AC 43(1) SouthGATE BOROUGH OF SOUTHGATE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938. WM. CLUNE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital. BOROUGH OF SOUTHGATE. OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938. WM. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital Crush a & Son, Ltd. (T.U.), Tottenham, Enfield, Palmers Green & Wood Green. To the MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE. Mr. Mayor, Ladies and Gentlemen, The vital statistics for the past twelve months are definitely satisfactory. The Death Rate has fallen from 10.59 to 9.34, the Infantile Mortality Rate from 42.55 to 31.09, while the Maternal Mortality Rate has been reduced from 4.44 to 1.25. The Zymotic Death Rate and the deaths of children under 5 years show a very slight rise, but in these instances the comparable figures are so small as to make no appreciable statistical deviation. For the third year in succession the Infectious Sickness Rate for the district has been under 4 per thousand, an enviable record for any highly urbanised community. The year 1938 was, of course, outstanding for the rapid development of A.R.P. throughout the country. Fuller mention of this will be found in the body of the report, but I should like here to stress the fact that the routine Public Health activities of the Department were carried out under no little difficulty, at least so far as the latter part of the year was concerned. Fortunately, no evidence has yet appeared that the health of the district has been allowed to suffer. Nevertheless, it would obviously be highly dangerous to neglect basic Public Health safeguards, even for such an important development as A.R.P. For this reason, the negotiations at present proceeding for the augmentation of the existing staff are at once extremely welcome and fundamentally necessary. At one time it even appeared that the production of this Annual Report would present an almost insuperable problem. I was, however, extremely unwilling to forego the privilege of presenting such comments as appeared necessary upon the various aspects of Public Health during 1938. As a compromise I have reduced these comments to what I consider a reasonable minimum, without, I trust, in any way affecting the structure of the report. 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 Chairmen and Members of the Public Health and Maternity and Child Welfare Committees, to the Members of the Council, and also to my Staff, or 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, 1938. Councillor G. Peverett (Chairman). His Worship the Mayor (Councillor Robert Grant, J.P.). Councillor A. R. Abercromby. Councillor W. A. Clarke. Councillor Victor Dover. Councillor J. Owers. Councillor Mrs. C. M. A. Vandy. Councillor V.J. AVestlake. MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1938. Councillor Mrs. C. M. A. Vandy (Cliairman). His Worship the Mayor (Councillor Robert Grant, J.P.). Councillor Miss G. E. Appleyard. Councillor J. H. Barker. Councillor A. C. Crane. Councillor R. B. Dearie. Councillor A. E. Lauder. Councillor G. Peverett. Councillor C. William Skinner. CO-OPTED MEMBERS. Miss H. M. Corry. Mrs. A. L. Davy. Mrs. Victor Dover. Dr. L. Westlake. JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1938. SOUTHGATE REPRESENTATIVES. Councillor G. Peverett (Chairman). Councillor W. A. Clarke. Councillor Mrs. C. M. A. Vandy. 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 Officer of Health and Medical Superintendent, Isolation Hospital: W. C. Harvey, M.D., Ch.B., D.P.H. (Full Time.) *Medical Officer for Maternity Centres: Dorothy M. Catchpool, M.B., B.S., L.R.C.P., M.R.C.S., D.P.H. (Part Time.) *Senior Sanitary Inspector (No. 1 District): L. Skeeles. Cert .R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 2 District): H. Hill, M.R.San.I., A.M.Inst.S.E., M.S.I.A., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 3 District): A. E. Gooday. Cert.R.San.I., M.S.I .A., Cert.R.San.I. Meat Inspection. Chief Clerk: P. E. Barber. Clerk: Miss M. Munch. ,, Miss K. Stoten. Health Visitors: *Mrs. E. M. Rising, S.R.N., S.C.M., R.S.I., H.V. *Miss E. M. Hart. S.R.N., S.C.M. ^hUd *Miss M. Maddock, S.R.N., S.C.M., Welfare. H.V. MissB.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(Resigned May 31st.) *Full-time Assistant (Maternity Centres): Miss N. Freeman. (Appointed May 16th.) 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, 1938 67,860 Number of inhabited houses (end of 1938) according to Rate Books 20,200 Rateable Value (1938) £867,557 Sum represented by a penny rate (1938) £3,584 No material alterations have taken place in the local conditions outlined in the Annual Reports for the past few years. The Southgate Social Service Council still distributes a considerable quantity of clothing, furniture, footwear, etc., to necessitous families, a service which fills a very definite want. Close contact is maintained between the officials of the Social Service Council and the staffs of the Public Health and Maternity and Child Welfare Departments, in order that the best use may be made of the articles received for distribution. Meteorology.—The total rainfall recorded by the Council's rain-gauge in Broomfield Park measured 23.78 inches during 1938, the daily average being 0.065 inches. The greatest fall in 24 hours occurred on November 25th when 1.28 inches were recorded. The total number of days on which no rain fell was 204. RAINFALL RECORDED AT BROOMFIELD PARK. Total Rain for month. Number of 0.01 or more ins. Wet Days with 0.04 or more ins. 1938. 1937. 1938. 1937. 1938. 1937. Ins. Ins. Days. Days. Days. Days Jau. 3.27 3.82 23 23 17 17 Feb. 0.57 4.35 10 23 7 19 Mar. 0.38 2.49 3 19 3 13 April 0.20 3.04 7 15 3 13 May 2.11 2.72 14 15 9 12 June 0.63 1.89 6 13 6 9 July 1.43 0.58 16 10 11 7 Aug. 2.29 1.15 11 7 7 4 Sept. 2.47 1.59 15 14 10 13 Oct. 3.11 2.25 18 11 16 8 Nov. 3.64 1.43 18 9 15 7 Dec. 3.68 3.52 20 22 17 9 Totals. 23.78 23.83 161 181 121 131 7 A fully-equipped meteorological station has been established in Oakwood Park (Long. 0" 7' 18" W., Lat. 51° 38' 28" N.). The site is approximately the highest in the Borough (221.81 0 .D. Newlyn). The following instruments have been installed, and will be added to in the course of time as occasion arises:— Dines recording anemometer; chronometer; Fortin barometer; bare patch for earth inspections; 5in. Snowdon rain gauge; Campbell Stokes sunshine recorder; Stevenson's screen with maximum and minimum mark 1 thermometers, wet and dry fitments; earth thermometer; recording rain gauge (Hyetograph); grass thermometer. Since March 1st, 1938, readings have been taken each day at 9 a.m., and from that date until the end of the year 1,310.2 hours sunshine were recorded. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. , Male. Female. Live Births Legitimate 747 401 346 Illegitimate 26 11 15 Totals 773 412 361 Birth Rate per 1,000 of the estimated resident population .. .. 11.39 Stillbirths 27 15 12 Rate per 1.000 total (live and still) births .. ..33.75 Deaths 647 314 333 Corrected Death Rate per 1,000 of the estimated resident population.. 9.34 Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live and still) births. From Puerperal Sepsis 1 1.25 From other Puerperal causes 0 0.00 Total 1 1.25 8 Death Rate of infants under one year of age:— All infants per 1,000 live births 31.09 Legitimate infants per 1,000 legitimate live births 30.79 Illegitimate infants per 1,000 illegitimate live births 38.46 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 4 POPULATION. The Registrar-General's estimate of the population at the middle of 1938 was 67,860. an increase of 1.630 over the estimate for 1937. This is taken as the population of the Borough for the purposes of this report. The number of births exceeded the number of deaths by 126. as compared with an excess of deaths over births of 58 in 1937. The population for the past 5 years has been as follows:— 1934 59,997 1935 62,180 1936 64,000 1937 66,230 1938 67,860 BIRTHS—BIRTH RATE. The nett total births accredited to the district was 773, an increase of 115 on the preceding year; of these, 412 were males and 361 females (11 males and 15 females were illegitimate). The birth-rate was therefore 11.39 per 1,000 of the population, as against 9.93 in 1937. The birth-rate for England and Wales for 1938 was 15.1. The total number of births actually registered in the district during the year amounted to 692. The birth-rate figure (11 .39) is the highest since 1931. MORTALITY. General Mortality and Death Rate.—The nett number oi •deaths accredited to this district was 647, a decrease of 69 as compared with the previous year. 9 This gives a corrected death-rate of 9.34 per 1,000 of the population, a decrease of 1.25 on the rate for the previous year, which was 10.59. This rate is appreciably below that for England and Wales (11.6 for 1938). As compared with 1937, there were increases of 12 deaths from nephritis, 5 from appendicitis, and 3 from syphilis; while there were decreases of 24 deaths from influenza, 9 from cancer, 16 from respiratory diseases, and 9 from premature birth, etc. The most striking feature of the mortality statistics for 1938 is the decrease in the influenza mortality rate, which in turn is directly associated with the fall in the respiratory death-rate. That apart, there are no other deviations worthy of special record, although the fall in cancer deaths, while not in any way significant, at least makes pleasant reading. 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 58.11. Next came the group 45-65 years with 26.74 per cent., after which there was a marked fall to 7.73 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 15.15 per cent. of the aggregate deaths. Infantile Mortality.—There were 24 (1 illegitimate) deaths of infants under 1 year of age, which gives an infantile death-rate of 31.09 per 1,000 births registered, as compared with 28 deaths and a rate of 42.55 in the preceding year. The rate for England and Wales for 1938 was 53. It will be seen that the infant mortality rate showed a very definite fall during the year, and that it is still well below that for England and Wales. Table III on page 15 subdivides the infant deaths according to the weeks or months at which they occurred. 45.83 per cent. of the total deaths occurred during the first month, while 81.81 per cent. of these occurred during the first week. It is perhaps worthy of note that the percentage of infant deaths occurring within the first month has fallen from 67.86 per cent. in 1937, to 45.83 per cent., while the percentage of these deaths which 10 occurred during the first week of life has risen from 68.42 per cent. in 1937, to 81.81 per cent. As I have remarked before, it may be dangerous to draw definite conclusions from such small numbers (11 deaths under 1 month, 9 of which were under 1 week), but I feel it safe to infer that the fall in the percentage of deaths under 1 month indicates increased benefit from pre-natal supervision ; while the rise in the figure for deaths under 1 week points to a larger proportion of infant deaths occurring from non-preventable causes. Prematurity accounted for only 1 infant death, while pneumonia was responsible for 9 and congenital malformations for 2. All infant deaths were investigated. Stillbirths.—Twenty-seven stillbirths, none of which was illegitimate, were accredited to the district for 1938. This is equal to a death-rate of 33.75 per 1,000 total (live and still) births registered, the corresponding figures for 1937 being 18 stillbirths, with a rate of 26.63. It is to be regretted that there should be an increase of 9 in the number of stillbirths, and 7.12 in the stillbirth-rate. It is extremely difficult to ascertain the reason for this increase, which may be a purely temporary phenomenon. I hope to report further on this matter in the light of more recent statistics. 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 1.25 for 1938. This represents 1 maternal death, which occurred in the Southgate Isolation Hospital, the confinement having taken place in a local nursing home. Last year there were 3 deaths, with a corresponding rate of 4.44. Mortality of "Toddlers"—i.e., children between the ages of 1 and 5 years. Amongst children of 1 to 5 years of age there were 6 deaths during 1938. This represents a corrected death-rate of 0.09 per 1,000 of the total population, and 0.93 per cent. of the total deaths for the year, at all ages. In 1937 there were 4 deaths, giving a rate of 0.06 and a percentage of 0.56. 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 persons over the age of 65 (58.11 per cent.). In this connection, it is 11 interesting to note that 12 females died at the age of 90 or over, the oldest (in two instances) being 96 years; while 3 males also died within this age period, the oldest being 94. Zymotic Mortality.—This includes the deaths from the seven principal zymotic diseases, viz.: Smallpox, scarlet fever, diphtheria, typhoid fever, measles, whooping cough and diarrhoea (in children under 2 years of age). There were 7 deaths in this category: 1 from diphtheria, 1 from typhoid fever, 1 from whooping cough, and 4 from infantile diarrhoea. The zymotic death-rate for 1938 was therefore 0.10 per 1,000 of the population, as against 0.06 in 1937, with 4 deaths. 12 Table I. Causes of Death DurIng the Year 1938. Causes of Death. Male. Female. Total. Rates per 1,000 of Population. All Causes (Civilians only) 314 333 647 1 Typhoid and Paratyphoid Fevers .. 1 1 0.01 2 Measles .. .. .. .. 3 Scarlet Fever .. .. .. 4 Whooping Cough 1 .. 1 0.01 5 Diphtheria .. 1 1 0.01 6 Influenza 3 3 0.04 7 Encephalitis Lethargica .. .. .. .. 8 Cerebro-Spinal Fever .. .. .. .. 