Journal Rebind Co, Ltd. Unit A. Pier Whari, Grays Essex, AC 439(1) SOUTH GATE BOROUGH OF SOUTHGATE. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946. WM. CLUNIE HARVEY, M.D., D.P.H., Medical Officer of Health and Medical Superintendent, Isolation Hospital, Printed by Crusha & Son, Ud. (T. U.), Tottenham, Wood Green k EJnfleld. 68663 SOUG 3 BOROUGH OF SOUTHGATE. of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946. 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 beg to present the Annual Report of the Medical Officer of Health for the year 1946. As I was not released from service with the Forces until April, Dr. M. Manson, Acting Medical Officer of Health during my absence from the Borough, was responsible for the work carried out during the first quarter of the year. The Report for 1946 follows the general pattern of the last few years, with minor amendments to bring the Report into conformity with the standard required by the Ministry of Health. Opportunity has, however, been taken to discuss various aspects of the health situation. The very fact that conditions can by no stretch of imagination be described as having returned to normal, leaves us with problems which call for early consideration. This fact, coupled with the changes envisaged by the National Health Service Act, and the re-grouping of staff which will come about when we take over the School Health Service, justifies an up-to-date survey of our present and future needs. It is for this reason that the comments referred to above have been interpolated in the body of the present Report. Viewing 1946 from the broad aspects of health, morbidity and mortality, the year can be considered satisfactory. In at least one field of preventive medicine, it has been outstanding. The birth rate has risen slightly, although it is doubtful whether one should consider this satisfactory in the light of the present housing situation. The death rate has not materially altered, but the figure is in no way unusual when the tendency towards a middle-aged 3 and elderly population in Southgate is taken into account. The infantile mortality rate shows a welcome drop, and is one of the lowest yet recorded in the district. The infectious sickness rate has also fallen, although it must be admitted that a considerable decrease in measles and whooping cough notifications was almost entirely responsible for the reduction. None the less, a glance at the returns will show that, once again, Southgate was spared the rigours of an epidemic or even a localised outbreak of infectious disease. A noteworthy feature of the year was the negotiations which were begun with a view to transferring our Isolation Hospital to the County Council for use as a Maternity Unit. These negotiations were protracted, but a satisfactory conclusion was eventually reached. This matter will be more fully dealt with later in the Report. Miss M. Evans, Health Visitor, left to take up another appointment on 28th February, 1946, the vacancy being filled by the appointment of Miss P. Carter. With this exception, the staff of the Public Health Department remained unaltered during the year. The rapidly increasing number and variety of social services available to the general population has thrown additional burdens on the shoulders of the Public Health Department. The extended use of the Home Help Scheme and the inauguration of the Council's Domestic Help Scheme are two examples of this widening horizon; but they do not by any means exhaust the story. The deterioration in living conditions brought about by the war, together with the additional strain under which we now struggle to exist, have presented new problems and magnified old ones, sometimes out of all recognition. Two years' absence from England brought this very forcibly to my notice, more forcibly, perhaps, than continuous contact with these problems might have done. If we are to have any hope of maintaining even our present standard of living, we must fight as we never fought before. That may be a truism of which we hear too much. But truism or not, in no field more than the vital domain of Public Health is it so significant. It will be noted that there is no specific mention in this Report of the work of the School Health Service. This work continued to be undertaken by the Middlesex County Council during 1946, although I prepared a detailed plan during the year for taking over the School 4 Health Service in 1947. This scheme has been submitted to the Education Executive Committee and to the County Education Committee, for approval. It is anticipated that we will become responsible for the day-to-day administration of the local School Health Service some time during the coming year. I should like to take this opportunity of expressing my thanks to the Chairman and Members of the Public Health and Maternity and Child Welfare Committees for their support and consideration throughout the year. I must also thank the members of my Department for the manner in which they have carried out their many duties, not only during 1946, but during the years when I was absent from the Borough. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. Southgate Town Hall, N.13. 5 PUBLIC HEALTH COMMITTEE at December 31st, 1946. Alderman G. Peverett (Chairman). Alderman Mrs. C. M. A. Vandy. Councillor Mrs. G. G. Adams. Councillor H. S. Beardow. Councillor W. A. MacGregor. Councillor R. Prior. Councillor W. Saxon (Vice-Chairman). MATERNITY AND CHILD WELFARE COMMITTEE at December 31st, 1946. Alderman Mrs. C. M. A. Vandy (Chairman). Alderman G. Peverett. Councillor Mrs. G. G. Adams. Councillor R. C. Evans. Councillor A. E. Lauder. Councillor W. A. MacGregor. Councillor Mrs. R. Winston. CO-OPTED MEMBERS. Mrs. E. Forward. Mrs. E. Miatt. Mrs. J. Skinner. Dr. L. Westlake (Vice-Chairman). HOSPITAL JOINT MANAGEMENT COMMITTEE at December 31st, 1946. SOUTHGATE REPRESENTATIVES. Alderman G. Peverett (Chairman). Alderman Mrs. C. M. A. Vandy. Councillor Mrs. G. G. Adams. Councillor W. Saxon. TOTTENHAM REPRESENTATIVES. Alderman A. R. Turner. Alderman R. H. Warren. Councillor Lady Morrison. 6 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 until April 24th, 1946). Acting Medical Officer of Health: M. Manson, M.C., G.M., M.A., M.D., D.P.H. (part-time until April 23rd, 1946). Acting Medical Superintendent, Isolation Hospital: Dr. G. G. Macdonald, M.A., M.D. (part-time until April 23rd, 1946). ♦Assistant Medical Officer of Health: Marjorie K. Hall, M.B., B.S.(Lond.), D.P.H. (Lond.), (full-time). ♦Senior Sanitary Inspector (No. 1 District): A. E. Gooday, Cert.R. San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. ♦Sanitary Inspector (No. 2 District): J. D. Dant, Cert.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. ♦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. Health Visitors (Maternity and Child Welfare): *Miss M. Maddock, S.R.N., S.C.M., H.V. ♦Miss A. Joy, S.R.N., R.F.N., S.C.M., H.V. ♦Miss B. M. Finnegan, S.R.N., S.C.M., H.V. ♦Miss M. L. Evans, S.R.N., S.C.M., H.V. (left 28th February, 1946). ♦Miss P. Carter, S.R.N., S.C.M., H.V. (commenced 23rd April, 1946). Health Visitor (Public Health): Miss B. E. Wellman, S.R.N., S.C.M., H.V.Cert.R.San.I. 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. ♦ These Officers' salaries are repaid to the Council, in part, by the Ministry of Health or the County Council. 7 Statistics and Social Conditions of the Area. Area (in acres) 3,764 Registrar General's estimate of Resident Civilian Population, 1946 72,710 Number of inhabited houses (end of 1946) according to Rate Books 21,361 Rateable Value (1946) £927,625 Sum represented by a penny rate (1946) £3,827 While the local geography of Southgate, details of which will be found in previous Annual Reports, has not altered, the same cannot be said for the nature of the district. The main deviation may be summed up in the fact that, while the number of houses available for occupation in the Borough has decreased owing to war damage and several years' cessation of building operations, the population has increased by at least 7,000 since before the war. The result is overcrowding, and the splitting up of houses, never intended for this purpose, into separate flats. Thus, while there has been no material alteration in the general type or distribution of the population, the over-all total has increased to a point which passes saturation. This has presented and will continue to present public health problems. of which housing is only one. Superficially, one cannot say that the face of Southgate has altered more than the passage of years might lead one to expect; in actual fact, processes are at work which may not yet have shown themselves to any marked extent, but which are none the less fraught with grave possibilities. They all point to the need for continued vigilance and the adoption of a balanced, long-term policy, designed to retain the individual character and amenities of the Borough. The absence of a factory area or even of many individual factories is still a satisfactory feature of the Borough. But a dormitory may still be overcrowded, and perhaps not so spick and span as those who have its future at heart would wish to see. We cannot be altogether content with the explanation that conditions are abnormal, the road to progress still impeded, obstacles virtually insurmountable. Much can be done to repair the ravages of war, to ensure that what we still have we make certain of retaining. There is much at stake, more, perhaps, than some imagine. We stand, literally, at the cross-roads, and must take steps to ensure that we continue along the path which past endeavours have so clearly indicated. 8 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Male. Female. Total. Live Legitimate 587 582 1,169 Birth rate per 1,000 of the estimated population . . 16.68 Births Illegitimate 20 24 44 Totals 607 606 1,213 Still Legitimate 11 18 29 Rate per 1,000 total (live and still) births .. ..24.92 Births Illegitimate 1 1 2 Deaths from all causes and at all ages 401 482 883 Death Rate per 1,000 of the estimated population 12.14 Deaths from puerperal causes:—- Deaths. Rate per 1,000 total (live and still) births. From puerperal sepsis 0 0.00 From other puerperal causes . 6 4.82 Total 6 4.82 Deaths of Infants under 1 year of age:— Male. Female. Total. Legitimate 19 14 33 Illegitimate 1 2 3 Totals 20 16 36 Infant Death Rate:— All infants per 1,000 live births 29.68 Legitimate—per 1,000 legitimate live births 28.23 Illegitimate—per 1,000 illegitimate live births 68.18 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 3 9 POPULATION. The Registrar-General estimated the civilian population of the Borough at the middle of 1946 to be 72,710, an increase of 7,740 as compared with 1945. BIRTHS—BIRTH RATE. The nett total of births accredited to the district was 1,213. an increase of 237 on the preceding year. Of these, 607 were males and 606 females (20 males and 24 females being illegitimate). The birth-rate for the year was 16.68 per 1,000 of the population.. The birth-rate for England and Wales for 1946 was 19.1 and for: the administrative County of London, 21.5. The births and birth-rates for the past 5 years were as follows:— No. of Births. Southgate. Birth Rates. England & Wales London. 1942 925 14.06 15.8 14.0 1943 1,088 16.55 16.5 15.8 1944 . 1,096 17.07 17.6 15.0 1945 976 15.02 16.1 15.7 1946 . 1,213 16.68 19.1 21.5 During 1946, the number of births recorded was 330 greater than the number of deaths, as compared with 195 in 1945. The total number of births actually registered in the district during the year amounted to 1,435, of which 23 were unnotified. The percentage of births notified was therefore 98.4 as compared with 99.16 in 1945. MORTALITY. General Mortality and Death Rate.—The nett number of deaths accredited to this district was 883, 102 more than in 1945. This gives a death-rate of 12.14 per 1,000 of the population, an increase of 0.12 on the rate for the previous year, which was 12.02. The rate for England and Wales (1946) was 11.5 and for London 12.7. The deaths and death-rates for the past 5 years were as follows No. of Deaths. Southgate. Death Rates. England & Wales. London.. 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 1946 . 