BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1954 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1954 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE Mr. Mayor, Ladies and Gentlemen, I beg to present the Annual Report of the Medical Officer of Health for the year 1954. 1954 was again a placid year with few, if any, highlights. So far as infectious diseases were concerned, the total number of cases notified during the year fell from 1.554 to 276, one of the lowest totals ever recorded in the Borough. This, of course, was very largely due to the marked decline in measles notifications, from 1.053 to 28. These matters will be referred to in greater detail in the body of the Report, but it is meantime satisfactory to record a year in which infectious diseases played a very minor part in the life of the community. In previous Annual Reports, I have emphasised the fact that epidemiology is no longer concerned merely with infectious diseases. The term must now embrace the study of any condition or condi' tions prejudicial to health or, to look at the matter from another angle, conditions which are capable of causing actual disease. Although Southgate is extremely fortunate in its character and amenities, especially the absence of factory development and serious overcrowding, it is still our duty to make a careful search for any conditions hidden or disclosed detrimental to health and well'being. In this connection, I need scarcely stress that it is infinitely easier to prevent the setting-up of such conditions than to remove them once they have been established. It is mainly for this reason that I have long pursued the policy of bringing all matters affecting health to the notice of the Public Health Committee. I count myself extremely fortunate that the Public Health Committee has always studied my perhaps lengthy statements and reports with the care which one has come to expect from the Southgate Borough Council. This has greatly heartened me, since it is almost a truism to say that unless the Public Health Committee can be supplied with full information, the Medical Officer of Health has no right to expect the full measure of support without which success can never be attained. 3 With regard to the vital statistics for 1954, these were also satisfactory. The birth-rate once again rose, from 11.48 to 12.3. The death-rate fell from 9.18 to 8.8, the lowest death-rate for many years. So far as these two figures are concerned, however, it should again be emphasised that yearly fluctuations have no more than a limited significance unless considered over a lengthy period. The infantile mortality rate fell from 27.63 to 16.0. This, of course, is in keeping with the national trend, although the fall in Southgate produced one of the lowest infantile mortality rates in the Borough. For the first time in several years, one maternal death was recorded. The last maternal death took place in 1949, since when 4,049 births have taken place. Altogether the vital statistics for 1954 make very pleasant reading and have yet to be bettered in Southgate. The vital statistics for 1954 will be considered in more detail later in the Report. I need scarcely repeat that the personal health services operated in the Borough are under the control of the Middlesex County Council. It will be remembered that last year I included a report submitted to Area Health Committee No. 2, as an appendix to my Annual Report. It is doubtful whether my 'latest statement to the Area Committee will be ready by the time this Annual Report goes to press. I therefore intend to ask the County Council's permission to circulate my Area report to all members of the Council as soon as it is ready. I feel very strongly that the Borough Council should know what is happening within the Borough, not only the steps which the Public Health Committee is taking to safeguard health, but the comparable action pursued by the County Council. In no other way can these separate but parallel activities be properly integrated. If and when Southgate becomes an Area, it will, of course, be much easier to paint a composite picture. Until then, the steps which I have outlined above will, I hope, enable the Borough Council to appreciate more fully the various measures being taken within the Borough to improve and safeguard the health, not only of the invidual, but of the community. It has been my custom for several years to include, as an appendix to my Annual Report, a brief statement on health education. This year, I should like to incorporate this statement in the introductory section of the Report, since it is becoming more and more obvious that health education is playing an essential part in preventive medicine. The significance of health education in the vast field of public health is now accepted. It has been stated that we are still only in the experimental phase of health education. We certainly have much to learn, both as to method and content. Be that as it may, 4 we would do well to study and review from time to time the part which health education can play, the contribution it has to offer, and the uses to which it can be put. I should now like to return to a subject which I have ventilated on several occasions, but which cannot be stressed too often or too strongly. Preventive medicine is, and always will appear unspectacular to the general public, unless in those isolated instances where the discovery of a new vaccine or the introduction of important legislation are focussed in the national press. The day-to-day measures designed to erect a barrier against the spread of infection and to encourage positive health, are still taken for granted by too many people. This, of course, is both illogical and unfortunate, but the facts are, to some extent, understandable and must be accepted. When a child develops poliomyelitis or when an adult is rushed to hospital with acute appendicitis, the whole family is acutely aware of the emergency, and equally grateful for the remedial measures undertaken. It is not so with preventive medicine. Too often the public is supremely oblivious of the work being carried out on its behalf in the realm of public health. It is here that health education can and should play such a vital part. There are certainly pitfalls. We must avoid creating a nation of hypochrondriacs who are constantly dwelling on the ills which might befall them. We must equally avoid placing too much stress on aspects of health which have comparatively little significance. Our duty must be to enlighten the public on matters which vitally concern them, to choose our material with loving care, to establish and review from time to time a programme of priorities. This can be done in several ways. We should make quite certain that the services available to the public are fully known and understood. We should draw attention to factors which have topical interest and are of immediate significance, e.g. measles and influenza outbreaks, the existence of food poisoning or dysentery. We should endeavour by every means available to stress the fundamental principles upon which a healthy individual and community are based. Lastly, we should try to concentrate on those age groups and sections of the community most in need of education in its widest sense, without making the cardinal mistake of always preaching to the converted, and neglecting those groups which are most difficult to reach. Our health education programme in Southgate is, I venture to say, comprehensive. Apart