AC 439(1) SOUTHGATE BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1948 Wm. CLUNIE HARVEY, M.D.. D.P.H. Medical Officer of Health SOUG- 33 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health lor the Year 1948 Wm. CLUNIE HARVEY, m.d., d.p.h. Medical Officer of Health 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 1948. Officially the present Annual Report covers the period 1st January to 5th July, 1948, when the National Health Service Act came into operation. For the purposes of clarity and continuity, however, the various rates have been calculated for the whole of 1948. Information has also been supplied for the whole of the year on those Public Health activities transferred to the County Council. Without this information, it would have been very difficult, indeed almost impossible, to present a health picture which would be comprehensible. I felt that the Borough Council would wish to have this information, even having regard to the fact that the personal health services were removed from their control on 5th July. It will not be necessary for me to state that the year 1948 marks a very important milestone in social medicine. The implications of the National Health Service have been discussed so often that no useful purpose would be served by a re-statement of the changes introduced by the National Health Service Act and by their impingement on the Borough Council as a health authority and on the population as a whole. It will be sufficient to state that the changes have been many and important, and that the change-over presented a variety of problems. It can, I think, be said that the translation was smoother than many people expected, and that the work of public health has been carried on without the slightest interruption. It now remains to be seen whether the new concept of social medicine will be accompanied by the same progress as has marked the past hundred years. We have closed an illustrious chapter in the history of preventive medicine; it is our sincere hope that the new chapter will give the same abiding satisfaction. The various changes which took place during the year in the staff of the Public Health Department, most of them' brought 3 about by transference of staff to the Middlesex County Council under the National Health Service, w ill be found set out on pages 7 and 8 of this Report. The staffs employed on public health duties under the Borough Council at 1st January and 5th July, 1948, have been set out separately, so that the alteration in personnel can be fully appreciated. Opportunity has been taken in the body of this Report to comment on such aspects of the year's work as appear to call for special consideration. Particular reference is made to health education and immunisation. Southgate has been very active in both these phases of public health for many years. The results of our immunisation campaign are now showing themselves in a very clear pattern. Although the effects of health education may not be so obvious, I am none the less satisfied that our work has been fully justified, and that the results will be manifest for many years to come. The work of the Sanitary Section is also featured in the Report, with particular emphasis to housing. From the point of view of vital statistics, 1948 has been one of the outstanding years in the health history of Southgate. The birth rate has fallen from 16.76 to 13.69 but is still higher than the pre-war average. The death rafe has fallen from 11.5 in 1947 to 10.40, the increase of births over deaths for the year being 244. The Infantile Mortality Rate, which was 32.90 in 1947, has fallen to 22.68, by far the lowest figure yet recorded in the district. The Still-birth Rate shows a corresponding decrease, from 24.30 in 1947 to 14.58 in 1948. This is again the lowest figure recorded in Southgate. It is also pleasing to report that, for the second year in succession, no maternal deaths were recorded. The last maternal death took place on 6th December, 1946. Since that time, 2,334 births have occurred without a maternal fatality. It is equally pleasing to be able to state that there were no deaths from zymotic diseases (including measles, whooping cough, diarrhoea diphtheria) in children under the age of five, or indeed in persons in any other age group. So far as I can ascertain, this is the first time that the zymotic death rate has been nil for a period of twelve months. It is particularly satisfactory that again no cases of diphtheria occurred in Southgate during the year. It is now over a year since a case of this disease was reported; the last case of diphtheria in a child took place in October, 1945. This will be referred to in greater detail in the section of the Report dealing with Immunisation. It would, of course, be highly dangerous to draw any farreaching conclusions from these figures, excellent as they may be. Although we can take pleasure in the knowledge that the vital statistics present the brightest picture yet recorded in the 4 Borough, the period under review, i.e., twelve months, is much too brief to allow us to adopt a complacent attitude, or to encourage us to assume that our position will be maintained without additional effort. As this is the last Annual Report which I will have the honour of presenting as full-time Medical Officer of Health to the Borough of Southgate, 1 should like to take this opportunity of expressing my sincere thanks to the members of the Borough Council, and particularly the Public Health Committee, for their unfailing courtesy during the eighteen years which cover my tenure of office. The encouragement which 1 have never failed to receive was of incalculable benefit to me, and made my work not only easier but much more pleasant. 1 should also like to thank those members of the staff who were associated with me for so many years, and who have now been transferred to the County Council. I would particularly like to mention my Chief Clerk, Mr. P. E. Barber, w hose work has invariably been of the highest order. The know ledge that one had the continued support of a loyal, conscientious and efficient staff was a real stimulus, and has undoubtedlv had its effect upon the results achieved. Although the Public Health Department staff is now very much depleted, 1 am quite sure that the same standard will be maintained. 1 am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, VV. C. HARVEY, Medical Officer of Health. Southgate Town Hall, Palmers Green, X.13. 5 PUBLIC HEALTH COMMITTEE at December 31st, 1948 Alderman G. Peverett (Chairman). Councillor H. S. Beardow. Councillor R. V. Faithfull. Councillor S. C. Jenner. Councillor W. A. MacGregor. Councillor R. Prior. Councillor W. Saxon (Vice-Chairman). MATERNITY AND CHILD WELFARE COMMITTEE 1st January to 5th July, 1948 Councillor Mrs. R. Winston (Chairman). Alderman G. Peverett. Councillor H. S. Beardow. Councillor R. C. Evans. Councillor R. V. Faithfull. Councillor E. H. Lake, J.P. Councillor A. F. Pullinger. Councillor W. H. Warren. CO-OPTED MEMBERS Mrs. E. Forward. Mrs. E. Miatt. Mrs. J. Skinner. Dr. L. Westlake (Vice-Chairman). 6 PUBLIC HEALTH STAFF 1st January to 5th July, 1948 **Medical Officer of Health and School Medical Officer: W. C. Harvey, M.D., Ch.B., D.P.H. **Assistant Medical Officer of Health: Nora T. U. O'Callaghan, M.B., Ch.B., B.A.O., D.P.H. **Assistant Medical Officer of Health: Christina M. Small, M.B., B.S., D.P.H. *Senior Sanitary Inspector (No. 1 District): A. E. Gooday, Cert.R.San.I., M.S.I.A., Cert.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 (Resigned November, 1948). *Sanitary Inspector (No. 3 District): R. L. Burkill, A.R.San.I., M.S.I. A., Cert.R.San. I. Meat Inspection. *Sanitary Inspector (No. 4 District): E. T. Jephcott, M.S.I.A., Cert.R.San. 1., Cert.R.San.I. Meat Inspection. Chief Clerk: P. E. Barber. Clerk: Miss M. Munch. Clerk: Miss K. Stoten. Clerk: Miss E. W. Barratt (appointed 24th May, 1948). Clerk: Mrs. A. B. Preston (appointed 7th June, 1948). Junior Clerks: Miss M. Baylis (resigned 5th June, 1948). Miss E. Anderson. Health Visitors (Maternity and Child Welfare) : **Miss M. Maddock, S.R.N., S.C.M., H.V.Cert. **Miss B. M. Finnegan, S.R.N., S.C.M., H.V.Cert. **Miss P. Carter, S.R.N., S.C.M., H.V.Cert. **Miss G. J. Franklin, S.R.N., S.C.M., H.V.Cert. **Miss E. Thurgood, S.R.N., S.C.M., H.V.Cert. **Miss M. N. Hilton, S.R.N., H.V.Cert. **Miss J. McNamee, S.R.N., S.C.M., H.V.Cert. 7 Superintendent Health Visitor: Miss B. E. Wellman, S.R.N., S.C.M., H.V., Cert. R. San. I. Home Help and Domestic Help Organiser: Mrs. W. Mitchell. 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. Dow sett. * These Officers' salaries are repaid to the Council, in part, by the Ministry of Health or the County Council. ** As from 1st April, 1947, these Officers carried out parttime duties in connection with the School Health Service. 5th July to 31st December, 1948 **Medical Officer of Health and School Medical Officer: W. C. Harvey, M.D., Ch.B., D.P.H. *Senior Sanitary Inspector (No. 1 District): A. E. Gooday, M.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. *Sanitary Inspector (No. 4 District): E. T. Jephcott, M.S.I.A., Cert.R.San.I., Cert.R.San.I. Meat Inspection. Clerk: Miss E. W. Barratt (appointed 24th May, 1948). Clerk: Mrs. A. B. Preston (appointed 7th June, 1948). Disinfector: A. G. Bates. Assistant Disinfector: B. Latter. Rodent Operator: W. Dowsett. ** As from 1st April, 1947, this Officer carried out part-time duties in connection with the School Health Service. * These Officers' salaries are repaid to the Council, in part, by the Ministrv of Health or the County Council. 8 Statistics and Social Conditions of the Area Area (in acres) 3,764 Registrar General's estimate of Resident Civilian Population, 1948 74,030 Number of inhabited houses (end of 1948) according to Rate Books 21,754 Rateable Value (1948) 940,610 Sum represented by a penny rate (1948) 3,810 The social conditions of the area are very much the same as set out in the Annual Report for 1947. Overcrowding is still a problem which continues to exert its influence on the lives and well-being of the population. It is not easy to evaluate either the extent of overcrowding or the degree to which this factor affects health. The information at our disposal is unfortunately not sufficient to allow us to trace the effects of overcrowding, either gross or comparatively slight, through the various phases of health and disease. Until, for instance, we have more detailed information as to the actual degree of overcrowding which exists in individual families and in specific portions of the district, we cannot say how far death and morbidity rates are being affected by this social factor. In a district such as Southgate, where evidence of gross overcrowding is relatively meagre, the problem is particularly difficult. None the less, this is an aspect of environmental hygiene which must receive attention. Now that a clear-cut line has been drawn between environmental and personal hygiene, 1 propose to take such steps as are practicable to investigate the effects of overcrowding on individual families and on the community as a whole. The results of these investigations will be communicated to the Public Health Committee as soon as they have been completed. In the meantime co-operation between the Public Health Department and the Housing Section will, it is hoped, remove or at least alleviate