883 12.14 11.5 12.7 10 The various rates for 1946 are, of course, based on the RegistrarGeneral's estimate of population at mid-year, which was 72,710. For the first time in quite a number of years one may accept this estimate as reasonably accurate, although other evidence, e.g., returns from the Food Office, would lead one to believe that the actual population at mid 1946 was slightly in excess of the RegistrarGeneral's estimate. We must, however, base our returns on the figures supplied by the Registrar-General, although it will be obvious that, if our population was actually around the 74,000 mark, as one might be justified in assuming, the mortality figures contained in this report are very slightly in excess of what would otherwise be the case. Infant Mortality.—There were 36 (3 illegitimate) deaths of infants under 1 year of age, which gives an infantile death-rate of 29.68 per 1,000 births, as compared with 38 deaths and a rate of 38.93 in the preceding year. The corresponding rates for England and Wales and London were 43 and 41 respectively. The infant deaths and rates for the past 5 years were as follows:— Infantile Death Rates. No. of Deaths. Southgate. England & Wales. London 1942 34 36.75 49 60 1943 36 33.08 49 58 1944 42 38.32 46 61 1945 38 38.93 46 53 1946 36 29.68 43 41 Of the 36 infant deaths during 1946, 15 or 41.7 per cent, occurred within the first week of life, while the total under 1 month numbered 24 or 66.6 per cent. Six of these deaths were due to prematurity, 6 to pneumonia, 3 to gastro-enteritis and 7 to congenital abnormalities. The infantile mortality rate shows a very welcome decrease, and is the second lowest rate yet recorded in Southgate. If, as is accepted, the infantile mortality rate of an area can be regarded as the most sensitive index of the success or failure of the local health services, then we have some reason for satisfaction. It must be remembered, of course, that, with such comparatively small totals, meticulous comparison might be misleading. None the less, the saving of infant life which took place during the year represents an 11 important contribution to human welfare, and points the way to the urgent need for even greater effort in this vital field. An even more welcome feature of the infant mortality figures is a drop in the neonatal rate, i.e., deaths of children in the first month of life. It is now generally agreed that most progress can be expected during these four vital weeks, when the influence of ante-natal care and home conditions are exerting their maximum effect. It is here that the value of mothercraft makes itself apparent; indeed, at no other time does the mother exert such an enormous influence on the child. Now that admissions to hospital for confinements are more than ever restricted, and early discharge from hospital an accepted procedure, this home influence gains added weight. When we remember the conditions under which mothers are having their babies at home, and under which children are being reared during the first few weeks of life, the importance of home environment takes on an even more significant pattern. Ante-natal care in Southgate can justly be claimed to be of a high standard; the standard of midwifery is equally good. A glance at the numbers of mothers attending our clinics shows that this aspect of our work is also satisfactory. When, however, we consider the amount of time being devoted by our Health Visitors to visits in the home, especially just after confinement has taken place, the picture is by no means so happy. We should be able to reduce the number of children dying in the first four weeks of life still further than has been possible in the past, but to do this we must provide a home visiting service on a much more generous scale than has yet been practicable. Every life lost during the first twelve months is a tragedy; in approximately 50 per cent, of cases an avoidable tragedy. And that is only the beginning of the story. We know perfectly well that many children survive the first twelve months of life, only to be left with unfortunate sequelae which cloud and stultifythe remainder •of their existence. It is just as important that these tragedies should be avoided, as that we should save actual life. Any other criterion would be quite illogical. The practical minimum to which the infantile mortality rate can be reduced is said to be in the neighbourhood of twenty per thousand, but we should not rest content to achieve this figure. Zero may be a Utopian dream, but who, fifty years ago, would have contemplated a reduction in infant mortality approaching the figure to which we are so accustomed to-day ? Our present difficulties are many, yet we must not allow that fact to discourage our efforts. We have won great triumphs in the past few decades; there is no reason why greater triumphs should not lie ahead. Practically, our most immediate methods of approach to the problem would appear to lie: 12 (a) In the close and careful examination of every infant death, with a view to ascertaining the exact cause or causes which lead to the tragedy and their elimination; and (b) A greater measure of home supervision, especially during the first few weeks of life. The former we can and will do; the latter should also be included in our programme. Stillbirths.—Thirty-one stillbirths, (2 illegitimate) were accredited to the district for 1946. This is equal to a death rate of 24.92 per 1,000 (live and still) births, the corresponding figures for 1945 being 24 stillbirths, with a rate of 24.00. The rate per 1,000 of the population was 0.426, the rates for England and Wales and London being 0.53 and 0.54 respectively. From the above it will be noted that our still-birth rate shows a very slight increase over the previous year, although it is still slightly below the rate for England and Wales and London. This fact gives no grounds for complacency. Every still-birth is a tragedy, in many cases avoidable. Adequate ante-natal supervision, together with good midwifery, will help to reduce the figure, but it will be quite obvious that this very important problem is intimately bound-up with other factors which have a much wider implication. Here again, a careful investigation must be made into every stillbirth, so that the cause or combination of causes may be properly understood. It is hoped that investigation of the Rhesus factor, which we are arranging to undertake, will eliminate a proportion of these tragedies. But this proportion will almost certainly be small, and the great bulk of the problem will still remain with us. No study of infant mortality can ever be complete unless the question of the still-birth rate is included with it. The two problems are inextricably united. Indeed, there is much to be said for their inclusion in a comprehensive index figure which would show the total number of presumptive infant lives lost to the community in any year. We are giving this matter very close attention, and the Council can rest assured that every effort will be made to reduce a total which marks one of the really tragic milestones in our present civilisation. As a further contribution to this problem, and to the problem of maternity and child welfare generally, arrangements are being made to carry out a Kahn or Wasserman test on all new cases attending our ante-natal clinics. 13 Maternal Mortality.—The maternal mortality rate, i.e., the number of mothers dying a,s the result of childbirth per 1,000 total (live and still) births was 4.82 for 1946. representing a total of 6 deaths. In 1945 there were 3 deaths with a corresponding rate of 3.00. It is once again emphasised that year-to-year comparisons of our maternal mortality serve very little useful purpose. This is not to say that we must not take every known precaution to reduce our rate to the practicable minimum. All maternal deaths are carefully investigated, and where any correctable circumstance appears to exist, the matter is taken up in the proper quarter. Mortality of "Toddlers".—Five deaths occurred amongst children of the age group 1—5 years during 1946. This represents a death-rate of 0.07 per 1,000 of the population, and 0.56 per cent, of the total deaths for the year at all ages. In 1945 there were 2 deaths giving a death-rate of 0.03 and a percentage of 0.25. Mortality of Persons over the Age of 65.—550 or 62.3 per cent, of the total deaths during the year were persons over the age of 65. Of these, 168 died between the ages of SO and 90, while a further 40 were over the latter age (13 males, the eldest being 97, and 27 females, the eldest being 100). A study of the figures set out above will show the general trend of the death rate in Southgate. A study of the individual causes of death set out on page 16 will also show that diseases of the heart and circulatory system were responsible for the majority of the deaths of elderly persons in the district. This group of diseases is taking the place of cancer as the major cause of mortality in elderly persons, a fact which, to a large extent, must be attributed to the increasing strain of living, especially in the later phases of life. Zymotic Mortality (including deaths from the seven principal zymotic diseases, viz. : smallpox, scarlet fever, diphtheria, typhoid fever, measles, whooping cough and diarrhoea (in children under 2 years of age).— There were 3 deaths in this category, all from infantile diarrhoea. The zymotic death-rate for the year was therefore 0.04 per 1,000 of the population, as compared with 2 deaths and a rate of 0.03 in 1945. 14 The most pleasing feature of the zymotic death rate is the absence from the list of diphtheria as a cause of death. The last death from diphtheria in Southgate occurred in 1943, and it is quite probable that diphtheria has now disappeared as a major killing factor, especially in the younger age groups. The increase in deaths from gastro-enteritis is more disturbing, and although only three such deaths were reported during 1946, it points to the appearance of a new problem, the solution to which will almost certainly tax the ingenuity of the nation as a whole. The fact that these deaths almost invariably occur in young infants adds point to the issue. 15 Table I. Causes of Death During the Year 1946. Causes of Death. Male. Female. Total. Rates per 1,000 of Population All Causes (Civilians only) 401 482 883 12.14 1 Typhoid and Paratyphoid Fevers — — — — 2 Cerebro-spinal Fever — 1 1 0.01 3 Scarlet Fever — — — — 4 Whooping Cough — — — — 5 Diphtheria — — — — 6 Tuberculosis, Respiratory System 13 12 25 0.34 7 Tuberculosis, Other forms — 4 4 0.05 8 Syphilitic Diseases 5 2 7 0.09 9 Influenza 3 9 12 0.16 10 Measles — — — — 11 Acute Poliomyelitis and Polioencephalitis — — — 12 Acute Infectious Encephalitis 1 1 2 0.03 13 Cancer, Oesoph. (M) Uterus (F) 3 7 10 0.14 14 Cancer, Stomach and Duodenum 3 12 15 0.21 15 Cancer, breast — 28 28 0.38 16 Cancer, other sites 62 49 111 1.52 17 Diabetes 2 5 7 0.09 18 Intra-cranial vasculai lesions 34 68 102 1.40 19 Heart Disease 99 119 218 2.99 20 Other Circulatory Diseases 12 14 26 0.36 21 Bronchitis 24 14 38 0.52 22 Pneumonia 29 21 50 0.69 23 Other Respiratory Diseases 6 5 11 0.15 24 Ulcer, Stomach or Duodenum 8 4 12 0.16 25 Diarrhoea under 2 years 1 2 3 0.04 26 Appendicitis 3 1 4 0.05 27 Other Digestive Diseases 9 12 21 0.29 28 Nephritis 12 16 28 0.38 29 Puerperal Sepsis — — — — 30 Other Maternal causes — 6 6 0.08 31 Premature Birth 2 4 6 0.08 32 Congenital Malformations, Birth Injuries, etc. 13 8 21 0.29 33 Suicide 3 4 7 0.09 34 Road Traffic Accidents 4 3 7 0.09 35 Other violent causes 7 14 21 0.29 36 All other causes 43 37 80 1.10 1G TABLE II. Deaths from all causes, divided as to sex and certain age groups, and showing a percentage of total deaths and death-rate per 1,000 of population for each group. 1946. Age. MALES. FEMALES. TOTALS. No. %ot Total Deaths. Rate per 1,000. No. %of Total Deaths. Rate per 1,000. No. %°f Total Deaths. Rate per 1,000. 0— 1 year . . 20 2.26 0.27 16 1.81 0.22 36 4.07 0.49 1— 5 years .. 1 0.11 0.01 4 0.45 0.05 5 0.56 0.07 5—15 ,, 2 0.22 0.03 3 0.34 0.04 5 0.56 0.07 15—25 ,, 3 0.34 0.04 9 1.02 0.12 12 1.36 0.16 25—45 ,, 26 2.94 0.36 27 3.06 0.37 53 6.00 0.73 45—65 110 12.45 1.51 112 12.68 1.54 222 25.14 3.05 65 and over .. 239 27.06 3.29 311 35.22 4.28 550 62.28 7.56 Totals 401 45.41 5.51 482 54.59 6.63 883 100.0 12.14 17 Table III. Infantile Mortality. 1946. Nett Deaths from stated causes at various periods under 1 Year of Age. Causes of Death. | Under 1 Week. | 1—2 Weeks. I 2—3 Weeks. j 3—4 Weeks. Total under 1 Month. 1—3 Months 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under 1 Year. 1 Smallpox 2 Chickenpox 3 Measles 4 Scarlet Fever 5 Whooping Cough 6 Diphtheria and Croup 7 Erysipelas 8 Tuberculous Meningitis 9 Abdominal Tuberculosis 10 Other Tuberculous Diseases .. 11 Meningitis (Not Tuberculous) .. 12 Convulsions 13 Laryngitis 14 Bronchitis 15 Pneumonia ... 1 2 3 1 2 ... ... 6 16 Diarrhoea 17 Enteritis ... ... ... ... ... 