aC 439(1) Southgate BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the year 1952 Wm. CLUNIE HARVEY, M.D.. D.P.H. Medical Officer of Healtih Sou G- 37 BOROUGH OF SOUTHGATE ANNUAL REPORT of tlie Medical Officer of Health for the Year 19 52 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 1952. Once again, the Annual Report takes the form in which it has been presented during the past few years. As I have mentioned before, it is in many ways unfortunate that the Annual Report of the Medical Officer of Health no longer covers such a wide and comprehensive field as that to which we were accustomed before the war. It will be appreciated that almost every phase of activity within our boundaries can be said to affect health, either directly or indirectly. Thus, it is very proper that the Annual Report of the Medical Officer of Health should make mention of such amenities and services as our parks and open spaces, our open-air swimming bath, and the work of refuse collection and disposal. It is equally desirable that the report should, where necessary, make reference to cultural activities and to the manner in which our leisure time is being occupied. I am not, however, referring so much to this aspect of the Report, since conditions have not materially altered, at least in recent years. I would refer to the fact that the personal health services, which used to form such an integral and illuminating part of the Medical Officer's Report, can now only be discussed in a detached, non-critical manner. The explanation is, of course, obvious. These services are provided in Southgate by the Middlesex County Council. The writer of this report, although Medical Officer of Health for Southgate, is also an officer of the Middlesex County Council. Criticism would thus be invidious and, in the circumstances, highly embarrassing ! I do not mean to suggest that there is, in fact, any reason for criticism. I merely mention the existing situation, so that the reason for the omission of certain information which used to be such a prominent feature of my Annual Report will not be misunderstood. 3 I should say, however, that although the operation of the personal health services in Southgate receives very limited attention in this Report, the Public Health Department is keenly interested in the provision of these services, and closely co-operates with the County Council's staff in their implementation, so far as our powers permit. Thus, the closest liaison is maintained between the staffs of the Public Health Department, the School Health Service and the Area Health Office. Consultations are held as and when necessary ; combined visits are very often paid to schools and to individual homes, where it appears that members of two or more staffs may be concerned. At all times information is readily available between the three departments mentioned. We thus try to avoid working in watertight compartments, a state of affairs which is becoming all too frequent these days, and which is apt to lead to quite unnecessary wastage of time and energy. Having regard to the extremely complicated machinery of local government which we are endeavouring to operate, the importance of team work cannot be over-emphasised. This team spirit must extend beyond the Public Health Department itself, and should include those workers in the same field who may not be employed by the Borough Council. I am happy to think that this team spirit does exist in Southgate, that it is helping us to overcome difficulties which the involved, artificial structure of preventive medicine as it exists today so often presents. At the time of writing this Report, it appears that still further changes are pending. It is not my province to anticipate events, nor to dogmatise on the suggested alterations. I would merely state that we will continue to work as in the past, making the best of conditions as we find them and suggesting improvements, so that the system in force may operate with the maximum efficiency. Compared with pre-war years, it must be admitted that this is becoming a more and more difficult task. Those of us who remember the part which districts such as Southgate played in preventive medicine in the past are very sensible of the change, and regret it sincerely. None the less, as I have stated, it is our duty as officials to get on with the job, and to see that the system works to the advantage of the community. This -we will most assuredly do. So far as 1952 is concerned, the year was satisfactory. The statistics relating to the period under review will be found set out in the body of the report, with appropriate comments. It might meantime be stated that the Infantile Mortality Rate, i.e., the number of children born in the Borough who died during the first 12 months of life, set up a new record for the Borough. This figure (11.61) is considerably lower than any rate yet recorded in 4 Southgate, and would have been unbelievable not so many years ago. Here, of course, one must issue a word of warning. The number of deaths concerned is so small that a very few additional fatalities would greatly increase the rate. This is a point which one must always bear in mind. The Birth Rates and Death Rates for the Borough were both low, but call for little comment at this juncture. The infectious diseases picture was satisfactory, especially in so far as the type of case met with during the year was extremely mild. The number of measles cases recorded (421) was extremely high, but the epidemic caused no alarm and seems to have run its course without severe after-effects. It is my very pleasant duty to express my sincere thanks to the Aldermen and Councillors of the Borough Council and to the members of the Public Health Committee for their continued support. This is no lip service. The support which the Public Health Committee has given its staff over so many years, and which I personally have enjoyed for more than 22 years, has been a constant source of help and inspiration, without which our burdens must surely have increased. I should also like to thank the staff of the Public Health Department for their loyalty and team-work throughout the year. Once again, the tribute is sincere. As before, ! would especially mention the work of Mr. A. E. Gooday, Chief Sanitary Inspector. Mr. Gooday has been of undeviating assistance to me throughout the year, and has never failed to accept any responsibility which I asked him to shoulder. 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 12th May, 1952 Alderman G. Peverett (Chairman) Councillor H. S. Beardow Councillor Mrs. D. M. Deacock Councillor Mrs. C. T. McConnell Councillor R. Prior (Vice-Chairman) Councillor A. V. Stapleton Councillor A. F. B. Start From 20th May to 31st December, 1952 Councillor R. Prior (Chairman) Alderman G. Peverett (Vice-Chairman) Councillor H. S. Beardow Councillor Mrs. D. M. Deacock Councillor S. C. Jenner Councillor A. V. Stapleton 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.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 (resigned 30th Augu'st, 1952). Miss M. R. Byrne (appointed 1st September, 1952). Junior Clerk: Miss J. A. Wright. 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, 1952 72,480 Number of Inhabited Houses (end of 1952) according to Rate Books 21,620 Rateable Value (1952) £938,313 Sum represented by a penny rate (1952) £3,820 The remarks set out under this heading in the Annual Report for 1951 stand, and need not be repeated in detail. It will be sufficient to emphasise the importance of constant supervision, so that the nature and individuality of Southgate is maintained at its present level. I would again repeat that this is not an easy matter. Thanks to careful planning in the past, Southgate enjoys many advantages denied to other districts. This does not mean, however, that we can afford to be in any way complacent. A policy of laissez-faire would be highly injudicious; if one cannot improve—and who can say that this is beyond our powers ?