LIBRARY Aut39(1)SmntGate BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1949 Wm. CLUNIE HARVEY, M.D.TD.P.H. Medical Officer of Health SOUG 34 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer o( Health for the Year 1949 W'm. 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 1949. The form which the Annual Report for 1949 should take has been altered in the light of the changes brought about by the National Health Service Act. Although the report will still contain information relating to vital statistics affecting the Borough, it will no longer be possible to comment on the personal health services which have presumably affected such statistics. The reason for this will be readily appreciated. It would scarcely be judicious or even courteous for a Medical Officer of Health who is also a County Officer, to offer comment upon services provided by the County Council in his area. It will still be possible, however, to refer to statistics in an uncritical manner. It appears only right that this should be done. If these comments are not available, it would be very difficult, if not impossible, to present a picture which accurately depicts the health of the Borough. As the Borough Council is intimately concerned with all matters affecting the health of the community, it is only right and proper that the information presented should be comprehensive and intelligible. The vital statistics for 1949 are satisfactory. The Birth Rate shows a slight decline, from 13.69 to 12.69, while the corrected Death Rate is 9.49 as against a Death Rate of 10.40 in 1948. The Infantile Death Rate, while somewhat higher than last year (25.42 as against 22.68), is still one of the lowest recorded 3 in the district. As will be noted in the body of the Report, the infectious diseases picture is also satisfactory. 1949 was the first complete year during which the new regime inaugurated by the National Health Service Act, 1946 operated. Reference to the change-over was made in my Annual Report for 1948. It will suffice to state here that all concerned have satisfactorily adapted themselves to the new order. So far as the Public Health Department is concerned, the change has been considerable. The Public Health Department now consists of a Medical Officer of Health and Deputy, both of whom are employed for the major part of their time on County Council duties. It has also a Chief Sanitary Inspector, three District Inspectors, a Disinfector, Assistant Disinfector, Rodent Operator and a clerical staff of three. At first sight, it might appear that the transfer of so many duties to the County Council, with the related reduction in staff, has reduced the importance of the Borough Council's functions in the field of Public Health to a more or less negligible quantity. This is very far from being the case. It might be worth while to consider for a few moments the duties which the Borough Council has to perform as a Public Health or Sanitary Authority. There is first of all the vast field of epidemiology. In the past, epidemiology was mainly concerned with the study and control of the spread of infectious diseases. Although this is still an important aspect of the work, it no longer properly describes the aims and purport of epidemiology. Apart from receiving notifications of infectious diseases, tracing and supervising contacts, arranging for disinfection and removal of cases to hospital, the Borough Council is charged with the very much wider duties of investigating all causes of illness, whether infectious or non-infectious, to be found within the Borough boundaries. It will thus be seen that every factor which affects the health of the individual or of the community properly comcs within the ambit of epidemiology. If this were our only duty as a Public Health Authority, it would thus be clear that our responsibilities are onerous. In point of fact, however, the work of the Borough Council as a Public Health Authority does not by any means end there. The Public Health Department is concerned with housing, as it affects health. It is also concerned with the inspection of meat and other foodstuffs, with particular emphasis on milk and icecream. It deals with shops and factories, with rodent control, with pollution of the atmosphere, and with the investigation and eradication of all the varied types of nuisances which can and do affect individual and communal health. The Public Health Department is also keenly interested in health education, and has not slackened its efforts in this important field since the 5th July, 1948. Mention 4 might also be made of the activities sponsored by the Public Health Committee in the very important held of food hygiene. This very brief resume of the duties covered by the Public Health Committee will surely make it obvious that the work of the Borough Council in the field of preventive medicine is by no means insignificant. It is, of course, a fact that preventive medicine as opposed to curative medicine is non-spectacular, and is apt to be taken for granted or even forgotten. Preventive medicine seldom enters the limelight unless things go wrong; at all other times it is relegated to the shadowy hinterland of medicine, continuing from day to day, from year to year, without publicity. No one seeks publicity, yet one cannot help feeling that the very fact that this work is carried on without fuss or blare of trumpets has, in part at least, resulted in the emphasis on curative medicine which signalised the National Health Service Act, 1946. This same principle applies even more forcibly to the Public Health services undertaken by the Borough Council. The personal health services have at least the satisfaction of a direct, positive approach. These personal services furnish the means whereby mothers and children can attend clinics for advice and even treatment; they can immunise, vaccinate, provide goods and services which are very real and at all times visible to the recipients. The Public Health services of the Borough Council are not so fortunate. Our approach must of necessity be indirect and circuitous in many instances. Our main concern is to ensure that the conditions under which the community lives and works is such as to encourage positive health. Need the fact that this problem is gigantic be emphasised? We know only too well that conditions exist which should not be tolerated; we know what we would like to do, what we feel we ought to do. And yet, in so many cases, the remedy is either inadequate, or is quite without our reach. In this connection one need only specify the problems presented by tuberculosis. So long as living conditions remain as they are, this problem will continue to present itself. Vast sums are being spent on treating cases of tuberculosis, either at home of in sanatoria; those who are attempting to control the spread by improving environmental conditions are prevented from exercising the full measure of such control by lack of adequate means. This is indeed an unhappy state of affairs, which must give one cause for perturbation. It is an unfortunate corollary of present-day conditions that a Medical Officer of Health should feel