hospital, the original diagnosis had to be amended on several occasions). Small-pox.—No cases of small-pox occurred in the district during 1937. 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-vaccinationg under the Public Health (Smallpox Prevention) Regulations, 1917, were required during 1937. Scarlet Fever.—Sixty-one cases of scarlet fever were notified during the year, as against 74 in 1936. 58 The ward distribution was as follows:— 1936. 1937. South Ward 18 20 Middle Ward 22 15 North-West Ward 18 12 North-East Ward 16 14 16 cases were removed to the Isolation Hospital, representing 75.4 per cent, of the total number of cases notified. Two "secondary" cases occurred in houses from which previous cases had been notified. In each instance the primary casa had been removed to hosipital. For the second year in succession, no "return" cases were reported. Three of the cases occurring during the yeai' were "imported." The position with regard to scarlet fever is still far from satisfactory. The type of disease met with is certainly mild, a fact clearly evidenced when it is remembered that no deaths have occurred for many years past. The total number of cases recorded is also so small that, taking both these facts into consideration, scarlet fever as we now know it has not been a disease of any major significance in Southgate for some considerable time. But this ia only one side of the picture. The disease labelled "scarlet fever" is merely one manifestation of the effects of the ubiquitous streptococcus pyogenes, of which at least more than twenty separate strains have already been isolated. Depending upon the general condition of the person infected, i.e., the host, and also upon the particular reaction of that person's epidermis, this parasite may cause conditions typified by swollen, engorged tonsils (Acute Tonsillitis), a diffuse rash appearing on the trunk and limbs (Scarlet Fever), a. well-defined area of inflammation, commonly seen on the face (Erysipelas), or inflammation of the deeper tissues (Cellulitis). It should be emphasized that these diseases are all caused by the same organism, andJ that, so far as we are aware, each is of an infectious character. In addition, from the aggregate available evidence, it has been definitely proved that any one of these diseases may produce, in a contact, any of the remainder. Yet what is the position 1 The particular group of infections in which a generalised rash is apparent is labelled "scarlet fever," and is placed among the notifiable infectious diseases. Another group is labelled "erysipelas," and is also classified as an acute infectious disease. A person suffering from either of these infections is dealt with by the complicated machinery at present at our disposal, and may lie either isolated at home or removed to an Isolation Hospital. 59 The remainder of the diseases caused by the streptococcus pyogenes are granted not the slightest epidemiological significance. They are not notifiable, their occurrence seldom comes to the notice of the Local Authority, and if they are treated in hospital at all, they are admitted to the open wards of a general institution. Pursuing the matter still further, there is now strong evidence in existence which leads us to believe that streptococcal infection without a rash, e.y., aoute tonsillitis, is miore likely to be followed by serious after-effects than the variety typified by a rash and dreaded under the anachronistic caption of "scarlet fever!" The position is thus illogical, indeed absurd. The remedy, unfortunately, is not simple, although it can and should be found. Notification of all conditions caused by the streptococcus pyogenes and the isolation of every person suffering from siuoh infections in his or her own home or in an Isolation Hospital, would almost certainly solve the problem, but the expense would be considerable. Several authorities are now tending towards the only other logical solution, the elimination of scarlet fever as such from the list of acute notifiable infectious diseases, at least until the whole matter can be dealt with in a satisfactory manner. While I still personally do not agree that scarlet fever can safely be left to its own devices, remembering the tragic sequelae which may follow this disease, it is obvious that the present procedure is little short of futile and touches merely the fringe of the question. This matter has led to considerable discussion during recent months, and it is to be hoped that some action will shortly be taken which will rid us of this painful legacy of the past and bring existing legislation into line with modern, scientific knowledge. The procedure with regard to the visiting of schools and the supervision of cases after discharge from hospital remains unaltered, and is still proving of the very greatest value. The following table sets out the information collected under this heading : Total number of persons discharged during 1936 42 Number of persons visited after 1 year 36 (6 removed from district.) Number of persons remaining perfectly well throughout the year 35 (1 patient complained of rheumatism which persisted for 9 weeks after discharge from hospital.) Total number of persons discharged during 1937 38 60 Persons in whom no abnormalities attributable to the original attack were discovered after 14 days 23 Patients developing transient rhinitis 6 ,, ,, mild rheumatism 3 ,, not examined (removed) 4 In all cases exhibiting abnormalities, complete recovery was made after a short period. From the inception of the scheme to December, 1937, 151 patients have been discharged at the end of .'S weeks, and there have been no return oases. Diphtheria.