CI AC 439 (1) SOUTH GATE Soug 24 BOROUGH OF southgate ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH fOR THE YEAR 1939 WM. CLUNIE HARVEY, M.D.,D.P,H. Medical Officer of Health and Medical Superintendent, Isolation Hospital. To the MAYOR, ALDERMEN and COUNCILLORS of the BOROUGH OP SOUTHGATE. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1939. The Ministry of Health have issued instructions to the effect that the Annual Reports of Medical Officers of Health should be curtailed as far as possible, and that they should be confined to the presentation of essential material, together with such comments as appear advisable. It has also been laid down that comments should be reduced to a minimum. I have attempted to carry out these instructions, although I trust that the Report will still present a sufficiently clear picture of conditions as they prevailed in Southgate during 1939. The Report has been delayed, owing to the fact that the Registrar General's figures only became available a few weeks ago. The year 1939 was satisfactory from a health point of view. The effect of the war had not shown itself to any appreciable extent, although the population fluctuated very considerably during the last few months of the year. The following points seem worthy of special mention: Birth Rate. The Birth Rate of 11.24 is one of the highest recorded during recent years. 1 Still-birth Rate. The Still-birth Rate for the year (37.45) is higher than normal, a fact which was very possibly due to the abnormal conditions prevailing during the latter months of 1939. Death Rate. The Death Rate of 10.16 approximates to the average for the past few years. Infantile Mortality. The Infantile Mortality Rate of 26.92 is exceptionally satisfactory, and compares very favourably with the corresponding rates of 50 for England & Wales, and 48 for London itself. When one remembers that the Infantile Mortality Rate for Southgate was 42.55 in 1937 and 31.09 in 1938, the continued fall is more than ever pleasing. Maternal Mortality Rate. The Maternal Mortality Rate of 4.99, which represents 4 maternal deaths during the year, is higher than normal. Here, however, as I have previously pointed out, it is not possible to draw important conclusions from such scanty material. Other Vital Statistics. It will be noted that the Registrar General has supplied two population figures for use in the compilation of different types of statistics. It is satisfactory that both the Zymotic and the Toddlers Death Rates show a very definite decrease from the figures of the previous year. 2 Infectious Sickness Rate. The Infectious Sickness Rate for 1939 (2.17) is the lowest ever recorded for Southgate. The case rates for scarlet fever, diphtheria and tuberculosis all show a marked decrease. It is significant that this decrease continued throughout the year, and did not seem affected in any way by the onset of hostilities. Maternity & Child Welfare. It is particularly pleasing that the work of the Maternity & Child 'welfare Department was kept up, notwithstanding the difficulties met with during the latter part of the year. A complete re-organisation of the Centres was, of course, necessary; but in spite of this the attendance figures remained extremely satisfactory. The work of the Pre-Natal Clinic was also maintained; while, for the first time in Southgate, an ad hoc Post-Natal Clinic was inaugurated. Work of Sanitary Inspectors. Every endeavour was made to keep housing inspections at an adequate level. This was by no means easy, as the time of two out of the three Sanitary Inspectors was very much taken up with Civil Defence matters. In addition, the enormous increase in the number of carcases to be examined, threw an additional burden on that branch of the Public Health Department. Broadly speaking, it has been our policy to maintain the essential services of the Public Health Department in full activity. We have had to adapt our outlook and our procedure to changing conditions; while the abnormal circumstances consequent upon the declaration of war has necessitated a review of many of our previous activities. 