it necessary to act as an advocate for the Public Health services sponsored by his local authority. I am quite aware, of course, that the Borough Council is fully cognisant of the part which the Public Health Department has to play, and appreciates its responsible obligations. The 5 interest invariably displayed by the Borough Council in all matters affecting the health of the community can be allowed to speak for itself. I am equally convinced, however, that many outside the Council are not yet in a position adequately to understand the changes which have come about. I can only hope that the brief explanation set out in the paragraphs above will help to clarify the situation. In conclusion, I should like to express my sincere thanks to the members of the Borough Council, and especially to the members of the Public Health Committee, for the continued support which I have received during the past year. I should also like to thank the staff of the Public Health Department, all of whom, as already indicated, have adapted themselves admirably to the altered conditions. 1 would particularly tender my thanks to Mr. A. E. Gooday, Chief Sanitary Inspector, for the conscientious and able way in which he has assisted me in my work. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. Southgate Town Hall. Palmers Green, N.13. 6 PUBLIC HEALTH COMMITTEE From 1st January to 15th May, 1949 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) From 16th May to 31st December, 1949 Alderman G. Peverett (Chairman) Councillor H. S. Beardow Councillor R. V. Faithfull (resigned 22nd October, 1949) Councillor S. C. Jenner Councillor C. F. Lintott (elected 26th November, 1949) Councillor Mrs. C. T. McConnell Councillor R. Prior (Vice-Chairman) Councillor Mrs. R. Winston PUBLIC HEALTH STAFF Medical Officer of Health: 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 (appointed Chief Sanitary Inspector on 1st April. 1949) *Sanitary Inspector (No. 2 District), R. L. Burkill, A.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection, Cert.R.San.I. Smoke Inspector. *Sanitary Inspector (No. 3 District), E. T. Jephcott, M.S.I.A., Cert.R.San.I., Cert.R.San.I. Meat Inspection. *Sanitary Inspector (No. 4 District), W. Shackcloth, M.R.San.I., M.S.I.A. Clerk: Miss E. W. Barratt (appointed Senior Typist 1st April, 1949) Clerk: Miss E. A. Montague (appointed 1st March, 1949) Junior Clerk: Miss R. J. Bonnett (appointed 31st January, 1949) Clerk: Mrs. A. B. Preston (died 26th January, 1949) Disinfector: A. G. Bates (died 2nd June, 1949) General Assistant: B. Latter (appointed 1st July, 1949) Driver: J. L. Arnold (seconded from Borough Engineer's Department on 6th May, 1949) Rodent Operator: W. Dowsett *These Officers' salaries are repaid to the Council in part, by the Ministry of Health or the County Council. 7 Statistics and Social Conditions of the Area Area (in acres) 3,764 Registrar General's estimate of Resident Civilian Population, 1949 74,350 Number of Inhabited Houses (end of 1949) according to Rate Books 21,872 Rateable Value (1949) £930,372 Sum represented by a penny rate (1949) £3,770 The social conditions of the Area have shown no material alteration during the year. The comments which I made in this connection in the Annual Reports for 1948 and 1949 still apply. EXTRACTS FROM VITAL STATISTICS OF THE YEAR Male Female Total Live Births Legitimate 459 467 926 Illegitimate 9 9 18 468 476 944 Birth Rate per 1,000 of the estimated population 12.69 Births Still Legitimate 12 8 20 Illegitimate — 1 1 12 9 21 Rate per 1,000 (live and still) births 21.76 Deaths from all causes and at all ages 820 Death Rate per 1,000 of the estimated population 9.49 Deaths from puerperal causes: Rate per 1,000 total (live and still) Deaths births From puerperal sepsis 0 0 From other causes 2 2.07 2 2.07 8 Deaths of Infants under 1 year of age: Male Female Total Legitimate 16 8 24 Illegitimate — — — 16 8 24 Infant Death Rate: All infants per 1,000 births 25.42 Legitimate—per 1,000 legitimate live births 25.92 Illegitimate—per 1,000 illegitimate live births 00.00 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0.001 Deaths from Diarrhoea (under 2 years of age) 0 POPULATION The Registrar General estimated the civilian population of the Borough at the middle of 1949 to be 74,350, an increase of 320 as compared with 1948. BIRTHS—BIRTH RATE The nett total births accredited to the district was 944, a decrease of 70 on the preceding year. Of these, 468 were males and 476 females (9 males and 9 females being illegitimate). The birth-rate for the year was 12.69 per 1,000 of the population. The birth-rate for England-Wales for 1949 was 16.7 and for the administrative County of London, 18.5. The births and birth-rates for the past five years were as follows: No. of Births Birth-Rates Southgate England & Wales London 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 1949 944 12.69 16.7 18.5 During 1949, the number of births recorded was 123 more than the number of deaths, as compared with 244 in 1948. The total number of births actually registered in the district during the year amounted to 651, of which none was unnotified. The percentage of births notified was therefore 100 as compared with 99.15 in 1948. 9 MORTALITY General Mortality and Death-rate.—The nett number of deaths accredited to this district was 820, 50 more than in 1948. This gives a crude death-rate of 11.04 per 1,000 of the population' and a corrected death-rate of 9.49 (rate for 1948—10.40). This is the first time for a number of years that the Registrar General has supplied a comparability factor for application to the death rate for the area. Death-Rates No. of England Deaths Southgate & Wales London 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 1949 820 9.49 11.7 12.2 Infant Mortality.—There were 24 deaths of infants under 1 year of age, which gives an infantile death-rate of 25.42 per 1,000 births, as compared with 23 deaths and a rate of 22.68 in the preceding year. The corresponding rates for England and Wales and London were 32 and 29 respectively. The infant deaths and rates for the past five years were as follows: No. of Deaths Infantile Death Rates Southgate England & Wales n 1945 38 38.93 46 53 1946 36 29.68 43 41 1947 41 32.90 41 37 1948 23 22.68 34 31 1949 24 25.42 32 29 As noted elsewhere, the infantile mortality rate for 1949 (25.42), although somewhat higher than last year, is still one of the lowest recorded in Southgate. Stillbirths.—21 stillbirths (1 illegitimate) were accredited to the district for 1949. This is equal to a death-rate of 21.76 per 1,000 (live and still) births, the corresponding figures for 1948 being 15 stillbirths, with a rate of 14.58. The rate per 1,000 of the population was 0.282, the rates for England and Wales and London being 0.39 and 0.47 respectively for 1949. The average rate for the past ten years was 25.82. 10 Maternal Mortality.—The maternal mortality rate, i.e. the number of mothers dying as the result of childbirth per 1,000 total (live and still) births was 2.07. Mortality of Toddlers.