2 ... 1 ... 3 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 3 1 ... ... 4 ... ... ... ... 4 23 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 24 Congenital Malformations 3 1 ... 1 5 2 ... ... ... 7 25 Premature Birth 6 ... ... ... 6 ... ... ... ... 6 26 Atrophy, DebilityandMarasmus ... ... ... ... ... 1 ... ... ... 1 27 Other Causes 2 2 1 ... 5 2 ... ... i 8 Totals .. 15 5 3 1 24 8 2 1 1 36 18 Table IV. Vital Statistics of Whole District during 1946 and Seven Previous Years. Y ear. Population estimated at Middle of each Year. Nett Births belonging to District. Nett Deaths belonging to the District. At all Ages. Under 1 Year of Age. Number. Rate per 1,000 Population. Number. Rate per 1,000 Population. Number. | Rate per 1,000 Nett Births. 1 2 3 4 5 6 7 8 1939 67,770 780 11.24 693 10.16 21 26.92 1940 66,570 707 10.62 769 10.97 23 32.81 1941 64,890 647 9.97 771 11.28 25 40.91 1942 65,790 925 14.06 702 10.67 34 36.75 1943 65,720 1,088 16.55 802 12.20 36 33.08 1944 64,190 1,096 17.07 803 12.51 42 38.32 1945 64,970 976 15.02 781 12.02 38 38.93 1946 72,710 1,213 16.68 883 12.14 36 29.68 Comparison of the Rates of Southgate with those of England and Wales, and London, for the Year 1946. Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births. Still Births. All Causes. Typhoid Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 19.1 0.53 11.5 0.00 0.00 0.00 0.00 0.02 0.01 0.15 4.4 43 126 Count y Boroughs and Great Towns, including London 22.2 0.67 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.13 6.1 46 148 Smaller Towns (1931 Census Populations 25,000—50,000). 21.3 0.59 11.7 0.00 0.00 0.00 0.00 0.02 0.01 0.14 2.8 37 London -., 21.5 0.54 12.7 0.00 — 0.01 0.00 0.02 0.01 0.12 4.2 41 Southgate 16.68 0.42 12.14 — — — — — . — 0.16 0.04 29 68 A dash (—) indicates that there were no deaths. 19 General Provision of Health Services. Hospitals.—The arrangements set out in previous Annual Reports relating to the provision of special and general hospital accommodation, together with the provision of maternity beds, remained unaltered during the year. The remarks which I made in my Annual Report for 1945 regarding the inadequacy of hospital accommodation in this area have even more point to-day. This inadequacy applies to all types of hospital accommodation, with the exception of that required for infectious diseases, for which we have been able to make ample provision. Beds for the chronic sick, accommodation for patients suffering from pulmonary tuberculosis in all stages, and maternity beds are particularly short. Even where actual space is available, shortages of staff have made it impossible for empty beds to be filled. This is, of course, not only a local problem; the country as a whole is suffering in the same way to a greater or lesser degree. Until the number of beds required to meet existing demands are ready, and until the necessary nursing staff can be recruited, we must continue to fall back upon such expedients as are available to us. These expedients include the provision of Domestic Helps, Home Nursing Services, Post-natal supervision to an even greater extent than has been undertaken in the past, and an adequate service of Home Helps after confinement. But whatever they are, they still remain expedients. No matter how well organised and adequate such alternatives may be, they can never take the place of a proper hospital service. It may be that the setting up of the new Regional organisation under the National Health Service Act will improve the situation, although one takes leave to doubt whether this will, in fact, be the case. The problem is not one which can be solved by legislation; it is basic, nationwide and physical, and will require corresponding methods of approach if present ills are to be overcome. In the meantime, we must accept the position, and do what we can locally to alleviate the hardships and actual dangers which it brings in its wake. Under the National Health Service, and for the first time in the history of this country, preventive and curative medicine are to be almost wholly divorced. One can only hope that the new Regional Hospital Boards will be made fully aware of and attempt to meet the varying needs of each of the areas constituting the Region. The fact that the newly constituted Health Authorities, 20 not to mention existing Local Authorities, are not directly represented by any official on the Regional Hospital Boards appears regrettable, although intelligent co-operation and understanding may overcome the obvious difficulties which can be foreseen. The negotiations which took place during 1946 to transfer our Isolation Hospital to the County Council for use as a Maternity Annexe are more fully dealt with on Page 55 of this Report. It merely remains to be stated here that the Southgate Borough Council made a definite contribution to local needs, wholly designed to throw urgently needed maternity beds into the very shallow pool. Ambulance Facilities.—The following table sets out the total number of journeys carried out by our Ambulance Service during the past four years:— 1946. 1945. 1944. 1943. General removals to or from hospitals, etc. 1,930 1,577 1,112 988 Maternity cases 318 352 394 334 Traffic accidents 71 57 29 47 Other accidents 390 505 436 407 2,709 2,491 1,971 1,776 Included in the above figures for 1946 are 196 journeys made at the request of neighbouring authorities, and 94 Southgate journeys made by ambulances of other authorities at our request. From this table it will be seen that the service has grown each year. The Ambulance Service will, of course, be transferred to the County Council under the National Health Service Act, but it is to be hoped that a local Ambulance Station will be retained in Southgate, and that our present personnel will have the opportunity of continuing their excellent work. It became obvious during 1946 that additions to the Ambulance Staff would be required in the very near future. Arrangements to re-organise the service on a three-shift basis were begun, but had not been completed by the end of the year. Arrangements were also made whereby cases of infectious disease could be conveyed to the Finchley, Hornsey, Wood Green and Friern Barnet Isolation Hospital, when the time came for Southgate patients to be admitted there. 21 Mortuary.—The alteration in the shifts worked by the National Fire Service personnel stationed at the Town Hall deprived us of our Mortuary Attendant, who was a member of the National Fire Service. The Coroner for the area was approached, and after consultation it was decided that bodies requiring a post-mortem examination should be conveyed direct to the Prince of Wales's Hospital, where mortuary facilities are adequate. Our mortuary is still being maintained, and will be available for use as and when required. Thirty-nine post-mortem examinations were carried out during the year. Laboratory Facilities.—As noted in the annual report for 1945, laboratory facilities became available on the 1st April, 1946, at the Central Public Health Laboratory, Colindale. Specimens are collected daily, during the early afternoon, the Public Health Department being one of the collecting points on a route served by a vehicle from the laboratory. The fact that specimens sent in after the appointed time have to be retained until the following day, was not at first particularly acceptable to general practitioners. They soon, however, accustomed themselves to the new routine, and no great difficulties have been encountered. Urgent specimens received in the late afternoon, at night or during week-ends, have either to be taken by one of our own vans to Colindale, or can be sent to the laboratory at Coppetts Road Isolation Hospital, where an expert technician is employed. We are thus adequately covered for any reasonable eventuality. It might also be stated that we still retain our own laboratory in Wolves Lane. This is used for emergency work, particularly the investigation of diphtheria swabs delivered late in the day. The Laboratory Service provided by the Central Public Health Laboratory is very much fuller than any comparable service available in the past. The Laboratory staff is prepared to carry out detailed investigations, on behalf either of general practitioners or of the Public Health Department, while any reasonable type of bacteriological examination is undertaken. This has placed a powerful new weapon at our disposal. It might also be stated that the service is free. The opportunities available for personal contact with the Director of the Laboratory Service and his assistants are also valuable and appreciated. Individual problems and problems affecting the district as a whole can be discussed at length, on a more personal and intimate basis. This is an obvious advantage. The 22 Laboratory Service has also been of great help in arranging short courses on Food Hygiene. Three such courses are being arranged for Sanitary Inspectors, with the prospect of additional courses for Canteen Supervisors and Canteen Staff. General practitioners are beginning to make very good use of the laboratory services, the extent and variety of which have been repeatedly brought to their attention. The Public Health Department has also called on the Laboratory staff on several occasions, particularly in connection with outbreaks of infection in our Day Nurseries. In every instance, co-operation was immediate and of considerable assistance. It is probable that the present laboratory service will be extended in the relatively near future, by the establishment of branch laboratories throughout the county. Consultations have already taken place on the siting of these branch laboratories, which should provide an even more intimate and easily accessible service, especially for general practitioners. Summary of work carried out at Central Public Health Laboratories, Colindale:— Hospital Positive. Specimens. Negative. Borough Positive. Specimens. Negative. Swabs for Diphtheria Bacilli 78 707 1 85 Swabs for Virulence Tests 2 1 — — Swabs for Haemolytic Streptococci 4 — 4 1 Swabs for Vincent's Angina — — 1 — Sputa for Tubercle Bacilli — — 3 55 Blood film for Malaria — — 1 — The following specimens were also examined:— Urine 9 Faeces 26 Cerebro-spinal fluid 2 Blood 7 Vaginal swab 1 Pus 1 23 Summary of work carried out at Council's Laboratory:— Hospital Positive. Specimens. Negative. Borough Positive. Specimens. Negative. Swabs for Diphtheria Bacilli 27 234 — 89 Swabs for Haemolytic Streptococci — 3 2 9 Swabs for Vincent's Angina 4 4 — 2 Sputa for Tubercle Bacilli — — 2 27 specimens sent to Clinical Research Association:— Faeces 3 Swabs for virulence tests 3 Specimens sent to Prince of Wales's Hospital Laboratory:— Cerebro-spinal fluid 3 Swab for bacteriological investigation 1 Scabies and Lice.—The arrangements set out in last year's Annual Report for the treatment of patients suffering from scabies or vermin infestation remained unaltered until the end of the year. Details of work carried out under this heading during the year are as follows: 57 patients were treated for scabies. 4 patients were treated for head lice. Arrangements were made to have this work carried out at the Hornsey Disinfestation Station, when the facilities at the Isolation Hospital ceased to be available. In view of the comparatively small demands, it is felt that these arrangements should be satisfactory, at least for the time being. The anticipated addition of two Health Assistants to the School Medical Service will allow this work to be more adequately covered so far as children attending our schools are concerned. Nursing in the Home.—(a) The Southgate Queen's Nursing Association continues to provide nursing facilities in the home, on the same generous scale as we have come to expect in the past. The standard of these services needs little commendation from me, but I should not like to let this opportunity pass without expressing my personal appreciation and the appreciation of the Public Health Department for the excellent work carried out each year by the Nursing Association. There has always been close and cordial co-operation between the Public Health Department and the Queen's Nursing Association, co-operation which is officially recognised by the appointment of the Medical Officer of Health on the Executive Committee of the Association. 24 Details of the work carried out by the Southgate Queen's Nursing Association on behalf of the Borough Council are as follows: 1945. 