—Nine cases of diphtheria were notified during 1937, as against 12 during 1936, and 25 during 1935. Two of these cases were secondary. The figure for the year, 9, is only one higher than the lowest recorded in Southgate, and illustrates the comparative freedom of the Borough from this particular disease. The average for the past 10 years i8 28.1. The ward distribution was as follows :— 1936. 1937. South Ward 2 1 Middle Ward 2 1 North-West Ward 7 5 North-East Ward 1 2 The type of disease m,et with was mild on the whole and no deaths occurred. While the present position with regard to diphtheria is extremely satisfactory, it is sincerely to be hoped that these statistics will not result in any falling off in the figures of those seeking immunisation. As with other infectious diseases, we cannot hope to remain free for all time. Unlike other infectious diseases, we have a safe and certain means of protecting the population. The proper time to carry this out is during those periods when the infection is not prevalent in; the district. The dates of notification were as follows: — 1st day 0 2nd ,, 3 3rd ,, 2 4th ,. 0 5th 1 6th „ 0 7th 0 8th„ 1 10th 1 21st „ 1 61 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.—Four hundred and ninety persons attended for immunisation during 1937 at the weekly clinic held in Broomfield House or at the schools visited during the year, as compared with a total of 319 for the previous year. The schools selected during the past year were De Bohun, and Oakwood, 87 and 168 children attending at each school respectively. All the schools within the Borough have now been visited, and this year the cycle will be re-commenced. It. will be seen that the figures show a rise over those of the previous year, due, in part, to the type of schools visited, and also to the campaign for immunisation carried out during the Health Week in October. This campaign resulted in a large number of mothers attending the Welfare Centres applying for immunisation for their children. This was particularly welcome, as the best time to have a child immunised is before school age has been reached. The following tables set out the work performed during the year :— Results of Schick Tests. Over l-5yrs. 5-10 yrs. 10-15 yrs. 15yrs. Total. Negatives:— 2 2 13 17 3.47% Positives:— Mild — 42 10 7 59 12.04% Moderate — 91 20 5 116 23.67% Marked — 38 10 1 49 10.00% Nil 171 40 13 224 Not tested 249 — — — 249 50.81% Total for yea 490 Completed, Cases 546 546 192 13 1,297 (To 31.12.37 from commencement of scheme) 62 Number of persons who have attended for immunisation since commencement of scheme (including Schick negatives, uncompleted cases and defaulters) 2,287 Results of Schick Test after Three Months (1937). Negatives 185 Positives 38 223 f urther Results of the 38 "Positives" — After 4th injection Negatives 37 Positives 1 After 5th injection:— Negatives 1 Positives Nil Number of Cases failing to complete Immunisation (1937) 20 Before three injections 8 After three injections 12 Total number of visits paid to schools and Clinic for purposes of immunisation (1937) 2,009 Total number of visits paid to schools and Clinic for purposes of immunisation since inception of scheme 10,439 Number of cases to be completed in 1938 307 Reactions after Injections (1937). Over 1-5 yrs. 5-10 yrs. 10-15 yrs. 15 yrs. Total. Mild 1 — — 3 4 Moderate — — — 1 1 Severe 1 — — — — 2 — — 4 6 So far as can be ascertained, not a single child immunised against diphtheria during 1937 developed olinieal diphtheria. Typhoid Fever (including Paratyphoid).—Three cases of paratyphoid B fever were notified during the year, as against 8 cases of typhoid and 2 of paratyphoid B fever during 1936. In all three instances, the infection occurred in children between the ages of 4 and 5, although there was no apparent connection between any case. No evidence as to the source of infection was obtained. Two cases were removed to the Isolation Hospital. All three cases made a satisfactory recovery. 63 Puerperal Fever and Puerperal Pyrexia.