—Six deaths occurred amongst children of the age group 1-5 years during 1949. This represents a deathrate of 0.08 per 1,000 of the population, and 0.73 per cent of the total deaths for the year at all ages. In 1948 there were three deaths, giving a death-rate of 0.04 and a percentage of 0.38. Mortality of Persons over the Age of 65.—Five hundred and forty-one, or 65.98 per cent of the total deaths during the year occurred in persons over the age of 65. Of these, 161 died between the ages of 80 and 90, while a further 24 were over the latter age (7 males, the eldest being 96, and 17 females, the eldest being 96). 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 was one death in this category during the year, from pertussis. The rate per thousand of the population was therefore 0.013. It was once again satisfactory to note that only one death occurred from any zymotic disease, a very different picture from that which prevailed not so many years ago. 11 TABLE I. Causes of Death During the Year 1949 Causes of Death. Male. Female. Total. Rates per 1,000 of Population. All Causes (Civilians only) 388 432 820 9.49 1 Typhoid and paratyphoid levers - - - - 2 Cerebro-spinal fever - 1 1 0.001 3 Scarlet fever - - - - 4 Whooping Cough 1 - 1 0.001 5 Diphtheria - - - - 6 Tuberculosis (respiratory system) 12 13 25 0.33 7 Tuberculosis (other forms) 2 3 5 0.006 8 Syphilitic diseases 5 5 10 0.01 9 Influenza 4 5 9 0.12 10 Measles - - - - 11 Acute Poliomyelitis and Polioencephalitis 1 1 2 0.02 12 Acute Infectious Encephalitis 1 - 1 0.001 13 Cancer, Oesoph. (M) Uterus (F) 5 2 7 0.09 14 Cancer, Stomach and Duodenum 14 8 22 0.29 15 Cancer, Breast - 23 23 0.30 16 Cancer, other sites 59 55 114 1.53 17 Diabetes - 5 5 0.06 18 Intra-cranial vascular lesions 35 63 98 1.31 19 Heart Disease 98 120 218 2.98 20 Other Circulatory Diseases 22 12 34 0.45 21 Bronchitis 20 21 41 0.55 22 Pneumonia 21 20 41 0.55 23 Other Respiratory Diseases 11 3 14 0.19 24 Ulcer, Stomach or Duodenum 7 3 10 0.01 25 Diarrhoea under 2 years - - - - 26 Appendicitis 1 1 2 0.02 27 Other Digestive Diseases 5 11 16 0.20 28 Nephritis 8 6 14 0.19 29 Puerperal Sepsis - - - - 30 Other Maternal causes - 2 2 0.02 31 Premature Birth- 4 3 7 0.09 32 Congenital Malformations, Birth Injuries, etc. 7 6 13 0.17 33 Suicide 4 5 9 0.12 34 Road Traffic Accidents 4 2 6 0.07 35 Other violent causes 10 8 18 0.23 36 All other causes 27 25 52 0.69 12 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. 1949 Age MALES. FEMALES. TOTALS. No. % of Total Deaths. Rate per 1,000. No. % of Total Deaths Rate per 1,000. No. % of Total Deaths Rate per 1,000. 0—1 year 16 1.96 0.22 8 0.98 0.10 24 2.93 .32 1—5 years 5 0.61 0.06 1 0.12 0.02 6 0.74 .08 5—5 years 2 0.24 0.03 1 0.12 0.02 3 0.36 .04 15—25 years 3 0.36 0.05 2 0.24 0.03 5 0.60 .08 25—45 years 22 2.68 0.29 21 2.57 0.28 43 5.25 .58 45—65 years 94 11.46 1.26 104 12.68 1.39 198 24.14 2.66 65 years & over 246 30.00 3.32 295 35.98 3.97 541 65.98 7.28 Totals 388 47.31 5.23 432 52.69 5.81 820 100.00 11.04 13 TABLE III. Infantile Mortality 1949. 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 - - - - - - - 1 - 1 6 Diphtheria and Croup 7 Erysipelas 8 Tuberculous Meningitis 9 Abdominal Tuberculosis 10 Other Tuberculous Diseases 11 Meningitis (Not Tuberculous) - - - - - 1 - - - 1 12 Convulsions 13 Laryngitis - - - - - - 1 - - 1 14 Bronchitis 15 Pneumonia - - - - - 1 - - - 1 16 Diarrhoea 17 Enteritis 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 23 Atelectasis 5 - - - 5 - - - - 5 24 Congenital Malformations 2 - - - 2 - - - - 2 25 Premature Birth 7 - - - 7 - - - - 7 26 Atrophy, Debility and Marasmus 27 Other Causes 4 - 1 - 5 - 1 - - 6 Totals 18 - 1 - 19 2 2 1 - 24 14 TABLE IV. Vital Statistics of Whole District during 1949 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 ] 1941 64.890 657 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 3'6 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 3'6 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 1949 74.350 944 12.69 820 11.04 24 25.42 crude 9.49 corrected Comparison of the Rates of Southgate with those of England and Wales, and London, for Year 1949. Rate per 1,000 Total Population. Annual Death Rate per 1.0C0 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 undeT one year. England and Wales 16.7 0.39 11.7 - - 0.01 - 0.15 3.0 32 126 County Boroughs and Great Towns. Including London 18.7 0.47 12.5 - - 0.02. - 0.15 3.8 37 148 Smaller Towns <1931 Census Populations 25,000-50,000) 18.0 0.40 11.6 - - 0.01 - 0.14 2.4 30 18.5 0.37 12.2 - - 0.01 - 0.11 1.7 29 Southgate 12.69 0.28 11.04 - - 0.01 - 0.12 - 24 crude 8.49 corrected - - A dash (—) indicates that there were no deaths. 15 GENERAL PROVISIONS OF HEALTH SERVICES Hospitals.—As noted in the Annual Report for 1948, the administration of hospitals now rests with Regional Hospital Boards. In the case of Southgate, the Borough comes within the area administered by the North West Metropolitan Regional Hospital Board, although facilities are still provided for the admission of cases to the North Middlesex Hospital, which is administered by the North East Metropolitan Regional Hospital Board. From reports received from general practitioners and also from information received in the Public Health Department, it is apparent that difficulty is still being met with in securing admission of cases to hospital. This particularly applies to the chronic sick and to the aged and infirm who are not suffering from any acute or even specific disease. The circumstances surrounding many of these cases are tragic. The valuable services provided by the County Council, e.g. Home Help Service and Home Nursing Service, are, of course, available, but can be regarded only as palliative in this connection. 1 need scarcely point out that the Borough Council has no say in the admission of cases to hospital, other than those of infectious disease. It is none the less very trying for officers of the Public Health Department to be aware of conditions governing the admission of cases to hospital which impose great hardship on individual families but which they have no power to improve. The obvious difficulty lies in the availability of nursing and to a lesser degree, domestic staff. Until this problem is solved it is unlikely that betterment can be expected. The arrangements whereby cases of infectious disease from the Borough are admitted to South Lodge Hospital have worked very well during the year. The medical and nursing attention available at the hospital is of the highest order, and although staffing difficulties at the Hospital have been great, every effort has invariably been made to meet requests for admission. 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 arrangements set out in my Annual Report for 1948 relating to laboratory facilities remain unaltered. As in the past, the Central Public Health Laboratory Service has been of great assistance to us. The setting up of the branch laboratory in Edmonton Town Hall referred to in last year's Annual Report has been an advantage, and has allowed us to maintain more close contact with the bacteriologist and technical staff. 