the more serious aspects of this menace to health. Although, as has been so often stated, Southgate is very largely a dormitory and therefore free from major industrial problems, these problems do exist. Two instances of disturbance to the health of a section of the community, alleged to have been caused by industrial undertakings, have been investigated during the year. Various reports have been made to the Public Health Committee, which has considered the question as it relates to health. In both cases, the evidence available was not considered sufficient to warrant action by the Borough Council on health 9 grounds. Nevertheless the Public Health Department has been and still is keenly interested in the situation, and has taken such steps as were possible to effect improvement. In spite of these two instances, it can still be said that Southgate is singularly free from industrial problems. Indeed, few boroughs of this size can find themselves in such a fortunate position. As has been stated in recent Annual Reports, it is imperative that every effort be made to safeguard the character and amenities of our Borough. This is not an easy matter, although the health statistics over the past few years would appear to show that the efforts now being made are for the time being successful. Our future aim should be to conserve the gains already won, and to ensure conditions which will allow of their continuance. EXTRACTS FROM VITAL STATISTICS OF THE YEAR Male. Female. Total. Live Legitimate 482 506 988 Births i Illegitimate 14 12 26 Totals 496 518 1,014 Birth Rate per 1,000 of the estimated population 13.69 Still Legitimate 5 10 15 Births Illegitimate Rate per 1,000 total (live and still) births 14.58 Deaths from all causes and at all ages 770 Death Rate per 1,000 of the estimated population 10.40 Deaths from puerperal causes : Rate per 1,000 total (live and still) Deaths. births From puerperal sepsis 0 0 From other puerperal causes 0 0 Total 0 0 Deaths of Infants under 1 year of age: Male. Female. Total Legitimate 14 8 22 Illegitimate 1 0 1 Total 15 8 23 10 Infant Death Rate: All infants per 1,000 births 22.68 Legitimate—per 1,000 legitimate live births 22.27 Illegitimate—per 1,000 illegitimate live births 38.46 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 0 POPULATION The Registrar-General estimated the civilian population of the Borough at the middle of 1948 to be 74,030, a decrease of 290 as compared with 1947. This figure was rather surprising in view of the fact that the excess of births over deaths during 1948 was 244. I wrote to the Registrar-General for further information on the subject. His reply stated that the apparent decrease in the population arose from the fact that the 1947 population figure was only a provisional estimate. Since the publication of this figure, population estimates of local areas have apparently been carefully scrutinised in the light of all available data (National Register records, Ration Book issues, Civilian Electorate). As a result of this scrutiny, the mid-1947 estimated population of the Borough was amended to 73,670. This means that the estimate of population in respect of mid-1948 is 360 in excess of that relating to mid-1947. BIRTHS—BIRTH RATE The nett total births accredited to the district was 1,014, a decrease of 232 on the preceding year. Of these, 496 were males and 518 females (14 males and 12 females being illegitimate). The birth-rate for the year was 13.69 per 1,000 of the population. The birth-rate for England and Wales for 1948 was 17.9 and for the administrative County of London 20.1. The births and birth-rates for the past five years were as follows : No. of Births. Birth-Rates Southgate. England. & Wales. London. 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 1947 1,246 16.76 20.5 22.7 1948 1,014 13.69 17.9 20.1 During 1948, the number of births recorded was 244 more than the number of deaths, as compared with 410 in 1947. 11 The total number of births actually registered in the district during the year amounted to 832, of which 7 were unnotified. The percentage of births notified was therefore 99.15 as compared with 98.6 in 1947. MORTALITY Ceneral Mortality and Death-rate. The nett number of deaths accredited to this district was 770, 66 less than in 1947. This gives a death-rate of 10.40 per 1,000 of the population, a decrease of 0.85 on the rate for the previous year, which was 11.25. The rate for England and Wales (1948) was 10.8 and for London 11.6. The deaths and death-rates for the past five years were as follows : No. of Deaths. Death Rates. Southgate. England. & Wales. London. 1944 803 12.51 11.6 15.7 1945 781 12.02 11.4 13.8 1946 883 12.14 11.5 12.7 1947 836 11.25 12.0 12.8 1948 770 10.40 10.8 11.6 Infant Mortality.— There were 23 (1 illegitimate) deaths of infants under 1 year of age, which gives an infantile death-rate of 22.66 per 1,000 births, as compared with 41 deaths and a rate of 32.90 in the preceding year. The corresponding rates for England and Wales and London were 34 and 31 respectively. The infant deaths and rates for the past five years were as follows : No. of Deaths. Infantile Death Rates Southgate. England & Wales. London. 1944 42 38.32 46 61 1945 38 38.93 46 53 1946 36 29.68 43 41 1947 41 32.90 41 37 1948 23 22.68 34 31 The Infantile Mortality Rate for 1948 (22.68) is by far the lowest yet recorded in Southgate. The graph set out on page 13 illustrates the Infantile Mortality Rate over the past 25 years, as compared with England and Wales. From this graph it will be seen that the Infantile Mortality Rate in Southgate has been 12 INFANTILE MORTALITY 1923-1948 13 consistently lower than that for the country as a whole, a fact which is scarcely surprising when the character of the district is taken into account. It will also be seen, however, that, during the war years, when the Infant Mortality Rate for England and Wales continued to drop, the rate for Southgate did not show the same decrease. This was almost certainly due to the conditions which prevailed in the Borough during the years in which bombing took place, and to the influx into the district of families from Inner London. The return to more normal conditions was very quickly reflected in a decrease in the Infantile Mortality Rate, culminating in the very low figure for 1948. As has already been stated in the preface to this Report, it would be highly dangerous to draw any sweeping conclusions from the figures relating to one year. The very low Infantile Mortality Rate is none the less a source of satisfaction, and encourages us to continue along the lines which have presumably been responsible for this result. Stillbirths.—15 stillbirths (0 illegitimate) were accredited to the district for 1948. This is equal to a death-rate of 14.58 per 1,000 (live and still) births, the corresponding figures for 1947 being 31 stillbirths with a rate of 24.27. The rate per 1,000 of the population was 0.202, the rates for England and Wales, and London being 0.42 and 0.39 respectively for 1948. The average rate for the past ten years was 25.83. It is pleasing to be able to record that the Stillbirth Rate for 1948 was by far the lowest yet recorded in the district. It will thus be seen that the fall in the Infantile Mortality Rate has been accompanied by an equally spectacular drop in the Stillbirth Rate. Taken together, these figures are particularly satisfactory. Here again, however, one must not draw hasty conclusions. Continued vigilence is obviously required, with an extension of available facilities for prevention and investigation in the light of experience gained. Maternal Mortality.—The maternal mortality rate, i.e., the number of mothers dying as the result of childbirth per 1,000 total (live and still) births was nil. For the second year in succession, no maternal deaths occurred in the Borough, the first time that it has been possible to record such a fact. All maternal deaths are fully investigated. Where any preventable cause is ascertained, the matter is immediately followed up, with a view to the elimination of the causal factor. Mortality of "Toddlers."—Three deaths occurred amongst children of the age group 1-5 years during 1948. This represents a death rate of 0.04 per 1,000 of the population, and 0.38 per cent of the total deaths for the year at all ages. In 1947 there were eight deaths, giving a death rate of 0.11 and a percentage of 0.95. 14 Mortality of Persons over the Age of 65. - Five hundred and one or 65.06 per cent of the total deaths during the year occurred in persons over the age of 65. Of these, 154 died between the ages of 80 and 90, while a further 26 were over the latter age (six males, the eldest being 101, and 20 females, the eldest being 97). Diseases of the heart and circulation formed the largest group appearing in the list of causes of death of elderly persons. This is in keeping with the findings of recent years. Zymotic Mortality.—There were no deaths in this category during the year. It is particularly pleasing to be able to record that there were no deaths in children under two years of age from diarrhoea. This cause of death in young children has always been regarded as especially unfortunate, indicating as it does the existence of a preventable cause of infection in a highly susceptible age group. It would be extremely foolish to assume that this cause has been eliminated. We know very well that it still exists, and that preventive measures must be continued without abatement. It is also satisfactory to know that measles, whooping cough and diphtheria did not appear among the causes of death in early childhood. Here again we must continue our efforts with vigour until the occurrence of any of these diseases as a cause of death in young children is considered a rare event. When one bears in mind the changing outlook towards zymotic diseases and the advances which have been made within the past decade to reduce their powers to cripple and to kill, there is no reason to believe that this goal should remain beyond our reach. TABLE I. Causes of Death During the Year 1948. Causes of Death. Male. Female. I Total. Rates per 1,000 of Population. All Causes (Civilians only) 368 402 770 10.40 1 Typhoid and Paratyphoid Fevers 2 Cerebro-spinal Fever — — — 3 Scarlet Fever — — — — 4 Whooping Cough — — — 5 Diphtheria — — — 6 Tuberculosis, Respiratory System 15 8 23 0.31 7 Tuberculosis, Other Forms — — — — 8 Syphilitic Diseases 3 2 5 0.06 9 Influenza 2 1 3 0.04 10 Measles — — — 11 Acute Poliomyelitis and Polioencephalitis 1 1 0.01 12 Acute Infectious Encephalitis — — — — 13 Cancer, Oesoph. (M) Uterus (F) 6 6 12 0.10 14 Cancer, Stomach and Duodenum 10 10 20 0.27 15 Cancer, breast — 17 17 0.22 16 Cancer, other sites 55 52 107 1.35 17 Diabetes 3 5 8 0.10 18 Intra-cranial vascular lesions 33 51 84 1.13 19 Heart Disease 111 127 238 3.21 20 Other Circulatory Diseases 9 22 31 0.41 21 Bronchitis 21 18 39 0.52 22 Pneumonia 7 13 20 0.27 23 Other Respiratory Diseases 4 3 7 0.09 24 Ulcer, Stomach or Duodenum 6 4 10 0.13 25 Diarrhoea under 2 years — — — — 26 Appendicitis — 2 2 0.02 27 Other Digestive Diseases 7 12 19 0.25 28 Nephritis 14 12 26 0.35 29 Puerperal Sepsis - — — — 30 Other Maternal causes — — — — 31 Premature Birth 7 2 9 0.12 32 Congenital Malformations, Birth Injuries, etc. 7 5 12 0.10 33 Suicide 8 5 13 0.17 34 Road Traffic Accidents 3 — 3 0.04 35 Other violent causes 5 8 13 0.17 36 All other causes 31 17 48 0.64 16 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 age group. 