Ack 13/11/02 A C 439 (1) 500 TAGATE BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1951 Wm. CLUNIE HARVEY, m.d., d.p.h. Medical Officer of Health Soug 36 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1951 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 1951. The form of this year's Annual Report is broadly the same as that of previous years. Certain minor amendments have been made, especially in the rearrangement of material and the inclusion of new tables. As before, uncritical reference has been made to the work carried out in Southgate by the Middlesex County Council and other bodies. This allows the health picture to be presented as a whole, and not in isolated fragments. The vital statistics for 1951 were again satisfactory. These statistics are set out in greater detail in the body of the Report. It may meantime be stated that the Infantile Mortality Rate for Southgate, i.e., the number of children born during 1951 who died within the first 12 months of life, was a new record for the district. Indeed, the figure (15.494) would have been considered phenomenal not so many years ago. The infectious diseases picture for the year was also satisfactory, in spite of the fact that no less than 980 cases of measles were reported during the year, together with 136 cases of pertussis. There was also an increase in the incidence of Sonne dysentery, particularly in the New Southgate part of the district. As will be seen from the appropriate section of the Report, the type of infectious disease met with throughout the year and throughout the Borough was generally mild, in many instances extremely mild. Although it is hoped that the Annual Report of the Medical Officer of Health is still regarded as a useful document, which contains information of interest to members of the Council, as well as to local organisations and ratepayers generally, it cannot be denied that the transference of personal health services from Borough Councils such as Southgate to the County Council has robbed the Annual Report of some, at least, of its former appeal. It was always a pleasure, as well as a salutary exercise, to report 3 on the work of the Health Visitors and Maternity and Child Welfare Centres under the control of the Council, and to set out in detail the progress which had been made in such matters as immunisation against diphtheria. As has already been stated on more than one occasion, these services, all of which, incidentally, are still under my personal control as Area Medical Officer, can still be mentioned, although it would obviously be highly injudicious to deal with them in other than a purely objective manner. It will be appreciated, however, that there still remains a volume of work which should be fully reported. Without in anyway attempting to advance the claims of the Public Health Department, it will be clear that the functions which the Department performs have an intimate bearing on the health and well-being, not only of the community, but of the individuals who make up that community. This is neither the time nor place to discuss the possible effects which the 1948 Act has had on the health services of a borough such as Southgate. Although this is a matter which intimately affects the district, previous comments can be allowed to stand. It is our duty to do our utmost to see that the system works, and that the very best is being made of the various types of facility available. So far as the Borough Council is concerned, we have our statutory duties to perform, including the vast field of epidemiology. It may be that our responsibilities will be increased in the relatively near future, as the functions and value of environmental hygiene come to be more generally appreciated. In addition, and this is quite an important point, the Public Health Department has the task of establishing liaison with such bodies as the Middlesex County Council, the Regional Hospital Boards, and other statutory organisations dealing with health, either preventive or curative health. We have always striven to establish the most cordial relations with these bodies. Indeed, it might not be too much to say that co-operation has always been taken more or less as a matter of course so far as Southgate is concerned. It is still a fact that the position of the Medical Officer of Health of a local authority which is not a local health authority is not clearly defined at every point. Thus, the precise duties of the Medical Officer of Health vis-a-vis the School Medical Officer in regard to school exclusions is sometimes ambiguous, and can give rise to more than theoretical difficulty when the two offices are not held by the same person. Needless to say, this does not apply in Southgate. In the same way, the responsibilities of the Medical Officer of Health in relation to food hygiene still require clarification, particularly in respect of certain types of canteens. Finally, the position in regard to food sampling could, with advantage, be simplified. 4 It was, of course, to be expected that the coming into operation of such a vast scheme as the National Health Service would produce certain difficulties and anomalies. There can be little doubt that these problems will be resolved in time. Meanwhile, as T have already suggested, we should not look for difficulties, but should rather apply our whole energies to the important task to hand. One way and another, it is to be hoped that the Annual Report of the Medical Officer of Health of a district such as Southgate is not now regarded as a mass of dry, relatively unimportant statistics, of no great interest except to the expert. Although it is by no means so easy now to clothe the bare bones of an Annual Report with attractive material, there is quite sufficient left to paint a picture which should still appeal. This I have attempted to do, so far as is practicable. This Report continues to represent the yearly appraisal of Southgate's health. As such, I trust that it will be as acceptable to the Borough Council as were its predecessors. I should like once again to express my sincere thanks to the members of the Borough Council, more especially to the members of the Public Health Committee, for their constant support. Without this support, my own work, and the work of the Public Health Department as a whole, would undoubtedly suffer. I should also like to thank the staff of the Public Health Department for their loyalty and efficiency throughout the year. I would particularly mention the work of Mr. A. E. Gooday, Chief Sanitary Inspector, who has had to accept added responsibility following the wider duties which I have recently undertaken. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, W. C. HARVEY, Medical Officer of Health. Town Hall, Palmers Green, N.13. 5 PUBLIC HEALTH COMMITTEE From 1st January to 14th May, 1951 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) From 22nd May to 31st December, 1951 Alderman G. Peverett (Chairman) Councillor H. S. Beardow Councillor Mrs. D. M. Deacock Councillor C. F. Lintott Councillor Mrs. C. T. McConnell Councillor R. Prior (Vice-Chairman) Councillor A. F. B. Start 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.1. 