- Nine cases of puerperal pyrexia were notified during the year, as against two in 1936, and 11 in 1935. Six of the oases notified occurred in nursing homes in the district, the remaining three occurring in the patients' own homes. Two of the patients were removed to the Isolation Hospital, while two were admitted to the Queen Charlotte's Isolation Block, Hammersmith. Three deaths occurred, none within the district. The services of Mr. Read, the Council's consulting gynaecologist, were requisitioned on three occasions during the year. An important alteration in the nomenclature of this disease was made during 1937. Previously, puerperal infection was either classified as fever or pyrexia, according to severity and nature of infection. Under the provisions of the Public Health Act, 1936, puerperal fever disappeared from the list of notifiable diseases on October 1st, 1937, the position being thus simplified by the grouping of all oases of puerperal infection under the heading " Puerperal Pyrexia," Erysipelas.—Twenty-four cases of erysipelas were notified during the year, as against 7 in 1936 and 23 in 1935. No deaths occurred. Sixteen cases were removed to the Isolation Hospital. It will be seen that the number of notifications rose considerably during 1937 over those of the previous year, but. not to a higher level than has been shown during several recent years. The type of disease was definitely mild, and all cases admitted to the Isolation Hospital responded readily to treatment. Pneumonia.—Fifty-three cases of pneumonia were notified during 1937, as against 34, 24 and 41 cases during the previous three years. The age groups of these oases are interesting, and were as follows:— Under 5 years 5 5 to 10 years 5 10 to 15 years 3 15 to 20" 0 20 to 25 8 35 to 4511 45 to 65 ,, 13 Over 65 years 8 The abnormally high figure for pneumonia was due in part to the second' phase of the influenzal epidemic of 1936/7, but there 64 also appears to be a definite indication that pneumonia as a notifiable disease is on the increase in Southgate. Last year, approximately 17 per cent, of the total number of cases of infectious disease notified during the year was attributable to this disease, while for the past year the percentage has risen to 24.4. It is still obvious that pneumonia is not receiving the attention which it demands. Scientific investigation, particularly along the lines of typing the strains of pneumococcus responsible for infection and providing specific sera in each case, has done much in other countries to reduce the severity of the disease. Here, we would appear to have lagged behind, as the treatment of pneumonia in many parts of this country still savours of the hit or miss, purely symptomatic method. I hope, when the extensions at the Isolation Hospital admit of improved facilities, to establish th,e means of investigating every case reported, in a. thorough, scientific manner. AVhen this is done, it should be possible to offer treatment to pneumonia patients which at the moment is only available in certain, isolated instances. Eleven cases of pneumonia, mostly associated with influenza, were admitted to the Isolation Hospital during the epidemic period, following a letter addressed to all general practitioners offering accommodation. It is my own firm belief that pneumonia is best treated in an Isolation Hospital, rather than at home or in the open wards of p ceneral institution. At the moment, accommodation at the Isolation Hospital does not permit of this ideal being reached, but with the new extensions, accommodation sihould be available for every case notified within the Borough. Tuberculosis.—Forty-four cases of pulmonary and eight cases of non-pulmonary tuberculosis were notified during the year under the Public Health (Tuberculosis) Regulations, 1912, the corresponding figures for 1936 being, pulmonary cases, 47; nonpulmonary cases, 11. In addition to these notified oases, 28 patients were entered in the register (24 pulmonary, 4 nonpulmonary), these cases being new residents in the district, previously notified elsewhere. Twenty-eight deaths occurred, 25 from pulmonary and 3 from non-pulmonary tuberculosis. Five of these cases had not previously been notified, a ratio of 17.8 per cent, as against 18.9 per cent, in 1936. It will be observed that the notifications of tuberculosis showed a small but welcome decrease from the figures relating to the 65 vious year, while the deaths also showed a corresponding fall. In spite of this, tuberculosis still remains a major problem, both from, the viewpoint of morbidity and mortality. This is particularly shown when the age groups of those cases notified are studied. The table is as follows: 1 to 5 years 0 5 to 15 years 2 15 to 20 years 1 20 to 35 ,, 29 35 to 45 ,, 6 45 years and over 14 It will be seen that the age group 20-35, i.e., the peak of adolescence and early adult life, shows the highest notification rate, a fact which was also tragically apparent in the figures for 1936. Public Health (Prevention of Tuberculosis) Regulations, 1925, Public Health Act, 1925, Section 62. (Compulsory removal to hospital of persons suffering from pulmonary tuberculosis). It was not necessary to take any action during the year in connection with the above. Laboratory Facilities.—See page 20. Non-Notifiable Infectious Diseases.