1948. Age MALES. FEMALES. TOTALS. No. % of Total Deaths. Rate per 1.000. No. %0f Total Deaths Rate per 1.000. No. % of Total Death Rate per 1,000. 0— 1 year 15 1.95 0.20 8 1.04 0.10 23 2.99 0.32 1— 5 years 1 0.13 0.01 2 0.26 0.02 3 0.39 0.04 5—15 years 4 0.52 0.05 1 0.13 0.01 5 0.65 0.07 15—25 years 3 0.39 0.04 2 0.26 0.02 5 0.65 0.07 25—45 years 25 2.99 0.31 18 2.59 0.27 43 5.59 0.58 45—65 years 99 12.60 1.31 91 12.08 1.25 190 24.67 2.56 65 and over 221 28.72 2.98 280 36.36 3.78 501 65.06 6.76 Totals 368 47.30 4.91 402 52.70 5.48 770 100.00 10.40 17 TABLE III. Infantile Mortality. 1948. Nett Deaths from stated causes at various periods under 1 Year of Age. Causes of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 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 — - - - — 1 — — - 1 15 Pneumonia — - - 1 1 - — — - 1 16 Diarrhœa 17 Enteritis 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 -Want of Attention and Injury at Birth 23 Atelectasis 2 - — - 2 — — — - 2 24 Congenital Malformations 1 - 1 1 3 - 1 — - 4 25 Premature Birth 10 - - - 10 - - - - 10 26 Atrophy, Debility and Marasmus 27 Other Causes 3 1 - - 4 - 1 - 5 Totals 16 1 1 2 20 1 1 1 — 23 18 TABLE IV. Vital Statistics of Whole District during 1948 and Eight Previous Years. Year. 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 Population. 1 2 3 4 5 6 7 8 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 1947 74,320 1,246 16.76 836 11.25 41 32.90 1948 74,030 1,014 13.69 770 10.40 23 22.68 Comparison of the Rates of Southgate with those of England and Wales, and London, for the Year 1948. 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. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 17.9 0.42 10.8 0.00 - 0.02 - 0.03 3.3 34 126 County Boroughs and Great Towns including London 20.0 0.52 11.6 0.00 - 0.02 - 0.03 4.5 39 148 Smaller Towns (1931 Census Populations 25,000-50,000) 19.2 0.43 10.7 0.00 - 0.02 - 0.04 2.1 32 London 20.1 0.39 11.6 0.00 - 0.01 0.01 0.02 2.4 31 Southgate 13.69 0.20 10.40 - - - - 0.04 - 23 A dash (—) indicates that there were no deaths. 19 CENERAL PROVISION OF HEALTH SERVICES Hospitals. - There would appear to be little point in discussing in detail the arrangements which exist for the admission of cases to hospital. The position is, of course, that the administration of hospitals was transferred on 5th July, 1948, from the County Council and from local authorities to Regional Hospital Boards. So far as Southgate is concerned, the whole of the Borough comes within the area administered by the North-West Metropolitan Regional Hospital Board, although facilities are provided for sending cases to the Xorth Middlesex Hospital, which is administered by the North-East Metropolitan Regional Hospital Board. As from 5th Julv, 1948, cases of infectious disease occurring in Southgate were sent to South Lodge Hospital (formerly the Enfield and Edmonton Joint Isolation Hospital). These arrangements are working very well, no difficulty having been experienced in arranging for the admission of cases which require hospitalisation. In actual practice, the procedure adopted by the North-West Regional Hospital Board in regard to the admission of cases of infectious diseases to hospital follows very closelv that which we ourselves adopted in Southgate. When the new system came into operation, I took the opportunity of suggesting certain minor amendments which, in my opinion, facilitated the change-over. These were agreed to by the Principal Medical Officer of the North-West Regional Hospital Board, with whom cordial relations have invariably been maintained. It is still a fact that the number of hospital beds available for the sick, and particularly the aged sick, is inadequate. This is due not so much to lack of actual beds as to shortages of staff. Representations have been made from time to time to the NorthWest Regional Hospital Board and to the appropriate Hospital Management Committees, in an effort to secure a more adequate allocation of hospital beds for patients who are unable to look after themselves at home and for whom adequate medical and nursing arrangements cannot be provided otherwise than in hospital. Although the need is fully appreciated, a solution to the problem has not yet been achieved. No great difficulties were experienced during 1948 in obtaining accommodation for maternity cases. The use of our former Isolation Hospital as a Maternity Annexe was of considerable assistance in this respect. 20 Ambulance Facilities. —The following table sets out the total number of journeys carried out by the Ambulance Service during the first six months of 1948: 1948 (1st 6 mths.) 1947 1946 1945 General Removals to or from Hospitals, etc. 1,623 2,794 1,930 1,577 Maternity Cases 156 320 318 352 Traffic Accidents 33 80 71 57 Other Accidents 283 418 390 505 2,095 3,522 2,709 2,491 The Ambulance Service was transferred to the County Council on 5th July, 1948. It was fortunately possible to continue the previous arrangements whereby ambulances were stationed at the rear of the Town Hall. This has allowed the Ambulance Service to continue more or less as before, with such amendments, particularly in regard to financial matters, as were brought about by. the introduction of the National Health Service. The functioning of the Ambulance Service during the latter half of 1948 does not come within the scope of this Report. It might be said, however, that cordial relations have been maintained between the staff of the new Ambulance Service and the Public Health Department. Mortuary—The position with regard to the Council Mortuary at the rear of the Town Hall is as set out in the report for 1946. The Mortuary is still being maintained, and is available for use as and when required. No post-mortem examinations were carried out in the Mortuary during the period under review. Laboratory Facilities. -The Central Public Health Laboratory, Colindale, has continued to carry out bacteriological examinations from cases within the Borough. An important change in procedure was brought about by the setting up of a branch laboratory in Edmonton Town Hall. This laboratory began to receive specimens from the Borough on 15th November, 1948. The branch laboratory at Coppets Wood Hospital (formerly Finchley, Hornsev, Wood Green and Friern Barnet Isolation Hospital) is also available for urgent work during week-ends and after office hours. The staff of the Central Public Health Laboratory has been most helpful in a number of different ways. They undertook the investigation of a localised outbreak of streptococcal infection which occurred at Tottenhall Road School in December, 1948. In addition, thev have co-operated in the investigation of localised foci of infectious disease manifesting themselves at our various Day Nurseries. The Director of the Public Health Laboratory attended the first meeting of Canteen workers and Cafe proprietors with their staffs, held at Minchenden School Canteen in connection 21 with the Food Hygiene campaign inaugurated by the Borough Council. Professor Cruickshank gave a very interesting address. Dr. Charles Cockburn, one of the principal bacteriologists on the staff of the Public Health Laboratory, attended the second meeting on Food Hygiene in a similar capacity. On each occasion, Dr. Hobbs from the Central Public Health Laboratory arranged attractive food hygiene demonstrations. Cordial thanks are due to all concerned for their generous co-operation. Summary of work carried out at Central Public Health Laboratories: Borough Positive Specimens. . Negative. Swabs for Diphtheria Bacilli — 251 Sputa for Tubercle Bacilli 7 108 The following specimens w ere also examined : Urine 9 Faeces 94 Blood 3 Rhesus Factor 97 positive, 46 negative Khan Factor 2 „ 27 „ Others 22 Scabies and Lice.— The arrangements set out in the Annual Report for 1945 for the treatment of patients suffering from scabies and vermin infestation remain unaltered, with the additions set out in the Annual Report for 1947. Considerable improvement has been shown in the degree of infestation among children attending our schools. The results of the work carried out by our Health Assistants, under the supervision of the Health Visitor concerned, are shown in the table set out below: HEAD INSPECTIONS Date of Examination Sept., 1947 Jan., 1948 Apr., 1948 Sept. 1948 Number of children examined at the initial inspection 4,666 3,989 4,136 4,901 Number of children found to be harbouring nits or live lice 256 193 182 173 (5.3%) (4.8%). (4.4%) (3.5%) The improvement obtained is well illustrated in relation to DeBohun Primary School, where infestation was particularly marked. In September, 1947, when the staff of the Public Health Department became responsible for the day-to-day administration of the School Health Service, 468 children were examined at this 22 school. Of these, 117 were found to be harbouring nits or live lice. This was equivalent to 25% of the children examined. In September, 1948, when 459 children were examined, the number of children infested had fallen to 57, or 12% of the total. This improvement has been maintained at more recent examinations. It would thus appear that our present policy of peaceful persuasion, coupled with adequate treatment facilities, is proving successful. We still have to contend with difficult families whose co-operation is not readily obtained. Even in these cases, however, very definite improvement has been achieved. More stringent action will be taken if and when this policy appears desirable. Nursing in the Home.—The Southgate Queen's Nursing Association continued to provide nursing in the home during the first six months of 1948. On 5th July, 1948, these services were transferred to the County Council, under the National Health Service. In actual fact, the Southgate Queen's Nursing Association continued this work on behalf of the County Council until the latter part of the year. The change-over to the County Council was effected with a minimum of disturbance. Fortunately for all concerned, the same excellent staff continued to be available, under the efficient supervision of Miss Rowe, Superintendent at Osidge. Nursing Services in the home are no longer the direct concern of the Borough Council, although this phase of public health is obviously one in which all local councils will continue to be interested. It would be appropriate here to record the thanks of the Public Health Department to the Southgate Queen's Nursing Association for the valuable co-operation extended over so many years. Southgate has been fortunate in having the benefit of such a publicspirited Association. One cannot help feeling that the work of the Nursing Association has too often been taken for granted. Those who benefited from the facilities provided were undoubtedly grateful, but the part which the Association played in the communal life of the Borough was not always fully appreciated. It can at least be said that the Public Health Department realised to the full the benefits conveyed to the public by the Nursing Association, and equallv realised the great value of the long and happy partnership. Very much the same remarks apply to the Midwifery Services. Here again, these services have been transferred from the Queen's Nursing Association, which acted as agent for the County Council, to the County Council itself. The same efficient staff is fortunately available, the only difference being that the staff will now be employed as County Council officers and not as midwives whose salaries are paid bv the Southgate Queen's Nursing Association. 