—we must at least retain those characteristics and amenities which have made Southgate such a pleasant place in which to live and work. The foundations of a healthy district have been very soundly laid in Southgate. It is quite impossible to estimate the degree of health and happiness which such amenities as our delightful parks and open spaces, our open-air swimming bath, our wide pleasant streets, even our many and significant cultural activities, have provided over the years. It can at least be said that the sum total is substantial. Although it is very often claimed that the Southgate of today owes much to the planners of yesterday, this is a statement which can well bear repetition. We should, however, realise lhat the problems of a fully-developed Borough, built up on many years of what can truly be described as loving care, are very different from those of an area which is still being developed, or of a congested district which has passed its zenith. This is a theme which I have felt compelled to elaborate on several occasions. I do not apologise for its reappearance. With an ageing population and a standard of property of which any Borough could rightly be proud, we are, by virtue of these facts, faced with problems which are in some ways unique. To realise this fact, to face it squarely, will go a long way towards success, 7 EXTRACT FROM VITAL STATISTICS OF THE YEAR Male Female Total Live Legitimate 394 363 757 Births Illegitimate 12 6 18 406 369 775 Birth Rate per 1,000 of the estimated population 10.37 Still Legitimate 10 9 19 Births Illegitimate - - - 10 9 19 Rate per 1,000 (live and still) births 23.93 Deaths from all causes and at all ages 900 Death Rate per 1,000 of the estimated population 10.55 Deaths from puerperal causes: Kate per 1,000 total (live and still) births Deaths From puerperal sepsis — — From other causes — — Deaths of Infants under 1 year of age: Male Female Total Legitimate 6 3 9 Illegitimate — — — 6 3 9 Infant Death Rate : All infants per 1,000 births 11.61 Legitimate—per 1,000 legitimate live births11.88 Illegitimate—per 1,000 illegitimate live births 0 Deaths from Measles—all ages 0 Deaths from Whooping Cough—all ages 0 8 POPULATION The Registrar-General estimated the civilian population of the Borough at the middle of 1952 to be 72,480, a decrease of 360 as compared with 1951. The population once again shows a slight decrease over the figure for 1951. It has often been stated that our Borough is still over-populated. If that is, in fact, the case, and the arguments in favour are very cogent, it can at least be said that we are gradually veering towards the optimum. Whether the distribution of the population in the most advantageous age-groups is equally satisfactory is quite another matter. One has only to consider the child population of Southgate set against the adult population, especially the older age groups, to realise the potential dangers which face a Borough such as Southgate in the future. This, of course, presents a major problem, a problem which is national rather than local. It is as well, however, to realise the local situation since the makeup of the population obviously has a direct bearing on the life of the community and the hazards which can be anticipated. Our health services, both those provided by the Borough Council and by the County Council, must be planned with these specific problems in mind. This planning, this pre-planning, is essential if the community is to receive the full consideration which it rightly demands. BIRTHS —BIRTH RATE The nett total births accredited to the district was 775, a decrease of 64 on the preceding year. Of these, 406 were males and 369 were females (12 males and 6 females being illegitimate). The birth rate for the year was 10.37 per 1,000 of the population. The birth rate for England and Wales for 1952 was 15.3, and for the administrative County of London 17.6. The births and birth rates for the past five years were as follows: No. of Births Birth Rates Southgate England & Wales London 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 1952 775 10.37 15.3 17.6 During 1952, the number of births recorded was 125 less than the number of deaths, as compared with 112 less in 1951. The total number of births actually registered in the district during the year amounted to 228, of which 4 were unnotified. The 9 percentage of births notified was therefore 98.27 as compared with 99.02 in 1951. The fall in the birth rate is intimately bound up with the distribution of the population in its various age-groups, as discussed above. As an increase in the birth rate to the level experienced immediately after the war would present a series of almost insoluble problems within the Borough, it might be well to say no more on this subject. MORTALITY General Mortality and Death Rate The nett number of deaths accredited to this district was 900, 51 less than in 1951. This gives a crude death rate of 12.42 per 1,000 of the population and a corrected death rate of 10.55 (rate for 1951 was 1 1.098). No. of Deaths Death Rates Southgate England & Wales London 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 1952 . 900 10.55 11.3 12.6 Infant Mortality There were nine deaths of infants under one year of age, which gives an infantile death rate of 11.61 per 1,000 births, as compared with 13 deaths and a rate of 16.494 in the preceding year. The corresponding rates for England and Wales and London were 27.6 and 23.8 respectively. The infant deaths and rates for the past five years were as follows: No. of Deaths Infantile Death Rates Southgate England& Wales London 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 1952 9 11.61 27.6 23.8 As noted in the introduction to the Report, the Infant Mortality Rate for 1952 is once again a record for the Borough. 10 It must be remembered, of course, that the figures are much too small to allow of any complacency. It must also be remembered that the Infant Mortality Rate for the country as a whole has been falling steadily for several years, although the Southgate figures are still considerably lower than those for England and Wales or for London. Having regard to the nature of the Borough, together with the social conditions applicable to the population as a whole, this is to be expected. The figures are none the less encouraging, and at least support the belief that the policy previously pursued by the Borough Council, and now implemented and extended by the County Council, is in the main satisfactory. Still-births Nineteen still-births (0 illegitimate) were accredited to the district for 1952. This is equal to a death rate of 23.93 (live and still births), the corresponding figures for 1951 being 15 still-births with a rate of 17.564. The rate per 1,000 of the population was 0.262, the rates for England and Wales being 0.35 and 0.34 respectively for 1952. The average rate for the past ten years was 21.129. It will be noted that the still-birth rate for 1952 shows a rise over the rate for 1951, which was the second lowest recorded in Southgate. Here again, we must remember that a very few stillbirths will substantially alter the rate in an upwards or downwards direction. Maternal Mortality One death attributed to causes associated with child-birth occurred in Southgate during 1952. Three deaths have been recorded in this category within the last six years, during which time 5,678 births took place. All maternal deaths are very fully investigated under a system which has recently been revised and extended by the Ministry of Health. This is a matter which concerns the County Council as local health authority : quite obviously it is equally a matter in which the Borough Council will be interested. Mortality of Persons over the age of 65 Six hundred and eight or 67.55 of the total deaths during the year occurred in persons over the age of 65. Of these, 211 died between the ages of 80 and 90, while a further 30 were over the latter age (7 males, the oldest being 96, and 23 females, the oldest being 100). As previously, diseases of the heart and circulation were responsible for more deaths in this age group than any other cause. 