—As will be seen from the list of non-notifiable infectious diseases received from the various schools during the year, as set out below, the numbers have fallen by almost 50 per cent, from those of 1936. This was entirely due to the absence of measles notifications (3 as against 511), 1937 being an inter-epidemic year for this particular disease. Needless to say, we can anticipate a return to the previous level during 193S. Members of the Council will, however, doubtless be aware that steps have now been taken to provide prophylactic material for use in households where measles makes its appearance. This procedure will not have the effect of reducing the number of cases which occur, but it is hoped that the severity will be beneficially affected. The following list sets out the information received from the schools regarding case® of non-notifiable infectious disease during the year: 66 1935. 1936. 1937. Measles 7 511 3 Whooping Cough 83 70 167 Mumps 182 116 143 Ringworm — 1 2 Influenza 9 9 26 Pneumonia — 1 — Bronchitis — 5 — Chickenpox 69 251 175 German Measles 1 3 6 Total 351 967 522 As already noted there were no deaths from measles. Notifiable Diseases occurring amongst School Children.— The arrangements remain unaltered from those detailed in the Report for 1932. 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 295 Number of school class-rooms (Private, Elementary and Secondary) fumigated 268 Number of articles disinfected by steam 1,947 Number of articles destroyed 8 (2) Disinfection in connection 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 57 Number of articles disinfected by steam 648 Number of articles destroyed 267 (b) Disinfection of rooms and bedding, on request, after cases of Non-Notifiable Disease (charge 5s.):— Number of rooms fumigated 14 Number of articles disinfected by steam 153 Amount received in respect thereof £7 5. 67, (3) Disinfestation:— Eradication op Bed Bugs:— (i) Number of premises found to be infested : (a) Council Houses 10 (b) Church Army Housing Estate 18 (c) Other Houses 129 All these premises were disinfested. Total number of rooms disinfested 373 Total number of articles disinfested 13 ,, ,, ,, destroyed 3 (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, inspected by the Sanitary Inspectors prior to removal to Council houses; a report obtained from the Medical Officer of Health of the district concerned in cases where the incoming tenant resides outside the Borough (no case requiring the disinfestation of incoming tenant's belongings occurred during 1937); any Council house found to be infested after vacation by an outgoing tenant disinfested by the Public Health Department before being reoccupied. (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, 156 books were so disinfected. The school and other books found in homes where casee of notifiable or non-notifiable infectious diseases have occurred are disinfected, together with individual school books from class-rooms from whioh a case of infectious disease has been notified. 68 ISOLATION HOSPITAL. The number of patients treated in hospital during 1937 was 505, as against 565 during 1936, and 616 in 1935. (This number comprises all patients admitted during the year, together with those in hospital on 1st January, 1937). The number has thus again shown a decrease, although, actually, the number of "patient days" was greater. This is explained by the fact that the total diphtheria admissions rose during the year, this particular infection necessitating a longer detention in hospital than any other. The type of disease treated was rather more severe than in previous years, particularly with regard to diphtheria, many of the patients suffering from this latter disease being acutely ill upon admission. The following table sets out the number of patients admitted to the hospital during 1937, and the areas from which those patients were admitted :— 1937. (1936.) Southgate 105 (111) Tottenham 349 (394) Middlesex County Council 2 (5) The diseases for which the 456 patients were admitted during 1937 were as follows: Scarlet fever 149 Diphtheria 172—Faucial 149 Nasal 7 Nasal and faucial 10 Laryngeal 4 Laryngeal and faucial 1 Aural 1 Diphtheria "carrier'' 1 Diphtheria and Scarlet fever 8 Scarlet fever and Diphtheria "carrier" 3 Scarlet fever and Bronchitis 1 Scarlet fever and Impetigo 1 Scarlet fever and Chicken Pox 1 Measles 1 Measles and Pneumonia 4 Measles and Bronchitis 2 Measles and Diphtheria "carrier" 1 Acute Primary Lobar Pneumonia 1 69 Influenzal Pneumonia 2 Whooping Cough 1 Whooping Cough and Broncho Pneumonia 5 Whooping Cough and Otorrhoea 2 Whooping Cough and Bronchitis 1 Whooping Cough. Broncho Pneumonia and Chicken Pox 1 Paratyphoid fever 5 Puerperal Pyrexia 3 Baby with mother 3 Erysipelas 34 Erysipelas and Impetigo 1 Erysipelas, Influenza and Quinsy 1 Cellulitis 1 Rubella 1 Chicken Pox 3 Mumps 2 Poliomyelitis 2 Enteritis 1 Cerebro-spinal Meningitis 1 Colitis 1 Influenza 3 Gastric Influenza 1 Tonsillitis 26 Quinsy 1 Haematuria 1 