SOUG 25 SOUTHGATE AC 439(1) BOROUGH of southgate ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For THE YEAR 1940 WM. CLUNIE HARVEY, M.D.,D.P.H. Medical Officer of Health and Medical Superintendent, Isolation Hospital. To the MAYOR, ALDERMEN and: COUNCILLORS of the BOROUGH OF SOUTHGATE. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1940. Once again, the Ministry of Health has issued instructions to the effect that the Annual Reports of Medical Officers of Health should he curtailed as far as possible. This instruction has been followed, without, I hope, omitting any information of an essential character. I need scarcely point out that the production of the Report has been delayed owing to difficulties in obtaining the appropriate statistics. The year 1940 was very satisfactory from a health point of view. This remark could have been made with equal force during normal times, but in conditions such as prevail to-dey, it is a source of even greater satisfaction to be able to paint a health picture in colours which are eminently pleasing. The following points call for special consideration: Birth Rate. The Birth Rate fell somewhat during 1940, from 11.4 in the previous year, to 10.62 In this connection, as with the remaining statistics set out in this Report, it is not possible to obtain a true - 1 - comparison with the figures relating to the previous year. This is due mainly to the fact that the non-civilian population figures for this area are not available, so that we" can only arrive at an approximate estimate of the total population. Nevertheless, a comparison of the figures relating to 1940 with those of previous years will not be out of place, and is therefore Supplied. Still Birth Rate. The Still Birth Rate for 1940 shows a Very welcome decrease, from 37.45 to 28.53. Death Rate. The Death Rate for 1940 was 10.97 , as against 10.10 in 1939. This compares with a London. Death Rate of 17.8, and a Death Rate for Ehgland & Wales of 14.3. Infantile-Mortality The Infantile Mortality Rate rose slightly during the year from 26.92 to 32.81, but it is still below the average for previous years. The satisfactory, nature of this figure may better be gauged when it is set against the Infantile Mortality Rates for london and England & Wales, which were. 50 and 55. respectively. ??? Maternal Mortality. The Maternal Mortality Rate fell during the year rom 4.99 to 2.76 As mentioned in last year's Annual Report, the figures are too small to admit 2 - of any important conclusion being derived. Other Vital Statistics. The remaining vital statistics applicable to Southgate do not show any points which seem to call for special notice. Maternity & Child Welfare. The total attendances at the various Maternity & Child Welfare Clinics held in the district during the year show little or no alteration from those of 1939. It is, however, pleasing to be able, to report that approximately 83% of mothers in this area are taking advantage of the Clinic facilities, as against 75% in. 1939. Our aim should be to increase this percentage still further although it may be difficult to better figures which are in many ways outstanding. It is also a source of great satisfaction -to note that the average attendance at our Pre-Natal Clinics has risen from 17.9 in 1939 to 19.12 last year, the totals for the saiae two years being 1092 and 1912 respectively. The importance of pre-natal work need not be stressed, this being a field which obviously repays all the effort put into it. It will be noted that the total number of visits paid by the Health Visitors for all purposes during'. 1940, was 4,794, as against 5,7l5 during the previous year. The declitre in the number of visits paid is quite obviously due to the increased number of clinics held, and the consequent number of hours devoted to that phase of Maternity & Child Welfare work. The staff of the Maternity b Child Welfare Department is well aware of the fact that home visiting. plays an important part in Child Welfare, and all possible steps are being taken to raise the number of visits to the -3- previous level. This is not an easy task, but there is already evidence to show that a sortition is being found to the problem of making both ends meet. Work of Sanitary Inspectors. The number of visits paid by Sanitary Inspectors during the year rose from 23,877 in 1939, to 27,803, When one considers the many and responsible duties which the war has thrown upon the Department controlled by the Sanitary Inspectors, it will be appreciated that this increase in the number of visits carried through is to be commended. House-to-house inspections have continued more or less on pre-war level, although the general inspection of house property has had to be curtailed. The extraordinary increase in the work of meat inspection, referred t.o in the body of this Report, needs no comment. Control of Infectious Diseases. The Infectious Sickness Rate for 1940 was 8.88, an increase of 6.71 over that of the previous year. This sudden increase might at first sight appear alarming, yet. this is very far from being the case. Actually, 1940 was a very satisfactory year from an infectious diseases standpoint. The increase in