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 J. E. Bryan (resigned 21.4.51). Junior Clerk: Miss J. A. Wright (appointed 7.5.51). 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. 6 Statistics and Social Conditions of the Area Area (in acres) 3,764 Registrar-General's Estimate of Resident Civilian Population, 1951 72,840 Number of Inhabited Houses (end of 1951) according to Rate Books 21,555 Rateable Value (1951) £934.108 Sum represented by a penny rate (1951) £3,810 There is little new to report in regard to the social conditions of the Borough. The problems of maintaining the environmental background to what is substantially, indeed almost entirely a dormitory suburb, continue. These problems tend to become intensified year by year, as the district grows older. This is particularly the case, since rebuilding and replanning are not at present possible on an extensive or even an appreciable scale. This problem is not peculiar to Southgate, although it obviously applies more to this type of district than to many others. We are at present reaping the benefit of past wisdom. If future generations are to continue to gain the same benefits, vigilance must in many ways be intensified. It is not always certain that this important fact is fully appreciated by all burgesses, although I am personally convinced that the vast mapority of our residents do appreciate the amenities provided, make good use of them, and are anxious to do what is possible to safeguard their heritage. Careful planning in the past has made Southgate a very pleasant place in which to live and work. The active co-operation of all who enjoy this privilege is required, if that benefit is to continue. The type of district which Southgate undoubtedly represents a potent factor in maintaining the health and well-being of its inhabitants. Indeed, having regard to the fact that so many of our burgesses have to travel to the centre of London every day under trying conditions, and have to work under conditions which cannot be described as so satisfactory as those in which they live, the effect of their home environment is probably greater than many imagine. For that reason alone, it is supremely important that the character of Southgate should not be allowed to alter. This is a matter which I have mentioned several times in my Annual Report. I feel it is of sufficient importance to warrant repetition. 7 EXTRACTS FROM VITAL STATISTICS OF THE YEAR Male Female Total Live Legitimate 439 386 825 Births Illegitimate 8 6 14 447 392 839 Birth Rate per 1,000 of the estimated population 11.172 Still Legitimate 10 5 15 Births Illegitimate — — — 10 5 15 Rate per 1,000 (live and still) births 17.564 Deaths from causes and at all ages 951 Death Rate per 1,000 of the estimated population 11.098 Deaths from puerperal causes: Deaths Rate per 1,000 total (live and still) births From puerperal sepsis 0 0 From other causes 0 0 0 0 Deaths of Infants under I year of age: Male Female Total Legitimate 6 5 11 Illegitimate — 2 2 6 7 13 Infant Death Rate: All infants per 1,000 births 15.494 Legitimate—per 1,000 legitimate live births 13.3 Illegitimate—per 1,000 illegitimate live births 142.857 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 2 8 POPULATION The Registrar-General estimated the civilian population of the Borough at the middle of 1951 to be 72,840, a decrease of 1,340 as compared with 1950. It will be noted that the population of Southgate has again fallen. As the figure supplied by the Registrar-General is based on the latest census, we can assume that it does, in fact, represent the population as it now stands. When one remembers the number of families who are still sharing houses which were intended for only one unit, it would appear that this population is still in excess of the optimum total. Unless and until the limited amount of additional housing which can be provided within our boundaries is made available, it is difficult to see how the position can be altered. BIRTHS—BIRTH RATE The nett total births accredited to the district was 839, a decrease of 21 on the preceding year. Of these, 447 were males and 392 females (8 males and 6 females being illegitimate). The birth-rate for the year was 11.172 per 1,000 of the population. The birth-rate for England-Wales for 1951 was 15.5, and for the administrative County of London 17.8. The births and birth-rates for the past five years were as follows: Birth-Rates No. of Births Southgate England & Wales London 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 1951 839 11.17 16.7 17.8 During 1951, the number of births recorded was 112 less than the number of deaths, as compared with 8 less in 1950. The total number of births actually registered in the district during the year amounted to 407, of which 6 were unnotified. The percentage of births notified was therefore 99.02 as compared with 99.43 in 1950. 9 MORTALITY General Mortality and Death Rate The nett number of deaths accredited to this district was 951, 83 more than in 1950. This gives a crude death-rate of 13.056 per 1,000 of the population and a corrected death-rate of 11.098 (rate for 1950 was 10.06). Death-Rates No. of Deaths Southgate England & Wales London 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 1951 951 11.098 12.5 13.1 Infant Mortality There were 13 deaths of infants under 1 year of age, which gives an infantile death-rate of 16.494 per 1,000 births, as compared with 20 deaths and a rate of 23.25 in the preceding year. The corresponding rates for England and Wales and London were 29.6 and 26.4 respectively. The infant deaths and rates for the past five years were as follows: Infantile Death-Rates No. of Deaths Southgate England & Wales London 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 1951 13 15.49 29.6 26.4 The infant mortality rate for 1951 (15.494) is by far the lowest yet recorded in Southgate. Too much significance cannot, however, be given to this figure, in view of the comparatively small number of births and infants' deaths which take place in the area each year. Still-births Fifteen still births (0 illegitimate) were accredited to the district 10 for 1951. This is equal to a death-rate of 17.564 (live and stillbirths), the corresponding figures for 1950 being 12 still-births with a rate of 13.76. The rate per 1,000 of the population was 0.206, the rates for England and Wales and London being 0.36 and 0.37 respectively for 1951. The average rate for the past ten years was 21.06. The still-birth rate for 1951 (17.564) is the second lowest yet recorded in Southgate. Maternal Mortality No deaths attributable to causes connected with childbirth occurred during 1951. This is the second year in succession in which the maternal mortality for the district has been nil. Indeed, only two reaths have been recorded in this category within the last five years, during which time 4,903 births took place. These figures are very satisfactory when compared with the returns of previous years. Mortality of Persons Over the Age of 65 Six hundred and sixty-eight or 70.24 per cent. of the total deaths during the year occurred in persons over the age of 65. Of these 223 died between the ages of 80 and 90, while a further 28 were over the latter age (5 males the oldest being 94, and 23 females the oldest being 102). As previously, diseases of the heart and circulation were responsible for more deaths in this age group than any other cause, including cancer. li TABLE I. Causes of Death During the Year 1951 Causes of Death Male Female Total Rates per 1,000 of Population All causes (Civilian only). 