pc. Act. 3.9.54 (my) AC. 439 (1)SOUTH GATE B BOROUGH OF SOUTHGATE ANNUAL REPORT ot the Medical Officer of Health lor the Year 1955 Wm. CLUN1E HARVEY, M.D.. D.P.H. Medical Officer of Health SouG- 38 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health (or the Year 1955 Win. CLUNIE HARVEY, mix. 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 1953. The general structure of the report remains as before, although minor alterations have been made, in accordance with the instructions received from the Ministry of Health. The year 1953 was placid from a health point of view. Apart from the number of measles cases reported, to which reference will be made later in the report, the district was free from any major outbreak of infectious diseases. More important still, the type of infectious disease which occurred was mild, admissions to hospital being relatively few. Although the absence of any spectacular features from a health report such as this may be unfortunate from the point of view of the author, the fact that the road has been relatively clear of obstacles is highly satisfactory. It has frequently been stated that preventive medicine is seldom spectacular: its victories are unobtrusive, and too often pass unnoticed. For this reason, public health is apt to be taken for granted. This attitude, cither of complacency or of laissez faire, is dangerous, since preven'ive medicine must always be regarded as the real foundation on which our system of living, at least so far as positive health is concerned, should be based. This aspect of public health is particularly applicable to Southgate. Our Borough has many advantages, not only natural ldvantages, but amenities which have been provided over the years by the care and foresight of those who were responsible for Southgate's growth from a rural outpost to a busy thriving community. Just as, however, conditions of life have hardened over the past few decades, so far as the individual is concerned, the lifficulties which face a community such as Southgate are constantly increasing. We have few, if any, slums; our carefully regulated density of population, our parks and open spaces are an envy to many. None the less, the housing and economic situation is making it clearer every year that the fight to maintain what we have won must continue unabated, if not with added power. This is a fact which can bear constant repetition; to shut one's eyes to the obvious needs would be nothing short of folly. 3 The Council will be well aware that the personal health services are now under the control of the Middlesex County Council. Although this is so, the Borough Council has always shown the keenest interest in all matters affecting health, either personal or environmental. For this reason, and with the permission of the County Council, I have included as Appendix 5 to this Report a copy of a document which 1 presented to the Area Health Committee of Area No. 2. This document seis out in brief the work carried out in the Area, of which Southgate makes up a substantial part, during 1953. I am sure the Council would wish to have these facts, since without them the health picture for the year would obviously be incomplete. Although it does not come within the purview of this Report, it might be stated here that important changes are foreshadowed for 1954. The anticipated coming into operation of new legislation in regard to food hygiene and housing will throw added responsibility on the Council, and will be directly reflected in the work of the Public Health Department. It may even be that more far-reaching changes will come about in the structure of local government as a whole. No more may be said on these issues at the moment, although one might dare to suggest that the present system of local government, particularly so far as public health is affected, leaves much to be desired. The vital statistics for 1953 do not call for much comment. The birth rate rose from 10.37 to 1.1.48, although this may be regarded as a mixed blessing. The death rate fell from 10.55 to 9.18. Here, of course, fluctuation over such a short period cannot be said to have much significance. The infantile mortality rate is higher than has been the case for several years although, with such small totals, it only requires a very small increase to raise the rate out of all proportion. The number of measles cases reported during the year (1,073) is the highest we can find as having been recorded in Southgate. This was part of a nation-wide epidemic and should at least mean that the number of cases will fall materially during the next twelve months. As I have already stated, the significant feature of the epidemic was the fact that the complication and death rates were minimal, the disease having little more than nuisance value. It is once again my pleasing 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. It is indeed a pleasure to receive this support in such generous measure, and to realise that due weight is given to any suggestion which may be put forward. 4 I would also express my sincere thanks to the staff of the Public Health Department for their loyalty and devotion to duty. These thanks include all members of the staff, although I would make particular reference to the valuable assistance rendered, as always, by Mr. A. E. Gooday, Chief Sanitary Inspector. 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 11th May, 1953 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 From 19th May to 31st December, 1953 Councillor R. Prior (Chairman) Councillor S. C. Jenner (Vice-Chairman) Alderman G. Peverett Councillor H. S. Beardow Councillor A. V. Stapleton Councillor A. F. B. Start Councillor A. S. Tyler 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.l., 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 M. R. Byrne (Resigned 17th July, 1953). Miss A. G. Alcock (Appointed 4th August, 1953). Junior Clerk: Miss J. A. Wright (Resigned 5th February, 1953). Miss S. A. Roger (Appointed 23rd February, 1953). 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, 1953 72,110 Number of Inhabited Houses (end of 1953) according to Rate Books 21,735 Rateable Value (1953) £942,703 Sum represented by a penny rate (1953) £3,833 There is little I can add to the remarks set out under this leading in previous Reports. The character of the Borough has not hanged over the past years. We are still a dormitory suburb, with he peculiar problems associated with this type of district. We are t least fortunate in that we know the nature of these problems, ad are therefore able to prepare our policy accordingly. This does ot mean, of course, that we can afford to stand still, while even linor changes take place around us. Nothing is static, even in a torough such as Southgate. Let us hope that stagnation, even a lowing of the current, will ever be avoided. If we realise this fact, ad constantly look ahead, we should be able to avoid the pitfalls ito which one can so easily slip. As I write these words, it is now almost exactly twenty-one ears since Southgate received its Charter of Incorporation. If the ext twenty-one years are as jealously guarded, as carefully reasured as their immediate predecessors, all will indeed be well. 7 EXTRACT FROM VITAL STATISTICS OF THE YEAR Male Female  Live Legitimate 354 386 740 Births Illegitimate 11 9 20 365 395 760 Birth Rate per 1,000 of the estimated population 11.48 Still Legitimate 7 5 12 Births Illegitimate — 1 1 7 6 13 Rate per 1,000 (live and still) births 16.81 Deaths from all causes and at all ages 838 Death Rate per 1,000 of the estimated population 9.18 Deaths from puerperal causes: Rate per 1,000 total (live and still) Deaths Births From puerperal sepsis — From other causes — — Deaths of Infants under 1 year of age: Male Female Total Legitimate 11 8 19 Illegitimate — 2 2 11 10 21 Infant Death Rate: All infants per 1,000 births 27.63 Legitimate—per 1,000 legitimate live births 25.67 Illegitimate—per 1,000 illegitimate live births 100.00 Deaths from Measles—all ages 1 Deaths from Pertussis—all ages 0 8 POPULATION The Registrar-General estimated the civilian population of the Borough at the middle of 1953 to be 72,110, a decrease of 370 as compared with 1952. The population once again shows a slight decrease as compared with the figure supplied for 1952. On the whole, it now looks as though little change can be anticipated within the next few years. BIRTHS—BIRTH RATE The total nett births for the year accredited to the district was 760, a decrease of 15 on the preceding year. Of these, 365 were males and 395 were females (11 males and 9 females being illegitimate). The birth-rate for the year was 11.48 per 1,000 of the population. The birth-rate for England and Wales for 1953 was 15.5, and for the administrative County of London, 17.5. The births and birth-rates for the past five years were as follows: Year No. of Births Birth Rates Southgate England & Wales London 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 1953 760 11.48 15.5 17.5 During 1953, the number of births recorded was 78 less than he number of deaths, as compared with 125 less in 1952. The total number of births actually recorded in the district during the year amounted to 181, of which 2 were unnotified. The percentage of births notified was therefore 98.9. as compared with 98.27 in 1952. The birth rate in Southgate over the past six years has shown ittle alteration. Our birth-rate is still substantially below that for ngland and Wales and for London, a state of affairs which one ould expect, having regard to the type of population resident in he Borough. 9 MORTALITY Genera! Mortality and Death Rate The nett number of deaths accredited to this district was 838. 62 less than in 1952. This gives a crude death rate of 11.62 per 1,000 of the population and a corrected death rate of 9.18 (the late for 1952 was 10.55). Year No. of Deaths Death Rates Southgate England & Wales London 1949 820 9.49 11.7 12.2 1950 868 10.06 11.6 11.8 1951 951 11.09 12.5 13.1 1952 900 10.55 11.3 12.6 1953 838 9.18 11.4 12.5 Infant Mortality There were 21 deaths of infants under 1 year of age, which gives an infantile death rate of 27.63 per 1,000 births, as compared with 9 deaths and a rate of 11.61 in the preceding year. The corresponding rates for England and Wales and London were 26.8 and 24.8 respectively. The infant deaths and rates for the past five years were as follows: Year No. of Deaths Infantile Death Rates Southgate England & Wales London 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 1953 21 27.63 26.8 24.8 As noted in the introduction to this Report, the infantile mortality rate is higher than has been the case for several years. It will be remembered that, in my report for 1952, when the infant mortality rate reached the lowest figure yet recorded in Southgate, I stressed the fact that the totals involved were much too small to be regarded as significant. It may be stated here that every infant death is fully investigated in an effort to arrive at any facts which might remove conditions detrimental to our infant population. In connection with the 21 infant deaths which took place in Southgate during 1953, 9 occurred during the first four weeks of life and could be attributed to causes very largely if not entirely outside local control, so far as the Area Health staff was concerned. 10 Still-Births Thirteen still-births (1 illegitimate) were accredited to the district for 1953. This is equal to a death rate of 16.81 (live and still births), the corresponding figures for 1952 being 19 still-births with a rate of 23.93. The rate per 1.000 of the population was 0.18, the rates for England and Wales being 0.35 and for London 0.38. The average rate for the past ten years was 20.47. The still-birth rate for 1953 shows a substantial decrease over the figure for the previous year, and is considerably below the average rate for the past ten years. Indeed our records show that this is the lowest still-birth rate yet recorded in Southgate. This is satisfactory, as is the fact that the still-birth rate has been showing a definite downward trend, although it must once again be stressed that the figures are too small to justify far-reaching conclusions being drawn. Maternal Mortality There were no maternal deaths reported during the year 1953. It is pleasing to be able to record that only three deaths have been recorded in this category within the last seven years, within which time 6,438 births took place. This is extremely satisfactory when one compares the position which held before the war. The reasons are varied and include highly specialised ante-natal care, great advancement in midwifery itself, and the advent of chemotherapy as a means of combating infection before, during and immediately after child-birth. Although this is not a matter with which the Borough Council is directly concerned, it is one which I feel certain will give great pleasure to the Council. Mortality of Persons over the age of 65 Five hundred and eighty-three or 69.47 of the total deaths luring the year occurred in persons over the age of 65. Of these, 190 died between the ages of 80 and 90, while a further 33 were over 'he latter age (12 males, the oldest being 95, and 21 females, the oldest being 95). 