Rhinitis 1 Supra-orbital Herpes 1 Cancrum Oris 1 Non-infectious Rashes 4 Food Rash 1 456 Staff-— Pharyngitis 1 Contusion of Hip 1 Injury to Head 1 Tonsillitis 2 Influenza 1 Alterations in Diagnosis: During the past three years:, the number of cases in which it was necessary to- make an amended diagnosis was 58, 52 and 50 respectively. In many cases this change of diagnosis is not of very 70 great^ importance, but in other instances the fact that a patient may be admitted to a ward suffering from a disease or diseases other than that being treated in the ward in question, is of the greatest significance from the point of view of possible crossinfection. Certain errors are unavoidable, but, so long as they persist, so long will the reputation of isolation hospitals continue to be jeopardised by the stigma of cross-infection. The following list setsi out the full details regarding the amended diagnoses:— Diphtheria to Scarlet fever 1 Diphtheria to Diphtheria and Scarlet fever 4 Laryngeal Diphtheria to Simple Croup 1 Diphtheria to Tonsillitis 18 Diphtheria to Quinsy 1 Laryngeal Diphtheria to Pneumonia and Whooping Cough 1 Scarlet fever to Scarlet fever and Diphtheria "carrier" 3 Scarlet fever to Scarlet fever and Diphtheria 2 Scarlet fever to Tonsillitis 8 Scarlet fever to Rubella 1 Scarlet fever to Cancrum Oris 1 Scarlet fever to Food Rash 1 Scarlet fever to Gastric Influenza 1 Scarlet fever to Measles 1 Scarlet fever to Non-infectious Rashes 4 Scarlet fever and Mastoid to Scarlet fever and Impetigo 1 Erysipelas to Cellulitis 1 Erysipelas to Rhinitis 1 Erysipelas to Supra-orbital Herpes 1 Typhoid fever to Enteritis 1 Typhoid fever to Colitis 1 Pneumonia to Whooping Cough and Pneumonia 1 Influenzal Pneumonia to Whooping Cough and Pneumonia 1 Whooping Cough and Pneumonia to Whooping Cough and Bronchitis 1 Pleurisy to Influenzal Pneumonia 1 58 71 Number of Patients in Isolation Hospital on any one day during each Month:— Greatest Lowest Number. Number. January 58 48 February 57 48 March 54 44 April 54 46 May 49 33 June 41 30 July 51 38 August 49 33 September 54 33 October 61 52 November 55 47 December 63 52 Complications.—The complications met with during 1937 were as follows: Scarlet Fever.-—(Total of 176 cases treated during the year). Adenitis 3 Late Albuminuria 2 Double Otorrhoea 2 Left ,, 2 Right ,, 1 10 The complication rate for scarlet fever during 1937 was 5.6 per cent., as against 4.2 per cent, during 1936 and 6.6 per cent, during 1935. One would like to believe that the treatment received by the patients at the hospital played a major part in maintaining the complication rate at so low a level, but it must always be remembered that the type of scarlet fever admitted during the past few years has been definitely mild, the risk of complications being thus correspondingly reduced. In spite of the apparent mildness of the disease, however, it may be stated that 10 cases were admitted to hospital already suffering from otorrhoea. The complication rate for otorrhoea at the hospital (2.8%) would thus appear satisfactory, especially when it is remembered that, so far at least as Tottenham is concerned, we only receive the most severe cases. 72 Diphtheria.—Apart from the 7 fatal cases met with during the year, only 14 complications occurred among the remaining 211 cases of diphtheria receiving teatment. This gives a complication rate of 6.6 per cent, as against 9.17 per cent, during ,1936 and 15.1 per cent, during 1935. The complications met with were as follows: Adenitis 1 Late Albuminuria 2 Double Otorrhoea 1 Left ,, 1 Right ,, 1 Ocular Paralysis 2 Palatal ,, 5 Endocarditis (mild) 1 14 This is by far the lowest complication rate recorded at the hospital since such rates were first calculated. It is particularly pleasing in view of the fact that the type of case admitted was more severe than lias been the ca.se for many years. Seven complications occurred among the remaining 111 case; treated in hospital during 1937. In every instance, whether the patients were suffering from scarlet, fever, diphtheria or othei disease, the complications yielded to treatment and it was possibli to discharge the patients in a. satisfactory condition. Deaths.—Eleven deaths took place during the year, a.i against 20 in 1936 and 17 in 1935. These deaths occurred fron the following diseases :— Diphtheria 7 Scarlet fever 1 Broncho-Pneumonia 1 Broncho-Pneumonia and Septicaemia 1 Influenza and Lobar Pneumonia 1 11 One patient, died within 6 hours of admission to hospital, and several others within 48 hours. The death rate from diphtheria was 3.2i per cent., as against 3.3 per cent, the previous year, a figure which is again satisfactory in view of the severity of the cases admitted. The death rate from pulmonary infections was 23.1 per cent., an illuminating, although tragic figure. 73 General Treatment.