1946. Diseases Treated. Cases. Visits. Cases. Visits. Pneumonia 23 219 27 196 Influenza 1 2 19 94 Hospital cases 41 479 46 1,156 Children under five years 66 436 73 333 Others 1 6 4 50 132 1,142 169 1,829 In addition to the above, 482 children under five years of age were sent from the Maternity and Child Welfare Centres for treatment in the Physiotherapy Department of the Nursing Association during 1946. The following table sets out the work carried out by the Association during 1946, so far as its own activities are concerned:— 1945. 1946. Domiciliary Nursing Visits 15,551 16,315 Midwifery, Maternity and Ante-natal Visits 3,342 5,277 Patients attending Physiotherapeutic Clinics 3,837 3,337 Treatments given 15,913 15,534 The Southgate Queen's Nursing Association also undertakes the official midwifery service in the Borough, acting as agent for the Middlesex County Council. As is the case with the general nursing services provided by the Association, co-operation between the Queen's Nurses and the staff of the Maternity and Child Welfare Department is intimate, and operates to the mutual benefit of all concerned. (b) As indicated above, home nursing of certain infectious disease is being undertaken by the Southgate Queen's Nursing Association at the request of the Borough Council, where such home nursing is considered necessary or desirable. The scheme continues to operate in a very satisfactory manner. 25 CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare (Southgate Council).—At 31st December, 1946. Infant Welfare: Methodist Church, The Bourne, Southgate Monday 2—4 Methodist Church, Palmerston Road, Bowes Park Tuesday and Thursday 2—4 Combined Clinic, Bowes Road, New Southgate Wednesday 2—4 Methodist Church, Green Lanes, Winchmore Hill Tuesday and Thursday 2—4 De Bohun School Clinic, Green Road, Southgate Friday 2—4 Pre-Natal: Combined Clinic, Bowes Road, New Southgate Tuesday and 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 (Middlesex County Council).—The Dispensary serving the area is situate at 980, High Road, Whetstone. Veneral Disease Clinic (Middlesex County Council).— Prince of Wales's Hospital, Tottenham. All London General Hospitals are included in the London and Home Counties Joint Scheme for the treatment of Veneral Diseases. Day Nurseries.—Alderman House, Aldermans Hill, Palmers Green; Tottenhall Sports Ground, Tottenhall Road, Palmers Green; Hoppers Road, Palmers Green. 26 Orthopaedic Treatment.— Arrangements exist for the investigation and treatment of orthopaedic cases discovered in connection with our Maternity and Child Welfare Services to be carried out at the County Council's Orthopaedic Clinic held at Combined Clinic, Bowes Road. Fifteen new cases and 17 old cases were dealt with during the year. It is certain that the list of clinics set out in the foregoing paragraphs will be materially altered during 1947. As will be mentioned later in this Report, we contemplate adding to our Child Welfare and Ante-Natal Clinics, whilst immunisation will also be extended by the provision of new facilities and the addition of of whooping cough to the infectious diseases against which protection is offered. We will also be taking over the administration of the local School Health Service Minor Ailment Clinics, and will be responsible for the Orthopaedic Clinic, to which reference has just been made. It should be possible to make a more accurate estimate of the adequacy of our clinic facilities generally, when the new School Health Service has had a chance to function. The problem of the provision of clinics, whether for adults, school children, or infants, is one which should always be considered as a single entity, since each one of the individual services provided impinges either directly or indirectly upon the remainder. I therefore hope to be able to submit a more detailed report on this subject in my next Annual Report, although adjustments will be suggested in the interim as and when the need arises. DOMESTIC HELPS. It will be remembered that the Borough Council instituted its Domestic Help Scheme in June, 1945. Up to the end of 1945 only 13 cases had been assisted; during 1946 this number rose to 80. The increase in the demand is also shown by the fact that only one fulltime Domestic Help was available for duty at the end of 1945, while 5 full-time and 3 part-time Domestic Helps were engaged on this type of work twelve months later. The problems of old age, coupled with infirmity, so often referred to nowadays as gerontology, have come to the front in recent years. Southgate, with its population heavily weighted towards the older age groups, must be particularly interested in these problems which no one can any longer afford to ignore. Our Domestic Help Scheme, which supplies temporary help to families which require this assistance, is particularly valuable in the case of 27 old persons who, by reason of age and infirmity, are unable to look after themselves and their homes. The scheme is also useful in cases of temporary illness in a family, where no other type of help happensto be available. One way or another, the Domestic Help Scheme has proved a valuable addition to our existing social services and has. quite obviously come to stay. In this connection, it may at some time not too far distant be necessary to arrange for the Council's combined Home Help and Domestic Help Schemes to be handled by a specially appointed member of the staff. The work entailed in running these schemes is considerable, and occupies quite a proportion of the time of one of the Health Visitors and the Chief Clerk. This is both unsatisfactory and uneconomical, since the work could quite easily be undertaken by anyone possessing reasonable organising ability, sympathetic understanding of human problems, and common sense. It is doubtful whether the work entailed would at present justify a fulltime appointment, but this may become necessary in the relatively near future. There can be no doubt that the work is important, and that, to equate the various problems which arise from day to day, much thought and time must be expended. More time could alsobe profitably spent in attempting to recruit additional Home and Domestic Helps, by direct, personal approach to local Women's Organisation, Churches and the like. The services of an ad hoc organiser would be particularly useful here. If we cannot devote sufficient time to these problems, we are leaving a duty undone which remains a clear and urgent responsibility. It should quite soon be possible to assess the need more clearly and to determine how much, if any, additional help is required. When that time arrives, I hope to have the privilege of presenting a special report to the Committees concerned. 28 Maternity and Child Welfare It will be noted that attendances at our various Clinics and Centres continued at a satisfactory level during 1946. Indeed, the numbers became so great at certain Centres, that consideration had to be given to the establishment of new clinics. Attendances amounting to 100 mothers and children at Infant Welfare Centres and 30 to 40 expectant mothers at Ante-Natal Centres are much too high. Individual attention cannot possibly be adequate in such circumstances, no matter how hard or conscientiously the staff may work. Because of this, the whole question of our clinic provision was reviewed towards the end of 1946, with a view to increasing the scope of the services provided. The fact that Southgate will assume responsibility for the day-to-day administration of the School Health Service during 1947 tended to complicate the issue, but the situation was considered sufficiently serious to warrant immediate action. Quite apart from the excessive attendances at our Centres, it is now obvious that insufficient time is being devoted to visiting in the home. With the early discharge of maternity cases from hospital, post-natal supervision in the home is more than ever important. The housing situation and the many difficulties with which young mothers are now faced, adds urgency to the problem, which has never been so great as it is to-day. It is hoped that the new arrangements under which we will operate the School Health Service and Maternity and Child Welfare Services combined, will ease the situation, but it may well be that additional help in the way of Health Visitors will still be required. We cannot possibly afford to exclude any precautions which safeguard the health and future of mothers and young infants. To do so would be nothing less than criminal folly, viewed either from the humanitarian angle, or from the welfare of the nation as a whole. Southgate has good reason to be proud of the foundations on which its Maternity and Child Welfare work has been laid; there is even more reason for the acceptance of extended responsibilities in the immediate future. The part played by the Southgate Voluntary Helpers deserves S'pecial mention. These ladies, actuated by a selfless desire to be of service, help out at all our Clinics and Centres, according to an established rota. The assistance which they render cannot be too highly praised, and is appreciated most by those who really understand its worth. If loyalty and devotion to duty can help us towards our ideal, we know that this will always be available. 29 In an early section of this report I passed comment on the satisfactory infantile mortality rate for the year, a rate to which our Maternity and Child Welfare Services must surely have contributed. This shows us what can and should be done; it also points the way to greater achievements. Unfortunately, present-day conditions are not on our side; even to hold what we already have calls for sustained, strenuous effort. In no field of social medicine will the effort be more worth-while and show a greater yield. The future lies with youth, but whether or not there is a future at all depends not on youth but on us. STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURING 1946. Number on Registers:— Under 1 year. Over 1 year. Totals 1946. 1945. January 1st, 1946 558 1,064 1,622 1,445 December 31st, 1946 1,820 1,588 3,408 3,017 New cases during 1946 1,262 524 1,786 1,572 Seventy-four of the new cases under 1 year were "removals'' into the district. The remaining 1,188 represent 97.93 per cent, of the total births credited to the district. Attendances at Centres, 1946:— Under 1 year. Over 1 year. Totals. Sessions. The Bourne 3,769 1,818 5,587 94 Bowes Park 4,019 2,178 6,197 103 Combined Clinic 3,472 1,469 4,941 51 Winchmore Hill 4,402 2,390 6,792 103 De Bohun 2,179 1,079 3,258 49 Totals—1946 17,841 8,934 26,775 400 1945 13,222 9,163 22,385 347 Average—1946 44.60 22.33 66.93 1945 38.10 26.40 64.50 30 STATISTICS OF ATTENDANCES AT PRE-NATAL CENTRES. Number on Registers :— 1946. 1945 January 1st 178 113 December 31st 201 181 New cases during the year 555 451 Number of sessions held 142 130 Total attendances 3,707 2,675 Average per session 26.1 20.57 POST-NATAL CLINIC. The Post-Natal Clinic was continued throughout the year, the following being the details of attendances Attendances, 183; Sessions, 12; Average attendance, 15.25. TABLE OF VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OF BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. Children:— 1945. In addition to first visits. 1946. First visits 643 738 Under 1 year of age 1,1221 793 Over 1 year of age 3,018 2,043 Visits re:— Deaths under 5 years of age — 3 Stillbirths — 3 Pre-natal visits 316 541 Clinics attended 944 1,036 Special visits (test feeds, following up special cases seen by M.O. at Clinics, failing lactation, etc.) 194 120 6,300 5,277 31 Child Life Protection.— The following is a summary of the work carried out in this connection during 1946:— Number of registered Foster Mothers 18 Number of Foster Children on register during the year 19 Number of Foster Children at end of year 11 Number of visits paid by Health Visitors 82 No unsatisfactory conditions were met with throughout the year. Maternity Outfits.— Sterilized maternity outfits were supplied to expectant mothers during 1946, as follows:— 25 were supplied free of charge. 26 were supplied at one-sixth full charge. 26 were supplied at one-third full charge. 19 were supplied at one-half full charge. 6 were supplied at two-thirds full charge. 5 were supplied at five-sixths full charge. 38 were supplied at cost price. Totals: 1946, 145; 1945, 99. Care of Illegitimate Children (Circular 2866).— The Council continues to participate in the scheme operated by the Middlesex County Council in conjunction with the British Red Cross Society for the care of unmarried mothers and their babies at the Society's hostels at "Maryland" and 16, The Park, Hendon. Four cases were dealt with during 1946. Care of Premature Infants (Circular 2044).