9 Tuberculosis of Respiratory System 14 8 22 0.32 10 Other Tuberculous Diseases 1 1 2 0.03 11 Syphilis 2 1 3 0.04 12 General Paralysis of the insane. Tabes Dorsalis 2 .. 2 0.03 13 Cancer, Malignant Disease 54 62 116 1.67 14 Diabetes 3 2 5 0.07 15 Cerebral Haemorrhage, etc. 16 17 33 0.48 16 Heart Disease 96 102 198 2.86 17 Aneurysm 1 1 2 0.03 18 Other Circulatory Diseases. 18 31 49 0.71 19 Bronchitis 6 5 11 0.16 20 Pneumonia (all forms) 12 20 32 0.46 21 Other Respiratory Diseases 6 2 8 0.11 22 Peptic Ulcer 7 .. 7 0.10 23 Diarrhcea, etc. (under 2 years) 2 2 4 0.06 24 Appendicitis 5 2 7 0.10 25 Cirrhosis of Liver 1 1 2 0.03 26 Other Diseases of Liver, etc. 1 2 3 0.04 27 Other Digestive Diseases 5 4 0 0.13 28 Acute and Chronic Nephritis 14 10 24 0.35 29 Puerperal Sepsis .. 1 1 0.01 30 Other Puerperal Causes .. .. .. .. .. .. 31 Congenital Debility, Premature Birth and Malformation, etc. 5 5 10 0.15 32 Senility 1 5 6 0.09 33 Suicide 6 4 10 0.15 34 Other Violence .. .. .. 15 11 26 0.38 35 Other defined Diseases 18 31 49 0.71 36 Causes ill-defined or unknown .. • • • • • • Totals 314 333 647 9.34 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. 1938. Age. MALES. FEMALES. TOTALS. No. %of Total Deaths. Rate per 1,000. No. % of Total Deaths. Rate per 1,000. No. %°f Total Deaths. Rate per 1,000 0— 1 year 13 2.01 0.19 11 1.70 0.16 24 3.71 0.35 1— 5 years 4 0.62 0.06 2 0.31 0.03 6 0.93 0.09 5—15 ,, 3 0.46 0.04 2 0.31 0.03 5 0.77 0.07 15—25" 8 1 .24 0.11 5 0.77 0.07 13 2.01 0.18 25—45 ,, 30 4.64 0.43 20 3.03 0.29 50 7.73 0.72 45—65 ,, 97 14.99 1.40 76 11.75 1.10 173 26.74 2.50 65 and over 159 24.57 2.30 217 33.54 3.13 376 58.11 5.43 Totals 314 48.53 4.53 333 51.47 4.81 647 100.0 9.34 14 Table III. Infantile Mortality. 1938. Nett Deaths from stated causes at various periods under 1 Year of Age. Causes of Death. | Under 1 Week. 1 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. A11 Causes 9 2 .. 11 2 3 6 2 21 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 Meningits (not Tuberculosis) .. .. .. .. .. 1 1 2 12 Convulsions 13 Laryngitis 14 Bronchitis .. .. .. .. .. 1 .. ... .. 1 15 Pneumonia 1 .. .. .. 1 1 9 4 1 9 16 Diarrhoea 17 Enteritis .. ... .. .. .. .. .. 1 .. 1 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at British0 1 .. .. .. 1 .. .. .. .. 1 23 Atelectasis 1 .. .. .. 1 .. .. .. .. 1 24 Congentinal Malformations 1 .. 1 .. 2 .. .. .. .. 2 25 Premature Birth .. .. 1 1 .. .. .. .. 1 26 Atrophy, Debility and Marasmus 27 Other Causes 5 .. .. .. 5 .. .. 1 .. 6 Totals 9 .. 2 .. 11 2 3 6 2 24 15 Table IV. vital Statistics or Whole District during 1938 and Seven 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 65,460 663 11.68 512 8.67 30 45.24 1932 57,250 651 11.37 589 9.67 25 38.40 1933 58,820 570 9.69 591 9.44 19 33.33 1934 59,997 640 10.66 596 9.73 25 39.06 1935 62,180 681 10.95 561 8.81 30 44.05 1936 04,000 645 10.08 631 9.66 28 43.41 1937 66,230 658 9.93 716 10.59 28 42.55 1938 67,860 773 11.39 647 9.34 24 31.09 compabison of the rates of the southgate e distbiot with those of England and Wales, and London, fob the Yeab 1938. Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births Still Births. All Causes. Typhoid Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhea and Enteritis (under two years). Total Deaths under one year. England and wales 15.1 0.60 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 5.5 53 126 County Boroughs and Great Towns, including 15.0 0.65 11.7 0.00 0.00 0.05 0.01 0.03 0.07 0.10 7.0 57 148 Smaller Towns (1931 Census Populations 25,000—50,000). 15.4 0.60 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.0 51 London 13.4 0.48 11.4 0.00 0.00 0.00 0.01 0.03 0.05 0.06 13.1 57 Southgate 11.39 0.40 9.34 0 01 0.00 0.00 0.00 0.01 0.01 0.04 5.17 31.09 16 General Provision of Health Services. Hospitals.—General Hospitals.—The arrangements set out in the Annua] Report for 1930 regarding the provision of general and special hospital accommodation for the inhabitants of Southgate remain unaltered. They still appear satisfactory. Provision for Maternity Beds.—The agreement with the Royal Northern Hospital and the Salvation Army Maternity Hospital to admit Southgate mothers at reduced fees continues to work satisfactorily. As before, the North Middlesex County Hospital is also being utilised by a proportion of our maternity cases. Closer contact is now being maintained with the North Middlesex County Hospital, particularly with regard to the examination of expectant mothers at our Pre-natal Clinic. We still have no binding arrangement whereby Southgate mothers can be admitted to that Hospital and be maintained at the Borough Council's expense. Isolation Hospital.—The following improvements were carried out at the Isolation Hospital during 1938:- Redecoration of wards; purchase of additional furniture and equipment, including steam sterilizing apparatus, stainless steel fitments and additional bed-pan sterilizers; improvements to grounds. Additional alterations and improvements are scheduled for 1939, designed to maintain the hospital in an efficient condition. The permanent nursing, domestic and outdoor staff remained unaltered during 1938. As before, additional nursing staff was obtained when occasion required. Once again I find myself in the unhappy position of having to state that the proposed extensions at the Isolation Hospital are still a matter for the future. At one time it appeared likely that building operations would be commenced before the end of the year. Various difficulties arose, however, which necessitated the postponement of this anticipated pleasure. How long a period must elapse before we can see even the foundation stone laid is still a matter for conjecture, but in the interest of all concerned it is sincerely to be hoped that before another twelve months have passed, it may be possible to report a happier position. 17 Nursing Homes.—There are in the district 6 registered Nursing Homes, the same number as during 1937. 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, Southgate. 4. Uvedale Nursing Home, Elmscott Gardens, Winch- more Hill. 5. 116, Aldermans Hill, Palmers Green. 6. 2, Downes Court, Winchmore Hill. These Nursing Homes provide facilities for the treatment of medical, surgical and maternity cases, and are under the direct supervision of the Middlesex County Council. Nursing in the Home, —(a) The Southgate Queen's Nursing Association has continued the work set out in the Annual Reports for the past two years. The apparent decrease in the work undertaken is explained by the fact that all midwifery visits have now been deleted, following the transfer of these duties to the County Council. There can be no doubt that this service is proving of very great value to the inhabitants of Southgate. It is indeed an excellent example of the co-operation which can and should exist between a statutory authority and an efficient, well-organised voluntary body operating in that authority's area. Table of work carried out by the Southgate Queen's Nursing Association under the Borough Council's scheme:— Diseases Treated. Cases. Visits. Pneumonia 14 179 Influenza 15 60 Measles 3 10 Measles with Pneumonia 4 21 Children under 5 (notifiable) 4 23 ,, ,, (not notifiable) 76 436 Others 2 4 118 733 (1937) 220 2,212 18 In addition to the work outlined above, the Southgate Queen's Nursing Association provides its customary general services, the high standard of which has been fully maintained. The following table sets out the work carried out by the Queen's Nursing Association during 1938, so far as its own activities are concerned. 1937. 1938. Domiciliary Nursing Visits 15,574 13,482 Midwifery, Maternity and Antenatal Visits - 3,979 Patients attending Physicotherapeutic Clinic 1,614 1,620 Treatments given 8,701 8,661 The arrangements mentioned in last year's Annual Report whereby the Queen's Nursing Association undertakes the recognised midwifery service in the Borough under the auspices of the Middlesex County Council, still hold good. The Maternity Department continues to co-operate with the Nursing Association in this very necessary work, a co-operation which is obviously to the advantage of all concerned. (b) 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 continues to operate in a very satisfactory manner. Midwives.—There are 9 midwives practising in the area. These come under the supervision of the County Authority, and none is employed or subsidised by the local Council. As alread noted, the Southgate Queen's Nursing Association undertakes midwifery work in the Borough under the jurisdiction of the Middlesex County Council. Clinics and Treatment Centres.—The following Clinics and Treatment Centres are available for the inhabitants of the Borough: 19 Maternity and Child Welfare .(Southgate Council).—At 31st December, 1938. 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—4 p.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. Orthopaedic Treatment.—Arrangements are made for the treatment of any orthopaedic cases discovered in connection with the Maternity and Child Welfare services. No such cases were met with during the year. As before, the Middlesex County Council undertakes the responsibility when the children reach school age. 20 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 the Annual Report for 1936, hold good. All cases of doubt are referred to the Medical Officer of Health. Council Employees.—Eleven Council employees were examined at the Town Hall during 1938, either for admittance to the superannuation scheme or before being accepted into the Council's service. Mortuary.—During 1938, 36 bodies were deposited in the Council's mortuary situated at the rear of the Town Hall. Thirtytwo post-mortem examinations were made. The new mortuary constructed in 1937 has already justified the expense incurred in its erection. Several minor improvements have already been made, and further alterations intended to increase efficiency are contemplated during the present year. It is interesting to note that several Boroughs have already sent representatives to inspect the mortuary, with a view to collecting information for similar provisions in their own districts. It is also evident that local medical practitioners are making use of the mortuary, when such an unfortunate necessity arises. 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 1938. AVork carried out at the Council's laboratory during 1938:— Hospital. Borough. Positive . Negative. Positive. Negative Swabs for Diphtheria Bacilli 604 3,537 47 757 Swabs for Haemolytic Streptococci - - - 21 Sputa for Tubercle Bacilli - - 18 109 Urine for Albumin - - - 1 Pleural Effusion (1) - - Total 5,095 (Total, 1937—4,503). 21 Specimens sent to Clinical Research Association during 1938:— Positive. Negative. Total. Blood for Widal Test (Typhoid ) 2 10 12 Faeces - 12 12 Rectal Swabs - - - Blood (Wasserman Test) - 1 1 Cerebro-spinal Fluid - 2 2 2 25 27 Specimens sent to laboratory at the Prince of Wales's Hospital during 1938:— Positive. Negative. Diphtheria swabs for virulence test 11 6 Failing to incubate Diphtheria Bacilli - 17 Rectal swabs 18 55 Swabs for Meningococci 1 1 Swabs for Streptococci - 2 Swabs for Gonococci - 1 Faeces 1 1 31 83 Total 114 BACTERIOLOGICAL EXAMINATION OF MILK. This work has followed mainly along the routine lines of the past two years, with the addition of the phosphatase test as a standard method of investigation. On the whole, the results of the examinations carried out approximate closely to those of previous years, the standard remaining satisfactorily high, with a few unrelated exceptions. As stated in previous reports, any marked lowering of the general standard, together with the presence of obvious defects in processing, are immediately reported to the appropriate authority. It will be noted that this year no tuberculosis bacilli were found in any of the samples examined, a very definite step in a forward direction from the results of 1937, when two samples out of 104 were found to contain such organisms. 22 Summary of Work carried out during 1938. Total number of samples examined 206 Samples examined for total bacterial count 152 Samples submitted to reductase test 54 Samples submitted to phosphatase test 65 Samples examined for presence of bacillus coli 130 Samples examined for presence of tubercle bacilli 107 Samples of Non -designated Milks, including Raw Milk, Pasteurised (Non-designated) Milk, Sterilized Milk and Irradiated Milk, examined 98 Percentage of satisfactory results, as regards total bacterial count 100% Percentage of satisfactory results, as regards b. coli content 100% Percentage of Non-designated Pasteurised Milks complying with phosphatase test 90.9% Average bacterial count 27,042 Samples of Designated Milks examined 108 Tuberculin Tested (Certified) 18 Tuberculin Tested 25 Tuberculin Tested (Pasteurised) 8 Accredited 11 Pasteurised 46 Fifty-four samples of raw. designated milks were submitted to the methylene blue (reductase) test with the following results :— Percentage found satisfactory. Tuberculin Tested (Certified) 94.4% Tuberculin Tested 88.0% Accredited 100.0% Forty-six 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% Percentage of samples not complying with phosphatase test 12.5% Average bacterial count 21,701 23 Pasteurised Milk. Percentage of samples found satisfactory in every respect 93.4% Percentage of samples not complying with phosphatase test 6.6% Average bacterial count 27,535 No tubercle bacilli were present in any of the samples examined. Causes of failure to pass phosphatase test:— Breakdown of automatic temperature recorder 1 No automatic temperature recording apparatus 1 Fall in temperature of milk in holder 1 Breakdown in pre-heater 1 Note.