448 503 951 11.09 1 Tuberculosis, Respiratory 11 4 15 0.20 2 Tuberculosis, Other — 2 2 0.02 3 Syphilitic Disease 1 — 1 0.01 4 Diphtheria — — — — 5 Whooping Cough 2 — 2 0.02 6 Meningococcal Infections 1 — 1 0.01 7 Acute Poliomyelitis — — — — 8 Measles — — — — 9 Other Infective and Parasitic Diseases — 1 1 0.01 10 Malignant Neoplasm, Stomach 5 15 20 0.27 11 Malignant Neoplasm, Lung, Bronchus 27 9 36 0.49 12 Malignant Neoplasm. Breast — 26 26 0.35 13 Malignant Neoplasm, Uterus — 8 8 0.10 14 Other Malignant and Lymphatic Neoplasms 33 41 74 1.01 15 Leukaemia, Aleukaemia 5 2 7 0.09 16 Diabetes 2 5 7 0.09 17 Vascular Lesions of Nervous System 46 75 121 1.66 18 Coronary Disease, Angina 86 45 131 1.79 19 Hypertension with Heart Disease 18 19 37 0.50 20 Other Heart Disease 59 103 162 2.22 21 Other Circulatory Disease 19 18 37 0.50 22 Influenza 4 13 17 0.23 23 Pneumonia 23 18 41 0.56 24 Bronchitis 31 30 61 0.83 25 Other Diseases of Respiratory System 4 5 9 0.12 28 Ulcer of Stomach and Duodenum 12 3 15 0.20 27 Gastritis, Enteritis and Diarrhoea — 3 3 0.04 28 Nephritis and Nephrosis 2 6 8 0.10 29 Hyperplasia of Prostate 3 — 3 0.04 30 Pregnancy, Childbirth, Abortion — — — — 31 Congenital Malformations 1 2 3 0.04 32 Other Defined and Ill-defined Diseases 40 38 78 1.07 33 Motor Vehicle Accidents 2 1 3 0.04 34 All Other Accidents 8 8 16 0.22 35 Suicide 3 3 6 0.08 36 Homicide and Operations of War — - — — 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. 1951 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 8 0.84 0.11 5 0.53 0.07 13 1.37 0.18 1- 5 years 2 0.21 0.03 — — — 2 0.21 0.03 5-15 years 2 0.21 0.03 1 0.10 0.01 3 0.31 0.04 15-25 years 3 0.32 0.04 1 0.10 0.01 4 0.42 0.05 25-45 years 18 1.89 0.25 21 2.21 0.29 39 4.10 0.54 45-65 years 121 12.73 1.66 101 10.62 1.38 222 23.35 3.04 Over 65 years 298 31.33 4.09 370 38.91 5.08 668 70.24 9.17 Totals 452 47.53 6.21 499 52.47 6.84 951 100.00 13.05 13 TABLE III. Infantile Mortality 1951. 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 Tuberculosis 11 Meningitis (Not Tuberculous) 12 Convulsions 13 Laryngitis 14 Bronchitis 15 Pneumonia - - - - - 1 1 — 1 3 16 Diarrhoea 17 Enteritis 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 23 Atelectasis 1 — - - 1 - - - - 1 24 Congenital Malformations 25 Premature Birth 7 1 - - 8 - - - - 8 26 Atrophy, Debility and Marasmus 27 Other Causes — 1 - - 1 - - - - 1 Totals 8 2 — — 10 1 1 — 1 13 14 TABLE IV. Vital Statistics of Whole District during 1951 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. 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 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 1950 74,180 860 11.46 868 11.70 20 23.25 1951 72,840 839 11.17 951 13.056 crude 13 15.49 11.09 corrected Comparison of the Rates of Southgate with those of England and Wales, and London, for Year 1951. Rate peT 1,000 Total Population. Annual Death Rate per 1,000 Population Rate peT 1,000 Live Births. Live Births. Still Births. All Causes. Whooping Cough. Diphtheria. Influenza. Total Deaths under one year. England and Wales 15.5 6.36 12.5 0.01 - 0.38 29.6 126 County Boroughs and Great Towns, including London 17.3 0.45 13.4 0.01 - 0.36 33.9 148 Smaller Towns (1931 Census Populations 25,000-30,000) 16.7 0.38 12.5 0.01 - 0.38 27.6 London 17.8 0.37 13.1 0.01 - 0.23 26.4 Southgate 11.17 0.20 13.05 crude 11.09 corrected 0.02 - 0.23 15.49 15 GENERAL PROVISIONS OF HEALTH SERVICES Hospitals The position in regard to the admission of cases to hospital has shown very little alteration from that recorded in the Annual Reports for the past few years. Most difficulty is encountered in the admission to hospitals of the chronic elderly sick. To the substantial total of such cases must be added the growing number of infirm, elderly persons, who require care and attention in some sort of institution, although they may not be suffering from any specific ailment, and may not require actual treatment in hospital. The provision of this type of accommodation largely lies with the County Council, which is actively trying to meet these needs. At the moment, the position is still acute, and far from satisfactory. Many of the cases brought to our attention are indeed tragic. It is unfortunately not within our power to take definite action, except by using Section 47 of the National Assistance Act 1948. None the less, we do try to assist families placed in this unfortunate position, and can at least put them in touch with various bodies which are in a position to help them in a practical manner. The admission of cases of infectious disease to hospital has continued to work very satisfactorily indeed throughout the year. From my monthly reports to the Public Health Committee, it will be obvious that the infectious diseases picture has changed materially during the past few years. This has eased the strain on hospital beds. The principle which we adopt in regard to the admission of cases of infectious disease has remained unaltered. Broadly speaking, we recommend the admission to hospital of all cases in which continuous nursing and medical advice are required, or where the danger of complications or sequelae is likely to arise. So far as mild infectious diseases are concerned, e.g., measles, scarlet fever and the like, we do not press for admission to hospital unless suitable isolation cannot be provided in the home, or unless the employment of a bread-winner is affected. For practical purposes, "suitable isolation" is defined as the provision of a room for the patient's sole use. It is worth recording that the general practitioners co-operate most cordially in the application of these principles, as do the various hospitals to which our cases are admitted. Laboratory Facilities The remarks set out in the Annual Report for 1950 relating to the assistance and advice provided by the Central Public Health Laboratory Service apply as before. It is still very satisfactory to note that we can call upon the Laboratory Service for assistance in 16 special cases, quite apart from the routine work which they carry out in regard to the investigation of specimens, including the examination of milks and ice creams. Our relations with the Laboratory Service have always been cordial; this relationship has undoubtedly helped us in our work, and must be of the greatest service to the general practitioner. 