11 TABLE I. Causes of Death During the Year 1952 Causes of Death Male Femalf Total Rates per 1,000 of Population All causes (Civilians only). 447 453 900 12.42 1 Tuberculosis, Respiratory 7 4 11 0.15 2 Tuberculosis, Other 3 — 3 0.041 3 Syphilitic Disease 1 1 2 0.027 4 Diphtheria — — — — 5 Whooping Cough — - — 6 Meningococcal Infections — — - — 7 Acute Poliomyelitis — 1 1 0.013 8 Measles — — 9 Other Infective and Parasitic Diseases 1 1 2 0.027 10 Malignant Neoplasm, Stomach 10 12 22 0.30 11 Malignant Neoplasm, Lung, Bronchus 31 5 36 0.49 12 Malignant Neoplasm, Breast — 22 22 0.30 13 Malignant Neoplasm, Uterus — 10 10 0.13 14 Other Malignant and Lymphatic Neoplasms 36 49 85 1.17 15 Leukaemia, Aleukaemia 2 — 2 0.027 16 Diabetes 2 3 5 0.068 17 Vascular Lesions of Nervous System 40 79 119 1.64 18 Coronary Disease, Angina 92 46 138 1.90 19 Hypertension with Heart Disease 11 15 26 0.35 20 Other Heart Disease 54 82 136 1.87 21 Other Circulatory Disease 21 22 43 0.59 22 Influenza 1 2 3 0.041 23 Pneumonia 24 17 41 0.56 24 Bronchitis 31 13 44 0.60 25 Other Diseases of Respiratory System 5 3 8 0.10 26 Ulcer of Stomach and Duodenum 11 5 16 0.23 27 Gastritis, Enteritis and Diarrhoea 3 4 7 0.096 28 Nephritis and Nephrosis 3 — 3 0.041 29 Hyperplasia of Prostate 6 — 6 0.082 30 Pregnancy, Childbirth, Abortion — 1 1 0.013 31 Congenital Malformations 2 1 3 0.041 32 Other Defined and Ill-defined Diseases 26 40 66 0.91 33 Motor Vehicle Accidents 7 2 9 0.012 34 All Other Accidents 11 8 19 0.26 35 Suicide 6 5 11 0.15 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-rates per 1,000 of population for each age group. 1952 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 0.89 0.11 2 0.22 0.02 10 1.11 0.13 1-5 years 2 0.22 0.03 2 0.22 0.02 4 0.44 0.05 5-15 years 2 0.22 0.02 — — — 2 0.22 0.02 15-25 years 3 0.33 0.05 3 0.33 0.04 6 0.66 0.09 25-45 years 22 2.44 0.33 16 1.78 0.22 38 4.22 0.55 15-65 years 140 15.56 1.92 92 10.23 1.28 232 25.79 3.20 Over 65 years 270 30.00 3.59 338 37.56 4.79 608 67.56 8.38 Totals 447 49.66 6.05 453 50.34 6.37 900 100.00 12.42 13 Infantile Mortality 1952. 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 - - - - - - 1 - - 1 15 Pneumonia - - - - - - - 1 1 2 16 Diarrhoea 17 Enteritis 18 Gastritis - - - - - - 1 - - 1 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 23 Atelectasis 2 — - - 2 — - - - 2 24 Congenital Malformations 25 Premature Birth 26 Atrophy, Debility and Marasmus 27 Other Causes - 1 1 - 2 1 - - - 3 Totals 2 1 1 — 4 1 2 1 1 9 14 TABLE IV. Vital Statistics of Whole District during 1952 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 1,030 Population. 1 Number. Rate per 1,000 Population. Number. Rate per 1.000 Population. 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 22.63 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 11.09 13 15.49 1952 72,480 775 10.69 crude 900 12.42 crude 9 11.61 10.37 corrected 10.55 corrected Comparison of the Rates of Southgate with those of England and Wales, and London, for Year 1952. Rate per 1,000 Total Population. Annual Death Rate 1,000 Population per Rate per 1,000 Live Births. Live Births. Still Births. All Causes. Whooping Cough. Diphtheria. Influenza. Total Deaths under one year. England and Wales 15.3 0.35 11.3 - 0.04 27.6 126 County Boroughs and Great Towns, including London 16.9 0.43 12.1 0.04 31.2 143 Smaller Towns (1931 Census Populations L 25.000-30,000) 15.5 0.36 11.2 - - 0.04 25.8 London 17.6 0.34 12.6 — — 0.05 23.8 Southgate 10.69 crude 0.26 12.42 crude - - 0.41 11.61 10.37 corrected 10.55 corrected .15 GENERAL PROVISION OF HEALTH SERVICES Hospitals There is little difference to record in regard to the admission of cases to hospital from the Borough. We are still experiencing great difficulty in securing the admission to hospital or to a home, of chronic, elderly sick. As I have already mentioned, the population of Southgate is tending to age. This means that the number of elderly persons in the district who either live alone or with relatives is increasing year by year. It has often been stated with great truth that the increased actuarial expectation of life has brought with it many problems. Thus it is completely futile to add years on to life, unless these years can be made at least reasonably comfortable. The picture of an elderly person remaining relatively uncared for in the community, possibly suffering pain, extreme discomfort or loneliness, is highly distressing. Unfortunately, it is a situation which we meet with pathetic regularity. Apart from the action which a local authority can take under Section 47 of the National Assistance Act 1948, there is little we can do in regard to securing admission to a hospital or a home of elderly persons for whom there is, quite frankly, no expectancy of permanent rehabilitation. It will almost be a platitude to state that the hospitals continue to be understaffed, sometimes to a dangerous degree. They are therefore only able to cope adequately with acute cases, where admission to hospital is more or less a necessity. This leaves a large number of persons, particularly of the type referred to above, for whom no adequate provision can be made. I would also state that Southgate seems to be particularly unfortunate in that we are, so far as elderly persons are concerned, included in a catchment area which places us at a very definite disadvantage. I have taken this matter up very strongly with the special Liaison Committee set up under the auspices of the North Middlesex Division of the British Medical Association, and have hopes that the position will shortly be improved. The setting up of geriatric units in connection with several large hospitals, to which Southgate patients are admitted, is a welcome innovation. Where these units have not yet been established, the Area Health staff, in conjunction with the Public Health Department, is very willing to undertake the investigation of individual cases at the request of the hospital concerned. We then have the opportunity to express opinions based on what is often an intimate knowledge of the individuals and families involved. Although we can never guarantee that our reports will secure the 16 admission to hospital of any given case, we do know that our opinions receive due weight. It will scarcely be necessary for me to point out that we do try to help our elderly chronic sick in every other way, by the supply of home nurses and home helps (Middlesex County Council) and by visits from Health Visitors and Sanitary Inspectors. Most of this work is carried out under the auspices of the County Council, although the Public Health Department is also concerned. We keep in very close touch with the Old People's Welfare Committee, and with other voluntary organisations. Finally, we make the best possible use of the homes provided bv the Middlesex County Council, and by other voluntary bodies. It will still be realised that these activities are palliative, and do not provide an ultimate solution to a problem which is constantly increasing in magnitude. At the present moment, it is difficult to visualise an adequate solution. In the meantime, therefore, we are compelled to continue our present policy, ever living in the hope, however pious, that matters will improve. It is at least satisfactory to know that special accommodation is being provided in the Borough for elderly people. This is very badly needed, and will undoubtedly play its part in providing some amelioration for a class of the community which is most unfortunately placed. The position in regard to the admission of cases of infective disease to hospital remains as set out in my Annual Report for 1951. No difficulties have been encountered, and I should like to take this opportunity once again of thanking the Medical Superintendent of South Lodge Isolation Hospital and also the Medical Superintendent of Coppetts Wood Isolation Hospital for the help and consideration so willingly supplied throughout the year. No difficulties have been experienced in regard to the admission to hospital of