3 The re-organisation of the Maternity and Child Welfare Clinics has already received mention. The difficulty in maintaining suitable propaganda work through the medium of talks, films, etc, together with the whole question of how to deal with the property owner at a time when materials required to remedy sanitary defects were virtually unprocurable, might also be instanced. It is obvious that our problems will increase; by the time this report is published, some of them will be very evident. We may have to consider drastic re-adjustments, but, for the moment we are still capable of maintaining our previous policy. For obvious reasons, this Report can make no mention of the work carried out by members of the Public Health Staff in relation to Civil Defence. I should like to conclude by thanking the Members of the Borough Council and also my Staff for the continued support which I have received throughout the year. It may be a platitude to state that team work is essential to success, but none the less, this fact becomes more and more apparent. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W.C.HARVEY. Medical Officer of Health. Southgate Town Hall, N. 13. December, 1940. 4 PUBLIC HEALTH COMMITTEE at December 31st, 1939. 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. Westlake MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1939. Councillor Mrs. C. M. A. Vandy (Chairman) 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 Mrs. D. M. Gipp Councillor A. E. Lauder Councillor G. Peverett CO-OPTED MEMBERS. Miss H. M. Corry Mrs. A. L. Davy Mrs. Victor Dover Dr. L. Westlake -5- JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1939. 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 PUBLIC HEALTH STAFF Medical Officer of Health and Medical Superintendent, Isolation Hospital:W. C. Harvey,M.D.,Ch.B.,D.P.H. (Full Time) ø Medical Officer of Maternity Centres: Dorothy M. Catchpool,M.B.,B.S.,L.R.C.P.,M.R.C.S.,D.P.H.(Part Time) (Appointment terminated as from December 18th, 1939) ø Assistant Medical Officer of Health Marjorie K. Hall, M.B.,B.S.(Lond),D.P.H.(Lond). (Full Time) Appointed November 1st, 1939. ø Assistant Medical Officer for Air Raid Precautions: John MacMillan,M.B.,Ch.B. (Full Time). Appointed May 4th, 1939, called up for military service Aug.24th. Senior Sanitary Inspector (No.l District): L. Skeeles, Cert.R.San.I.,M.S.I.A.,Cert.R.San.I.Meat Inspection. 6 ø 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 . ø Sanitary Inspector (No.3 District): A. E. Gooday, Cert.R.San.I.,M.S.I.A.,Cert.R.San.I.Meat Inspection, A.R.P.S. Chief Clerk: P. E. Barber. Clerk: Miss M. Munch. Clerk: Miss K. Stoten. . Health Visitors: øMrs. E. M. Rising,S.R.N.,S.C.M., (Maternity & R.S.I.,H.V. (Retired as from Child Welfare) November 4th, 1939) ø Miss E. M. Hart,S.R.N.,S.C.M. ø Miss M. Maddock,S.R.N.,S.C.M.,H.V. ø Miss A. Joy,S.R.N.,S.C.M.,R.F.N., H.V. (Appointed, October 23rd,1939) Health Visitor: Miss B. E. Wellman,S.R.N.,S.C.M., (Public Health A.R.San.I.,H.V. and General) Pull-time Assistant (Maternity Centres) Miss N. Freeman. Disinfector: A. G. Bates. Temporary Assistant Disinfector: B. Latter. ø These Officers' salaries are repaid to the Council, in part, by the Ministry of Health or the County Council. 7 STATISTICS OF THE AREA. Area (in acres) 3,764 Registrar-General's estimate of Resident Population, 1939: (a) For calculation of Birth-rate 69,400 (b) For calculation of Death-rate, etc. 67,770 Number of inhabited houses (end of 1939) according to Rate books 20,300 Rateable Value (1939) £903,981 Sum represented by a penny rate (1939) £3,642 EXTRACTS FROM VITAL STATISTICS OP THE YEAR. Total Male Female Live Legitimate 761 393 368 Births Illegitimate 19 6 13 Totals 780 399 381 Birth rate per 1,000 of the estimated population 11.24 Total live births for calculation of Infant Mortality rate, etc. 771 395 376 Stillbirths 30 16 14 Rate per 1,000 total (live and still) births 37.45 Deaths 693 336 357 Corrected Death rate per 1,000 of the estimated resident population 10.16 8 Deaths from puerperal causes:- Rate per 1,000 Deaths. total (live and still) births. From puerperal sepsis 3 3.74 From other puerperal causes 1 1.25 Total 4 4.99 Death rate of infants under one year of age:- All infants per 1,000 live births 26.92 Legitimate infants per 1,000 legitimate live births 24.96 Illegitimate infants per 1,000 illegitimate live births 105.26 Deaths from measles (all ages) 0 " "whooping cough (all ages) 0 " " diarrhoea (under 2 yrs. of age) 2 POPULATION. The Registrar General's estimate of the population at the middle of 1939 was 69,400, an increase of 1,540 over the estimate for 1938. This is taken as the population of the Borough for the purpose of the calculation of the Birth-rate, while the figure of 67,770 is given as the estimate of the civilian population for the calculation of the Death-rate. The number of births exceeded the number of deaths by 87, as compared with an excess of 126 births in 1938. 