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. Scabies and Lice The number of scabies cases reported during the year was very small indeed. In each instance, it was possible to arrange for treatment to be carried out at home, under the supervision of the family doctor. In addition, it may be presumed that we can still make use of the facilities provided in neighbouring Boroughs, particularly Enfield and Edmonton, who have generously helped us on rare occasions in the past. So far as infestation by lice is concerned, this is a matter which very largely concerns the School Health Service. Full details of the amount of infestation which occurred in school children, together with the action taken, is reported to the Divisional Executive. It need merely be stated that infestation amongst school children, and indeed among the general population is very low in Southgate. Low as the total is, it has been reduced within the past few years. Every case of infestation is fully investigated and treated. We now seem to have arrived at a very small hard core of families in which, through one reason or another, infestation and reinfestation occurs. The Public Health Department, in conjunction with the Area Health Office staff, is fully aware of the conditions which obtain in these families, and pursues an active policy of education and 17 Summary of work carried out at Central Public Health Laboratories for the year 1951: Positive Negative Swabs for diphtheria bacilli — 105 Sputa for tubercle bacilli 5 86 Throat and Nose 453 Faeces 966 Urine 39 Blood 63 Others 29 treatment. Largely by reason of this policy, it has not been found necessary to send anyone for specific cleansing during the year. 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 1951 under this section. 18 Service of Notices Total informal sanitary notices served 502 Total informal dustbin notices served 262 Total informal notices served 764 Total informal notices complied with 729 Total statutory notices served 79 Total statutory notices complied with 85 Repairs to Houses Considerable work has been carried out by the Sanitary Inspectors during the year in connection with repairs to houses. As the result of their efforts, repairs were carried out to 536 houses. Of these, the repairs to 202 houses were of a major character, including such matters as 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 rainwater pipes, renewal or extensive repair of flooring, renewal of windows, extensive renewal of wall and cciling plaster, and renewal of external paintwork. At the remaining 334 houses, the repairs were not of such an extensive nature but were necessary to abate specific nuisances. Sanitary Services Summary of Visits, 1951 Inspections re complaints received 1,156 Re-visits in connection therewith 4,293 Visits to Food Premises (including butchers, bakehouses, cafes, restaurants, fish shops and dairies) 1,453 Inspections re Shops Acts 1912/34 371 Inspections re Factories 357 Visits re housing conditions and overcrowding (applicants for housing accommodation) 130 Visits re Infectious Diseases 1,324 Visits re Places of Public Entertainment 40 Visits re Prevention of Damage by Pests Act, 1949 1,487 Miscellaneous Visits 4,456 15,067 19 It is, I think, worthy of note that the repairs referred to above were carried out mainly as a result of informal action on the part of the Inspectors. It will be seen from the summary concerning the service of notices that it was found necessary in 79 instances only to follow-up informal notices by the service of statutory notices. Owing to non-compliance with eight statutory notices requiring repairs, legal proceedings were instituted against the owners and Court Orders obtained enforcing compliance with the notices. Following non-compliance by an owner with a statutory notice served under Section 9, Housing Act 1936. requiring repairs to be carried out to make the house fit for habitation, the Council carried out the works and recovered the cost thereof from the owner. Demolition Orders under Section 11, Housing Act 1936, were made by the Council in 1951 in respect of two houses in Springfield Road, N.ll, and one house in High Street, N.14. The houses were subsequently demolished. Consideration was given by the Council to the demolition of a house in Chase Road, N.14. The owner, however, gave an undertaking, in accordance with the provisions of Section 11, Housing Act 1936, to carry out extensive repairs to make the house fit for habitation, and these repairs were carried out. Housing Applications Visits by the Sanitary Inspectors to applicants for housing accommodation and the preparation of reports as to living conditions has continued in 1951. The number of visits for this purpose has understandably fallen, being 130 as against 261 in 1950, 560 in 1949 and 969 in 1948. This work has, I feel certain, been of value to the Housing Committee. The close liaison existing between the Public Health Department and the Housing Department has been maintained during 1951. On several occasions during the year I have been asked by the Town Clerk to advise as to the degree of urgency on medical grounds applicable to particular applications. Food Hygiene During the year, 1,453 visits were made to food premises in the Borough, as against 1,610 in 1950. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. 20 During the year, it was suggested that we might hold a Clean Food Week in the course of 1952. The idea of this Clean Food Week was to stimulate interest in food hygiene in various ways, including the organisation of a Clean Food Exhibition, the display of posters, activities in the schools, newspaper articles, and other types of activity designed to bring this important matter before the general public. Unfortunately, these arrangements had later to be postponed. It will be appreciated that, to hold a Clean Food Week on a scale likely to appeal to our burgesses, and in keeping with the traditions of the Borough, an expenditure running into several hundred pounds would be involved. In the past, the Infestation Division of the Ministry of Agriculture and Fisheries has been able and prepared to assist in this direction, particularly in the way of arranging Clean Food Exhibitions. When an approach was made to the Ministry of Agriculture and Fisheries we were informed that they were no longer in a position to afford this assistance, because of recent financial cuts. We were then left with the alternative of postponing the project until times were more favourable, or arranging a Clean Food Week on a restricted scale. The alternatives were duly placed before the Public Health Committee, which decided upon postponement. I am quite sure that this was a wise move, as a local campaign in a district such as Southgate should either be organised on an adequate scale, or should be dropped until times are more propitious. It need scarcely be emphasised that, although we are not organising any specific Clean Food Campaign during 1952, the work of supervision and health education will continue. It is greatly to be regretted that the proposed Hygienic Food Traders' Guild has not materialised. This matter more properly belongs to the Annual Report for 1952, but it can be stated here that local interest in the formation of a Southgate Food Traders' Guild has not warranted the Council taking more active steps in promoting such a venture. The Council will be aware that the Public Health Department arranges a number of film shows and talks during the year. During 1951, many such film shows and talks were centred on the question of clean food. This subject lends itself to discussion, while an excellent film is available to accompany a talk. Although most local organisations have already seen the best film available, and have been supplied with a talk on food hygiene, we will continue to offer this service. 