Middx AC 493(1) SOUTHGATE BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Ofiicer of Health for the Year 1950 Wm. CLUNIE HARVEY, m.d.. d.p.h. Medical Officer of Health SOUG -35 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1950 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 1950. The form which this year's Annual Report has to take is virtually the same as that for 1949. Thus, information relating to vital statistics affecting the Borough are contained in the body of the Report, and are referred to in an uncritical manner. Although the personal health services are not the direct concern of the Borough Council, it would be quite impossible to present a composite picture of the health of the district without including this information and linking it up with environmental hygiene. In point of fact, the vital statistics for 1950 were satisfactory, and would seem to indicate that the health of the community has been maintained at what could be described as a reasonable level. The position in regard to infectious diseases was also satisfactory, apart from the fact that gastro-intestinal infections were more prevalent in Southgate than has been the case for many years. These matters will be referred to in greater detail in the body of the Report. Although the health of the district, as evidenced by the relevant vital statistics and by the returns relating to infectious disease, gives no cause for alarm, we cannot blind ourselves to the fact that conditions do exist which are prejudicial to health. The degree of overcrowding known to be present in the Borough, 3 although perhaps less than in the majority of districts of comparable size, is still greater than would have been tolerated before the war. Equally although the number of houses which would have been scheduled for demolition in more normal times is certainly not great, we again have to accept conditions as they are today and temporise with a practical policy which does not make excessive or unreasonable demands upon the housing situation. No Medical Officer of Health, especially one who has worked in a district as long as I have in Southgate, can accept such a situation with equanimity. A counsel of perfection may be a Utopian dream, yet it still remains the goal, however distant, to which we must aspire. I need scarcely point out that the Public Health Department staff, especially the Sanitary Inspectors, are doing their very best under difficult conditions, to safeguard the health of the community. The fact that difficulties seem to increase year by year, as problems become more acute, has in no way daunted their enthusiasm. Indeed, it has spurred them to greater efforts, since we all realise only too well how much the future may depend upon our present vigilance. As I mentioned in the Annual Report for 1949, the results of the Public Health activities still left with Borough Councils are never so immediately apparent as is the case with the personal health services, except insofar as the control of infectious disease is concerned. None the less, it has become more and more obvious that neglect of the environmental health services strikes at the very roots of public welfare. It is surely illogical to provide a complete and costly service for attending to mothers, infants and school children while still permitting the continuance of conditions in the home, the place of work, and even in the school which prejudice health. It is even more illogical to spend vast sums of money in attempting to cure conditions which might never have occurred if the basic principles of preventive medicine had been allowed to operate. It might be too much to say that every patient admitted to hospital represents an individual breakdown in the public health system. Even if this is an exaggeration, it remains a fact that too much time and money are being expended on patching up instead of providing sound adequate safeguards. For all those reasons, the public health activities of the Borough Council are of truly vital significance. We have all-toolittle control over those aspects of preventive and curative medicine sponsored by other authorities. Time may effect improvement in this direction, but meantime, it is essential that we continue our present efforts to safeguard the future health of the Borough by such means as remain at our disposal. It has been a source of considerable personal satisfaction to me to realise that the Public Health Committee has always 4 ciated the magnitude and ramifications of the task which lies before us, and that it has given the staff unstinted and continuous encouragement in their efforts. This encouragement has been of great help to the staff of the Public Health Department. We have always known that we have had the Committee behind us, and that any measure we ventured to suggest would receive full and sympathetic consideration. Before concluding this introduction, there is one other topic which I should like particularly to mention. This concerns research and investigation. A great deal has been talked and written of late about the work which can be carried out by Public Health Departments in the field of research. No one will deny that research is vitally important to progress; no one will deny that much valuable information has been gleaned by workers in comparatively restricted fields of public health. The difficulties which beset the Public Health Department of a Borough such as Southgate under existing conditions do not always seem to be so clearly appreciated. The National Health Service has scarcely recovered from its birth pangs, let alone its teething troubles. Too often, we cannot quite see the wood for the trees. Also, although many functions have been removed from Borough Councils, depleted Public Health Department staffs are still finding it difficult to cope adequately with the duties which remain. I should personally like very much to be able to devote sufficient time to research in the field of environmental hygiene and epidemiology, with the co-operation of those members of the Public Health Department staff who are well qualified to help. The time may come, one hopes that it will come, when this will be possible. In the meantime, we continue our routine duties, collecting data and information which may be of very great use in the future. Altogether, as I have tried to indicate, this is not a particularly easy time for the staff of a Public Health Department. Transitional periods never are; this is no exception. We appreciate, however, that we must accept the situation as it is. Knocking one's head against a brick wall is neither a pleasant nor a profitable pastime. We know only too well what could and should be done, and await the day with patience if limited optimism, when the fundamentally important part to be played by environmental hygiene will be fully appreciated. I should like once again to express my very sincere thanks to the members of the Borough Council, and especially to the members of the Public Health Committee, for their support, support to which I have already alluded. I should also like to thank the staff of the Public Health Department who, as always, have contributed loyally to the work of the Department. In this connection 5 I would particularly mention Mr. A. E. Gooday, Chief Sanitary Inspector. Mr. Gooday has been of the greatest assistance to me at all times; I am happy to be able to pay this tribute to his zeal and efficiency. 1 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, 1950 Alderman G. Peverett (Chairman) Councillor H. S. Beardow Councillor C. F. Lintott Councillor S. C. Jenner Councillor Mrs. C. T. McConnell Councillor R. Prior (Vice-Chairman) Councillor Mrs. R. Winston From 23rd May to 31st December, 1950 Alderman G. Peverett (Chairman) Councillor H. S. Beardow Councillor Mrs. D. M. Deacock Councillor S. C. Jenner Councillor C. F. Lintott Councillor Mrs. C. T. McConnell Councillor R. Prior (Vice-Chairman) PUBLIC HEALTH STAFF Medical Officer of Health: W. C. Harvey, M.D., Ch.B., D.P.H. * Chief 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): 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., Cert.R.San.I. Meat Inspection. Senior Typist: Miss E. W. Barratt. Clerk: Miss E. A. Montague. Junior Clerk: Miss R. J. Bonnett (resigned 6th October, 1950). Junior Clerk: Miss J. E. Bryan (appointed 23rd October, 1950). General Assistant: B. Latter. Driver: J. L. Arnold. 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, 1950 74,180 Number of Inhabited Houses (end of 1950) according to Rate Books 21,766 Rateable Value (1950) £928,436 Sum represented by a penny rate (1950) £3,790 The social conditions applying in the Borough show no material difference from those of the past few years. Attention has already been drawn to the need for safeguarding health through the medium of environmental hygiene. There can be little doubt that the general character of the district, particularly its over-all planning and generous provision of open spaces have contributed materially and are still contributing to the welfare of the inhabitants. The Borough can properly be described as a dormitory area, with the specified minor problems and absence of major problems associated with factories, peculiar to this type of district. EXTRACTS FROM VITAL STATISTICS OF THE YEAR Male Female Total Live Births Legitimate Illegitimate 453 13 372 22 825 35 466 394 860 Birth Rate per 1,000 of the estimated population 11.46 Still Births Legitimate 7 5 12 Illegitimate — — — 7 5 12 Rate per 1,000 (live and still) births 13.76 8 Deaths from causes and at all ages 868 Death Rate per 1,000 of the estimated population 10.06 Deaths from puerperal causes: Rate per 1,000 total 'live and still) Deaths births From puerperal sepsis 0 0 From other causes 0 0 0 0 Deaths of Infants under 1 year of age: Male Female Total Legitimate 14 2 16 Illegitimate 1 3 4 15 5 20 Infant Death Rate: All infants per 1,000 births 23.25 Legitimate—per 1,000 legitimate live births 19.39 Illegitimate—per 1,000 illegitimate live births 114.28 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 POPULATION The Registrar General estimated the civilian population of the Borough at the middle of 1950 to be 74,180, a decrease of 170 as compared with 1949. BIRTHS—BIRTH RATE The nett total births accredited to the district was 860, a decrease of 84 on the preceding year. Of these, 466 were males and 394 females (13 males and 22 females being illegitimate). The birth-rate for the vear was 11.46 per 1,000 of the population. The birth-rate for England-Wales for 1950 was 15.8, and for the administrative County of London, 17.8. 