infectious diseases which we all anticipated has not so far materialised. Certain diseases have shown a sporadic tendency to increase, while other diseases, previously rare in epidemic form, have developed epidemic tendencies. Southgate has fortunately eocaped any major visitation, the infectious diseases picture being actually that of a normal peace-time Pear, The apparently alarming jump in the Infectious _4_ Sickness Rate is due entirely to tlie inclusion, for the first complete year, of measles and whooping cough notifications. The 347 cases of measles and 58 cases of whooping cough notified during 1940 accounted for no less than 68.52% of the total cases reported during the year, a fact which might well be left to speak for itself. From the table set out on page 38, it will be seen that measles notifications rose to a peak during September. After a slight lull during November, a return of the previous severity .made itself apparent in December. It is satisfactory to be able to report that the type of cases met with was mild on the whole. Admission to hospital was required in 12 cases only, while the number of deaths was confined to one. A slight increase in diphtheria notifications is apparent in the 1940 figures. This increase was almost entirely the result of a small localised outbreak in the Ilew Southgate area, towards the end of the year. The number of families involved was small, an interesting fact being the comparatively large number of children in the same families ( 2, 3 and 5) who became infected. Conclusion. The policy set out ift last year's Annual Report, i.e. the maintenance of all essential Public Health Services, has been continued during 1940. In spite of the heavy and continued raiding which took place during the latter part of 1940 dislocation, of Public Health services was very slight. We have had to adapt, ourselves to ever-changing conditions. Fortunately, a Public Health Department must be modelled on mobile lines, and it' is this principle which has very largely enabled us to adapt ourselves so quickly and so easily to fresh developments. -5- It is impossible in a Report such as this to set out in more than the very briefest detail, the measures of safeguard which we have had to adopt or to prepare, in order to meet future emergencies. It will be sufficient to state that we have prepared a scheme to deal with possible pollution of water supplies on a vast scale, and that we have carried out - and are still carrying out - immunisation against one of the most serious war-time diseases, typhoid infection. The remaining activities of the Public Health Department in relation to war-time background, belong rather to Civil Defence, and have been set out in Committee and other Reports from time to time. TJhilo we have much upon which to congratulate ourselves, it would be 'suicidal to believe that we have seen the worst of our difficulties.No one can expect conditions to improve, while a worsening is highly probable. At any time, diseases such as cerebro-spinal meningitis and acute poliomyelitis may descend upon us. Such occurrences need not be catastrophic, so long as we are prepared to meet them, and so long as we have the necessary machinery to hand. Already one disease, scabies, has. .changed from a minor to a major problem, and there is no reason to believe that others may not follow that undesirable course. It is in many ways unfortunate that the Staff of the Public Health Department, as is the case with all other Local Government Departments, has had so many additional duties thrust upon it, at a time when all our energies'may have to be devoted to essential work- of a purely Public Health nature. Y/e have accepted this responsibility willingly, and have no complaint to make, nevertheless, I feel that a word of warning must be issued. Public Health is still, and always will be, a factor of supreme importance, during war as well as peace. -6- Medical problems could lose us this war, as they have lost many wars in the past. One must remember this fact and refuse to allow ourselves to,be deviated from a path which Local Government in "this country.has wisely elected to follow. Before concluding,.-this introduction to the Annual Report for 1940, I would make, reference to two specific points relating to conditions of war.It will be understood that the death rate for 1940 includes the total number of civilians who lost their lives in consequence of enemy action. While it would not be politic to set out the exact number of civilians so killed, it might be stated that the total in this, category accounts for the slight rise in the 1940 death rate. The second point concerns the shelter problem, This problem has not been acute in Southgate, and it is not, therefore, possible to draw any important conclusions, either positive or negative, from the period under review. It will be obvious that the use of air raid shelters, whether domestic, communal or public, has not thus far increased the infectious sickness or morbidity rates for the area; while there is no evidence to show that the general sickness rate has risen/to any appreciable degree This is satisfactory, but must not be taken to mean that the use of air raid shelters is'devoid of any Ptiblic. Health danger. We must keep the possibilities very much in front of oiir minds and be prepared at arfy time to deal with an environmental problem of unknown magnitude, Finally, I wish to tender my. thanks to the Members of the Borough Council and also to my Staff for their assistance and support throughout the year, without the wholehearted co-operation of every one concerned, the work of the Public health Department could not continue, and I am especially grateful at a time like this to be able to report the- existence of this co-operation. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. Southgate Town Hall, N.13. Nov.1941. PUBLIC HEALTH COMMITTEE at December 31st, 1940. Alderman G. Peverett (Chairman) His Worship the Mayor (Councillor Frank E.Cooper,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 AID CHILD WELFARE COMMITTEE at December 31st, 1940, Councillor Mrs. C. M. A. Vandy (Chairman) His Worship the Mayor (Councillor. Frank E.Cooper, J.P, ) Alderman G. Peverett Councillor Miss G. E. Appleyard. Councillor J. H. Barker Councillor R. B. Dearie Councillor Mrs. D. M. Gipp Councillor A. E. Lauder (One vacancy) CO- OPTED. MEMBERS. Miss H. M. Corry Mrs. Victor Dover Mrs. G. Pheasey Dr. L. Westlake -8- JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1940. SOUTHGATE REPRESENTATIVES Alderman G. Peverett (Chairman) Councillor W. A. Clarke Councillor Mrs. C. M. A. Vandy Councillor V. J. Westlake T0TTENHAM REPRESENTATIVES Alderman R. K. Warren Councillor C. J. Hurd Councillor Mrs. G. E. Morrison Councillor A. R. Turner PUBLIC HEALTH STAFF Ø Medical Officer of Health and Medical Superintendent, Isolation Hospital: W. C. Harvey,M.D.,Ch.B.,D.P.H. (Full Time) Ø Assistant Medical Officer of Health: Marjorie K.Hall, M.B.,B.S. (Lond),D.P.H. (Lond) . (Full Time.) Ø Senior Sanitary Inspector (No.l District):L.Skeeles, Cert.R.San.I.,M S.I.A.,Cert.R.San.I.Meat Inspection. Ø Sanitary Inspector (No.2 District): H. Hill,M.B.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 -9- Chief Clerk: Clerk: Clerk: P. E. Barber Miss-M-. Munch Miss K. Stoten Health Visitors: (Maternity & Child Welfare) Ø Miss E. M. Hart,S.R.N., S.C.M.,H V. Ø Miss M. Maddock,S.R.H.,S.C.M.,H.V. Ø Miss A. Joy,S.R.N. ,S.C.M- ,R.F.N.,H.V. Health Visitor: (Public Health and General) Miss B.3. Wellman,S.R.N.,S.C.M., A.R.San.1. ,H.V-.' Pull-time Assistant (Maternity Centres) Miss N.Freeman Disinfectort A. G. Bates Temporary Assistant Disinfect or: B. Latt.er . Ø These Officers' salaries are repaid to the Council, in part, by the Ministry of Health or the County Council. STATISTICS OF THE AREA Area (in acres) 3,764 Registrar-General's estimate of Resident Civilian Population, 1940 66,570 Number of inhabited houses (end of 1940) according to Rate books 20,240 Rateable Value (1940) £924,736 Sum represented by a penny rate (1940) £3,693 -10- EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total Male Female Live (Legitimate 682 355 327 Births(Illegitimate 25 14 11 Totals 707 369 338 Birth Rate per 1,000 of the estimated population. 10.62 Total live births for calculation of Infant Mortality Rate, etc. 701 369 332 Stil1b1rths (Legitimate) 21 16 5 (Illegitimate) 2 2 - Totals 25 18 5 Rate per 1,000 total (live and still) births 28.53 Deaths 769 338 431 Corrected Death Rate per 1,000, of the estimated population 16.97 Deaths from puerperal causes:- Deaths Rate per 1,000 total (live and still) births. From puerperal sepsis 1 1.38 From other ptierperal causes 1 1.38 Total 2 2.76 Death Rate of infants under one year of age:- All infants per 1,000 live births 32.81 Legitimate infants per 1,000 legitimate live births 32.54 Illegitimate infants per l,OO0illegitimate live births 40.00 Deaths from measles (all ages) 1 " " whooping cough(all ages) 0 " " diarrhoea (under 2 years of age) 2 -11- POPULATION. The Registrar General estimated the civilian population of the Borough at the middle of 1940 to he 66,570, 1,200 less than at the same period of 1939. He also states that "estimates of the numbers and distribution of the non-civilian population are not available". The population and birth-rate figures are, therefore, not strictly comparable with those of previous years. BIRTHS - BIRTH RATE The nett total births accredited to the district was 707, a decrease of 73 on the preceding' year. Of these, 369 were males and 338 females (14 males and 11 females were illegitimate), although, as previously indicated, the Registrar General gives a total of 701 births for the calculation of the' Infant Mortality and certain other rates. The birth-rate for the year was 10.62 per 1,000 of the population. The birth-rate for England and Wales for 1940 was 14.6 and for the administrative County of London, 13.7 During 1940, the number of births recorded was 62 less than the number of deaths, as compared with an excess of 87 births in 1939. The total number of births actually registered in the district during the year amounted to 704, of which 15 were unnotified. The percentage of births notified was therefore 97.87 as compared with 98.6% in 1939. Two hundred and thirty two births were notified by midwives. MORTALITY. GENERAL MORTALITY AND DEATH RATE.