SOU 30 borough of southgate ANNUAL REPORT OF the medical officer of health FOR THE YEAR 1945. Wm. CLUNTE 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 beg to present the Annual Report of the Medical Officer of Health for 1945. It will be appreciated that I was absent from the Borough during the whole of 1945, while serving in H. M. Forces, and that this report deals entirely with work supervised by the Acting Medical Officer of Health, Dr. Malcolm Manson. I should like to take this opportunity of thanking Dr. Manson for the most valuable services which he rendered during my absence in the Forces. Very largely due to Dr. Manson's continued efforts, it has been easy for me to take up my civil duties in a smooth and pleasant manner. The same remarks apply to Dr. G. Macdonald, who acted as locum at the Isolation Hospital during my absence. The present report follows the pattern imposed upon us by necessity during the war. It is little more than a factual record of statistics, although opportunity has been taken to make such comments as are called for, throughout the report. It is to be hoped that improved conditions will allow a fuller report to be issued next year., when the entire situation can be reviewed in the light of past experience, and suggestions made as to expansion in the future. The year under review was satisfactory from a health point of view. The birth-rate shows a drop, although it is still considerably higher than the average for the pre-war years. The death-rate is slightly reduced, while the infantile mortality rate remains practically the same as that for the previous year. The infectious sickness rate rose considerably, but as this was almost entirely due to the fact that - 1 - 1945 was an epidemic year so far as measles was concerned, this fact has very little practical significance. The work of the Public Health Department as a whole followed along the lines which characterised the six years of war. Brief comments on various aspects of the work carried out, will be found set out in the body of this report. The Maternity & Child Welfare Department lost a valuable member of the staff by the. death, in May, 1945 of Miss E. M. Hart, Senior Health Visitor. Miss Hart had acted as Health Visitor in Southgate from 5th May, 1936 until a few weeks before her death. She gave loyal and conscientious service, and was highly esteemed both by her colleagues and by the many mothers whom she helped during her term of office. Miss M. Evans was appointed on April 23 to fill the gap created by Miss "Hart's absence from duty. Dr. Manson has asked me to express his thanks to the Chairmen and Members of the Public Health and Maternity & Child Welfare Committees for their support and consideration throughout the year. He has also asked me to place on record his appreciation of the work carried out by the staff of the Health Department during the three years in which he acted as Medical Officer of Health for the Bor ough. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY. Medical Officer of Health. Southgate Town Hall, N. 13. September, 1946. -2- PUBLIC HEALTH COMMITTEE at December 31st, 1945. Alderman G. Peverett (Chairman) His Worship the Mayor (Councillor W.A.Clarke,J.P.) Councillor Mrs. G. G. Adams. Councillor A. C. Crane. Councillor Mrs. D. M. Gipp. Councillor W. C. Ludlow. Councillor W. Saxon. Councillor Mrs. C. M. A. Vandy (Vice Chairman) MATERNITY AND CHILD WELFARE COMMITTEE at December 51st, 1945. Councillor Mrs. C. M.- A. Vandy (Chairman) His Worship the Mayor (Councillor W.A.Clarke,J.P.) Alderman J. T. Barber , J.P. Alderman G. Peverett. Councillor Mrs. G. G. Adams. Councillor A. C. Crane. Councillor Mrs. D. M. Gipp. Councillor J. W. Kimber. Councillor Mrs. R. Winston. CO-OPTED MEMBERS, Mrs. E. Forward. Mrs. M. Piggott. Mrs. E. Miatt. Dr. L. Westlake. HOSPITAL JOINT MANAGEMENT COMMITTEE. at December 31st, 1945. SOUTHGATE-REPRESENTATIVES Alderman G. Peverett (Chairman) His Worship the Mayor (Councillor W.A.Clarke,J.P.) Councillor Mrs. G. G. Adams. Councillor Mrs. -C. M. A. Vandy. TOTTENHAM REPRESENTATIVES. Alderman A. R. Turner. Alderman R. H. Warren. Councillor C. J. Hurd. Councillor Lady Morrison. -3- PUBLIC HEALTH STAFF. Medical Officer of Health and Medical Superintendent, Isolation Hospital: W. C. Harvey,M„D.,Ch.B.,D.P.H, (serving in H. M. Forces) Acting Medical Officer of Health: M. Manson,M.C.,G.M., M.A.,M.D.,D.P.H. (Part time) Acting Medical Superintendent, Isolation Hospital: G. G. Macdonald,M.A.,M.D. (Part time) 1/ Assistant Medical Officer of Health: Marjorie K.Hall, M.B.,B.S.(Lond),D.P.H.(Lond) (Full time) 1/ Senior Sanitary Inspector (No.l District):A.E.Gooday, Cert.R.San.I.,M.S.I.A.,Cert.R.San."I.Meat Inspection. 1/ Sanitary Inspector (No.2 District): J. D. Dant, Cert.R.San.I.,M.S.I.A.,Cert.R.San.I.Meat Inspection. 