'The population for past 5 years has been as follows. 1935 62,180 1936 64,000 1937 66,230 1938 67,86 0 1939 69,400 9 BIRTHS - BIRTH RATE. The nett total births accredited to the district was 780, an increase of 7 on the preceding year. Of these, 399 were males and 381 females (6 males and 13 females were illegitimate), although, as previously indicated, the Registrar General gives a total of 771 births for the calculation of the Infant Mortality and certain other rates. The birth-rate was therefore 11.24 per 1,000 of the population, as against 11.39 in 1938. The birth-rate for England and Wales for 1939 was 15.0, and for the administrative County of London, 12.3 The total number of 'births actually registered in the district during the year amounted to 718, of which 10 were unnotified. The percentage of births notified was therefore 98.6 as compared with 98.25% in 1938. One hundred and eighty seven births were notified by midwives. MORTALITY. GENERAL MORTALITY AND DEATH RATE.- The nett number of deaths accredited to this district was 693, an increase of 46 as compared with the previous year. This gives a corrected death-rate of 10.16 per 1,000 of the population, an increase of 0.82 on the rate for the previous year, which was 9.34. The rate for England and Wales (1939) was 12.1, and for London 11.9. INFANT MORTALITY.- There were 21 (2 illegitimate) deaths of infants under 1 year of age, which gives an infantile death-rate of 26.92 per 1,000 births registered, as compared with 24 deaths and a rate of 31.09 in the preceding year. 10 The rate for. Engl and & Wales (1939.) was 50, and for London 48. STILLBIRTHS.- Thirty stillbirths, (none illegitimate) were accredited to the district for 1939. This is equal to a death-rate of 37.45 per 1,000 (live and still) births registered, the corresponding figures for 1938 being 27 stillbirths, with a rate of 33.75. MATERNAL MORTALITY.-' The maternal mortality rate - i.e. the number of mothers dying as the result of childbirth per 1,000 total (live and still) births - was 4.99 for 1939, representing a total of 4 deaths. In 1938 there was 1 death, with a corresponding rate of 1.25. MORTALITY OP "TODDLERS".- Two deaths occurred amongst children of the age group 1-5 years during 1939. This represents a death-rate of 0.03 per 1,000 of the total population, and 0.29 per cent. of the total deaths for the year, at all ages. In 1938 there were 6 deaths, giving a rate of 0.09 and a percentage of 0.93. MORTALITY OF PERSONS OVER THE AGE OF 65.- It may be noted that 58.00% of the total deaths during the year took place in persons over the age of 65. Seventeen females died at the age of 90 or over, the oldest being 94 years; while 5 males also died within this age period, the oldest being 95. ZYMOTIC MORTALITY (including 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 3 deaths in this category; 1 from diphtheria and 2 from infantile diarrhoea. The zymotic death rate for 1939 was therefore 0.04 per 1,000 of the population, as against 0.10 in 1938 with 7 deaths. 11 CAUSES OF DEATH DURING THE YEAR 1939. Causes of Death Male Female Total All Causes (Civilians only) 336 357 693 Typhoid & Paratyphoid fevers - - - Measles - - - Scarlet fever - - - Whooping cough - - - Diphtheria 1 - 1 Inflenza 2 7 9 Encephalitis Lethargica - - - Cerebro-spinal fever - - - Tuberculosis of Respiratory system 20 10 30 Other Tuberculous diseases 5 2 7 Syphilis 1 - 1 General Paralysis of insane, Tabes Dorsalis 2 1 3 Cancer, Malignant disease 61 56 117 Diabetes 5 8 13 Cerebral Haemorrhage, etc. 13 15 28 Heart disease 120 137 257 Aneurysm 2 2 4 Other Circulatory diseases 18 21 39 Bronchitis 10 5 15 Pneumonia (all forms) 15 13 28 Other Respiratory diseases 3 1 4 Peptic Ulcer 4 - 4 Diarrhoea, etc.