- The nett number of eaths accredited to this district was 769, an increase ??? 76 as compared with the orevibus year -12- This gives a corrected death-rate of 10.97 per 1,000 of the population, an increase of 0.81 on the rate for the previous year, which was 10.16 The rate for England and Wales (1940) was 14.3 and for London 17.8 INFANT MORTALITY.- There were 23 (1 illegitimate) deaths of infants under 1 year of age, which gives an infantile death-rate of 52.81 per 1,000 births registered, as compared with 21 deaths and a rate of 26.92 in the preceding year. The corresponding rates for England and Wales and London were 55 and 50 respectively. STILLBIRTHS.- Twenty-three stillbirths, (2 illegitimate) were accredited to the district for 1940. This is equal to a death-rate of 28.55 per 1,000 (live and still) births registered, the corresponding figures for 1939 being 30 stillbirths, with a rate of 37.45 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 2.76 for 1940, representing a total of 2 deaths. In 1939 there were 4 deaths, with a corresponding rate of 4.99 MORTALITY OF "TODDLERS" . - Eight deaths occurred amongst children of the age group 1-5 years during 1940. This represents a death-rate of 0.12 per 1,000 of the population, and 1.04 per cent of the total deaths for the year, at all ages. In 1939 there were 2 deaths, giving a rate of 0.03 and a percentage of 0.29 MORTALITY OF PERSONS OVER THE AGE OF 65.- 56.56% of the total deaths during the year took place in persons over the age of 65. Fifteen females died at the age of 90 or over, the oldest being 100 years; while 3 males also died within this age period, the oldest being 93. -13- ZYMOTIC MORTALITY (including deaths from the seven principal zymotic diseases, viz: smallpox, scarlct 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 measles and 2 from infantile diarrhoea. The zymotic death-rate for 1940 was therefore 0.04 per 1,000 of the population, the same as in the previous year. 14 CAUSES OF DEATH DURING THE YEAR 1940. Causes of Death Male Female Total All Causes (Civilians only) 338 431 769 Typhoid & Paratyphoid fevers _ _ _ Cerebro-spinal fever 2 _ 2 Scarlet fever _ _ _ Whooping Cough. _ _ _ Diphtheria _ _ _ Tuherbulosils,Respiratory system 17 10 27 " other forms 4 1 5 Syphilitic diseases 3 1 4 Influenza 9 6 15 Measles _ 1 1 Ac.Poliomyelitis & Polioencephalitis _ _ _ Acl. Inf. Encephalitis , _ _ _ Cancer, oesoph. (M) uter|us (F) 6 6 12 11 stomach & duodenum 10 10 20 " breast _ 16 16 " other sites 25 39 64 Diabetes 3 5 8 Intra-cran: vase: lesiops 22 58 80 Heart disease 101 107 208 Other Circulatory diseases 9 11 20 Brpncliltis 23 22 45 Pneumonia 24 26 50 Other Respiratory diseases 6 6 12 Ulcer,stomach & duodenum 6 3 9 Diarrhoea urtd4r 2 years 1 1 2 Appendicitis 2 3 5 Other Digestive diseases 4 14 18 Nephritis 6 8 14 Puerperal sepsis _ 1 1 Other Maternal causes _ 1 1 Prematjure birth 5 3 8 Con:Malformations,Birth injuries,etc. 4 3 7 Suicidle 4 3 7 Road Traffic accidents 7 _ 7 Other violent causes 16 34 50 All other causes 19 32 51 -15- INFANTILE MORTALITY, 1940. 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 Diphther ia & Croup Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous diseases Meningitis (not tuberculous) Convulsions Laryngitis Bronchitis 1 1 Pneumonia 1 1 1 - 3 1 1 - 1 6 Diarrhoea Enterttis 1 1 Gastritis Syphilis Rickets Suffocation Want of Attention and Injury at Birth Atelectasis 2 2 2 Congenital Malformations 1 1 Premature Birth 7 1 8 8 Atrophy, Debility & Marasmus Other Causes 1 1 2 1 1 4 Totals 11 2 2 - 15 3 3 1 1 23 -16- 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, having due regard to present circumstances, ISOLATION HOSPITAL. - As stated in my last Annual Report, certain scheduled alterations and improvements at the Isolation Hospital have been of necessity postponed. Every effort has been made, however, to maintain the hospital in a state of efficiency, and no essentials have been neglected. CLINICS and TREATMENT CENTRES. MATERNITY AND CHILD WELFARE (Southgate Council). At 31st December, 1940. Infant Welfare:- Methodist Church,The Bourne, Southgate. Monday 2-4 Methodist Church,Palmerston Road, Bowes Park. )Tuesday 2-4 )Wednesday 2-4 Methodist Church, Green Banes, Winchmore Hill. Thur sday 2-4 De Bohun School Clinic, Green Road, Southgate. Friday 2-4 Pre-Natal. Methodist Church,Palmerston Road, Bowes Park. )Wednesday 10-12 )Thursday 10-12 -17- Post-Natal. Methodist Church, Palmerston Road, )First Tuesday in Bowes Park. )eacli month, 10-12 IMMUNISATION (against diphtheria) CLINIC - (Southgate Council) Tovm Hall, Palmers Green. Thursday 2-4 The Tuberculosis, Venereal Disease.apd 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 arrangement's in the Report for .1930. 'AMBULANCE FACILITIES. - The . details set out in' t.he Annual Report for 1935, as amended by the alterations referred to in the Reports for 1936 and 1939 still obtain. MORTUARY. - During 1940, 48 bodies wer.a. 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'srlaboratory, and at other laboratories to which Material was sent during 1940. 