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 1953. Causes of Death Male Female Total Rates per 1.000 of Population All causes (Civilians only). 445 393 838 11.62 1 Tuberculosis, Respiratory 7 2 9 0.12 2 Tuberculosis, Other — — — — 3 Syphilitic Disease 1 — 1 0.01 4 Diphtheria — — — — 5 Pertussis — — — — 6 Meningococcal Infections — — — — 7 Acute Poliomyelitis — — — — 8 Measles 1 — 1 0.01 9 Other Infective and Parasitic Diseases 2 1 3 0.04 10 Malignant Neoplasm, Stomach 11 8 19 0.26 11 Malignant Neoplasm, Lung, Bronchus 20 6 26 0.36 12 Malignant Neoplasm, Breast 2 13 15 0.21 13 Malignant Neoplasm, Uterus — 5 5 0.07 14 Other Malignant and Lymphatic Neoplasms 50 48 98 1.36 15 Leukaemia, Aleukaemia 2 1 3 0.04 16 Diabetes — 3 3 0.04 17 Vascular Lesions of Nervous System 50 62 112 1.55 18 Coronary Disease, Angina 91 35 126 1.74 19 Hypertension with Heart Disease 12 6 18 0.25 20 Other Heart Disease 57 78 135 1.87 21 Other Circulatory Disease 12 14 26 0.36 22 Influenza 6 7 13 0.18 23 Pneumonia 18 15 33 0.45 24 Bronchitis 34 19 53 0.73 25 Other Diseases of Respiratory System 5 — 5 0.07 26 Ulcer of Stomach and Duodenum 6 2 8 0.11 27 Gastritis, Enteritis and Diarrhoea 4 2 6 0.08 28 Nephritis and Nephrosis — 4 4 0.05 29 Hyperplasia of Prostate 10 — 10 0.13 30 Pregnancy, Childbirth, Abortion — — — — 31 Congenital Malformations 4 2 6 0.08 32 Other Defined and Ill-defined Diseases 22 48 70 0.97 33 Motor Vehicle Accidents 2 — 2 0.02 34 All Other Accidents 9 10 19 0.26 35 Suicide 7 2 9 0.12 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. 1953 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 10 1.2 0.13 11 1.31 0.16 21 2.51 0.29 1-5 years 1 0.12 0.01 1 0.12 0.01 2 0.24 0.02 5-15 years 1 0.12 0.01 — — — 1 0.12 0.01 15-25 years 2 0.24 0.02 1 0.12 0.01 3 0.36 0.03 25-45 years 20 2.38 0.28 11 1.31 0.16 31 3.69 0.44 45-65 years 125 14.92 1.74 72 8.69 0.99 197 23.61 2.73 Over 65 years 286 34.13 3.98 297 35.34 4.12 583 69.47 8.10 Totals 445 53.11 6.17 393 46.89 5.45 838 100.00 11.62 I3 TABLE III. Infantile Mortality 1953. Nelt 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 Pertussis 6 Diphtheria and Croup 7 Erysipelas 8 Tuberculous Meningitis 9 Abdominal Tuberculosis 10 Other Tuberculosis 11 Meningitis (.Not culous) — - 1 1 12 Convulsions — 1 1 13 Laryngitis 14 Bronchitis 5 - 1 6 15 Pneumonia 16 Diarrhoea 17 Enteritis 1 1 18 Gastritis 19 Syphilis 20 Rickets 21 Suffocation 22 Want of Attention and Injury at Birth 23 Atelectasis 6 1 7 24 Congenital Malformations 25 Premature Birth 1 1 2 — — 2 26 Atrophy, Debility and Marasmus 27 Other Causes 1 — — — 1 1 — — 1 3 Totals 8 1 — — 9 9 — 1 2 21 14 TABLE IV. Vital Statistics of Whole District during 1953 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. 1945 64,970 976 15.02 781 12.02 38 38.93 1946 72,710 1,213 16.68 883 12.14 36 29.68 1947 74,320 1,246 16.76 836 11.25 41 32.90 1948 74,030 1,014 13.69 770 10.40 23 22.68 1949 74,350 944 12.69 820 11.04 24 25.42 1950 74,180 860 11.46 868 11.70 20 23.25 1951 72,840 839 11.17 951 11.09 13 15.49 1952 72,480 775 10.37 900 10.55 9 11.61 1953 72,110 760 10.54 crude 11.48 corrected 838 11.62 crude 9.18 corrected 21 27.63 Comparison of the Rates of Southgate with those of England and Wales, and London, for Year 1953. Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population Rate per 1,000 Live Births. Live Births. Still Births. All Causes. Pertussis Diphtheria. Influenza. Total Deaths under one year of age. England and Wales 15.5 0.35 11.4 0.01 — 0.16 26.8 26 County Boroughs and Great Towns, including London 17.0 0.43 12.2 0.01 – 0.15 30.8 148 Smaller Towns (1931 Census Populations 25,000-30,000) 15.7 0.34 11.3 – – 0.17 24.3 London 17.5 0.38 12.5 – – 0.15 24.8 Southgate 10.54 crude 11.48 corrected 0.18 11.62 crude 9.18 corrected – – 0.18 27.63 15 GENERAL PROVISION OF HEALTH SERVICES Hospitals The remarks set out under this heading in last year's Annual Report still apply. Our greatest difficulty remains in securing the admission to hospital, institution or home of the chronic, elderly sick. This is a problem which applies materially to Southgate, with its ageing population. I have taken the opportunity to raise our difficulties in several quarters, notably the Liaison Committee set up by the North Middlesex Division of the British Medical Association. There are at least prospects that the position will be improved by a re-distribution of areas so far as the admission of chronic, elderly sick to hospital is concerned. The situation with regard to the admission to a home of elderly persons still presents great difficulties. The position clearly is that the number of homes available nowhere approaches the need. Although the Public Health Department is not responsible for admissions to hospitals or homes, except to a most limited extent, we still take a most active interest in the situation, and have been able to influence the final result on occasion. It would be a truism to say that the care of the aged represents a problem which is here to stay, a problem which will certainly increase as the years pass. Although little of note was achieved during 1953, there are definite hopes that the problem will be more realistically and more effectively tackled during 1954. 1 look forward to the day when the many authorities and organisations which are involved in one way or another with the welfare of the aged, will be brought more closely together and will act in concert rather than as separate bodies. There can be little doubt that such an approach to the problem would result in nothing but good. At the moment, energy is being dissipated, and allowed, in part at least, to run to waste. It should be our aim to direct those energies into the proper channels, to ensure that the maximum use is being made of the facilities available, that the field is being adequately and continuously covered. Only when this is done can we be reasonably sure that the pathetic, indeed tragic, conditions so often associated with old age receive their proper share of attention. At the moment, we must await events, continue to help wherever help can be afforded, and in every way strive to seek for betterment. In this connection, I should like to pay a sincere tribute to the offers of help which I received when 1 brought forward the suggestion that a scheme might be elaborated to deal with those elderly, infirm victims of a "Smog" attack. Fortunately, (here was no need to put the emergency scheme into operation during 1953. None the less, the response revealed the fact that willing helpers would be found if an emergency did arise. This 16 is only one small point which could be so much better covered were there an ad hoc Committee or body in existence dealing with all phases which affect old age and its tribulations. Although the situation in regard to the supply of hospital nurses has not materially altered, enquiries have shown that the admission of acutely ill patients to hospital does not present any serious problem. In the same way, the admission to hospital of expectant mothers has proceeded smoothly and presents no difficulty. Indeed there is evidence to show that the proportion of expectant mothers seeking admission to hospital is rather too high than too low. Cases of infectious disease are admitted to South Lodge Isolation Hospital, or to Coppetts Wood Isolation Hospital. I have not heard of any difficulty in regard to such admissions, and would take this opportunity of thanking the Medical Superintendents of the two hospitals concerned for their co-operation and help. The admission of cases of tuberculosis to sanatoria is still not entirely satisfactory, due to the fact that a sufficient number of beds does not yet seem to be available. This is unfortunate, since the greatly extended facilities for the discovery of early cases of tuberculosis has meant an increasing demand on hospital and sanatorium beds. This matter is, of course, receiving attention, and should be regarded as a problem of the greatest urgency. Laboratory Facilities As in past years, I would record my appreciation and thanks to the staff of the Central Public Healtn Laboratory, both at Colindale and at the branch laboratory in Edmonton, for the material assistance rendered during the year. We did not have to call upon the Laboratory to any great extent during 1953, apart from the routine work carried out on our behalf and on behalf of general practitioners throughout the year. It is, however, a source of great satisfaction to know that the Public Health Laboratory Service stands behind us, and is ready and willing at all times to carry out any investigation in the field of epidemiology. Summary of work carried out at Central Public Health Laboratories for the year 1953: Positive Negative Swabs for diphtheria bacilli — 105 Sputa for Tubercle bacilli 13 74 Throat and Nose 541 Faeces 913 Urine 48 Blood 95 Others 33 Mortuary The position in regard to the Council mortuary at the rear of 17 the Town Hall is still as set out in the Report for 1946. 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 1953 under this Section. 18 Sanitary Services Summary of Visits, 1953 Inspections re complaints received 1,041 Visits in connection therewith ... ... ... ... 3,895 Visits to Food Premises (including butchers, bakehouses, cafes, restaurants, grocers and fish shops) 1,880 Inspections re Shops Act 1950 ... ... ... ... 280 Inspections re Factories ... ... ... ... 218 Visits re housing conditions and over-crowding (applicants for housing accommodation) ... ... 117 Visits re Infectious Diseases ... ... ... ... 1,235 Visits re Places of Public Entertainment 40 Visits re Prevention of Damage by Pests Act 1949 ... 1,469 Visits re Smoke Observations 46 Miscellaneous Visits ... ... ... ... ... 4,490 14,711 Service of Notices Total Informal Notices served ... . . ... 495 Total Informal Dustbin Notices served ... ... ... 233 Total Informal Notices served ... ... ... ... 728 Total Informal Notices complied with ... ... ... 710 Total Statutory Notices served ... ... ... ... 77 Total Statutory Notices complied with ... ... ... 66 Repairs to Houses Considerable work has been carried out by the Sanitary nspectors during the year in connection with repairs to houses. As result of their efforts, repairs were carried out to 532 houses. Of hese, the repairs to 135 houses were of a major character. At the smaining 397 houses, the repairs were not of such an extensive ature but were necessary to abate specific nuisances. It is, I think, worthy of note that the repairs referred to above ere carried out mainly as a result of informal action on the part of ie Inspectors. Reference to the summary concerning the service of iotices will show that in only 77 instances was it found necessary o follow-up informal notices by the service of Statutory Notices. Owing to non-compliance with one Statutory Notice requiring -pairs, legal proceedings were instituted against the owner. The 19 works were commenced prior to the Court hearing. Following an adjournment for the completion of the works, the Court awarded costs to the Council. In another case of non-compliance with a Statutory Notice, the Council carried out the necessary works, the cost of which is being recovered from the owner. During the year under review, the Council made Demolition Orders under Section 11, Housing Act 1936, in respect of three houses, viz. 80 Springfield Road, N.ll, and 34 and 36 Palmers Road, N.ll. These houses were found on inspection to be unfit for habitation and incapable at reasonable expense of being made fit. At the end of 1953, in anticipation of the passing of the new Housing Repairs and Rents Bill, a preliminary survey was commenced to obtain information necessary to enable the Council to formulate their proposals for dealing with unfit houses in the Borough. In this Bill, and in subsequent circulars from the Minister of Housing and Local Government, it is envisaged that the Council's proposals are to be communicated to the Minister within twelve months of the passing of the new Act. Housing Applications Visits by the Sanitary Inspectors to applicants for housing accommodation and the preparation of reports as to living conditions has continued in 1953. The number of visits for this purpose was 117 against 128 in 1952. The close liaison between the Public Health Department and the Housing Department has been maintained in 1953 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, 1,880 visits were made to food premises in the Borough as against 1,504 in 1952. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. A Clean Food Month was held in April. A copy of the special report made to the Public Health Committee following this venture will be found set out in Appendix II. It is not suggested that a Clean Food Month should be held every year, although the total expenditure involved was extremely small. I hope, however, to make arrangements for a comparable campaign during 1955, since the matter of clean food is one which should be brought to the notice of food handlers and the burgesses in general from time to 20 time. It will also be appreciated that we carry out a continuous campaign in regard to food hygiene, both during the visits paid to food premises by Sanitary Inspectors, and by talks and film shows given by members of the Public Health staff. The coming into force of the anticipated Food and Drugs Act in its amended form should enable us to pursue the matter of clean food with even greater vigour. At the present juncture, the general standards of clean food could not be described as satisfactory, even in Southgate. I am not suggesting that our standards are not at least as high as those in neighbouring authorities. The problem is national rather than local, and is one which demands the attention of all right-thinking citizens. We must aim at making Southgate a Borough as famed for its food hygiene standards as for its many other excellencies. This will require time and energy, which could scarcely be expended in a better cause. 21 INSPECTION AND SUPERVISION OF FOOD Food Inspection The following is a summary of the food condemned during the year as unfit for consumption. The method of disposal of this condemned food was mainly by incineration at the Council's Refuse Destructor works. In one or two instances of relatively larger quantities, it was found possible to arrange salvage for purposes other than food: Fish 34 stone Carcase Meat 3,564 lbs. Bacon 19 lbs. Sausages 475 lbs. Canned Luncheon Meat 156 lbs. Canned Cooked Ham 718 lbs. Canned Meat (various) 285 lbs. Canned Food (various) 2,858 cans Meat Pies . 14 Butter 28 lbs. Cheese 35 lbs. Processed Cheese 49 cartons Soup Powder 327 packets Cake 19 lbs. Cake Powder 20 packets Biscuits 2 lbs. Flour 27 lbs. Cereals 48 lbs. Dried Fruit 26 lbs. Skimmed Milk Powder 40 lbs. Jam and Marmalade 92 lbs. Number and Classes of Food Premises in the Borough Below is a summary of the food premises classified under type of business: Bakers and Confectioners 36 Butchers 61 Grocery and Provisions 116 Fruit and Greengrocery 62 Wet Fish 14 Fried Fish 9 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 108 Confectionery and sweets 80 486 22 In the Borough there are 271 premises registered under Section 14 of the Food and Drugs Act 1938, 183 in respect of ice-cream and 88 in respect of preserved foods. There is one dairy in the Borough registered under the Milk and Dairies Regulations 1949. Under the provisions of the Middlesex County Council Act, 1950, relating to hawkers of food and their premises, there were 76 hawkers on the register at the end of 1953. Of these 15 have storage premises in the Borough and 61 have their storage premises in other areas. Post-Mortem Inspection of Animals No slaughtering of animals took place in the Borough during 1953. Milk Regulations and Milk Sampling During 1953, 79 samples of milk as against 77 in 1952 were obtained and submitted to the Public Health Laboratory for bacteriological examination. Three of the samples gave unsatisfactory results on examination. In each case, this was taken up with the purveyors concerned. Check samples were taken and proved satisfactory. Ice-Cream Sampling During 1953, 75 samples of ice-cream as against 174 in 1952 and 77 in 1951, were obtained and submitted for bacteriological examination. The results of examination of the 75 samples were: Grade 1 — 68 2—6 „ 3—1 4 — nil It was not found necessary to carry out any special investigation into methods of manufacture, storage or distribution in respect of any particular ice-cream vendor during the period under review. The Laboratory reports, however, were invaluable in the work of maintaining a constant check on the quality of the ice-cream sold in the Borough, from a bacteriological point of view. Establishments for Massage or Special Treatment Under the Middlesex County Council Act, 16 existing licences were renewed, and two 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: 23 1953 1952 Adults (Mixed and Spectators) 20,126 28,045 Children (Mixed and Spectators) 35,036 39,100 From Schools 2,647 4,671 Season Tickets 10,651 12,605 68,460 84,421 Costumes, etc., hired 138 230 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 the samples taken, couched in general terms, were displayed at the Bath. Attendances at the Bath of members of the St. John Ambulance Brigade during crowded sessions and hot week-ends has been continued. This assistance is very greatly appreciated. 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 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 on the health of children. 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 1953, 464 complaints of rats and mice were received and dealt with, as against 442 in 1952. In March, 1953, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 355 manholes were baited. In 87 of these, complete or part takes of bait were noted. At the conclusion of the treatment, takes of poison were recorded. 13 manholes showed complete takes of poison and 55 showed part takes. In September, 1953, test baiting was carried out by the Borough Engineer's Department to 245 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 293 manholes were 24 baited. Of these, 128 showed complete or part takes of bait. In accordance with the recommendations of the Ministry of Agriculture and Fisheries, an alternative bait base and poison was used for this treatment. Owing to inclement weather at the time of the treatment, it was found impracticable to record poison takes. 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. 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 London Transport Executive 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 ncludes conveniences provided for the use of the public in public louses 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. In connection with the paragraphs in my Report for 1952 concerning the provision of an additional convenience within the Borough, this matter is still under consideration by the Public Health Committee. 25 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 1952, 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 17,331 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 961 1 3 Cullet 2 3 0 Metals 1 10 3 Rags 36 0 0 Carpets and Gunny 22 13 2 Tins 574 18 3 Bottles 20 15 6 Mixed Scrap 91 18 2 The value of this material amounted to £11,441 13s. 6d. The machinery at the Destructor is provided with picking tables over which all materials pass. Such items as tins, rags, etc., are removed therefrom. 26 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 cooperation of all concerned, the tonnage of paper collected will increase considerably during the coming year. Kitchen Waste During the year, 844 tons of kitchen waste were collected. Under instructions from the Board of Trade, this was sold to Tottenham Borough Council for £3,434. The material is collected throughout the Borough on Monday mornings. Individual kitchen waste containers are supplied on request by the Borough Engineer. 27 1. FACTORIES ACTS, 1937 and 1948. Details of Work Carried Out During the Year 1953. —INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. M/c. line No. Number on Register. Number of Inspections. Written Notices. Occupiers Prosecuted. M/c. line No. (i) Factories in which Sections 1, 2, 3. 4 and 6 are to be enforced by Local Authorities 1 62 64 4 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 154 154 12 - 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 3 - - - - 3 Total 216 218 16 — 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 7 7 - 1 4 Overcrowding (S.2) 5 - - - - - 5 Unreasonable temperature (S.3) 6 - - - - - 6 Inadequate ventilation (S.4) 7 1 1 - - 7 Ineffective drainage of floors (S.6) 8 - - - - - 8 Sanitary Conveniences (S.7) (a) insufficient 9 3 3 1 1 — 9 (b) unsuitable or defective 10 4 4 1 1 — 10 (c) not separate for sexes 11 1 1 - - — 11 Other offences against the Act (not including offences relating to Outwork) 12 - - - - - 12 Total .. 60 16 16 2 3 — 60 28 29 OUTWORK—(Sections 110 and 111). Nature of Work. Section 110. No. of prosecutions for failure to supply lists. Section 111. M/c. Line No. 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. 13 106 — — — — — — Cleaning and washing 14 — — — — — — — Curtains & Furniture Hangings 17 1 — — — — — — Furniture and Upholstery 18 1 — - — — — — Fur Pulling 22 1 —. - — — — — Artificial Flowers 28 5 — - — — — — Paper Bags 33 4 Making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 5 — - — — — — Brush Making 35 3 — - — — — — Feather Sorting 37 6 — - — — — — Carding, etc. of Buttons, etc. 38 5 Stuffed Toys 39 1 — - — — — — Cosaques, Christmas crackers. Christmas Stockings, etc. .. 42 2 — — — — — — Total — 140 — - - — — Prevalence and Control of Infectious Diseases From the table of infectious diseases set-out on page 40, it will be seen that 1,579 cases of infectious diseases were notified during the year, as against 781 in 1952. The Infectious Sickness Rate for the district was therefore 21.89 as compared with 10.77 during the previous year. The increase in the total number of infectious disease cases notified during the year was due almost entirely to a rise in the notifications of pertussis (132 as against 40 in 1952), measles (1073 as against 421 in 1952), and dysentery (94 as against 17 in 1952). I would repeat what I have stated from time to time in my reports to the Public Health Committee, and what I have set out in this Report for previous years, namely the fact that the type of disease met with, so far as the commoner infectious diseases are concerned, is extremely mild. Indeed, the whole picture has changed in regard to the older infectious diseases, so much so that, for instance, the present type of scarlet fever can scarcely be compared with the more severe manifestation with which we were familiar before the war. The change in severity of quite a few of the older type of infectious diseases, together with the virtual disappearance of some infectious diseases and the appearance for the first time of others, is a matter which has received considerable attention from epidemiologists. The reasons are far from simple, including as they do a number of associated factors of varying significance. It is highly improbable that the true explanation has yet been found, although it will scarcely be necessary to say that there must be a clearly defined reason behind the changing pattern. This brings up two further points regarding epidemiology, both of which I have referred to before. In the first place, although we can congratulate ourselves on the mildness of most of the infectious diseases which have recently manifested themselves in the Borough, this state of affairs should not give rise to complacency. Although the high standard of health among our infants and school children, together with the care given to these children by Southgate parents, very possibly contributes to the absence of complications and sequelae, it must be appreciated that a general fall in severity, so far as a number of infectious diseases are concerned, has been reported from all parts of the country. In other words, we are part of a nation-wide rather than local pattern. We must also be prepared for a return to the more serious 30 type of infectious disease, which even the present generation can still remember. Thus, scarlet fever is known to have been extremely mild in the latter half of the nineteenth century. After quite an appreciable period, the severity of scarlet fever increased, until it again became a serious disease, capable of causing dangerous complications and even death. We have no reason to believe that this transmutation may not again occur. While taking advantage of the present mild character of so many infectious diseases, we must therefore be prepared for an increase in virulence. The second point to which I would refer is the fact that epidemiology can now be regarded as covering all types of illness which can affect either the individual or the community. It is certainly a fact that, in a district such as Southgate, one does not expect either occupational diseases or complaints specifically associated with factory conditions. Nor do the housing standards lend themselves to being regarded as possible culprits, even having regard to the housing waiting list and the degree of overcrowding which exists within the Borough. In other words, the problem of epidemiology, in the modern concept of the term, is again national rather than local so far as Southgate is concerned. In company with their counterparts in Lancashire or the Midlands, the majority of our burgesses are subjected to the quickened tempo of life, to the added stresses and strains which are being shown in the rapid increases in psycho-somatic diseases. Many of these same residents are being further subjected to travelling conditions which should have a very serious effect upon their health, but which, on the evidence available, cannot be regarded as a live occupational hazard. We can exercise an extremely limited control over such matters, except to do everything within our power to make our Borough a pleasant place in which to live and work. If we do so, paying due attention to the factories, workshops and shops within our boundaries, and making equally certain that the leisure time of our burgesses is being fully catered for, both by outdoor and indoor recreations, it would seem that we will be making a worth-while contribution to this quite serious problem. This matter may be very closely linked with the remarks which I set out in the section of this Report which deals with social conditions in the area. Our duty, which is to ensure that the first-rate character of the Borough is maintained by all practicable means, will be more than ever clear. If this matter receives proper and constant attention, there is no doubt that we will be achieving something substantial in the way of removing conditions which prejudice health and which encourage both dis-ease and disease. This is a task which is still well within our compass, and to which energy and initiative might well be applied. 