—All failures to comply in both Designated and Nondesignated Milks were due to failure to pass phosphatase test. 24 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. 15. 8. 1913. Public Health Act, 1925, Part II. 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. 25 24. 7. 1934. Bye-laws with respect to nuisances in connection with the removal of offensive or noxious matters in the Borough. 25. 9. 1934. Bye-laws with respect to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family in the Borough. 26. 2. 1935. Bye-laws for the good rule and government of the Borough and for the prevention and suppression of nuisances. 1. 3. 1935. Bye-laws with respect to pleasure grounds 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. Bve-laws with respect to hairdressing establishments. 19. 11. 1937. Bye-laws as to establishments for massage or special treatment. SCHEMES. 20. 8. 1938. Southgate (No. 1) Planning Scheme. Maternity and Child Welfare Services. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1938. Number on Registers:- Under 1 year. Over 1 year. Totals 1937. January 1st, 1938 393 640 1.033 1.056 December 31st, 1938 972 972 1,944 1,947 New cases during 1938— Southgate 579 332 911 894 East Barnet - - - - 43 of the new cases under 1 year were "removals" into the district. The remaining 536 represent 69.34 per cent. of the total births credited to the district. Attendances at Centres, 1938:— Under 1 year. Over 1 year. Totals. 1937. The Bourne 1,515 1,109 2,624 2,926 Broomfield House 1,711 1,028 2,739 2,303 Bowes Park 2,241 1,746 3,988 3,623 New Southgate 1,464 1,516 2,980 3,486 Community Hall 1,470 1,844 3,314 3,408 Wiuchmore Hill 2,113 1,697 3,810 3,794 Totals 10,514 8,941 19,455 19,540 Average 34.70 29.51 64.21 64.70 27 Number Seen by Doctor:— Under 1 year. Over 1 year Totals. 1937. The Bourne 495 447 942 1,107 Broomfield House 547 509 1,056 938 Bowes Park 672 593 1,265 1,274 New Southgate 382 480 862 1,168 Community Hall 415 468 883 1,058 Winchmore Hill 610 608 1,218 1,351 Totals 3,121 3,105 6,226 6,896 Average per session 10.30 10.25 20.55 22.83 Percentage of total attendance seen by Doctor. 29.7% 34.7% 32.0% 35.3% Number of Sessions held (1938) . 303 Talks and Practical Demonstrations in Mothercraft given at Centres (1938) 17 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:— 1937. 1938. January 1st 69 99 December 31st 121 84 New cases during the year 245 290 The number of new cases during the year represents 36.25% of the total births (live and stillbirths). Number of sessions held 51 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. 28  1937. 1938. Total attendances 841 996 Average per session 16.49 19.53 Number seen by Doctor 788 956 Average per session 15.45 18.74 Percentage of total attendance seen by Doctor 93.7% 95.9% Percentage of mothers attending natal Centre 36.13% 36.25% 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:— 1937. 1938. First visits 444 In addition to first visits. 529 Under 1 year of age 1,629 1,016 Over 1 year of age 2,821 2,878 Visits re:— Deaths under 5 years of age 9 5 Stillbirths 5 3 Ophthalmia Neonatorum cases - - Pre-natal visits 493 498 Visits re:— Puerperal Fever cases - - Puerperal Pyrexia cases 9 - Special visits (test-feeds, following special cases seen by M.O. at Centres, failing lactation, etc.) 841 566 Special visits re Day Nursery - 346 Special visits re Immunisation - 129 Total visits 6,251 5,970 29 As hitherto, the vast majority of notified births are visited by the Health Visitors upon the notification being received. Any cases requiring special attention are revisited periodically, and mothers are given a cordial invitation to attend the Centres if they so desire. These arrangements continue to operate in a satisfactory manner. From the table set out on the previous page, it will be noted that the total number of attendances at the various Infant Welfare Centres during 1938 shows no material alteration from the figures relating to 1937. When, however, it is remembered that last year represented the first full twelve months during which no mothers from East Barnet were received at our Centres, it will be realised that the work, so far as Southgate mothers were concerned, actually shows a further increase. When one comes to consider the work of the Pre-Natal Clinic, the position is even more satisfactory. The total number of new cases attending the Pre-Natal Centre for the past three years has been 194, 245 and 290 respectively; while the total Attendances for the same period were 669, 841 and 996. The work has thus shown a steady increase, a fact which must of necessity exercise a beneficial effect upon this very important aspect of preventive medicine. Attempts are still being made to bring the facilities afforded by the various clinics more prominently before the citizens of Southgate. In these days it seems strange that any residents in the Borough, however new, should be unaware of the fact that the Council provides a full and varied service for the use of women and children under the age of 5 years. It would, nevertheless, appear that some families are still ignorant of these facilities. The number cannot be very high, but every instance of such lack of familiarity represents so much sterilization of effort. For this reason, we should not rest satisfied until we can feel reasonably certain that the necessary information has been made available to all residents within the Borough. It is also important that this information should not be confined to those families who might obviously be expected to avail themselves of the Council's services. To-day, poverty and hardship are found in unexpected places. So long as this is the case, our canvass should of necessity be universal. 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 13 Number of foster children 14 Total visits paid 74 Work in connection with the above Acts did not present any difficulties during 1938. The distressing occurrences reported in 30 last year's Annual Report were not repeated, and there does not appear to be any reason to lead us to assume that the provision of the Acts are being either neglected or loosely carried out. Miscellaneous Statistics. 1937. 1938. Births registered in the district 628 692 Attended by Midwives 113 155 Un-notified Births 17 12 Percentage of Births notified 97.3% 98.25% Stillbirths notified 12 20 Stillbirths notified by Midwives 2 2 Stillbirths notified by Doctors 10 18 Stillbirths notified occurring in Institutions : In the district 5 11 Outside the district 4 5 Maternal Deaths 3 1 Infant Deaths:— Under 1 year of age 28 24 Under 1 month (inc. above) 19 11 1 to 5 years of age 4 6 Number of Southgate Births in North Middlesex Hospital Maternity Home 113 114 Infant Mortality amongst children attending Centres 6 (2 over, 4 under 1 year.) 12 (3 over, 9 under 1 year.) Number of cases in which milk was granted:—1935, 225; 1936, 241; 1937, 305; 1938, 352. Approximate cost:—1935, £731; 1936, £776; 1937, £964; 1938, £1.024. Grants of Trufood were made in 13 cases, Cow and Gate in 10 cases, Allenbury's in 19 cases; Nestle's in 29 cases; and Ostermilk in 2 cases; while grants of cod liver oil emulsion, cod liver oil and malt, and syrup minadex were allowed in 58, 50 and 35 cases respectively. Number of children under 1 year of age granted free milk during 1938 150 Percentage of total live births 19.40 List of Foods Sold at Centres. £ Trufood, amounting to 210 (approximate) Cow & Gate, amounting to 158 ,, 31 Dental Treatment.—The arrangements outlined in the Annual Report for 1935 continue to operate in an extremely satisfactory manner. The difficulties previously encountered in persuading mothers to attend personally at the Eastman Dental Clinic, and to take their children, has been almost entirely overcome by the provision of a free transport service. This transport is provided by one or more of the Council's ambulances, and, while occasional difficulties in attendance are still being encountered, there can be little doubt that the provision of the new service has eliminated the major portion of our previous difficulties. Number of "Council" patients attending Clinic. 1938 .. 82 Cost of such cases £32 Home Help Scheme.—The following table sets out the details of the work carried out under the above scheme during 1938: Number of Home Helps provided free of charge—36. 1 for 25 davs. 1 ,, 23 2 ,, 21 „ 1 ,, 19 „ 30 ,, 14 ,, 1 ,, 7 „ Number of Home Helps provided at a charge of Is per day—16. 1 for 21 days. i ,, 20 1 ,, 14 ,, 13 ,, 14 ,, Number of Home Helps provided at a charge of 2s. per day—6. 6 for 14 days. Number of Home Helps provided at a charge of 3s. per day—2. 1 for 21 days. 1 ,, 14 „ Number of Home Helps provided at a charge of 5s. per day—1. 1 for 14 days. Total cost of operating the Scheme during 1938'—-£200 2s. Od. Average number of Home Helps on Council's roll—12. During six months of 1937, when the Home Help scheme was operated, 30 cases were assisted. It will thus be seen that the 32 total for 1938 (61) is strictly comparable. Certain minor alterations were made in the appropriate scale during the year, but the operation of the scheme has remained more or less unaltered. I think that it can now be definitely stated that the Home Help scheme has filled a very definite gap in the maternity services, and that the assistance so provided is not only keenly appreciated, but extremely valuable from a preventive point of view. Voluntary Helpers.—It is once again a privilege to record my official thanks to the Voluntary Workers for the many and excellent services which they rendered throughout the year. Space does not permit of an elaboration of these services, but as Medical Officer of Health I should like the Voluntary Helpers to know that the part they have voluntarily chosen to play in the maternity work of the district is in many respects unique and invaluable. General.—The scheme mentioned in the Annual Reports for the past two years of an ad hoc maternity clinic, with or without the addition of a Day Nursery, has not yet materialised, but one important step has been taken. Arrangements have now been entered into with the Middlesex County Council, whereby the Maternity Department can have the part use of the combined School and Maternity and Child Welfare Clinic which the County Council is erecting in Bowes Road. These premises have been constructed to meet the Maternity Department's requirements, and, when they are finally completed, should provide a modern and adequate Maternity Centre. As the Council will be aware, it is proposed to transfer the New Southgate Clinic from the Grove Road Baptist Church Hall to these premises, so soon as they are ready for tenancy. With such admirable accommodation available, it should be possible in the future to increase the scope of this clinic, by incorporating certain additional special sessions to meet the growing needs of maternity and child welfare in Southgate. The question of the erection of a Day Nursery is more complex, and requires very careful consideration. Evidence that such an institution is required in Southgate is still somewhat conflicting, and until the need is definitely established it would obviously be unwise to embark upon any elaborate financial scheme. An alternative is at present being explored whereby special cases may be dealt with on a domiciliary basis. As, however, this scheme has not yet been put into operation, no more detailed report is possible at the moment. Maternity and Child Welfare in Southgate has now passed its infancy and childhood, and is growing steadily into healthy, 33 vigorous adolescence. Of all the services provided by the Borough Council, the Maternity and Child Welfare sphere is probably the one which, above all, requires to be fostered and encouraged with unsparing vigilance. More and more has it come to be realised that Maternity and Child Welfare lays the foundation of a district's health. If that service be neglected or reduced, the result will make itself apparent in numerous and highly undesirable directions. Money spent on Maternity and Child Welfare services is an excellent insurance policy, the premiums of which are remarkably small when the ultimate yield comes to be considered. As with all other forms of insurance, the cover should be adequate and the premiums never allowed to go by default. 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 carried out at two schools in the district. As noted in the appendix, several visits were also paid to elementary and secondary schools for the purpose of giving health film shows. In an endeavour to co-operate more closely with the school medical authorities, arrangements have been made whereby swabs taken from suspected cases of diphtheria can be examined at our own laboratory. This enables us to obtain vital information more quickly than was previously possible, while it provides the County Council with a more speedy, local bacteriological service. Arrangements are also being made to pass on information concerning children who attain the age of five years, to the school authorities. In this way the work of the Maternity and Child Welfare Department will be made available at a time when this information may prove extremely valuable to those in charge of the children's welfare. Medical Inspection.