expectant mothers. The position in this respect has eased very considerably since the difficult days immediately following the war. Here again, of course, this is a matter which directly concerns Regional Hospital Boards and the Area Health administration of the County Council. Laboratory Facilities A summary of the work carried out at the Central Public Health Laboratory during the year 1952 is set out below. It is once again very pleasing to record the great assistance afforded by the Public Health Laboratory Service. Those of us who remember the days when we had no comparable Laboratory Service at our disposal, are very cognisant of the urgent need which this Service has met. We are not only grateful for the work carried 17 out at the Laboratories which serve this area. We are equally grateful for the fact that an expert staff is available for help and guidance whenever this is required. Nowadays, one cannot hope to claim an expert knowledge of all branches of even preventive modern medicine. It would indeed be foolish to make such a claim. It is therefore all the more gratifying that we can call upon the Laboratory Service, and that we invariably receive a prompt and cordial response to our approach. 1 make it my duty to acquaint general practitioners from time to time of the laboratory services available to them. Quite obviously, the more these services are used by the general practitioner, the more will the community benefit. In time, the fact that bacteriology is playing an ever-increasing part in medicine will be fully realised. That time has not, perhaps, yet arrived, but it would be true to say that the Laboratory Service is now accepted as a powerful ally in the constant fight against infection and disease. Summary of work carried out at Central Public Health Laboratories for the year 1952 : Positive Negative Swabs for diphtheria bacilli — 86 Sputa for tubercle bacilli 1 83 Throat and Nose 438 Faeces 329 Urine 35 Blood 47 Others 34 Mortuary The position in regard to the Council mortuary at the rear of the Town Hall is still as set out in the Report for 1946. There is every prospect, however, that circumstances will alter in 1953. Up to the present, no difficulties have arisen. Scabies and Lice I reported fully on this aspect of our work in the Report for 1951. The remarks set out in that Report still apply. 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 1952 under this Section. 18 Sanitary Services Summary of Visits, 1952 Inspections re complaints received 1,083 Re-visits in connection therewith 4,241 Visits to Food Premises (including butchers, bakehouses, cafes, restaurants, fish shops and dairies) 1,504 Inspections re Shops Act 1950 460 Inspections re Factories 307 Visits re housing conditions and overcrowding (applicants for housing accommodation) 128 Visits re Infectious Diseases 850 Visits re Places of Public Entertainment 40 Visits re Prevention of Damage by Pests Act 1949 1,853 Visits re Rag Flock and other Filling Materials Act 1951 100 Visits re smoke observation 28 Miscellaneous Visits 5,119 15,713 Service of Notices Total informal sanitary notices served 436 Total informal dustbin notices served 270 Total informal notices served 706 Total informal notices complied with 707 Total statutory notices served 57 Total statutory notices complied with 62 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 to 451 houses following inspections and service of notices by the 19 tors. In 57 instances it was found necessary to follow up Intimation Notices by the service of Statutory Notices under the Public Health Act 1936 or the Housing Acts 1936/49 in order to secure execution of the necessary repairs. In the case of one house, legal proceedings had to be instituted against the owner to enforce compliance with a Statutory Notice. The repairs, however, were carried out prior to the Court hearing. Accordingly, after an adjournment to ascertain that the repairs carried out had abated the nuisance, the Council's application for a Court Order was not proceeded with. Costs were granted to the Council. The repairs carried out at 127 of the 451 houses referred to above were of a major character, including such works as extensive roof repairs, damp-proofing of walls, provision of site concrete, underpinning of walls, renewal or extensive repair of flooring, renewal of windows, extensive renewal of wall and ceiling plaster, and renewal of external paintwork. At the remaining 324 houses, the repairs were not of such an extensive nature, but were necessary to abate specific nuisances. No Demolition Orders under Section 11, Housing Acts 1936/49 were made by the Council during 1952. Housing Applications Visits by the Sanitary Inspectors to applicants for housing accommodation and the preparation of reports as to living conditions has continued in 1952. The number of visits for this purpose remains understandably low, being 128 as against 130 in 1951, 260 in 1950, 560 in 1949 and 969 in 1948. The close liaison existing between the Public Health Department and the Housing Department has been maintained during 1952. As in previous years, on several occasions 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, 1,504 visits were made to food premises in the Borough as against 1,453 in 1951. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. It was not found possible to arrange a Clean Food Week during 1952. Arrangements were made during the year, however, to hold a Clean Food Month during the spring of 1953. The programme has already been carried out, although its implementation does not fall within the scope of this Report. A full report 20 was, however, made to the Public Health Committee; the result of our activities will be discussed in next year's Annual Report. We have taken the opportunity during the year to stress the importance of clean food in the various talks and film shows arranged for local organisations. As before, the Sanitary Inspectors also take the opportunity during their daily visits round the district of pressing forward the need for a wider understanding of food hygiene. It is at least satisfactory that no major outbreak of food poisoning was reported in Southgate during 1952. There is none the less considerable room for improvement. I intend to submit a detailed report to the Public Health Committee on this aspect of our work, having regard to the outcome of our Clean Food Month, together with suggestions relating to the education of food handlers and the raising of present standards. Meantime, we await amendments to the present Food and Drugs legislation, now long overdue. 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: Fish 55 stone Carcase Meat 2,321 lbs. Sausages 124 lbs. Rabbits 856 lbs. Canned Corned Beef 20 lbs. Canned Luncheon Meat 284 lbs. Canned Cooked Ham 575 lbs. Canned Tongue 15 lbs. Canned Food (various) 2,855 cans Cheese 14 lbs. Processed Cheese 36 packets Cake 8 lbs. Pudding Mixture 13 lbs. Flour 38 lbs. Biscuits 94 lbs. Cereals 120 packets Dried Fruit 421 lbs. Jams and Marmalade 69 lbs. Tomato Puree 70 lbs. Salad Dressing 4 jars Pastes and Pickles 10 jars Eggs 55 Dried Egg 2 packets Sweets 8 lbs. Post-Mortem Inspection of Animals No slaughtering of animals took place in the Borough during 1952. Milk Regulations and Milk Sampling During 1952, 77 samples of milk, as against 83 in 1951, were obtained and submitted to the Public Health Laboratory for bacteriological examination. All the samples were found to be satisfactory. lee-Cream Sampling During 1952, 174 samples of ice-cream, as against 77 in 1951, were obtained for bacteriological examination. Of the samples taken : 98 were Grade 1 41 „ „ 2 17 „ „ 3 18 ,, „ 4 It is of interest to record that of the I74 samples, 76 were 22 taken during an investigation into the unsatisfactory methods of one manufacturer in respect of the production, storage and distribution of ice-cream. At one stage of the investigation, the Public Health Committee had seriously to consider possible revocation of the registration of the premises for the manufacture and sale of