Soug 26 AC. 439 (1) South cate Borough of Southgate Annual Report of the Medical Officer of Health 1941 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, In accordance with instructions received from the Ministry of Health, this Report has been severely curtailed, only information of an essential character being included. It is becoming increasingly difficult to gain accurate information from a comparison of the vital statistics relating to a series of years. Movements of the population today are complex and bewildering, so much so that any estimate of the population of an area must of necessity be arbitrary. This means that vital statistics no longer have the comparative value of previous years, when it was quite easy to guage the health of a district by comparing the statistics of one year with its predecessors. Specific points brought up by this statistical difficulty will be referred to later in the Report. Broadly speaking, we can be very satisfied with the health of the community in 1941. The general health picture is good, and gives no ground for pessimism or alarm. Nutrition appears to be satisfactory, the resistance of the individual to infectious disease has been maintained at a very much higher level than many of us expected, while the increased use being made of health services is one of the most satisfactory features of war-time public health. The following points relating to the health of the Borough would appear to merit special consideration: - 1 - Birth. Rate. The Birth Rate once again showed a slight fall during the year, from 10.62 in 1940 to 9.97. It is difficult to explain this fall, especially when the attendances at our Maternity and Child Welfare Centres are noted, but this latter fact is explained by the increased proportion of mothers attending the Centres. Still Birth Rate. The Still Birth Rate for 1941 shows a slight rise, from 28.53 in the previous year to 34.71. In spite of this rise, the total number of still births recorded during the year fell from 25 to 22, once again showing the danger of comparative statistics Death Rate. The Death Rate for 1941 was 11.27 as against 10.97 in 1940. This compares with a London Death Rate of 13.5 and a Death Rate for England & Wales of 12.9 Infant Mortality. The Infant Mortality Rate for 1941 was 40.91, as against 52.81 in the previous year, comparing with a similar rate for England & Wales of 59, and for London, of 68. The fact that the Registrar General asks us to base our calculations on a lesser number of births than those actually credited to the district, throws our Infant Mortality Rate out of balance. This is shown very clearly when it is realised that the total number of deaths of children under the age of 1 year was only two more in 1941 than in 1940 (25 as against 23). Maternal Mortality. The Maternal Mortality Rate was 5.16 for 1941, as against 2.76 in 1940. The number of deaths was the same each year, i.e. 2. Maternity & Child Welfare. From the various tables set out under the heading "Maternity and Child Welfare Services" on page 17 et seq.,it will be seen that - 2 - the attendances at our Centres are steadily rising. This applies equally to our Child Welfare Clinics, as to our Pre-Natal and Post-Natal Centres'. This is a matter for considerable satisfaction, as at no time has it been more essential to pay the strictest attention, to our child population. Although the matter belongs to 194-2 rather than 1941, it may perhaps not be out of place to state here that" additional clinics are being arranged to meet the increased demand, while extra assistance is also being engaged. Control of Infectious Diseases. The Infectious Sickness Rate for 1941 was 19.59 as against 8.88 in 1940. This figure need give no cause for alarm, as the increase was almost entirely due to the fact that 1941 was an epidemic year so far as measles and whooping cough were concerned. In addition to a very marked increase in measles and whooping cough notifications, scarlet fever, pneumonia and tuberculosis were slightly more prevalent