'work carried out at the Council's laboratory: HOSPITAL Posit ive Negative BOROUGH Positive Negative Swabs for Diphtheria bacilli 78 1534 14 446 -18- Swabs for Vincents Angina - - - 1 Swabs for Haemolytic streptococci - - - 19 Sputa for Tubercle bacilli - 2 15 116 Pus for Tubercle bacilli - - - 1 Total 2,225 (1939, 3r507) The decrease in the work carried out at the laboratory was due to the continued small number of patients treated at the Isolation Hospital. Specimens sent to Clinical Research Association; Faeces for Typhoid Negative 10 Positive 1 Blood 11 " " Negative 9 Positive 4 Cerebro-spinal fluid " 1 Specimens sent to laboratory at the Prince of Wales's Hospital. Cerebro-spinal fluid Negative 2 Positive 4 Swabs for meningococci Negative 43 Positive 6 (17 negative & 6 positive were military contacts) Swab from eye for gonococci Faeces for Typhoid Negative 1 2 Blood Positive 1 Negative 4 " " blood count 1 Pleural fluid 1 Pus for staphylococcus aureus Positive 1 " " tubercle bacilli Negative 1 -19- BACTERIOLOGICAL EXAMINATION OP MILk. One hundred and sixty-one samples of milk were examined during the year, all of which were satisfactory. MATERNITY AND CHILD" WELFARE SERVICES, STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1940. Number on Registers:- Under 1 year Over 1 year Totals 1940 1939 January 1st, 1940 368 609 977 1,087 December 31st, 1940 1050 1209 2,259 2,130 New cases during 1940 682 600 1,282 1,043 97 of the new cases under 1 year were "removals" into , ther dis.tr ict. The remaining 585 represent 82.74 per cent of the total births credited to the district. ATTENDANCES AT CENTRES. 1940. Under 1 year Over 1 year Totals Sessions. The Bourne 1901 1371 3272 51 Bowes Park (Tues) 2206 2006 4212 52 " (Wed) 1979 1576 3555 51 inchmore Hill 2171 1743 3914 51 De Bohun 1042 1519 2561 50 Totals 1940. 9299 8215 17514 255 1939. 10157 7607 17764 258 Average 1940. 33.47 32.21. 68.68 1939 39.36 29.49 68.35 -20- STATISTICS OF ATTENDANCES AND WORK DONS AT PRE-NATAL C3NTRS. Number on Register 1940. 1939. January 1st 97 92 December 31st 82 95 New cases during the year 301 285 Number of sessions held 100 61 Total attendances 1912 1092 Average per session 19.12 17.9 POST NATAL CLINIC. The Post Natal Clinic referred to in my last Annual Report was continued throughout the year. The following figures give details of the attendances, but are obviously an inadequate indication of the benefit derived by attendance at such a Clinic. New cases 72 Attendances 91 Sessions 12 Average 7.58 Three sessions of a special clinic for TODDLERS were held, at which .38 children attended. -21- TABLE OF VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OF BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. Children: 1940. 1939. First visits 430 517 Under 1 year of age 626(In addition to) 914 Over 1 year of age 2305(first visits) 2850 Visits re: Deaths under 5 years of age – 6 Stillbirths 3 11 Ophthalmia Neonatorum – – Dental cases – 108 Pre-Natal visits 276 606 Special visits ( test feeds, following up special cases seen by M.O. at Centres, failing lactation, etc.) 1154 753 Totals 4,794 5 ,765 CHILD LIFE PROTECTION - The following is a summary of the work carried out in this connection during 1940 Number of registered Foster Mothers 15 Number of Foster children on register during the year 21 Number of Foster children at end of year 15 Number of visits paid by Health Visitors 103 No unsatisfactory conditions were mot with throughout the year. -22- MILK (MOTHERS & CHILDREN) ORDER. Number of cases in which milk was granted: 1936 1937 1938 1939 1940 241 305 352 362 351 Total quantity of milk distributed 1940,(7 months) 7786 gallons (approx) Approximate cost: £ £ £ £ £ 776 964 1024 1145 876 The distribution of milk under this Order was discontinued on July 31st. The scheme of the Ministry of Food for the provision of milk free or at reduced rate to expectant mothers, nursing mothers and children under 5 came into operation at that time. Dried milk continued to be issued throughout the year, 6764 lbs (approx) being distributed free or at cost price. DENTAL TREATMENT.- Number of "Council" patients aft attending the Eastman Dental Clinic, 1940 ' Children 62 Mothers 45 Cost of such cases £53 HOLE HELP SCHEME.- The following table sets out the details of the work carried out under the above scheme during 1940. Number of Home Helps provided free of charge 51 3 for 21 days 43 " 14 " 3 " 13 " 1 " 11 " 1 " 10 " -23- Additional payment to Home Help for children in excess of 6 2 Additional payment to Home Help for night attendance 1 Days worked without charge to patients, 1939 711 1940 725 Number of Home Helps provided at charge of l/- per day 9 8 for 14 days 1 " 12 " Days worked at charge of l/- per day, 1939 238 1940 124 Number of Home Helps provided at charge of 2/- per day 10 10 for 14 days Days worked at charge of 2/- per day, 1939 126 1940 140 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 1940 14 Number of Home Helps provided at charge of 5/- per day 4 1 for 21 days 3 for 14 days Additional payment to Home Kelp for night attendance 1 Days worked at charge of 5/- per day, 1939 42 1940 63 24 Total number of days worked during 1939 1131 1940 1068 Total number of cases 1939 79 1940 75 Total cost of operating the scheme,1939 £245. 10. 6. 1940 £230. 18. 