—The Middlesex County Medical Officer is the Chief School Medical Officer for this district, and organises and supervises the work. 34 With the approval of the Board of Education, the Education Committee made arrangements for the introduction of a fourth routine medical inspection during the school life of children attending the Council's elementary schools. The revised age groups came into operation on the 1st January, 1938, and I set out below the ages at which children are routine medically inspected. (1) All children who have not previously been medically examined at any school, or in respect of whom no medical record cards are available. (2) Children who are between the ages of 7 and 8, and who have not been examined at this age. (3) Children who are between the ages of 10 and 11, and who have not been examined at this age. (4) Children aged 13 years and over who have not been examined since attaining the age of 13. (5) Special children, not included amongst the above, presenting some urgent condition needing medical examination. The total number of children inspected at the elementary schools during 1938 was as follows:— Inspected. Requiring Treatment. Entrants 369 43 Age 7 years 380 26 Age 10 years 511 65 Age 13 years and over 254 37 1,514 171 Other ages 351 61 Special 6 - 357 61 1,871 232 School Clinics.—These are provided by the Middlesex County Council. (a) Minor Ailments Treatment Clinics.—The Education Committee authorised the establishment of a temporary minor ailments clinic in the neighbourhood of Tottenhall Road, pending the erection of an additional clinic at Bowes Road. Arrangements were made for the renting of St. Mary's Church Hall for one session per week. 35 The clinic was opened on the 30th March, 1938, and is attended weekly by one of the County Council's staff of Health Visitors and School Nurses, who refers cases which, in her opinion, should be seen by a doctor either to the clinics at Winchmore Hill or Holly Park, according to the district in which the child resides. Other minor ailments treatment clinics are in operation at Winchmore Council School, Highfield Road, Winchmore Hill, where 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 Wednesday and Friday mornings. The total number of children attending Southgate schools dealt with at the minor ailments clinics during 1938 was as follows: New Cases. Attendances . Treated. Not requiring Treatment. Winchmore Hill 1,300 3,889 1,192 108 De Bohun 522 1.200 496 26 Tottenhall Road 139 276 68 71 Holly Park 467 1,161 280 187 2,428 6,526 2,036 392 (b) Ophthalmic Clinic.—An ophthalmic clinic is held twice weekly, on Monday mornings and Thursday afternoons, at Holly Park School, Friern Barnet, school children being seen by Mr. E. F. King, F.R.C.S., D.O.M.S., Ophthalmic Surgeon. Four hundred and seven children attended the clinic and were seen by the Ophthalmic Surgeon during 1938. Spectacles were prescribed and provided for 255 of these. The corresponding figures for 1937 were 248 and 148 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 Arnos, Bowes Road and Garfield Road Council Schools continue to receive treatment at the clinic at Holly Park Council School. 36 The Dental Officer inspects children in the various schools, and those requiring treatment are referred to the dental clinic, where treatment is provided at a charge of 1s. 6d. (remitted in necessitous cases). Two thousand three hundred and fifty-nine children were dentally inspected at the schools during the year, as against 2,083 in 1937, while 1,872 attended at the clinics (1937, 1,894) where they received treatment for various dental defects. 37 Sanitary Circumstances of the Area. Water.—The circumstances as to the water supply of the district remain as set out in the report for 1934, and continue satisfactory. Following the Ministry of Health's requirements, information relating to any infection which might theoretically be water borne is transmitted to the Metropolitan Water Board. This information was transmitted in 12 cases during 1938, but in each instance the result of the examination was reported as entirely satisfactory. Broomfield Park Swimming Lake.—Following the submission of several reports upon the analysis of the water taken from the above lake, the Public Health Committee decided to recommend the Council in January that the lake be closed for swimming. Following this recommendation, the lake was closed. This matter was fully discussed at several Council meetings, and no good purpose would therefore seem to be served by re-opening the matter at this juncture. 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. 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 efficient manner. 38 Swimming Bath.—The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows:— 1937. 1938. Mixed Bathers 46,847 33,611 From Schools 24,066 18,248 Season Ticket Holders 15,278 11,169 86,191 63,028 Spectators 2.895 3,278 Costumes, etc., hired 1,019 2,275 Roads.—There are now more than 82 miles of roads in the district, made up as follows:— County Roads 12.89 miles. Arterial Roads 1.89 „ District Roads 54.18 ,, 68.96 ,, Private Roads 13.36 ,, 82.32 ,, Public Conveniences.—Three public conveniences are available within the Borough, situated as follows : North Circular Road, Palmers Green; The Triangle, Palmers Green; Fords Grove, Winchmore Hill. In addition, public conveniences provided by the London Passenger Transport Board at Southgate and Enfield West Underground stations are also available to the public. The question of the provision of a public convenience to serve the New Southgate area received consideration during the year, but, owing to difficulty in obtaining a suitable site, the matter has been deferred. The need, however, still remains. 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 Borough Surveyor's Department. In an endeavour to reduce the nuisance caused by garden fires, and to assist in the extraction of saleable material and incineration at the Destructor, a system of separate collection of garden refuse at a small charge has been on trial during 1938. This method has proved highly successful and, with slight modifications, is being continued. Several complaints were received during the year regarding fly nuisance, particularly around the Destructor. This nuisance did not, fortunately, assume serious proportions, and by the exercise of certain preventive measures it was possible to keep the matter under reasonable control. 39 The following is a brief summary of the work carried out during the year:— No. of days worked—Hired Horses 328 ,, ,, ,, ,, ,, Pagefield Containers 1.246 ,, ,, ,, Freighters .. 515 ,, ,, ,, Hired Lorries 36 No. of Loads to Destructor 7,535 Total Weight to Destructor 16.154 tons. N o. of Loads to Shoots - Smoke Abatement.—The following is a summary of the work carried out during 1938 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. Camping Sites.—There are no camping sites within the Borough. Ponds and Rubbish Dumps.—Very few complaints were received during 1938 regarding ponds and rubbish dumps, which are fortunately becoming more scarce each year in Southgate. Not so many years ago these matters gave the Public Health Department no little concern, but recently, owing to the steady development of the district, the nuisance has been very considerably abated. 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. Rag Flock Acts, 1911 and 1928.—There are no premises in the district manufacturing, selling or using Rag Flock according to the Acts. 40 Inspection and Supervision of Food. Milk Supply.—No registration of retailers or producers has had to be refused under the provisions of the Milk and Dairies (Amendment) Act. 1922 (Milk and Dairies Order, 1926). Eleven additional retailers were registered during the year under this Act. Under the Milk (Special Designations) Order, 1936, 21 Dealers' Licences to sell Pasteurised Milk, 8 to sell Tuberculin Tested 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 Pasteurised 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. Last year I deplored the fact that the Government had not seen fit to introduce legislation rendering the pasteurisation of all milk supplied within any district compulsory. Since then the position has not altered, except in so far as certain statements have appeared which tend to prejudice pasteurisation in the mind of the public. It is most unfortunate indeed that such statements find their way into the Press, more often than not as isolated excerpts from an article or debate. Opponents will always be found to any progressive step, especially when that step envisages the positive application of scientific principles to those food products which, in the opinion of such individuals, are natural products, the possibility of disaster being apparently quite a secondary concern. It is more unfortunate still that this type of protagonist is usually vocal, and that the statements made are sometimes based on half-truths and in certain instances on no truth at all. In spite of all opposition, the fact is apparent that the pasteurisation of the nation's milk supply remains the only answer 41 to the problem of contamination of this vital foodstuff. Serious national and international problems have tended to crowd out the subject of milk from current agenda, but the problem remains none the less urgent and deserving of immediate attention. If the Government refuses to act, the initiative would appear to lie with the local authorities. The promotion of local legislature may be more costly, but the expenditure incurred would be amply repaid by the additional safety with which the public would be supplied. 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. 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 Council's laboratory provides an extremely valuable check upon such inspections. Meat.—There are no public abattoirs in the district. Butchers' shops are visited frequently, while slaughterhouses are kept under strict control. Once again the total number of carcases inspected in the district during the year has shown a substantial increase. Thus, the duties of meat inspection assume an even greater significance than before. The following is a summary of the work carried out during 1938:— Total number of carcases examined, 23,424. 42 Bovines, 258; Sheep and Lambs, 8,343; Calves. 69; Pigs, 14,754. (1937. Bovines, 240; Sheep and Lambs, 7,133; Calves, 87; Pigs, 15,334. Total 22,794.) As a result of these examinations, 225 separate diseased or unsound conditions were discovered, the carcases or organs receiving the necessary attention. Details of these conditions are as follows: Bovine Carcases. Weight in lbs. 5 separate portions affected with Tuberculosis 150 3 ,, ,, ,, ,, Actinomycosis 89 4 ,, ,, ,, ,, Abscesses 42 281 Calves. 1 separate portion affected with Bruising 42 Sheep Carcases. 3 separate portions affected with Distoma 8 1 ,, portion ,, ,, Caseous Lymphadenitis 9 Pig Carcases. 17 193 separate portions affected with Tubgrculosis 826 14 ,, ,, ,, ,, Cirrhosis 72 1 ,, portion ,, ,, Abscesses 5 903 1,243 (11 cwts. 11 lbs.) The incidence of disease in the different food animals inspeoted during the past year as compared with the previous four years is shown in the following table:— 43 Animals. All Diseased Conditions. Tuberculosis. Slightly Affected. Extensively Affected. Slightly Affected. Extensively Affected. No. % No. % No. % No. % Bovines- 1934 15 27.77 1 1.85 13 24.07 1 1.85 1935 19 22.50 4 4.76 16 19.04 2 2.38 1936 17 21.79 5 6.41 14 17.94 5 6.41 1937 18 7.08 2 0.83 17 7.08 2 0.83 1938 12 4.67 - - 5 1.93 - - Sheep- 1934 2 0.05 - - - - - - 1935 4 0.10 - - - - - - 1936 8 0 10 - - - - - - 1937 6 0.08 - - - - - - 1938 4 004 - - - - - - Calves- 1935 - - 1 0.80 - - - - 1936 - - I 0.26 - - - - 1937 - - - - - - - 1938 1 1.44 - - - - - - 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 1938 206 1.39 2 0.01 191 1.29 2 0 01 The incidence of disease, which was extremely low during 1937, has once again shown a decrease. This decrease is not quite so marked as in previous years, merely for the reason that it is now scarcely possible to raise the standard to any appreciable degree. 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 1 Other Foods.-The bakehouses, fish, fruit and grocers' shops situated within the district continue to be kept under observation. 44 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. Additional work under this Act became necessary following the operation of the Sunday Trading Restriction Act. Duties under this Section of the Act have necessitated additional week-end duty on the part of the Shops Inspectors. Altogether, and including the administration of the byelaws relating to hairdressing and massage establishments, Shops Act duties now represent quite an important part of the Sanitary Inspectors' work. In many respects it is doubtful whether the vast amount of time necessary to carry out the duties in a proper and efficient manner is really justified from a Public Health point of view; but in such a district as Southgate, any other apportionment does not seem a practicable proposition. Infringements under Shops Acts:— Sales after hours 4 Sunday closing infringements (warnings given) 10 One prosecution on account of sales after hours was instituted, resulting in a fine of £1 being imposed upon the offender. 45 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 Taken. Found Adulterated. Milk 108 2 Milk, sterilized 14 - Butter 9 - Cream Pastries 5 3 Meat 3 - Sheep's Liver . . 3 - Gin 2 - Port Wine 1 - Whisky 6 - 151 5 One prosecution was instituted in respect of the sale of Devonshire cream scones which contained foreign fat. 46 ANNUAL REPORT, 1938 On the Administration of the Factory and Workshop Act, 1901, and the Factories Act, 1937, in connection with Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Pro seen tions. 1937 1938 1937 1938 Factories with Mechanical Power 550 280 ?6 27 .. ?o9 183 29 24 .. Workplaces (other than Outworkers' premises, included in Part 3 of this Report) 10 10 1 4 .. Total 819 473 56 55 .. 