16 As noted elsewhere in this Report, the Laboratory Service co-operated with the School Health Service in the investigation of an outbreak of streptococcal infection in a local school. The Laboratory Service has also assisted in the control of limited outbreaks of infectious disease at the County Council's Day Nurseries situated within the Borough. Summary of work carried out at Central Public Health Laboratories: Positive Negative Swabs for Diphtheria Bacilli — 168 Sputa for Tubercle Bacilli 4 114 The following specimens were also examined: Faeces 89 Urine 22 Blood Ill Others 12 Throat 226 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. During 1949, three cases of scabies were reported. In each case the patients were advised to consult their medical attendant under the National Health Act, and were able themselves to carry out the treatment prescribed by the medical attendant. It was not found necessary to send any families for cleansing during the year in respect of infestation by lice, although the necessary facilities are available should the need arise. It should be noted that details of infestation occurring among school children and dealt with by County Council staff are not included in this report. It will suffice to state that the incidence of infestation amongst children in Southgate is very low, and has shown a decrease over the past few years. NATIONAL ASSISTANCE ACT, 1948 Section 47—Removal to suitable premises of persons in need of care and attention. No action was taken by the Council in 1949 under this Section. 17 Sanitary Services Summary of Visits, 1949 Inspections re complaints received 788 Re-visits in connection therewith 3,241 Visits to Food Premises (including butchers, bakehouses, cafes, restaurants, fishshops and dairies) 1,273 Inspections re Shops Acts, 1912/34 131 Inspections re Factories 365 Visits re housing conditions and overcrowding (applicants for housing accommodation) 560 Visits re Infectious Diseases 959 Visits re Places of Public Entertainment 40 Visits re Rats and Mice Destruction Act, 1919 1,452 Miscellaneous Visits 4,832 13,641 Service of Notices:— Total informal sanitary notices served 585 Total informal dustbin notices served 260 Total informal notices served 845 Total informal notices complied with 1,008 Total statutory notices served 131 Total statutory notices complied with 107 Repairs to Houses:— Considerable work has been carried out by the Sanitary Inspectors during the year in connection with repairs to houses. As in previous years, the Inspectors have found that lack of maintenance work carried out to houses during the war years has necessitated the service upon owners of a substantial number of notices calling for repairs of a major character. Of the 631 intimation notices complied with, no less than 318 required major repairs. The repairs carried out at these houses included the provision of damp-proof courses, extensive rendering of walls to remedy dampness, provision of site concrete, under-pinning of walls, renewal of eaves gutters, and extensive renewal of wall and ceiling plaster. In seven houses it was found necessary to require the taking down and rebuilding on new foundations of one or more main or back addition walls owing to serious settlement. At the remaining 313 houses the repairs were not of such an extensive character, but works had to be carried out in order to abate specific nuisances. It is, I think, worthy of note that, in their efforts to secure the maintenance of a reasonable standard in the condition of houses within the Borough, the Inspectors have, by their 18 appreciation of the difficulties of owners and tenants alike and in the reasonable nature of their requirements, brought about improvements in 631 houses, with the service of only 131 statutory notices. In addition to the above, inspections revealed that the basement rooms of 20 houses were unfit for human habitation and were not capable at reasonable expense of being made so fit. Following consideration of reports on the condition of these basement rooms, the Council made Closing Orders under the Housing Act, 1936, prohibiting the use of the basement rooms for human habitation. Inspections made of three cottages in Church Hill, N.21 revealed that these cottages were in such a condition as to be unfit for human habitation and were not capable at reasonable expense of being rendered so fit. Following consideration of reports submitted on the condition of the cottages, the Council made Demolition Orders in respect of them, under the Housing Act, 1936. The cottages were thereafter demolished by the owners. Housing Applications:— Continuing the work begun in 1945 at the express wish of the Housing Committee, the Sanitary Inspectors visited 560 housing applicants during 1949 and made reports in each case relating to living conditions. As previously, each report contained full details of the number of people living in the house, the manner in which the accommodation was being utilised, the state of health of the applicants, and other relevant facts, together with an indication of the urgency of need for alternative accommodation. The number of visits made in this connection during 1949 compared with 969 visits in 1948. This decrease is, of course, to be expected. I feel, however, that the work has been of real value, and am pleased to record that the close liaison which has existed between the Public Health Department and the Housing Department continues to be maintained and that it serves a useful purpose. Food Hygiene:- During the year, 1,273 visits were made to food premises in the Borough. As a result of these visits, it was found possible to bring about improvements, and generally to encourage a higher standard of food hygiene. The formation of the proposed Food Hygiene Guild in Southgate was postponed because of a variety of circumstances which called for careful consideration. It is fully anticipated that 1950 will see the inauguration of such a Guild within the Borough. Until the Guild is formed, the Public Health Department will continue its previous efforts to maintain and, where necessary, to improve the standard of hygiene in premises and among personnel preparing, handling and distributing foodstuffs. 19 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 364 stone Carcase Meat 754 lbs. Jellied Veal 42 lbs. Rabbits 1,345 lbs. Chicken 1 Canned Corned Beef 133 cans Canned Foods (various) 2,792 cans Cheese 58 lbs. Processed Cheese 205 boxes Cake 82 lbs. Flour 113 lbs. Semolina 75 lbs. Sugar 22 lbs. Cereals 416 packets Seedless Raisins 30 lbs. Currants 56 lbs. Dates 90 packets Eggs 36 Salad Dressing 44 jars Pastes and Pickles 20 jars Sweets 5½ lbs. Post-Mortem Inspection of Animals:— No slaughtering of animals took place in the Borough in 1949. Milk Sampling.—During 1949, 122 samples of milk were obtained and submitted for bacteriological examination. Of these, only three were found to be 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. When 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.