(under 2 years) 1 1 2 " " (over 2 years) 1 1 2 Appendicitis - - - Cirrhosis of Liver 2 - 2 Other diseases of liver, etc. - - - Other digestive diseases 2 4 6 Acute & Chronic. Nephritis 7 6 13 Puerperal sepsis - 3 3 Other Puerperal causes - 1 1 Congenital, Debility, Premature Birth, Malformation, etc. 10 6 16 12 CAUSES OF DEATH (continued) Male Female Total Senility 1 5 6 Suicide 5 6 11 Other Violence 8 21 29 Other defined diseases 17 25 42 Causes ill-defined or unknown – – – Totals 336 357 693 13 INFANTILE MORTALITY, 1939: Deaths from stated causes at various periods under 1 year of age. Causes of Death. Under 1 wk. 1-2 weeks 2-3 3-4 " Total under 1 month. 1-3 mths. 3-6 " 6-9 " 9-12 " Total under 1 year. Measles Scarlet fever Whooping cough Diphtheria & Croup Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous diseases Meningitis (not tuberculous) Convulsions Laryngitis Bronchitis Pneumoia 1 1 1 2 Diarrhoea Enteritis 1 1 Gastritis Syphilis Ricket s Suffocation Want of Attention and Injury at Birth 3 3 3 Atelectasis Congenital Malformations 2 1 3 1 4 Premature Birth 7 7 1 8 Atrophy,Debility & Marasmus Other Causes 2 1 3 3 Totals 14 2 - 1 17 1 1 1 1 21 14 GENERAL PROVISION OF HEALTH SERVICES. HOSPITALS.- General Hospitals - The arrangements set out in the Annual Reports for 1930 and 1938 relating to the provision of general and special hospital accommodation, together with the provision of maternity beds for the inhabitants of Southgate, remain unaltered. They still appear satisfactory. ISOLATION HOSPITAL.- Improvements carried out during 1939 include:- Redecoration of wards; purchase of additional furniture and equipment, stainless steel fitments, and additional bed-pan sterilizers; improvements to grounds; and replacement of obsolete, sanitary apparatus. Alterations and improvements scheduled for the latter part of 1939 and for 1940 have been postponed. CLINICS and TREATMENT CENTRES. MATERNITY AND CHILD WELFARE (Southgate Council). At 31st December, 1939. Infant Welfare:- Methodist Church, The Bourne, Southgate.Monday 2-4 Methodist Church, Palmerston Road,)Tuesday 2-4 Bowes Park.)Wednesday 2-4 Methodist Church, Green Lanes, Winchmore Hill. Thursday 2-4 De Bohun School Clinic, Green Road, Southgate. Friday 2-4 Pre-Natal. Methodist Church, Palmerston Road,)Wednesday 10-12 Bowes Park.)Thursday 10-12 15 Post-Natal. Methodist Church, Palmerston Road,)First Tuesday in Bowes Park;)each month, 10-12 IMMUNISATION (against diphtheria) CLINIC- (Southgate Council) Town Hall, Palmers Green. Thursday 2-4 Owing to the outbreak of war, "black-out" restrictions, the necessity for air-raid protection, and the requisitioning of certain premises used for clinic purposes, various adjustments to existing arrangements had to be carried out. The child welfare and'pre-natal clinics held at Broomfield House and New Southgate Baptist Church Hall were transferred to the Bowes Park Methodist Church Hall, while the child welfare clinic at Community Hall was discontinued, to be resumed later at the De Bohun School Clinic. The Immunisation against diphtheria Clinic held at Broomfield House was transferred to the Town Hall. The Tuberculosis, Venereal Disease and School Clinics (Middlesex County Council) continue as set out in the Report for 1938. 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, as amended by the alterations referred to in the Report for 1936, still obtain, with the following additions and improvements. A Novox resuscitating apparatus was provided for use in both ambulances, together with electric heating for blankets. A canvas sling stretcher, to enable patients to be carried comfortably and with safety 16 down awkward staircases, etc., was added to the ambulance equipment, COUNCIL EMPLOYEES.- Five Council employees were examined at the Town Hall during 1939, either for admittance to the superannuation scheme, or before being accepted into the Council's service. MORTUARY.- During 1939, 51 bodies were deposited in the Council's mortuary situated at the rear of the Town Hall. Forty-five post-mortem examinations were held. 