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 96 stone Carcase Meat 1,051 lbs. Sausages 81 lbs. Rabbits 48 lbs. Poultry 5 lbs. Canned Corned Beef 387 lbs. Canned Corned Mutton 2 lbs. Canned Luncheon Meat 64 lbs. Canned Cooked Ham 1,510 lbs. Canned Food (various) 2,289 cans Cheese 19 lbs. Butter 5 lbs. Processed Cheese 18 lbs. Cake 29 lbs. Cake Flour 117 lbs. Pudding Mixture 74 Packets Flour 3 lbs. Biscuits 8 lbs. Cereals 38 lbs. Dried Fruit 30 lbs. Jams 132 lbs. Apricot Pulp 20 lbs. Salad Dressing 5 jars Pastes and Pickles 85 jars Sweets 102 lbs. Post-Mortem Inspection of Animals No slaughtering of animals took place in the Borough during 1951. Milk Regulations and Milk Sampling During 1951, 83 samples of milk, as against 88 in 1950, were obtained and submitted for bacteriological examination. Of the 83 samples taken, two were found to be unsatisfactory. The unsatisfactory samples were of pasteurised milk from a dairy firm with a distributing depot in this Borough. It was found on investigation that the milk was purchased already pasteurised and bottled from a wholesale dairy firm outside the Borough. The wholesale dairy firm were informed of the unsatisfactory samples and, in the course of their investigation into the matter, invited the Chief 22 Sanitary Inspector and one of the other Sanitary Inspectors to visit their premises. The Inspectors found that the premises, although reasonably modern and satisfactory, were being improved, and formed the impression that the firm was fully aware of the necessity for care in the processing of milk. 1 am pleased to be able to report that subsequent samples of the firm's milk have proved satisfactory. Ice Cream Sampling During 1951, 77 samples of ice cream, as against 104 in 1950, were obtained for bacteriological examination. The smaller number of samples taken was due to the inability of the Public Health Laboratory to deal with more samples owing to work in connection with Sonne Dysentery. Of the 77 samples taken: 38 were Grade 1 16 „ „ 2 10 „ „ 3 13 „ „ 4 Establishments for Massage or Special Treatment Under the Middlesex County Council Act, 12 existing licences were renewed, and one new licence was granted. Swimming Bath The figures of attendances at the Barrowell Green Open Air Swimming Bath for the last two years were as follows: 1951 1950 Mixed Bathers 51,195 55,524 From Schools 3,687 3,269 Season Ticket Holders 10,426 12,988 65,308 71.781 Spectators 3,883 3,808 Costumes, etc., hired 230 210 As in the past, samples of water were taken at regular intervals from the Swimming Bath. The results were uniformly satisfactory. In order that the public might be reassured as to the quality of the water, reports on samples taken, couched in general terms, were displayed at the Bath. During the year, arrangements were made with the St. John Ambulance Brigade to staff a First Aid Room at the Bath during weekends and crowded periods. The First Aid Room was 23 quately equipped, after consultation with the Superintendent of the local Division of the Brigade. This arrangement has proved a useful addition to the facilities provided at Barrowell Green. As hitherto, the Superintendent of the Swimming Bath and her staff have shown a very keen appreciation of their duties in relation to public health. The condition of the Bath was always found to be excellent on inspection, while co-operation has been as close and cordial as in past years. Altogether, Barrowell Green Swimming Bath provides the district with a valuable amenity, which must have an appreciable effect on health, particularly the health of children. Rivers and Streams After a lapse of several years, complaints have once again been received of smells emanating from Bounds Green Brook. This issue has been before the Public Health Committee on several occasions, and has been brought to the notice of the Lea Conservancy Board. The matter is being actively pursued. As finality has not yet been reached, this is a subject which might better be postponed until the Report for 1952 is issued. It can meantime be stated that the Public Health Department is taking such action as is possible in the circumstances, including repeated sampling of the brook, together with consultations with other bodies and authorities. Prevention of Damage by Pests Act, 1949 During 1951, 513 complaints of rats and mice were received and dealt with, as against 406 in 1950. In March, 1951, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. .333 manholes were baited. In 129 of these, complete or part takes of bait were noted. In September, 1951, test baiting was carried out by the Borough Engineer's Department to 267 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 358 manholes were baited. An additional feature of this treatment was the recording, at the request of the Ministry of Agriculture and Fisheries, of the poison takes in the manholes. Of the 358 manholes baited, the poison bait was taken completely in 19 manholes and partly in 55 manholes. In the remaining 284 manholes, there was no take of poison bait. 24 All 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. "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 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. The question of additional public conveniences within the Borough has been discussed by the Public Health Committee on a number of occasions. The possibility of providing a public convenience to serve the area round Southgate Green, including Southgate Cemetery and the Walker Cricket Ground, was fully 25 explored, although no action has yet been taken. The possible erection of a small additional convenience to serve the New Southgate area has recently been discussed. Here again, this is a matter which more properly belongs to the Report for 1952. Ponds anil 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 1950, 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 examination 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: 2 S. & D. Freighters (moving floor type) 2 Karrier Barrier Loaders. 4 Scammell Barrier 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 1951/2 was 16,601 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 1,211 17 3 Cullet 8 7 0 Metals 2 9 0 Rags 30 2 1 Carpets and Gunny 22 17 3 Tins 522 10 1 Bottles 20 19 2 Mixed Scrap 103 1 2 26 The value of this material amounted to £24,227 3s. lid. 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, 1,071 tons of kitchen waste was collected. Under instructions from the Board of Trade, this was sold to Tottenham Borough Council for £3,437. The material is collected throughout the Borough on Monday mornings. Individual kitchen waste containers are supplied on request by the Borough Engineer. 27 FACTORIES ACTS, 1937 and 1948. Details of Work Carried Out During the Year 1951. 