—During 1949, 71 samples of ice cream were obtained for bacteriological examination. Of these: 43 were Grade 1 21 „ „ 2 2 „ „ 3 5 „ „ 4 While it is appreciated that these grades 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 20 if only for the reason that it enables the Sanitary Inspectors to concentrate their efforts of improving the standard of manufacture and methods of distribution of those traders whose products show consistently 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. It is worthy of note that the results obtained in 1949 showed a marked improvement on those obtained in 1948. Of 38 samples taken in 1948, 6 were Grade 3 and 18 were Grade 4. Of the 71 samples taken in 1949, only 2 were Grade 3 and 5, Grade 4. Establishments for Massage or Special Treatment. Under the Middlesex County Council Act, 1944, ten existing licences were renewed. Two new Licences were granted. Swimming Bath.—The figures of the attendances at the Barrowell Green Open-Air Swimming Bath for the last two years were as follows: 1949 1948 Mixed Bathers 88,307 46,618 From Schools 9,015 7,505 Season Ticket Holders 12,161 10,709 109,483 64,832 Spectators 5,723 3,347 Costumes, etc., hired 334 298 A system of break-point chlorination was instituted at the Bath during 1949. This has improved the condition of the water, by virtually ensuring a standard of bacteriological purity which even exceeds drinking water. It was at one time feared that the installation of the break-point chlorination system might result in occasional difficulty owing to the somewhat complicated system of operation and the need for the highest accuracy in testing. This has not proved to be the case. The purity of the water is evidenced by the very satisfactory results of the samples taken at regular intervals during the season. These samples are taken at different times during days on which the Bath is being fully used. In each instance the samples have been entirely satisfactory. I would again emphasise the fact that, in our Open Air Swimming Bath, we have at once a valuable amenity and a very practical aid to health. The increasing popularity of our Bath will undoubtedly be reflected in the well-being of the Borough. As hitherto, the Superintendent of the Swimming Bath, Mrs. Barry, and her most efficient staff have co-operated wholeheartedly with the Public Health Department in all matters relating to hygiene. Rivers and Streams.—Very few complaints were received during the year concerning the above. 21 Rats and Mice Destruction Act, 1949. During 1949, 356 complaints of rats and mice were received and dealt with, as against 303 in 1948. In March, 1949, a baiting and poisoning treatment was carried out by the Borough Engineer’s Department in the Council’s soil sewers. 198 manholes were baited. In 48 of these complete or part takes of bait were noted. In September, 1949, test baiting was carried out by the Borough Engineer’s Department to 240 manholes, representing approximately 13 per cent, of the total manholes on the Council's soil sewers. On the results obtained from this test, a baiting and poisoning treatment followed, during which 209 manholes were baited. One hundred and twenty-seven of these showed complete or part takes of bait. All the work done in the sewers was carried out in accordance with the recommendations of the Ministry of Agriculture and Fisheries (Infestation Division). An official of the Ministry visited the district on each occasion, and was given facilities for inspecting the work while in progress. He expressed himself entirely satisfied with the way in which the work was being carried out. Public Conveniences.—Seventeen public conveniences are available in the Borough, situated as follows: Broomfield Park (2). Arnos Park. Bramley Sports Ground. Oak wood 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, N.14. “Crown,” Chase Side, N.I4. “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 Transporl Board at Southgate and Oakwood Underground Stations are also available to the public. 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. 22 Ponds and Rubbish Dumps.—These continue to be kept under observation. During the summer months, spraying was carried out where and when this was considered necessary to prevent breeding. As in 1948, it was found possible to secure improvement in respect of the dumping of rubbish on undeveloped land. Water Supply.—The water supply 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 wells which previously existed having now been discontinued. It was not considered 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 Scammell self-loaders. A weekly collection from all dwelling houses 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 exercise of preventive measures. The total tonnage of refuse collected and dealt with at the Destructor during the year 1949/50 was 16,544 tons. An important factor in connection with house refuse collection is the salvage of various materials. The following table sets out the tonnage sold during the year: tons cwts. qrs. Paper 1,001 18 2 Cullet 28 9 0 Metals 3 0 3 Rags 36 6 1 Carpets and Gunny 28 11 3 Tins 566 10 2 Bottles 26 17 2 Mixed Scrap 66 17 3 1,758 12 0 23 The value of this material amounted to £9,383 17s. Od. 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 Secretary of the Board of Trade states that “the collection of waste paper during 1949 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 1 value their contribution. I want, therefore, to urge all concerned with collecting waste paper to continue and, if possible, increase their efforts.” Residents are requested to bundle their paper and to keep it separate, as special compartments are provided in the vehicles for this material. Kitchen Waste.- During the year, 1,221 tons 7 cwt. 1 qr. of kitchen waste was collected. Under instructions from the Board of Trade, this was sold to the Tottenham Council for £3,511 8s. 4d. This material is collected from every house in the Borough on Monday mornings. FACTORIES ACTS, 1937 and 1948. Details of Work Carried Out During the Year 1949. 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 85 101 11 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 166 264 23 - 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 3 - - - - 3 Total .. 251 365 34 - 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 24 24 - - - 4 Overcrowding (S.2) 5 - - - - - 5 Unreasonable temperature (S.3) 6 1 1 - - - 6 Inadequate ventilation (S.4) 7 2 2 - - - 7 Ineffective drainage of floors (S.6) 8 - - - - - 8 Sanitary Conveniences (S.7) (a) insufficient 9 - - - - - 9 (b) unsuitable or defective 10 9 9 - - - 10 (c) not separate for sexes 11 - - - - - 11 Other offences against the Act (not including offences relating to Outwork) 12 - - - - - 12 Total .. 