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 1939. Work carried out at the Council's laboratory: HOSPITAL BOROUGH Positive Positive Negative Negative Swabs for Diphtheria bacilli 432 2327 6 605 Swabs for Streptococci – 1 – 7 Swabs for Haemolytic streptococci – – – 6 Sputa for Tubercle bacilli – 1 14 108 Total 3507 (1938, 5095) The decrease in the work carried out at the laboratory was due to the marked drop in the number patients treated at the Isolation Hospital, and to the very low incidence of diphtheria within the Borough. 17 Specimens sent to Clinical Research Association: Faeces for Typhoid Negative 3 Blood " " " 5 Sputum for Tubercle bacilli " 1 Specimens sent to laboratory at the Prince of Wales's Hospital: Swabs for virulence test Negative 5 Positive 12 Negative swabs 14 Cerebro-spinal fluid Negative 2 Positive 1 Swabs for HaemOlytic Streptococci Negative 5 " " Diphtheria bacilli " 1 Faeces for Dysentery Positive 3 Rectal swabs for Dysentery Negative 4 Positive 4 Blood for Typhoid Negative 3 " " Wassermann reaction " 1 " " blood count 3 Urine for blood and casts " 1 BACTERIOLOGICAL EXAMINATION OF MILK.- One hundred and forty-seven samples of milk were examined during the year, 5 of which did not conform to the required standards. Due notice was sent in each case to the producers and to the appropriate authorities. 18 MATERNITY AND CHILD WELFARE SERVICES. STATISTICS OP ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1939. Number on Registers:- Under 1 year Over 1 year Totals 1939 1938 January 1st, 1939 398 689 1,087 1,033 December 31st, 1939 1031 1099 2,130 1,944 New cases during 1939 633 410 1,043 911 52 of the new cases under 1 year were ''removals'' into the district. The remaining 581 represent 75.35 per cent of the total births credited to the district. ATTENDANCES AT CENTRES. January - August, 1939. Under 1 year Over 1 year Totals. 1938. The Bourne 1293 767 2, 060 2,624 Broomfield House 1440 754 2,194 2,739 Bowes Park 1693 1089 2,782 3,988 New Southgate 989 932 1,921 2,980 Community Hall 890 1230 2,120 3,314 Winchmore Hill 1631 1160 2,791 3,810 Totals 7936 5932 13,868 19,455 Average 38.33 28.65 67.00 64.21 19 ATTENDANCES AT CENTRES. September - December, 1939. Under 1 year Over 1 year Totals Sessions. Bowes Park (Tues) 871 544 1,415 14 " " (Wed) 221 199 420 7 " " (Thurs) 418 283 701 11 The Bourne 604 525 1,129 14 Winchmore Hill 95 85 180 3 De Bohun 12 39 51 2 Totals 2221 1675 3,895 51 Average 43.55 32.84 76.39 Grand totals for year 1939 10157 76 07 17,764 258 -do.- 1938 10514 8941 19,455 303 Average 1939 39.36 29.49 68.85 " 1938 34.70 29.51 64.21 STATISTICS OF ATTENDANCES AND WORK DONE AT PRE-NATAL CENTRE. Number on Register: 1939. 1938. January 1st 92 99 December 31st 95 84 New cases during the year 285 290 Number of sessions held 61 51 Total attendances 1092 996 Average per session 17.9 19.53 20 POST NATAL CLINIC. An ad hoc Post Natal Clinic was instituted for the first time in Southgate, at the end of the year. The Clinic was held a t the Bowes Methodist Church Hall, Palmerston Road, on the first Tuesday of each month. One session was held, at which 4 mothers attended. TABLE OP VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OP BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. Children: 1938 1939 First visits 529 517 Under 1 year of age 1,016(In addition to) 914 Over 1 year of age 2,878( first visits) 2,850 Visits re: Deaths under 5 years of age 5 6 Stillbirths 3 11 Ophthalmia Neonatorum – – Dental cases – 108 Pre-Natal visits 498 606 Special, visits (test feeds, following up special cases seen by M.O. at Centres, failing lactation, etc.) 566 753 Special visits re Day Nursery 346 – Special visits re Immunisation 129 – Totals 5,970 5,765 21 CHILD LIFE PROTECTION.- The following is a summary of the work carried out in this connection during 1939: Number of registered Foster Mothers 6 Number of Foster children on register during the year 17 Number of Foster children at end of year 7 Number of visits paid by Health Visitors 87 No unsatisfactory conditions were met with throughout the year. MILK (MOTHERS & CHILDREN) ORDER. Number of cases in which milk was granted: 1936 1937 1938 1939 241 305 352 362 Total quantity of milk distributed (1939), 9982 gallons (approx) Approximate cost: £ £ £ £ 776 964 1024 1146 Grants of Trufood were made in 8 cases, Cow & Gate in 25 cases, Allenbury's in 17 cases, Nestles in 27 cases, codliver oil emulsion in 123 cases and syrup Minadex in 72 cases. Total quantity of dried milk distributed, 4320 lbs. (approx) Number of children under 1 year of age granted free milk during 1939 214 Percentage of total live births 27.43 DENTAL-L TREATMENT.