9 The births and birth-rates for the past five years were is follows: No. of Births Birth-Rates Southgate England & Wales London 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 1950 860 11.46 15.8 17.8 During 1950, the number of births recorded was 8 less than the number of deaths, as compared with 123 more births than deaths in 1949. The total number of births actually registered in the district during the year amounted to 531, of which three were unnotified. The percentage of births notified was therefore 99.43 as compared with 100 in 1949. MORTALITY General Mortality and Death-rate.—The nett number of deaths accredited to this district was 868. 48 more than in 1949. This gives a crude death-rate of 11.70 per 1,000 of the population and a corrected death-rate of 10.06 (rate for 1949—11.04). No. of Deaths Death-Rates Southgate England & Wales London 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 1950 868 10.06 11.6 11.8 Infant Mortality.—There were 20 deaths of infants under I year of age, which gives an infantile death-rate of 23.25 per 1,000 births, as compared with 24 deaths and a rate of 25.42 in the preceding year. The corresponding rates for England and Wales and London were 29.8 and 26.3 respectively. 10 The infant deaths and rates for the past five years were as follows: No. of Deaths Infantile Death-Rates Southgate England & Wales London 1946 36 29.68 43 41 1947 41 32.90 41 37 1948 23 22.68 34 31 1949 24 25.42 32 29 1950 20 23.25 29.8 26.3 The infant mortality rate for 1950 (23.25) is the second lowest rate recorded in Southgate. Stillbirths.—12 stillbirths (0 illegitimate) were accredited to the district for 1950. This is equal to a death-rate of 13.76 (live and still births) the corresponding figures for 1949 being 21 stillbirths, with a rate of 21.76. The rate per 1,000 of the population was 0.162, the rates for England and Wales and London being 0.37 and 0.36 respectively for 1950. The average rate for the past ten years was 22.87. The stillbirth-rate for 1950 (13.76) is the lowest rate yet recorded in Southgate. Maternal Mortality.—No deaths which were attributable to causes connected with childbirth occurred during 1950. This is the third occasion in recent years when no deaths in this category have been recorded in Southgate, the two previous years being 1947 and 1948. In 1949 two deaths occurred giving a rate per 1,000 births (live and still) of 2.07. Mortality of Toddlers. -Six deaths occurred amongst children of the age group 1-5 years during 1950. This represents a deathrate of 0.07 per 1,000 of the population, and 0.69 per cent of the total deaths for the year at all ages. In 1949 there were six deathsgiving a death-rate of 0.08 and a percentage of 0.73. Mortality of Persons over the Age of 65.—Six hundred and eighteen or 71.19 per cent of the total deaths during the year occurred in persons over the age of 65. Of these, 207 died between the ages of 80 and 90, while a further 29 were over the latter age (7 males the oldest being 94, and 22 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. 11 TABLE I. Causes of Death During the Year 1950. Causes of Death Male Female Total All causes (Civilian only). 435 433 868 1 Tuberculosis, respiratory 12 10 22 2 Tuberculosis, other — — — 3 Syphilitic disease 2 — 2 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — 1 1 7 Acute Poliomyelitis 1 — 1 8 Measels — — - 9 Other infective and parasitic diseases 1 3 4 10 Malignant Neoplasm, stomach 8 13 21 11 Malignant Neoplasm, lung, bronchus 16 1 17 12 Malignant Neoplasm, breast — 18 18 13 Malignant Neoplasm, uterus — 5 5 11 Other malignant and lymphatic neoplasms 45 44 89 15 Leukaemia, aleukaemia — 3 3 16 Diabetes 1 3 4 17 Vascular Lesions of nervous system 43 72 115 18 Coronary disease, angina 95 41 136 19 Hypertension with heart disease 15 18 33 20 Other Heart diseases 55 79 134 21 Other circulatory disease 20 19 39 22 Influenza — 2 2 23 Pneumonia 19 12 31 24 Bronchitis 27 16 43 25 Other diseases of respiratory system 4 4 8 26 Ulcer of Stomach and Duodenum 8 3 11 27 Gastritis, Enteritis and Diarrhoea — 3 3 28 Nephritis and Nephrosis 4 6 10 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, Childbirth, Abortion — — — 31 Congenital malformations 3 3 6 32 Other defined and ill-defined diseases 34 36 70 33 Motor Vehicle Accidents 4 3 7 34 All other accidents 9 10 19 35 Suicide 4 4 8 36. Homicicide and operation of war - 1 1 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. 1950 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 1.84 0.19 4 0.46 0.05 20 2.30 0.24 1—5 years 2 0.23 0.02 4 0.46 0.05 6 0.69 0.07 5—15 years 2 0.23 0.02 — - - 2 0.23 0.02 15—25 years 3 0.35 0.03 6 0.69 0.08 9 1.04 0.11 25—45 years 9 1.04 0.11 24 2.77 0.27 33 3.81 0.38 45—65 years 101 11.64 1.17 79 9.10 0.91 180 20.74 2.08 65 years and over 302 34.78 3.50 316 36.41 3.66 618 71.19 7.16 Totals 435 50.11 5.04 433 49.89 5.02 868 100.00 10.06 13 TABLE III. Infantile Mortality 1950. 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 Tuberculoid) - - - - - 1 - - - 1 12 Convulsions 13 Laryngitis 14 Bronchitis — - - - - - 2 - - 2 15 Pneumonia 2 - - - 2 - 1 - - 3 16 Diarrhoea 17 Enteritis 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 1 - - - 1 - - - - 1 23 Atelectasis 2 - - - 2 - — - - 2 24 Congenital Malformations 1 - - - 1 - - - - 1 25 Premature Birth 5 - - - 5 - - - - 5 26 Atrophy, Debility and Marasmus 27 Other Causes 3 - - - 3 1 1 - - 5 Totals 14 — — — 14 2 4 — — 20 14 TABLE IV. Vital Statistics of Whole District during 1950 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. 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 1949 74,350 944 12.69 820 11.04 24 25.42 1950 74,180 860 11.46 868 11.70 crude 10.06 corrccted 20 23.25 Comparison of the Rates of Southgate with those of England and Wales, and London, for Year 1950. Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population Rate per 1,000 Live Births. Live BiTths. Still Births. All Causes. Whooping Cough Diphtheria. Influenza. Total Deaths under one year. England and Wales 15.8 0.37 11.6 0.01 0.00 0.10 20.9 126 County Boroughs and Great Towns, including London 17.6 0.45 12.3 0.01 0.00 0.09 33.8 148 Smaller Towns (1931 Census Populations 25,000-30,0001 16.7 0.38 11.6 0.01 0.00 0.10 29.4 London 17.8 0.36 11.8 0.01 0.00 0.07 26.3 Southgate 11.46 0.16 11.70 crude 10.06 corrected 0.00 0.00 0.003 20 15 GENERAL PROVISIONS OF HEALTH SERVICES Hospitals.—As noted in the Annual Report for 1949, 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 admission of cases to the North Middlesex Hospital, which is administered by the North-East Metropolitan Regional Hospital Board. The most clamant need so far as hospitalisation is concerned would appear to be the case of the chronic, elderly sick. Scarcely a week passes but the needs of chronic, elderly sick persons, for whom a hospital or institutional need is not available, are brought to our notice. Many of those cases are tragic. As a local sanitary authority we are only able to act in circumstances where individuals are in obvious need of admission to an institution, because they are a danger either to themselves or to others, and where the individual concerned has refused to leave home. In such cases an order has to be obtained from a magistrate directing removal to hospital. It was not found necessary to take any such action during 1950. The large mass of chronic sick would be only too willing to enter an institution where they would be guaranteed that care and attention which cannot be adequately obtained at home. Unfortunately we have no jurisdiction over such admissions, which can only be arranged by the family doctor, in consultation with the hospitals or institutions concerned. The County Council can, of course, provide nursing facilities in the home, and can also arrange for the provision of a domestic help. As I have mentioned before, these arrangements are merely palliative, and can at best be regarded as expedients, at least so far as patients who ought to be in hospital are concerned. As I write this report, I have been informed that the local Division of the British Medical Association is making arrangements for a conference to be held, at which the urgent need for making more adequate arrangements to deal with chronic sick will be discussed. This approach is welcomed. One can only hope, roost sincerely hope, that the conference will effect some practical improvement, even if the result does not provide a complete solution to what is an obvious and urgent problem. It is pleasing to be able to report that admission of maternity cases to hospital is now easier than has been the case for the past few years. It is equally satisfactory to be able to state that the arrangements whereby cases of infectious disease from the Borough are admitted to South Lodge Hospital have continued to work very well indeed during the year. Although staffing difficulties at this hospital have been none too easy, every effort has invariably been made to meet our requests for admission. 