in the district, while diphtheria notifications decreased. The rise in pneumonia notifications was to be expected in view of the prevalence of measles and whooping cough, while the increase in the notifications of tuberculosis was not excessive. Apart from measles and whooping cough, the district was free from anything in the nature of an epidemic. Work of Sanitary Inspectors. The work of the Sanitary Department will be found on pages 21 to 23. Prom the tables there enumerated it will be observed that the number of visits paid during the year fell slightly, although they are still above pre-war level. House-to-house inspections decreased, due almost entirely to the fact that this work has, for the time being, lost a great deal of its significance. So long as permission cannot be obtained to acquire the — 3 — necessary materials to carry out alterations and improvements to house property, it is of very little use asking Sanitary Inspectors to spend any more than the minimum time on such duties. It need scarcely be pointed out that this situation is far from satisfactory. Every effort has been and will be made to deal with major housing defects, but we cannot justifiably demand materials which are of prime importance to the war effort. The remarks set out above also explain the decrease in the number of notices served. Meat and food inspection still occupies a great deal of time, the importance of which cannot be gainsaid. Conclusion. Our previous policy so far as the Public Health Department is concerned, was continued during 1941, i.e. to maintain essential Public Health services while omitting anything which savoured of embroidery. As noted earlier in this Report, it is exceedingly difficult to guage with any degree of accuracy the health of such an urbanised community as Southgate, but I think it would be safe to state that our health index is high and that it shows no present sign of falling. 1940 presented us with the problem of air raid shelters in extensive use; the problem of 1941 is more that of women in industry. For the first time in its recorded history, the women of Southgate are being absorbed into essential industries in one shape or another. This absorption brings with it a variety of problems, all of which demand adequate solution. The solution to one aspect of the problem - the provision of day nurseries - is already being found, but it is too soon yet to say what final effects this radical alteration in the life and organisation of our community will have upon its - 4 - general health. Up to the present, we have met our problems and overcome them; it now only remains to readjust our outlook to the ever-changing situation and to plan, so far as lies within our power, for the future. In conclusion, I would tender my sincere thanks to the members of the Borough Council and the Public Health Staff for their assistance and support throughout the year. We can only meet the present situation by adequate team work, and I am happy to state that 1941 revealed the existence of this team work to a very marked degree. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY. Medical Officer of Health. Southgate Town Hall October, N. 13. 1942. - 5 - PUBLIC HEALTH COMMITTEE at December 31st, 1941. Alderman G. Peverett (Chairman) His Worship the Mayor (Councillor T.J. Oldland,J.P.) Alderman V.J. Westlake (Vice Chairman) Councillor W.A. Clarke Councillor Victor Dover Councillor Mrs. E.L. Mason Councillor J. Owers Councillor Mrs. C.M.A. Vandy MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1941. Councillor Mrs. C.M.A. Vandy (Chairman) His Worship the Mayor (Councillor T.J. Oldland,J.P.) Alderman G. Peverett Councillor J.H. Barker Councillor Mrs. D.M. Gipp (Vice Chairman) Councillor J.W. Kimber Councillor A.E. Lauder Councillor Mrs. E.L. Mason Councillor W. Saxon CO-OPTED MEMBERS. Miss H.M. Corry Mrs. Victor Dover Mrs. G. Pheasey Dr. L. Westlake 6 - JOINT HOSPITAL MANAGEMENT COMMITTEE at December 31st, 1941. SOUTHGATE REPRESENTATIVES Alderman 6. Peverett (Chairman) Alderman V.J. Westlake Councillor w.A. Clarke Councillor Mrs . C.M.A. Vandy TOTTENHAM REPRESENTATIVES Alderman A.R. Turner Alderman R.H. Warren. Councillor C.J. Hurd Councillor Mrs. G.E. Morrison PUBLIC HEALTH STAFF Ø Medical Officer of Health and Medical Super intendent, 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 (Novl District); L.Slceeles, Cert. R.San.I.,M.S.I.A.,Cert R.San. I.Meat Inspection. 