1/ Sanitary Inspector (No.3 District): R. L. Burkill, A.R.San. I. ,M.S. I. A., Cert. R.San. I., Meat Inspection. Chief Clerk: P. E. Barber. Clerk: Miss M. Munch. Clerk: Miss K. Stoten. Junior Clerk: Miss C. Everest (commenced Oct.1) Health Visitors: 1/ Miss E.M.Hart,S.R.N.,S.C.M.,H.V. (Maternity & (died May 3rd, 1945) Child Welfare) 1/ Miss M. Maddock,S.R.N.,S.C.M.,H.V. 7 Miss A. Joy,S.R.N.,R.F.N.,S.C.M.,H.V. 7 Miss B.M.Finnegan,S.R.N.,S.C.M,,H.V. 1/ Miss M.L.Evans,S.R.N.,S.C.M.,H.V. (commenced April 25rd, 1945) Health Visitor: Miss B.E.Wellman,S.R.N.,S.C.M.,H.V. (Public Health Cert.R.San.I. and General) Full-time Assistant. (Maternity Centres): Miss N. Freeman. Part-time Assistant (Maternity Centres): Mrs. M. Edwards. Disinfector: A. G. Bates. Assistant Disinfector: B. Latter. Rodent Operator: W. Dowsett. 1/ These Officers' salaries are repaid to the Council, in part, by the Ministry of Health or the County Council. -4- STATISTICS OF THE AREA. Area (in acres) 3,764 Registrar General's estimate of Resident Civilian Population, 1945 64,970 Number of inhabited houses (end of 1945) according to Rate Books 20,736 Rateable Value (1945) £924,375 Sum represented by a penny rate (1945.) £ 3,777 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Male Female Total LIVE ( Legitimate 480 451 931 BIRTHS (Illegitimate 26 19 45 Totals 506 470 976 BIRTH RATE per 1,000 of the estimated population.. 15.02 STILLBIRTHS Legitimate 14 9 23 Illegitimate 1 0 1 RATE per 1,000 total (live and still) births 24.00 DEATHS from all causes and at all ages 379 402 781 DEATH RATE per 1,000 of the estimated population 12.02 Deaths from PUERPERAL CAUSES:- Deaths Rate per 1,000 total (live and still) births. From puerperal sepsis 1 1.00 From other puerperal causes 2 2.00 Deaths of INFANTS under 1 year of age:- Male Female Total Legitimate 20 14 34 Illegitimate 3 1 4 Totals 23 15 38 INFANT DEATH RATES:- All infants per 1,000 live births 38.93 Legitimate - per 1,000 legitimate live births 36.52 Illegitimate - per 1,000 illegitimate live births 88.88 -5- Deaths from MEASLES (all ages) 0 " " WHOOPING COUGH (all ages) 0 " " DIARRHOEA (under 2 years of age) 1 POPULATION. The registrar General estimated the civilian population of the Borough at the middle of 1945 to be 64,970, an increase of 780 as compared with 1944. BIRTHS - BIRTH RATE. The nett total of births accredited to the district was 976, a decrease of 120 on the preceding year. of these, 506 were males and 470 females (26 males and 19 females being illegitimate). The birth-rate for the year was 15.02 per 1,000 of the population. The birth-rate for England and Wales for 1945 was 16.1 and for the administrative County of London, 15.7 The births and birth-rates for the past 5 years were as follows: No. of Births Birth Rates. Southgate. England & Wales. London. 1941 647 9.97 14.2 8.9 1942 925 14.06 15.8 14.0 1943 1088 16.55 16.5 15.8 1944 1096 17.07 17.6 15.0 1945 976 15.02 16.1 15.7 During 1945, the number of births recorded was 195 greater than the number of deaths, as compared with 293 in 1944. The total number of births actually registered in the district during the year amounted to 953, of which 8 were unnotified. The percentage of births notified was therefore 99.16 as compared with 99.06 in 1944. -6- MORTALITY. GENERAL MORTALITY AND DEATH RATE.- The nett number of deaths accredited to this district was 781, 22 less than in 1944. This gives a death-rate of 12.02 per 1,000 of the population, a decrease of 0.49 on the rate for the previous year, which was 12.51. The rate for England and Wales (1945) was 11.4 and for London 13.8. The deaths and death-rates for the past 5 years were as follows: No. of Deaths Death Rates Southgate. England & Wales. London. 1941 771 11.28 12.9 16.3 1942 702 10.67 11.6 13.9 1943 802 12.20 12.1 15.0 1944 803 12.51 11.6 15.7 1945 781 12.02 11.4 13.8 INFANT MORTALITY.- There were 38 (4 illegitimate) deaths of infants under 1 year of age, which gives an infantile death-rate of 38.93 per 1,000 births, as compared with 42 deaths and a rate of 38.32 in the preceding year. The corresponding rates for England and Wales and London were 46 and 53 respectively. The infant deaths and rates for the past 5 years were as follows: No. of Deaths Infantile Death Rates. Southgate. England & Wales. London. 1941 25 40.91 59 68 1942 34 36.75 49 60 1943 36 33.08 49 58 1944 42 38.32 46 61 1945 38 38.93 46 53 Of the 38 infant deaths during 1945, 22 or 57.9% occurred within the first week of life, while the total under 1 month numbered 30 or 78,9% Thirteen of these deaths were due to prematurity, 4 to pneumonia and 5 to bronchitis. -7- It must be admitted that comparison with other areas or parts of the country are of very doubtful value. It does not really matter how good or bad the rates were elsewhere; what does matter is the number of children who died in Southgate, and it is with this figure only that we should be concerned. If, as is generally agreed, an infantile mortality rate of less than 40 is considered good, then we have at least the satisfaction of knowing that our own rate falls within that limit. Theoretically, it should be quite possible to reduce the rate to 20 or below, and until we are satisfied that all steps are being taken to effect this reduction, we have no reason to sit back in complacent satisfaction. We have not, in fact, done so. The lowering of the Infant Mortality Rate has always received the closest attention in this area; every death is investigated, in an effort to find out whether the tragedy might have been averted, a practice which we shall, of course, continue. Conditions being what they are to-day, we do not have to go out and search for difficulties, We know what the problems are, and must cope with them as best we can, striving always towards the early removal of environmental stigmata which prejudice both the future and the immediate lives of our infant populat ion. STILLBIRTHS.