23 Details of work carried out by Southgate Queen's Nursing Association during 1948 are: 1947. 1948. Domiciliary Nursing Visits 15,562 17,817 Midwifery, Maternity and Ante-Natal Visits 5,539 3,448 Patients attending Physiotherapeutic Clinics 2,948 3,141 Treatments given 14,418 17,148 In addition to the above, 363 children under 5 years of age were sent from the Maternity and Child Welfare Centres for treatment in the Physiotherapy Department of the Nursing Association during the year. CLINICS AND CENTRES The following lists set out the various clinics and treatment centres in operation within the Borough at 5th July, 1948: Infant Welfare: The Grange, The Bourne, Southgate Broomfield House, Broomfield ParkCombined Clinic, Bowes Road, N.ll Methodist Church, Palmerston Road Methodist Church, (ireen Lanes, N.21 De Bohun Clinic, Green Road, N.14 Pre-Natal: Cambined Clinic, Bowes Road, N.ll Broomfield House, Broomfield Park The Grange, The Bourne, Southgate Monday and Wednesday, 2—3.45 Tuesday, 2—3.45 Tuesday and Wednesday, 2—3.45 Thursday, 2—3.45 Tuesday and Thursday, 2—3.45 Friday, 2—3.45 Friday, 10—12 Tuesday and Thursday, '10—12 Wednesday, 10—12 Post-Natal: Post-natal examinations are carried out at the above antenatal clinics at the first session each month. Mothers are strongly urged to take advantage of this service as soon as possible after confinement. Immunisation: Against diphtheria or against diphtheria and whooping cough: Broomfield House, Broomfield Park Thursday, 2—3.45 Against whooping cough alone: Broomfield House, Broomfield Park Monday, 2.30—3.30 24 Tuberculosis. - The tuberculosis services previously carried out by Middlesex County Council were transferred to the NorthWest Regional Hospital Board on 5th July, 1948. The Chest Clinic serving this area is still situated at 980 High Road, Whetstone, N.20. Venereal Disease Clinic.—Arrangements for the diagnosis and treatment of venereal disease were transferred from Middlesex County Council to the North-West Regional Hospital Board on 5th July, 1948. Day N urseries.—Alderman House, Aldermans Hill, Palmers Green; Tottenhall Sports Ground, Tottenhall Road, Palmers Green; Hoppers Road, Palmers Green. The Day Nurseries previously administered by the Borough Council were transferred to the Countv Council on 5th July, 1948, under the National Health Service. Domestic Help. —Once again the period under review shows a considerable increase in the scope of our Domestic Help Scheme. During the first six months of 1948, the number assisted under this scheme was 254, while in the second half of the year 298 applicants received help. Thus the total for the year was 552, as compared with 180 in 1947. The increase in the work is shown bv the increase in the number of full-time and parttime domestic helps employed. The total number of staff employed in this category rose from 8 full-time and 15 part-time helps at the end of 1947, to 10 full-time and 21 part-time helps respectively at the 5th July, 1948, when the service was transferred to the County Council. At the end of the year the number employed had risen to 12 full-time and 37 part-time domestic helps. I think it can be said that the Borough Council handed over to the County Council an efficient, well-organised Home Help Service which, although not able to assist every case to the fullest possible extent, still made a very definite contribution to the welfare of those unfortunate individuals who, by reason of illhealth, old age or infirmity, were unable to help themselves. MATERNITY AND CHILD WELFARE On and after 5th July, 1948, the Maternity and Child Welfare services became the responsibility of the County Council, under Part 3 of the National Health Service Act. The change-over to the County Council on 5th July, 1948, was brought about with very little disturbance, and did not result in any appreciable alteration in the extent or quality of the previous services. Various changes are scheduled for the near future, but these do not properly belong to this Report. I would merely state that the quality of the Maternity and Child Welfare services, of which the Borough Council was justly proud, will, I have no doubt, be maintained. 25 STATISTICS OF ATTENDANCES AND WORK DONE AT THE WELFARE CENTRES DURINC 1948 Numbers on Registers: Under Over Totals 1 year. 1 year. 1948. 1947. January 1st, 1948 877 1,029 1,096 1,752 December, 31st, 1948 1,923 1,337 3,260 3,407 New Cases during 1948 1,046 308 1,354 1,655 One hundred and nineteen new cases under 1 year were "removals" into the district. The remaining 927 represent 91,42 per cent, of the total births credited to the district. Attendances at Centres, 1948. Under 1 year. Over 1 year. Totals Sessions The Grange 3,327 1,897 5,229 100 Bowes Park 2,958 1,740 4,698 68 Broomfield House (10 months) 1,642 1,019 2,661 43 Combined Clinic 2,444 1,641 4,085 101 Winchmore Hill 4,919 2,471 7,390 102 De Bohun 2,000 1,131 3,131 50 17,290 9,899 27,189 464 Totals for 1947 19,834 8,403 28,237 416 Average: 1948 37.26 21.33 58.59 1947 47.68 20.19 67.87 STATISTICS OF ATTENDANCES AT PRE-NATAL CENTRES Number on Registers : 1947. 1948. January 1st 201 146 December 31st 146 181 New cases 428 415 Number of Sessions 159 197 Total attendances 3,547 3,248 Average per session 22.3 16.5 POST-NATAL CLINIC The Post-Natal Clinic was continued throughout the year, 193 mothers being examined within a few weeks after confinement. 26 TABLE OF VISITS MADE BY THE HEALTH VISITORS UNDER THE NOTIFICATION OF BIRTHS, MATERNITY AND CHILD WELFARE, AND PUBLIC HEALTH ACTS. Children : 1948. 1947. First visits 881 932 Under 1 year of age 1,637 In addition to first visits 1,245 Over 1 year of age 4,050 4,148 Visits re : Deaths under 5 years of age 21 15 Stillbirths 5 2 Pre-Natal Visits 172 510 Clinics attended 1,295 1,210 Special visits (test feeds, etc.) 127 70 8,188 8,132 Child Life Protection. The following is a summary of the work carried out in this connection during 194S: Number of Registered Foster Mothers 17 Number of Foster Children on Register during the year 17 Number of Foster Children at end of the year 11 Number of Visits paid by Health Visitors 138 No unsatisfactory conditions were met with Maternity Outfits. Sterilised maternity outfits were supplied to expectant mothers during the first six months of 1948 as follows: 5 were supplied free of charge. 5 were supplied at one-sixth full charge. 7 were supplied at one-third full charge. 12 were supplied at one-half full charge. 10 were supplied at two-thirds full charge. 8 were supplied at five-sixths full charge. 25 were supplied at full charge. 72 27 From July 5th onwards maternity outfits were supplied bv the County Council, free of charge, as part of the National Health Service. During the second six months of the year 94 outfits were issued to expectant mothers, making a total of 166 for the year. Total for 1947—137. Care of Premature Infants.—During 1948, 51 premature infants were notified, of whom 46 survived at the end of one month, as compared with 55 and 48 respectively for the whole of 1947. This service was transferred to the County Council on 5th July, 1948. Care of Illegitimate Children (Circular 2866). -No cases were dealt with during the first six months of 1948 under the scheme operated by 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. This service was transferred to Middlesex Countv Council on 5th July, 1948. Home Help Scheme. Particulars of the work carried out under the above scheme during the first six months of 1948 were as follows: Home Helps were provided for 22 patients confined at home during this period. 3 were provided free of charge. 3 were provided at one-third full charge. 7 were provided at half full charge. 1 was provided at one-sixth full charge. 1 was provided at two-thirds full charge. 7 were provided at full charge. From 5th July to the end of the year, 28 patients were provided with the services of a Home Help at charges fixed by the County Council. This makes a total of 50 for the year, compared with 76 in 1947. As hitherto, we were able to meet all demands made on the service. The Home Help Scheme was transferred to the Middlesex County Council on 5th July, 1948, and was incorporated with the Domestic Help Scheme to form a co-ordinated whole. In actual fact, this was the principle on which the Southgate Borough Council had previously worked. No difficulty was therefore experienced in effecting the necessary transfer. 28 Day Nurseries. During 1948 attendances at our Day Nurseries were as follows : Aldermans Hill Tottenhall Road Hoppers Road Total attendances. Daily average attendance. Total attendances. Daily .average attendance. Total attendances. Daily average attendance. Jan. 846 38.45 822 37.36 1,111 50.5 Feb. 648 32.4 732 36.6 925 46.25 Mar. 565 26.90 819 39.0 1,117 53.19 Apr. 778 35.36 916 41.64 1,196 54.36 May 797 39.85 825 41.25 1,019 50.95 June 919 41.7 849 38.59 978 44.45 July 907 41.2 740 33.63 1,112 50.5 Aug. 804 38.28 623 29.6 950 43.1 Sept. 863 39 921 41.86 1,072 48.72 Oct. 821 39 920 43.8 1,071 51 Nov. 915 41.5 923 41.9 1,157 52.5 Dec. 812 40.6 722 36.1 974 48.7 1948 9,675 37.94 9,812 38.47 12,682 49.73 1947 9,451 37.06 9,394 36.84 10,416 40.85 It can, I think, be said that we have transferred to the County Council three Day Nurseries adequately staffed and run on up-todate, efficient lines. Apart from comparatively minor changes in administration, it would appear that the Day Nurseries will continue to operate on existing lines. The waiting list for admission of children to our Day Nurseries still exists, but 110 longer represents a serious problem. We have been able to accommodate all urgent priority cases, together with most of those other cases whose needs were not so urgent. I am of opinion that the provision of three Day Nurseries within the Borough is sufficient to cope with present needs. It will be appreciated, of course, that this is a matter with which the Borough Council is no longer directly concerned. 29 Sanitary Services Summary of Visits, 1948:— Inspections re complaints received 746 Re-visits in connection therewith 3,683 Visits to Food Premises (including butchers, bakehouses, cafes, restaurants, fishshops and dairies) 1,051 Inspections re Shops Acts 1912-34 120 Inspections re Factories 309 Visits re housing conditions and overcrowding (applicants for housing accommodation) 969 Visits re Infectious Diseases 1,109 Visits re Places of Public Entertainment 40 Visits re Rats and Mice Destruction Act, 1919 1,200 Miscellaneous Visits 5,772 Service of Notices: — 14,999 Total informal sanitary notices served 878 Total informal dustbin notices served 298 Total informal notices served 1,176 Total informal notices complied with 1,039 Total statutory notices served 178 Total statutory notices complied with 169 From the above summary, it will be seen that, as a result of the efforts of the Sanitary Inspectors, repairs were carried out and improvements made at 746 houses during the year. Information as to housing defects continue to come to the Sanitary Inspectors, mainly as a result of complaints by occupiers. Due to the lack of maintenance work carried out to houses during the war years, it was found that the repairs required were in many cases extensive. Of the 746 houses mentioned above, 397 had repairs carried out of a major character. By this is meant such repairs as provision of damp-proof courses or extensive rendering of walls to remedy dampness, under-pinning of walls, provision of site concrete, renewal of flooring, complete re-construction of drains, renewal of roofs and gutters, extensive renewal of wall and ceiling plaster and renewal of windows. The easing of the materials and labour shortages has, of course, assisted in the execution of these major repairs. Of the remaining 349 houses, the repairs carried out were not of such an extensive character, being necessary mainly to remedy public health nuisances. Housing.