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. - 7 - Chief Clerk. P.E. Barber Clerk Miss M. Munch Clerk: Miss K. Stoten Health Visitors; Ø Miss E.M. Hart,S.R.N.,S.C.M.,H.V. (Maternity & Ø Miss M. Maddock,S.R.N.,S.C.M.,H.V. Child Welfare) Ø Miss A. Joy,S.R.N.,S.C.M.,R.F.N.,H.V Health Visitor: Miss B.S. Wellman,S.R.N. ,S.C.K., (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. STATISTICS OF THE AREA - Area (in acres) 3,764 Registrar-General's estimate of Resident Civilian Population, 1941 64,890 Number of inhabited houses (end of 1941) according to Rate Books 20,267 Rateable Value (1941) £926,138 Sum represented, by a penny rate (1941) £3,665 - 8 - EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total Male Female LIVE ( Legitimate 625 312 313 BIRTHS ( Illegitimate 22 15 9 Totals 547 325 322 Birth Rate per 1,000 of the estimated population..9.97 Total live births for calculation of Infant Mortality Rate, etc. 611 305 306 STILLBIRTHS ) Legitimate 22 9 13 ) Illegitimate — - -- -- Rate per 1,000 total (live and still) births 34.75 DEATHS from all causes and at all ages 771 374 397 Death Rate per 1,000 of the estimated population 11.28 Deaths from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. From puerperal sepsis 0 0.00 From other puerperal causes 2 3.16 Deaths of Infants under 1 year of age - Total Male Female Legitimate 24 13 11 Illegitimate 1 1 -- Total 25 14 11 infant Death Rates:- All infants per 1,000 live births 40.91 Legitimate - per 1,000 legitimate live births 40.74 Illegitimate - per 1,000 illegitimate 1ive births 45.45 - 9 - Deaths from measles (all ages) 0 " " whooping cough (all ages) 0 " " diarrhoea (under 2 years of age) 0 POPULATION The Registrar General estimated the civilian population of the Borough at the middle of 1941 to be 64,890, 1,680 less than at the same period of 1940. 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 2 BIRTH RATE. The nett total births accredited to the district was 647, a decrease of 60 on the preceding year. Of these, 325 were males and 322 females (13 males and 9 females were illegitimate), although, as previously indicated, the Registrar General gives a total of 611 births for the calculation of the Infant Mortality and certain other rates. The birth-rate for the year was 9.97 per 1,000 of the population. The birth-rate for England and Wales for 1941 was 14.2 and for the administrative County of London, 8.9 During 1941, the number of births recorded was 124 less than the number of deaths, as compared with 62 in 1940. The total number of births actually registered in the district during the year amounted to 584, of which 9 were unnotified. The percentage of births notified was therefore 98.46 as compared with 97.87% in 1940. Two hundred and nine births were notified by midwives. -10 - MORTALITY. GENERAL MORTALITY AND DEATH RATE.- The nett number of deaths, accredited to this district was 771, an increase of 2 as compared with the previous year. This gives a death-rate of 11.28 per 1,000 of the population, an increase of 0.31 on the rate for the previous year, which was 10.97 The rate for England and Wales (1941) was 12.9 and for London 16.3 INFANT MORTALITY.- There were 25 (1 illegitimate) deaths of infants under 1 year of age, which gives an infantile death rate of 40.91 per 1,000 births registered, as compared with 23 deaths and a rate of 32.81 in the preceding year. The corresponding rates for England and Wales and London were 59 and 68 respectively. Of the 2 5 infant deaths during 1941, 14 or 56% occurred within the first week of life, while the total deaths under 1 month numbered 19 or 76% Seven of these deaths were due to prematurity, 7 to pneumonia and 2 to bronchitis. STILLBIRTHS.