- Twenty-four stillbirths, (1 illegitimate) were accredited to the district for 1945. This is equal to a death rate of 24.00 per 1,000 (live and still) births, the corresponding figures for 1944 being 26 stillbirths, with a rate of 23.17. -8- 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 3.00 for 1945, representing a total of '3 deaths. In 1944 there was 1 death, with a corresponding rate of 0.891. MORTALITY OF "TODDLERS".- Two deaths occurred amongst children of the age group 1-5 years during 1945. This represents a death-rate of 0.03 per 1,000 of the population, and 0.25 per cent of the total deaths for the year at all ages. In 1944 there were 3 deaths giving a. death-rate of 0.04 and a percentage of 0.37. MORTALITY OF PERSONS OVER THE AGE OF 65.478 or 61.2% of the total deaths during the year were persons over the age of 65. Of these, 141 died between the ages of 80 and 90, while a further 24 were over the latter age, (4 males, the eldest being 93, and 20 females, the eldest being 96). 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 2 deaths in this category; 1 from scarlet fever and 1 from infantile diarrhoea. The ZYMOTIC DEATH-RATE for the year was therefore 0.03 per 1,000 of the population, as compared with 6 deaths and a rate of 0.09 in 1944. -9- CAUSES OP DEATH DURING THE YEAR 1945. Male Female Total All Causes (Civilian only) 379 402 781 Typhoid & Paratyphoid fevers — — — Cerebro-spinal fever — — — Scarlet fever — 1 1 Whooping cough — — — Diphtheria - - - Tuberculosis, Respiratory system 20 7 27 " Other forms 3 2 5 Syphilitic diseases 3 1 4 Influenza 2 4 6 Measles - — — Ac. Poliomyelitis & Polioencephalitis - - — Ac. Inf. Encephalitis - - — Cancer, oesoph.(M) uterus (F) 3 8 11 " stomach & duodenum 14 10 24 " breast — 19 19 " other sites 56 49 105 Diabetes 5 6 11 Intra-cran: vascular lesions 44 57 101 Heart disease 86 99 185 Other circulatory diseases 18 15 33 Bronchitis 23 19 42 Pneumonia 15 15 30 Other respiratory diseases 6 4 10 Ulcer, stomach or duodenum 6 2 8 Diarrhoea under 2 years — 1 1 Appendicitis 1 - 1 Other digestive diseases 6 7 13 Nephritis 4 10 14 Puerperal sepsis - 1 1 Other maternal causes - 2 2 Premature birth 8 5 13 Con. malformation, birth injuries, etc, 10 8 18 Suicide 4 5 9 Road traffic accidents 6 1 7 Other violent causes 8 8 16 All other causes 28 36 64 -10- 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, except for a slight reduction in the total number of beds available, due to enemy action. In this connection it can no longer be said that the provision of hospital beds for the area is satisfactory. It need scarcely be stated that- the war held up hospital development schemes, which by now should have solved many, if not all, of our difficulties. It will be equally obvious that the hiatus created by six years of war has not yet been filled. The need for additional hospital beds is too well known to require elaboration, but it is to be hoped that the plans which had to be temporarily shelved will now be put into operation with as little delay as possible. This particularly applies to the need for maternity beds. With the rising birth rate and the general deterioration in housing conditions, the position is rapidly becoming desperate, and, by the end of 1945, had presented a problem of the very first magnitude. The schemes now under consideration,.and which are intended to ease the critical situation, do not come within the scope of this report. It is none the less imperative that nothing be allowed to stand in the way of their speedy completion. Isolation "Hospital: As Whitherto, essential work at the Isolation Hospital was not neglected during the year. It was very quickly appreciated that, to allow the Isolation Hospital to fall into a state of disrepair, would be the worst possible economy. Such a short-sighted policy has fortunately been avoided, and it can truthfully be stated that the Isolation -11- Hospital has been maintained in as satisfactory a condition as cimcumstances and human ingenuity would permit. We should now reap the benefit of this wise precaution, and should be able to start the post-war era with singularly little leeway. CLINICS AND TREATMENT CENTRES.