ice-cream. The proprietor, however, acting on advice received from his trade association and from the Sanitary Inspectors, effected improvements to his premises, and improved his methods of manufacture, storage and distribution. These improvements brought about a marked up-grading of the ice-cream concerned. The Laboratory reports on the samples gave valuable assistance in demonstrating to the proprietor (a) the unsatisfactory state of affairs at the commencement of the investigation, and (b) the marked improvement at its conclusion. Establishments for Massage or Special Treatment Under the Middlesex County Council Act, 13 existing licences were renewed, and three new licences were granted. Swimming Bath The figures of attendances at the Barrowell Green Open-air Swimming Bath for the last two years were as follows: 1952 1951 Mixed Bathers 62,656 51,195 From Schools 4,671 3,687 Season Ticket Holders 12,605 10,426 79,932 65,308 Spectators 3,883 4,489 Costumes, etc., hired 230 229 The arrangements whereby samples of the water in the swimming bath are taken at regular intervals has been continued. The results of the samples taken during 1952 were satisfactory in every case. Attendance at the bath of members of the St. John Ambulance Brigade during crowded sessions and hot weekends has also continued. This assistance is very greatly appreciated. I can add nothing to the remarks which 1 have made in my previous Annual Report regarding the usefulness of our Open-air Swimming Bath, not only as a very pleasant amenity, but as a truly health-giving service. I am always delighted to visit the swimming bath, and to see the excellent manner in which the premises are being maintained. It is particularly pleasant to call in at the bath during a hot weekend and to see large numbers of adults and young people enjoying themselves and gaining such obvious benefit under delightful conditions. Although the prices of admission to our swimming bath have 23 been slightly increased of late years, I understand that these prices are considerably lower than in surrounding districts. From a public health standpoint, I am completely satisfied that this is a very wise move. Although we can never guarantee that residents of neighbouring authorities do not take advantage of the facilities provided in Southgate, we can be equally sure that our own population, especially the children, are being provided with a healthgiving amenity of the greatest value, which is still well within the financial reach of all members of the community. In other words, our Open-air Swimming Bath represents an insurance policy, the premium for which is trifling in comparison with the lasting benefits received. Rivers and Streams There is nothing to report beyond the statement set out under this heading in the Annual Report for 1951. Prevention of Damage by Pests Act 1949 During 1952, 442 complaints of rats and mice were received as against 513 in 1951. In March, 1952, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 358 manholes were baited. In 129 of these complete or part takes of bait were noted. Following a request made in 1951 by the Ministry of Agriculture and Fisheries, poison takes were recorded during this treatment. Of the 358 manholes treated. 12 showed complete takes of poison and 51 showed part takes of poison. In September, 1952, test baiting was carried out by the Borough Engineer's Department to 266 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 352 manholes were baited. At the request of the Ministry of Agriculture and Fisheries, an alternative bait base and poison was used for this treatment. Poison takes in the manholes were again recorded. Of the 352 manholes baited, poison bait was taken completely in 11 manholes and partly in 47. In the remaining 294 manholes, there was no take of poison bait. 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 carried out. 24 Public Conveniences Seventeen public conveniences are available in the Borough, situated as follows: Broomfield Park (2). Arnos Park. Bramley Sports Ground. Oakwood Park. Grovelands Park. Tottenhall Sports Ground. North Circular Road, Palmers Green. Triangle, Palmers Green. Fords Grove, Winchmore Hill. Southgate Tube Station, N.14. "Cherry Tree" Hotel. "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 are situated. The Public Health Committee has again considered the advisability of providing at least one additional convenience within the Borough. Nothing has yet been definitely settled, so that this is not a matter which need be discussed at length in this particular Report. There is, however, one other matter which calls for comment. In July, 1951, the Borough Council decided to offer free washing facilities, including soap, hot water and paper towels, at those public conveniences within the Borough which were manned by a full-time attendant. It is extremely difficult to determine the actual benefit of this service, but I am fully convinced that it was a public health measure in the truest sense of the term. It has always seemed ridiculous to find notices in a public convenience advising visitors to wash their hands, and then to charge them a few coppers for what should be considered a routine duty. The provision of free washing facilities has removed this anachronism, and has ensured that the Borough Council does make it as easy as possible for individuals visiting their conveniences to take such 25 safeguards as will reduce the spread of disease from at least one source. I understand that, although no definite check has been kept on the number of individuals using these facilities, they have been appreciated. I also understand that the privileges are not being abused. 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 1951, 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). 1 S. & D. Freighter (fore and aft tipper). 2 Karrier Barrier Loaders. 3 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 was 16,926 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 948 6 2 Cullet 6 11 0 Metals 1 19 2 Rags 31 12 2 Carpets and Gunny 25 4 2 Tins 494 19 3 Bottles 24 18 0 Mixed Scrap 85 7 0 The value of this material amounted to £12,176 4s. 4d. 26 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, 986 tons of kitchen waste were collected. Under instructions from the Board of Trade, this was sold to Tottenham Borough Council for £3,762. 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 1952. 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 66 78 6 – 1 (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 2 155 229 11 – 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 3 – – – – 3 Total 221 307 17 – 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.1) 4 12 12 – – – 4 Overcrowding (S.2) 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 1 1 – 1 — 9 (b) unsuitable or defective 10 7 7 – 4 — 10 (c) not separate for sexes 11 – – – – – 11 Other offences against the Act (not including offences relating to Outwork) 12 – – – – – 12 Total 60 20 20 – 5 – 60 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 cases of default in sending lists to the Council. No. of instances of work in unwholesome premises. Notices served. Prosecutions. M/c. Line No. Wearing Apparel- Making, etc. 13 127 — — — — — — Cleaning & Washing 14 — — — — — — — Curtains & Furniture Hangings 17 2 — — — — — — Fur Pulling 22 1 — — — — — — Artificial Flowers 28 5 — — — — — — Paper Bags 33 1 — — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 4 — — — — — — Brush Making 35 13 — — — — — — Feather Sorting 37 4 — — — — — — Stuffed Toys 39 9 — — — — — — Cosaques, Christmas crackers, Christmas Stockings, etc. 42 2 — — — — — — Lampshades 44 2 — — — — — — Total — 179 — — — — — — 29 Prevalence and Control of Infectious Diseases From the table of infectious diseases set out on page 38. it will be seen that 781 cases of infectious disease were notified during the year, as against 1,400 in 1951. The Infectious Sickness Rate for the district was therefore 10.77 as compared with 19.22 during the previous year. The fall in the Infectious Sickness