16 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 Reports for 1948 and 1949, relating to laboratory facilities, remain unaltered. The Central Public Health Laboratory Service continues to provide generous and expert assistance. Requests for assistance are always willingly met, either from the branch laboratory situated in Edmonton Town Hall, or from the Central Public Health Laboratory at Colindale. This assistance was of particular value in connection with the outbreak of Sonne dysentery, to which reference will be made later in the Report. The cordial co-operation which exists between the Laboratory Service and the Public Health Department is undoubtedly a potent factor maintaining the local Public Health services. I should like to take this opportunity of thanking all those concerned for the help afforded throughout the year. It is a source of great satisfaction to know that the laboratory is behind us, ready and willing at all times to answer any queries or to provide practical assistance. Summary of work carried out at Central Public Health Laboratories for the year 1950: Positive Negative Swabs for Diphtheria Bacilli — 141 Sputa for Tubercle Bacilli — 79 The following specimens were also examined: Throat and Nose 449 Faeces 698 Urine 49 Blood 56 Others 35 Scabies and Lice.—In November, 1950, a letter was received from Ihe Medical Officer of Health of Hornsey stating that cases of scabies could no longer be accepted at the Hornsey Cleansing Station, as there was no nursing staff to undertake the work. This concluded an arrangement which had obtained since 1946, whereby severe and recurring cases of scabies could be sent to the Hornsey Disinfestation Centre for treatment. Actually the number of such cases reported remains very small. Treatment can normally be carried out by the patients themselves, under the guidance of their medical attendants. 17 One case of scabies was reported in 1950; the patient was a hospital nurse living in lodgings who was anxious to obtain treatment at a disinfestation centre. In this case, arrangements were made with the Medical Officer of Health of Edmonton to undertake the necessary treatment. No difficulty is expected to arise in future cases. The courtesy of neighbouring authorities, e.g., Enfield or Edmonton, could undoubtedly be relied upon in the very few instances in which help might be required. 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 among 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 As noted on page 16, no action was taken by the Council in 1950 under this section. 18 Sanitary Services Summary of Visits, 1950:— Inspections re complaints received 856 Re-visits in connection therewith 3,996 Visits to Food Premises (including butchers, bakehouses, cafes, restaurants, fish shops and dairies) 1,610 Inspections re Shop Acts, 1912/34 214 Inspections re Factories 365 Visits re housing conditions and overcrowding (applicants for housing accommodation) 261 Visits re Infectious Diseases 2,157 Visits re Places of Public Entertainment 40 Visits re Rats and Mice Destruction Act, 1919 1,576 Miscellaneous Visits 4,744 15,819 Service of Notices:— Total informal sanitary notices served 488 Total informal dustbin notices served 208 Total informal notices served 696 Total informal notices complied with 771 Total statutory notices served 103 Total statutory notices complied with 113 Repairs to Houses:— Information as to housing defects continues to come to the Sanitary Inspectors mainly as a result of complaints by occupiers. During the year under review, repairs were carried out at 510 houses following inspections and service of notices by the Inspectors. In 103 instances it was found necessary to follow up Intimation Notices with the service of Statutory Notices under the Public Health Act, 1936, or Housing Acts, 1936/49, in order to secure execution of the necessary repairs. In the case of four houses, legal proceedings had to be instituted by the Council against the owners to enforce compliance with Statutory Notices. In each instance a Court Order was obtained, with costs against the owner. The repairs were subsequently executed by the owners. Following service upon the owners of Statutory Notices under Section 9, Housing Act, 1936, 19 repairs to two houses were carried out by the Council in default of the owners, from whom the cost of the works was subsequentlyrecovered. Of the 510 notices complied with, the repairs required were of a major character in 249 cases. These repairs included such works as the provision of damp-proof courses, provision of site concrete, under-pinning of walls, renewal of eaves gutters, and rainwater pipes, renewal or extensive repair of flooring, renewal of windows, extensive renewal of wall and ceiling plaster, and renewal of external paintwork. At the remaining 261 houses the repairs were not of such an extensive character. No demolition or closing orders under the Housing Acts, 1936/49, were made by the Council in 1950. Reports were made to the Council as to the condition of two houses in Springfield Road, N.11, and one house in Chase Road, N.14. These cases were still under consideration at the close of the year. Housing Applications:— The task of visiting housing applicants and the preparation of reports in such cases as to living conditions has continued in 1950. The number of visits made by Sanitary Inspectors during the year was 261, as against 560 in 1949 and 969 in 1948. The decrease in the number of these visits is to be expected. I feel, certain, however, that the work has been of value to the Housing Committee. I am pleased once again to record that the close liaison existing between the Public Health Department and the Housing Department has been maintained. Food Hygiene:— During the year, 1,610 visits were made to food premises in the Borough, as against 1,273 in 1949. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. Late in 1949, the Council adopted Byelaws with respect to the handling wrapping and delivery of food, and the sale of food in the open. These Byelaws have been adopted by the majority of Local Authorities throughout the country. They undoubtedly provide a useful instrument designed to improve the standard of food hygiene. In Southgate, it was not found necessary during 1950 to take action against any food trader under the Byelaws. Much was, however, done by the Sanitary Inspectors in the encouragement of traders to carry out the provisions of the Byelaws without recourse to the Byelaws themselves. As already noted, 1,610 visits were made to food premises in the Borough during the year. Although this total may appear 20 reasonable, I am still of the opinion that more could be done in this direction. Visits to food premises fulfil a very useful purpose. It is not only possible during such visits to discover defects and to suggest the appropriate remedy; what is much more significant, opportunity is afforded for the tendering of advice on a variety of subjects associated with clean food, all of which are of vital importance to the community at large. The Sanitary Inspector who visits food premises does so in a dual capacity. He has the duty of ensuring that statutory requirements are being strictly observed. He must also make his visits as a counsellor, approaching the proprietors and staffs in a friendly manner and offering such help and guidance as may be required. This latter approach has always received due prominence in Southgate, and I know that the Sanitary Inspectors make the fullest possible use of the opportunities so afforded. When I say that more work could be done in the way of inspection of food premises, particularly in regard to the matter of advice and guidance, I am not suggesting that the Sanitary Inspectors have been in any way lacking in their duties. That is very far from being the case. I do suggest, however, that the time has arrived to consider the amount of time to be allocated to food hygiene and clean food, in relation to the other duties covered by the Sanitary Inspectors. In America, for instance, special officers are appointed to carry out the important duties relating to clean food. It may be a coincidence that the standard of cleanliness in regard to food handling and distribution in the United States is particularly high; but one cannot help feeling that the amount of time devoted to this subject has had a definite bearing on the results achieved. I would personally like to see such an officer appointed in Southgate or, if this is not possible, more time being available to the Sanitary Inspectors to undertake duties in relation to clean food. If, for instance, the Chief Sanitary Inspector were relieved of district duties, he could devote a substantial portion of his time to work in connection with food hygiene. I put this forward as a suggestion for future consideration, in the sincere conviction that the results would fully justify the expenditure involved. In my Annual Report for 1949, I stated that the following year should see the inauguration of a Hygienic Food Traders' Guild in Southgate. Unfortunately, due to circumstances over which the Borough Council had no control, progress has not been quite so rapid as one had hoped. Steps have certainly been taken to inaugurate a local Hygienic Food Traders' Guild, but that Guild is not yet in active operation. From information recently received, however, it is fully anticipated that progress will be speeded up, and that the Southgate Hygienic Food Traders' Guild will be an established, operative body within the next few months. 