9. Average number of Home Helps on Council's roll, 10. MATERNITY OUTFITS.- Sterilized maternity outfits were supplied to expectant mothers during 1940, as follows: 17 at cost price. 51 free of charge, 1 at a charge of l/-(costing-£18.14.8. 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). No additional retailers were registered during the year. Under the Milk (Special Designations) Order, 1936, 31 Dealers' Licences, 18 Supplementary Licences, and 1 Pasteuriser's Licence were granted. MEAT AND OTHER FOODS.- Butchers shops are visited frequently and the bakehouses, fish,fruit and grocers shops are kept under observation. -25- Since the commencement of the war, there has been little or no slaughtering of animals for human consumption at the 4 private slaughterhouses in the Borough which have continued to be licenced for this purpose. The premises at Winchmore Hill which were taken over as a distributing depot of the London Meat Market,have been extensively used throughout the year. During 1940. no less than 370,389 carcases were dealt with there, as follows: Pigs 11,314; Sheep & Lambs 327,380; Calves 7,239; Bovines 24,456. The total for 1939 was 87,167 carcases, comprising seven months' slaughtering at private slaughterhouses and five months' working at the distributing depot. The amount of unsound meat surrendered and destroyed during the year owing to diseased condition was 26,348 lbs (11 tons 15 cwts 1 qr.) In addition, 98 lbs cod fillet, 56 lbs cod(headless) 161 lbs herrings 90 lbs smoked haddock, 77 lbs skate, 1 box of roe, 8 doz. escollops and 36 tins of pineapple were also surrendered and destroyed as unsound. Several tons of food stuffs were condemned and destroyed owing to contamination by broken glass, following enemy action. -26- -27- SANITARY INSPECTIONS 1940. Housing Inspections & Re-inspections. 2,319 Registered premises, including factories, workshops, bakehouses, milk shops and other food shops - Visits & Inspections. 2,253 Infectious Disease - Visits & Inspections. 1,536 Miscellaneous Visits & Inspections, including various complaints, Rats & Mice Destruction Act, ditches and ponds, non-notifiable diseases, etc. 21,377 Visits re Verminous premises 318 27,805 SERVICE OF NOTICES. Total informal sanitary notices served 1,282 Total informal dustbin notices served 316 Total informal notices served 1,598 Total informal notices complied with 1,160 Total statutory notices served 6 Total statutory notices complied with 6 SANITARY IMPR0VEMENTS. - The following is a summary of the sanitary improvements effected, and the defects remedied: Housing: Premises cleansed; ceilings repaired, distempered; walls repaired, redecorated 1,597 Dampness remedied; floors repaired; air gratings fixed; floor ventilation, lighting and ventilation improved 397 Roofs, gutters, rainwater pipes repaired 312 Yards repaired or repaved 39 Window frames, door frames, sash cords repaired or renewed 220 Brickwork repaired or repointed 71 Cooking ranges, firegrates repaired or renewed 55 Sinks,waste pipes repaired or renewed 82 Staircases, internal woodwork, food stores, coal sheds repaired 19 Water supply: draw taps, storage cisterns, new taps fitted, pipes repaired, coppers repaired or renewed 115 Drainage repairs and renewals, including:Inspection 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 285 Sanitary accommodation improved:- W.C. pans renewed; seats, flushing cisterns, flush pipes, cone joints repaired or renewed; W.C's repaired or newly constructed 294 New dustbins provided 343 Dairies, Cowsheds, Slaughterhouses and Bakehouses limewashed, etc. 12 Factories, Workshops and Shops:- repairs and renovations 140 Miscellaneous sanitary defects remedied and complaints investigated 515 HOUSE-TO-HOUSE INSPECTIONS.- Five hundred and forty nine houses were inspected and recorded under the Housing Acts, as compared with 609in 1939. REMISES UNDER PERIODICAL INSPECTION- The following Premises are inspected from time to time, and, as in previous years, they were found to be kept satisfactorily. -28- Description of Premises. No, in District. Dairies and Millcshops 46 Cowsheds 2 Bakehouses 20 Dining Rooms 51 Slaughterhouses 4 Fish Shops 26 Factories and Workshops 210 Public House Conveniences 24 Grocers 125 Greengrocers 55 Butchers 55 Confectioners 31 Hairdressers 44 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. Under the bye-laws governing this class of establishment, the following licences and exemptions were granted during 1940: Two new licences, 12 renewals of existing licences, and 5 exemptions to members of the medical profession and/or the Chartered Society of Massage and Medical Gymnastics. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Five hundred and ninety one cases of infectious disease were notified during the year, as against 147 in 1939 and 256 in 1938. The Infectious Sickness Rate for the district was 8.88, as against 2.17 in 1939 and 3.8 in 1938. -29- SMALLPOX. Wo cases of smallpox occurred in the district during 1940. SCARLET FEVER. Forty-one cases were notified during 1940, as compared with 42 in 1939. The 1940 total is one of the lowest recorded in Southgate. DIPHTHERIA. Twenty-one cases of diphtheria were notified during 1940, as against 6 in 1939 and 26 in 1938. Nineteen cases were removed to the Isolation Hospital, together with 1 diphtheria "carrier" and 6 suspected cases. There were no deaths. IMMUNISATION: (a) against Diphtheria.