- Maternity and child Welfare (Southgate Council) at 31st December, 1945. Infant Welfare: Methodist Church, The Bourne, Southgate. Monday 2-4 Methodist Church, Palmerston Road, Bowes Park. Tuesday & Thursday 2-4 Combined Clinic, Bowes Road, New Southgate Wednesday 2-4 Methodist Church, Green Lanes, Winchmore Hill. Tuesday & Thursday 2-4 De Bohun School Clinic, Green Road, Southgate. Friday 2-4 Pr e-Natal: Combined Clinic, Bowes Road, New Southgate. Tuesday & Wednesday 10-12 Methodist Church, Palmerston Road, Bowes Park. Thursday 10-12 Post-Natal: Combined Clinic, Bowes Road, New Southgate. First Tuesday in each month 10-12 Immunisation (against diphtheria) Clinic: (Southgate Council) Town Hall, Palmers Green. Thursday 2-4 Tuberculosis. Venereal diseases and School Clinics (Middlesex County Council) continue as set out in the Report for 1938, except that the Tuberculosis Dispensary at Hornsey has been closed. WAR-TIME DAY NURSERIES.Alderman House, Aldermans Hill, Palmers Green. Tottenhall Sports Ground, Tottenhall Road, Palmers Green. Hoppers Road, Palmers Green. -12- AMBULANCE FACILITIES.- There has been no material change in the Ambulance Facilities as recorded in the Reports for 1935, 1936 and 1939. The table below sets out brief particulars of the work carried out during 1945. It will be remembered that reciprocal arrangements exist with all neighbouring authorities . Total journeys made: General removals to or from hospitals, etc. 1982 Traffic accidents. 54 Other accidents. 297 Sudden illness in streets, etc. 97 2430 Included in the above totals are 146 journeys made at the request of neighbouring authorities and 155 Southgate journeys made by ambulances of other authorities at our request. MORTUARY.- During 1945, 66 bodies were deposited in the Council's mortuary situated at the rear of the Town Hall, 64 post-mortem examinations were held. LABORATORY FACILITIES.- The following tables set out the work carried out at the Council's laboratory and at the laboratories of the Clinical Research Association to which material was sent during 1945. Work carried out at the Council's laboratory:- HOSPITAL specimens. Positive. Negative. BOROUGH specimens. Positive. Negative. Swabs for Diphtheria bacilli 75 574 8 273 " " Haemolytic streptococci - 2 7 17 " " Staphylococci - - 1 - " " Vincents Angina 2 1 4 4 Sputa for Tubercle bacilli - - 9 101 Total 1078. (1944, 1405) -13- Specimens sent to Clinical Research Association: Faeces for Dysentery Positive 4 Negative 31 " " Typhoid Negative 1 Swabs for Diphtheria bacilli Negative 10 " " " , virulence Positive 2 Negative 2 " Vincents Angina Positive 1 !i " Gonococci Negative 1 Although it does not come within the purview of this report, it might be noted that the new arrangement whereby specimens for examination are sent to the Central Public Health Laboratory, Colindale, came into force on 1st. April, 1946. The operation of the new service will be fully reported upon in the Annual Report for 1946. SCABIES AND LICE.- The previous arrangement whereby patients requiring treatment for scabies or vermin infestation were dealt with at the First Aid Post at Grovelands, was discontinued on 30th June, 1945. Arrangements were then made for the work to be transferred to the Isolation Hospital, the treatment being carried out by a specially appointed Operator. This arrangement has proved satisfactory and should continue. Details of the work carried out during the year were as follows: 116 patients were treated for scabies. 11 " " " " head lice. It cannot be said that either scabies or lice infestation present a serious problem in Southgate, -14- MATERNITY AND CHILD WELFARE SERVICES. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1945. Number on Registers:- Under 1 year Over 1 year Totals 1945 1944 January 1st, 1945 607 838 1445 1689 December 31st, 1945 1534 1483 3017 3124 New cases during 1945 927 645 1572 1435 87 of the new cases under 1 year were "removals" into the district. The remaining 840 represent 86.07% of the total births credited to the district. ATTENDANCES AT CENTRES, 1945. Under 1 year Over 1 year Totals Sessions. The Bourne 2135 1685 3820 49 Bowes Park 3343 2289 5632 99 Combined Clinic 2294 1486 3780 49 Winchmore Hill 3302 2458 5760 100 De Bohun 2148 1245 3393 50 1945 13222 9163 22385 347 Totals 1944 14690 7957 22647 355 1945 38.10 26.40 64.50 Average 1944 41.38 22.41 63.79 STATISTICS OF ATTENDANCES AT PRE-NATAL CENTRES. Number on Registers:- 1945 1944 January 1st 113 195 December 31st 181 113 New cases during the year 451 407 Number of sessions held 130 138 Total attendances 2675 2782 Average per session 20.57 20.16 -15- POST-NATAL CLINIC. The Post-Natal Clinic was continued throughout the year, the following being the details of attendances: Attendances, 127; Sessions, 12; . Average attendance, 10.58. It will be observed with satisfaction that the attendances at our various clinics and centres were maintained at a high level throughout 1945. This is a very healthy and encouraging sign, and must give pleasure to all who have the welfare of such an important section of the community at heart. Encouraging as the figures are, there is still room for improvement. It is hoped that additional facilities will shortly allow us to realize, if only in modified