31 Diphtheria For the sixth year in succession no case of diphtheria was notified in the Borough. The last death took place approximately 11 years ago. In February of the present year, I made a brief report to the Public Health Committee, setting out details of the immunisation programme carried out in Southgate, and also referring to the fact that, apart from our system of propaganda in Area No. 2, the Area was taking part in a County scheme to popularise immunisation. As I anticipated, the Public Health Committee offered its full support in this campaign. My report, which summarised the present position in regard to immunisation, was as follows: — " (c) Immunisation The Ministry of Health has recently issued a statement setting out the quite spectacular results which have followed the introduction of large-scale immunisation against diphtheria in England and Wales. This statement, issued to local authorities, has been followed-up by a " hand-out" sent to local newspapers. In this connection, I have asked the editors of local newspapers in Southgate to publish a fuller statement featuring the Southgate figures. These figures show that 612 primary immunisations, either against diphtheria alone or against diphtheria and pertussis (whooping cough) were carried out in Southgate during 1953. During the same year. 1.829 children received reinforcing doses in the schools, while 55% of infants were fully immunised by the time they reached the age of two years. These figures are satisfactory, but give no grounds for complacency, although it is pleasing to be able to report that the last case of diphtheria occurred in Southgate in 1947, the last death being reported in 1943. Our scheme of propaganda for immunisation in Southgate is extensive and continuous. Indeed, in at least one respect— propaganda by way of schools—it is possibly unique. In addition to this continuous propaganda, we endeavour to add periodic stimuli in the form of local campaigns. I understand that the County Council will be suggesting one such campaign, to be held later in the year, probably in April. Full details of this campaign should shortly be available. I would suggest that we co-operate to the fullest possible extent. I recently addressed a letter to general practitioners, pointing out the need for maintaining the level of immunisation, and stressing the fact that primary immunisation might well 32 be carried out earlier than seems at present to be the case. At the same time, 1 addressed a memorandum to my Assistant Medical Officers and Health Visitors, asking them to neglect no opportunity to make the same points. It will be appreciated that the work of immunisation is carried out in Southgate by the County Council and by general practitioners. 1 know, however, how interested the Southgate Borough Council is in the work, and that I can count on full support in this very vital effort." Following a rise in the number of cases of poliomyelitis reported from surrounding districts, we suspended the combined type of immunisation against diphtheria and pertussis for several weeks during August and September. Immunisation against diphtheria alone continued during this period. In order that our policy should be fully made known to general practitioners, I addressed a letter to all practitioners in Southgate on August 5th, telling them what was being done, and asking for their co-operation. In the same letter, I took the opportunity of stressing the various safeguards which we adopt at our County Council Clinics. It is very important lhat our programme of immunisation should be properly correlated, so that the family doctor and the clinic are not working along different lines. In this connection. I should state that general practitioners do accord us their full co-operation, not only in the matter of immunisation, but in all the other fields of public health in which we so often meet. Scarlet Fever Scarlet fever notifications during 1953 showed a decline over the figures for the previous year (133 as against 188). The remarks which I made in last year's Annual Report regarding lack of severity and the existing system of notification hold good. As I previously indicated, the only valid reason which one can see for maintaining our present vigilance is the fear that the prevailing type of scarlet fever may change, and that the change may be insidious. For those reasons we still regard scarlet fever as an infectious disease which should be notified, and which calls for medical attention and isolation, together with the exclusion of contacts from school. Acute Anterior Poliomyelitis Four cases of acute anterior poliomyelitis were notified during 1953, three of which were paralytic. This figure is the same as that recorded for 1952, when all four cases were paralytic. Widespread investigation into the aetiology and mode of spread of poliomyelitis is still being carried on, not only in this country, but throughout the civilised world. Up to the present. 33 spectacular results have not been obtained, although definite progress has been and is still being made. Several theories which were previously held have now been discarded, by a process of very careful elimination. A good deal more is now known about the virus which causes poliomyelitis. We are also coming to believe that the spread of poliomyelitis is by restricted channels, rather than by the presence in the population of a comparatively larger number of potentially dangerous "carriers." In other words, our previous idea that every clinical case of poliomyelitis which was definitely confirmed represented a vast number of incidents so mild as to pass unnoticed, is being revised. This latter theory is still held in certain quarters, although the evidence now tends to show that spread is along definite often detectable routes. It is quite possible that non-detected "carriers" still play a part in the spread of poliomyelitis ; it is equally clear that discovery of the means by which individual cases are infected is seldom easy, especially during those periods when few cases are occurring. If one could definitely state that any given case were the first in a series, and if this information were obtainable at a sufficiently early stage, detection of the route by which infection is spread would be much more simple. Uufortunately, although every case is very carefully investigated, this vital information is seldom available. Claims have been made by United States workers that there are now reasonable hopes of an effective vaccine against poliomyelitis being available in the relatively near future. If and when this vaccine does become available, we may look forward to the day when protection against poliomyelitis can be achieved along the lines which have proved so successful in the case of diphtheria. A certain degree of protection has also been obtained by the use of gamma globulin, a fraction of blood plasma which has proved useful in the past in controlling outbreaks of measles in closed communities such as day nurseries and the like. It will be realised that these safeguards are not yet available. For the moment, therefore, we must continue to rely on more general measures, particularly the safeguards which lie in the practice of strict personal hygiene and the surveillance of contacts. As reported in my Annual Report for 1952, we carried out certain investigations into the possible spread of the poliomyelitis virus in sewage at the request of the Central Public Health Laboratory. These investigations did not yield positive results, and have now been discontinued. This is merely one example of the many types of investigation which are being carried on and which will doubtless be continued. The fact that an investigation of this character is negative does not lessen its importance. Few if any discoveries of real significance have been made without a prolonged 34 period of trial and error. There seems no reason to doubt that the final conquest of poliomyelitis will follow parallel lines. In September 1953, I addressed a letter to all Head Teachers in Southgate, pointing out the precautions which could be taken in schools to minimise the spread of poliomyelitis, having due regard to the information at our disposal. As in the case of the general practitioner, co-operation was generous and immediate. As will be noted in the paragraphs dealing with diphtheria, we suspended the combined type of immunisation against diphtheria and pertussis during most of August and part of September, following a rise in the number of cases of poliomyelitis reported from surrounding districts. Measles 1,073 cases of measles were notified during the year, as against 421 cases in 1952. So far as can be ascertained, this is the highest number of measles cases recorded during any one year. As might be expected, the number of cases so far reported during 1954 has been comparatively low. The disease was again extremely mild, admission to hospital being required in no more than 17 cases. It must be admitted that, although the severity of measles has appreciably declined during the past decade, incidence has not been in any way affected. So long as complication and death rates remain at the present negligible level, the position can be regarded as reasonably satisfactory, although we still look forward to the day when measles can be fully controlled and will not even have the nuisance value it at present possesses. Pertussis One hundred and thirty-two cases of pertussis were notified during the year, as against 40 in 1952. Once again, it will be seen that the rise and fall in pertussis notifications very closely followed the curve of measles. We are still continuing our policy of immunisation both against pertussis alone and against diphtheria and pertussis combined. The Ministry of Health has still not given its unqualified blessing to immunisation against pertussis, as has been the case in regard to diphtheria. We have not, therefore, had the advantage of a national campaign, the practice varying quite considerably from district to district. Extensive investigations have been proceeding in various parts of the country, to estimate not only the precise benefits of immunisation against pertussis, but also the value of the various types of antigen available. When these investigations have been completed, and the appropriate reports compiled, I have little doubt that the policy of protection against pertussis by means of immunisation will be extended. In the meantime. I am satisfied that our present policy should be pursued. 35 Food Poisoning (including Sonne Dysentery) Fourteen cases of food poisoning and 94 cases of dysentery were reported during 1953, as against totals of five and 17 respectively during the previous year. I would again state that these figures cannot he regarded as a true indication of the incidence of any type of food poisoning within the Borough, for the reasons set out in previous Reports. So far as Sonne dysentery is concerned, the work carried out by the Public Health Department in tracing and supervising contacts and " carriers " has been reported on several occasions to the Public Health Committee. I am not at all certain that the amount of time involved in these operations can be fully justified. Whether we like it or not, it must now be recognised that Sonne dysentery is indigenous in Great Britain, being presumably here to stay. This being so, it is extremely doubtful whether our measures of control have any appreciable effect on its spread. This statement gains added weight when it is remembered lhat many cases of dysentery never come to our notice. Indeed, many cases never come to the notice of the family doctor. We also know that Sonne dysentery is not a serious disease, except in very young and very old. For those reasons, I am very seriously considering a modification in our present system of control. Broadly speaking, the changes which I hope to suggest to the Public Health Committee and the Development Sub-Committee during the present year should reduce the amount of work carried out by our Sanitary Inspectors, while still allowing us to control the attendance at school of children who are suffering or have suffered from diarrhoea and sickness, together with those children who are contacts and " carriers I intend to suggest the putting into operation of our modified procedure for a trial period, during which time the results will be carefully scrutinised and evaluated. It will still be necessary, of course, to control those adults who have any connection with food handling, and whose continuance at work, either as cases or "carriers" would represent a public health danger. Mention might also be made of the appearance in several of our schools of the disease commonly known as " Winter vomiting." This disease is almost certainly a virus infection. Once again, it has little more than nuisance value, although it can disrupt the activities of any school in which it makes its appearance. The control of winter vomiting follows very closely along the lines of that laid down for Sonne dysentery. Our present procedure which is to exclude for one week all children who have suffered from sickness and/or diarrhoea, without too much time being taken up in the collection of laboratory specimens, has worked well to date. I therefore propose to continue along these lines until more information is available. 