21 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 52 stone Carcase Meat 610 lbs. Sausages 29 lbs. Cooked Ham 24 lbs. Rabbits 115 lbs. Poultry 29 lbs. Canned Corned Beef 478 lbs. Canned Corned Mutton 18 lbs. Canned Foods (various). 1,471 cans Butter 24 lbs. Cheese 16 lbs. Processed Cheese 5 packets Cake Flour 148 packets Flour 61 lbs. Sago 17 lbs. Sugar 14 lbs. Cereals 161 packets Dried Fruit 66 lbs. Jams 84 jars Christmas Puddings 252 lbs. Soup Powder 175 packets Salad Dressing 36 bottles Pastes and Pickles 55 jars Sweets 9J lbs. Post-Mortem Inspection of Animals:— No slaughtering of animals took place in the Borough during 1950. Milk Regulations and Milk Sampling.—During 1950, 88 samples of milk, as against 122 in 1949, were obtained and submitted for bacteriological examination. The smaller number of samples taken was due to the fact that the Public Health Laboratory at Edmonton was unable to deal with any samples during November and December owing to work in connection with infectious diseases. Of the 88 samples taken, three were found to be unsatisfactory. In these cases, investigation was made with a view to tracing the cause of the unsatisfactory result. Subsequent samples proved satisfactory. Although it has not yet been necessary to take legal action in connection with unsatisfactory samples of milk, there can be little doubt that the sampling of milk consumed within the Borough 22 is a wise measure. It proves to producers, retailers and public alike that the Borough Council is fully alive to the importance of a clean, safe milk supply. It also brings possible faults to the notice of those concerned, and affords an opportunity of investigating the source of the fault and effecting the necessary remedy. In almost every instance, we have found that milk producers and distributors are only too willing to co-operate in correcting existing faults, and that they are grateful for the advice supplied by the Sanitary Inspectors. As I have stated many times before, much better results can be expected from this type of co-operation than from more rigorous action through existing legal machinery. Ice Cream Sampling.—During 1950, 104 samples of ice cream, as against 71 in 1949, were obtained for bacteriological examination. Of these: 46 were Grade 1 20 „ „ 2 22 „ „ 3 16 „ „ 4 As with milk, the routine sampling of ice cream fulfils a very useful purpose. On numerous occasions we have been able to point out faults, particularly faults in storage and in the actual sale of ice cream, which have resulted in better grading of subsequent samples. It should also be remembered that the visiting of premises for the purpose of taking samples of ice cream affords the Sanitary Inspectors an opportunity for health education and practical demonstration. It is becoming more and more obvious that this work represents perhaps the most important aspect of the control and supervision of what is becoming virtually a stable article of diet. Establishments for Massage or Special Treatment.—Under the Middlesex County Council Act, twelve existing licences were renewed. Swimming Bath.—The figures of attendances at the Barrowell Green Open Air Swimming Bath for the last two years were as follows:— 1950 1949 Mixed Bathers ... ... ... 55,524 88,307 From Schools ... ... ... 3,271 9,015 Season Ticket Holders ... ... 12,988 12,161 71,783 109,483 Spectators ... ... ... ... 3,806 5,723 Costumes, etc., hired ... ... 210 334 Swimming Bath.—The figures of attendances at the Barrowell Green Open Air Swimming Bath for the last two years were as follows:— 1950 1949 Mixed Bathers 55,524 88,307 From Schools 3,271 9,015 Season Ticket Holders 12,988 12,161 71,783 109,483 Spectators 3,806 5,723 Costumes, etc., hired 210 334 The system of break-point chlorination installed at the Bath during 1949 has proved successful. Samples of water are taken at regular intervals; in all instances, the samples were reported as wholly satisfactory. Indeed, the standard of water in Barrowell Green Swimming Bath is even purer than drinking water, from a bacteriological standpoint. The chlorinating system should be capable of dealing very rapidly with any anticipated form of pollution. Once again, the Superintendent of the Swimming Bath and her staff have co-operated cordially with the Public Health Department in all matters relating to hygiene. This is particularly the case in respect to general cleanliness. It would not be too much to say that Barrowell Green Swimming Bath might be regarded as an example in the matter of the standard of cleanliness maintained in the lavatories, dressing rooms and, indeed, throughout the entire premises. Rivers and Streams.—Very few complaints were received during the year concerning the above. Prevention of Damage by Pests Act, 1949.— During 1950, 406 complaints of rats and mice were received and dealt with, as against 356 in 1949. In March, 1950, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 219 manholes were baited. In 128 of these, complete or part takes of bait were noted. In September, 1950, test baiting was carried out by the Borough Engineer's Department to 274 manholes, representing approximately 15 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 331 manholes were baited. 228 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. Oakwood Park. Grovelands Park. 24 Tottenhall Sports Ground. North Circular Road, Palmers Green. Triangle, Palmers Green. Fords Grove, Winchmore Hill. Southgate Tube Station, N.14. "Cherry Tree" Hotel. "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. 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. Ponds and Rubbish Dumps.—These continue to be kept under observation. During the summer months, spraying was carried out where and when necessary to prevent insect breeding. As in 1949, improvement in respect of the dumping of rubbish on undeveloped land was effected. 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 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 consists of ten Scammel Self-loaders. A weekly collection from all dwelling houses in the Borough is being carried out. The total tonnage of refuse collected and dealt with at the Destructor during the year 1950/51 was 17,740 tons. 25 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 1,089 10 2 Cullet 5 10 0 Metals 2 8 1 Rags 24 0 1 Carpets and Gunny 21 12 1 Tins 639 6 0 Bottles 24 13 0 Mixed Scrap 96 18 0 The value of this material amounted to £10,734 14s. lOd. The machinery at the Destructor is provided with picking tables over which all materials pass. Such items as tins, rags, etc., are removed therefrom. Waste Paper.—The importance of waste paper cannot be stressed too strongly. The Council are making every effort to stimulate a keen interest in the salvaging of all types of paper and cardboard. Sacks are supplied to encourage householders to keep paper separate from other types of salvage and refuse. It is hoped that, with the co-operation of all concerned, the tonnage of paper collected will increase considerably during the coming year. Kitchen Waste.—During the year, 1,010 tons of kitchen waste was collected. Under instructions from the Board of Trade, this was sold to Tottenham Borough Council for £3,028. This material is collected throughout the Borough on Monday mornings. Individual kitchen waste containers are supplied on request by the Borough Engineer. 26 FACTORIES ACTS, 1937 and 1948. Details of Work Carried Out During the Year 1950. 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 69 84 2 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 159 175 6 - 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 3 - - - - 3 Total 228 259 8 — 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 2 2 - - - 4 Overcrowding (S.2) 5 - - - - - 5 Unreasonable temperature (S.3) 6 1 1 - - - 6 Inadequate ventilation (S.4) 7 1 1 - - - 7 Ineffective drainage of floors (S.6) 8 - - - - - 8 Sanitary Conveniences (S.7) (a) insufficient 9 - - - - - 9 (b) unsuitable or defective 10 6 6 - — 10 (c) not separate for sexes 11 - - - - - 11 Other offences against the Act (not including offences relating to Outwork) 12 - - - - - 12 Total 60 10 10 — — — 60 27 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 list required 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. 208 — — — — — Cleaning and Washing 1 — — — — — Curtains and Furniture Hangings 3 — — — — — Furniture and Upholstery 1 — — — — — Fur Pulling 4 — — — — — Artificial Flowers 5 — — — — — Paper Bags 2 — — — — — Making of Boxes or other receptacles or parts thereof made wholly or partially of paper 11 Brush Making 8 — — — — — Feather Sorting 4 — — — — — Carding, etc., of Buttons, etc. 2 — — — — — Stuffed Toys 8 — — — — — Cosaques, Christmas Crackers, Christmas Stockings, etc. 3 _ Lampshades 3 - — — — — Total 263 - — — — 28 Prevalence and Control of Infectious Diseases From the table of infectious diseases set out on page 37 it will be seen that 1.088 cases of infectious disease were notified during the year, as against 809 in 1949. The Infectious Sickness Rate for the district was therefore 14.67, as compared with 11.18 during the previous year. I would once again point out that the Infectious Sickness Rate has no longer any very great practical epidemiological significance, due mainly to the fact that, year by year, measles makes up 50% or more of the total cases notified. The prevalence of measles in a district seems to bear little or no relationship to environmental hygiene, except that overcrowding, both in the home and in schools, can be accepted as playing a part. The remarks relating to infectious diseases set out in the Annual Report for 1949 hold good today. The picture is still changing, and is particularly obscure in regard to virus infections. Until more is known regarding the nature, behaviour, reservoir and mode of spread of viruses, it does not appear that substantial progress can be expected in the fight against such virus infections as poliomyelitis, influenza and even measles. Much work is being done in this field, with particular reference to the reservoir, without which virus infection would presumably cease to operate. We await the results of such investigations with interest, in the knowledge that virus infections now represent the most serious threat to the community in the field of infectious diseases. 