—Two major alterations in treatment were instituted during the year. The first was the more extensive use of Prontosil or one of its allied substances in the treatment of infections due to the streptococcus pyogenes, the second being the purchase of an oxygen tent. It has now been proved beyond dispute that the former material acts in a specific manner against streptococcal infection. Patients suffering from such diseases as erysipelas, puerperal sepsis, septic scarlet fever and acute throat infections receive very decided benefit from administration of the drug, especially when such administration is combined with other forms of treatment. The oxygen tent has proved invaluable in the treatment, of pulmonary infections, and it is not too much to state that several children's lives have been saved by its use. On several occasions, while the tent was in use, it became necessary to hire a second tent, and never has expenditure received better justification. With the purchase of the oxygen tent, it seems possible to claim that our hospital possesses equipment equal to any similar institution. No parents need fear that apparatus necessary for the treatment of acute infectious diseases will not be available for their children. Apart from these additions, treatment followed mainly along the lines of previous years, with certain improvements as regards technique, material used, etc. As I have remarked before, the treatment of infectious disease should never be static. Scientific discoveries are being made from day to day, and, if we are to keep abreast with the times, these discoveries must be harnessed to our use. Operations.—The following operations were performed during the year:— Appendicectomy (Scarlet Fever) 1 Tracheotomy (Diphtheria) 1 Tonsillectomy (Diphtheria "Carriers") 6 „ (Scarlet Fever) 1 9 All the patients made a satisfactory recovery, and, in the case of the diphtheria "carriers," it was possible to discharge the patients free from bacilli. In addition to the operations enumerated above, several minor operations—mainly gland incisions—were performed, with satisfactory results. 74 Dr. Macdonald, Consulting Surgeon to the Hospital, performed all the operations, while, in addition, he paid 110 consultative visits. Once again, I should like to thank him most sincerely for his invaluable services. Discharge Procedure.—The discharge procedure detailed in the Report for 1933 has remained unaltered, with the addition noted in the Report for 1935. Period of Isolation in Hospital.—The average period of isolation in hospital was as follows :— Scarlet Fever.—23.1 days (longest, 76 days; shortest, 2 days—died). Average duration, 1936—22.6 days. Diphtheria.—68.5 days (longest, 133 days; shortest, 6 hours—died). Average duration, 1936—59.6 days. It will be seen that the average detention in the case of scarlet fever increased very slightly, while, in the case of diphtheria, the increase was more marked (0.5 and 8.9 days respectively). The increase in the case of diphtheria was entirely due to the more severe nature of the infection being treated, while the comparatively short detention for scarlet fever patients is due, in part at least, to the continued use of serum, together with Prontosil. Staff.—(a) Illness.—The following illnesses occurred among the Staff during 1937:— Pharyngitis (Sister) 1 Contusion of Hip (Maid) 1 Injury to Head (Maid) 1 Tonsillitis (Nurse and Porter's Wife) 2 Influenza (Nurse) 1 6 From this table it will be seen that the health of the Staff continued reasonably satisfactory throughout the year. (6) Immunisation.—In addition to protection against diphtheria, the majority of the Staff have now been immunised against typhoid infection. I have seriously considered the 75 question of immunisation against scarlet fever, but have decided to await the reports of recent investigations into the matter. At the moment, the position is scarcely satisfactory, as the results of the process as at present carried out are by no means certain or even easy to estimate. (c) Lectures.—Probationer nurses are now receiving a more extensive course of lectures in preparation for their State Examination. This course is of an even longer duration than that required by the General Nursing Council, and embraces lectures by the Matron, Mr. Hill and myself. Cross-Infection.—Seven cases of chicken-pox occurred in the hospital, following the admission of a patient to the scarlet fever ward suffering from scarlet fever, but incubating the former disease. Chicken-pox is particularly difficult to combat, by reason of its long incubation period and high infectivity rate, together with the fact that protective inoculation is not yet available. Fortunately, although a decided nuisance, chicken-pox is not a serious infectious disease, and it was scarcely even necessary to detain any of the patients infected longer in hospital than would normally have been the case. One child incubating whooping-cough was admitted to the diphtheria ward. As soon as the symptoms appeared, the patient was removed from the ward, while all the remaining children received a protective injection of whooping-cough vaccine. No further cases occurred. 