- Number of "Council" patients attending the ' Eastman Dental Clinic, 1939 Children 78 Mothers 55 Cost of such cases £69 HOME HELP SCHEME.- The following table sets out the details of the work carried out under the above scheme during 1939: Number of Home Helps provided free of charge 50 1 for 35 days 1 " 23 " 2 " 21 " 1 " 17 " 39 " 14 " 3 " 13 " 1 " 5 " 1 " 3 " 1 " 1 " Additional payment to Home Help for children in excess of 6 2 Days worked without charge to patients, 1939 711 1938 536 Number of Home Helps provided at charge of l/- per day 17 17 for 14 days Days worked at charge of l/- per day, 1939 238 1938 240 Number of Home Helps provided at charge of 2/- per day 8 1 for 28 days 7 " 14 " 23 Days worked at charge of 2/- per day, 1939 126 1938 84 Number of Home Helps provided at charge of 3/- per day 1 1 for 14 days Days worked at charge of 3/- per day, 1939 14 1938 35 Number of Home Helps provided at charge of 5/- per day 3 3 for 14 days Days worked at charge of 5/- per day, 1939 42 1938 14 Total number of days worked during 1939 1131 1938 909 Total number of cases 1939 79 1938 61 Total cost of operating the scheme, 1939 £245.10,6 1938 £200. 2.0 Average number of Home Helps on Council's roll,12 MATERNITY OUTFITS.- Sterilized maternity outfits were supplied to expectant mothers during 1939, as follows: 40 at cost price. 51 free of charge, costing £17.17.0 24 INSPECTION AND SUPERVISION OP FOOD. MILK SUPPLY.- Ho 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). Five additional retailers were registered during the year. Under the Milk (Special Designations) Order, 1936, 32 Dealers' Licences, 18 Supplementary Licences, and 1 Pasteuriser's Licence were granted. MEAT AND OTHER FOODS.- Butchers' shops are visited frequently, while slaughterhouses continue to be kept under strict control. The bakehouses, fish, fruit and grocers' shops are also kept under observation. Immediately after the outbreak of war, certain premises at Winchmore Hill were taken over as part of the London Meat Market, being utilized as a meat distribution depot. This resulted in a very large increase in the work of meat inspection and supervision, the number of carcases examined being out of all proportion to the total of previous years. To the end of August, the following animals had been examined: Bovines 30; Sheep & Lambs 2,344; Calves 36; Pigs 165; (Total - 2,575). For the whole year, the totals were:- Bovines 4,394; Sheep & Lambs 76,876; Calves 1,644; Pigs 4,253. Thus, a grand total of 87,167 carcases was examined during 1939, as against 23,424 in 1938 and 22,794 in 1937. 3,886 lbs (1 ton,14 cwt,2 qr,22 lbs) of unsound meat were surrendered and destroyed. 25 In addition, 6 lbs corned beef, 46 lbs (1 box) ox tongues, 6 lbs (3 tins) gammon, 30 lbs (5 tins) ham, 211 lbs chilled beef, 1 turkey (6 lbs) and 212 lbs fish were also surrendered and destroyed as unsound. SANITARY INSPECTIONS 1939. Housing Inspections & Re-inspections. 3,183 Slaughterhouse Visits & Inspections. 608 Registered premises, including factories, workshops, bakehouses, milk shops and other food shops - Visits & Inspections. 1,511 Infectious Disease - Visits & Inspections. 1,851 Miscellaneous Visits & Inspections, including various complaints, Rats & Mice Destruction Act, ditches and ponds, non-notifiable diseases, etc. 16,531 Visits re Verminous premises 193 23,877 SERVICE OF NOTICES. Total informal sanitary notices served 1,823 Total informal dustbin notices served 422 Total informal notices served 2,245 Total informal notices complied with 1,658 Total statutory notices served 25 Total statutory notices complied with 25 SANITARY IMPROVEMENTS.- The follwoing is a summary of the, sanitary improvements effected, and the defects remedied: Housing: Premises cleansed; ceilings repaired, distempered; walls repaired, redecorated.. 