1 would again emphasize that modern epidemiology must never be confiined to a study of what we still term the infectious disease. The causes of ill-health and of death, i.e., morbidity and mortality, from whatever source, must be linked into a broad homogeneous pattern. Thus, the comparatively recent and alarming increase in deaths from diseases of the heart and circulation in early and late middle life, presents a major problem to the epidemiologist. The ravages caused by cancer, rheumatism and gastro-intestinal disorders, none of which can be regarded as infectious within the strict meaning of that term, are further epidemiological factors which call for consideration. In a district such as Southgate, it is difficult to place one's finger on any local conditions which could be said to influence the incidence and severity of such diseases, at least to any material extent. So far as diseases of the heart and circulation and such conditions as gastric and duodenal ulcer are concerned, the pace and strain of presentday living are undoubtedly playing a significant part. It is our duty to consider such problems and to try to ascertain whether any local factors might be operating to the disadvantage of the community. 29 In this connection, it must also be remembered that actual disease invariably follows a period during which the physiological functions of the body are disordered. This period of prodromal disorder, which may be long or short, mild or severe, represents the time when action should be taken, if indeed such action should not have been considered before. Factors which influence the beginnings of ill-health, and over which we do have control, include housing, supervision of working conditions and, perhaps even more important, supervision of conditions under which our children are housed in local schools. All this is epidemiology, as that term is now understood. If we remember this fact and act upon it, we may one day be able to apply the brake when and where it is most required. At the moment, as 1 have already stated, it is not easy to pick out local conditions which call for immediate, urgent improvement. We can. however, adopt a policy of education which will indicate such dangers as exist, and suggest the appropriate remedies. This we have always endeavoured to do through our local policy of health education. Diphtheria.-For the third year in succession no case of diphtheria was notified in the Borough. The last case of diphtheria reported in Southgate was notified on 24th February, 1947, while the last death took place in 1943. It will be obvious that this very satisfactory situation is due in great part to immunisation. Remembering this, it has been somewhat perturbing to find that requests for immunisation have been affected by the fact that incidents have been reported in which immunisation has been followed by poliomyelitis, particularly affecting muscles in the area of injection. In this connection it must be clearly understood that such cases have been very few indeed compared with the very large number of injections given in the course of immunisation throughout the country. It should also be stated that, so far as we are aware, and I am quite sure that our information is correct, no case of poliomyelitis following immunisation has occurred in Southgate. Types of immunising material are now available which lessen the risk of such untoward happenings. Our present policy is to keep a close watch on the virus potential known or suspected to be present in and around the Borough. If there is any reason to believe that this is increasing, steps are taken to limit the types of immunisation offered to parents. Thus, the combined immunisation against diphtheria and pertussis, which would appear from available evidence to be most often followed by poliomyelitis, ;s suspended, although it has never been found necessary to suspend immunisation against diphtheria alone. The position is made quite clear to parents, the final decision being left to them. Although it was very right that the attention of all concerned should have been drawn to the possibility of poliomyelitis following 30 immunisation, it is sincerely to be hoped that the publicity given to this matter in the National Press will not affect the level of immunisation to any appreciable extent. This would indeed be a tragedy. As I have already pointed out, the number of cases of poliomyelitis known to have followed immunisation is minute compared with the number of children protected against diphtheria. Should the level of immunisation be allowed to fall below the safety margin, the results might well be catastrophic. We should at all costs maintain a comnionsense outlook towards this problem, reviewing the position in the light of existing circumstances, and not allowing any panic measures to dictate our policy. It will be appreciated that immunisation against diphtheria is a matter for the County Council, acting as local health authority. I felt, however, that the information set out above would be of interest to the Borough Council, as the Council is intimately concerned in the incidence of diphtheria within the Borough and the preventive measures designed to limit spread. Scarlet Fever.—Scarlet fever notifications during 1950 were slightly above the average for the past few years. The increase was almost entirely due to localised outbreaks of scarlet fever which occurred during the latter part of 1950 among children attending Hazelwood Lane School and two private schools, one in Southgate and one in Winchmore Hill. The type of disease met with throughout the year was exceptionally mild. This mildness has almost certainly meant that the total number of cases reported during 1950 is substantially less than the number which, in fact, occurred. We have again been faced with the difficult situation which demands that scarlet fever cases shall be notified, but excludes from notification cases of simple tonsillitis, no matter how severe the infection may be. It is known that cases of tonsillitis without a rash can be just as infectious, in some instances more infectious, than cases in which a rash occurs. So long, however, as the present practice in regard to notification continues, we have no alternative but to operate the existing system of control. The time would appear to have arrived, if, indeed, it has not already passed, when the position of scarlet fever among the notifiable infectious diseases should be reviewed. It is admittedly a fact that the more severe type of scarlet fever may return at any time. Should that happen, more stringent methods of supervision and control would be required. At the moment, however, and for some time past, notifications of cases of the present type of scarlet fever appears to be little more than a waste of time from the point of view of epidemiology. There seems, for instance, to be slender evidence that the exclusion of cases of scarlet fever from school has any appreciable effect on the spread of this disease. 31 In the same connection, disinfection, terminal or otherwise, which is still requested after a case of scarlet fever occurs has now lost most of its significance, except as a psychological placebo. I would like to take this opportunity of once again thanking the Central Public Health Laboratory for the valuable assistance afforded in relation to the outbreak of scarlet fever at Hazelwood Lane School. The following work was carried out by the Laboratory in connection with this outbreak: Number of swabs examined 660 Number of samples of dust, etc., examined 22 Number of children excluded 32 The help afforded by the Central Public Health Laboratory was greatly appreciated. It certainly allowed us to appraise the situation more accurately than would otherwise have been the case. Acute Anterior Poliomyelitis.—Twelve cases of acute anterior poliomyelitis were reported during 1950, as against four in 1949. These cases were made up as follows: Paralytic, 8 (4 children, 4 adults). Non-paralytic, 4 (2 children, 2 adults). The distribution in the various wards was as follows: North-West. North-East. Middle. South. 2 5 4 1 Opportunity was taken during the year to keep general practitioners fully informed regarding the trend of poliomyelitis, while information of a non-sensational nature was supplied to the local Press and also to head teachers, as circumstances demanded. The following statement was circulated to head teachers in September, 1950, so that they could take such steps as appeared desirable to reduce the risk of infection: "Acute Anterior Poliomyelitis.