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 176 cases treated in hospital during the year. This gives a Return Case Rate of 0.56 per cent. as against 0.55 per cent. during 1936. Transfers to and from other Hospitals.—The following transfers occurred during the year:— From the Prince of Wales's Hospital 11 cases „ North Middlesex County Hospital 4 „ „ Enfield and Edmonton Isolation Hospital 1 case „ Jewish Home for Incurables 1 „ Total 17 cases 76 To the North Middlesex County Hospital 2 cases „ London Homoepathic Hospital 1 case „ Jewish Home for Incurables 1 „ 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. Laboratory.—Details of the Laboratory work carried out in connection with the Hospital will be found on page 20. Miscellaneous.—(1) The oldest patient treated in the Hospital during the year was a female aged 78 years suffering from erysipelas; the youngest was a. baby aged 6 days admitted with its mother, who was suffering from puerperal pyrexia. (2) One patient from Southgate was admitted by error to the Enfield and Edmonton Joint Hospital. As soon as the error was discovered, the patient was transferred to our own hospital. (3) Miss Beatrice M. West, Matron at the Isolation Hospital since August, 1930, resigned her position in July and was later appointed Matron of the Barnet Isolation: Hospital. Miss Marian T. Durward, Matron of the Florence Nightingale Hospital, Bury, was appointed to fill the vacancy, and commenced her duties in October. I should like to take this opportunity of expressing my appreciation of the many services which Miss West rendered to the hospital during her tenure of office, and at the same time to express to Miss Durward and the members of the Hospital Staff my sincere thanks for the admirable way in which they carried out their varied and responsible duties. I 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. 77 Table V. NOTIFIED CASKS OP INFECTIOUS DISEASES, 1937. 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 9 .. .. .. 1 .. 2 4 1 1 .. .. .. .. Scarlet Fever 61 .. 1 2 1 .. 23 12 4 13 4 .. .. .. Typhoid Fever 3 .. .. .. .. 3 .. .. .. .. .. .. .. .. 5 .. .. .. .. 1 .. .. 3 .. 1 .. .. .. 9 .. .. .. .. .. .. .. .. 8 1 .. .. .. Erysipelas 24 1 .. .. .. .. .. .. 1 4 6 7 5 .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Poliomyelitis 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 53 .. .. 4 1 .. 5 3 .. 8 11 13 8 40 Tuberculosis- Pulmonary 44 .. .. .. .. .. .. .. .. 25 5 11 3 25 Non-Pulmonary 8 .. .. .. .. .. 1 1 1 4 1 .. .. 3 Totals 217 1 1 6 3 4 31 20 10 63 30 32 16 71 78 Table VI. Cases op Infectious Disease Notified each Month of the Year, 1937. Notifiable Diseases. Small pox. Scarlet Fever. Diphtheria. Typhoid Fever. Dysentery. Erysipelas. Puerperal Pyrexia. Acute Poliomyelitis. Encephalitis Lethargica. Cerebro-spinal Meningitis. Malaria. Ophthalmia Neonatorum. Pneumonia. Tuberculosis Totals. Pulmonary. NonPulmonary January .. 8 .. .. .. 1 .. .. .. .. .. .. 18 1 .. 28 February .. 4 1 .. .. 3 .. .. .. .. .. .. 3 4 .. 15 March .. 7 .. .. .. 1 3 .. .. .. .. .. 5 5 1 24 April .. 6 .. .. .. 3 .. .. .. .. .. .. 3 3 2 17 May .. 4 1 .. .. 2 1 .. .. .. .. .. 2 6 .. 16 June .. 2 .. .. .. 1 2 .. .. .. .. .. 2 2 .. 9 July .. 2 4 .. .. 2 1 .. .. .. .. .. 2 5 2 18 August .. 3 .. .. .. .. .. 1 .. .. .. .. 1 1 .. 6 September .. 9 1 1 .. 2 1 .. .. .. .. .. 2 4 .. 20 October .. 4 .. .. .. 1 .. .. .. .. .. .. 2 3 .. 10 November .. 4 1 .. .. 5 1 .. .. .. .. .. 6 4 2 23 December .. 8 1 .. 5 3 .. .. .. .. .. .. 7 6 1 31 Totals .. 61 9 3 .. 24 9 1 .. .. .. .. 53 44 8 217 Ophthalmia Neonatorum, 1937. TABLE VII. Nil Notified . Cases. Nil At Home. Treated. Nil In pital. Nil Vision Unimpaired. Nil Vision Impaired. Nil Total Blindness. Nil Deaths 79 TABLE VIII. Tuberculosis, 1937. Age Periods. *New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 yr. — — — — — — — — 1-5 years — — — — — — — — 5-10 „ — — 1 — — — — — 10-15 „ — — — 3 — — — — 15-20 „ — — 1 — — 1 — — 20-25 „ 6 6 — 3 1 1 — 1 25-35 „ 17 12 1 1 6 4 1 — 35-45 „ 6 4 2 — 1 1 — — 45-55 „ 8 3 — — 6 — — 55-65 „ 3 — — — 3 1 — 1 65 and over 2 1 — — — — — — Totals 42 26 5 7 17 8 1 2 REGISTER OF CASES. Pulmonary. NonPulmonary. Total M. F. M. F. Cases on Register, 1/1/37 115 81 24 24 244 Cases notified for first time, 1937 26 18 4 4 52 Cases restored to Register 2 2 — — 4 Other Cases added 14 6 1 3 24 Cases removed from Register 33 21 6 5 65 Remaining on Register, 31/12/37 124 86 23 26 259 *These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the District. 