36 Puerperal Pyrexia One case of puerperal pyrexia was notified during the year, as against five during 1952. No deaths were attributable to puerperal causes. The great advances which have come about in safeguarding the health, indeed the lives of mothers during and after child-birth will be apparent in these figures, which may be taken as typical of the situation over the past ten years. Many factors have contributed to this satisfactory situation, including more specialised pre-natal care, substantial advances in midwifery, the extended use of anti-biotics and chemotherapy generally, and the many facilities now available to women before, during and after child-birth. Puerperal pyrexia which, not so many years ago, was an extremely serious disease, has now been robbed of most of its terrors. There is no reason to believe that the present happy situation will not continue, or even be improved. Smallpox Once again, no case of smallpox occurred in Southgate during the year. Indeed, for the first time in many years, not even one doubtful rash was reported. It is none the less a fact that the vaccination state in this country is showing a deplorable decline. Because of this decline, the Middlesex County Council now encourages us to carry out vaccination of infants at our Maternity and Child Welfare Clinics, so that mothers may have every opportunity of having their children vaccinated with the minimum degree of inconvenience. This is now being done in Southgate. and although it is too soon yet to assess results, there is every reason to believe that the policy will bear fruit. I have also arranged to supply general practitioners with an attractive show-card emphasising the value of vaccination and also, incidentally, immunisation against diphtheria and pertussis. This card will be offered to general practitioners for display in their waiting rooms. All the Area staff concerned, particularly Health Visitors, have also been instructed to stress the need for vaccination at every session and home visit. Tuberculosis Sixty-five cases of tuberculosis (61 pulmonary, four non-pulmonary) were notified during the year, as against 79 in 1952. The distribution of cases notified among the various wards during the year was as follows: North-East North-West Middle South 21 10 12 22 37 A broad classification of the cases notified during the past four years in relation to employment was: 1950 1951 1952 1953 Clerical 15 9 19 17 Housewives 12 24 10 12 Children 4 7 5 3 Manual Labour 8 — 5 8 Factory Workers 2 5 — 5 Professional Classes 3 3 5 2 Armed Forces 2 1 1 — Domestic Service 1 — 1 — Food Trades 2 — — — Students 4 — 1 1 Shop Assistants 3 — 4 1 Nurses — — 3 2 Non-Manual Trades, other than Food - 7 15 7 Teachers — — 2 — Unclassified 11 13 8 7 67 69 79 65 I would once again emphasise that the totals concerned are too small to allow of any significant conclusion being drawn, while the period covered is still too short to permit us to form a definite opinion. None the less, the compilation of these statistics is useful, in as much as we can form an over-all picture of the situation in the Borough from year to year. It must again be stated that there do not appear to be any conditions existing in Southgate which have a significant bearing on the spread of tuberculosis. During 1953, Mass X-ray Unit No. 5B visited Southgate for a period of three days. The Public Health Department co-operated very closely with the Unit in extending an invitation to local organisations, factories and firms to visit the Unit. Thanks to the cooperation of the local press, we were also able to inform the general public of the Unit's visit. The Secretary of the Unit supplied us with the following information relating to the visit: Number Recalled for Referred to Did not Pending & No further X-rayed Large Film Chest Clinic attend Re-check action 1,530 27 3 2 5 17 It will be noted that this is the second year in succession that Unit 5B has visited Southgate. The Secretary has promised that a further visit will be made to the Borough as soon as the Unit's programme permits. 38 For the first time, we were able to persuade the Unit to examine school leavers. As will be noted above, 982 parents took advantage of the opportunity to have their children's chests X-rayed before they left school. The advantage of this check-up need not be stressed. As before, we have worked in very close harmony with the Finchley Chest Clinic in regard to tuberculosis. Cases of tuberculosis in which re-housing appears desirable, if not essential, are reported to the Public Health Department, following which the necessary action is taken. In spite of the acute shortage of houses, I am very happy to bo able to state that the Housing Section cooperates whole-heartedly. It will be obvious that, apart from the work carried out by Chest Clinics in tracing and supervising cases and contacts, housing remains possibly the greatest factor in the control of tuberculosis. It is here that the Borough Council can help, within the obvious limits of its resources. 39 NOTIFICATIONS OF OF INFECTIOUS DISEASES, 1953. Jan.— March. April— June. JulySept. Oct.— Dec. Totals. Scarlet Fever 68 30 15 20 133 Pertussis 35 34 52 11 132 Poliomyelitis: Paralytic - 1 1 1 3 Non-paralytic — — — 1 1 Measles 862 79 3 129 1073 Diphtheria — — — — — Pneumonia 23 7 3 13 46 Dysentery - 78 11 5 94 Smallpox — — — — Encephalitis Erysipelas 8 2 3 1 14 Meningococcal Infection — — — — — Food Poisoning 1 3 2 8 14 Puerperal Pyrexia 2 — — 2 Ophthalmia Neonatorum — — 1 — 1 Paratyphoid B — — 1 — 1 TuberculosisPulmonary 22 17 19 3 61 Non-pulmonary 2 1 1 — 4 Totals 1023 252 112 192 1579 REGISTER OF TUBERCULOSIS CASES. Pulmonary. NonPulmonary. Totals. M. F. M. F. Cases on Register at 1/1/53 315 270 46 43 674 Cases notified for first time in 1953 36 25 1 3 65 Cases Restored to Register 2 1 — — 3 Other cases added 7 4 — — 11 Cases Removed from Register 22 25 — — 47 Cases Remaining on Register at 31/12/53 338 275 47 46 706 TUBERCULOSIS — 1953. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1- 5 years 1 - - - - - - - 5-10 years — 1 — 1 — — — — 10-15 years - - - - - - - - 15-20 years 4 1 - - - - - - 20-25 years 5 4 - - - - - - 25-35 years 8 9 — 1 1 — — — 35-45 years 6 8 — 1 — — — — 45-55 years 12 5 1 — 1 — — — 55-65 years 7 — — — 3 — — — Over 65 years .. 4 1 — — 2 2 — — Unknown - - - - - - - - Total . . 47 29 1 3 7 2 — — * These figures include all cases previously notified elsewhere and noted by the Tuberculosis Officer and others as having Temoved into the district. 41 Appendix 1 HEALTH EDUCATION Our programme of health education during 1953 followed closely along the lines set out in some detail in previous Reports. Our activities included 20 talks and film shows to local organisations, circulation of the magazine " Better Health," articles in the local press, the display of posters, leaflets and handbooks at various centres throughout the Borough. Although the results of health education are difficult to assess, it would appear that our policy is sound, and that we are obtaining results. There is certainly no doubt that the time and energy spent on health education represents a practical contribution to the achievement of positive health within the community. The film projector which we purchased in 1938, and which has been used on several thousand occasions, has now come to the end of its life. It can no longer be used without a serious risk, either of a breakdown or distortion. As the projector has proved of immense value in the field of health education, I sincerely hope that the Council will seriously consider its replacement during 1954. We must use every medium at our disposal. Here is a medium which has been thoroughly tried and has proved an unqualified success. As regards the press, I would once again pay a most sincere tribute to the editors of our local newspapers for their unfailing courtesy and assistance. I very often feel diffident at making so many requests, and for encroaching so often on the limited space available. I have none the less received the greatest help from our local editors on all occasions, help which has been the means of bringing matters of current interest and importance to the notice of thousands of burgesses. Mention has already been made of the Clean Food Month held in the Borough during April. We also had a fortnight's Spring campaign directed towards immunisation. This was sponsored by the Middlesex County Council, and added its weight to the continuous propaganda carried out by members of the Area Health and Public Health Department staffs in relation to immunisation. I should personally like to see more health education work carried out in our schools. I know how difficult it is to make inroads into the time available in school, and to add health propaganda to the many other commitments which head teachers have to accept. None the less, we are extremely eager to carry our work of Health education into the schools, where the soil is so receptive. I hope to make certain suggestions in this respect to the appropriate quarter within the coming year, and to present a scheme which will, I trust, be found acceptable. 42 I would again repeat that, in health education, we have a weapon, both of offence and defence, which should not be allowed to lie idle. The cost of health education is infinitesimal compared with the vast amounts of money spent in other directions. It seems virtually incredible that we should be spending so much time, energy and money in righting or even in preventing wrongs, while still neglecting the fundamental principles on which health must always be based, the education of the individual and of the community. Although health education has always bulked large in Southgate's programme of health. I am of opinion that we can still extend our efforts. I am very conscious of the fact that the Council has always encouraged me in this work. I therefore look forward to further support for such measures as I may venture to put forward. 43 Appendix 2 CLEAN FOOD MONTH Report to Public Health Committee—9th June, 1953 The following is a summary of the activities carried out during the Clean Food Month : (i) Attendances at Meetings held in Committee Room M.l., local halls and schools Members of Local Organisations 600 Food Handlers 150 School Meals Service Personnel 80 Schools 600 TOTAL: 1,430 (ii) Sixteen organisations availed themselves of our invitation either to have a talk and/or film show at a place selected by the organisation, or to attend at Room M.l. Particular thanks are due to the North-West Ward Ratepayers' Association, who arranged a special meeting in Oakwood School. Invitations were extended to quite a number of organisations in the North-West Ward to attend this meeting. (iii) Expenses £ s. d. Advertisements in local papers 12 0 0 Printing (posters, book markers and notices re dogs in food shops) 19 15 0 Leaflets 3 12 0 Leaflet Holders 6 5 0 Cinema Slides 1 16 0 Hire of Films—Central Film Library 13 10 0 Educational Foundation Film Library 1 16 1 Overtime for Operator 10 18 4 Fixing of Posters 3 19 6 Hire of Exhibition Material 6 0 0 Sundry Purchases from local shops 1 2 1½ Premium on Insurance Policy for Refrigerator 17 0 81 11 0½ (iv) In connection with the food display set out in Committee Room M.l display units and relevant leaflets etc. were lent to us by the Central Public Health Laboratory, Hackney Borough 44 cil, Eastern Electricity Board and several commercial firms. This very practical assistance has been suitably acknowledged. Window displays were arranged by the Eastern Electricity Board and Eastern Gas Board. Additional films were provided free of charge by the American Embassy. Film strips and commentaries were lent by the Ministry of Food. (v) Although our Clean Food Month was a comparatively modest effort, I think it can be said that the small expenditure involved has been amply justified. The talks and visual demonstrations supplied to more than 200 food handlers have been particularly useful, while we were also extremely glad to have the opportunity of visiting five schools in the district. In this latter connection, I should perhaps state that, in addition to these visits, I addressed the Head Masters and Domestic Science Teachers at our five secondary schools, the idea being that information on food hygiene should be passed on by the Domestic Science Teachers to the pupils attending their classes. (vi) As already mentioned, the organisations, firms and individuals who assisted us in our campaign have been thanked. Special mention might be made of the local press, which, as always, was particularly helpful. Two articles were published in the local press, one towards the beginning and one during the latter half of the month. Although the co-operation of the local press is more or less taken for granted in Southgate, this courtesy is none the less appreciated. Indeed, it is quite obvious that, without the valuable assistance so often provided by local editors, the work of health education in Southgate would very materially suffer. (vii) In conclusion, I should like to express my personal thanks to all four Sanitary Inspectors, under the direction of Mr. Gooday, for the valiant work carried out before and during Clean Food Month. These duties were cheerfully undertaken, and contributed in no small measure to the success of the venture. 