- Twenty-two stillbirths, (0 illegitimate) were accredited to the district for 1941. This is equal to a death-rate of 34.75 per 1,000 (live and still) births registered, the corresponding figures for 1940 being 23 stillbirths, with a rate of 28.5-3 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 3.16 for 1941, representing a total of 2 deaths. In 1940 there were 2 deaths, with a corresponding rate of 2.76 - 11 - MORTALITY OP "TODDLERS" Eight deaths occurred amongst children of the age group 1-5 years during 1941. 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 1940 the numbers were exactly the same. MORTALITY OF PERSONS OVER THE AGE OF 65.- 57,97% of the total deaths during the year took place in persons over the age of 65. Seven females died at the age of 90 or over, the oldest being 94 years; while -3 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)). For the first on record there were no deaths in this category during the year. The zymotic death-rate for the year 1940 was 0.04 per 1,000 of the population, when there were 3 deaths. 12 - CAUSES OF DEATH DURING THE YEAR 1941. Causes of Death Male Female Total All Causes (Civilians only) 374 397 771 Typhoid & Paratyphoid fevers - - - Cerebro-spinal fever - 1 1 Scarlet Fever - - - Whooping Cough - - - Diphtheria - - - Tuberculosis, Respiratory system 20 12 32 " ,Other forms 4 1 5 Syphilitic diseases 1 1 2 Influenza 2 5 7 Measles - - - Ac. Poliomyelitis & Polioencephalitis - - - Ac. Inf. Encephalitis 1 - 1 Cancer, oesoph.(M) uterus (F) 7 6 13 " stomach & duodenum 11 9 20 " breast - 18 18 other sites 37 39 76 Diabetes 1 2 3 Intra-cran:vasc: lesions 24 50 74 Heart Disease 91 99 190 Other Circulatory diseases 7 12 19 Bronchitis 22 16 38 Pneumonia 25 23 48 Other Respiratory diseases 5 4 9 Ulcer, stomach or duodenum 10 3 13 Diarrhoea under 2 years - - - Appendicitis 6 1 7 Other Digestive diseases 3 11 14 Nephritis 13 8 21 Puerperal sepsis - - - Other Maternal causes - 2 2 Premature birth 2 5 7 Con: Malformations,Birth injuries,etc. 9 5 14 Suicide 5 2 7 Road Traffic Accidents 6 3 9 Other violent causes 29 40 69 All other causes 33 19 52 -13- 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, every effort has been made to maintain the hospital in a state of efficiency, and no essentials have been neglected. Towards the end of the year it became increasingly obviotus that the steam disinfector, which had been in an unsatisfactory condition for some time, was beyond all hope of repair. Steps were therefore taken to provide a larger,modern disinfector. CLINICS and TREATMENT CENTRES. MATERNITY AND CHILD WELFARE (Southgate Council). At 31st December, 1941. Infant Welfare:- Methodist Church, The Bourne, Southgate. Monday 2-4 Methodist Church, Palmerston Road, Bowes Park. Tuesday 2-4 Combined Clinic, Bowes Road, New Southgate. Wednesday 2-4 Methodist Church, Green Lanes, Winchmore Hill. Thursday 2-4 De Bohun School Clinic, Green Road, Southgate. Friday 2-4 14- Pre-Natal. Combined Clinic, Bowes Road, New Southgate. Wednesday 10-12 Methodist Church, Palmerston Road, Bowes Park. Thursday 10-12 Post-Natal. Combined Clinic, Bowes Road, First Tuesday in New Southgate. each month, 10-12 IMMUNISATION (against diphtheria) CLINIC - (Southgate Council) Town Hall, palmers Green. Thursday 2- 4 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 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 Reports for 1936 and 1939 still obtain. MORTUARY. - During 1941, 45 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 1941. -15- Work carried out at the Council's laboratory: HOSPITAL Positive BOROUGH Positive Negative Negative Swabs for Diphtheria bacilli 106 1822 14 . 275 - Swabs for Vincents Angina - 1 - - Swabs for Haemolytic Streptococci - 2 - 30 Sputa for Tubercle bacilli - - 10 129 Total 2,389 (1940. 