— The draughtproof cots purchased by the Borough Council in 1944 for use in the care of premature babies proved to be of considerable value during the year 1946. Cots were loaned to nursing homes for the benefit of two premature infants, and to three mothers in their own homes. One of these was a case of premature twins. During the year, 46 premature infants were notified, of whom 43 survived at the end of one month, as compared with 30 and 24 respectively in 1945. The provision of this special equipment for the care of premature infants would appear to have made a small but none the less important contribution to the improved rate of survival. Home Help Scheme.— The following are details of the work carried out under the above scheme during 1946: 32 Home Helps were provided for 74 patients confined at home during the year, as compared with 25 in 1945. 12 were provided free of charge. 12 were provided at one-sixth full charge. 10 were provided at one-third full charge. 10 were provided at one-half full charge. 13 were provided at two-thirds full charge. 6 were provided at five-sixths full charge. 11 were provided at full charge. It will be noted that demands on the Home Help Service very definitely increased during the year. The number of Home Helps available for employment also rose, from one full-time helper at the end of 1945 to four at the end of 1946. In spite of this latter increase, it was not always possible to meet calls on the Home Help Service, although every effort was invariably made to do so, including on several occasions the utilisation of the services of Helpers in the Domestic Help Service. Now that maternity cases are being discharged at an earlier date from hospital— a practice which will presumably be continued, at least for some time to come—and housing conditions show no immediate promise of betterment, the need for a Home Help following confinement is more than ever apparent. During the year, letters were addressed to all women's organisations and churches in the Borough, asking them to assist us in our search for additional Home Helps. The local Employment Exchange also has a standing order to send any women interested in this work along to us. Yet another attempt was made to secure additional helpers by the circulation of the specially printed leaflet, "New Career for Women." These efforts have been partly successful, but we could still do with more women of the right type to undertake this very necessary social service. The uses to which a full-time organiser could be put in establishing personal contact have already been indicated. Apart from the Home Help supplied to women confined at home or discharged from hospital within a few days of delivery, assistance is also provided, within the limit of our resources, to women who spend a full fortnight after delivery in a hospital or nursing home. In these cases full-time assistance is very often not required, although part-time help is appreciated and eases the immediate burden. 33 The graduated scale of charges made by the Council for a Home Help is quite generous and in keeping with the present economic situation. Discretion is allowed in special circumstances. None the less, it appears as though the scale may shortly have to be reconsidered, in the light of changing conditions. This will be made the subject of a special report to the Maternity and Child Welfare Committee. In order to avoid misunderstandings and improve the service provided, steps are being taken to have the duties of Home and Domestic Helps printed on a special leaflet. Day Nurseries.— The Day Nursery facilities available in the Borough remain as set out in the Annual Report for 1944. If the present policy of encouraging women to enter the labour market is continued, the existing Day Nursery provision in Southgate will have to be retained. Whether or not this is a wise policy has yet to be decided. It can, I think, be justly claimed that the mental health of children cared for in our Day Nurseries is beneficially affected. Their behaviour improves, their emotional balance is more quickly stabilised, while their reaction to modified discipline noticeably alters. It cannot, however, be claimed that the physical health of these children is affected to the same degree. Indeed, the aggregation of young children in Day Nurseries, particularly children under the ageof three, is generally followed by an increase in respiratory infections and by a corresponding increase in most of the commoner infectious diseases. Moreover, the disruption of the family unit, to which the vast increase in Day Nursery facilities has substantially contributed, raises an issue of considerable magnitude. Any policy which encourages women to work away from their homes at the expense of their families is clearly wrong. This is not the place to suggest possible alternatives, although the problem is one which cries aloud for national solution. It must be admitted, of course, that the local problem, so far as Southgate is concerned, is rather different. Here, we are catering more for children whose mothers have to work in order to maintain their homes. Whether we like it or not—and few who look to the future can feel at all happy—the situation is there and must be faced. For that reason, we must obviously maintain our Day Nurseries at their present strength, although I personally hope that the day will come when the number of places available can be materially reduced. In the meantime, the responsibilities of parenthood are being inculcated by means of our Maternity and Child Welfare Service. In this connection the Maternity and Child Welfare Committee is considering a wider application of these principles through the agency of special talks and demonstrations. 34 During the year 6 outbreaks of infectious disease occurred in our Day Nurseries. These were quickly brought under control, use being made of the Central Public Health Laboratory Service on a number of occasions. The following table supplies details of attendances at each of the Nurseries during 1946:— Aldermans Hill. Tottenhall Road. Hoppers Road. Daily Daily Daily Total attendances. average attendance. Total attendances. average attendance. Total attendances. average attendance. Jan. 638 28 736 32 927 40 Feb. 718 36 524 26 829 41 Mar. 700 33 642 31 967 46 April 735 37 667 33 857 43 May 951 41 808 35 972 42 June 773 40 772 40 892 47 July 950 41 936 40 1,125 49 Aug. 770 37 851 41 1,004 48 Sept. 825 39 840 40 945 45 Oct. 1,041 45 1,008 44 1,220 53 Nov. 798 38 808 38 1,050 50 Dec. 664 37 769 40 902 47 1946 9,563 37.79 9,361 36.85 11,690 46.02 1945 7,775 31.10 8,167 32.67 10,294 41.17 35 Sanitary Services Sanitary Inspections, 1946:— Housing inspections and re-inspections 3,689 Registered premises, including factories, workshops, bakehouses, milk shops and other food shops, visits and inspections 1,034 Infectious Desease, visits and inspections 1,870 Miscellaneous visits and inspections, including various complaints, rats and mice infestations, ditches and ponds, non-notifiable diseases, etc. 9,397 Visits re verminous premises 94 Visits re nuisances from flies, etc. 5,128 21,212 Service of Notices:— Total informal sanitary notices served 957 Total informal dustbin notices served 575 Total informal notices served 1,532 Total informal notices complied with 1,244 Total statutory notices served 123 Total statutory notices complied with 116 As has been the case for the past few years, the work of the Sanitary Inspectors continues to be made more difficult by existing shortages and controls. The service of a notice, which in pre-war years was virtually tantamount to necessary work being carried out, no longer carries the same guarantee. This is particularly unfortunate, since it means that the leeway which five years of war has created, cannot yet be made up. The result is ever-increasing dilapidations, dilapidations which can only receive attention when they become sufficiently serious to represent an immediate danger to health. The effect upon the health of householders when work of a less serious nature has had to stand in abeyance is none the less unfortunate, more so as we know that the danger exists but cannot do much to overcome it. It became obvious during 1946 that the sanitary staff was insufficient to cope with the work in hand. Bearing in mind the conditions set out in the paragraph above, it will not surprise anyone to learn that the number of complaints received from day to day has risen appreciably over the past few years; nor will it be surprising that the eradication of a nuisance occupies a very much longer time to-day than was the case before the war. Added to this 36 is the fact that such matters as the periodic inspection of schools— a very necessary safeguard—work under the Shops Acts, and the supervision of food shops have not been able to receive the attention which they so clearly merit. Even more important is our inability to exercise strict and necessary control over the many canteens and eating houses which have sprung up within the Borough. This shortage of staff is being brought to the notice of the Public Health Committee, and it is hoped that 1947 will see an all-round improvement. It is a disturbing thought that, while the personal health services have been so materially stepped up over the past ten years, environmental hygiene, upon which so much of our health depends, has had to be partially, and in some important instances, substantially neglected. When one considers the effect upon our health and well-being of housing, control of food stuffs, and sanitary supervision in its widest sense, the importance of environmental hygiene will at once be realised. At the moment, we can only hope to adopt a policy of strictly limited activity, dealing with our problems in strict order of priority. This is highly unsatisfactory, but until we can return to anything even remotely approaching normality, there is little else to be said. Housing.—The Public Health Department has been happy to co-operate with the Housing Department in the investigation of cases of over-crowding reported in the district. This co-operation has been close and cordial, and although it has thrown considerable work upon the shoulders of the Sanitary Inspectors, they have accepted the burden very willingly, in the knowledge that no part of their duty is more important. It has fallen to my lot on a number of occasions to bring to the notice of the Housing Department cases of very serious overcrowding, particularly cases in which actual illness or ill-health have created a re-housing problem. Judged purely from the Public Health standpoint, the two most urgent types of cases with which we have to deal are cases of open tuberculosis in a family, and mothers returning from hospital with an infant to conditions detrimental to the health both of mother and baby. In all such cases it is pleasing to record that the Housing Department has given my recommendations immediate and sympathetic consideration. The need for re-housing families from which a case of open pulmonary tuberculosis has been reported, is particulary claimant. This will receive more detailed attention in the section of the report dealing with the prevalence and control of infectious diseases. 37 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, 30 Dealers' Licences, 1 Pasteuriser's Licence and 17 Supplementary Licences were granted. Bacteriological 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 until the end of March when the depot was transferred to Smithfield. 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. 38 FACTORIES ACT, 1937 Factories, Laundries and Homework. 1.—INSPECTION. Premises. Number of Inspections. 1946. Written Notices. 1946. Prosecu tions. Factories with Mechanical Power 262 36 — Factories without Mechanical Power 179 10 — Total 441 46 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of defects in respect of which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 40 40 — — Overcrowding (S. 2) — — Unreasonable temperature (S. 3) — — Inadequate Ventilation (S. 4) — — Ineffective drainage of floors (S. 6) — — Sanitary Convenience (S. 7) Insufficient — — unsuitable or defective 30 30 not separate for sexes — — Other Offences — — — — Total 70 70 39 40 3.—HOME WORK. Nature of Work. Outworker's Lists, Section 110. Prosecutions. Outwork in Unwholesome Premises, Sec. 111. Lists received from Employers. Notices served on Occ'prs as to keeping or sending Failing to keep or permit inspection of lists. Failing to send lists. Twice in the year. Once in the year. Instances Notices Served Prosecutions Lists. Outworkers Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Wearing Apparel — (1) Making, etc. 8 23 4.