3,335 Dampness remedied; floors repaired; air gratings fixed; floor ventilation, lighting and ventilation improved 446 26 Roofs, gutters, rainwater pipes repaired 659 Yards repaired or repaved 102 Window frames, door frames, sash, cords repaired or renewed' 420 Brickwork repaired or repointed 186 Cooking ranges, firegrates repaired or renewed 114 Sinks, waste-pipes repaired or renewed 148 Staircases, internal woodwork, food stores, coal sheds repaired 103 Water supply: draw taps, storage cisterns, new taps fitted, pipes repaired, coppers repaired or renewed 133 Drainage repairs and renewals, including:Ispection chambers repaired, new provided; drains tested, repaired, unstopped, reconstructed; new gullies, gulley grates provided; gullies unstopped cleansed; vent shafts, fresh air inlets repaired or renewed 968 Sanitary accommodation improved:- W.G. pans renewed; seats, flushing cisterns, flush pipes, cone joints repaired or renewed; W.C's repaired or newly constructed 326 New dustbins provided 411 Dairies, Cowsheds, Slaughterhouses and Bakehouses limewashed, etc. 28 Factories, Workshops and Shops:- repairs and renovations 63 Miscellaneous sanitary defects remedied and complaints investigated 68 HOUSE-TO-HOUSE INSPECTIONS.- Six hundred and nine houses were inspected and recorded under the Housing Acts,as compared with 701 in 1938 27 NUMBER OF NEW HOUSES ERECTED DURING 1939:- (a) Total (including number given separately under (b)) 466 (b) With State assistance under the Housing Act s:- (i) By the Local Authority 38 (ii) By other bodies or persons.. PREMISES UNDER PERIODICAL INSPECTION.- The following premises are inspected from time to time, and, as in previous years, they were found to be kept satisfactorily. 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 221 Public House Conveniences 24 Grocers 125 Greengrocers 55 Butcher s 55 Confectioners 31 Hairdressers 45 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. Under the bye-laws governing this class of establishment, the following licences and exemptions were granted during 1939: Two new licences, 9 renewals of existing licences, and 10 exemptions to members of the medical profession and or the Chartered Society of Massage and Medical Gymnastics. 28 PREVALENCE OP AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. One hundred and forty seven cases of infectious disease were notified during the year, as against 256 in 1938, and 217 in 1937. The Infectious Sickness Rate for the district was 2.17, as against 3.8 in 1938 and 3.3 in 1937. This is the lowest Infectious Sickness Rate ever recorded in Southgate, and is the more noteworthy in view of the fact that measles and whooping cough were made notifiable at the end of October. SMALLPOX. No cases of smallpox occurred in the district during 1939. SCARLET FEVER. Forty-two cases were notified during 1939, as compared with 95 in 1938. The 1939 total is the third lowest recorded in Southgate. DIPHTHERIA. Six cases of diphtheria were notified during 1939, as against 26 in 1938. This is the lowest number of cases ever notified in Southgate in any one year, the next lowest being 8 and. 9, in 1932 and 1937 respectively. The type of disease was definitely severe, one particularly virulent case ending fatally on the third day after onset. Three diphtheria "carriers" were reported during the year. IMMUNISATION. Two hundred and thirty-eight persons attended for immunisation during 1939, at the weekly clinic held at Broomfield House, and later transferred to the Town Hall; or at the school visited during bhe year. This compares with a total of 491 for the previous year. The school selected for immunisation was Arnos School, at which 28 children attended the session. 29 In addition to the above, Tottenhall Road School was visited, for the purpose of carrying out re-Schick tests, following immunisation sessions conducted in 1938. 121 children were so tested. The total attendances for immunisation during 1939 was 1,382. It will be obvious from the figures given above that the outbreak of war seriously affectedthe attendances at this clinic, although towards the very end of the year, the figures were showing a welcome tendency to rise. TYPHOID FEVER (including Paratyphoid). One case of typhoid fever was notified during the year, as against 2 in 1938. PUERPERAL PYREXIA , Pour cases of puerperal pyrexia were notified during the year, as against 9 in 1938. In addition to these notified cases, the Registrar General reported four maternal deaths, all of which occurred in institutions outside the district. ERYSIPELAS. Nine cases of erysipelas were notified during the year, compared with 24 during 1938. TUBERCULOSIS. Forty-one cases of pulmonary and 11 cases of non-pulmonary tuberculosis were notified during the year, the corresponding figures for 1938 being, pulmonary 50, nonpulmonary V. In addition to these notified cases, 27 patients (all pulmonary) were entered in the register, including 4 restored to the register, these cases being new residents in the district, previously notified elsewhere. 