45 Appendix 3 LETTERS TO DOCTORS The following letters were sent to general practitioners practising in Southgate during 1953. 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 29th: Notification and Exclusion from School March 18th: Collection of Laboratory Specimens during Easter Holiday Period May 18th: Collection of Laboratory Specimens during Whitsun Holiday Period „ 28th: Collection of Laboratory Specimens during Coronation Arrangements June 25th: Infective Hepatitis July 28th : Collection of Laboratory Specimens during August Holiday Period Sept. 2nd: Sonne Dysentery Nov. 12th: Visit of Mass X-ray Unit Dec. 9th: Collection of Laboratory Specimens during the Christmas Holiday Period 46 Appendix 4 "SMOG" Report to Public Health Committee—13th October, 1953 The early morning fog which we have recently been experiencing must have reminded many people of the unpleasant days towards the end of 1952, when London had its first experience of a real " smog." We all hope that this experience will not be repeated, although this is something about which we cannot be sure. Following the last meeting of the Public Health Committee, 1 addressed a letter to Sir John Charles, Chief Medical Officer to the Ministry of Health. My letter was passed on to Dr. Beattie, the Principal Medical Officer who is especially concerned with atmospheric pollution. Dr. Beattie wrote me a letter on the subject, asking me to call at the Ministry. 1 did so on the 15th September, when I had a long and interesting conversation with Dr. Beattie. It appeared that my letter was the first approach which the Ministry had had from a Medical Officer of Health ; it further appeared that they were very impressed by the fact that a local authority had thought it expedient to consult them on the subject. Dr. Beattie made it clear that a great deal of work had been done and is still being done in trying to ascertain the possible cause or causes of " smog," and in seeking to prevent a repetition. It will be realised that this is not an easy matter, since many factors are involved. One cannot expect a solution to these problems merely by a wave of the hand : the whole subject bristles with difficulties, and must be tackled as a long-term policy which is very closely linked with atmospheric pollution generally and with the various ways in which smoke can be prevented from finding its way into the atmosphere above and around towns. Until a solution is found, we agreed that we must look at the matter from a realistic point of view. In other words, we must be prepared for fogs during the winter months, and be ready to meet them on their own ground. Although the possibility of sulphurous fogs cannot, indeed must not be overlooked, this does not mean that we need go in fear and trembling, casting anxious eyes at the sky as soon as autumn is upon us. On the other hand, we should be prepared for a sudden emergency, and make such plans as are possible to meet a possible crisis. Dr. Beattie agreed that such suggestions as the mass evacuation of old people from London when a " smog " appears, and the wearing of masks by old people during foggy weather, have no practical value ; indeed, they are almost unthinkable. He did, however, equally agree that, during foggy weather, old people should remain indoors so far as is possible. One must admit that 47 fogs penetrate indoors, espcially the vicious type of fog which we remember so well. None the less, the risks are much greater outdoors, where concentrations are high. In addition, old people would be well advised to restrict their movements during foggy weather, since exercise combined with a thick fog is one of the most potent causes of lung trouble and heart failure. In short, old people, or those who suffer from chest complaints—asthma, bronchitis and the like—should cut down their movements during fog and should stay indoors as much as is humanly possible. In an extensive, serious fog such as we experienced last year, arrangements might be made whereby our very excellent Old People's Welfare Committee, together with other voluntary bodies in the district, could combine to assist old people with chest complaints, so that they need venture outdoors as little as possible during a fog. It should not be impossible to elaborate a system whereby those individuals who are likely to be most affected by a fog, and who can stay indoors, could call for assistance, e.g. shopping etc., from a specially selected centre designed to mee. just such an emergency. I am quite sure that this possibility is well worth exploring. Indeed, I should like to see a conference called of all those interested in the welfare of old people, so that this problem could be tackled as a whole, and not as a series of disconnected units. Whatever is or is not done, it is, I think, imperative that panic should be avoided. It would be most distressing to think of our old folk, as well as sufferers from chest complaints, spending weeks of fear, wondering whether they would have to face another few days of "smog" this winter. Indeed, this aspect of the problem could be much worse than the "smog" itself, and would undoubtedly result in lowered health, even in unnecessary fatalities. We must remember that the proper authorities are considering this problem as a matter of urgency ; we must hope that, sooner or later, an adequate remedy will be found. Until then, we might examine the position on the lines suggested above, trying to elaborate a system which will help those people most in need, should the need arise. This can do no harm, and may possibly do a very great deal of good. 1 have addressed a letter to the County Medical Officer, explaining the attitude of the Borough Council on the matter, and asking whether this is a problem which might be considered by the County as a whole, by the various Areas into which the County has been divided, or by local authorities. I feel that the County would be interested, since we could use Area personnel, particularly our Health Visitors, Home Nurses and Home Helps. If I receive a reply to my letter before the meeting of the Committee, I will submit it. In the meantime, 1 feel very strongly that this is a matter which should be fully explored, so that we can take 48 such practical steps as are possible to meet an emergency. So far as publicity is concerned, I am sure the Committee will agree that we must avoid any suggestion of panic. A statement might be prepared, which could be submitted to the local press if the need arises. 1 do not, however, suggest that anything further should be done at the moment, since unnecessary publicity might merely result in despondency and alarm, without achieving any useful purpose. 49 Appendix 5 COUNTY COUNCIL OF MIDDLESEX (Area No. 2) (Friern Bamet, Potters Bar, Southgate, Wood Green) THE YEAR, 1953 1. INTRODUCTORY The purpose of this report is to present to the Committee an over-all picture of the work carried out in the Area during 1953. It will be appreciated that the report is, of necessity, brief, and that it has only been possible to touch on the more important aspects and statistics relating to each section of the Area work. It will also be appreciated that, to include the work of the School Health Service, would call for a separate document. For this reason mainly, the matter of the School Health Service has been for the moment deferred, although I hope to be able to present a statement to the Committee at a later date. It would be true to state that the work carried out by the Area Health Staff in Area No. 2 last year was relatively uneventful. Opportunity has been taken to improve and extend our services wherever possible, and to introduce newer and more up-to-date methods. Minor changes in administration have also taken place ; the more important of these will be referred to in the body of the report. Altogether, the picture can, I think, be justly claimed to be one of steady progress. 2. AREA STATISTICS Population 169,050 Friern Barnet 28,260 Potters Bar 17,210 Southgate 72,110 Wood Green 51,470 Area (in acres) 12,840 Friern Barnet 1,340 Potters Bar 6,129 Southgate 3,764 Wood Green 1,607 Birth Rate 11.52 (per 1,000 population) Friern Barnet 13,23 Potters Bar 14,18 Southgate 10,54 Wood Green 11,65 50 Infantile Mortality Rate 25.68 (per 1,000 live births) Friern Barnet 23.33 Potters Bar 16.39 Southgate 27.63 Wood Green 28.33 Maternal Mortality Rate 0.51 (per 1,000 births) 3. MEDICAL STAFF The medical staff in Area No. 2 consists of myself, as Area Medical Officer, my Deputy, the Senior Assistant Medical Officer, and six Assistant Medical Officers. Dr. Campbell, my Deputy, assists me generally in my work, and is particularly responsible for the day-to-day administration of the School Health Service. The duties of the Senior Assistant Medical Officer are mainly those of supervising the health visiting, home nursing and domiciliary mid wives services, although she undertakes many other duties, including those of supervising nursing homes and work under the Child Minders Regulations. Each of the six Assistant Medical Officers is based at a Clinic, and has a number of schools allocated to her. These medical officers are directly responsible for the work carried out at the clinic, and for the school health service duties undertaken in their district. 1 would like to pay a warm tribute to our medical staff, who have co-operated whole-heartedly in the efforts made to maintain and improve the standard of the services provided in the Area. I would particularly refer to Dr. Janet Campbell, my Deputy, who has been my unfailing ally in all aspects of my work. In the same way, Dr. E. S. Stephen, the Senior Assistant Medical Officer, has played a notable part in co-ordinating the services for which she is responsible. 4. CLERICAL SECTION The Clerical Section is housed at the Area Health Office, Town Hall, Palmers Green, N.13, and at White Hart Lane (Old) School, N.22. This dichotomy is still necessary, as it has not yet been possible to obtain central accommodation which could be made available as an Area Health Office. The separation of members of the staff in this way is unfortunate, and is a problem which we hope will one day be solved. Clerks are also stationed at most of the Maternity and Child Welfare Centres in the Area. This arrangement facilitates the clerical work carried out at these Centres. 51 The clerical staff employed in the Area consist of the following: 1 Chief Clerk 1 Deputy Chief Clerk 2 APT IV 1 Higher Clerical Division 4 Clerical Division 20½ General Division 1 Telephonist The work is, to a certain extent sectionalised, although the setting-up of watertight compartments has been carefully avoided. Minor changes in the administrative pattern take place from time to time, in the light of experience. During the year, five members of the clerical staff resigned for various reasons, their places being filled in each instance. As the Committee will be aware, Mr. P. E. Barber, the Chief Clerk, suffered a heart attack in November last. The Committee will also be aware that Mr. Barber has not returned to work, but has expressed his intention to retire. T should like to pay a sincere tribute to Mr. Barber, who has been associated with me personally, first as Chief Clerk in the Southgate Public Health Department and later as Area Chief Clerk, for the past 23 years. No one could have wished for a better or more zealous and conscientious colleague, although we are extremely happy to have, in Mr. G. W. Jones, a very worthy successor. 5. ANTE-NATAL, POST-NATAL and CHILD WELFARE CLINICS By the end of 1953, Ante-natal Clinics, at which post-natal cases also attended, were provided in eight premises throughout the Area, approximately nine sessions being held every week, with an average attendance of 14. Both Health Visitors and Midwives attended these clinics, acting under the direction of an Assistant Medical Officer In addition, one session was held each week in Southgate, at which midwives only attended. The average attendance at this session was nine. During the year considerable extension of our Ante-natal Relaxation Classes took place, so that, by the end of the year, each district in the Area could take advantage of these excellent facilities. 