—REGISTERED FACTORIES. 5.—OTHER MATTERS. Factories on the Register at the end No. Class. (1) (2) (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factories Act (s. 114) .. Bakehouses 20 Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factories Act (s. 9) Notified by H.M. Inspector 5 Laundries 2 Reports of action taken sent to H.M. Inspector 5 Factories 232 Total Number on Register 254 Other Basement Bakehouses (s. 54);— .. Certificates granted during the year .. In use at the end of the year .. Establishments for Massage or Special Treatment.— Under the bye-laws governing this class of establishment, 12 existing licences were renewed. Seven new licences were granted. Swimming Bath.—The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows: 1945. 1946. Mixed Bathers 48,884 42,137 From Schools 9,576 6,872 Season Ticket Holders 14,903 9,288 73,363 58,297 Spectators Costumes, etc., hired 4,139 746 3,736 767 Our Open Air Swimming Bath is not only a very desirable amenity, it provides a valuable means of safeguarding health and raising resistance against infection and disease. For this reason, the anticipated scheme whereby a more fully organised attempt is to be made to encourage school children to use the Bath, either singly or in conducted parties, is cordially welcomed. The Swimming Bath is inspected by the Public Health Department staff throughout the season, and samples are regularly taken of the water. These samples are sent to the Central Public Health Laboratory for examination. The results of the samples taken during the year showed that the water was in a satisfactory condition. The various visits to the Bath also showed that the Bath Superintendent and her staff were carrying out their responsible duties in an admirable manner. Rivers and Streams.—Complaints continue to be received from time to time regarding unpleasant odours from Pymmes Brook. It will be remembered that this was a continuous source of complaint during pre-war years. The matter was then fully investigated, and it would not now appear that there is any point in taking further action. Rats and Mice Destruction Act.—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, 5,729 visits were made; treatments were carried out at 198 premises. 41 The Ministry of Food has for some time pressed the Borough Council to carry out the work of clearing rats from our sewers. Whilst it will be obvious that there are rats in our sewers, there is no evidence that infestation is heavy or that it constitutes a Public Health problem. This matter is to be considered by the Public Health Committee at an early date, when the decision may be taken to carry out a 10 per cent, test on all sewers in the district. Shops Acts, 1912-1936 .—As noted elsewhere in this Report, members of the sanitary staff have not had sufficient time to carry out as much work under the Shops Acts as one would wish to see. The work undertaken has been more or less confined to the investigation of specific complaints, and to the inspection of food premises. It is hoped that the addition of one Sanitary Inspector to the present staff will allow more ground to be covered, although it is unlikely that we will be able to return to our pre-war practice for some considerable time. The work of our sanitary staff has had to be governed very largely by the degree of urgency of the work involved. Although it plays its part in public health administration and is for that reason important, no one can say that work under the Shops Acts ranks, at the present time, with housing and the mitigation of public health nuisances which have a more direct bearing on the welfare of the individual and of the community. We will continue to do as much as is possible, especially in regard tothose premises, the nature of whose business can affect the public health. This applies particularly to food premises and cafes. Public Conveniences.—Seventeen public conveniences are available in the Borough, situated as follows: Broomfield Park (2). Arnos Park. Bramley Sports Ground. Oakwood Park. Grovelands Park. Tottenhall Sports Ground. North Circular Road, Palmers Green. Triangle, Palmers Green. Fords Grove, Winchmore Hill. Southgate Tube Station, N. 14. Cherry Tree Hotel, The Green, N. 14. Crown, Chase Side, N.14. White Hart, Chase Road, N.14. King's Head, Wades Hill, N.21. Orange Tree, Highfield Road, N.21. Fox Hotel, Green Lanes, N. 13. 42 Conveniences provided by the London Passenger Transport Board at Southgate and Oakwood Underground Stations are also available to the public. The question of an additional public convenience in the neighbourhood of The Green, Southgate, is to be considered during 1947. All public conveniences in the district are inspected by members of the Public Health Department staff. This inspection includes conveniences in our parks and open spaces, and conveniences provided for the use of the public in public houses and hotels. Defects are brought to the notice either of the Borough Surveyor's Department or of the proprietors of the premises in which the public conveniences in question are situated. Ponds and Rubbish Dumps.—There are now very few ponds or rubbish dumps left in the Borough, although the number of the latter has increased since the war. Ponds and rubbish dumps are kept under as strict observation as is possible in the circumstances, and the existence of any nuisance is brought to the attention of those responsible for the upkeep of the ground on which the nuisance has occurred. Ponds and rubbish dumps are sprayed regularly throughout the summer season, in order to minimise the breeding of insects. 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 now been discontinued. It was not necessary to carry out any bacteriological or chemical examinations of the drinking water during the year. There is no evidence of any plumbo-solvent action in the water. Collection and Disposal of Refuse.—The Borough Engineer informs me that, owing to lack of labour and up-to-date vehicles, the collection of house refuse during the year has not been entirely satisfactory. More men and new vehicles are now becoming available and a weekly collection is again being carried out. The fleet of vehicles now consists of eight Scammell Self Loaders, one S.D. Freighter and one Lorry. Minor complaints continue to be received. These are dealt with by the Borough Surveyor's Department. 43 Fly nuisance, particularly around the Destructor, of which complaints were received in previous years, has not assumed serious proportions owing to the continual exercise of preventive measures. The total tonnage of refuse collected and dealt with at the Destructor during the year 1946-47 was 14,048 tons. An important factor in connection with house refuse collection is salvage of various materials. The following is the tonnage sold during the year: Mixed paper 472 Books and magazines 36 Broken glass 79 Non-ferrous metal 5 Rags 27 Baled tins 605 Bottles 80 Carpets 13 Sundries 40 Cinders 87 Total 1,444 tons. The value of this material amounted to £6,341. Residents are requested to bundle their paper and keep it separate, as special compartments are provided in the vehicles for this material. The machinery at the Destructor is provided with Picking Tables over which all material passes. Such items as tins, rags, etc., are removed therefrom. During the year, 988 tons of kitchen waste were collected. This material is collected once weekly from every house in the Borough on Monday mornings. These salvage figures, whilst good, are still not good enough. Urgent appeal is made to residents to save every possible scrap of paper and kitchen waste, as the need is really urgent. 44 Prevalence and Control over Infectious Diseases From the table of notifications set out on page 51 it will be seen that 797 cases of infectious disease were notified during the year, as against 1,006 in 1945 and 636 in 1944. The Infectious Sickness Rate for the district was thus 10.96, as compared with 15.48 during 1945 and 9.91 in 1944. The fall in the Infectious Sickness Rate for the year was almost entirely due to the decrease in measles and whooping cough notifications, which together accounted for a reduction of 157 cases. Diphtheria.—The total of two cases notified during the year is the lowest yet recorded in Southgate. It is virtually certain that the decline in the incidence of diphtheria which has come about during the past ten years is almost solely due to immunisation in which Southgate has played its full part. Other factors which influence the spread of diphtheria infection—overcrowding, existence of "carriers," nutrition, early diagnosis—have either not altered in any way or have changed for the worse. The fact that, in spite of present-day hazards, diphtheria has been brought under strict control, represents a major victory for the principles and practice of immunisation. It is pleasing to remember that Southgate was a pioneer in this field of preventive medicine, and that, years before die national campaign in favour of immunisation was inaugurated, our system was in operation. We are reaping the benefits now, to ^uch an extent that, so long as present policy is continued, diphtheria as a major killing and incapacitating factor need cause no alarm. Scarlet Fever.—Notifications of scarlet fever dropped by 27 during the year, the total for 1946 being slightly under the average for the past ten years. The type of infection met with was mild, the complication rate being correspondingly low. The use of sulpha drugs, coupled with the exhibition of serum in selected cases, has greatly facilitated the treatment of this disease, although its position in relation to the general group of streptococcal infections still leaves much to be desired. So long as severe streptococcal infections, e.g., tonsil it is and the like, remain outside the group of notifiable infectious diseases, the inclusion of a similar type of infection, whose differentiation rests almost entirely upon the appearance of a rash, is unsatisfactory. This applies particularly to the type of 45 scarlet fever in which the rash is either transient or non-existent. Recent advances in bacteriology have helped to clarify the situation, but the time appears overdue for a new approach to this complicated problem. Puerperal Pyrexia.—The significance of puerperal pyrexia notifications has considerably changed since the regulations were altered in 1939. Now that any condition which can cause a rise in temperature over a comparatively short period is included in the generic term "puerperal pyrexia," such transient and non-infective •conditions as constipation fall within this category. This is not to say that the notification of such conditions during the puerperium is not proper; this is far from being the case. We should have a full and detailed record of all such abnormalities, whether or not they possess any clearly defined epidemiological significance. By no other means can we hope to increase our knowledge of a condition, or group of conditions, concerning which further information is still urgently required. Measles.—The fall in measles notifications was due to the fact that 1946 was a non-epidemic year so far as this disease was concerned. In spite of this fact, it will be noted that the number of cases reported made up 51.57 per cent, of the total cases of infectious disease notified during the year. The explanation is comparatively simple, the solution much more difficult. Measles is a virus infection, and is not subject to control by immunisation or vaccination. Nor is its treatment influenced by the use of sulpha drugs or penicillin, except in so far as secondary infection may be concerned. Thus, while such diseases as diphtheria, typhoid fever and pneumonia have been brought under reasonable control, measles continues on its way with little let or hindrance. This is unsatisfactory, especially when the after-effects, not so serious as in past decades but still demanding our attention, are remembered. The use of gamma globulin and similar concentrated serum preparations does, however, hold out hope that the spread of measles may at last be checked. The Central Public Health Laboratory has been most helpful in supplying "measles modifiers" to general practitioners, whilst our Day Nurseries have also had the benefit of this latest safeguard. There can be little doubt that the scientific use of measles modifiers would go far towards reducing the unpleasantness, as well as the dangers of measles, and it is in this direction that we must look for future progress. So long as measles notifications remain at their present high level, preventive medicine cannot claim undisputed victory. At least one major problem remains to be solved, a problem which, with the decline in other infectious diseases, calls for solution more than ever before. 