Rate was entirely due to a reduction in the number of cases of measles reported, from 980 to 421. As the Council will be aware, measles became more prevalent during the last quarter of 1952, and showed a very marked rise during the early part of 1953. As the previous period of measles prevalence covered the first six months of 1951, this means that the two-yearly interval between measles epidemics was reduced. This is in keeping with what has been happening during recent years, when the timing of a measles epidemic can no longer be accurately predicted. The type of infectious disease met with has once again continued mild, with few complications or deaths and a very limited demand for admission to hospital. This, of course, is the standard by which any period or district must be judged. It is quite impossible to ensure that infection of one kind or another is not imported into an area such as Southgate. What we do hope is that, although the infective agent is present, and although a varying number of susceptibles will be affected, the ultimate reaction, i.e., the appearance of a specific disease, will not be serious. Provided this is the case, and provided those individuals who develop an infectious disease recover without mishap, the situation might be described as satisfactory. I think it can be said that this has been the case so far as Southgate is concerned. I would once again remind the Council that the field of epidemiology is very wide, and that we must now think in terms very much wider than the investigation and control of common infectious diseases. As I stated in my Annual Report for 1951, the appearance in greater numbers of virus diseases is a matter in which we must be very keenly interested. We must also interest ourselves in any local conditions which are liable to encourage disease in any shape or form. Unfortunately, although it is very easy to say this, it is not so easy to carry the principle into practical effect. Indeed, I am sometimes disturbed by the glib statements which are occasionally made concerning the role which the Medical Officer of Health has to play in this particular field. It is readily admitted that the Public Health Committee and its Medical Officer of Health must be intimately concerned with the removal of 30 tions which encourage disease. This is an obvious truism, with which no-one will disagree. When one appreciates, however, that much of this problem will always be bound up with housing, travelling to business under conditions which should in theory decimate the population, and other related problems, and when one appreciates how little a local authority can do at the present juncture, the futility of vague impracticable statements can only be deplored. The housing position in Southgate although, as the Council will be aware, not what we desire, is apparently not so serious as in nearby districts. That, at all events, is the opinion which I have gathered after consultation with hospitals and chest clinics. It is also a known fact that the factory situation in Southgate presents very minor problems, which cannot be said to affect the population to any appreciable extent. When we come to consider the psychosomatic type of disease, of which coronary thrombosis and gastric and duodenal ulcers are probably the most prominent members, the position is still more involved. We all know that the occurrence of psycho-somatic diseases, very often extremely serious, is closely linked with the stress and strain of modern life. Here again, it could scarcely be said that residence in an area such as Southgate adds to this strain, unless the trying conditions entailed by travelling to and from London each day can be regarded as a significant factor. We must therefore continue to review the whole field of epidemiology from time to time, so far as Southgate is concerned, with a view to taking such action as is possible to eliminate or at least reduce known sources of danger. This will be done so far as is practicable. But it must once again be stated that, in a Borough such as Southgate, this is not such a simple problem as many facile writers and speakers seem to imagine. Diphtheria For the fifth year in succession, no case of diphtheria was notified in the Borough. Almost six years now have elapsed since a case occurred in Southgate; the last death took place approximately ten years ago. I took the opportunity in the Report for 1951 to set out in some detail the measures which the County Council are taking in this area in regard to immunisation. The programme is still being maintained, with certain amendments and additions, suggested by accumulated knowledge. Thus, children of five years of age entering our maintained and private schools are now being offered a reinforcing dose of combined antigen, if this is the type of immunisation which they received in infancy. We are also contemplating an alteration in the time at which immunisation is first offered, since it has now been established that immunisation can be safely 31 carried out at a younger age than was previously considered desirable. Our main object is to arrive at a time-table which will allow a child to be fully protected against pertussis, either alone or in conjunction with diphtheria, at an early age; and will also allow us to carry out vaccination without disturbing the sequence. In other words, we are trying to ensure that the administrative and family difficulties associated with immunisation and vaccination are so spaced and smoothed out, that a parent can take advantage of the facilities offered without disturbance of the child or family, and with the maximum degree of protection at the age when protection may be most required. We have not yet had sufficient time to judge the efficacy of our present programme, having regard to all the aspects involved. I hope, however, to be able to report further on this matter within 12 months. I would again state that, although immunisation is a process which is carried out in Southgate by the County Council, the Public Health Committee has very rightly expressed a keen and continuous interest in this phase of our work. It is for this reason that the details set out above have been supplied. Scarlet Fever Scarlet fever notifications during 1951 were higher than those received for the previous year (188 as against 99). The disease was again extremely mild, so much so that it would appear quite safe to say that notifications do not by any means represent the total number of cases which actually occurred. I have reminded general practitioners on several occasions of their statutory obligations in the matter of notification. It is still a fact that quite a number of mild cases of scarlet fever are almost certainly never seen by a doctor. As complications and sequelae are now extremely rare, this state of affairs is no longer as serious as would have been the case before the war. In short, the disease which we know as "scarlet fever" has a very different significance today. Although this is the case, we still have to carry out the standard procedure in regard to the exclusion of cases and contacts from school, a procedure which rests with the Public Health Department, working in conjunction with the family doctor. Fortunately, we have considerable latitude in this respect, a latitude which I never have the slightest hesitation in putting into practice. One might go so far as to say that each case has to be treated on its own merits as regards exclusion, so that a proper balance can be struck between safeguarding the patient, reducing the risk of infection and eliminating unnecessary absence from school. So long as scarlet fever retains its present mild form, we can, 1 think, be satisfied that our present policy is adequate. 