form, our ultimate ambition. These schemes do not belong to 1945, but the Council can rest assured that the expansion of the Maternity and Child Welfare services is receiving close and constant attention. No one can say that the premises in which Maternity and Child Welfare is carried out in this district are ideal; but it is equally obvious that, with certain exceptions, we shall have to continue our present practice of using Church Halls, at least for some time to come. It may, however, ever, be possible to. report progress in this direction within the next twelve months. Meantime, we still work towards the ideal of adhoc premises, adequately furnished and equipped for their important purpose. The fact that so many Southgate mothers take advantage of the existing facilities encourages the belief that the services provided are appreciated, and shows that even in improvised accommodation good work can still be carried out. -16- CARE OP ILLEGITIMATE CHILDREN (Circular 2866) The Council continues to participate in the scheme operated "by the Middlesex County Council. There were no cases requiring assistance during the year. CARE OP PREMATURE INFANTS (Circular 20/44) The Southgate Queens Nursing Association made good use of the draught-proof cots and other equipment purchased by the Borough Council during 1944. A private Nursing Home in the area also borrowed the equipment on one occasion. Both the Queens Nursing Association and the nursing home found the equipment of considerable value. During 1945, 50 premature infants were notified, of whom 24 survived at the end of one month. WAR-TIME DAY NURSERIES. The war-time Day Nursery facilities available in the Borough remain as set out in the Annual Report for 1944. The accommodation was used to very good advantage -during the year, and present indications would seem to show that, the accommodation should be maintained, at least until conditions become more stable. The whole question of Day Nurseries presents many problems, and the question of maintaining these nurseries over a limited period must not be confused with their retention as permanent institutions in the life of the community. Steps have already been taken to deal with the problem as it exists at the present moment. These steps will be fully dealt with in the Annual Report for 1946, when it is hoped that an opportunity will be found to discuss general policy, not only from the point of view of present expediency, but also with a view to establishing a long term programme. -17- The following table supplies details of attendances at each of the Nurseries during 1945. The same information is set out on page 19 in graphical form. ALDERMANS HILL TOTTENHALL ROAD HOPPERS ROAD Total attendances. Daily average attendance. Total attendances. Daily average attendance. Total attendances. Daily average attendance. Jan. 578 25 741 32 919 40 Feb. 592 29 693 34 912 45 Mar. 613 29 866 41 785 37 Apr. 420 21 715 36 613 31 May 697 35 627 31 780 39 June 813 39 747 35 766 36 July 793 36 729 33 915 41 Aug. 622 31 415 21 943 47 Sep. 624 31 462 23 988 49 Oct. 741 32 785 34 862 37 Nov. 731 33 874 40 1065 48 Dec . 551 31 513 28 746 41 1945 7775 31.10 8167 32.67 10294 41.17 1944 8075 31.79 8313 32.73 9368 36 .88 -18- DAILY AVERAGE ATTENDANCES AT DAY NURSERIES DURING EACH MONTH OF 1945. Aldermans Hill Nursery shewn thus: Tottenhall Road " " " Hoppers Road " " " 19 TABLE OF VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OF BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. 1945 1944 Children: First visits 643 744 Under 1 year of age 1122 (In addition ) 1278 Over 1 year of age 3081 (to 1st visits) 3238 Visits re: Deaths under 5 years of age 6 Stillbirths 7 Pre-natal visits 316 407 Clinics attended 944 979 Special visits (test feeds, following up special cases seen by M.O. at Clinics, failing lactation, etc.) 194 286 6300 6945 CHILD LIFE PROTECTION.- The following is a summary of the work; carried out in this connection duping 1945: Number of registered Poster Mothers 15 " " Foster Children on register during the year 24 " Foster Children at end of year 10 " " visits-paid by Health Visitors 173 No unsatisfactory conditions were met with throughout the year. MATERNITY OUTFITS.- Sterilized maternity outfits were supplied to expectant mothers during 1945, as follows: 18 were supplied free of charge. 17 " " @ one-sixth full charge. 15 " " @ one-third 15 " " @ one-half " " 1 was " © two-thirds " 1 " " @ five-sixths " " 32 were " @ cost price. _20 Total, 1945..99; 1944,.119. DENTAL TREATMENT.- The arrangements entered into with the Middlesex County Council as set out in the Annual Report for 1944, continued throughout the year and proved entirely satisfactory. The number of cases recommended for treatment during 1945 was 145 mothers and 109 children. ORTHOPAEDIC TREATMENT.