81 sessions were held during 1953, with an average attendance of 12. This average is steadily increasing. Child Welfare Clinics were held at 13 premises throughout the Area, special toddler sessions being a feature at most of these premises. A total of 26 sessions on an average was held each week, with an average attendance of 37. 52 During the earlier part of 1953, approval was given to provide vaccination against smallpox at our clinics, where immunisation against diphtheria, pertussis (whooping cough) or diphtheria and pertussis combined has been supplied for many years. Vaccination facilities are now available at most clinics in the Area. Graphs are kept of the quarterly figures relating to attendances at each of our welfare centres. These graphs allow us to judge the usefulness of our clinics, both on a geographical and numerical basis, and enable us to formulate our policy in advance. The graphs will be available for inspection by the Committee. A feature of the work carried out at our Child Welfare Clinics during the past few years has been the holding of special Birthday Sessions. Approximately one Birthday Session is held each month at all our Clinics. Birthday letters are sent to parents of children up to the age of five, who have at any time attended the Clinic. Special pre-school record cards are kept, so that an accurate record can be maintained of progress. When a child reaches its fifth birthday, these cards are attached to the routine school medical cards, and are available throughout the child's school life. These clinics are definitely appreciated by mothers, and allow us to pick up stragglers whose attendances have been irregular. Of the thirteen premises used as comprehensive clinics throughout the Area, four are church halls, two in Friern Barnet, one in Wood Green and one in Potters Bar. It will readily be understood that the use of church halls is not entirely satisfactory, since they compare unfavourably with ad hoc premises. Within recent years, we have transferred clinics from two church halls in Southgate to our own premises, with advantage to the services and to the mothers and children who take advantage of them. Plans are now being prepared to erect two new comprehensive centres, one in Friern Barnet and one in Potters Bar. It will presumably be some time before these centres are available, but we look forward eagerly to their inception. With regard to the number of mothers who use our infant welfare centres, we made a very careful check of approximately half the Area, over a five year period from 1947 to the end of 1951. This census was completed in 1952, but the Committee might be interested to see the results, which are illuminating. The mothers attending our clinics were divided into the five income classes used for Census purposes. The results of our enquiry were as follows: Southgate Potters Bar Class 1 65.25% Class 1 72.22% „ 2 81.36% „ 2 82.99% „ 3 87.84% „ 3 82.52% „ 4 84.93% „ 4 76.03% 53 Average 85.51% Average 81.76% Class 5 76.92% Class 5 95.45% The time occupied in compiling these figures was not inconsiderable, but was deemed worth while, as we were able to judge the class of population upon which we should concentrate, and were also able to compare the work of one health visitor with another. If time permits, we hope to extend the analysis to the whole of the Area. In concluding this section of the report, I would pay great tribute to the help afforded at our clinics by the Voluntary Helpers who attend so regularly. These ladies give unstintingly of their services, many having attended our clinics for a great number of years. We consider them part of the Area team, and we are delighted to think that they not only represent the continuance of voluntary service in the community, but are able to assist us materially in our work. 6. SPECIAL CLINICS Children under five may be referred for treatment to the following clinics established in Area 2: Ophthalmic Ear, Nose and Throat Orthoptic Speech Therapy Orthopaedic (including physiotherapy) 7. HEALTH VISITING With one exception, Health Visitors employed in the Area occupy a combined post, being also School Nurses. Tn addition, we have two Health Assistants, both of whom perform most useful work. Our average strength of Health Visitors in the Area during the year has been as follows: 20 Health Visitors and School Nurses 1 School Nurse 2 Health Assistants During the year, four members of the staff left our service. Fortunately, although Health Visitors are in very short supply, it was possible to recruit three whole-time Health Visitors and one part-time Health Visitor to take their places. During the year 1,318 visits were paid to expectant mothers ; 20,872 to children under 5 ; 2,684 to school children, and 1,976 to other cases, including old persons. In making these visits, approximately 15,500 households were visited. Our Health Visitors, School Nurses and Health Assistants are supervised by an Area Superintendent of Health Visitors and by a 54 Deputy Superintendent. Both ladies are under the immediate control of the Senior Assistant Medical Officer. In supplying the figures set out above, it is quite impossible to present an adequate picture of the work of a Health Visitor. The duties of the modern Health Visitor have been greatly extended since the coming into force of the National Health Service Act. Thus, their duties are no longer confined to the care of mothers and children under the age of five ; they are now expected to undertake much wider duties, including the care of the aged and close liaison with general practitioners working in the districts for which they are responsible. The influence which Health Visitors can bring to bear on mothers during visits to the home or during talks at the clinic, is invaluable. Their work in regard to schools and school children is of equal importance. Our Health Visitors are allocated to main clinics, from which they operate. They are thus enabled to get to know their district, and to establish close and cordial relationship with the mothers with whom they come into contact. In like way, each Health Visitor is allocated several schools in the same district, so that their work among children under five and school children can be closely integrated and will follow on as a natural sequence. We encourage Health Visitors to visit schools, to consult with Head Teachers, and to be aware of problems as they arise. We are fortunate in the fact that many of our Health Visitors have worked in this Area for a number of years. We are thus able to build on a solid foundation, which is of the very greatest help to us in our work. 8. MIDWIFERY SERVICE The number of births which occurred in Area No. 2 during 1953 was just over 2,000. Of these, approximately 80% took place in hospitals and nursing homes ; the remainder were domiciliary cases. Almost all the domiciliary cases were attended by our own midwives, 242 in the capacity of midwife, 153 as maternity nurse. In attending these cases, more than 7,000 visits were made, an average of approximately 18 visits per case. In addition, a percentage of the children born in hospitals and nursing homes were discharged sufficiently early to become, for a time, the responsibility of a domiciliary midwife. These cases accounted for a total of 225 visits. At the beginning of 1953 there were nine midwives on the staff. During the year two midwives left, one to be married and the other to take up a post in Indonesia. The approval of the County Council was obtained to replace these midwives, although considerable difficulty was experienced in filling both vacancies. Thanks to the generosity of the Potters Bar Urban District Council, we have obtained the provision of a flatlet, which has recently been 55 occupied by a full-time midwife. We are equally grateful to the Urban District Council of Friern Barnet, where similar provision has been made. In addition to the nine midwives mentioned above, we usually have two pupil midwives undergoing part of their training in the Area. These are normally resident at " Osidge," where there is a resident approved midwife teacher responsible for their training. All our domiciliary midwives are subject to the supervision of the Senior Assistant Medical Officer and the non-medical Supervisor of Midwives. Our midwives are all qualified to administer gas and air analgaesia. All have the use of portable apparatus for the administration of gas and air. In just over three out of four cases attended by our midwives, gas and air analgesia was given by a midwife ; in approximately three out of five cases pethidine was administered, again by a midwife. The availability of transport for our midwives has been adequate, due in large measure to the excellent fleet of cars handed over to the County Council in 1948 by the Southgate Queens Nursing Association. Communication by telephone is provided in the homes of all those midwives who are not resident at " Osidge." 9. HOME NURSING SERVICE In addition to the Superintendent of Home Nurses, who is also Non-medical Supervisor of Midwives, and the Superintendent at " Osidge," 21 whole-time and six part-time Home Nurses were employed at the end of 1953. Owing to the sharp rise in the demands on this service the approved establishment for the Area was increased during the year from 24 to 26. During the year, our nurses paid a total of 77,335 visits to 3,140 cases. These cases were divided as follows: Medical 2,612 Surgical 301 Infectious diseases 45 Tuberculosis 112 Maternal complications 45 Others 25 The local arrangements for operating the Home Nursing Service vary from district to district. In Potters Bar, the Urban District Council has provided a Council house, from which one fulltime and one part-time nurse operate. In Southgate, " Osidge " is the administrative centre for the service, although not all the home nurses are resident there. In Wood Green, a central office is provided in a room in the branch Area Health Office. In Friern Barnet, a small headquarters is housed in an ad hoc building in Wetherill Road. These arrangements are not entirely satisfactory. The room 56 used by the nurses in Wood Green is inadequate, since it is shared by two clerks and is not provided with a running water supply. We have made representations for the use of an extra room in this building. The result of this application is not yet known. Our administrative arrangements for the supply of a Home Nurse following the request of a general practitioner appear to be working satisfactorily. There is no evidence that the service is being abused or that unnecessary visits are being requested. This matter is kept under close review, and I would have no hesitation in making representations to the Committee if I thought that alterations should be made. With regard to transport, five nurses are provided with County cars, and one with a County auto-cycle. Eleven nurses receive an allowance for using their bicycles; the remainder use public transport. Recent experience has shown that the services of a Male Home Nurse would be advantageous. We are therefore taking steps to make such an appointment. 10. HOME HELP SERVICE The equivalent number of whole-time Home Helps at the end of 1953 was 63½, the actual number being 86. During the year 671 cases were provided with help, as follows: Maternity 121 Tuberculosis 33 Chronic sick (including aged and infirm) 214 Others 303 There is an Organiser of Home Helps and an Assistant Organiser. The Organiser is provided with transport on one day each week, with occasional extra transport to assist in urgent visiting. The County Council regulations as to priorities are strictly observed in operating the Home Help Service. This is one of the most difficult services to organise and run, since the number of Home Helps available is seldom, if ever, able to meet requirements. It will also be appreciated that our Home Helps come and go with disturbing frequency, being drawn from that section of the community which is not particularly interested in long-term employment. This will be seen from the fact that the number of resignations from the Home Help Service during 1953 was 27. Yet another difficulty lies in the fact that most of our Home Helps are married and have their own children, all of whom are liable to the illnesses associated with childhood. When this happens, the Home Help Organiser is liable to find herself without a number of Home Helps, at a time when these are most required. Continuous steps 57 are taken to implement the number of women used in this service, since there can be no doubt that the Home Help Service does supply a very definite need. The matter of payment for services rendered is dealt with by the Finance Department, while there is a Panel which meets regularly to consider appeals. 