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 68 89 11 1 1 (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 2 157 268 14 - 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 3 - - - - 3 Total 225 357 25 1 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 12 12 - - - 4 Overcrowding 5 — — - - - 5 Unreasonable temperature (S.3) 6 - - - - - 6 Inadequate ventilation (S.4) 7 - - - - - 7 Ineffective drainage of floors (S.6) 8 - - - - - 8 Sanitary Conveniences (S.7) (a) insufficient 9 - - - - - 9 (b) unsuitable or defective 10 16 16 - 2 1 10 (c) not separate for sexes 11 - - - - - 11 Other offences against the Act (not including offences relating to Outwork) 12 - - - - - 12 Total 28 28 - 2 1 28 OUTWORK—(Sections 110 and 111). Nature of Work. M/c. Line No. 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 oases of default in sending lists to the Council. No. of instances of work ii; unwholesome premises. Notices served. Prosecutions. M/c. Line No. Wearing Apparel— Making, etc. 13 245 — — — — — — Cleaning & Washing 14 1 —- — — — — — Household Linen 15 1 — — — — — — Curtains & Furniture Hangings 17 5 — — — — — Fur Pulling 22 4 — — — — — — Artificial Flowers 28 6 — — — — — — Paper Bags 33 2 — — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 12 — — — — — — Brush Making 35 9 — — — — — — Feather Sorting 37 4 — — — — — — Carding, etc., of Buttons, etc. 38 4 — — — — — — Stuffed Toys 39 12 — — — — — — Cosaques. Christmas crackers, Christmas Stockings, etc. 42 3 - - - - - - Lampshades 44 3 — — — — — — Total — 311 — — — — — — 29 Prevalence and Control of Infectious Diseases From the table of infectious diseases set out on page 37 it will be seen that 1,400 cases of infectious disease were notified during the year, as against 1,088 in 1950. The Infectious Sickness Rate for the district was therefore 19.22, as compared with 14.67 during the previous year. There is little to add to the remarks relating to infectious diseases contained in the Annual Reports for the past few years. The type of infectious disease met with has continued mild on the whole, with very few complications or deaths, and an extremely limited need for admission to hospital. This applies particularly to such conditions as measles, pertussis and scarlet fever, where the diseases are quite different from the entities which we knew and feared before the war. Although I have tried to bring this fact to the notice of burgesses in talks, newspaper articles and by the circulation of the magazine, "Better Health," it would still appear that the occurrence of even the mildest case of infectious disease, particularly scarlet fever, in a child, is very often regarded as a minor catastrophe. Although no one should belittle the possible effects of any infectious disease, and although adequate steps should be and are, in fact, taken to carry out proper treatment, isolation, supervision of contacts and, where necessary, terminal disinfection, there can be little doubt that a certain degree of anxiety is being caused by measures which do not seem to achieve any very obvious purpose. Thus, contacts are kept away from school in accordance with existing regulations, while parents are unduly worried, either as to the care of cases, or as to the health and safety of such of their children who may be contacts. I would again state that we observe existing regulations, and that we will continue to do so until these regulations are altered. This usually means that each case must be judged on its merits, as the regulations do permit of a certain degree of latitude. It is not always easy to explain the situation to parents in language which they can understand, as the issues involved are complicated, and depend upon so many, varying circumstances. I am always glad to discuss such matters with parents, either individually or at meetings. I find these discussions most helpful, and am not unoptimistic that they have a cumulative effect. Apart from the virtual disappearance of several major infectious diseases from our monthly list of notifications, and the 30 changing nature of several other diseases, there is evidence which leads one to believe that a newer type of infection is making itself apparent. This applies particularly to virus infections, which are responsible for several serious diseases, notably acute anterior poliomyelitis and the virus form of influenza. This evidence is still indefinite. None the less, it would appear that a certain type of virus infection is on the increase. Thus, one has been struck by the number of cases of encephalitis which have recently been reported, together with the occurrence of several cases of infection of the brain, following a simple attack of measles. This may, of course, be due to more accurate diagnosis, and greater care. On the other hand, the explanation may be entirely different. As the number of such cases which have occurred in Southgate is admittedly small, one can merely observe the situation and await further developments, if any. The field of epidemiology is one in which the Medical Officer of Health can play a more and more extensive role. Modern epidemiology can be applied to almost every phase of our life, and is a subject in which the Public Health Department of all local authorities, whatever their nature, must be intensely interested. I have been in the habit for many years of placing before the Public Health Committee each month, information relating to local epidemiology, so that the members may be aware of the position and trends. I should like to take this opportunity of expressing my personal thanks to the Committee for the interest and encouragement which I invariably receive in submitting this information. Diphtheria For the fourth year in succession, no case of diphtheria was notified in the Borough. It is now almost five years since a case of diphtheria occurred in Southgate. The last death from this disease took place approximately nine years ago. Although immunisation against diphtheria is the concern of the Middlesex County Council, 1 know that the Borough Council would wish to be aware of the steps which are being taken to implement the policy of immunisation throughout the Borough. Very briefly, the measures adopted are as follows: 1. An ad-hoc immunisation clinic is held each Monday afternoon in Broomfield House, Broomfield Park. Immunisation.against diphtheria, pertussis, or diphtheria and pertussis combined, is available at this clinic, while reinforcing injections are also supplied. 2. All the maintained schools in the Borough, as well as most private schools, are visited once each year. These visits are 31 mostly for the purpose of carrying out reinforcing injections, although children requiring immunisation for the first time also receive attention. Parents are written to, informing them of the details of the proposed school visit, so that they may be present if they so desire. Although reinforcing injections are only required at approximately four-yearly intervals, and although many parents therefore receive a letter offering immunisation which is not actually required, 1 am of opinion that this is a useful yearly reminder of the value of immunisation, and that it is very well worth-while. If the high percentage of school children whose parents ask us to supply a reinforcing dose at 4/5 yearly intervals throughout their school life is any criterion, the policy appears successful. It will be obvious that any policy which caters for initial immunisation and which does not take into consideration the importance of periodic reinforcing injections, cannot hope to maintain the level of immunity in its child population at the required height. From the latest returns applicable to Southgate (56% of children under 5 years immunised ; 85% children over 5 years) and taking into account the absence of diphtheria cases from the district, it would appear that this policy is having the necessary effect. 