2—DEFECTS FOUND. Partioulare. Number of Defects. Found. Remedied. Referred toH.M. Inspector. Number of defects in respect of which prosecutions were instituted. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 73 73 Overcrowding (S. 2) 1 treasonable temperature (S. 3) Inadequate Ventilation (S. 4) Ineffective d SanitaryConvenience drainage of floors (S. 6) Insufficient .. unsuitable or defective 4 4 - - (S. 7) 1 not separate for sexes Other Offences 3 3 - (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Hen 1th (Factories and Workshops Transfer of Poweisi Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1037.) Total 80 80 47 48 3.—HOME WORK. Nature of Work. (1) Outworkers' Lists, Section 107. Prosecutions. Outwork in Unwholesome Premises, Sec 108 Outwork in Infected Premises. Sees. 109 & 110. Tw Lists received from Employers. Notices served on Occ'prsas to keeping or send ing Lists. (8) Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) ce in the year. Once in the year. £ Instances. P Notices 3 Served Prosecut ions. Instances. Orders Made. (S.110) cutlons. (8.109-110) Lists. (2) Outworkers Outworkers. Contractors . (3) Workmen. (4) Lists. (5) Contractors . (6) Workmen. (7) Wearing Apparel — (1) Making, etc. 7 .. 29 .. .. .. .. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) No. (2) Bakehouses 20 Laundries 2 Other Workshops 195 shops on Register 217 5.—OTHER MATTERS. Class. (1) (2) Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 2 Reports of action taken sent to H.M. Inspector 2 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 1938. The total number of inspections decreased during 1938 from 30,780 to 28,927. This decrease is more than explained by the absence of the special housing visits carried out during 1937, in connection with the measurement of premises for the purpose of obtaining the "permitted numbers" required by the Housing Act. In other words, the total number of visits paid by the Sanitary Inspectors and Disinfectors in the course of their normal routine duties has actually increased during the past year. It may be well to point out here that, with the rapid increase in Air Raid Precautions duties, part of which has of necessity fallen upon the sanitary staff, it is doubtful whether it will be possible to make this statement in future years. The total of informal notices served during the year shows a slight increase, while the total of statutory notices served is again exceedingly low. Inspections. 1936. 1937. 1938. Housing inspections and re-inspections 5,323 3,862 3,750 Slaughterhouse visits and inspections 1,086 1,154 825 Factories and workshops (including bakehouses) visits and inspections 772 819 615 Dairies, cowsheds, milkshops and other food shops, visits and inspections 2,977 3,378 2,894 Various complaints, inspections and reinspections 1,476 994 1,139 Dustbins, inspections and re-inspections 2,076 1,901 2,125 Infectious Disease, visits and re-visits 4,080 3,436 4,019 Other inspections (Rent Act—Rats and Mice Destruction Act—Ditches and Ponds—Accumulations—Non-notifiable Diseases, etc.—Drain inspections and tests—Smoke observations) 10,379 15,236 13,560 Total 28,169 30,780 28,927 N.B.—The nett total of visits during 1937, excluding those made for the special purpose referred to above, was 28,327. 49 Service of Notices. 1936. 1937. 1938. Total informal sanitary notices served 1,433 1,568 1,568 Total informal dustbin notices served 357 383 425 Total informal notices served 1,790 1,951 1,993 Total informal notices complied with 1,792 1,755 2,004 Total statutory notices served 9 10 8 Total statutory notices complied with 8 11 8 Total notices carried forward 116 177 166 Sanitary Improvements.—The following is a summary of the sanitary improvements effected, and the defects remedied:— Housing. Premises cleansed 62 Ceiling plaster repaired 386 Ceilings washed and distempered 1,432 Wall plaster repaired 600 Walls redecorated 1,208 Dampness remedied 178 Floors repaired or relaid 122 Ventilation under floors improved 52 New air gratings fixed 74 Roofs repaired 283 Eaves gutters repaired or renewed 121 Rainwater pipes repaired or renewed 88 Yards repaired or repaved 78 Window frames repaired or renewed 156 Sash-cords provided 410 Doors and frames repaired or renewed 63 Brickwork repointed or repaired 188 Cooking ranges repaired or renewed 56 Firegrates repaired or renewed 42 New sinks provided 79 Waste pipes repaired or renewed 66 Internal steps and staircases repaired 17 Food stores repaired 15 Internal woodwork repaired 93 Lighting and ventilation improved 4 Water supply—Draw taps fixed on main service 9 Water storage cisterns cleansed or renewed 13 New taps provided 28 Defective pipes repaired 36 Washing coppers repaired or renewed 19 Coal sheds repaired 15 Drainage. Inspection chambers repaired 46 New inspection chambers provided 43 Drains examined and tested 415 Drains repaired 90 New drains laid 62 Drains unstopped or trapped 267 New gullies provided 84 Gully grates provided 64 Choked gullies cleansed 157 Vent shafts and soil pipes repaired or renewed 52 F.A.I.'s repaired or renewed 60 Sanitary Accommodation. W.C. pans renewed 52 W.C. seats repaired or renewed 73 New flushing cisterns provided 39 W.C. cisterns repaired 57 W.C. flush pipes repaired or renewed 51 W.C. cone joints repaired or renewed 78 W.C. structures repaired 37 New W.C.'s provided 7 Refuse Receptacles. Dustbins renewed (by owners) 467 Dustbins renewed (by Council—in default) — Cowsheds and Dairies. Cowsheds cleansed and limewashed 4 Dairies cleansed and limewashed 15 Dairies improved 1 Slaughterhouses. Cleansed and limewashed 10 Structure repaired 1 51 Bakehouses. Cleansed and limewashed 18 W.C.'s repaired 2 W.C.'s cleansed and limewashed 6 Notices posted 2 Factories and Workshops. Walls cleansed and limewashed 42 Ceilings cleansed and limewashed 43 Roofs repaired 4 Floors repaired 2 W.C. pans provided 1 W.C. cisterns repaired or renewed 2 W.C. cone joints repaired or renewed 2 W.C.'s cleansed and limewashed 58 Notices posted 6 Shops. Walls cleansed 19 Floors cleansed 12 Accumulations removed 45 Yards repaired, paved or drained 3 W.C.'s cleansed 47 W.C.'s repaired or renewed 18 New W.C.'s provided 1 Notices posted 146 Miscellaneous. Cesspools emptied and cleansed 17 Accumulations of refuse and manure removed 69 Foul ditches, ponds and stagnant water abated — Moveable dwellings (vans and tents) removed 6 Smoke nuisances abated 7 Nuisances from animals abated 8 House-to-House Inspection.—The number of houses inspected under the Housing Schedules during 1938 is practically the same as the total for the previous year. No amendment was necessary in respect of existing schedules. 52 Seven hundred and one houses were inspected and recorded under the Housing Acts, as follows:— No. of houses Scheduled. No. 1937 Inspected. 1938. District No. 1. Annual List 65 65 65 Biennial List 26 12 14 Quinquennial List 637 128 127 District No. 2. Annual List 190 190 190 Biennial List 103 56 47 Quinquennial List 599 114 133 District No. 3. Annual List 86 86 86 Biennial List 26 — 26 Quinquennial List 268 105 13 Total 2,000 696 701 Non-Scheduled Houses.—In addition to the above, 867 non-scheduled houses were inspected for housing defects and insanitary conditions, mostly upon complaint of the occupiers, as follows:— 1937. 1938. North-East Ward 138 150 North-West Ward 114 128 Middle Ward 182 147 South Ward 451 442 Total 885 867 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, 519 premises were visited in this connection, 222 verbal notices and 166 preliminary notices being served. These special inspections alone resulted in the provision of 408 new bins, which included a number of bins supplied following notices served during 1937. 53 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 46 Cowsheds 2 Bakehouses 20 Dining Rooms 52 Slaughterhouses 4 Fish Shops 28 Factories and Workshops 197 Public House Conveniences 24 Grocers 133 Greengrocers 57 Butchers 54 Confectioners 31 Total 648 (1937—619) ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. As a result of the adoption of portions of the Middlesex County Council Act, 1934, it is now necessary for the proprietors of certain establishments for Massage or Special Treatment within the Borough to obtain licences from the Council. Two new licences were granted and nine licences renewed. Eight exemptions under the Act were granted to members of the Chartered Society of Massage and Medical Gymnastics, and three to medical practitioners. HOUSING. From the figures relating to overcrowding, it will be noted that the position has been improved by the abatement of 12 cases. As I have remarked before, we should not be satisfied until overcrowding has been abolished in its entirety. When, however, the position in Southgate is set against that in many other districts, it would appear that we have almost reached our irreducible minimum. We are, nevertheless, still taking steps to abate every case of overcrowding which comes to our notice. We realise, of 54 course, that cases exist which do not come to our notice, and which might never be brought to light unless reported direct to the Department. For that reason we welcome any information on this important subject, and would ask for the cordial co-operation of the burgesses, realising that without this co-operation we cannot fight the menace with completely adequate weapons. Number of New Houses Erected during the Year 1938:— (a) Total (including numbers given separately under (&)) 571 (b) With State assistance under the Housing Acts:— (i) By the Local Authority 36 (ii) By other bodies or persons Nil 1. Inspection of Dwelling-houses during the year:— 1937. 1938. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,581 1,568 (b) Number of inspections made for the purpose 1,680 1,693 (2) (a) Number of Dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 696 701 (b) Number of inspections made for the purpose 795 787 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil Nil (4) Number of Dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,465 1,412 55 (5) Number of Dwelling-houses closed tarily by owners 16 6 (6) Number of Dwelling-houses demolished voluntarily by owners 22 6 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 1,283 1,286 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 10 8 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 11 8 (b) By owners, after legal proceedings 2 Nil (c) By local authority in default of owners Nil Nil 56 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 20 (2) Number of families dwelling therein 20 (3) Number of persons dwelling therein 156 (b) Number of new cases of overcrowding reported during the year Nil (c) (1) Number of cases of overcrowding relieved during the year 12 (2) Number of persons concerned in such cases 70½ (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil 57 Rent Restrictions Acts.—No applications for certificates under these Acts were received during the year. 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. 58 Prevalence of and Control over Infectious and Other Diseases. From Table V, on page 80, it will be seen that 256 cases of infectious disease were notified during the year, as against 217 in 1937 and 199 in 1936. These 256 cases represent infection in 238 houses. The Infectious Sickness Rate for the district was 3.8, as against 3.3 during 1937 and 3.1 during 1936. It will be observed that the lower infectious sickness rate which Southgate has recently been enjoying continued during 1938; indeed, this is the first instance which I can find of the infectious sickness rate having remained below the level of 4 per 1.000 for three years in succession. At one time it appeared as though the rate would show a very marked rise, the notifications during the first six months being very greatly in excess of those for the same period of 1937. During the second moiety of the year, however, the notification rate fell and, had it not been for the occurrence of a localised diphtheria outbreak in New Southgate, it is probable that the total of the year would actually have been less than that of its predecessor. While this is a happy position in many respects, I feel that I must again voice a warning. In spite of excellent housing conditions, satisfactory physique in the younger element of the population, and the progressive attention paid both to physical fitness and immunisation, no urbanised community such as Southgate can hope to remain free from major epidemic visitations over an indefinite period. Unfortunately, epidemiology has not placed any weapons in our hands other than those already enumerated. Fortunately, they are usually sufficient to prevent, if not an attack, at least the most serious effects of infectious disease . In point of fact, this is illustrated both in our death rates and in our complication rates. Each of these is low, and has remained low for a considerable number of years. Thus is emphasized the ancient axiom that any cause must be judged by the ultimate effect produced. So long as it appears safe to assume that the condition of the district and the population residing therein will result in the effects of infectious disease being merely temporary and slight, so long will the position continue to be satisfactory. When, if ever, the time arrives that the resistance of the population is so denuded as not only to render attack easy, but also to magnify the 59 evil results of such attack, then and only then can we consider the position serious. Our aim must therefore be to maintain the standard in Southgate at such a level as to postpone indefinitely the possibility of retrogression. The ward distribution of the cases of infectious disease notified during the year was as follows: 1937. 