- Six hundred and fifty-six persons attended for immunisation during 1940, at the weekly clinic held at the Town Hall; or at the school visited during the year. This compares with a total of 238 for the previous year. The school selected for immunisation was Winchmore School, at which 82 children attended. In addition to the above, Winchmore School was also visited for the purpose of carrying out re-Schick tests, following -immun±sation sessions conducted earlier in the year. 72 children were so tested. The total attendances for immunisation during 1940 was 2,206 as compared with 1,382 in 1939. The total for 1940 (656) is the largest number of immunisations carried out in any one year since the Clinic was started in 1933, with the exception of the first year, when an outbreak of diphtheria and other contributory circumstances resulted in a total of 740 persons attending for immunisation. -30- Comparison of the 1940 attendances with those of 1939 might give a somewhat false impression, owing to the fact that the outbreak of hostilities seriously interfered with the work of the Clinic. During the first few months of 1940, the pre-1939 standard was regained. Later in the year, undoubtedly as a result of general and local intensified propaganda, the numbers still further increased, particularly in November and December. The increase in the number of immunisations is most gratifying, especially at the present time, when abnormal conditions resulting from the war greatly magnify the risk of widespread epidemics. At the time of writing this report, it is quite evident that the figures for 1941 will easily surpass anything yet attained in Southgate. It should however be pointed out that these results give no grounds whatever for complacency, but should rather act as an incentive to even greater effort. The total number of persons attending the Clinic for immunisation from the commencement of the scheme in March 1933, until December 31st, 1940, has been 3,672. (b) against Typhoid.- Immunisation against typhoid was carried out at the Isolation Hospital to a limited extent during 1940. Members of the Casualty Services personnel numbering 60 were so protected. (c) against Colds.- Inoculation against the common cold has been offered to members of the Town Hall Staff for several years past. The number of persons inoculated during 1940 numbered 75. TYPHOID FEVER (including Paratyphoid). Eight cases of typhoid fever were notified during the year, as against 1 in 1939. -31- PUERPERAL PYREXIA. Five cases of puerperal pyrexia were notified during the year, as against 4 in 1939. In addition to these notified cases, the Registrar General reported two maternal deaths which occurred in institutions outside the district. ERYSIPELAS. Twenty-two cases of erysipelas were notified during the year, compared with 9 in 1939 and 24 in 1938. TUBERCULOSIS. Thirty-seven cases of pulmonary and 11 cases of non-pulmonary tuberculosis were notified during the year, the corresponding figures for 1939 being, pulmonary 41, non-pulmonary 11. In addition to these notified cases, 26 patients ( 22 pulmonary) were entered in the register, including 10 restored to the register, these cases with the exception of those restored to the register, being new residents in the district, previouslynotified elsewhere. SCABIES AND LICE. The incidence of scabies infection and pediculosis is still unusually low in this district. It is estimated that of the children with whom officers of the Local Authority come into contact, e.g. those attending the Welfare Clinics, those visited by the Health Visitors or those admitted to the Isolation Hospital, less than 1% are affected. It has, therefore, been considered unnecessary to provide a cleansing station within the Borough. Arrangements have, however, been made with a neighbouring Council for the treatment, at a moderate charge, of such cases as are reported or discovered. During 1940, no case was sent for treatment. DISINFECTION AND DISINFESTATION. The following is a summary of the work carried out under this heading during the year. 32 Total number of rooms disinfected 425 Total number of articles of bedding, etc. disinfected 2,178 Total number of articles destroyed 193 Total number of library books disinfected 174 Total amount received in respect of disinfection of bedding, by request, after non-notifiable disease £6. 0. 0. Number of verminous houses disinfested 159 Number of rooms disinfested 428 In addition to the above, a large number of blankets and pillows used by the Casualty Services and Auxiliary Fire Service Personnel have been regularly disinfected. The number of blankets and pillows disinfected in this connection during 1940 was as follows: Casualty Services Personnel 5,367 Auxiliary Fire-Service Personnel 2,165 Homeless Persons 200 7,732 A further duty placed upon the disinfection staff has been the frequent disinfection of public shelters, particularly during the period when shelters were in constant use by large numbers of the public. ISOLATION HOSPITAL. The number of patients treated in hospital during 1940 was 381, as against 334 during 1939, and 562 during 1938. (This number comprises all patients admitted during the year, together with those in hospital on 1st January, 1940). The following table sets out the number of patients admitted to the hospital during 1940, and the areas from which those patients were admitted: 1939. 