3. A continuous campaign designed to encourage parents to have their children immunised is pursued in Southgate. This policy includes the mention of immunisation at Parents/ Teachers and other meetings, occasional articles in the local press, a very complete system of letters addressed to parents whose children are under 12 months of age, the distribution of leaflets, and continuous propaganda by Health Visitors, both in the home and at clinics. This continuous propaganda is reinforced from time to time by more intensive campaigns. I am still of the opinion, however, that immunisation is a matter which calls for unceasing attack, rather than more sporadic efforts. 4. Apart from the immunisation carried out by the Area Health staff, protection against diphtheria can be supplied by most family doctors. Material for immunisation against diphtheria is supplied free of charge by the Area Health Office, on request, records being kept of the immunisations carried out. The scheme for immunisation against diphtheria in Southgate is part of a wider campaign which embraces the whole of Area No. 2. This campaign will shortly be modified, so that use may be made of recent developments. Thus, a more efficient method 32 of immunising children against diphtheria and pertussis combined will be introduced, while reinforcing injections of the combined immunising antigen will be available to children commencing school. Altogether, the Council can be assured that immunisation against diphtheria, either alone or in conjunction with pertussis, is being actively pursued in Southgate. and that this policy is of advantage to the children. It might be noted that the occurrence of cases of poliomyelitis in the neighbourhood are carefully scrutinised, so that the existing scheme may be modified for a time in the light of such incidents. Scarlet Fever Scarlet fever notifications during 1951 were slightly less than those for the previous year (99) as against 115). The total approximates to the average for the post-war years. 1 have commented on several occasions on the very mild type of scarlet fever which is now occurring. I will therefore content myself with stating that, although this is highly satisfactory from the point of view of morbidity and mortality, the very mildness of the disease gives rise to many administrative problems. This particularly applies to exclusion from school. Each case is treated as an individual problem both as regards removal to hospital, exclusion of contacts, and terminal disinfection. The assistance of the Central Public Health Laboratory is requested whenever it appears that a bacteriological investigation is called for in a school. This assistance was not necessary during 1951. Acute Anterior Poliomyelitis From the table of infectious diseases set out on page 37, it will be noted that only one case of acute anterior poliomyelitis occurred during 1951. This is very satisfactory, although it must not be taken for granted that the low rate will continue. We must obviously be prepared for a recrudescence of this disease at any time, and must be ready with our control measures. So long as poliomyelitis is not prevalent in Southgate or any surrounding district, it would appear wise to abstain from any measures of publicity which might tend to encourage a feeling of uneasiness or even alarm. We therefore content ourselves with making a balanced leaflet on poliomyelitis available throughout the district, and by treating all suspected cases of poliomyelitis as though they were, in fact, suffering from this disease, until the contrary has been proved. This applies to contacts as well as to cases. In doing so, we always endeavour to ensure the absence of 33 sensationalism. This is particularly important, as most of these cases are eventually proved to be suffering from some other form of infection. Measles Nine hundred and eighty cases of measles were notified during the year, as against 629 in 1950. This total was unusually high, and was part of the national picture. Once again, the type of disease met with was extremely mild. Admission to hospital was only required in eight cases. Pertussis Although the number of cases of measles which occurred during 1951 was higher than the total for the previous year, pertussis notifications showed a slight drop (126 in 1951, as against 155 in 1950). It was once thought that the incidence of these diseases tended to run along parallel lines. Our views have now had to be modified, due to various circumstances. It is extremely doubtful whether the amount of immunisation against pertussis, mostly carried out in conjunction with diphtheria, has yet had time to influence the incidence of this disease. I am personally convinced that, if immunisation against pertussis were pursued with the same vigour as had been the case with immunisation against diphtheria, the results would be comparable. At the moment, we await the findings of the widespread investigation at present being carried out by the Medical Research Council. If this investigation produces the type of evidence which is, I believe, expected, it is sincerely to be hoped that pertussis will receive the same attention in regard to immunisation as did diphtheria during the war. Food Poisoning Sixteen cases of food poisoning occurred during 1951, as against 22 during the previous year. Against this, it should be noted that 57 cases of Sonne dysentery occurred during the same period, as against 28 in 1950. As before, it is virtually certain that these figures represent no more than a percentage of the total number of cases which occurred. Our policy of collecting specimens of faeces from all cases of food poisoning or suspected food poisoning, and also from family contacts, has been continued. It is, perhaps, unfortunate that districts vary in the matter of the bacteriological control of these types of infection. This is particularly significant when it is remembered that a district such as Southgate can never expect to remain a separate entity, being directly influenced by what happens in surrounding areas. 