—Four cases of acute anterior poliomyelitis (infantile paralysis) have been notified in Southgate within the past three weeks. One of these cases was "imported," the infection having been contracted elsewhere. A further suspected case was notified this morning. Two of the four definite cases were paralytic, the remaining two were mild and showed no paralysis." "In order to allay any unnecessary anxiety, but at the same time to indicate the simple precautionary measures which should be taken, I prepared the statement which was sent to the local Press. This was published in the current issue of the 'Palmers Green Gazette' and 'Weekly Herald.' 32 "There does not at the moment seem to be any reason to deviate from the policy set out in the article referred to above. "So far as the schools are concerned, may I suggest that the following simple measure of precaution be instituted: "(a) Teachers should be asked to keep a close watch on children, so that any early signs or symptoms which might indicate poliomyelitis can be observed. Such signs and symptoms are very often vague, indicating little more than an ordinary feverish illness, or the early stages of any one of the common infectious diseases. Headache, particularly accompanied by pain and/or stiffness at the back of the neck are particularly associated with the early stages of poliomyelitis, although these indications are not always present. If, at the present time, any child appears definitely under the weather, I think it would be best for them to be sent home with a note advising the parent to consult the family doctor. At a time such as this, it is obviously very much better to have children seen by a doctor even if they are not suffering from any serious disease, rather than miss an early case of poliomyelitis. "I need scarcely say that either myself or a member of my staff will be only too happy to visit any school on request and see a child about whom there is any doubt. Please do not hesitate, therefore, if you wish to call upon us. "(b) Sports and games involving undue exercise to the point of fatigue should be avoided. I am not for a moment suggesting that a physical training programme of any school should be disrupted. I would merely remind head teachers that, if a child is deveoping poliomylitis, exercise, especially if it is prolonged, during the early stages or even during the incubation period, may result in severe paralysis or even death. "(c) It might be well to impress upon the children that paddling or bathing in dirty water, e.g., in the ponds in our various parks, which incidentally were never intended for this purpose, is highly dangerous. Visits to the Open Air Swimming Bath at Barrowell Green, or to the Southgate School of Swimming are to be recommended, as the water in both these Baths is adequately chlorinated. "(d) It will scarcely be necessary for me to point out that scrupulous cleanliness in canteen premises, cloakrooms, lavatories, etc., is an obvious deterent to the spread of poliomyelitis, as is adequate control of flies. I am quite sure that these matters will receive due attention. "I would again emphasize that the staff of the Area Health Office and Public Health Department is always available for advice. Please let us know if there is any way in which you think we can help." 33 I have already stated that, until more information is available as to the nature, behaviour and reservoir of the virus responsible for poliomyelitis, it is not likely that substantial progress will be made. We eagerly await such information, whether it be of a positive or negative character, so that more adequate steps can be taken to safeguard the community. Measles.—Six hundred and twenty-seven cases of measles were notified during the year, as against 498 in 1949. The type of disease continued mild, admission to hospital being only necessary in a very small number of cases. The measles epidemic expected early in 1951 actually arrived during the latter part of 1950. Although the period covered by this epidemic does not strictly come within the purview of this report, it might be stated that the total number of cases notified in Southgate during the past six months has been higher than I can remember. Owing, however, to the very mild character of the disease, we have not been called upon to do much more than receive and tabulate notifications. Pertussis.—One hundred and fifty-four cases of pertussis were reported during 1950, as against 73 in 1949, an increase of just over 100%. Here again, the type of infection was mild, although it should be remembered that pertussis is still one of the most serious diseases of early childhood. For this reason, the advocacy of immunisation against pertussis alone, or against pertussis and diphtheria combined, in children under 12 months, would appear wise. It must be admitted that work is still going on to establish the best type of vaccine to be used for this purpose. 1 am personally convinced, however, that the Borough Council's policy of offering immunisation against pertussis (instituted in 1945), either alone or in conjunction with diphtheria, was a progressive measure, and that it has had beneficial results. The Council will be aware that this work is now carried out by the Middlesex County Council. Food Poisoning.—From the table of infectious diseases notified during the year, it will be seen that 22 cases of acute food poisoning were notified, as against seven in 1949. This increase is almost entirely due to the fact that general practitioners have been notified on several occasions of their duties in this respect. It must still be emphasized that the total almost certainly does not in any way represent the amount of food poisoning which occurred in Southgate during the year. It should also be stated that, apart from the outbreaks of dysentery which occurred, to which further reference will be made, there is no evidence that food poisoning is on the increase in the Borough. At one time during the latter part of the year, we had to contend with simultaneous outbreaks of Sonne dysentery in the New Southgate area and Flexner dysentery in Winchmore Hill. 34 During the same period a case of typhoid fever was notified from Winchmore Hill. Apart from the fact that two outbreaks of dysentery were occurring at the same time, it is interesting to note that the occurrence of a case of typhoid fever is now considered an event in the health history of any area. This is gratifying, and shows the advances which have been made in at least one field of preventive medicine. Full particulars relating to the outbreaks of Sonne and Flexner dysentery are set out in Appendix 2 to this Report. These outbreaks placed quite a heavy burden on the shoulders of the Sanitary Inspectors, who had many extra visits to make, especially for the purpose of collecting the necessary bacteriological specimens. These extra duties were accepted willingly, and proved that the Sanitary Inspectors were well able to deal with this type of situation. As this was the first time since the coming into force of the National Health Service Act, 1946, that we had a chance of trying out the new system, in which the Sanitary Inspector plays such an important part, it was particularly pleasing to note that the system worked. I would like to take this opportunity of thanking the Sanitary Inspectors for a very tine job of work. I would also thank the Health Visitors working in this part of Area No. 2 for the valuable co-operation which they invariably provided. For at least the past twelve months, Sonne dysentery has been unusually prevalent, not only in London but throughout most of the country. Apart from the New Southgate outbreak, a substantial number of cases were reported from Southgate, Enfield West, and to a lesser extent, Winchmore Hill. Although most of these cases occurred during the early part of 1951, they are obviously linked to the outbreak which began in the New Southgate area. It is, of course, impossible to state how far the very stringent methods of control which we adopted affected the future of the New Southgate outbreak. I am reasonably satisfied, however, that the measures undertaken were fully justified, and that although, as I have already stated, they placed a very heavy burden on the shoulders of the Public Health Department, our system of investigation and control had the anticipated effect. Present evidence tends to show that the high incidence of Sonne dysentery has passed. Puerperal Pyrexia.—Five cases of puerperal pyrexia were notified during the year, as against 14 in 1949. It is pleasing to be able to report that no maternal deaths occurred during the year. Tuberculosis.—Sixty-seven cases of tuberculosis (64 pulmonary, 3 non-pulmonary) were notified during 1950, as against 81 in 1949, The distribution of the cases notified among the various wards during the year was as follows: North-East. North-West. South. Middle. 