1940. Southgate 67 101 Tottenham 258 150 Wood Green -– 1 Hornsey -- 1 Middlesex County Council - - 4 Refugees — - 4 Military Authorities —– 111 325 372 It will be seen from this table that, but for the admission of 111 military cases, the total patients admitted would have been considerably below the figure for 1939. 34 The diseases for which the 372 patients were admitted during 1940 were as follows: Scarlet fever 77 Scarlet fever & Diphtheria 1 Scarlet fever & Bronchitis 1 Diphtheria 41 Diphtheria "Carriers" 2 Diphtheria & Pneumonia 1 Erysipelas 13 Typhoid fever 5 Dysentery 1 Puerperal Pyrexia 4 Baby with mother 3 Pneumonia (incl. Influenza) 45 Measles 35 Measles & Bronchitis 12 Measles & Pneumonia 5 Measles & Ulcerative Colitis 1 Measles, Mumps & Otitis Media 1 Measles & ? Mastoid 2 Mother with child 1 German Measles 82 German Measles & Bronchitis 1 German Measles & Appendicitis 1 Whooping Cough 2 Whooping Cough & Pneumonia 2 Chicken pox 2 Cerebro-spinal Meningitis 6 Cerebro-spinal Meningitis "Carrier" 1 Others 24 DEATHS. Five deaths took place during the year, as compared with 2 in 1939. These 5 deaths occurred from the following diseases: Diphtheria 1 (Tottenham patient, aged 6) Cerebro-spinal Meningitis 2 (1 Southgate patient,aged 1½) (1 Tottenham patient,aged 15) -35- Pneumonia & whooping cough 1 (Tottenham patient aged 6 months) Pneumonia, measles & septicaemia 1 (Southgate patient aged 3) These 5 fatal cases give a mortality rate of 1.3% of the total cases treated, as compared with 0.6% in 1939, a figure which Was exceptionally low. OPERATIONS. No major operations were carried out during 1940. One minor operation for redraining an old mastoid infection was performed. NUMBERS IN HOSPITAL. The daily average of patients treated in hospital during each month of 1940 was as follows: January 9.32 July 15.16 February 29.79 August 15.74 March 19.36 September 17.63 April 10.96 October 17.58 May 11.19 November 16.63 June 13.50 December 26.87 Average 16.98 The daily average number of patients treated (16.98) shows a decrease from that for the previous year, which was 30.03. The highest and lowest numbers of patients in hospital on any one day during 1940 were as follows: Highest (February llth) 43 Lowest (January 19th ) 6 36 GENERAL. Although the daily average of patients in hospital during 1940 was little more than half the daily average for 1939, the total number of patients admitted in 1940 shows an increase over the total for the previous year. This indicates shorter periods of detention in hospital, with more frequent admissions and discharges. The work of the hospital generally was considerably greater as compared with the preceding year. The increase was outstandingly noticeable in connection with the laundry. In addition to the normal hospital laundry, vast quantities of linen, etc., including some 1600 blankets, 4200 towels, 300 sheets,3400 pillow cases, etc., were washed and laundered for the various sections of the Civil Defence Personnel. -37- Notified Cases of Infectious Diseases, 1940. Diseases. Totals Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Deaths Smallpox -– Diphtheria 21 – – 1 1 1 – – 1 – 1 4 12 – Scarlet fever 41 1 2 — 3 6 1 6 7 2 5 4 4 – Typhoid fever 8 - – 1 2 - 2 1 1 - – – 1 – Dysentery 1 – – — — – – 1 — – – — — — Puerperal Pyrexia 5 – 1 1 – – 1 – 1 – 1 – – 2 Erysipelas 22 1 1 - 2 - 3 1 2 6 2 2 2 – Ophthalmia Neonatorum 1 – – – – – – 1 – – – – – – Measles 347 5 12 8 9 2 6 7 14 82 66 24 112 1 Whooping Cough 58 1 – - 1 6 21 - - 2 3 6 18 – Acute Poliomyelitis –– Cerebro-spinal Meningitis 2 - – — – 1 1 – – – – – – 2 Ø Pneumonia 36 4 7 12 3 1 2 1 — 1 2 2 1 50 || Tuberculosis Pulmonary 37 – 4 1 3 4 2 8 3 4 3 3 2 27 Non-Pulmonary 11 1 2 1 – - – - 2 1 1 - 3 5 Totals 591 13 29 25 24 21 39 26 31 98 84 45 156 87 Ø 1 of these was an un-notified case occurring outside the Borough. || Including all forms of pneumonia, notifiable & non-notifiable. REGISTER OF TUBERCULOSIS CASES. Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register 1. 1. 40 118 96 28 28 270 Cases Notified for first time,1940 23 14 3 8 48 Cases Restored to Register 4 4 1 1 10 Other cases added 8 6 1 1 16 Cases Removed from Register 32 24 3 2 61 Remaining on Register, 31.12.40 121 96 30 36 283 -39- TUBERCULOSIS, 1940 Age Periods" - / New Cases Deaths Pulmonary -Non- Pulmonary Pulmonary NonPulmonary M... - \F... - f M. p. M. F. M. F. Under 1 yr. • j __ ^ iL. -. 1 - 5 yrs. ; - 1- i -i — 1 5 - 1- 0- u \ 41 i- ; I ■ — 1 10- 15 1" i i 15- 20 " 4 5 ; 1 I H 20- 25 " -4 ! 5 j 1- S 2 2 2 t ■1 25-35 " 11 _ 7 1 2 2 3" 1 35- 45 " 10; 6 2 11 2 2 1 45- 55 " 4 2 ■ «• ; i . i A -V 2 1 55- 55 i _ . L— i -- 4 —1— 1 1 ; 65 & over 3 Totals 34 24 6 10 17 10 4 1 /These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. 1-0-