60 36 36 - - - 60 25 26 OUTWORK—(Sections 110 and 111). Nature of Work. Section 110. No. of prosecutions for failure to supply lists. Section 111. No. of out-workers in August listrequired by Sec. 110 (1) (c) No. Of cases of default in sending lists to the Council. No. of instances of work m unwholesome premises. Notices served. Prosecutions. Wearing Apparel— Making, etc. 104 — — — — — Cleaning and Washing 1 — — — — — Household Linen 1 — — — — — Curtains and Furniture Hangings 1 — — — — — Furniture and Upholstery 1 — — — — — Fur Pulling 3 — — — — — Artificial Flowers 3 — — — — — Paper Bags 1 — — — — — Making of Boxes or other receptacles or parts thereof made wholly or partially of paper 8 - - - - - Brush Making 3 — — — — — Feather Sorting 3 — — — — — Carding, etc., of Buttons, etc. 1 — — — — — Stuffed Toys 4 — — — — — Cosaques, Christmas Crackers, Christmas Stockings, etc. 1 - — — - - Lampshades 2 - - - - - Prevalence and Control of Infectious Diseases From the table of Infectious Diseases set out on page it will be seen that 809 cases of infectious disease were notified during the year, as against 1,156 in 1948 and 887 in 1947. The infectious sickness rate for the district was 11.18, as compared with 15.62 in 1948 and 11.93 in 1947. For some time past it has been more and more apparent that the Infectious Sickness Rate has no real epidemiological significance. This rate is very largely governed by the prevalence of measles in any given area and provides little, if any, indication of the trend of infectious diseases generally. It is interesting to note the change in the infectious diseases picture which has taken place within the last few decades. Although, perhaps, not presenting quite such a dramatic comparison as that between, say, 1849 and 1949, the changes which are taking place are none the less interesting and significant. When I came to Southgate in 1931, diphtheria was a serious disease, taking its toll of life almost every year and presenting what seemed to be a permanent and major problem. Scarlet fever was, on occasion, a serious disease, with crippling sequelae. Admission to hospital had to be arranged in a fairly substantial proportion of measles and pertussis cases, in which bronchopneumonia, otitis media, and other complications were relatively common. Typhoid infections, usually sporadic, occurred at regular intervals; while variola minor (the mild type of smallpox) was prevalent throughout the country, especially in and around London. Today the picture has materially altered. Diphtheria has been eliminated from the list of major infectious diseases which one expects to meet, although, when it does occur, the severity and fatality rates show very little alteration. Scarlet fever, on the other hand, although just as prevalent now as in 1931, is very much less severe. Complications have been materially reduced, while the more serious forms of septic and toxic scarlet fevers are very rarely encountered. Measles and whooping cough have also shown a reduced severity, although, once again, the incidence is very little changed. Variola minor has disappeared, its place being taken by occasional importation of the severe Asiatic form of smallpox. Individual cases of typhoid and paratyphoid fevers are much less common, although outbreaks still occur. Food poisoning outbreaks have increased, almost certainly to a greater degree than improved facilities for diagnosis and methods of recording would explain. Of more immediate significance poliomyelitis, previously 27 a comparatively rare disease in this country, has tended to occur in widespread epidemics over the past few years. A great deal has been written around this change in the infectious diseases picture, but the fact still remains that a full explanation is not yet available. It is, however, very patent that our previous approach to the control of infectious diseases must be overhauled. Basically, we are still dependent on the isolation and adequate treatment of cases, the supervision of contacts, education of the public, immunisation, vaccination and disinfection. To these weapons must be added a more widespread search into the factors which affect the spread of infectious diseases throughout the community. As 1 mentioned in the foreword to this Report, we must also remember that epidemiology should never be confined to a study of infectious diseases. It is just as important, indeed in many ways more important, to uncover the reasons for ill-health as a whole, than to attempt to explain the appearance of specific types of disease. The varying grades of severity which characterise different types of infection and also diseases produced by the same infecting agent, alike await investigation. Control of the spread of scarlet fever is less significant today than is a study of the psycho-somatic group of diseases, of which the gastric and duodenal ulcer is a striking example. To carry the comparison one stage further, the diagnosis and treatment of cardiac conditions following scarlet fever, although still requiring our continued attention, have less significance than the problem as to why so many individuals die in early middle age from coronary thrombosis. The vast field of virus infections also remains to be explored. Today our approach to epidemiology has been virtually revolutionised. We must recognise the expanding horizon which opens out before us and appreciate that a fruitful field is available to the worker in public health who is in daily contact with the local population. Diphtheria.—For the second year in succession, no case of diphtheria was notified in the Borough. It will scarcely be necessary for me to stress the fact that this happy state of affairs is due very largely to the level of immunisation maintained among our children. Our scheme of immunisation, which is now a County Council Service, remains substantially as set out in my Annual Report for 1948. I think it would be reasonable to assume that the success of this scheme is reflected in the absence of diphtheria from the Borough for a period approaching two-and-a-half years. Scarlet Fever.—Scarlet fever notifications during the year fell from 104 to 70. The type of disease continued mild, admission to hospital being necessary in only 17 cases. Scarlet fever was most prevalent during January, May and June, when 10, 15 and 13 cases were notified respectively. No particular portion of the 28 district was specially affected. During the latter part of 1949 the Medical Superintendent of the Isolation Hospital to which cases of infectious disease from the Borough are admitted, called a conference to discuss the acute shortage of beds occasioned by staff difficulties. It was then agreed that the admission of cases of scarlet fever to hospital might have to be curtailed. In actual fact, the recommended policy differed very little from that pursued by the Southgate Borough Council for many years, i.e., that cases of scarlet fever should not be admitted to hospital unless and until the need for such admission had been definitely proved. There was therefore no need to aiter our outlook or procedure, although opportunity was taken to inform general practioners of the acute shortage of available beds and to ask for their co-operation. This has been willingly received. The difficulty in controlling streptococcal infections generally was very well exemplified during the year by a localised outbreak of streptococcal infection at one of our schools (Garfield Road Primary). On May 17th, the Headmistress of Garfield Road Primary School reported that 23 children and four members of the staff were absent with “sore throats,” and that, over a period of several weeks, a further 30 children and seven members of the staff had been absent with the same complaint. At or