—In 1945, the Housing Committee expressed the wish that all applicants for housing accommodation should be visited by a Sanitary Inspector and a report made in each case as to living conditions. During the year under review, this work has been carried on, 969 visits having been made by the Inspectors. In their reports, the Inspectors endeavour to give an indication of 30 the urgency of need for accommodation in each case. Their conclusions are based on legal overcrowding, crowded conditions as distinct from families living in legally overcrowded premises, the state of health of applicants, and other relevant considerations. The bulk of this work has now been completed. The cases remaining to be visited are either new applications or existing applications which, for one reason or another, have not been visited or require re-visiting. Close liaison between the Public Health Department and the Housing Department continues to be maintained and serves a useful purpose. Food Hygiene During the year 1,051 visits were made to food premises in the Borough. As a result of these visits, it was found possible in some premises to bring about structural improvements, and in all premises generally to encourage a higher standard of food hygiene. Additional information on food hygiene will be found set out in Appendix 3 of the Report. INSPECTION AND SUPERVISION OF FOOD Food Inspection.—The following is a summary of the food condemned during the year as unfit for human consumption. This was disposed of wherever possible as salvage: Fish 277½ stone Carcase Meat 79 lbs. Rabbits 1,095 lbs. Chickens 329 lbs. Ducks 50 lbs. Chitterlings 6 stone Canned Corned Beef 241 cans Canned Foods (Various) 3,348 cans Potatoes 6 cwt. Flour 90 lbs. Margarine 10 lbs. Sugar 61 lbs. Dried Egg Powder 14 lbs. Milk Sampling.—During 1948, 40 samples of milk were obtained and submitted for bacteriological examination. Of these, 36 were found to be satisfactory, and 4 unsatisfactory. In the case of the latter samples, investigation was made with a view to tracing the cause of the unsatisfactory result and preventing recurrence. Where necessary, this was done in collaboration with the Local Authority in whose area the milk was produced and/or heat treated and bottled. Ice Cream Sampling.—Commencing in August, 1948, 34 samples of ice cream were obtained for bacteriological examination. Of these: 3 were Grade 1 7 „ „ 2 6 „ „ 3 18 „ „ 4 31 While it is appreciated that these (irades are provisional and that the present system of grading cannot be said to give conclusive results, it is thought that sampling of ice cream is worth while if only for the reason that it enables the Sanitary Inspectors to concentrate their efforts on improving the standard of manufacture and methods of distribution of those traders whose products consistently show poor results. In this connection, it is the practice of the Public Health Department to co-operate with other Local Authorities in whose areas the ice cream sold in Southgate is produced. Establishments for Massage or Special Treatment.—Under the Middlesex County Council Act, 1944, nine existing licences were renewed. One new licence was granted. Swimming Bath.— The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows: 1948. 1947. Mixed Bathers 46,618 63,574 From Schools 7,505 17,023 Season Ticket Holders 10,709 16,505 64,832 97,102 Spectators 3,347 5,440 Costumes, etc., hired 298 836 It will be noted that attendances at the Open-Air Swimming Hath fell considerably in 1948, due entirely to the very bad weather experienced during the summer. In spite of this, our Swimming Bath continued to represent a very important adjunct to the public health services. During the year, negotiations were begun to instal a system of break-point chlorination at the Bath. This system is now in operation, and although it does not form part of the structure of this Report, it can already be said that it has proved a practical success. The Public Health Committee also considered various methods of improving the amenities of the Bath. These amenities will add to the attractiveness of the Bath, and should encourage still more adults and children to make use of the very valuable facilities for added health which the Bath offers. I would like to extend to Mrs. Barry and her most efficient staff the thanks of the Public Health Department for the valuable co-operation invariably extended. Samples of the Bath water are taken at regular intervals and sent to the Public Health Laboratory for bacteriological examination. The present practice is to take various samples at different times, on days during which the Bath is being extensively used. The results of these samples have been uniformly satisfactory. 32 Rivers and Streams.—Very few complaints were received during' the year concerning the above. Rats and Mice Destruction Act.—During the year, 303 complaints of rats and mice were received and dealt with. In August and September a two-stage initial baiting- and poisoning treatment was undertaken in the soil sewers. The work was done in accordance with the recommendations of the Ministry of Agriculture and Fisheries (Infestation Division). Two officials of the Ministry visited the district and were given facilities for inspecting the work whilst in progress. They expressed themselves entirely satisfied with the organisation of the scheme and of the way in which the work was carried out. In the first stage of the treatment, 1,507 manholes were baited. Of these, 384 showed complete or part pre-bait takes. In the second stage of the treatment, a different bait and poison were used. 1,269 manholes were baited; of these, 60 showed complete or part takes of pre-bait. 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. 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 being considered. 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 of the Borough Surveyor's Department or are notified to the proprietors of the premises in which the public conveniences in question are situated. 33 Ponds and Rubbish Dumps.— These continue to be kept under observation. During the summer months, spraying is carried out wherever this is found necessary to prevent insect breeding. Undeveloped land, particularly corner sites, present a difficult problem in relation to the dumping of rubbish. It has been found possible, however, to secure improvement at several such sites, where the owners have agreed to erect notices forbidding dumping or where they have alternatively provided some sort of fencing. 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 and Surveyor, who is responsible for this service, reports that the fleet of vehicles used in this connection consists of ten Scammel Self-Loaders. A weekly collection from all dwellinghouses in the Borough is being carried out. Minor complaints continue to be received and are dealt with by the Borough Engineer and Surveyor's Department. 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 1947-1948 was 17,523 tons. An important factor in connection with house refuse collection is the salvage of various materials. The following is the tonnage sold during the year : T. cwts. qrs. Mixed paper, books, etc. 922 0 0 Broken glass 26 13 0 Non-ferrous metal 2 9 0 Rags 31 0 1 Baled tins 406 16 3 Bottles 24 9 2 Carpets 22 9 2 Sundries 12 19 3 Mixed scrap 81 15 0 Total 1,530 12 3 34 The value of this material amounted to £8,761 19s. 9d. The machinery at the Destructor is provided with Picking Tables over which all material passes. Such items as tins, rags, etc., are removed therefrom. Waste Paper.—The Board of Trade states that "the collection of waste paper during 1948 made a substantial contribution to the supply of paper and board making materials. We all appreciate the efforts made by the housewife and authorities in achieving this increase but I would particularly like to take the opportunity to congratulate Local Authorities on their contribution to the work and say how much I value their contribution. I want, therefore, to urge all concerned w ith collecting waste paper to continue, and, if possible, increase their efforts. Unless as much waste paper as possible can be supplied we may easily run short of paper and board, and so be forced to cancel the arrangement for increased newspapers, etc. The need to keep up waste paper collection is as important as ever." Residents are requested to bundle their paper and keep it separate, as special compartments are provided in the vehicles for this material. Kitchen Waste.—During the year, 1,237 tons 17 cwts. of kitchen waste were collected and under instructions from the Board of Trade, sold to the Tottenham Council for £3,558 16s. 3d. This material is collected once each week from every house in the Borough on Monday mornings. After careful consideration, the Cleansing Committee decided as an experiment to take one district and supply the housew ives with pails with fixed lids for use in the collection of kitchen waste. The Committee also decided to take a canvass of the whole district, to ascertain the number of housewives willing to take pails supplied by the Council and place them by their front gate for the weekly collection scheduled for each Monday. Six thousand two hundred and sixty housewives responded to this appeal. The experimental area with the use of pails showed an increase of approximately 300 per cent. Thereafter the Council, on the recommendation of the Cleansing Committee, decided to purchase a number of containers. The distribution of containers began in September throughout the district. Up to the moment, 7,266 containers have been issued. As a result, the whole district has shown an increase in collections varying from 100 per cent to 134 per cent in tonnage. The number of containers issued covers approximately onethird only of the district. It is hoped that a larger number of residents will be willing to accept these containers. The result of such acceptance would undoubtedly increase the amount of kitchen waste collected. 35 FACTORIES ACTS, 1937 and 1948. Details of Work Carried out During the Year 1948. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. M/c. line No. Number on Register. Number of M/c. line No. Inspections. Written Notices. Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 1 83 118 10 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 146 191 31 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (*excluding outworkers' premises) 3 3 Total 229 309 41 — 2.