18 16 17 16 35 A broad classification of the cases notified during the past three years in relation to employment was: 1948 1949 1950 Clerical 10 24 15 Housewives 16 10 12 Children 9 8 4 Manual Labour 6 11 8 Factory Workers 6 6 2 Professional Classes 6 — 3 Armed Forces 4 2 2 Domestic Service 2 5 1 Food Trades 1 1 2 Students — — 4 Shop Assistants — — 3 Nurses — 1 — Unclassified 9 15 11 TOTALS 69 83 67 It would be quite misleading to attempt to draw any very definite conclusions from the tables set out above. It might nonethe-less be noted that the number of housewives notified each year as suffering from tuberculosis is relatively high. It might also be noted that the incidence of tuberculosis among workers in the food trades is low, while this disease does not particularly tend to single out manual or factory workers. So far as Southgate is concerned, of course, this latter incidence may be specifically influenced by the fact that the proportion of such workers among the local population is not as high as in many other areas. It is pleasing to note that the number of new cases of tuberculosis reported among children has fallen each year since 1948. I would again emphasize that, while these figures may be interesting, the number of cases and the period covered are not such as to warrant significant conclusions being drawn. There is little to add to the comments made in the Annual Report for 1949. There is no evidence of any specific local factors which have a direct bearing on the incidence of tuberculosis within the Borough. As I mentioned last year, however, we must still remember that malnutrition and overcrowding must always be considered in relation to tuberculosis. This is a field in which environmental hygiene plays a most important part. Tuberculosis has been well described as a social disease. Each case can be said to represent a definite flaw in our defensive system. Until proper emphasis is laid on prevention rather than cure, too much energy will still continue to be expended in what are, at best, palliative measures. No one would deny that the treatment facilities available to patients suffering from tuberculosis must be of the highest order, and that they must be adequate to meet all reasonable 36 needs. It will be equally obvious that a reduction in the number of cases of tuberculosis, brought about by the removal of conditions which predispose to the spread of infection and disease, represents a much more acceptable and logical programme. Arrangements have been made whereby Southgate schools will take part in the Clinical Trials in respect of B.C.G. vaccine, . sponsored by the Medical Research Council. The parents of school leavers in our Secondary Modern schools will be invited to have their children tested and where the tests indicate that protection is required, vaccinated with B.C.G. or similar vaccine. This scheme will not start until 1951 and does not therefore call for more than brief mention in this Report. Mass X-ray Unit No. 5B visited Southgate during 1950 for the specific purpose of dealing with employees of the Eastern Electricity Board. After consultation with the Mass X-ray Unit, the Public Health Department communicated with commercial firms in Southgate and with local organisations, extending an invitation to visit the Mass X-ray Unit by appointment, and to make use of the facilities afforded. We have not been supplied with the number of persons who visited the Mass X-ray Unit during its brief stay in Southgate, but the facilities made available by the Unit were nonethe-less highly acceptable. We have now had the pleasure of two visits from a Mass X-ray Unit within the past three years. NOTIFICATIONS OF INFECTIOUS DISEASE, 1950. Jan.— March. April— June. JulySept. Oct.— Dec. Totals. Enteric Fever — — — 1 1 Diphtheria — — — — — Scarlet Fever 24 39 13 39 115 Paratyphoid Fever — — — — — Sonne Dysentry — — 2 30 32 Malaria — — — — — Puerperal Pyrexia 2 2 — 1 5 Ophthalmia Neonatorum — 1 — — 1 Erysipelas 1 — 3 4 8 Measles 1 142 89 397 629 Whooping Cough 48 45 21 41 155 Pneumonia 21 10 1 8 40 Cerebro-spinal Fever — — — — — Acute Poliomyelitis 1 — 9 3 13 Tuberculosis— Pulmonary 19 18 10 17 64 Non-pulmonary 1 — 2 — 3 Food Poisoning 1 3 8 10 22 Totals 119 260 158 551 1,088 37 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. F. M. F. Cases on Register at 1/1/50 262 227 38 43 570 Cases Notified for first time in 1950 32 32 2 1 67 Cases Restored to Register — — — — — Other cases added 13 7 1 2 23 Cases Removed from Register 30 31 2 3 66 Cases Remaining on Register at 31/12/50 277 235 39 43 594 TUBERCULOSIS—1950. 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 — — — — — — 5-10 years — — 1 — — — — — 10-15 years 1 — 1 1 — — — — 15-20 years 4 7 1 — — 3 — — 20-25 years 10 9 — — 1 2 — — 25-35 years 9 14 — 2 — 3 1 — 35-45 years 10 6 — — 3 3 — — 45-55 years 5 — — — — 2 — — 55-65 years 8 1 — — 2 — — — Over 65 years — 2 — — 3 — — — Unknown — 1 — — — — — — Total 48 41 3 3 9 13 1 — * These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. 38 Appendix 1 HEALTH EDUCATION Health Education in Southgate during 1950 followed closely along the lines set out in detail in the Annual Report for 1949. During the year, 31 local organisations were visited, and were given either a talk on a subject associated with health, or a combined film show and talk. The popularity of these arrangements has been maintained, and I am quite confident that this medium is responsible for a welcome increase in general knowledge concerning matters which directly affect the welfare of the community. As before, opportunity has been taken to enlist the support of the local Press in the publication of topical articles relating to health, especially infectious diseases. As hitherto, the Editor of the Press has been truly generous in allotting a portion of his limited space, very often in a prominent position. I should like to take this opportunity of once again thanking the Editors most sincerely for their generous co-operation. Without this co-operation and help, the work of health education in Southgate would undoubtedly suffer. Arrangements have already been made to extend the scope of health education in the schools. This, of course, is largely the concern of the County Council staff, but it all forms part of our general health education programme. It is indeed pleasing to be able to report that the co-operation of the Borough Education Officer and of all head teachers is invariably cordial, and that we have been afforded all reasonable facilities to carry out this important work. The fourth edition of the Southgate Public Health Services Handbook was issued to us in 1950, and was duly circulated. The steps taken by the Public Health Committee to encourage the inauguration of a Food Traders' Hygienic Guild in Southgate have received attention elsewhere in this Report. We hope to continue our programme of health education, making such adjustments and amendments as appear desirable in the light of existing circumstances. As I have said in the past, one seldom sees the results of this work until considerable time has elapsed. I am none-the-less convinced that the time and very limited expenditure involved have been amply justified. The future of public health in almost every field of this vast subject lies more and more in adequate education of the coming generation. Our aim must be to educate members of the community, applying such technique and methods of approach as are best fitted to each section and age group. By such means, and by such means alone, can we hope to bring to the notice of those intimately concerned the part which each individual and group of individuals has to play 39 in the scheme of preventive medicine. I never lose an opportunity of stressing the fact that public health is very largely a matter of teamwork. Unless every section of the team plays its part, the results will never be satisfactory. We are fortunate in Southgate that the community is willing, indeed eager, to co-operate. This affords us very great satisfaction, and encourages us to continue the work which has been such a prominent feature of our public health programme during the past years. I cannot let this opportunity pass without thanking the burgesses for the support they have given to our health education programme. I would equally be failing in my duty if I did not express my personal thanks to the members of the Public Health Committee, and to the Council as a whole, for similar encouragement and support. 40 Appendix 2 COPIES OF SPECIAL REPORTS ON OUTBREAKS OF FLEXNER AND SONNE DYSENTERY Outbreak of Flexner Dysentery.—On 11th October, St. Ann's Hospital, St. Ann's Road, N.17, notified the Southgate Public Health Department that a child aged five had been admitted, and that the diagnosis was confirmed as Flexner dysentery. Immediate investigations showed that symptoms suggestive of dysentery had occurred in a number of families in the Winchmore Hill part of Southgate, and that all the famiiles concerned had had contact with the case. Investigations also showed that the infection seemed to have arisen in a family which had returned from hop-picking in the Maidstone district of Kent. The family in question gave a history of signs and symptoms compatible with dysentery while in Kent, symptoms being still present in all its members when they returned to their home in Southgate. This information was passed on to the Medical Officer of Health of Maidstone Rural District Council on 18th October, 1950. To date, one hundred and fifty fasces specimens have been collected from fifty-six members of the families implicated. Of these, thirty-seven have been returned as containing Flexner W. organisms. Frequent visits were made to the homes from which infection had been reported. Advice on precautionary measures was given, and all possible steps taken to ensure that this advice was followed. Fifteen of the "carriers" and contacts discovered were admitted to hospital for supervision and treatment, after consultation with the family doctors concerned. Although the child referred to in paragraph 1 above was the only case officially reported as suffering from Flexner dysentery, it is highly probable that other cases did occur among the families concerned. With the exception of the case notified, the illnesses were mild in every instance, and no further notifications have as yet been received. It is known, however, that two cases of Flexner dysentery did occur in children in Edmonton. These children were relatives of, and had had contact with, one of the families in Southgate. The family originally involved moved to Friern Barnet shortly after the outbreak was discovered. A second child in this family is reported to have suffered from Flexner dysentery. Although all the "carriers" and contacts admitted to hospital were discharged as free from infection, later specimens were reported as positive in five cases. These individuals are being kept under strict observation. Contacts and "carriers" are not being 41 considered free from infection until three consecutive negative specimens taken at weekly intervals have been obtained. The effect of treatment by one or other of the sulpha drugs is duly taken into account in this connection. So far as can be ascertained, this outbreak was confined to the ten families in contact with the original family which brought the infection to Southgate. At the time of writing this report all the positive "carriers" are free from infection, with the exception of six children. These children will be kept under supervision until the requisite number of negative specimens have been obtained. Laboratory work has been carried out by the Central Public Health Laboratory Service (Edmonton Local Laboratory), with whom the closest contact has been maintained. General practitioners in the area, and surrounding local authorities concerned, have been informed of developments. Outbreak of Sonne Dysentery.