- Children found at the Welfare Clinics to be suffering from orthopaedic defects are sent, by arrangement with the Middlesex County Council, to the County Council's Orthopaedic Clinic at Combined Clinic, Bowes Road, for examination by the Orthopaedic Surgeon. During 1945, 40 children attended the Orthopaedic Clinic. Special shoes or other appliances, as may be found to be necessary, are supplied through the workshops of the Royal National Orthopaedic Hospital at cost price. In addition, shoe wedges for the correction of minor faults are supplied at the Welfare Clinics. Special shoes, etc. were supplied to 6 children during 1945. Institutional treatment, if required, is provided at the Royal National Orthopaedic Hospital at Stanmore. One child was sent to the Hospital during 1945. HOME HELP SCHEME.- The following details of the work carried out under the above scheme during 1945 are supplied: Home Helps were provided for 25 patients confined at home during the year. 6 were provided free of charge. 4 " " @ one-sixth full charge. 6 " " @ one-third " " 4 " " @ one-half " " 5 " " @ full charge. As hitherto, this service has been very severely handicapped by shortage of available helpers. -21- With the increasing birth-rate and the general deterioration of housing, demands on the Home Help Help Service have tended to increase; with publicity these demands should increase still further. The provision of Home Helps in suitable cases has now been established as an integral part of the Maternity and Child Welfare services. Every avenue should be explored to insure the provision of an adequate number of full and part-time helpers. The number of Home Helps available for employment at the end of 1945 was 1. DOMESTIC HELPS.- Statutory Rules & Orders, 1944, dated 23 Nov. 1944, gave Local Authorities the requisite power to institute schemes of Domestic Help; Ministry of Health Circular No.179/44 of 14 Dec. 1944 recommended Local Authorities to adopt such a scheme as a matter of some urgency. The Domestic Help scheme is intended to assist persons' sick or infirm (whether through old age or otherwise) who are unable to obtain domestic help . The Public Health Committee decided to act on the Ministry's recommendation and the necessary scheme, including a graduated scale of charges, was accordingly instituted in June 1945. The Ministry undertakes to pay the difference between the cost of the scheme and the amount collected. Up to the end of the year, 13 cases were assisted. The Domestic Help scheme is still in its infancy, and has been handicapped through lack of adequate helpers. There can be no doubt as to its value as a Social Service, and steps are being taken to obtain further assistance in the way of staff. During the 6 months' working 4 helpers were employed for varying periods, although the number actually available at end of the year was reduced to 1. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. Under the bye-laws governing this class of establishment, 8 existing licences were renewed and 1 was refused during 1945. Three applications for new licences were not granted. — 2 2 — SANITARY SERVICES. SANITARY INSPECTIONS, 1945.- Housing Inspections & Re-inspect ions 2029 Registered premises, including factories, workshops, bakehouses, milk shops and other food shops,- Visits & Inspections 856 Infectious Disease,- Visits & Inspections 2389 Miscellaneous Visits & Inspections, including various complaints, rats and mice infestations, ditches and ponds, non-notifiable diseases, etc. 9579 Visits re verminous premises 99 Visits re nuisances from flies, etc. 4339 19291 The work of the Sanitary Inspectors continues to be hampered by the multiplicity of restrictions with which the country as a whole is faced to-day. This report is not the place in which the need for such restrictions should be argued. As public servants, we must accept the situation and do what we can to overcome the various problems as they arise. This the Sanitary Inspectors have endeavoured to do, with quite a considerable measure of success. SERVICE OP NOTICES.- Total informal sanitary notices served 837 Total informal dustbin notices served 638 Total informal notices served 1475 Total informal notices complied with 1154 Total statutory notices served 115 Total statutory notices complied with 62 -23- 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, 1 Pasteuriser's Licence and 17 Supplementary Licences were granted. Bacteriological etc. examinations of milk are no longer carried out by the Borough Council. This work is undertaken by the County Council, but we continue to co-operate very closely with the County in checking up on local milk supplies. MEAT AND OTHER FOODS.