—Cases in which DEFECTS were Found. (If defects are discovered at the premises on 2, 3 or more separate occasions they should be reckoned as 2, 3 or more cases). Particulars. M/c. line No. No. of cases in which defects were found. Number of cases in which prosecutions were instituted. M/c. line No. Found. Remedied-. Referred To H.M.. Inspector. By H.M. Inspector. Want of Cleanliness (S.l) 4 15 15 — — — 4 Overcrowding (S.2) 5 — — — — — 5 Unreasonable temperature (S.3') 6 — — — — — 6 Inadequate ventilation (S.4) Ineffective drainage of floors (S.6.) 7 1 1 1 — — 7 Sanitary Conveniences (S.7) 9 — — — — — 9 (a) insufficient — — — — — — (b) unsuitable or defective 10 26 26 — — — — 10 (c) not separate for sexes 11 — — — — — 11 Other offences against the Act (not including offences relating to Outwork) 12 — — — — — 12 Total 60 42 42 1 2 — 60 * Electrical stations (Section 103/1), Institutions (section 104) and ana sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 36 37 OUTWORK—(Sections 110 and 111). Nature of Work. M/c. Line No. Section 110. No. of prosecutions for failure to supply lists. Section 111. Line No. No. of out-workers in August list required by Sec. 110 (1) (c) No. of oases of default in sending lists to the Council. No. of instances of work in unwholesome premises. Notices served. Prosecutions. Wearing Apparel 69 — — — — — Envelopes, Stationery 2 — — — — — Furs 2 — — — — — Embroidery and Art Needlework 2 — — — — — Boxing of Buttons 1 — — — — — Lining Cardboard Boxes 3 — — — — — Lamp Shades 1 — — — — — Leather Goods and Handbags 2 — — — — — Chair Covers 1 — — — — — Feather Mounter 1 — — — — — Cotton Goods 2 — — — — — Prevalence and Control over Infectious Diseases From the table of notifications set out on page 45 it will be seen that 1,156 cases of infectious disease were notified during the year, as against 887 in 1947 and 797 in 1946. The Infectious Sickness Rate for the district was thus 15.62, as compared with 11.93. during 1947 and 10.96 in 1946. The rise in Infectious Sickness Rate was almost entirely due to the increase in measles notifications. Diphtheria. —For the first year in the recorded health history of Southgate, no cases of diphtheria have been notified. This will be referred to in greater detail later in the Report, in the section dealing with Immunisation. Scarlet Fever.—Scarlet fever notifications received during the year were almost identical with those relating to 1947 (104 as against 105). The type of disease was again mild, admission to hospital being necessary in only 34 cases. It is interesting to note that the policy adopted by the Regional Hospital Board in regard to the admission of cases of scarlet fever to hospital is almost identical with that approved by the Southgate Borough Council. Broadly speaking, cases of scarlet fever are only admitted to hospital when either the severity of the illness, home conditions or accompanying circumstances relating to a breadwinner in the family warrant this action being taken. So long as scarlet fever retains its present mild character, I have no doubt that this policv is sound. In this connection, it is becoming increasingly obvious that the term "scarlet fever" is a misnomer and that it is based on false premises. The rash in scarlet fever, from which the disease takes its present name, can only be regarded as one among a collection of symptoms. Indeed, it is not too much to say that the rash has little or no epidemiological significance, beyond the fact that it draws attention to the underlying condition. Unfortunately, we are still inclined, indeed encouraged, to limit our consideration of scarlet fever cases to those patients who exhibit a rash, or in which the occurrence of a rash can be presumed, except in comparatively rare circumstances. This leaves out of account the very large variety of streptococcal infections of the throat, many of which are equally infectious. This presents immediate difficulties when one has to deal with an outbreak of streptococcal infection in a school. It is to be hoped that this situation will receive more attention than it has in the past, and that steps will be taken to alter the machinery at present at our disposal for dealing with and controlling all forms of streptococcal throat infection. 38 Puerperal Pyrexia. Thirteen cases of puerperal pyrexia were notified during the year. As noted in the Annual Report for 1947, the terrors of this disease have been materially reduced by the use of the sulphanilamides and penicillin. No fatal case of puerperal pyrexia occurred during 1948. Acute Anterior Poliomyelitis. -No cases of this disease were reported during 1948. This negative incidence was in keeping with the picture reported from the remainder of the country. Measles.—767 cases of measles were reported during the year, as against 392 in 1947 and 411 in 1946. The type of disease met with was again mild, admission to hospital being necessary in only a very small percentage of cases. The use of "measles modifiers" was extended during the year, particularly in our Day Nurseries. This has provided a valuable means of controlling the spread of the disease at a time when measles should, if possible, be avoided. Work is still in progress to determine the most efficient type of "measles modifier," and also the dosage. When this work has been completed, our knowledge of the means whereby the severity of measles can be reduced should be considerably enhanced. Pertussis. 149 cases of pertussis were reported during the year, as against 208 in 1947 and 136 in 1946. Further details regarding this disease will be found set out in the section of the Report dealing with immunisation. When it is remembered that pertussis is now almost certainly the most serious disease of early childhood, the possibility of controlling its spread by means of immunisation takes on added significance. Improved laboratory methods for the diagnosis of pertussis in the early stages are also helping to reduce present dangers. In this connection, 1 have taken the opportunity of reminding general practitioners of the existence of these latter facilities, which are, however, still used with insufficient frequency. Although no cases of diphtheria have been reported in Southgate for approximately two years, during which time a total of more than 350 cases of pertussis have been notified, the number of throat swabs sent to the Laboratory for investigation as to the possible presence of the c. diphtherias far outnumbers the total of swabs sent with a view to ascertaining whether or not the organism responsible for pertussis was present. This is, of course, understandable, having regard to the major part which diphtheria has played for so very many years in the field of medicine. It should none the less be realised that the taking of a swab for the presence of the h. pertussis has at the present time much more practical significance than the examination of a swab where diphtheria is suspected. One cannot afford to neglect any means which will allow us to detect the presence of pertussis in a child at the earliest possible stage. The laboratory offers us 39 this service; it is surely to the advantage of every medical practitioner to make the maximum use of it. Tuberculosis.—Tuberculosis notifications fell during 1948 to 69, from 82 in 1947. This is one of the lowest totals recorded for many years. The fall has, of course, very little social significance. It would be most unwise to draw any lasting qonclusions from the figures relating to any one year. It is also difficult in a district such as Southgate, and with such comparatively small totals on which any inference can be made, to correlate the incidence of tuberculosis with any single social factor or group of factors. There is, for instance, no evidence in Southgate that tuberculosis is associated either with overcrowding or with poverty. The following table, which illustrates this point, sets out the notifications of tuberculosis received from the various wards of the Borough: South 15 Middle 25 North-East 18 North-West 11 The occupations of the notified cases were as follows : 5 scholars, 16 housewives, 4 infants, 4 teachers, 1 scientific instrument maker, 2 R.A.F. personnel, 1 builder, 1 naval rating, 1 motors, 1 machinist, 6 clerks, 1 art student, 1 civil servant, 1 factory worker, 1 timber merchant, 1 telephone engineer, 1 domestic servant, 3 typists, 2 light engineering, 1 butcher, 1 usherette, 1 apprentice bookbinder, 1 chemist, 1 upholsterer, 1 mason, 1 soldier, 1 hospital worker, 40 1 insurance official, 1 motor driver, 1 Post Office engineer, 1 dressmaker, 4 unclassified. Of the four "unclassified" cases, one has died, one has left the district, and two did not follow any occupation. In no case was there any marked degree of poverty. It is further known that, of the 69 cases of tuberculosis reported during the year, only seven occurred in houses which could be classified as overcrowded. Although the evidence is negative so far as Southgate is concerned, it will still be obvious that the Borough Council, as a sanitary authority responsible for environmental hygiene, must do what it can, not only to maintain living conditions in the Borough at the highest possible level but to improve the conditions under which cases of tuberculosis or contacts of cases of tuberculosis are required to live. In this connection, the scheme considered by the Borough Council whereby a block of flats will be set aside for families in which a case of tuberculosis has occurred has very much to commend it. The provision of these flats undoubtedly represents a concrete contribution to the prevention of tuberculosis, and is a social experiment which deserves whole-hearted support. It is a tragic corollory to our present lack of treatment facilities that cases of open tuberculosis, both early and late, still have to wait for beds in sanatoria. This is not a matter over which the Borough Council has any control, and I understand that it is receiving the urgent attention of Regional Hospital Boards. Facilities for the early diagnosis of tuberculosis, particularly through the medium of Mass X-ray units and the like, are improving but could still, with advantage, be extended. Until these facilities are entirely adequate, and until immediate treatment can be guaranteed for all patients discovered to be suffering from tuberculosis, the position will remain unsatisfactory. It must again be stressed, however, that the prevention of tuberculosis lies further back than that. Prevention will always be governed by such conditions as housing, overcrowding, nutrition, and the purity of our milk supply. These are all matters in which the Borough Council must be interested. It will therefore be obvious that we have an important part to play in the prevention of a disease which is one of the greatest menaces to health and to life itself. Food Poisoning.