about the same time, four cases of scarlet fever were notified from the school. The assistance of the Centra] Public Health Laboratory Service was enlisted, and altogether 519 children and members of the staff, including the Canteen staff, were swabbed. Of these, 70 were proved to be carrying haemolytic streptococci. Fifteen children who were heavily infected “carriers” were excluded until after the Whitsun break. Nine of these children were able to return to school early in June. This outbreak is interesting for two reasons. It illustrates the fact that streptococcal infection in a school tends to be polymorphic; thus, the reaction may be (a) an infection of the throat without any rash, (b) scarlet fever, or (c) the setting up of a “carrier” condition, with or without original signs and symptoms. The outbreak also shows the value of early liaison with the Laboratory Service. The assistance afforded by the Public Health Laboratory Service enabled us to trace “carriers” without delay, and to segregate the heavily infected “carriers” until they were no longer a danger to their fellows. In this connection I have asked Head Teachers to inform me as soon as possible whenever any conditions likely to have epidemiological significance appear in a school. This enables us to take the necessary action with the minimum of delay. As speed is essential to success in such cases, the co-operation to which I have referred is a most important factor. Although this is a matter which more intimately concerns the School Health Service, 29 it may be stated here that the co-operation received from Head Teachers has been generous and prompt. Acute Anterior Poliomyelitis.-Four cases of poliomyelitis were reported during 1949. On was an adult aged 41 years, who developed severe paralysis. The remaining three were children. One was described as “abortive poliomyelitis,” recovery being uneventful. The two remaining cases, a child of five and a child of three, were both fatal. Diagnosis was made in each instance following post-mortem examination. It is, of course, not possible to draw any significant conclusions from such a small number of cases. There was no connection between any of the cases, the picture being one of sporadic infection with no obvious correlation. It is, however, of interest that all four attacks occurred in individals in whom resistance, because of general health, background and home conditions, should have been high. This is in keeping with the accepted theory that poliomyelitis tends to attack the well-nourished and members of the higher social strata. It was not considered necessary to take any special steps to safeguard the public against poliomyelitis during 1949, other than informing medical practitioners of the occurrence of individual cases. Measles.—Four hundred and ninety-eight cases of measles were reported during the year, as against 767 in 1948 and 392 in 1947. The type of disease continued mild, admission to hospital being only necessary in a very small number of cases. Pertussis.—Seventy-three cases of pertussis were reported during the year, as against 149 in 1948 and 208 in 1947. This is one of the lowest totals returned in recent years, and continues the decline shown in 1949. It is highly unlikely that this decline will be sustained. The type of disease met with was once mild, very few admissions to hospital being required. The scheme for immunisation against pertussis, either alone or in conjunction with diphtheria, is now undertaken by the County Council. It will suffice to say that the work is being continued and that the fullest possible records are being maintained in the hope that they will prove useful in the future. Food Poisoning.—From the table of infectious diseases notified during the year, it will be seen that only six cases of food poisoning were notified. Although no outbreaks were reported from the Borough during 1949, it is highly improbable that this total represents the incidence of food poisoning over that period. Medical practitioners are reminded from time to time of their responsibilities in this matter, but it is doubtful whether more than 30 a small percentage of cases seek medical advice. All cases reported are fully investigated, information being passed on to other local authorities when their areas seem to be implicated. Puerperal Pyrexia.—Fourteen cases of puerperal pyrexia were notified during the year as against 13 during 1948. Although two maternal deaths occurred during the year, it should be noted that in neither case was the death due to septic causes. Improvements in the technique of midwifery, together with the introduction of modern antibiotics, have considerably reduced the dangers of puerperal pyrexia, particularly as a fatal disease. Tuberculosis.—Tuberculosis notifications rose from 69 in 1948 to 83 in 1949. 1 would once again point out that it would be most unwise to attempt to draw any significant conclusions from these figures. The notifications of tuberculosis received during the year were distributed among the various wards as follows: North East. North West. Middle. South. 24 20 17 22 A broad classification of the cases notified in relation to employment was:— Clerical 24 Domestic Service 5 Food Trades 1 Manual Labour 11 Children 8 Nurse 1 Housewives 10 Armed Forces 2 Factory Workers 6 Unclassified 15 From the tables set out above, it will be noted that the Ward distribution did not reveal any significant features. The comparatively high figures for the North-East Ward are explained by the fact that a number of the cases notified were diagnosed in Highlands Hospital and were not originally residents of Southgate. It will also be noted that the distribution of cases according to type of employment was more or less what one would expect. When it is remembered that comparatively few of the patients were actually employed within the Borough, it would not appear that there is any factor in Southgate associated with local employment which predisposes to tuberculosis. A careful study was made of the home condition of all the cases notified. This investigation showed that overcrowding could not be held responsible for infection in many cases. Only two of the houses from which a 31 case was reported revealed any overcrowding. In five other instances the house concerned was shared by two families; in all other cases living conditions, so far as space was concerned, were entirely adequate. It will thus be seen that no specific factor has emerged which has an obvious bearing on the incidence of tuberculosis. This should not allow us to lose sight of the obvious fact that malnutrition and overcrowding must still be regarded as the greatest obstacles to the eradication of this very serious disease. It is to be hoped that the judicious use of the vaccine BCG will enable contacts to be more adequately protected; a more extensive use of the mass radiography units available would also be of obvious service. NOTIFICATIONS OF INFECTIOUS DISEASE, 1949. Jan.— March. April— June. JulySept. Oct.