2,226) Specimens sent to Clinical Research Association; Faeces for Typhoid - Negative 7 positive 4 Blood " " Negative 5 Nasopharyngeal swab Negative 1 Sputum for tubercle bacilli Negative 1 Specimens sent to laboratory at Prince of. Wales's Hospital. Cerebro-spinal fluid Negative 4. Positive 7 Swabs for meningococci Negative 12 Faeces for typhoid " 3 " " dysentery Positive 1 Blood for typhoid Negative 4 " " paratyphoid Positive 2 " " dysentery Negative 1 " " blood county etc. 1 Urine for staphylococcus aureus Positive 1 Pus " " " Positive 2 Swab " " " Negative 1 Swabs for virulence test Negative 2 Negative swabs 4 Swab for K.L. B. Negative 1 Swabs for haemolytic streptococci " 3 -16- MATERNITY AND CHILD WELFARE SERVICES. STATISTICS OP ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1941. Number on Registers: - Under 1 year Over 1 year Totals 1941 1940 January 1st, 1941 360 725 1085 977 December 31st, 1941 1028 1292 2320 2259 New cases during 1941 668 567 1235 1282 122 of the new cases under 1 year were "removals" into the district. The remaining 546 represent 84,4 per cent of the total "births credited to the district. ATTENDANCES AT CENTRES. 1941. Under 1 year Over 1 year Totals Sessions The Bourne 1621 1814 3435 48 Bowes Park 2737 2153 4890 51 Combined Clinic 1538 1603 3141 52 Winchmore Hill 2061 1904 3965 51 De Bohun 1309 1503 2812 49 Totals 1941 9266 8977 18243 251 1940 9299 8215 17514 255 - Average 1941 36.92 35.76 72.68 1940 36.47 32.21 68.68 -17- STATISTICS- OF- ATTENDANCE AND- WORK- DONE A-T PR2-NATAL CENTRES. Number on Register. 1941. 1940. January 1st 82 97 December 31st 110 82 New cases during the year 428 301 Number of sessions held 106 100 Total attendances 2508 1912 Average per session 23.66 19.12 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 135 Attendances 159 Sessions 13 Average 12.23 -18- TABLE OF VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OF BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. Children 1940 1941. First visits 430 426 Under 1 year of age 626(In addition to) 890 Over 1 year of age 2305 (first visits) 3162 Visits re Deaths under 5 years of age - 10 Stillbirths 3 4 Ophthalmia Neonatorum - - Dental cases - - Pre-Natal visits 276 422 Clinics attended 752 763 Special visits (test feeds, following up special cases seen by M.O. at Centres, failing lactation, etc.) 1154 513 Totals 5,545 6,190 CHILD LIFE PROTECTION- The following is a summary of the Work carried out in this connection during 1941. Number of registered Poster Mothers 17 Number of Foster children on register during the year 32 Number of Foster children at end of year 20 Number of visits paid by Health Visitors 119 No unsatisfactory conditions were met with throughout the year. -19- MILK (MOTHERS & CHILDREN) ORDER. The distribution of milk, free or at reduced price, has, as stated in my last Report, been taken over by the Ministry of Food. The issue of dried milk has been continued throughout the year, 7536 lbs (approx) being distributed free or at cost price. DENTAL TREATMENT. number of "Council" patients attending the Eastman Dental Clinic, 1941 Children 22 Mothers 38 Cost of such cases £50 HOME HELP SCHEME.- The following table sets out the details of the work carried out under the above scheme during 1941. 1941 1940 Total cases dealt with 59 75 No. provided free of charge 27 51 " " @ 1/- per day 15 9 " " @ 2/- " " 7 10 " " @ 3/- " " 4 1 " " @ full charge 6 4 The Home Help worked for 21 days in 3 cases. " " " " " 18 " " 1 case. " " " " " 14 " " 53 case. " " " " " 8 " " 1 case. " " " " " 18 " " 1 " Total No. of days worked 832 1068 " cost (1941) £195. 2. 5. (1940) £230. 18. 9. Average No. of Home Helps on Council's roll, 8 10 - 20- MATERNITY OUTFITS.- Sterilized maternity outfits were supplied to expectant mothers during 1941, as follows. 53 free of charge 6 at a charge of 1/- 4 " " " " 2/- 1 " " " " 3/- 1 " " "" 4/- 22 at cost price costing £20.10.8 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, 19 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. 