46 Whooping Cough.—The problems of whooping cough are allied to those of measles, with which the disease is so often associated in endemic or epidemic form. We have too long taken whooping cough for granted, tending to concentrate our efforts on the ancient enemies, diphtheria, scarlet fever and the typhoid infections. This should no longer be the case. Recent work, particularly that of Harriet Felton in America, has shown that whooping cough is susceptible to control by immunisation in an urban community. At the moment, the antigens available do not guarantee immunity against infection, as is the case with diphtheria. But they do offer a means of modifying the disease, should it occur in an immunised individual. The great weight of evidence available has already shown that whooping cough in the immunised occurs in a mild form, failing to embarrass the sufferer and seldom leaving •any serious after-effects. The advantages will be obvious. In Southgate, we hope to offer immunisation against whooping cough to parents, commencing early in 1947. We await the results of our campaign with eagerness, and also with hope. Tuberculosis.—Tuberculosis notifications rose by four during the year, with a total of 71 as against 67 during 1945. This is not surprising when full consideration is given to the present state of housing, living conditions generally, and the employment of so many young women in industry. The role of the Southgate Borough Council in the control of tuberculosis is not so active as in other fields of public health, but we do have very definite responsibilites. Although such matters as the investigation and supervision of contacts, treatment in hospital or sanatorium, and after-care rest with the County Council, the environmental aspect of the problem Temains with the local authorty. So far as lies within its power, the Public Health Department attempts to improve the housing conditions of those families from which a case of tuberculosis or suspected tuberculosis has been reported. It is pleasing to report that the Housing Committee has never failed to give our representations the most sympathetic consideration, and that, in spite of present difficulties, most of these unfortunate sufferers have been assisted. But this only represents a fraction of the problem. So long as overcrowding exists in its present form, and so long as necessary repairs are being impeded or delayed, the situation will remain acute. It is a sad thought that tuberculosis, which before the war was being steadily fought and to a limited degree overcome, is now showing signs of overstepping the bounds of control. It is no consolation to blame this on the war, nor to say that present 47 conditions make the change inevitable. We must face up to th issue, in the knowledge that, unless the problem is tackled in ai adequate manner, a heritage of ill-health and suffering will remaii for many generations to come. To conclude on a slightly more cheerful note, it may be pointei out that the information contained in the register of tuberculosi cases set out on page 51 is not so gloomy as might appear at firs sight. Although the totals have increased, this has been very largel; brought about by the addition of cases to our register from outsid' Southgate. In spite of our acute housing shortage, it would appea that Southgate still retains the reputation of being a health; Borough, a Borough in which a return to health may be more favour ably anticipated than in other areas. This has resulted in cases o early tuberculosis moving into the district, where accommodatioi could be found. In turn, this has meant additions to our register We have no reason to complain of these additions which, as I hav just indicated, actually redound to Southgate's credit. Other Infectious Diseases.—The remaining infectious disease notified during the year call for little comment. Typhoid fever anc dysentery were absent from the Borough, while the total of cerebro spinal fever and acute anterior poliomyelitis (infantile paralysis cases was small. Pneumonia notifications showed a decrease o thirteen over the previous year. Immunisation against Diphtheria.—Nine hundred am thirty seven children attended for immunisation during 1946 at th' weekly clinic held at the Town Hall or at the schools visited during the year. In addition, 672 children received reinforcing injection: during the year. Totals (new cases) for the past five years are a follows: 1941 2,440 1942 1,762 1943 906 1944 558 1945 792 Recent returns show that 48.3 per cent, of Southgate children unde five years of age have been immunised against diphtheria, either b; the Council's officers or by their own doctors; the correspondin; figure for children between the age of five and fifteen is 71.5 per cent These figures are satisfactory, but they are still not good enough It might, however, be pointed out that, if accurate returns wer< obtainable from general practitioners, and if the considerable number of children moving in^o the district and immunised else where could be added, they would almost certainly be better. 48 During the year, opportunity was taken to review our immunisation programme in its entirety, in order to ascertain whether any improvements could-be effected. Briefly, our programme for 1947 will be carried out along the following lines: (а) A weekly clinic will be held at the Town Hall for immunisation against diphtheria or diphtheria and whooping cough combined. Children of all ages will be invited to attend this clinic, although it is hoped that the bulk will be infants (around the age of 9—12 months) referred from Maternity and Child Welfare Centres. This is the optimum age at which immunisations should be performed. As soon as Broomfield House is ready for occupation, the Clinic will be moved back to its previous premises, which are more suitable for clinic purposes. (b) Schools will be visited for the purpose of carrying out reinforcing injections approximately five years after the first immunisation has taken place. This should prolong immunity throughout the bulk of school life and thus prevent a dangerous falling off between the ages of ten and fifteen. The ideal procedure is, of course, to immunise a child for the first time at the age of 9—12 months, and to give one reinforcing dose when the child begins school. It may even be desirable to repeat the reinforcing dose at the age of ten, although this is not yet the general practice. Visits to the schools also enable us to immunise children who have been missed during our previous campaigns. (c) Other duties permitting, it may be possible to carry out a certain amount of immunisation at two of our Infant Welfare Clinics—De Bohun and Combined Clinic. I am still not satisfied that the advantages of persuading mothers to accept immunisation on the spot counteracts the dislocation which immunisation brings to a busy clinic. If and when the number of our weekly clinics is enlarged, this difficulty may be overcome: but until that is possible I feel that our programme should mainly be based on a weekly ad hoc session, either at the Town Hall or at Broomfield House. (d) Parents will be encouraged to accept immunisation by personal advice at Maternity and Child Welfare Clinics, articles in the local press and "Better Health," distribution of leaflets, and the despatch of birthday greeting cards. Any campaign to promote immunisation should be continuous, with periodic stimuli as and when required. One such stimulus 49 was the local campaign in September, 1946, when slides and trailer films were shown in local cinemas and advertisements appeared in the local press. The campaign lasted approximately three weeks, and was quite successful. Antitoxin.—Various types of antitoxins and vaccines are kept in stock in the Public Health Department, and are available for issue to general practitioners on application. Disinfection and Disinfestation.—The following is a summary of the work carried out under this heading during the year:— Total number of rooms disinfected 187 Total number of articles of bedding, etc., disinfected 2,157 Total number of articles destroyed 58 Total number of library books disinfected 235 Number of verminous houses disinfested 22 Number of verminous rooms therein 110 Number of verminous articles disinfested 61 50 NOTIFICATIONS OF INFECTIOUS DISEASE, 1946 Jan.— March. April— June. July— Sept. Oct.— Dec. Totals. Diphtheria 1 - - 1 2 Scarlet fever 30 26 16 20 92 Typhoid fever — — — — — Dysentery — — — — — Malaria — 3 — — 3 Puerperal Pyrexia 3 2 5 6 16 Erysipelas 1 6 3 5 15 Ophthalmia Neonatorum Measles 73 1 186 93 1 59 2 411 Whooping Cough 37 42 31 26 136 Pneumonia 23 8 4 10 45 Cerebro-spinal fever 2 1 — — 3 Acute Poliomyelitis 1 — — — 1 Tuberculosis— Pulmonary 21 15 19 7 62 Non-Pulmonary 3 1 2 3 9 Totals 195 291 173 138 797 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. F. M. F. Cases on Register, 1/1/46 175 166 40 37 418 Cases Notified for first time, 1946 34 28 2 7 71 Cases Restored to Register 3 — — — 3 Other cases added 10 10 2 4 26 Cases Removed from Register 40 33 3 10 76 Remaining on Register, 31.12.46.. 192 171 41 38 442 61 TUBERCULOSIS, 1946 Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1-5 years - - - - - - - - 5-10 ,, 1 — — — — — - - 10-15 „ 1 — 2 — — — - - 15-20 ,, 4 4 — 2 — — - 1 20-25 ,, 10 4 1 2 3 2 - 2 25-35 ,, 13 17 — 2 2 3 - — 35-45 ,, 4 6 — 3 2 4 - 1 45-55 ,, 6 4 1 — 2 1 - — 55-65 ,, 5 1 — 1 4 — - — 65 and over — 2 — 1 — 2 — — Totals 44 38 4 11 13 12 - 4 *These figures include all cases previously notified elsewhere and noted by the luberculosis Officer and others as having removed into the district. 62 ISOLATION HOSPITAL. The number of patients treated in Hospital during 1946 was 417, as against 430 during 1945 and 441 during 1944 (this total comprises all patients admitted during the year, together with those in Hospital on 1st January, 1946). The drop in the total number of patients treated was due, very largely, to the fact that arrangements were proceeding during the latter part of the year for the Hospital to be transferred to the County Council on 31st December, 1946. ihe following table sets out the number oi patients admitted to the hospital during 1943, 1944, 1945 and 1946, and the areas from which those patients were admitted: 1943. 1944. 1945. 1946. Southgate 178 144 119 105 Tottenham 346 225 252 272 Middlesex County Council 5 8 5 3 Military Authorities 15 11 19 4 Friern Barnet 1 — — — Wood Green — 2 — — Kensington — — 1 — 545 390 396 384 The diseases for which the 384 patients were admitted during 1946 were as follows: Scarlet fever 177 Scarlet fever and Diphtheria 1 Scarlet fever and Chicken pox 2 Diphtheria 85 Post-diphtheric paralysis 1 Laryngeal croup 1 Chicken pox 6 Bronchitis and Chicken pox 1 Whooping cough 6 Whooping cough and Pneumonia 2 Measles 26 Measles and Pneumonia 6 Measles and Bronchitis 1 German measles 2 Erysipelas 15 Pneumonia 2 53 Cerebro-spinal fever 3 Puerperal pyrexia 6 Baby with mother 5 Dysentery 1 Enteritis 1 Impetigo 3 Mumps 3 Scabies 2 Vincent's Angina 2 Septicaemia 1 Meningitis 1 Observation cases 22 Deaths.