30 DISINFECTION AND DISINFESTATION. The following is a summary of the work carried out under this heading during the year Total number of rooms disinfected 387 Total number of articles of bedding, etc. disinfected 3,007 Total number of articles destroyed 312 Number of verminous houses disinfested 100 Number of rooms disinfested 205 ISOLATION HOSPITAL. The number of patients treated in hospital during 1939 was 334, as against 562 during 1938, and 505 during 1937 (This number comprises all patients admitted during the year, together with those in hospital on 1st January, 1939). The following table sets out the number of patients admitted to the hospital during 1939, and the areas from which those patients were admitted; 1939. 1938. Southgat e 67 164 Tottenham 258 339 Edmonton — 1 Middlesex County Council — 2 325 506 31 The diseases for which the 325 patients were admitted during 1939 were as follows: . Scarlet fever 184 Diphtheria 69 Diphtheria "Carriers" 6 Diphtheria & Whooping cough 2 Erysipelas 11 Puerperal Pyrexia 4 Baby with mother 2 Pneumonia (including Influenza) 6 Measles 2 German Measles 2 Whooping cough 2 Whooping cough & Pneumonia 6 Whooping cough & Bronchitis 4 Chicken pox 3 Mump s 1 Meningococcal Meningitis 1 Septicaemia 1 Others 19 325 DEATHS, Two deaths took place during the year, as compared with 11 in 1938. These 2 deaths occurred from the following diseases: Primary lobar pnuemonia 1 (Southgate patient, aged 48) Broncho-pneumonia following whooping cough 1 (Tottenham patient, ages 5 months) Even taking into account the decrease in the total number of cases treated, two deaths from among a total of 334 is very satisfactory; while it is particularly pleasing that no deaths took place among the cases of diphtheria treated during the year. 32 OPERATIONS. Tonsillectomy 2 Mastoidectomy 1 Gland Incision 1 The number of operations performed during 1939 was considerably less than was the case during 1938, when the total was 15. NUMBERS IN HOSPITAL. The daily average of patients treated in hospital during each month of 1939 was as follows: . i January 53.32 July 34.29 February 45.42 August 35.35 March 44.54 September 21.10 April 39.70 October 9.70 May 30.74 November 10.09 June 26.70 December 9.4 Average 30.03 The daily average number of patients tr;eatedi (30.03) shows a decrease from that for the previojus year, which was 48.80. The highest: and lowest numbers of patients in hospital on any one day during 1939 were as follows: Highest (January 6th - 8th) 59 Lowest (December 22nd-r28th) 6 33 34 Diseases. At all ages. Under 1 year 1 to 2 2to3 3 to 4 4 to 5 5 to 10 10 to 111 15 to 20 20 to 35 35 5 of 65 65 over Deaths Notified Cases of Infectious Diseases, 1939. Smallpox -- Diphtheria 6 4 1 l 1 Scarlet fever 42 1 1 3 3 12 10 7 3 2 Typhoid fever 1 1 Dysentery 1 Puerperal Pyrexia 4 1 3 4 Erysipelas 9 1 3 5 Ophthalmia Neonatorum Measles 2 1 1 Whooping Cough 1 l Acute Poliomyelitis Cerebro-spinal Meningitis Pneumonia 29 1 1 4 l 2 3 2 13 2 28 Tuberculosis Pulmonary 41 1 1 8 19 5 6 1 30 Non-Pulmonary 11 — 1 1 2 l 1 2 1 1 1 7 Totals 147 – 4 4 3 5 23 14 20 31 13 25 5 70 TUBERCULOSIS, 1939. Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M- F. Under 1 yr. 1-5 years. 1 l 1 1 5-10 " 1 l 1 10 - 15 " l • 1 15 - 20 " 5 6 l 1 1 20 - 25 " 7 7 1 2 2 1 25-35 " 13 10 1 4 X 4 35 - 45 " 3 5 l 3 45 - 55 " 3 3 l 5 1 2 55 - 65 " 3 4 2 2 55 & over 1 1 1 1 1 1 Totals 37 31 7 4 20 10 7 2 Ø These figures include all cases previously notified elsewhere and noted "by the Tuberculosis Officer and others as having removed into the district. 35 REGISTER OP TUBERCULOSIS CASES. Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register 1.1. 39 132 95 27 28 282 Cases Notified for first time, 1939 23 18 7 4 52 Cases Restored to Register 2 2 — — 4 Other cases added 11 12 — — 23 Cases Removed from Register 50 31 6 4 91 Remaining on Register, 31.12.39 118 96 28 28 270 36