1938. South Ward 60 80 Middle Ward 57 74 North-West Ward 42 43 North-East Ward 58 59 The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 207 premises. During such inspections, 31 houses were found to contain sanitary defects, consisting chiefly, as previously, of defective water-closets, dampness and want of cleansing. These defects have all been remedied. No case of overcrowding was met with in any of the houses inspected in connection with cases of infectious disease. Of the 256 cases of notifiable infectious disease reported during the year, only 28 occurred in Council property. These were as follows:— Scarlet fever 23 Erysipelas 1 Ophthalmia neonatorum 1 Pneumonia 1 Tuberculosis 2 Only one case was reported from the Church Army Housing Estate at Barrow Close. This was a case of erysipelas in an adult. One hundred and sixty-four cases were removed to the Isolation Hospital at Tottenhall Road. Of these, 66 were admitted suffering from scarlet fever, 27 from diphtheria (including 1 case transferred from another hospital and notified elsewhere), 2 from scarlet fever and measles, 2 from scarlet fever and chicken-pox, 7 from erysipelas, 2 from typhoid fever, 4 from puerperal pyrexia, 12 from measles, 6 from measles and pneumonia, 2 from measles and (?) mastoid, 1 from measles and whooping cough, 2 from measles and appendicitis, 4 from pneumonia, 1 from whooping cough, 1 from whooping cough and pneumonia, and 1 from chicken-pox. Six observation cases, 3 babies with mothers, and 15 diphtheria "carriers" were also admitted. 60 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. Smallpox.—No cases of smallpox occurred in the district during 1938. Vaccination.—No primary vaccinations or re-vaccinations under the Public Health (Smallpox Prevention) Regulations, 1917, were required during 1938. Scarlet Fever.—Ninety-five cases of scarlet fever were notified during the year, as against 61 in 1937. The ward distribution was as follows:— 1937. 1938. South Ward 20 18 Middle Ward 15 27 North-West Ward 12 24 North-East Ward 14 26 Sixty-six cases were removed to the Isolation Hospital, representing 69.4 per cent. of the total number of cases notified. Twelve "secondary" cases occurred in houses from which previous cases had been notified. In each instance the primary case had been removed to hospital. One ''return'' case was notified. Two of the cases occurring during the year were "imported." The confusion regarding the notification of this disease, still anachronistically known as "scarlet fever," persists. There now does not appear to be the slightest doubt that many cases occur which have all the symptoms except a rash. These cases are highly infectious, and are a potent means of spreading the disease from person to person. Equally, many other cases present none of the symptoms of scarlet fever except the appearance of a more or less typical scarlatiniform eruption. These cases, which in many instances are never infectious, are usually notified, and find their way into an Isolation Hospital. While there, they may easily pick up a variety of streptococci, which are then harboured in their throats and noses for an indeterminate period. Thus, the end result is that such non-infectious cases are converted into potential "carriers." One can easily see how ludicrous the position becomes. Very fortunately, the type of scarlet fever met with in Southgate during the past few years has been exceptionally mild. 61 Complications have been few, while the death rate is nil. The anomalies outlined above therefore assume merely academic importance for the time being, while one additional satisfaction is apparent. The older, more virulent type of scarlet fever presented no difficulties in diagnosis, but it did produce results which were far-reaching and tragic in their effects. So long, therefore, as we are spared further visitation from this dangerous type of infection, it would appear that, in spite of regrettable confusion, we may have much upon which to congratulate ourselves. One other fact calls for attention. It will be noted above that 12 "secondary" cases occurred in houses from which a primary case of scarlet fever had been removed to hospital, and that no "secondary" cases manifested themselves when the original patient remained at home. This apparently trivial observation is yet exceedingly important. It abundantly illustrates the fact that removal to an Isolation Hospital does not in any way modify the course of infectious disease in a district. Thus, the original use of an Isolation Hospital may be said to have entirely disappeared. Indeed, the term itself is shown to be obsolete. This fact should be much more fully realised, but, unfortunately, the general public is not always able to keep fully abreast with scientific advance. Until that is the case, the Isolation Hospital will be called upon to perform services which it never has been able to render, while it will be saddled with the blame for occurrences which it is entirely powerless to prevent. 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 1937 36 Number of persons visited after 1 year 32 (4 removed from district.) Number of persons remaining perfectly well throughout the year 29 (3 patients (2 adults and 1 child) complained of rheumatism, which had been present during their treatment in hospital.) 62 Total number of persons discharged during 1938 58 Persons in whom no abnormalities attributable to the original attack were discovered after 14 days 44 Patients developing rhinitis 6 ,, ,, mild rheumatism 1 ,, not examined (removed) 5 In all cases exhibiting abnormalities, complete recovery was made after a short period. From the inception of the scheme to December, 1938, 209 patients have been discharged from the Isolation Hospital at the end of 3 weeks, with only one "return" case. Diphtheria.— Twenty-six cases of diphtheria were notified during 1938, as against 9 during 1937. Four of these cases were "secondary," while one was "imported." The ward distribution was as follows:— 1937. 1938 South Ward 1 22 Middle Ward 1 2 North-West Ward 5 — North-East Ward 2 2 As will be seen, the vast majority of cases occurred in the South Ward. Most notifications were received from the New Southgate area, mainly among children attending Garfield Road School. The first case occurred towards the end of June, notifications continuing, with intermissions, until December. While the total number of cases was definitely small, considerable difficulty was experienced in controlling the sporadic incidence. This was due almost entirely to the fact that Garfield Road, the school principally affected, accepts children from the Friern Barnet and East Barnet districts in addition to Southgate. Thus, the examination and swabbing of contacts was rendered somewhat difficult. The second feature of the epidemic was the extraordinary ''carrier'' rate uncovered. Following the notification of 21 cases from the New Southgate area, 285 swabs were taken from contacts, no less than 13 "carriers" being discovered. This "carrier" rate is much 63 higher than one would normally anticipate, and must have exerted a considerable eSect in prolonging the outbreak. The only satisfactory element associated with the outbreak was the number of children sent for immunisation. During the months of August and September, 145 immunisations were carried out in children from the New Southgate area, this total being implemented by various additions during the later months of the year. The type of cases occurring was very definitely severe. Quite a number of the patients were severely ill, and one death occurred. Two children who contracted diphtheria during the outbreak had previously been immunised, although in one instance a post-Schick examination had not been made, owing to the fact that the parents had not brought the child for the necessary test. In each of the two cases referred to above the attack was mild, the children recovering without complications. As hitherto, swabs were taken from all home contacts and from all cases fourteen days after their discharge from hospital. Diphtheria Antitoxin is kept in stock at the Public Health Department for issue to medical practitioners on application. Immunisation.—Four hundred and ninety-one persons attended for immunisation during 1938 at the weekly clinic held in Broomfield House or at the schools visited during the year, as compared with a total of 490 for the previous year. The schools selected during the past year were Chase Road C. of E. and Tottenhall Road, 17 and 148 children attending at each school respectively. Mention has already been made of the two children who developed diphtheria after immunisation. In addition to those cases, one other child falls into the same category. Here, again, the attack was exceedingly mild, complete recovery being effected without complications. It is sincerely to be hoped that the occurrence of these few cases of diphtheria in immunised children will not prejudice the public against this form of protection. It has never been claimed that one hundred per cent, success can be obtained. What has been claimed, and what we know to be absolutely true, is that the vast majority of children inoculated will not develop diphtheria, while among the remainder (approximately 5 per cent, on the average) the attack will almost invariably be mild and harmless in its after-effects. These claims, in the opinion of those most qualified to judge, are so overwhelming as to require no further justification. 64 The following tables set out the work performed during the year:— Results of Schick Tests. 1-5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total. Negatives — 7 5 14 26 5.29% Positives:— Mild - 53 8 4 65 13.24% Moderate — 87 22 7 116 23.63% Marked — 29 3 1 33 6.72% Nil 169 33 12 214 Not tested . 251 — — — 251 51.12% Total for year 491 Completed Cases (to 31.12.38 from commencement of scheme) 1,677 Number of persons who have attended for immunisation since commencement of scheme (including Schick negatives, uncompleted cases and defaulters) 2,778 Results of Schick Test after Three Months (1938). Negatives 358 Positives 22 380 Further Results of the 22 "Positives"— After 4th injection:— Negatives 22 Positives — Number of Cases failing to complete Immunisation (1938) 43 Before three injections 17 After three injections 26 Total number of visits paid to schools and Clinic for purposes of immunisation (1938) 2,435 Total number of visits paid to schools and Clinic for purposes of immunisation since inception of scheme 12,874 65 Number of cases to be completed in 1939 273 Reactions after Injections (1938). 1-5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total. Mild 3 1 — - 4 Moderate — — - 1 1 Severe — — — 3 3 3 1 — 4 8 The material used as diphtheria prophylactic is toxoid-antitoxin mixture (T.A.M.). Typhoid Fever (including Paratyphoid).—Two cases of typhoid fever were notified during the year, as against 3 cases of paratyphoid B fever during 1937. In each case the source of infection appeared to be connected with a localised Metropolitan outbreak which occurred towards the latter part of the year. Puerperal Fever and Puerperal Pyrexia.—Nine cases of puerperal pyrexia were notified during the year, this being the same number of cases as occurred during 1937. It will be remembered that the term "Puerperal Pyrexia" now includes "any febrile condition occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4° F. or more has been sustained during a period of 24 hours or has recurred during that period." Five of the cases notified occurred in nursing homes in the district, the remaining four occurring in the patients' own homes. Four of the patients were removed to the Isolation Hospital, while two were admitted to the Queen Charlotte's Isolation Block, Hammersmith, and one to the Mildmay Hospital. One death occurred. The services of Mr. Read, the Council's consulting gynaecologist, were requisitioned on two occasions during the year, while Mr. Hudson, of the North Middlesex County Hospital, was called in consultation on one occasion. 66 Erysipelas.—Twenty-four cases of erysipelas were notified during the year, the same number having been notified during 1937. No deaths occurred. Seven cases were removed to the Isolation Hospital. The type of case met with was mild on the whole, and recovery, so far as the cases admitted to the Isolation Hospital were concerned, rapid. From personal experience of the type of case treated in the Isolation Hospital over the past few years, it would appear that the virulence of erysipelas has recently been lowered. This may be only a passing phase in the disease, and for that reason it is still necessary to treat the infection as a matter of urgency. Pneumonia.—Thirty-seven cases of pneumonia were notified during 1938, as against 53 during the previous year. The age groups of these cases are interesting, and were as follows: Under 5 years 7 5 to 10 years 6 10 to 15 years 2 15 to 20 ,, 1 20 to 35 „ 5 35 to 45 ,, 5 45 to 65 ,, 9 Over 65 ,, 2 The fall in the pneumonia notifications is welcome, although the total still stands at a high level. The remark which I made concerning this disease in my Annual Report for last year still stands, and I cannot find any evidence of marked improvement in remedial technique during the past twelve months, apart from the more general use of a bacteriostatic drug (M. & B. 693) for which outstanding results have been claimed. Until additional facilities are available at the Isolation Hospital it would be almost im. possible to introduce locally the scientific technique of serum typing, etc., which, in my opinion, should be an integral part of any scheme for the prevention and control of infectious diseases. Pneumonia is still essentially a disease in which, apart from general methods of control, the curative aspect receives much more attention than does its preventive counterpart. So long as the advice tendered by the medical profession, either the family doctor or the local health official, falls upon heedless ears, so long will pneumonia take its toll among all ages of the population. We must, therefore, accept this fact, and provide the most adequate treatment at our disposal. 