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. he premises at Winchmore Hill which were taken over as a distributing depot of the London Feat Market, continue to be extensively used. -21- During 1941, 232,281 carcases were dealt with there, as follows: Pigs 11,186; Sheep & Lambs 195,655; Calves 7,982; Bovines 17,458. The total for 1940 was 370,389 carcases. The amount of unsound meat surrendered and destroyed during the year owing to diseased and other conditions was 4 tons 15 cwts 10 lbs. In addition, 84 lbs cod fillet, 14 lbs codling, 84 lbs pilchards, 74 lbs witches, 19 tins sardines, 201 eggs, 138 tins meat, 46 tins soup, 6 tins rabbit, 9 tins milk, 3 tins jam, 24 tins cherries and 94 lbs chocolate 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. SANITARY INSPECTIONS 1940. Housing Inspections & Re-inspections. 1,003 Registered premises, including factories, workshops, bakehouses, milk shops and other food shops - Visits & Inspections. 2,359 Infectious Disease - Visits & Inspections. 3,980 Miscellaneous Visits & Inspections, including various complaints, Rats & Mice Destruction Act, ditches and ponds, non-notifiable diseases, etc. 19,083 Visits re Verminous premises 331 26,756 -22- SERVICE OF NOTICES. Total informal sanitary notices served 977 Total informal dustbin notices, served 183 Total informal notices served 1160 Total informal notices complied with 980 Total statutory notices served 1 Total statutory notices complied with 1 HOUSE-TO-HOUSE INSPECTIONS.- One hundred and sixty-one houses were inspected and recorded under the Housing Acts as compared with 549 in 1940. 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 50 Slaughter houses 4 Fish Shops 26 Factories and Workshops 217 Public House Conveniences 24 Grocers 124 Greengrocers 55 Butchers 55 Confectioners 29 Hairdressers 4.4 -23- ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. Under the bye-laws governing this class of. establishment, ten existing licences were renewed during 1941. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. One thousand two hundred and seventy-eight cases of infectious diseases were notified during the year, as against 591 in 1940, 147 in 1939 and 256 in 1938. The Infectious Sickness Rate for the district was 19.69, as against 8.88 in 1940, 2.17 in 1939 and 3.8 in 1938. SMALLPOX No cases of smallpox occurred in the district during 1941. SCARLET FEVER. Sixty-seven cases were notified during 1941, as compared with 41 in 1940. DIPHTHERIA. Twelve cases of diphtheria were notified during 1941, as against 21 in 1940 and 6 in 1939. 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.- 2,440 persons attended for immunisation during 1941 at the weekly clinic held at the Town Hall, or at the schools visited during the year. This compares with a total of 656 during 1940, and is by far the highest -24- yet attained in Southgate. Some idea of the work involved may be gained when it is stated that a total of 10,143 attendances were made for the purpose of immunisation during the year. This increase in the numbers attending our Immunisation Clinics is very pleasing. Our latest figures show that 44.6% of children under 5 have already been protected against diphtheria in Southgate, while 52.95% between 5 and 15 have been similarly protected. This work has undoubtedly reduced the dangers of a diphtheria epidemic to the known minimum, and it is not too much to say that if the same standard were maintained throughout the country, diphtheria as a serious disease of childhood would disappear from these islands. We are losing no opportunities to encourage more and more parents to take advantage of our immunising facilities, and are now visiting all the schools in the area at least once every year. Free immunising material is being supplied to all general practitioners upon request, and there is evidence to show that here also the number of children being protected is showing a steady increase. Altogether, the increase in immunisations against diphtheria is one of the most pleasing features of the present emergency, although it is sad to think that it took a war to awaken the conscience of parents to the . urgent need for this vital form of protection. The total number of persons attending the Clinic for immunisation from the commencement of the scheme in March 1953, until December 31st, 1941, is 6,112. (b) against Typhoid.