32 Acute Anterior Poliomyelitis Four cases of acute anterior poliomyelitis were notified during 1952, two in the July/September quarter and two in the last quarter of the year. All four cases were paralytic. We have maintained our previous policy in regard to the investigation of cases and contacts, and in regard to the dissemination of information. The latter subject is never easy. It is highly probable, for instance, that many cases of poliomyelitis are never seen even by a doctor. These cases, which may be described as abortive, may only be ill for a few days, with general symptoms which are not in any way alarming. It would, however, be extremely dangerous to give this fact too much publicity, since many cases of simple tonsillitis or even a common cold might then give rise to grave anxiety among parents. In the absence of anything approaching an epidemic or even a seasonal outbreak, it would appear sufficient to remind parents of the general precautions which should be taken whenever a child develops a feverish illness of unknown origin, i.e.. to consult the family doctor as soon as possible and to maintain whatever isolation is possible in the home until the doctor has given an opinion. We must at all costs maintain a commonsense attitude in regard to poliomyelitis, unless or until conditions are reported which call for more stringent measures. It is probable that, during 1953, we will be carrying out certain investigations at the request of the Central Public Health Laboratory in regard to the possible spread of the responsible virus in sewage. The investigations will be conducted with due regard to the principles set out above. Although the results will undoubtedly provide useful information either of a positive or negative nature, it is highly unlikely that they will cause any disturbance among the general population. Measles Four hundred and twenty-one cases of measles were notified during the year, as against 980 cases during 1951. As indicated in the introduction to this Report, measles did not spread in Southgate until towards the end of the year, when 208 cases were reported between October and December. The disease was extremely mild on the whole, admission to hospital being required in no more than 11 cases. Pertussis The number of pertussis cases notified during the year showed a marked fall (40 as against 126 in 1951). No significance can be attached to these figures, as pertussis is a disease which is apt to show marked fluctuation over a limited period. As noted in previous Reports, we are pressing forward with our scheme of immunisation either alone or in conjunction with diphtheria. As 33 noted elsewhere in this Report, we are also planning to offer a reinforcing dose of pertussis and diphtheria combined antigen to those children commencing school who were originally immunised with this material. It is extremely doubtful whether immunisation against pertussis in a district such as Southgate can have any appreciable effect upon the population as a whole, so long as surrounding areas do not adopt the same policy, and so long as there is the degree of inter-communication between urbanised communities which exists today. None the less, I am convinced that our policy is sound, and that even although we cannot expect any spectacular drop in pertussis notifications, individual children will be protected. We must still look forward to the day when, as in certain western countries, pertussis is almost as rare as diphtheria. When one remembers that pertussis is possibly the most serious infectious illness among infants, its abolition and ultimate disappearance from the infective scene is greatly to be desired. Food Poisoning Only five cases of food poisoning, as against 16 in 1951 and 22 in 1950, were reported in 1952. If one includes the number of dysentery cases reported during 1952 (17), this still gives a total of only 22 cases, as against a total (Sonne dysentery and food poisoning) of 73 cases during 1951. From these figures it would appear at least on the surface, that food poisoning is on the decline in Southgate. This would be a wholly inaccurate assumption. It still remains a fact that the majority of cases of food poisoning do not seem to be notified; indeed, one comes to the conclusion that a great many cases of food poisoning are never seen by a doctor. This also, of course, applies to Sonne dysentery, at least so far as that disease occurs in children. It would certainly be true to say that 1952 was a very peaceful and uneventful year so far as food poisoning, in any shape or form, was concerned. No outbreaks occurred, while, so far as we are aware, the type of individual cases was extremely mild on the whole. This is satisfactory but must on no account encourage us to slacken our efforts in regard to food hygiene. As I write this report, we know that Sonne dysentery has appeared in several parts of the district in the form of limited outbreaks. We also know that quite a number of cases of food poisoning, mostly of the Salmonella type, have been reported, either associated with Sonne dysentery or as an entirely separate factor. Indeed, the prevalence of gastro-intestinal disorders has influenced me to prepare a detailed report on the subject, which should be ready for presentation to the Public Health Committee during 1953. The object of the report is to present the facts to the Public Health Committee, so far as they can be ascertained, and 34 to try to arrive at a policy of control which can be expected to produce practical results and at the same time to reduce the burden which has recently been thrown on the Sanitary Inspectors' shoulders. I am not entirely satisfied that we cannot improve our present methods, by eliminating unnecessary visits without in any way lessening control. I am firmly of the opinion that the whole matter should be reviewed in the light of experience and recent knowledge. In the meantime, we will continue our present methods of control, as we cannot afford to slacken our supervision in any respect. As already noted, it is at least satisfactory to be able to report that no outbreaks occurred during 1952, while those cases which were reported had no great clinical signficance. Puerperal Pyrexia Five cases of puerperal pyrexia were notified during the year, the same number as was notified in 1951. No deaths were attributable to puerperal causes. Smallpox Once again, no case of smallpox occurred in Southgate during 1952, although several doubtful rashes were reported. In each instance, smallpox could be eliminated. As the Council will be aware, vaccination is carried out by the County Council and not by the Borough Council. None the less, the control of smallpox is vested in the local authority, in this case the Borough Council, as part of its epidemiological programme. We must therefore be intimately concerned in vaccination as the recognised method, in this country, of controlling the spread of smallpox. A substantial number of cases of alastrim or variola minor, a mild type of smallpox, occurred in Lancashire towards the beginning of 1952. More recently, the severe or Asiatic form of smallpox has been reported from Lancashire and Yorkshire. This latter visitation makes it perfectly obvious, if the fact were not obvious before, that the state of vaccination in these islands cannot be neglected. Unfortunately, it is becoming increasingly difficult to persuade parents to accept vaccination for their infants. Immunisation is now regarded more or less as a matter of routine, and is seldom questioned. Vaccination is quite a different matter. Here, more often than not, persuasion has to be applied before the wisdom of the process is appreciated and accepted. During 1953, it is anticipated that the County Council will encourage vaccination at selected welfare centres. This should be of undoubted advantage and will, one trusts, raise the vaccination rate at a time when this is urgently required. It will scarcely be necessary for me to say that the obvious advantages of vaccination are carefully pointed out to the mothers of all young children attending our clinics. We also take the opportunity of stressing 35 this point in many of our talks to members of the general public, local organisations, etc. As Area Medical Officer, I have also arranged for vaccination to be offered to all members of the Public