11. DAY NURSERIES Two Day Nurseries were available in the Area at the beginning of 1953. Both were 50 place Nurseries, and comprised a training Nursery in Wood Green (White Hart Lane) and a nontraining Nursery in Southgate (Hoppers Road). Changes in Policy relating to conditions of admission and charges resulted in a continued fall in the number of cases attending these Nurseries. It was therefore decided to close Hoppers Road Day Nursery, closure taking place on 30th October, 1953. At the end of the year five children under the age of two and 35 children between the ages of two and five were on the register of White Hart Lane Day Nursery. At that time, the Nursery employed an equivalent of 6½ whole-time non-domestic staff, together with three part-time domestic staff. Having regard to all relevant circumstances, I am of opinion that one Day Nursery will continue to be required in the Area. The site on which White Hart Lane Day Nursery stands—the site is owned by Wood Green Borough Council—is eminently suited to this purpose. 12. IMMUNISATION I have already reported in some detail in a previous report on the position in regard to immunisation against diphtheria, pertussis (whooping cough) or diphtheria and pertussis combined. I will therefore confine myself to stating that, during 1953, 1.953 children were protected for the first time against diphtheria alone or against diphtheria and pertussis combined. In addition, 4,372 children were given reinforcing injections, mostly in the schools. Approximately 58% of infants in Area No. 2 were fully immunised before reaching their second birthday. The results which can be attributed to immunisation will be too well-known to require re-emphasis. The state of immunisation, both in infants and in school children, is high. This must not encourage complacency, as continued efforts will be required to maintain our present standards. I think it can be said that these efforts are being made, and that they might be regarded as adequate. Reference has already been made to the yearly campaign for immunisation against diphtheria, in which Area No. 2 plays its part This campaign includes the showing of slides in local cinemas, 58 advertisements and articles in local newspapers, special talks at clinics, and the display of posters. Members of our staff are constantly bringing the need for immunisation to the notice of parents, especially stressing the fact that immunisation should be complete some time before the end of the first year. We also make a point of acquainting general practitioners with our policy from time to time, so that the work of immunisation can be properly integrated. Thus, we notify general practitioners of changes in procedure as, for instance, when we discontinued immunisation against diphtheria and pertussis for a short time during the summer months because of the local prevalence of poliomyelitis. The Committee will be aware that health education in Middlesex is shared between the areas and the district councils which make up these areas. We co-operate very closely with the Borough and Urban District Councils concerned, so that maximum benefit can be expected. The work of health education in Area No. 2 includes: The circulation of the magazine " Better Health " ; health talks and film shows at Clinics and to local organisations ; the display of posters ; the supply of leaflets and pamphlets in the Area Health Office, libraries and at Clinics : articles in the local press, and special efforts designed as periodic stimuli, e.g. a yearly immunising campaign. Apart from these activities, it must always be remembered that the basis of health education lies in the advice given to mothers in the home and at Clinics by Medical Officers, Health Visitors, Midwives, Home Nurses and other members of the staff. We have also tried to make it known that the Area Health Office is to be regarded as an information bureau, to which any special problem can be brought and where advice and assistance will readily be forthcoming. Although the effects of health education are not readily discernible, I am convinced that we must always consider this to be an integral part of our work. Without health education, little progress of lasting value can be anticipated. It is for this reason that we have concentrated on health education, and that no avenue will be left unexplored. In this connection, it might be mentioned that we have collaborated with Messrs. Marmite Ltd in the making of a sound film, during which Cranborne Clinic was used. I would very much like to have the pleasure of arranging a sound film in which the general health activities in Area No. 2 were depicted. The Committee will remember that this has already been discussed and strongly supported by the Committee. As several years have now 59 elapsed since the project was first mentioned, may I put forward the suggestion that it might, with profit, be revived. 13. DENTAL CARE OF EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER SCHOOL AGE At the end of 1953 there were four whole-time and five parttime dental officers employed in the Area, representing a total of 6^ whole-time staff. During the year 232 sessions were allocated to this service. A total of 177 expectant and nursing mothers and 584 children under the age of five were treated. I need not remind the Committee that great difficulty has been experienced in the past in obtaining the services of sufficient Dental Officers to deal with the priority and school dental services in the Area. The situation did improve during 1953, when our available establishment was higher than has been the case for many years, This allowed us to deal with arrears of work unrgently required. The position is so variable that I would not hazard a guess as to how long this happy state of affairs is likely to continue. Each Dental Officer is provided with the services of a Dental Attendant, who combines chair-side assistance, the keeping of necessary records and the making of appointments. The Dental Service is under the direction of an Area Dental Officer, Mr. G. S. Williams. Mr. Williams has a difficult task to perform, as he also acts as Dental Surgeon at a very busy Clinic. He has carried out his many duties with devotion, and I am glad to have this opportunity of expressing my thanks to him. 14. CARE OF OLD PEOPLE The problem of old people, especially the aged and chronic infirm, is one which constantly occupies our attention. This is a problem with numerous facets, in which many bodies and authorities are concerned. Although the problem of old age is predominantly a welfare matter, it will be obvious that it is one which cannot be disassociated with public health. Up to the moment, our activities have mainly been directed towards the supply of Home Helps and Home Nurses, where admission to hospital is either undesirable or cannot be arranged. We also use our Health Visitors to visit old people in their homes, while we assist at least one large hospital in paying geriatric visits. I am especially perturbed to think that cases of extreme hardship occur among old people which may never come to our attention. For this reason I recently addressed a letter to general practitioners and to local organisations, asking them to let us know whenever such cases are discovered, so that we might play our part in helping to effect a remedy. T have also instructed my staff to act in a similar capacity. There is no doubt that the question of old age and its problems 60 is one which is not only here to stay, but which will obviously increase. I am of opinion that steps might be taken to correlate the activities of all the various bodies engaged in this work, so that over-lapping could be avoided and the best practical results achieved in the shortest time. 15. CO-OPERATION A feature of our work in Area No. 2 has always been cooperation with other bodies. I am happy to think that we offer and receive cordial co-operation from those other authorities and bodies with whom we come into contact. Thus, our relations with the district councils which constitute the Area, with Hospital Management Committees and hospitals generally, with general practitioners and with voluntary bodies, have been close and cordial. I am completely satisfied that this aspect of our work is important, and that it must never be neglected. As an instance of what is being done, it might be noted that the Area Health Staff is represented on the Executive Committee of the North Middlesex Division of the British Medical Association, the Liaison Committee set up by the same Division, the Northern Group Medical Advisory Committee, various Old People's Welfare Committees, local Social Service Councils, and the Executive Committee of the Southgate Physiotherapy Association. The fact that I am Medical Officer of Health for three of the constituent districts making up Area No. 2, and that the Deputy Area Medical Officer is my Deputy in two of these districts, is also of the greatest value. The Committee will remember that an attempt was made during 1953 to interest general practitioners and head teachers in the work of our clinics, by inviting them to " Open Days " at each clinic. The venture was successful, and it is hoped that it will be repeated during 1954. Opportunity is taken from time to time to communicate with general practitioners and also with schools, so that matters which seem to call for attention can be brought to their notice. This has become a regular feature of our work and is, I believe, appreciated by the recipients. 16. INVESTIGATION AND RESEARCH Although it is not always easy for a fully-occupied staff to carry out research, it is highly desirable that this should be done. We have therefore tried to follow such lines of investigation as lie within our power, and will continue to do so. All children attending for birthday examination at the welfare centres are given a tuberculin jelly test. These tests are also applied on children before admission to the Day Nursery. After consultation with the Chest Physician at the Finchley Chest Clinic, 61 we have agreed to extend the scheme still further, to include school entrants and school leavers attending certain of our schools. This work gives us valuable information relating to tuberculosis, and allows us to refer cases to the Chest Clinic for further investigation. We were privileged to take part in an investigation relating to the pre-menstrual syndrome, carried out by a general practitioner in conjunction with a hospital medical officer. This investigation has recently been published and won the Charles Oliver Hawthorne Award of the British Medical Association. We now hope to cooperate with the same general practitioner in a further study relating to the treatment of toxaemia of pregnancy. This is an extension of the previous work and will, it is hoped, produce significant results which should materially advance our knowledge of the cause and treatment of this distressing and serious phenomenon. Although, as I have already indicated, work under the School Health Service does not properly come within the scope of this report, it might be noted that we co-operated with the Medical Research Council in two schemes of research. One was designed to investigate haemoglobin levels in the blood, with particular regard to seasonal and other variations. The second investigation, which is still proceeding, relates to the possible efficacy of B.C.G. inoculation of school leavers. We were also able to assist in arranging a visit of Mass Radiography Units to Southgate, Wood Green and Friern Barnet and, for the first time, were permitted to include the examination of school leavers. Our work also involves the carrying out from time to time, of investigations which are requested for County purposes, and also on behalf of the Ministry of Health and other authorities. As I have already stated, we are not ideally equipped to undertake research on a large scale. None the less, this branch of our work is so important that we feel more than justified in devoting such time as is available to its pursuit. 17. ADDITIONAL In addition to the work set out in the foregoing paragraphs we carry out inspections of nursing homes, welfare establishments and childrens homes in the Area. We are also responsible for duties under the Nurseries and Child Minders Regulation Act. Considerable work is done in regard to the medical assessment of County staff appointed to or resident in Area No. 2, together with the medical examination and assessment of Student Teachers, prior to their entry to training colleges. We are also responsible for assessing the needs of persons of all ages applying for admission to holiday homes. So far as these duties are concerned, it may be stated that the Area staff is acting more or less directly on behalf of the County Medical Officer. 62 18. CONCLUSION I would once again stress that this report merely tries to supply a composite picture of the work carried out in the Area during 1953. I would conclude by paying tribute to the Area Staff generally for their unfailing loyalty and sense of duty. I would also most sincerely thank the Chairman and Members of the Area Health Committee for their continuous courtesy and support, which have been of the very greatest help to me in my work. Finally, I would take this opportunity of expressing my keen appreciation of the generous assistance provided by Dr. Perkins and his staff at head office, together with the equally valuable advice and assistance supplied by all other departments of the County Council. W. C. HARVEY. Area Medical Officer Area Health Office (Area No. 2), Southgate Town Hall, Palmers Green, N.13. May, 1954 63