—Opportunity was taken during the year to remind general practitioners that cases of acute food poisoning must be notified to the local sanitary authority. In spite of this, very few notifications were received. This does not mean that food poisoning has become a rare type of infection. It merely 41 means that many such cases were never seen by a doctor, or that the illness was of so trivial a character that notification was not made. During the year, an interesting outbreak of food poisoning occurred in one of our school canteens. This outbreak (at Minchenden School) involved some 150 children and staff, and was found to be due to salt beef served as the main dish at the school lunch on 21st October, 1948. The outbreak was traced to the manner in which the food had been cooked, with particular reference to the method of storage and cooling during the night prior to the outbreak. None of the children or staff affected was seriously ill, but the epidemic showed the dangers which can exist even in a well-ordered canteen. Further reference will be made in Appendix 3 to this Report to the steps taken by the Borough Council during the year to improve food hygiene throughout the Borough. Immunisation. —The work of immunisation was continued during 1948 along very much the same lines as held in previous years. Opportunity was, however, taken to extend the scheme, particularly in relation to the arrangements for supplying reinforcing-doses of immunising material against diphtheria. Very briefly, our procedure at 5th July, 1948, was as follows: (a) An immunisation clinic was held in Broomfield House each Thursday afternoon. Children were immunised at this clinic against diphtheria alone or against diphtheria and pertussis combined. All parents with children aged six months received a card on which the advantages of immunisation were clearly set out. An invitation was extended to bring the child to the clinic for immunisation as soon as possible after the age of nine months. When the child reached the age of twelve months, a further letter was sent, with a birthday greeting card. This letter took various forms, depending on whether or not the child's immunisation had already been commenced. Emphasis was also laid on the fact that immunisation could be obtained from the family doctor. (b) Our methods of immunisation followed the modern technique and were, I believe, as effective and fool-proof as practical precautions could guarantee. We employed a doctor, a health visitor and a clerk at the weekly clinic, while the clerical work entailed by the scheme called for still further clerical assistance. Having regard to the results obtained, I am satisfied that the system was both sound and economical. (c) All maintained and most of the private schools in the Borough were visited during the year for the purpose of 42 supplying reinforcing closes of immunising material against diphtheria. All the children attending each school were given a letter addressed to parents in which the need for supplying a reinforcing dose every four to five years was emphasised. The parents completed a tear-off slip, which was returned to the school. The letter stated a date on which the Medical Officer of Health or a member of his staff would visit the school for the purpose of immunising children. This system has worked very well and means that parents receive a yearly reminder of the need for reinforcing doses. It has also meant that many children attending Southgate schools are now receiving their second reinforcing dose. I am at present obtaining information which should allow us to assess the degree of immunisation which exists in our schools. Although this information is not yet complete, there is every reason to believe that at least 90% of all children attending our maintained and larger private schools are fully protected. (d) A weekly clinic for immunisation against pertussis and for the carrying out of Schick tests was held each Monday afternoon in Broomfield House. The response to our campaign for immunisation against pertussis was reasonably satisfactory, especially when one remembers that most of our young children are now being immunised against diphtheria and pertussis combined. The information which we have so far collected, although not sufficient to justify definite conclusions, leads one to believe that immunisatipn against pertussis does afford protection against the disease, particularly in the direction of modifying the severity of an attack. It is also worthy of note that the Schick test carrjed out three months after immunisation against diphtheria and pertussis combined reveals a higher degree of protection than was the case when immunisation against diphtheria alone was practised. It might also be mentioned that the number of reactions following immunisation has decreased during the last few years. This factor no longer possesses any real significance. (e) Apart from the sending of cards and letters to parents, opportunity was taken at our various clinics and centres to impress the need for immunisation on all mothers and expectant mothers. The magazine "Better Health" and the local press were also used for propaganda purposes, with the exhibition of posters and the use of trailer films in cinemas. During 1948, 1,260 children were immunised against diphtheria, either alone or in conjunction with pertussis; 1,026 children were immunised against pertussis, either alone or in conjunction with diphtheria. The total number of visits paid to our immunisation clinics during the period under review was 7,711. In addition to the above, 2,242 reinforcing injections against 43 diphtheria were given, mostly in our schools. This is by far the highest total yet achieved in the district. It is very satisfying to be able to report that, for the first year since records were kept in Southgate, no cases of diphtheria were reported during 1948. Indeed, up to the time of writing this Report, no case of diphtheria has occurred in the Borough for more than two years. On page 45 will be found a graph which sets out the number of cases of diphtheria recorded each year in Southgate since 1923, with the corresponding deaths. This graph illustrates very clearly two important facts. First, it will be seen that our local immunisation campaign, instituted during 1933, produced a downward trend in the number of cases. It will further be observed that this downward trend was initially not very marked. The results of the national campaign for immunisation against diphtheria, sponsored by the Minister of Health in 1940 and 1941, were much more striking. Inspection of the graph will show that, from this time, the number of cases of diphtheria being reported yearly fell dramatically, with a corresponding decrease in the death rate from the disease. It will thus be seen that immunisation, to be effective, must be carried out on a large scale. Until one can be sure that at least 50% or better still 75% of children in any area are immunised against diphtheria and remain fully protected, the dangers of diphtheria, even in epidemic form, will still persist. It is not claimed that immunisation alone has produced this spectacular drop in the numbers and death rates from diphtheria; nor is it claimed that immunisation should supercede the older, well-established methods of prevention. We must, of course, remember that diphtheria can and does occur in immunised children, especially when the gravis strain of the c. diphtherias is responsible. It should surely be obvious, however, that immunisation has brought about a revolution in our attitude towards disease. A safe method of protection has been made available, the results of which constitute one of the most spectacular achievements in the history of preventive medicine. Happily, the vast majority of parents are now convinced of the effectiveness of immunisation, which is accepted almost without question in every instance. As in all other fields of preventive medicine, we must be prepared not only to continue our efforts but to extend or modify them in the light of scientific advance. Immunisation must never be allowed to remain static; we must take advantage of each new discovery, once it has been proved. By so doing, it should be quite possible to maintain our position, and to banish diphtheria as a major killing or incapacitating factor from the population. 44 DIPHTHERIA Cases and Deaths for the past 25 years 45 NOTIFICATIONS OF INFECTIOUS DISEASE, 1948. Jan.— March. April— June. JulySept. Oct.— Dec. Totals. Enteric Fever 1 – – – 1 Diphtheria — — — — — Scarlet Fever 42 14 17 31 104 Paratyphoid Fever — — — — — Dysentery — — 1 — 1 Malaria — — 1 1 2 Puerperal Pyrexia 2 2 5 4 13 Erysipelas 4 1 4 3 12 Ophthalmia Neonatorum — — 1 — 1 Measles 400 316 46 5 767 Whooping Cough 27 50 35 37 149 Pneumonia 15 9 2 7 33 Cerebro-spinal Fever 3 — — – 3 Acute Poliomyelitis — — – — Tuberculosis— Pulmonary 10 12 22 18 62 Non-pulmonary 1 1 3 3 8 Totals 505 405 137 209 1,156 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. F. M. F. Cases on Register, 1/1/48 218 193 40 40 491 Cases Notified for first time, 1948 31 31 2 6 70 Cases Restored to Register 2 — — — 2 Other cases added 11 4 — 4 19 Cases Removed from Register 22 12 1 3 38 Remaining on Register, 31/12/48 240 216 41 47 544 46 TUBERCULOSIS—1948. Age Periods. *New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1-5 years 1 1 2 2 — — — — 5-10 years — 1 — 2 — — — — 10-15 years — 2 — 1 — — — 15-20 years 8 5 — — — 1 — — 20-25 years 4 5 — 2 — — — — 25-35 years 15 13 — 3' 3 4 — — 35-45 years 6 4 — — 2 1 — — 45-55 years 7 3 — — 5 2 — — 55-65 years 2 1 — — 3 — — — 65 years and over 1 — — — 2 — — — Totals 44 » 2 10 15 8 — — * These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. 47 Appendix 1. HEALTH EDUCATION Health Education has continued to play a prominent part in our health programme. Broadly speaking, activities under this heading followed the lines described in detail in last year's Annual Report. Twenty-nine film shows and talks were given during the year to local organisations. The numbers in the audiences at these meetings varied considerably, but in all cases the interest shown was keen. Opportunity was taken from time to time to seek the co-operation of the editors of our local papers in inserting articles of topical interest. This co-operation was invariably forthcoming, and has been a source of great satisfaction to the Public Health Department. From telephone messages received and personal conversations, it is obvious that these articles are read. I would like to take this opportunity of expressing once again my sincere thanks to the local Press for their invaluable assistance. The local edition of the magazine "Better Health" continued to circulate during 1948. It is now known that this local edition will shortly be withdrawn, owing to financial difficulties. The general edition of "Better Health" will, however, be continued in an altered and more attractive form. It would seem that the issue of such a magazine as "Better Health" is a matter in which both the local Council and the Middlesex County Council are concerned. It is hoped that some means will be arrived at whereby this valuable means of propaganda can be maintained or even extended. There is no doubt that health education, in one form or another, can and should play a prominent part in the field of public health. As noted above, the position is somewhat complicated by the fact that several authorities are involved—in our case, the Southgate Borough Council, the Middlesex County Council, and the Southgate Division Executive. It should be possible to correlate the activities of these three authorities in the field of health education, so that duplication is avoided. This is a matter in which I happen to be keenly interested, as I feel that the results of such work are lasting and substantial. 1 therefore hope to be in a position to report further on health education generally to the Public Health Committee. In the meantime, we will continue our efforts as before. 