—Six deaths took place during the year, as compared with 5 during 1945. These 6 deaths occurred from the following causes: Septicaemia and erysipelas 2 (Tottenham patient aged 34 and Southgate patient aged 62.) Septicaemia and infection of throat 1 (Tottenham patient aged 57.) Broncho-pneumonia 1 (Southgate patient aged 75) Broncho-pneumonia, measles and whooping cough 1 (Tottenham patient aged 4.) Bronchitis and whooping cough 1 (Tottenham patient aged 4 months.) These six fatal cases give a mortality rate of 1.44 per cent of the total cases treated, as compared with 1.16 per cent. during 1945. Numbers in Hospital during each Month of 1946:— Total patient days. No. in Hospital on any one day. Daily Average Highest. Lowest. January 1,002 37 29 32.38 February 1,107 49 30 39.53 March 1,124 45 27 36.25 April 990 38 26 33.00 May 996 38 26 32.12 June 833 30 26 27.76 July 743 28 20 23.96 August 6.63 26 18 21.38 September 727 28 19 24.20 October 850 32 23 27.41 November 510 25 8 17.00 December 133 8 0 4.63 Daily average for the year 1946 26.43 1945 27.78 1944 25.8 1943 41.14 During 1946 it became increasingly apparent that the use of our Isolation Hospital for the treatment of cases of infectious disease did not represent an economic solution to a problem, the approach to which has changed very materially during the past decade. The question was given still further point by the fact that maternity beds were urgently required by the Middlesex County Council, in order to deal with a shortage which was causing increasing alarm. These facts led the Public Health Committee to give very careful consideration to the future of our Hospital, and to the alternative uses to which it might be put. Negotiations were entered into with the County Council, with a view to transferring the Hospital for maternity purposes. The negotiations were long, and at times complicated by issues to which reference need not here be made. Finally, arrangements were completed whereby the Isolation Hospital was transferred to the County Council for use as a Maternity Annexe to the North Middlesex County Hospital, the transfer being fixed to take place on 31st December, 1946. This transfer necessitated arrangements being made for the treatment of cases of infections disease from the Borough, for which local hospital accommodation would no longer be available. Having considered all possible alternatives, the Council decided to enter into an agreement with the Finchley, Hornsey, Wood Green and 55 Priern Barnet Joint Hospital Committee for the admission of cases of infectious disease from Southgate to the Joint Committee's Hospital at Coppetts Road. Consideration of these arrangements, together with a survey of the manner in which they have operated, more .properly belongs to the Annual Report for 1947, but it may be stated here that negotiations with the Joint Hospital Committee were extremely cordial and that, to date, the arrangements have worked very well indeed. Quite apart from any financial consideration, which should never be allowed to outweigh such an important principle as the safeguarding of health and the prevention and treatment of infectious disease, the waiving of our hospital rights in favour of the County Council was a progressive, well-considered step. There can be little doubt that the beds at our Isolation Hospital will be much more advantageously used to deal with the very urgent maternity problem than in the treatment of infectious diseases. Alternative accommodation at a well-equipped, adequately staffed and reasonably situated Isolation Hospital was immediately available, while the transfer of approximately 50 beds for maternity purposes threw into the scale a small, but none the less valuable weight. The fact that those 50 beds have not yet been fully utilised does not affect the issue; the Council acted wisely and in the best interests of the Borough. It is fitting here that we should pay a last tribute to the services rendered to the community by the Southgate Isolation Hospital. The Hospital, situated in what was then known as Tile Kiln Lane, wras formally opened on January 4th, 1902, with accommodation for 24 patients, the first patient being admitted on February 7th of that year. The limited accommodation then available may be gathered from a statement made by the Medical Officer of Health for the Borough in his report for the year 1902. Dr. Ransome then stated: "If I have one patient of each sex suffering from the same disease at the same time I am unable to take in any case of any other disease." It is also interesting to note that the average detention in Hospital of cases of scarlet fever was then 50 days, while cases of diphtheria were only retained for an average of 26 days. The Hospital was extended in 1910, and further extended by the addition of a cubicle block in 1929. This latter addition brought the total accommodation available at the Hospital up to a practical maximum of 60 beds. 56 From the date of the Hospital being opened, until 1933, the major users were Southgate and Friern Barnet. In 1933 an agreement was entered into with the Tottenham Borough Council whereby Tottenham patients were admitted to the Isolation Hospital, the Tottenham Council sharing in the membership of the newly constituted Hospital Management Committee. In 1934 Friern Barnet patients ceased to arrive at our Isolation Hospital, following the incorporation of Friern Barnet into the Hornsey, Finchley, Wood Green Joint Hospital scheme. Tottenham patients continued to be admitted in large numbers to our Hospital, so far as accommodation permitted, until the end of 1946. From 1902 until 31st December, 1946, a grand total of 11,208 patients were treated in our Isolation Hospital. The areas from which these patients were admitted were as follows: Southgate 5,229 Tottenham 4,492 Friern Barnet 1,172 Service Patients 193 Other Districts 122 The highest number of patients treated in any year was 571 (in 1934), while the highest number of Southgate patients treated in any year was 287 (in 1914). These figures are impressive, but they cannot put into words the volume of work carried out at the Hospital during the 45 years of its existence; nor can they hope to make known the amount of suffering and legacies of ill-health which the Hospital was privileged to prevent. We were always proud of the fact that, although a small institution with admittedly limited facilities, we maintained an upto-date outlook on the treatment of infectious diseases; we are equally proud of the fact that our complication, cross-infection and death rates compared favourably with those of any hospital in the country. It was a great personal loss to me when my remaining touch with purely curative medicine was lost. The Hospital allowed me to forget for a time that a Medical Officer of Health is now very largely an administrative officer, with at most a medical background. There is no joy in medicine like the thrill of saving an individual patient, of knowing that the skill and attention provided at the bedside by nurse and doctor alike, have prevented an immediate or remote tragedy. But the change-over was 57 inevitable, and would merely have been postponed had the Borough Council not decided to adopt the progressive policy which it did. The National Health Service Act has definitely divorced curative from preventive medicine for the first time in the history of this country. One must accept this fact, whether one likes it or not, and remember our Hospital as an outstanding example of the smaller type of institution provided by wise and far-seeing Councils for the benefit of the community. 58 Appendix Health Education.—Health education has always had an important part to play in any well-organised scheme of public health, but at no time has this fact been so apparent as is the case to-day. The wide experience gained by so many young adults during the years of war, together with the increasing scope of presentday education, provide a suitable soil in which the seeds of a better health can be planted. The increasing demands-and difficulties of life in these post-war years has also tended to turn people's thoughts towards the various ways in which they themselves can help to build up their own health and that of their families. One way and another, the time is opportune to explore more fully the avenues of health education, and to see how this valuable adjunct can be put to its fullest use. To be of any practical advantage health education must be continuous. Sporadic, topical efforts as, for instance, Health Weeks or local exhibitions, are useful in their way, but they can never take the place of a balanced, long-term programme which makes use of as many avenues of approach as are available. Southgate can justly claim that its health publicity programme has been in operation for many years. It is difficult to assess the results of this work, but there can be little, if any, doubt that the sum total has justified the effort and expenditure incurred. Our 1946 programme included articles in the local press, the circulation of the magazine "Better Health," provision of leaflets at schools, Maternity and Child Welfare Centres and libraries, talks to local organisations, and the arranging of 33 film shows. In addition, a special publicity campaign to popularise immunisation against diphtheria was undertaken in the autumn; while seven circular letters were sent to general practitioners in the area acquainting them with the latest additions to our Public Health service. In this connection, I should like to pay a sincere, personal : nbute to the editors of our local newspapers. N ot once have they failed to allow the limited space at their disposal to be used for health education, when assistance was requested. This generous cooperation has been of the greatest possible help to the Public Health Department, and cannot be too highly regarded. 59 Another important feature of our campaign was the production of the third edition of the Public Health Services Handbook, an extremely useful brochure produced on behalf of the Council by Messrs. Ed. J. Burrows & Co., Ltd. 750 copies of the Handbook were issued throughout the Borough. A special leaflet setting out the facilities available through the School Health Service was also prepared and distributed to all schoolchildren. Forty local organisations were approached during the summer of 1946 and invited to accept a health film show as part of their winter programme. The response was gratifying, and although audiences were not always large, they were none the less appreciative. Newer and more effective sound films are now available, and it is hoped that the response during the coming year to a similar invitation will be even better. Our film projector, purchased in 1938, has now been used on more than 1,000 occasions and is due for overhaul. This is being arranged. It is hoped that our 1947 Health Education programme will be extended by the inclusion of several get-together discussions with Parent-Teacher Associations. These latter provide a particularly useful means of ventilating topics of practical interest and importance. The time has passed when health education can be considered the Cinderella of the Public Health services, a toy to be played with to modified advantage at infrequent intervals. We cannot afford these days to neglect any means of increasing human knowledge, especially when that knowledge intimately concerns the well-being of the individual and the community as a whole. It so happens that health education is not a costly business; the expenditure is extremely low when compared with any other branch of the Public Health Service. But that is relatively unimportant. It is the results which really count. Here we can truthfully say that the potential dividends are enormous, the benefits literally incalculable. We can justly claim to have been pioneers in at ieast one field of health education, that of the sound-film projector; if we are allowed to continue our present work, Southgate will undoubtedly reap substantial benefit. 60 examined. It still remains a fact, however, that the vast majority of children affected consumed tinned salmon during the mid-day meal on Thursday, September 11th, either in its raw state or in the form of a baked pie, and that no children who consumed the alternative dish, i.e. cheese, during the same mid-day meal, were affected within 48 hours of having eaten this meal. This is the only circumstance which associates tinned salmon with the outbreak. The possibility of explosive nausea and vomiting having been the cause of the outbreak was considered. The comparatively slow onset of symptoms in a large number of cases, together with the existence of raised temperatures and diarrhoea in many cases, lead one to reject this hypothesis. The laboratory findings add further confirmation. Conclusions. Bacteriological evidence supports the belief that the outbreak of food poisoning which affected 45 children attending Garfield Road School, New Southgate, was due to infection of foodstuff by a paracolon bacillus. The majority of children were taken ill within 24 hours of having consumed a mid-day meal in the school canteen. All the children who were taken ill during this period ate tinned salmon as the main dish. Of the children affected later, a few had not eaten tinned salmon. Bacteriological evidence is not available to prove that tinned salmon was the cause of the outbreak. Diarrhoea and sickness were the most prominent features of the illness, with raised temperature, mild collapse, abdominal pain and headache in a number of cases. Symptoms lasted 48 hours on the average, recovery being rapid and complete. The standard of hygiene in the School Canteen and among the Canteen workers was excellent. 61