- Immunisation against typhoid was offered to members of the general public and Civil Defence Services early in 1941. 332 persons responded, and were immunised at the Town Hall. In addition, 15 members of the Isolation Hospital Staff have been similarly protected. -25- (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 1941 was 51. TYPHOID FEVER (including Paratyphoid). Five cases of typhoid fever were notified during the year, as against 8 in 1940. PUERPERAL PYREXIA. Six cases of puerperal pyrexia were notified during the year, as against 5 in 1940. In addition to these notified cases, the Registrar General reported two maternal deaths which occurred in institutions outside the district. ERYS IPELAS. Twenty cases of erysipelas were notified during the year, compared with 22 in 1940. and 9 in 1939. TUBERCULOSIS. Fifty-seven cases of pulmonary and 13 cases of non-pulmonary tuberculosis were notified during the year, the corresponding figures for 1940 being, pulmonary 37, non-pulmonary 11. In addition to these notified cases, 28 patients (26 pulmonary) were entered in the register, including 2 restored to the register, these cases, with the exception of those restored to the register, being new residents in the district, previously notified elsewhere. SCABIES AND LICE. In keeping with the remainder of the country, the number of cases of scabies and lice infestation met with has shown an increase. Such cases are sent to the Hornsey Cleansing Station for treatment, and the arrangements in force still appear to be satisfactory. The time may come when we shall have to consider the provision of local facilities for the treatment of cases of scabies and lice infestation, but at the moment I see no reason to incur such unnecessary expense. -26- During 1941, 54 patients were treated for scabies and 5 for vermin. DISINFECTION AND DISINFSSTATION. The following is a summary of the work carried out under this heading during the year: Total number of rooms disinfected 286 Total number of articles of bedding, etc. disinfected 2,707 Total number of articles destroyed 112 Total number of library books disinfected 444 Total amount received in respect of disinfection of bedding, by request, after non-notifiable disease £3. 10. 0. Number of verminous houses disinfested 139 Number of rooms disinfested 380 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 1941 was as follows: Casualty Services Personnel 3,839 Auxiliary Fire Service Personnel 2,099 Homeless Persons 122 6,060 -27- ISOLATION HOSPITAL. The number of patients treated in hospital during 1941 was 393, as against 381 during 1940, and 334 during 1939. (This number comprises all patients admitted during the year, together with those in hospital on 1st January, 1941). The following table sets out the number of patients admitted to the hospital during 1940 & 41 and the areas from which those patients were admitted. 1940. 1941. Southgate 101 119 Tottenham 150 223 Wood Green 1 — Hornsey 1 — Middlesex County Council 4 1 Refugees 4 — Military Authorities 111 13 372 356 The diseases for which the 356 patients were admitted during 1941 were as follows. Scarlet fever 98 Scarlet fever & Diphtheria 1 Scarlet fever & Chicken pox 1 Scarlet fever & Scabies 2 Diphtheria 78 Diphtheria "Carriers" 9 Diphtheria & Measles 1 Diphtheria & Whooping cough 1 -28- Erysipelas 11 Typhoid fever 4 Puerperal Pyrexia 3 Baby with mother 3 Pneumonia (inc1. Influenza) 10 Measles 50 Measles & Bronchitis 5 Measles & Pneumonia 9 Measles &. ? Mastoid 1 German Measles 1 Whooping cough 18 Whooping cough & Pneumonia 21 Whooping cough & Measles 2 Chicken pox 5 Cerebro-spinal Meningitis 14 Others 8 DEATHS. Sixteen deaths took place during the year, as compared with 5 in 1940. These 16 deaths occurred from the following diseases Diphtheria 4 (Tottenham patient, aged 4) (Tottenham patinet, aged 1 yr. 10 mnths) (Tottenham patient, aged 