- Butchers' shops, restaurants, bakehouses, grocers' shops, fruit stores and fish shops have been inspected frequently. Regular visits were made to the Ministry of Food Meat Depot and large quantities of meat examined. A considerable quantity of food of all kinds was condemned during the year as unfit for human consumption. This was disposed of, whenever possible, as salvage. RATS AND MICE DESTRUCTION. Work under the above Act was carried out during the year in accordance with the procedure set out in the Annual Report for 1944. During the year, 6248 treatments were carried out at 289 premises. Although it cannot be said that infestation by rats and mice represents a serious problem in Southgate, especially so far as food stuffs are concerned, the work does play quite a useful part in the public health programme. -24- WATER SUPPLY. The water of the district, which is almost entirely supplied by the Metropolitan Water Board, remains satisfactory in quality and quantity. The supply is from high pressure mains. All houses in the district are provided with a direct pipe supply, the few remaining wells which previously existed having been discontinued several years ago. It was not necessary to carry out any bacteriological or chemical examinations of the drinking water during the year. There was no evidence of any plumbo-solvent action in the water. -25- INFECTIOUS DISEASE. DISINFECTION AND DISINFESTATION.- The following is a summary of the work carried out under this heading during the year: Total number of rooms disinfected 324 Total number of articles of bedding etc. disinfected 1547 Total number of articles destroyed 19 Total number of library books disinfected 152 Number of verminous houses disinfested 37 Number of verminous rooms therein 146 Number of verminous articles disinfested 34 IMMUNISATION AGAINST DIPHTHERIA.- 792 persons attended for immunisation during 1945 at the weeklyclinic held at the Town Hall, or at the schools visited during the year. This compares with a total of 558 during 1944. Plans are being prepared to stage a publicity campaign designed to stimulate interest in immunisation throughout the Borough. Although 49.1 per cent of Southgate children below the age of 5 have been immunised against diphtheria, this figure is not considered entirely satisfactory, and it is hoped that the proposed campaign will result in an improvement. It should, of course, be remembered that the figure of 49.1 does not include the bulk of children immunised by their own doctors. We have continually tried to obtain this latter figure, but so far have met with little success. Steps are now being taken to check up on all children attending our Clinics and Day Nurseries, and it is anticipated that in this way fuller information will become available. The value of immunisation against diphtheria has now been established beyond question. So far as Southgate is concerned, the fact that the average number of diphtheria cases notified during the past 10 years was 13.6 proves that immunisation is playing its part in reducing the dangers of this very serious -26- disease, especially among children. The even more important fact that only 8 persons (mostly adults), several of whom contracted the disease and were treated outside the district, died from diphtheria during the past 10 years, supports the need for continued immunisation. It is also interesting to note that the last outbreak of diphtheria in Southgate occurred in 1933, the year in which immunisation was begun in the district. This outbreak, which Only lasted a few weeks, was responsible for 17 cases and 2 deaths. NOTIFICATIONS OP INFECTIOUS DISEASE - INFECTIOUS SICKNESS RATE.- 1006 cases of infectious disease were notified during the year, as set out in the following tables. This compares with 636 notifications in 1944, 1229 in 1943, 796 in 1942 and 1278 in 1941. The Infectious Sickness Rate for the district was 15.48, as against 9.91 in 1944, 18.77 in 1943, 12.1 in 1942 and 19.69 in 1941. As noted in the introduction to this Report, the comparative value of the Infectious Sickness Rate has been considerably decreased, following the addition of measles and whooping cough to the list of compulsory notifiable diseases. A scrutiny of the notifications received during the year, as set out below, will, however, reveal the fact that infection generally was extremely low in the Borough. This particularly applies to diphtheria, which, although 11 cases were notified as against 8 during the previous year, is no longer a serious disease from an epidemiological point of view. It is also pleasant to note that tuberculosis notifications decreased by more than 25% during the year. -27- NOTIFICATIONS OF INFECTIOUS DISEASE, 1945. JanMar . AprJune JulSep. OctDec. Totals. Diphtheria - 8 1 2 11 Scarlet fever 32 30 23 34 119 Typhoid fever - - 1 - 1 Dysentery - 2 9 4 15 Malaria - 1 . - 2 3 Puerperal Pyrexia 1 1 3 - 5 Erysipelas 2 8 3 3 16 Ophthalmia Neonatorum 2 1 - - 3 Measles 193 264 101 - 558 Whooping Cough 49 31 56 10 146 Pneumonia 25 11 1 21 58 Cerebro-spinal fever - - - - - Acute Poliomyelitis - 1 1 2 4 Tuberculosis.- Pulmonary 16 16 14 12 58 Non-Pulmonary 2 2 2 3 9 Totals 322 376 215 93 1006 -28- REGISTER OF TUBERCULOSIS CASES. Pulmonary NonPulmonary Totals M F M F Cases on Register 1. 1. 45 166 159 39 43 407 Cases Notified for first time, 1945 - 34 24 6 3 67 Cases Restored to Register 3 3 - - 6 Other cases added 13 8 1 2 24 Cases Removed from Register 41 28 6 11 86 Remaining on Register, 31.12.45 175 166 40 37 418 -29- TUBERCULOSIS, 1945. New Gases Deaths Age Periods Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 yr. - - - - - - - 1 - 5 yrs. - - 2 - - - - - 5 - 10 " 3 - - - 1 - - - 10 - 15 " 2 1 - 1 1 - - - 15 - 20 " 5 4 2 - 1 - 2 1 20 - 25 " 7 9 - 1 1 1 - - 25 - 35 " 9 9 2 1 3 3 - - 35 - 45 " 8 4 1 1 3 - 1 1 45 - 55 " 6 3 - - 4 1 - - 55 - 65 " . 