48 Appendix 2. LETTERS TO DOCTORS The system of sending circular letters to doctors from time to time on matters of current interest was continued during the vear. The following letters were sent during 1948: 2nd Tan. Immunisation against diphtheria and whooping cough. 12th Jan. Food poisoning—recent increase. 19th Jan. Admission of cases to Isolation Hospital, etc. 19th Jan. Admission of urgent cases of infectious disease to Hospital; revised procedure. 19th Mar. Notification of infectious disease; information regarding immunisation against diphtheria and pertussis. 18ch Mat. Collection of Laboratory specimens—Easter week-end. Sth May Collection of Laboratory specimens—Whitsun weekend. 25th June Southgate Ambulance Service—Alteration of telephone numbers, etc. under Middlesex Fire Service. 28th June Admission of cases of infectious disease to Enfield and Edmonton Isolation Hospital. 1st July National Health Service—general information regarding new Services. 10th July National Health Service—admission of cases of infectious disease; smallpox and typhus consultants; vaccination and immunisation. 12th July National Health Service—immunisation and vaccination—record cards. 13th July National Health Service—work of Health Visitors. 20th July Immunisation—-combined inoculation. 20th July Collection of Laboratory specimens—August Bank Holiday week-end. 23rd Aug. Admission of Southgate cases to North Middlesex Hospital. 7th Oct. Staphylococcal Food Poisoning—requesting particulars of any cases heard of in their practice. 11th Oct. National Health Service—vaccination and immunisation—obtaining parents' consent. Sth Nov. Whooping Cough—records for information and to assess the value of immunisation against whooping cough. 16th Nov. Circular letter from Central Public Health Laboratory re new Laboratory at Edmonton. 13th Dec. Collection of Laboratory specimens—Christmas weekend. 13th Dec. Notification of cases of infectious disease. 49 Appendix 3. Food Hygiene. During 1948 the Council decided to institute a campaign designed to improve the standard of food hygiene throughout the Borough. As noted elsewhere in this Report, the campaign was inaugurated at a meeting held in Minchenden School Canteen on 1st June. The aims and objects of the campaign were the subject of a special report to the Public Health Committee in July, 1948, a copy of which is reproduced below: FOOD HYCIENE In planning our campaign on food hygiene, it might be as well to begin by clearly defining our objects. Bearing in mind the limited staff available for this type of work, and the time which the staff must devote to other and equally important duties, I am of opinion that our present activities should very largely be confined to effecting improvement in the standard of hygiene in establishments serving food. We will, of course, continue to supervise premises in which food is either stored, prepared or sold, and will not forget that this duty must always be an integral part of any comprehensive scheme designed to cover the field of hygiene. I do, however, suggest that the preparation and serving of food in canteens and cafes stands out as our most urgent problem, and that this aspect of the work should receive the greater part of our immediate attention. We must also remember that our prime object should be to encourage the proprietors and stall's of canteens and cafes to carry out their part and to improve their methods. Our role should be that of adviser rather than an operator or even administrator; if we can persuade the individuals concerned to help themselves, and to take a personal pride in their work and in the results which they attain, there can be no doubt that the final outcome will be much more satisfactory. It will, I am sure, be appreciated that this point is one of considerable importance. We must certainly use the statutory powers at our disposal but t is quite obvious that the willing co-operation of proprietors and staffs is very much more to be desired than forced compliance with rules and regulations. As 1 see it, our plan of campaign can be divided into two parts, a short-term immediate policy, and a long-term policy which may well have to be amended in the light of experience. The short-term policy might be briefly described thus:- 50 (a) The systematic visitation of canteens and cafes in the Borough by Sanitary Inspectors, as a follow-up to our recent meeting. (b) The distribution to cafes and canteens of notices, leaflets and posters, for use by the staff and display in kitchen premises, lavatories, etc. Attractive posters on a variety of important subjects are now available. We estimate that the quantity necessary to cover all applicable premises would cost approximately £2 12s. 6d., bearing in mind the fact that display notices have already been distributed to all cafes and canteens in the area. I should be glad to receive authority to purchase. (c) The distribution of suitable leaflets in Maternity and Child Welfare Centres, Libraries, Schools and the Public Health Department. A sufficient number of leaflets for this purpose can be obtained at a cost of £2 12s. 6d. (d) The arranging of talks, film shows and demonstrations to Youth Clubs, Women's Organisations, Parent/Teachers' Associations, Schools and the like, during the coming months. Mr. Gooday has prepared a special lecture/demonstration, which should be suitable for such audiences, and 1 propose to make this a feature of my 1948/49 Health Education Campaign. (e) The arranging of a further series of lectures and demonstrations for proprietors and staffs of cafes and canteens. These should be held during the early Autumn, and will entail very little expense. As all our Sanitary Inspectors have nowtaken a special course on food hygiene, they will be able themselves to organise such meetings. (f) The insertion from time to time in "Better Health" and the local press of articles designed to promote interest in food hygiene among the general public. Such articles should have a popular appeal, should keep the public informed of what is going on, and should encourage them to play their part in our efforts to raise the standard of food hygiene within the Borough. (g) Close liaison with the School Health Service and the Area Health Committee, so that work in the same field can be suitably correlated. This should present no difficulties. The long-term policy which 1 suggest might be summarised as follows : (a) A further approach should be made to the Chamber of Commerce with a view to enlisting their aid in the 51 tion of a Guild of Hygiene. This procedure is working well in Guildford, and has been tentatively adopted by several districts in Greater London. The difficulties are obvious but, with the co-operation of the Chamber of Commerce and the active interest of the Public Health Committee, prospects of success are favourable. It would at least appear worth while to investigate the possibilities. (b) The Central Council for Health Education is at present considering the advisability of drawing up National Codes of Practice for food handlers. These Codes of Practice are intended for voluntary adoption by the more enlightened members of the different trades, and should go far towards effecting much-needed improvement. If and when these Codes of Practice are prepared, their adoption could be incorporated into any Guild of Hygiene set up in Southgate. (c) Close liaison must be maintained with all proprietors and staffs of cafes and canteens, so that they continue to look upon us as friends and advisers, rather than as instruments of an outside supervisory body. This attitude is essential to the success of any long-term policy. (d) Talks and demonstrations on food hygiene will have to be continued so that the interest of the individuals concerned is maintained and opportunities taken to bring' new developments and improvements to their notice. (e) Close contact with the School Health Service and the Area Health Committee should be maintained. As 1 have already indicated, our long-term policy may have to be changed in the light of experience. Its adoption and operation will necessarily depend upon the success of the efforts which we make within the next six months. 1 therefore propose to report further to the Public Health Committee towards the end of the Autumn, when the position and needs of the Borough can be more accurately assessed. W.C. HARVEY Medical Officer of Health. All the various points set out under the heading of the immediate short-term policy have already been implemented. So far as the long-term policy is concerned, it is hoped that a Guild of Hygiene will shortly be formed, with the active co-operation of the local Chamber of Commerce. The Public Health Committee has been keenly interested in the possibility of such a development, which will be made the subject of a special report during 1949. 52 Appendix 4. WELFARE OF THE ACED The Public Health Department has been very keenly interested in the welfare of elderly people. This is a problem on which considerable attention has been focussed of late, and towards the solution of which numerous efforts have been made. In a district such as Southgate, with a population heavily weighted towards the older age groups, the problem exists in an acute form. The joint problems posed by old age and accompanying infirmity are by no means easy of solution. Measures adopted in this Borough to alleviate the hardship so increasingly the lot of elderly people include the provision of Home Helps, the establishment of Clubs for elderly people, the provision of suitable accommodation, the institution of a meals-on-wheels service, and the setting-up of a special Committee which considers the problem of elderly people and the measures which can be taken to provide a happier and fuller existence. Although it can be stated that much has been done, it is equally true that much still remains to be done. The special problem of the elderly person who is unable, by reason of age or infirmity, to look after himself or herself, but for whom no bed n a hospital or institution is available, is particularly clamant. This type of case is increasing, and stands as a tragic criticism of our modern society. The Public Health Department has been happy to co-operate with the various voluntary bodies within the Borough interested in the welfare of the aged. Close touch has been kept with the Southgate Old People's Welfare Committee and with the Southgate Social Service Council; talks and film shows have been given at Old People's Clubs, while the Medical Officer of Health has attended a number of Committee meetings at which the problems of old age have been discussed. Very active steps have also been taken to obtain hospital accommodation for aged people, whenever possible. The Public Health Department will continue its work, in the hope that a more permanent and happier solution will eventually be found to the whole problem of old age and infirmity. We cannot afford to neglect our aged, to blind ourselves to the fact that they have a very definite call upon our services. A district such as Southgate can never say that its future lies with the younger generation ; this is a truism which, as so often happens, tells only half the truth. There is ample and immediate room for an extension of the facilities available for the care of the aged. One can only hope that it will be possible to effect this extension within the not-too-distant future. 53 The Ghzette Pritery, Aldermans Hill, Palmers Green, N.13.