3) (Tottenham patient, aged 8) pneumonia 1 (Southgate patient, aged 40) Laryngitis & Broncho-pneumonia 1 (Southgate patient, aged 2) Whooping cough & Pneumonia 3 (Tottenham patient, aged 1¼) (Tottenham patient, aged 1) (Tottenham patient, aged 2) -29- Whooping cough 1 (Tottenham patient, aged 1 yr. 1 ninth) Pneumonia & Measles 1 (Tottenham patient, aged 11 mnths) Pneumonia, Measles & Whooping cough 1 (Tottenham patient, aged 3) Tubercular meningitis & measles 1 (Tottenham patient, aged 1) Meningococcal encephalitis 1 (Southgate patient, aged 17) Puerperal Fever 1 (Friern Barnet patient, aged 30) (Admitted from Southgate) Amoebic Dysentery 1 (Southgate patient, aged 62) (Admitted in 1940) These 16 fatal cases give a mortality rate of 4.07% of the total cases treated. OPERATIONS. The only operations performed at the Isolation Hospital during 1941 were one tonsillectomy and one incision of knee. NUMBERS IN HOSPITAL. The daily average of patients treated in hospital during each month of 1941 was as follows: -30- January 37.67 February 38.03 March 35.87 April 30.73 May 25.96 June 24.6 July 17.96 August 19.51 September 25.93 October 22.19 November 21.46 December 20.42 Average 26.69 The daily average number of patients treated (26.69) shows a substantial increase from that for the previous year, which was 16.98. The highest and lowest numbers of patients in hospital on any one day during 1941 were as follows: Highest (February 5th) 42 Lowest (July 19th & 20th) 13 GENERAL. As will be seen from the total number of deaths which occurred in the Hospital during the year, the type of case admitted was more severe than during the previous year. This was due almost entirely to the fact that 1941 was a measles and whooping cough epidemic year, which meant that a very high proportion of pneumonia cases, many of them in extremis, were admitted. Apart from this type of patient, the severity of the cases admitted to hospital was not marked. The complication rate was low, the vast majority of the patients admitted making an uncomplicated recovery. As in the previous year, the fact that some 13,000 Civil Defence personnel blankets, pillow slips, towels, etc. are being sent to the Isolation Hospital for cleansing has increased the strain on the hospital staff. -31- -52- Notified Cases of Infectious Diseases, 1941. Diseases. Totals Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec. D'ths Diphtheria 12 1 2 - 3 3 1 1 - - 1 - - - Scarlet fever 67 4 13 8 - 3 5 6 3 12 6 4 3 - Typhoid fever 5 - - - - 2 - 1 - 2 - - - - Dysentery 5 - - - - - - - - - - 5 - 1 Malaria 2 - - - - - - - - 1 - - 1 - Puerperal Pyrexia 6 - - - - 1 1 - - 2 1 - 1 2 Erysipelas 20 1 - 2 1 1 3 1 1 2 3 3 2 - Ophthalmia Neonatorum 5 - - - - - 1 3 - 1 - - - - Measles 699 190 125 40 75 159 90 15 3 2 - - - - Whooping Cough 325 6 3 13 46 67 59 57 34 19 5 5 11 - Acute Poliomyelitis 1 - - - - - - - - - 1 - - - Cerebro-spinal meningitis 7 - 2 1 2 - 1 - - - - - 1 1 Encephalitis Lethargica 5 - 1 - - - - - - - - 1 1 - pneumonia 51 7 15 4 3 8 2 - - 1 3 6 2 48 Tuberculosis Pulmonary 59 2 10 5 3 5 4 7 4 9 4 2 4 32 Non-Pulmonary 11 1 - 1 1 1 1 1 2 2 - 1 - 5 Totals 1278 212 171 74 134 250 168 92 47 53 24 27 26 89 " Including all forms of pneumonia, notifiable & non-notifiable. REGISTER OF TUBERCULOSIS CASES. Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register 1. 1. 41 121 96 30 36 283 Cases Notified for first time, 1941 35 24 6 5 70 Cases Restored to Register 1 1 - - 2 Other cases added 12 13 1 1 26 Cases Removed from Register 30 14 5 10 59 Remaining on Register, 31.12.41 139 119 32 32 322 - 33 - TUBERCULOSIS, 1941. Age Periods "/ New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 yr - - - - - - - - 1 - 5 yrs - - - - - - - - 5 - 10 " - - 3 1 - - 1 - 10- 15 " 2 1 - 1 - - - - 15- 20 " 5 4 - 2 1 3 1 1 20- 25 " 8 10 2 - 1 2 1 - 25- 35" 10 16 2 - 3 2 - - 35- 45 " 9 3 - 2 8 2 - - 45- 55 " 11 1 - - 3 1 - - 55- 65 " - 1 - - - 1 1 - 65 & over 3 1 - - 4 1 - - Totals 48 37 7 6 20 12 4 1 "/ These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. - 34 -