80 APPENDIX. I. Health Publicity. The features regarding health publicity set out in previous Annual Reports were continued during 1937, with the addition of a Health Week held in October. Full details as to the Health Week programme and the results achieved were set out in the Council minutes for November, and it need only be stated here that the effort very fully justified the small expenditure involved. Permission has now been granted to add the cinematograph to our armamentarium. The cinema, particularly the talking picture, is one of the best means of reaching the publics. With an up-to-date projector and a supply of suitable, interesting films, it should be possible to arrange regular meetings in connection with existing societies and organisations operating within the Borough. In this way it is hoped that reasonably large audiences will be reached, and a constant stream of useful propaganda provided. It is also anticipated that 1938 will see the publication of a hand-book setting out in some detail the public health services of the Borough. Following previous practice, opportunity was taken during the year to aquaint all general practitioners practising in Southgate with the full list of available services, in the hope that the information might be personally useful, and that it might also be passed on as and when required. I have reason to believe that this service is greatly appreciated. The advantages of health publicity require little if any emphasis. Publicity will always be required, and, considering the wares which we have to offer and the expense which these wares entail, it would appear only logical to advertise them in the best possible manner. II. Circular Letters. The following circular letters were issued to doctors during the year : (a) Letter re admission of influenza and influenzal pneumonia cases to the Isolation Hospital. (b) Letter re resuscitation apparatus fitted to ambulances. (c) Letter re arrangements with So-uthgate Queen's Nursing Association for the domiciliary treatment of certain cases. Also revised list, of Public Health Services. (d) Letter re bye-laws as to establishments for massage or special treatment. (e) Letter re occurrence of cases of dysentery. 81 III. Special Reports issued during 1937. (i) Cost of Home Help Scheme. The following report on the approximate cost of the Home Help Scheme was submitted to the Maternity and Child Welfare Committee on 8th March, 1937. " During 1936, the following applications were received for assistance under the Midwives Scheme. Income per head, per week, below 7s. 23 cases „ „ „ between 7s. and 9s. 10 „ „ „ „ „ 9s. and 12s. 6 „ „ „ „ „ 12s. and 15s. 1 case „ „ „ „ 15s. and 18s. 2 cases „ „ „ „over 18s. Nil. Total 42 cases If this scale were adopted in connection with the Home Help Scheme, the following expenditure might be expected. £ s. d. 23 applications at 5s. per day for 14 days 78 0 0 10 „ 4s. „ 28 0 0 6 „ 3s. „ 12 2 0 1 „ 2s. „ 1 8 0 2 „ 1s. „ 1 8 0 Total £121 8 0 This assumes that the applications for Home Helps would run parallel to those for assistance under the payment of Midwives Scheme. It also assumes that the scale previously adopted by the Committee would require a certain modification. In its amended form it would read as follows : Income below 7s. per head per week, no charge to be made. per day. between 7s. and 9s. per head per week, the charge to be 1s. „ 9s. and 12s. „ „ „ „ 2s. „ 12s. and 15s. „ „ „ „ 3s. „ „ 15s. and18s. „ „ „ „ 4s. „ over 18s. per head per week, the charge to be 5s. per day. Thus, the free supply of Home Helps would only be allowed for those with incomes below 7/- per week, instead of 9/- as 82 previously. As a 100% grant towards the payment of a midwife is only granted to families with income below 6 6 per head, per week, this would bring the two scales into closer approximation." (ii) Visits to Isolation Hospitals. A report on visits paid to Isolation Hospitals at Coventry, Barking and Wakefield, under the joint signatures of Councillor G. Peverett, Chairman of the Public Health Committee, A. C. J. Browne, Architectural Assistant, and the Medical Officer of Health, was submitted to the Public Health Committee on 4th February, 1937. (iii) Health Week. Two reports on Health Week, October 17th-23rd, were submitted to the Public Health Committee. The first dealt with the preliminary arrangements, while the second enumerated the various activities embraced by the programme, together with an estimate of the results achieved. IV. Air-Raid Precautions. It still appears premature to report fully upon this subject, especially in a Report such as this, but it might be stated that considerable work was carried out by members of the Public Health Department on Air-Raid Precautions during 1937. These duties are constantly increasing and demand careful attention. From the purely Public Health standpoint, it is pleasing to note that, as a corollary to A.B.P. training, many individuals previously ignorant of the principles and practice of First Aid and Home Nursing, will now receive valuable instruction in those subjects. I should not like to let this opportunity pass without thanking the local officers of the St. John Ambluance Brigade and the British Red Cross Society for their valuable co-operation, in what has been a somewhat difficult although very necessary task. V. 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 6,800 units, at a cost of £2 2s. 6d. No new cases were reported during the year. Periodical reports are forwarded to the Ministry of Health. 83