34 I have considered this matter very carefully on more than one occasion, and have discussed it fully with my medical and sanitary staff, both in the Public Health Department and in the Area. After weighing all the possibilities, I am satisfied that we are pursuing a commonsense, logical policy, based on the scientific information at our disposal. I am also convinced that our policy, although it does mean a collection of many specimens, is economical, both in time and money, if a long-term view is taken. This policy also has the advantage of allowing us to investigate the family circumstances of each case of food poisoning or dysentery. Tt can further be said that the families in which such cases occur are very often reassured by the action taken. Puerperal Pyrexia Five cases of puerperal pyrexia were notified during the year, as against five in 1950. It is pleasing to be able to report that no maternal deaths occurred during the year. Smallpox Although no cases of smallpox occurred in Southgate during 1950, several suspected cases were reported. In each instance, these proved to be cases of chicken-pox. Vaccination against smallpox is not the concern of the Borough Council, but is a subject in which we are obviously interested. In this connection, it might be stated that the Middlesex County Council has authorised the carrying out of vaccination at welfare clinics within the County. It is certainly a fact that the level of vaccination has fallen very seriously throughout the country, and that Southgate is no exception. I have therefore taken the opportunity to stress the value of vaccination in occasional newspaper articles; as Area Medical Officer I also address a letter to the parents of all young infants, strongly advising vaccination. Tuberculosis Sixty-nine cases of tuberculosis (60 pulmonary, 9 nonpulmonary) were notified during the year, as against 67 in 1950. The distribution of the cases notified among the various wards during the year was as follows: North-East North-West South Middle 17 15 27 10 35 A broad classification of the cases notified during the past three years in relation to employment was: 1949 1950 1951 Clerical 24 15 9 Housewives 10 12 24 Children 8 4 2 Manual Labour 11 8 — Factory Workers 6 2 5 Professional Classes — 3 — Armed Forces 2 2 1 Domestic Service 5 1 — Food Trades 1 2 — Students — 4 — Shop Assistants — 3 — Nurses 1 — — Civil Servants — — 3 Engineers — — 3 Schoolboys — — 5 Draughtsmen — - 2 Photographers — — 2 Unclassified 15 11 11 83 67 69 We are continuing to collect statistics relating to the occurrence of tuberculosis in the Borough, in the hope that sufficient material will eventually be obtained, from which we will be able to draw significant conclusions. At the moment, our figures are much too small to justify any such conclusions. There are once again no specific conditions existing in and peculiar to the Borough, which might be stated to favour the occurrence or spread of tuberculosis. It will, of course, be appreciated that overcrowding remains one of the most potent factors in the continued incidence of tuberculosis, especially in a Borough such as Southgate. While this report is being written, notification has been received that Mass X-ray Unit No. 5B will visit Southgate during 1952, and that we may look forward to a repetition of the valuable services which this Unit provided some two years ago. 36 NOTIFICATIONS OF INFECTIOUS DISEASES, 1951. Jan.— March. April— June. July— Sept. Oct.— Dec. Totals. Scarlet Fever 25 37 19 18 99 Whooping Cough 84 35 5 2 126 Poliomyelitis: Paralytic — — — — — Non-paralytic 1 — — — 1 Measles 566 401 9 4 980 Diphtheria — — — — — Pneumonia 25 5 — 3 33 Dysentery 20 24 1 12 57 Smallpox — — — — — Encephalitis — — — — — Erysipelas 5 1 5 1 12 Meningococcal Infection 2 — — — 2 Food Poisoning 7 1 1 7 16 Puerperal Pyrexia 2 2 — 1 5 Tuberculosis— Pulmonary 13 16 18 13 60 Non-pulmonary 3 1 4 1 9 Totals 753 523 62 62 1,400 37 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. P. M. F. Cases on Register 1/1/51 277 234 39 44 594 Cases notified for first time in 1951 41 19 4 5 69 Cases Restored to Register 3 1 - — 4 Other cases added 6 15 1 2 24 Cases Removed from Register 35 28 1 7 71 Cases Remaining on Register at 31/12/51 292 241 43 44 620 TUBERCULOSIS—1951. 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 4 - - - - - - - 15-20 years 2 3 1 — — - — — 20-25 years 7 9 1 1 — 1 — — 25-35 years 11 12 1 2 1 3 — — 35-45 years 7 6 — 2 — 3 — — 45-55 years 5 3 — 1 1 — — — 55-65 years 5 2 1 — 2 2 — — Over 65 years 2 — — 1 4 — Unknown - - - - - - - - Total 43 37 5 7 8 9 — — * These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having Temoved into the district. 38 Appendix 1 HEALTH EDUCATION Health Education in Southgate during 1951 again followed substantially along the lines reported in previous Annual Reports. During the year, 24 local organisations were visited, and were supplied with either a health talk or with a combined film show and talk. I would like to express my gratitude to those organisations who have accepted a speaker from the staff of the Public Health Department, with or without films. These meetings are not only valuable from the point of view of health education ; they allow us to make personal contact with local burgesses, and to meet them in a friendly atmosphere in which discussion is encouraged. The success or failure of the public health measures adopted in a district depend to an appreciable extent upon the goodwill of the recipients. Unless we can make it quite apparent to all concerned that we are friends and never enemies, that our object is to help and not to hinder, we can scarcely expect the degree of co-operation which is so desirable. I am fully convinced that health education helps to break down those barriers which so often stand between officials of the Public Health Department and their obvious duty. This would certainly seem to be the case in Southgate, where co-operation is generously offered. The Council will be aware that the sound film projector now in use was purchased in 1938. Since that time, it has been used on several thousand occasions, and has been repaired more than once. The projector has now passed its best; indeed, we can scarcely look forward much longer to efficient service. The time would seem to be fast approaching when the Council should consider replacing this valuable means of health education. It will, 1 think, be generally agreed that the purchase of our present film projector was a very wise move. We have had excellent service from it; there is at present no alternative to its use. I therefore hope that the Council will consider this matter during 1952. May I once more express my personal gratitude to the editors of our local newspapers for the invaluable courtesy and assistance in the matter of periodic articles. Here again, there is no alternative to the local newspaper as an invaluable means of disseminating information at the right time and to a large number of people. 39 Appendix 2 LETTERS TO DOCTORS The following letters were sent to general practitioners practising in Southgate during 1951. It is worthy of note that the relations existing between the general practitioner and the Public Health Department have been close and cordial for many years. We rely in very large measure upon the work carried out by the family doctor, and upon information received from that source. We are indeed fortunate in Southgate, in that this co-operation and exchange of information has never been lacking: January 15th.—Influenza. January 19th.—Influenza. January 31st.—Visit of Mass X-ray Unit 5B to Hornsey. June 26th.—Public Health (Leprosy) Regulations 1951. August 7th.—Puerperal Pyrexia Regulations 1951. December 4th.—Sonne Dysentery. 40