5 1 - 1 5 1 - - 65 & over 2 1 - 1 1 - - Totals 47 32 7 5 20 7 3 2 1 These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. -30- ISOLATION HOSPITAL. The number of patients treated in hospital during 1945 was 430, as against 441 during 1944 and 585 during 1943. (This number comprises all patients admitted during the year, together with those in hospital on 1st January, 1945.) The following table sets out the number of patients admitted to the hospital during 1943, 1944 and 1945, and the areas from which those patients were admitted: 1943. 1944. 1945. Southgate 178 144 119 Tottenham 346 225 252 Middlesex County Council 5 8 5 Military Authorities 15 11 19 Friern Barnet 1 — — — — Wood Green — — 2 — — Ken s ingt on — — — — 1 545 390 396 The diseases for which the 396 patients were admitted during 1945 were as follows: Scarlet fever 178 Scarlet fever & Chickenpox 2 Scarlet fever & Pneumonia 2 Diphtheria 72 Diphtheria & Scarlet fever 1 Diphtheria "carrier" 3 Dysentery 24 Enteritis 5 Typhoid fever 1 Erysipelas 13 Measles 26 Measles & Pneumonia 5 Measles & Croup 1 Measles & Appendicitis 1 Pneumonia 2 Croup 1 Whooping cough 11 Whooping cough & Pneumonia 1 -31- Puerperal pyrexia 3 Baby with mother 6 Mother with baby 1 Cerebro-spinal fever 2 Ophthalmia neonatorum 1 Chicken pox 2 Impetigo 2 Otorrhoea 1 Meningitis 3 Scabies 1 Trench mouth 1 Mumps 3 Vincents Angina 1 Observation cases 20 DEATHS.- Five deaths took place during the year, as compared with 10 during 1944. These 5 deaths occurred from the' following causes: Diphtheria 3 (Tottenham patients, aged 6, 4, and 3 years respectively) Pneumonia and whooping cough 1 (Tottenham patient, aged 10 months) Dermatitis exfoliative 1 (Southgate patient, aged 1 week) These 5 fatal cases give a mortality rate of 1.16% of the total cases treated, as compared with 2.26% in 1944. OPERATIONS.- Two tracheotomy operations were performed at the Isolation Hospital during 1945. -32- NUMBERS IK HOSPITAL during each month of 1945.- Total patient days. No. in on any Highest Hospital one day. Lowest: Daily Average. January 548 26 13 17.67 February 574 26 13 18.35 March 988 39 27 31.87 April 895 38 26 29.83 May 964 37 20 31.09 June 697 25 18 23.23 July 765 32 15 24.67 August 825 33 23 26.45 September 697 27 19 23.23 October 952 38 22 30.77 November 1142 42 34 38.06 December 1093 39 30 35.35 Daily average for the year 1945 27.78 " " " " " 1944 25.8 " " " " "1943 41.14 The time has now arrived for the future of our Isolation Hospital to be carefully considered. Our whole outlook on the treatment of infectious diseases in hospital has "been radically altered during the past few decades. It is now recognised that the isolation of cases of acute infectious disease in hospital does not affect the trend of the Infectious Sickness Rate in an area to any appreciable extent; indeed, the term "isolation hospital" has become a misnomer and should be discarded. Such hospitals exist for the purpose of treatment, and are to be regarded as instruments which come into play when the mechanism of prevention has, to some extent failed. A survey of this part of Middlesex would appear to show that available accommodation in the various Isolation Hospitals in the area has been very moderately used. This is both uneconomic and unsatisfactory, especially having regard to the fact that hospital -33- accommodation for other purposes is urgently required. Various alternatives present themselves. Empty beds might be filled by the admission of such conditions as impetigo, severe scabies, gastro-enteritis and skin infections of all kinds. This represents the policy which we ourselves have encouraged. Alternatively, districts might combine to admit their infectious disease cases to one or more hospitals leaving at least one hospital to be used for another purpose. The obvious use of a hospital so freed would be for maternity purposes, or for the admission of cases of tuberculosis, for which accommodation is at present limited. It will be obvious that, in attempting to solve existing local problems, the future of our own Isolation Hospital must be considered. I feel that this problem should be tackled now., and that it is of sufficient urgency to warrant an immediate investigation, followed, if at all possible, by prompt action. In times such as these, every hospital bed is a valuable acquisition to our defence mechanism. Eeds which are allowed to remain empty show no profit, and are certainly no credit to a progressive policy. The same remarks apply with added force to redundant staff. If this area can make any contribution to the general need, that contribution should be made as fully and as speedily as possible. For this reason, it is to be hoped that the Health Report for 1946 will contain a record of progress, made in this vitally important field. 34 -