—On the 16th November, the Headmistress of Garfield Road School, New Southgate, N.ll, reported that thirteen cases of diarrhoea had occurred over the past three weeks among children attending this school. Most of the children affected attended the Nursery School, although there was evidence that infection was spreading to the Infants' School. An immediate investigation was instituted, with a view to identifying the infecting organism and checking the spread. Thirty-one faces specimens were obtained from children who were suffering or had been reported to be suffering from diarrhoea. Five of these specimens were reported negative; fifteen were notified as containing Shigella Sonnei. Specimens were also collected from the canteen staff working at the school, and from all the teachers in the Nursery School. These were reported negative in every instance. The milk supplied to the school (pasteurised) was sent for examination, with negative results. All the cases reported were mild, apart from an infant aged four months admitted to St. Ann's Hospital, St. Ann's Road, N.17, and said to be suffering from gastro-enteritis. Two children in the same family had suffered from diarrhoea, Shigella Sonnei being found in their stools. Arrangements were made to exclude all children with positive faeces from school until three consecutive negative specimens had been obtained. The headmistress of the school was instructed to send home all children who complained of diarrhoea, stomach pains or sickness, and to notify the Public Health Department immediately. A thorough inspection of the school was made, with a view to recommending such sanitary improvements as appeared desirable. The staff of the school were warned to exercise the strictest care in regard to personal hygiene. Visits were paid to 42 the school at least once each day, the course of the outbreak being kept under constant review. A circular letter was addressed to local general practitioners, informing them of the position of all cases of diarrhoea encountered in their practice. Neighbouring local authorities were kept informed of developments. By November 24th it appeared that, although the rate of spread was apparently being checked, fresh cases were still occurring. By that date 29 cases of Sonne Dysentery had occurred in Garfield Road School, made up as follows: Nursery School 20 Infants' School 5 Junior School 4 Seventy faeces specimens had been collected from cases or contacts. It was known that Sonne Dysentery had appeared in a nearby school in Friern Barnet, while the elder brother of a case attending Garfield Road School had developed symptoms while attending Arnos Secondary Modern School, also in the New Southgate area. The closest liaison had been maintained between the Public Health Department and the Central Public Health Laboratory Service (Edmonton Branch Laboratory), responsible for the bacteriological investigations. A further conference was held between the bacteriologist concerned and the Medical Officer of Health. This was followed by a conference attended by the Chairman of the Southgate Divisional Executive, the Borough Education Officer, Chief Sanitary Inspector, Headmistress of Garfield Road School and Medical Officer of Health. The position was fully explained and discussed. As a result, the following measures were at once put into operation: 1. Bacteriological Control. (a) The twenty-eight children remaining in the Nursery School at Garfield Road to be excluded on Monday, November 27th, for at least a week (out of a total of fortyeight children attending this Nursery School, twenty had already been excluded). These children to be given a letter for their parents explaining the situation in simple language and requesting co-operation. Three specimen jars to be left at each home for every member of the family, the specimens to be collected daily over three days. All children showing three negative fasces to be allowed to return to school on Monday, December 4th, provided the entire family is clear. (b) No child attending the Nursery School to be allowed to return until all members of the family concerned have been cleared, in accordance with the standard set out above, 43 remembering the fact that there is no value in taking a second specimen from a positive case until ten days have elapsed from the onset of symptoms. (c) All children from families where any child attends the Nursery School at Garfield Road, to be excluded from school until the family has been cleared, it being presumed that these families represent a potential source of spreading the infection to other schools. (d) All families in which a case of Sonne Dysentery has occurred to be treated in the same way, so far as the exclusion of children attending school is concerned. In these instances, however, one negative specimen only will be required from members of the family who have not shown symptoms of dysentery. This specimen will be taken when the third specimen is obtained from the patient, following two consecutive negatives. (e) Steps to be taken to deal with adult members of families in which a case has occurred, where the adult concerned is a school teacher, a nurse, or a food handler. (f) Repeat specimens to be obtained from the staff employed in the Nursery School. 2. Control in School. (a) Measures already instituted at Garfield Road School to be intensified. Paper towels to be supplied in adequate quantities to the school, and the strictest possible measures of personal hygiene maintained. Disinfectant to be supplied to the school, to be used in lavatory pans and wash-basins and on lavatory seats. (b) Visits to be paid daily to the school by the School Nurse attached to the school and the District Sanitary Inspector concerned. These officers to work under the direct supervision of the Superintendent Health Visitor and Chief Sanitary Inspector, both of whom will report daily to the Medical Officer of Health, who is also Area Medical Officer responsible for day-to-day administration of local School Health Service. (c) Wherever possible, large classes at the school to be split up into smaller units. (d) The washing of children's hands in school to be regarded as first priority drill. The Sanitary Inspectors and School Nurses concerned have been supplied with a detailed memorandum prepared by the Medical Officer of Health in regard to advice to parents. The co-operation of parents is being sought in an effort to check the spread of the disease by the movement of children between 44 families. The importance of personal hygiene in the home is being continually stressed. The dangers attaching to the holding of or attendance at parties are also being emphasized. Surrounding Local Authorities are being kept informed of fresh developments as they occur, and have been told of the measures instituted in Southgate. Their co-operation is being requested. The position will be studied from day to day, so that the policy can be altered as and when desired. It is appreciated that further exclusion, either of affected cases or even of the whole Infants' School, may be required. At the moment, and bearing in mind the congested district from which the vast majority of the children come, this measure is not considered either necessary or desirable. It is hoped that the precautions set out above will prevent the infection spreading in any degree to other schools, although, as has already been stated, additional safety measures may be required at any time. So far as at present can be ascertained, the first child affected exhibited symptoms on 3rd October, 1950. There is, however, no direct evidence that this child was, in fact, suffering from Sonne Dysentery, as the case has never been notified. Owing to the lapse of time since the first case occurred, current enquiries have not yet elicited the original source of infection. 45 Appendix 3 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 1950: June 6th Public Health Service Handbook. July 28th Cocksackie Virus. Aug. 22nd Immunisation and Poliomyelitis. Sept. 5th Food poisoning. Sept. 6th Poliomyelitis. Sept. 11th Visit of Mass X-ray Unit. Oct. 17th Flexner Dysentery. Oct. 18th Doubtful cases of infectious disease admitted to Hospital. Oct. 31st Infectious Diseases (situation up to date). Nov. 21st Sonne Dysentery. Dec. 30th Smallpox. 46