— Dec. Totals. Enteric Fever - - - - - Diphtheria — — — — - Scarlet Fever 20 37 5 8 70 Paratyphoid Fever — - 1 — 1 Sonne Dysentry — - 3 — 3 Malaria — — — — — Puerperal Pyrexia 6 2 5 1 14 Ophthalmia Neonatorum — — 1 — 1 Erysipelas 7 6 3 5 21 Measles 128 345 22 3 498 Whooping Cough 31 24 7 11 73 Pneumonia 21 9 — 7 37 Cerebro-spinal Fever — — — — — Acute Poliomyelitis — — 4 — 4 Tuberculosis— Pulmonary 23 18 15 20 76 Non-pulmonary 1 2 1 1 5 Food Poisoning — 1 5 — 6 Totals 237 444 72 56 809 32 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. F. M. P. Cases on Register at 1/1/49 240 216 41 47 544 Cases Notified for first time in 1949 49 27 2 3 81 Cases Restored to Register 1 1 — — 2 Other cases added 9 19 1 2 31 Cases Removed from Register 35 37 6 9 87 Cases Remaining on Register at 31/12/49 264 226 38 43 571 TUBERCULOSIS—1949. Age Periods. *New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1-5 years — 2 — — — — 1 — 5-10 years — 2 - - - - - - 10-15 years 2 1 - - - - - - 15-20 years 7 5 — — — 1 — — 20-25 years 9 6 1 3 — 1 — — 25-35 years 8 21 1 2 2 3 — — 35-45 years 14 3 — — 2 3 — — 45-55 years 11 4 — — 2 2 — 1 55-65 years 3 — — — 3 3 — — Over 65 years 4 2 1 - - - - - Total 58 46 3 5 9 13 1 1 33 * These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. Appendix 1 HEALTH EDUCATION The work of health education being carried out within the Borough has been shared between the Borough Council and the Middlesex County Council since 5th July, 1948. This would scarcely be a satisfactory arrangement were it not for the fact that the same medical officer is responsible to both authorities. In point of fact, the joint scheme is working very well. In order to sustain local interest, a most important factor in health publicity, most of the work, especially talks and film shows, is arranged through the Public Health Department. The staff of the Public Health Department also co-operates in the work of health education generally, as it is extremely difficult to separate this segment of preventive medicine into that affecting personal health and that involving environmental hygiene. The general measures of health education adopted during the year have followed broadly along the lines which have, one ventures to claim, proved successful in the past. These might be briefly described as follows: (a) Articles on topical health matters are sent to the local press. Although we have come to accept the co-operation of the local press almost as a foregone conclusion, I cannot speak too highly of the help afforded during the year. Never once has this help been withheld; indeed, the generous response of the press has undoubtedly been one of the greatest single factors in maintaining our programme of health education. (b) Ten talks and fourteen film shows (with or without talks and demonstrations) have been given to local organisations. The film projector and services of the operator have also been loaned on twelve occasions to audiences of Girl Guides, Youth Organisations and the A.R.P. Association. However small the audience, we are always only too glad to take our projector along and show the latest health films available. We intend shortly to repeat our previous approach to local organisations, informing them of the facilities available and inviting their co-operation. (c) The magazine “Better Health” no longer appears as a local Southgate edition. In its place we receive, through the agency of the County Council, 750 copies of the magazine which circulates throughout the country. The copies are distributed through Maternity and Child Welfare Centres, libraries and schools, and are also available in the Town Hall. There is evidence that the magazine is read and appreciated. 34 (d) An exhibition stand was tried out in the Borough during the latter part of 1949. This exhibition stand, which was prepared by the Central Council for Health Education and supplied by the Middlesex County Council, has been placed in various parts of the Borough, the topic being changed from time to time. Thanks are due to the Eastern Electricity Board, Eastern Gas Board and Messrs. Evans and Davies Ltd. for permission to display the stand in their premises. The staff of the Public Health Department co-operates in erecting the stand and arranging for its display as and when required. (e) Health booklets and pamphlets are available in the Area Health Office. It was felt that one display stand of this character in the Town Hall would be sufficient. As the number of members of the public visiting the Area Health Office is considerably greater than that visiting the Public Health Department, the Area Health Office was chosen for this purpose. (f) The health education work being carried out in the schools and through the Maternity and Child Welfare Centres does not properly come within the scope of the work of the Public Health Department. It need only be mentioned here that progress in this field has been sustained, and that the work is expanding. (g) The fourth edition of the Southgate Public Health Services Handbook has been sent to the press and should, it is anticipated, be ready for distribution some time during the early part of 1950. (h) As noted elsewhere in this Report, steps were taken during 1949 to inaugurate a Food Hygiene Guild in Southgate. It is more than ever important to-day that the work of health education be continued. The rapidly expanding social services available to the public must be properly publicised if they are to be of practical use. It is becoming more apparent every day that education of the younger generation in matters affecting health and well-being is the only real and lasting solution to many of the problems at present facing us. Money spent on health education is never wasted; results may not be immediately obvious, but unless the work is misdirected, benefit will most definitely accrue. I am very happy to think that the staff of the Public Health Department has entered wholeheartedly into the work of health education, and that I never fail to secure their willing co-operation in our efforts to effect betterment in this most vital field of preventive medicine. 35 Appendix 2 LETTERS TO DOCTORS The system of sending circular letters to general practitioners from time to time on matters of current interest was continued during the year. The following letters were sent during 1949: 21st Jan. Specialist Services in Patient’s Home—arrangements for consultations in doubtful cases of infectious disease. 24th Jan. Influenza, 1949—Precautionary measures. 1st April Arrangements for collection of Laboratory specimens —Easter Holiday period. 30th May Arrangements for collection of Laboratory specimens —Whitsun period. 4th July Acute Anterior Poliomyelitis—services available. 21st July Arrangements for collection of Laboratory specimens —August Bank Holiday. 6th Sept. “Poliomyelitis—Diagnosis and Management”— suggested local showing of film. 27th Sept. Arrangemments for showing of above film and invitation to be present. 28th Nov. Corrections to Telephone Directory, relating, inter alia, to South Lodge Hospital. 2nd Dec. Scarlet Fever—cases for admission to hospital. 13th Dec. Arrangements for collection of Laboratory specimens —Christmas Holiday period. Palmers Green “Gazette Printery,”Aldermans Hill, Palmers Green.