Health Department and Area Health staffs, approximately every year. In this way, we hope to set the right example, and to make it quite apparent that we are not inviting parents to take advantage of a safeguard which we do not ourselves employ. Tuberculosis Seventy-nine cases of tuberculosis (74 pulmonary, 5 nonpulmonary) were notified during the year, as against 69 in 1951. The distribution of cases notified among the various wards during the year was as follows: Middle 21 North-East 25 North-West 9 South 24 A broad classification of the cases notified during the past four years in relation to employment was: 1949 1950 1951 1952 Clerical 24 15 9 19 Housewives 10 12 24 10 Children 8 4 7 5 Manual Labour 11 8 — 5 Factory Workers 6 2 5 — Professional Classes — 3 3 5 Armed Forces 2 2 1 1 Domestic Service 5 1 — 1 Food Trades 1 2 — — Students — 4 — 1 Shop Assistants — 3 — 4 Nurses 1 — — 3 Non-manual Trades, other than Food — — 7 15 Teachers — — — 2 Unclassified 15 11 13 8 83 67 69 79 From the statistics so far collected, it is still not possible to arrive at any definite conclusions. This is scarcely surprising, as one would hesitate to draw significant inferences from such a limited series of observations. However, I will continue to report our findings each year, so that in time it may be possible to present a more composite picture of the incidence and spread of tuberculosis within the Borough. Meantime, it can once again be stated that there does not appear to be any specific condition existing in Southgate which might be regarded as favouring the occurrence or spread of tuberculosis. 36 It is becoming more and more obvious that the number of cases of tuberculosis appearing on the official register is specifically influenced by the nature of our Borough. Apart from indigenous cases which arise in residents, there can be little doubt that patients, either in the mild early stages of the disease or after recovery, move to Southgate when accommodation is available. This is something which we must recognise, and which a residential area such as Southgate must be prepared to accept. Indeed, it is a frank testimonial to the reputation which Southgate has acquired over the years. During 1952, Mass X-ray Unit No. 5B visited Southgate for the purpose of examining the staff of the Eastern Electricity Board. During this visit, opportunity was taken to invite local organisations to take advantage of the facilities offered. At the same time, I wrote to general practitioners in the district, informing them of the Unit's visit and inviting them to send any of their patients along for a miniature X-ray. I also issued a general invitation to the staff at the Town Hall, and through the courtesy of the editors concerned, had a brief article inserted in each of the local newspapers. So far as housing is concerned, we keep in very close touch with the Finchley Chest Clinic, which deals with patients from Southgate. Any cases which the Chest Clinic wishes to draw to the attention of the Housing Section receive immediate and adequate attention. I am still convinced that good housing presents the most hopeful and permanent solution to the problem of tuberculosis. I should like to express my gratitude to the Housing Committee and to the officers of the Housing Section for their unfailing courtesy and willingness to consider all the evidence set before them. Even in the present difficult circumstances, it is obvious that the Housing Section is making a substantial contribution to this problem. During 1952, the Ministry of Health notified us that certain changes would be made in the registration of cases of tuberculosis. Broadly speaking, the official register is now being maintained by the appropriate Chest Clinics, although the Minister stated that he hoped an unofficial register would continue to be kept by local authorities. We have done this, so that we may know at any given time what is happening in the Borough. Our Sanitary Inspectors continue to visit cases of tuberculosis, not for the purpose of making unnecessary enquiries, but in order o ascertain whether there is any way in which the Public Health Department can be of assistance. Occasionally, we are told by the Chest Clinic that a patient does not wish us to visit. In such circumstances, we have due regard to the patient's wishes. 37 NOTIFICATIONS OF INFECTIOUS DISEASES, 1952. Jan.— March. April— June. July— Sept. Oct.— Dec. Totals. Scarlet Fever 42 26 32 88 188 Whooping Cough 10 15 12 3 40 Poliomyelitis: Paralytic — — 2 2 4 Non-paralytic — — — — — Measles 17 143 53 208 421 Diphtheria — — — — — Pneumonia 7 6 2 7 22 Dysentery 7 2 5 3 17 Smallpox — — — — — Encephalitis — — — — — Erysipelas — — — — — Meningococcal Infection — — — — Food Poisoning — 1 3 1 5 Puerperal Pyrexia — 1 2 2 5 Tuberculosis— Pulmonary 21 20 9 24 74 Non-pulmonary 2 1 — 2 5 Totals 106 215 120 340 781 38 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. F. M. F. Cases on Register at 1/1/52 292 241 43 44 620 Cases notified for first time in 1952 34 40 3 2 79 Cases Restored to Register 1 1 — — 2 Other cases added 7 11 j 2 — 20 Cases Removed from Register 19 23 2 3 47 Cases Remaining on Register at 31/12/52 315 270 46 43 674 TUBERCULOSIS—1952. 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 — 1 — — — — — 10-15 years — — 1 — — — — — 15-20 years 4 8 — 1 — — — — 20-25 years 6 15 — — — — — — 25-35 years 4 9 — — 1 1 — — 35-45 years 6 5 1 1 1 2 — — 45-55 years 6 1 — — — 1 — 55-65 years 3 1 — — 1 1 — — Over 65 years 3 — — — 2 — 1 — Unknown — — — — 2 — 1 — Total 34 40 3 2 7 4 3 — *These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having removed into the district. 39 Appendix 1 HEALTH EDUCATION Our programme of health education during 1952 followed very closely along the lines set out in detail in previous Reports. Forty-four health talks, with or without health films, were given during the year to local organisations. Although the numbers attending these meetings are sometimes not very large, and although the audiences are very often composed of individuals who almost certainly require education less than many other members of the public, I still feel that our action is justified. No-one knows where a fruitful seed may be sown, or what the results may be. For those reasons, I propose to accept any offer which we receive to give a talk and/or a film show, and to encourage local organisations to make use of the facilities available. During the coming year, it is proposed to have the film projector completely overhauled. Bearing in mind the fact that this apparatus has been in use since before the war, it is hoped that when the overhaul has been completed, the projector will give improved service. As in previous years, health education in Southgate is carried out both by the Borough Council and the County Council. This is one of the obvious public health measures which benefit by joint control. It will scarcely be necessary to point out that, apart from our talks, together with the issue of leaflets and our monthly edition of "Better Health," we depend to a very large extent on personal advice issued throughout the year, particularly by Health Visitors and Sanitary Inspectors. I am happy to think that the staffs concerned are keenly alive to their responsibilities, that they miss no opportunity to pass on fundamental knowledge in a way which can be fully understood by the recipients. Finally, I would be failing in my duty if I did not once again pay tribute to the editors of our two local newspapers for their unfailing help and courtesy. This help has never been refused, and forms a most valuable adjunct to the other measures of health education carried on during the year. I should also say that the editors and their staffs are most helpful in the manner in which health items of current interest are featured in their columns. Any suggestion of panic or foreboding is strictly taboo. This can be quite an important point, which one cannot afford to neglect. Fortunately, as I have already stated, it is a problem which has never arisen in Southgate. 40