67 Tuberculosis.—Fifty cases of pulmonary and seven cases of non-pulmonary tuberculosis were notified during the year under the Public Health (Tuberculosis) Regulations, 1912, the corresponding figures for 1937 being, pulmonary cases, 44; non-pulmonary cases, 8. In addition to these notified cases, 28 patients were entered in the register (24 pulmonary, 4 non-pulmonary), these cases being new residents in the district, previously notified elsewhere. Twenty-four deaths occurred, 22 from pulmonary and 2 from non-pulmonary tuberculosis. Three of these cases had not previously been notified, a ratio of 13.6 per cent., as against 17.8 per cent, in 1937. The age groups of the cases notified were as follows: 1 to 5 years 2 5 to 15 years 2 15 to 20 years 5 20 to 35 ,, 32 35 to 45 ,, 2 45 years and over 14 It will once again be observed that the age group 21-35 exhibits the highest notification rate, a fact which reappears with tragic regularity year after year. Public Health (Prevention of Tuberculosis) Regulations, 1925; Public Health Act, 1925, Section 62. (Compulsory removal to hospital of persons suffering from pulmonary tuberculosis). It was not necessary to take any action during the year in connection with the above. Laboratory Facilities.—See page 21. 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 final total shows very little variation from that of 1937. As was anticipated, the incidence of measles showed a marked increase, although not to the level of the preceding epidemic period. Whooping cough was less prevalent than has been the case for the past five years. With regard to the issue of Immune Globulin as a prophylactic measure against measles, mention of which was made in last year's Annual Report, 79 vials were issued through medical practitioners, 15 free of charge. The reports received from the various 68 titioners were generally satisfactory, but the totals involved are much too meagre to permit of any definite conclusions being reached. The following list sets out the information received from the schools regarding cases of non-notifiable infectious disease during the year: 1936. 1937. 1938. Measles 511 3 363 Whooping Cough 70 167 51 Mumps 116 143 60 Ringworm 1 2 — Influenza 9 26 6 Pneumonia 1 - - Bronchitis 5 — - Chickenpox 251 175 43 German Measles 3 6 17 Total.. 967 522 540 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 .. .. 414 Number of school classrooms (Private, Elementary and Secondary) fumigated 141 Number of articles disinfected by steam 2,536 Number of articles destroyed . . 21 (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 110 Number of articles disinfected by steam 871 Number of articles destroyed 393 69 (b) Disinfection of rooms and bedding, on request, after cases of Non-Notifiable Disease (charge 5s.):— Number of rooms fumigated 23 Number of articles disinfected by steam.177 Amount received in respect thereof .. £6 10s. (3) Disinfestation:— Eradication of Bed Bugs:— (i) Number of premises found to be infested : (a) Council Houses 18 (b) Church Army Housing Estat 28 (c) Other Houses 184 All these premises were disinfested. Total number of rooms disinfested.. 438 Total number of articles disinfested 201 ,, ,, ,, destroyed 2 (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 1938); any Council house found to be infested after vacation by an outgoing tenant disinfested by the Public Health Department before being re-occupied. (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. 70 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, 327 books were so disinfected. The school and other books found in homes where cases of notifiable or non-notifiable infectious diseases have occurred are disinfected, together with individual school books from classrooms from which a case of infectious disease has been notified. ISOLATION HOSPITAL. The number of patients treated in hospital during 1938 was 562, as against 505 during 1937 and 565 in 1936. (This number comprises all patients admitted during the year, together with those in hospital on 1st January, 1938.) It will be seen that the number of admissions shows a slight increase, in spite of the fall in the scarlet fever case rate. The number of diphtheria patients admitted was again high, being actually 63 in excess of the scarlet fever admissions. The type of disease treated was definitely severe so far as diphtheria was concerned, but somewhat milder in the case of the remaining infections. The following table sets out the number of patients admitted to the hospital during 1938, and the areas from which those patients were admitted: 1938. (1937.) Southgate 164 (105) Tottenham 339 (349) Middlesex County Council 2 (2) Edmonton 1 (-) 506 (456) The diseases for which the 506 patients were admitted during 1938 were as follows: Scarlet fever 120 Diphtheria 183—Faucial 154 Nasal 10 Nasal and faucial 12 Laryngeal 5 Laryngeal and faucial 2 Diphtheria ' 'carrier'' 22 7 1 Diphtheria ''carrier'' and Whooping Cough 1 Diphtheria and Scarlet Fever 4 Diphtheria and Measles 3 Diphtheria and Impetigo 1 Scarlet Fever and Burns 2 Scarlet Fever and Bronchitis 1 Scarlet Fever and Chicken Pox 5 Scarlet Fever, Nephritis and Pneumonia 1 Scarlet Fever and Measles 3 Measles 21 Measles and Broncho-Pneumonia 29 Measles and Bronchitis 19 Measles and Acute Mastoid 1 Measles and Whooping Cough 2 Measles and Encephalitis 1 Measles and Diphtheria "carrier" 1 Measles and Appendicitis 2 Measles, Pneumonia and Chicken Pox 1 Measles and Mastoiditis 1 Erysipelas 15 Erysipelas and Diabetes 1 Erysipelas and Furunculosis 1 Dysentery 1 Typhoid Fever 2 Enteritis 1 Septicaemia 1 Septic Rash 1 Urticaria 1 Erythema 2 Eczema 1 Tonsillitis 19 Tonsillitis and Diphtheria "carrier" 1 Broncho-Pneumonia 2 Pneumonia 4 Whooping Cough and Pneumonia 5 Whooping Cough and Bronchitis 1 Baby with Mother 5 Mother with Baby. 1 Puerperal Pyrexia 6 Ophthalmia Neonatorum 1 Meningismus 1 Sinusitis 1 Simple Croup 1 Gastric Influenza 1 Vincents Angina 2 Chicken Pox 4 506 72 Staff— Diphtheria ''carrier'' 1 Tonsillitis 1 Alterations in Diagnosis.—The following table sets out full details regarding the alterations in diagnosis necessitated during the year. As remarked in last year's Annual Report, extreme vigilance must be exercised in this respect, as errors in diagnosis all too frequently lead to immediate danger of cross-infection in the wards. Diphtheria to Tonsillitis 14 Diphtheria to Septicaemia 1 Diphtheria to Diphtheria "carrier" 3 Diphtheria to Diphtheria "carrier" and Whooping Cough Diphtheria and Impetigo 1 Diphtheria to Diphtheria and Measles 2 Diphtheria to Tonsillitis and Diphtheria ''carrier'' 1 Diphtheria to Vincents Angina. 2 Laryngeal Diphtheria to Simple Croup 1 Diphtheria to Eczema 1 Diphtheria and Measles to Diphtheria ' 'carrier'' and Measles 1 Diphtheria to Diphtheria and Scarlet Fever 1 Diphtheria to Scarlet Fever 1 Scarlet Fever to Septic Rash 1 Scarlet Fever to Non-infectious Rash 1 Scarlet Fever to Urticaria 2 Scarlet Fever to Erythema 2 Scarlet Fever to Scarlet Fever and Chicken- pox 3 Scarlet Fever to Scarlet Fever, Acute Nephritis and Pneumonia 1 Scarlet Fever to Infantile Scurvy 2 Scarlet Fever to Scarlet Fever and Measles 2 Scarlet Fever to Measles 1 Measles to Measles and Whooping Cough 1 Measles to Diphtheria and Scarlet Fever 1 Typhoid Fever to Simple Enteritis 1 Typhoid Fever to Gastric Influenza 1 Erysipelas to Sinusitis 1 Cerebro-Spinal Meningitis to Meningismus 1 51 73 Number of Patients in Isolation Hospital on any one day during each Month:— Greatest Number. Lowest Number. January 61 48 February 52 45 March 57 49 April 62 46 May 52 42 June 55 45 July 57 39 August 50 39 September 41 35 October 44 32 November 64 45 December 66 51 Complications.—The complications met with during 1938 were as follows: Scarlet Fever.—(Total of 137 cases treated during the year.) Left Otorrhoea 1 Right Otorrhoea 1 Late Adenitis 2 Rheumatism 1 The complication rate for scarlet fever during 1938 was 3.6 per cent., as against 5.6 per cent. during 1937 and 4.2 per cent. during 1936. This is actually the lowest complication rate for scarlet fever yet recorded at the hospital. Undoubtedly, the milder type of infection now being encountered had a very great deal to do with determining the scarcity of complications, while the absence of any overcrowding in the wards, due to the small number of cases admitted, must also have played a part. In addition, the more potent methods of treatment now available probably exercised an ancillary beneficial effect. Diphtheria.—Apart from the 3 fatal cases met with during the year, 14 complications occurred among the remaining 216 cases of diphtheria receiving treatment. This gives a complication rate of 6.4 per cent., as against 6.6 per cent, during 1937 and 9.17 per cent during 1936. The complications met with were as follows: 74 Mild Endocarditis 1 Endocarditis 1 Right Otorrhoea 1 Double Otorrhoea 1 Ocular Paralysis 2 Palatal Paralysis 4 Complete Hemiplegia 1 Late Adenitis 2 Acute Nephritis 1 This complication rate (6.4 per cent.) is the lowest yet recorded at the hospital, and is particularly pleasing in view of the definitely severe type of infection admitted throughout the year. Twelve complications occurred among the remaining cases admitted to the hospital during 1938. Deaths.—Eleven deaths took place during the year, this number being the same as that recorded during 1937. These deaths occurred from the following diseases: Diphtheria 3 Diphtheria and Scarlet Fever 1 Scarlet Fever, Acute Nephritis and Pneumonia 1 Broncho-Pneumonia 1 Broncho-Pneumonia and Measles 3 Puerperal Sepsis 1 Septicaemia 1 The death rate from diphtheria was 1.8 per cent., as against 3.2 per cent. the previous year. This rate is by far the lowest which I can find recorded at the hospital, being approximately less than half the average rate for the past 10 years. As compared with 1937, the death rate from pulmonary infections shows a definite and welcome decline. General Treatment.—No major alterations have been made in the general method of treatment carried out in the! hospital during the past year. The very low death rate from diphtheria, while by no means conclusive in itself, at least indicates that the method of approach, so far as this disease is concerned, is proving satisfactory. I am personally convinced that the higher dose of antitoxin which has been administered during the past few years, allied to the use of the sulphanilamide group of chemo-therapeutic drugs, redoxin, adrenalin and anti-scarlet serum, have had their 75 effect, not only in keeping down the death rate, but in reducing to a reasonable minimum the far-reaching complications so common in diphtheria. This principle is supported by the fact that the type of diphtheria case admitted within recent years to the hospital has been definitely severe, and that normally one would have expected a higher death rate and a very much larger number of severe complications. The part which the nursing services play in this satisfactory result cannot be estimated, but it is without doubt extremely significant. The use of the oxygen tent has probably had an effect in reducing, the pulmonary death rate. Unfortunately, a percentage of pulmonary cases, mostly complicating an original measles or whooping cough infection, are still being admitted in such a condition as to render the effects of treatment highly problematical. Until the general public can be persuaded to call in the services of a medical attendant at a sufficiently early stage in these diseases, similar tragedies will still occur. Our aim, so far as the hospital is concerned, should therefore be to provide such treatment as can reasonably be expected to save those lives which are not already virtually lost. Very fortunately, the vast majority of the cases admitted fall into this category, while educational measures will almost certainly continue to increase their number. Operations.—The following operations were performed during the year: Appendicectomy (Measles) 2 Mastoidectomy (Measles) 1 Tracheotomy (Diphtheria) 1 Tonsillectomy (Diphtheria "Carriers") 5 Exploration of Uterus (Puerperal Pyrexia) 1 10 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. Dr. Macdonald, Consulting Surgeon to the Hospital, performed all the operations, with the exception of that of exploration of uterus, which was performed by Mr. Chas. Read, Consulting Gynaecologist. Dr. Macdonald also paid 97 consultative visits, and once again I should like to thank him most sincerely for his valuable services. 76 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.—21.1 days (longest, 44 days; shortest, 10 days). Average duration, 1937—23.1 days. Diphtheria.—57.0 days (longest, 146 days; shortest, 2 days— died). Average duration. 1937—68.5 days. It will be seen that the average detention in the case of scarlet fever decreased slightly, from 23.1 days to 21.1 days. In the case of diphtheria the decrease was more marked, from 68.5 days to 57.0 days. This latter decrease is satisfactory, and it might be noted that the period could very possibly have been reduced still further in the light of recent improvement in technique. In my opinion, however, this could not have been done without jeopardising the ultimate safety of the patients concerned. The tragedy of the child who dies from diphtheria after several weeks' illness is much too poignant to permit of any latitude being taken. So long as an extra week or more in bed can reduce the possibility of serious after-effects or even of a fatal issue, it seems only logical to continue the procedure which has proved efficacious in the past. Staff.—(a) Illness.—The following illnesses occurred among the Stafi during 1938: Diphtheria "Carrier" (Nurse) 1 Tonsillitis (Nurse) 1 2 I cannot find records of any year during which only two members of the staff were warded for reasons of illness. It would therefore appear that the health of the staff is, at the moment, very satisfactory . (b) Immunisation.—Members of the staff are still being inoculated against diphtheria and typhoid infection. I have not yet instituted immunisation against scarlet fever, as the position has not altered from that set out in my Annual Report for 1937. 77 (c) Lectures.—Probationer Nurses continue to receive lectures from the Matron, Mr. Hill and myself. There is evidence that the standard of reception is showing a definite improvement. It is hoped that this will manifest itself in more satisfactory examination results. Cross-Infection.—Eleven 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. This outbreak continued from the latter part of 1937, the original patient having been admitted during that year. Short of complete isolation of all cases admitted to the Hospital in cubicle wards, there is no known method of preventing the entry of this disease into an open ward. Fortunately, as in our own particular instance, the end result is seldom more than inconvenience. So far as it was possible to ascertain, no patients suffered any ill-effects from the chicken-pox infection, and we were able to discharge all the children affected in a healthy condition. In many instances it was not even necessary to prolong their normal stay in hospital. During the summer months, when Sonne type dysentery was so prevalent in London, six cases occurred in two wards of the hospital. Complete investigation into the possibility of a ''carrier" existing among the staff, and also into the purity of the food supplies, including milk and water, failed to uncover the original source of infection. All the patients concerned were properly isolated, no further cases occurring after the initial outbreak. In every case, the patients were discharged without visible, permanent ill-effects. 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 137 cases treated in hospital during the year. This gives a Return Case Rate of 0.73 per cent., as against 0.56 per cent. during 1937. Transfers to and from other Hospitals.—The following transfers occurred during the year: From the Prince of Wales's Hospital 36 cases ,, North Middlesex County Hospital 6 ,, ,, Enfield and Edmonton Isolation Hospital 1 case ,, Grovel ands Hospital of Recovery 4 cases ,, Hornsey, Finchley and Wood Green Isolation Hospital 1 case 78 To the North Middlesex County Hospital 2 cases ,, Hornsey, Finchley and Wood Green Isolation Hospital 2 ,, ,, Royal Northern Hospital 1 case Visiting.—The arrangements for visiting patients remain unaltered and still appear satisfactory. Laboratory.—Details of the Laboratory work carried out in connection with the hospital will be found on page 21. Miscellaneous.—(1) The oldest patient treated in the hospital during the year was a male, aged 76 years, suffering from erysipelas; the youngest was a baby aged 9 days suffering from ophthalmia neonatorum. (2) One patient from Southgate was admitted by error to the Enfield and Edmonton Joint Hospital, and another to Coppett's Road Isolation Hospital. As soon as the errors were discovered, the patients were transferred to our own hospital. Two Wood Green patients were similarly admitted in error to our hospital, being transferred to Coppett's Road Isolation Hospital as soon as the error became apparent. (3) I should like to take this opportunity of thanking Miss Marian T. Durward and all the membeis of the hospital staff for the excellent work which they carried out during the entire year. As already remarked, it is difficult to estimate the effects of the actual nursing upon the patients. We can nevertheless state with every assurance that this nursing plays an integral part in the patients' well-being, and that the reputation of any hospital will always be indissolubly bound up with the standard of the nursing supplied. We are fortunate in Southgate, and it is for this reason that I should like to bring the quality of the nursing services before the Council. 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. 79 80 Diseases. At all ages Under 1 year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Deaths. Table V. Notified Cases of Infectious Diseases, 1938. Smallpox Diphtheria 26 1 1 15 5 2 2 1 Scarlet Fever 95 1 4 4 6 40 15 8 8 6 3 Typhoid Fever 2 1 1 1 Dysentery 3 1 1 1 Puerperal Pyrexia 9 6 3 1 Erysipelas 24 1 2 3 12 6 Ophthalmia Neonatorum 2 2 Encephalitis Lethargica Acute Poliomyelitis 1 1 Cerebro-spinal Meningitis Malaria Pneumonia 37 3 2 2 6 2 1 5 5 9 2 32 Tuberculosis— Pulmonary 50 1 1 1 5 28 2 11 1 22 Non-Pulmonary 7 1 4 1 1 2 Totals 256 5 4 7 5 7 64 22 14 58 22 38 10 59 81 Ophthalmia Neonatorum, 1938. TABLE VII. 2 Notified. Cases. 2 At Home. Treated. Nil In Hospital. 2 Vision Unimpaired. Nil Vision Impaired. Nil Total Blindness. Nil Deaths. Table VI. Cases of Infectious Disease Notified each Month of the Year, 1938. Notifiable Diseases. Smallpox. 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 .. .. .. 3 .. 1 .. .. .. .. 6 3 3 24 February .. 12 .. .. .. 2 1 .. .. .. .. .. 7 6 .. 27 March .. 17 1 .. .. 1 1 .. .. .. .. .. 8 7 .. 36 April .. 15 .. .. 3 1 3 .. .. .. .. .. 5 5 .. 32 May .. 13 3 .. .. 3 .. .. .. .. .. .. 3 1 23 June .. 13 .. .. .. 5 .. .. .. .. .. .. 1 4 1 24 July .. 6 4 .. .. 2 .. .. .. .. .. .. .. 8 1 21 August .. .. 4 .. .. 4 .. .. .. .. .. .. 2 1 .. 11 September .. 6 3 .. .. .. .. .. .. .. .. 1 • • 6 .. 16 October .. 2 2 1 .. .. 1 .. .. .. .. .. 2 2 1 11 november .. 1 2 l .. 1 2 .. .. .. .. .. 2 4 .. 13 December .. 2 7 .. .. 2 1 .. .. .. .. .. 1 5 .. 18 Totals •• 95 26 2 3 24 9 1 .. .. .. 2 37 50 7 256 TABLE VIII. Tuberculosis, 1938. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 yr. - - - - - - - - 1-5 years 2 — 1 — 1 — — 1 5-10 „ — 2 1 — — — 1 — 10-15 ,, - - - - - - - - 15-20 ,, 4 2 — 1 — — — — 20-25 ,, 10 8 3 — 2 1 — — 25-35 ,, 14 13 — 3 6 2 — — 35-45 ,, 4 — — — 1 3 — — 45-55 ,, 8 1 — — — 1 — — 55-65 ,, 2 2 1 — 2 — — — 65 and over 1 1 — 1 2 1 — — Totals 45 29 6 5 14 8 1 1 REGISTER OF CASES. Pulmonary. NonPulmonary. Total. M. F. M. F. Cases on Register, 1/1/38 124 86 23 26 259 Cases notified for first time, 1938 28 22 4 3 57 Cases restored to Register 3 2 — — 5 Other Cases added 14 5 2 2 23 Cases removed from Register 37 20 2 3 62 Remaining on Register, 31/12/38 132 95 27 28 282 *These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the District. 82 APPENDIX. I. Health Publicity. The most noteworthy feature of health publicity during 1938 was the inauguration of the film shows in October, made possible by the purchase of an up-to-date Bell and Howell sound film projector. During the summer I wrote to all the organisations in the Borough whom I thought might be willing to accept a film show in their winter programme. The response was exceedingly gratifying, and I have not the slightest doubt that the inception of this film service represents a very important milestone in the health history of Southgate. The audiences were invariably appreciative, and increased in number as the standard of the films provided became more widely known. During 1939 it is hoped that we may be able to extend our activities, by making and exhibiting a film illustrative of all the health activities within the Borough. Such a film would undoubtedly enhance the value of the publicity, as the personal touch is the only element still lacking to render this type of propaganda almost one hundred per cent. effective. The following table sets out the details regarding the film shows given from October until the end of the year: Number of film displays given 19 Approximate number in audiences 3,400 Number of different films shown 23 Cost of films met by the Public Health Department 15s. In addition to the film activities, useful propaganda was obtained by the publication of a booklet issued by Ed. J. Burrow & Co., Ltd., supplying an illustrated resume of the health services available to the burgesses of Southgate. This excellent brochure was distributed throughout the Borough, and received a favourable reception. Five hundred copies remain to be received during 1939. The usual avenues of publicity explored in previous years were also made use of during 1938. Health articles in the local Press, distribution of suitable literature, publication of the local edition of "Better Health," talks to various associations, etc.—all these means were employed to further the cause of Public Health and to stimulate interest in this most vital subject. 83 I should like to take this opportunity of thanking all those who made these activities possible. It is too often thought that pxiblicity is purely the concern of the responsible agent. That, of course, is not the case. Without the co-operation of local bodies who can provide the opportunities for obtaining a suitable audience, and without the co-operation of the burgesses themselves, publicity, of however satisfactory a nature, will fail completely in its object. Fortunately, the history of health publicity is usually the reverse of a vicious circle. The more people know, the more they wish to learn. For that very adequate reason, we should avail ourselves of every opportunity to extend our publicity campaign, until we can feel reasonably certain that no branch of the community has been neglected. Particular thanks are due to the local press, which, as always before, has supplied courteous, indeed invaluable assistance. II. Circular Letters. (1) The following circular letters were issued to doctors during the year: (a) Letter re Measles: Prophylaxis and Treatment. (b) Letter re consulting obstetrician. (c) Letter re new mortuary premises. (d) Letter re admission of cases of measles and whooping cough to the Isolation Hospital. (e) Letter in connection with Home Help Scheme, ing information of confinement cases sent to hospital in emergency. (f) Letter re Public Health Handbook. (g) Letter re occurrence of cases of typhoid fever. (h) Letter re extension of facilities for consulting stetrician. (2) In addition to the above, various circular letters were sent to Elementary and Private Schools, and also to Ratepayers' and other Associations, in connection with health matters. 84 III. Special Reports issued during 1938. Special reports were submitted to the Council during the year on the following subjects: (a) Food and Drugs Act, 1939. (b) Proposed Day Nursery. (c) Air Raid Precautions. (d) Samples of water from Swimming Lake, Broomfield Park. IV. Air Raid Precautions. It would be difficult in a report such as this to set out the vast amount of work which was undertaken in the field of Air Raid Precautions during 1938. Until the early autumn, matters were comparatively quiet, as the part which the Medical Officer of Health and his staff were to play in the scheme had not been properly defined. In August, however, it was definitely stated that the Medical Officer of Health would be held responsible for the organisation of the First Aid Section, together with the training of all the necessary personnel. This immediately presented the Public Health Department with a series of intricate and delicate problems, not to mention the addition of a vast load of responsibilities and labour. The occurrence of the September crisis did little to ease the burden. Unfortunately, matters are still in such a fluctuant condition that the presentation of any final report is rendered impracticable. We are still occupied in siting and adapting our fixed First Aid Posts; training some twelve hundred volunteers in the various branches of the First Aid Section; collecting and storing a miscellaneous array of equipment; building up a transport and ambulance section composed of properly equipped ambulances, adapted vehicles and private cars; and co-operating with the County Council and with the other interested Departments of our own Local Authority in the preparation of a co-ordinated, homogeneous scheme. Much progress has undoubtedly been made; very much more remains for the future. At the moment it is difficult to see the wood from the trees, to appreciate the order which must inevitably emerge from the existing confusion. One fact, an extremely pleasant fact, stands forth from the welter of inconsistencies, frustration and disappointments. The St. John Ambulance Brigade, the British Red Cross Society and the hundreds of keen volunteers who have offered their services in the First Aid Section, represent a band of individuals who are deserving of the very highest credit. Without their co-operation, 85 there would be 110 First Aid Section. Their assistance, and the assistance of their colleagues throughout the nation, has provided a quota of security; while, an even more important point, the provision of such voluntary service may well have postponed, either temporarily or indefinitely, the threat of war which has lain so heavily upon us. V. Insulin. As in previous years, a supply of insulin, free of charge, has been provided for necessitous patients residing in the Borough. Three such patients received a total of 25,700 units, at a cost of £10 6s. Od. Two new cases were reported during the year. Periodical reports are forwarded to the Ministry of Health. 86 -