from the work carried out from day to day by our Sanitary Inspectors and, so far as the County Council is concerned, by the Health Visitors, both in the Clinic and in the home, the Council will be aware that numerous talks and health film shows are given during the year, while articles appear from time to 5 time in the local press. We are extending our work in the schools, a field of paramount importance; while we undertake special campaigns from time to time to focus attention on important aspects of health and the prevention of disease. It must be realised that the results of our efforts are not readily discernible. We cannot say that, for a certain expenditure, we can guarantee certain results. Nor, although we believe this to be the case, can we say that our expenditure on health education has saved the community a given sum of money. What we can and do claim must emphatically is that a progressive policy of health education will be followed, either immediately or over the years, by results which have quite incalculable value. If these results are sometimes intangible, at least for a period, their value is not thereby diminished. When one remembers the infinitesimal sums being expended on health education as compared with the other branches of Local Government expenditure, and when one realises that health education lies at the very root of a healthy community, the arguments in its favour are surely undeniable. It must also be clear that Southgate is in many ways the ideal district in which to put into operation an enlightened and enlightening programme of health education. It may be said that most of our citizens are quite capable of knowing what to do and that, in fact, they require the minimum of guidance. On the other hand, it must equally be realised that, for one reason or another, mistakes are made and errors committed. Too often these mistakes or errors are not deliberate, or even accidental. They stem from lack of true knowledge, from the inherent apathy which has always beset the human race until something goes wrong. I make no apology for once again stressing this point. If we were to neglect health education, either because the cost was considered exorbitant or because it was not thought worth the trouble, the effect might not be immediately seen, but without the slightest doubt they would, in time, be felt. It was for this reason that the purchase of a new sound film projector was advocated; for the same reason we intend to concentrate on arranging an attractive Clean Food Campaign during 1955. I would take this opportunity of thanking the Public Health Committee and the Borough Council for their continued support and encouragement, without which our programme of health education could never have been carried out. I am satisfied that we are working along the right lines, although I am still not convinced that we have fully explored all available avenues. We will continue our policy of exploration, until we can be reasonably sure that the public is fully informed on matters concerning health and well-being—the two terms are not necessarily synonymous— and that no section of the community has been overlooked. 6 I have already thanked the Aldermen and Councillors of the Borough Council, including most especially the members of the Public Health Committee, for their continued support and encouragement. I would be failing in my duty if I did not do so once again. Nothing is more important in the life of a Medical Officer of Health; his efforts can be made or marred by the help which he receives from his Council and Public Health Committee. During the 24 years which I have been privileged to spend as Medical Officer of Health for Southgate, this support has invariably been forthcoming in most generous measure. I would again express my very sincere thanks to the staff of the Public Health Department for their continued loyalty and devotion to duty. In this connection, I would make particular reference to the assistance rendered by Mr. A. E. Gooday, Chief Sanitary Inspector, a collague who shows not only outstanding skill in his chosen profession, but also loyalty and organising ability of the highest order. I would also thank my Deputy Dr. Campbell for her unfailing loyalty and assistance at all times. I have particularly mentioned Dr. Campbell and Mr. Gooday, but my thanks are due to all members of the staff, a staff which can be regarded as a team in the truest sense of the word. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, W. C. HARVEY, Medical Officer of Health. Town Hall, Palmers Green, N.13. 7 PUBLIC HEALTH COMMITTEE From 1st January to 17th May, 1954 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 From 25th May to 31st December, 1954 Councillor R Prior (Chairman) Councillor G. D. Payne (Vice-chairman) Alderman G. Peverett Councillor H. S. Beardow Councillor R. A. Clarke Councillor S. C. Jenner Councillor Miss Dorothy M. Wells PUBLIC HEALTH STAFF Medical Officer of Health: W. C. Harvey, M.D., Ch.B., D.P.H. •Chief Sanitary Inspector (No. 1 District) : A. E. Gooday, M.R.San I., M.S.I.A., Cert.R.San.I. Meat Inspection. •Sanitary Inspector (No. 2 District): R. L. Burkill, A.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection, Cert.R.San.I. Smoke Inspector. •Sanitary Inspector (No. 3 District): E. T. Jephcott, M.S.I.A., Cert.R.San.I., Cert.R.San.I. Meat Inspection. •Sanitary Inspector (No. 4 District): W. Shackcloth, M.R.San.I., M.S.I.A., Cert.R.San.I. Meat Inspection. Senior Typist : Miss E. W. Barratt. Clerk : Miss A. G. Alcock. Junior Clerk : Miss S. A. Roger. 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. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,765 Registrar-General's Estimate of Resident Civilian Population, 1954 72,290 Number of Inhabited Houses (end of 1954) according to Rate Books 21,810 Rateable Value (1954) £945,374 Sum represented by a penny rate (1954) £3,855 I can add little to the remarks which I have set out under this heading over the past few years. One of the highest compliments that could be paid to Southgate is the statement that, in a world which seems to see little betterment, where moral and material values are continually declining sometimes to a frightening extent, where the struggle is very often not to improve but to hold one's ground, the Borough remains almost an oasis in which it is still truly pleasant to live and work. Need it be said that the struggle will almost certainly grow fiercer? The need to preserve, to build carefully on existing foundations, to sweep away, to re-arrange and to re-erect, becomes more acute, more difficult as a district ages. Nothing can be left to chance; a facile policy of laissez-faire would have a rapid and most unfortunate effect. We have, however, the results of past planning constantly before our eyes in Southgate. If this lead is followed, and surely it must be followed, the health of Southgate should be assured for many years to come. Further to this, there are two matters upon which I should like to comment. The first has to do with what one might describe as the outward appearance of the Borough. There is not the slightest doubt that the appearance of any district has an effect, sometimes a profound effect, on those who live and work within its confines. 9 So far as parks, open spaces, grass verges and excellent planning are concerned, we have much for which to be thankful. But that is not the end. Pleasant gardens, tidy streets, houses whose exteriors are pleasing to the eye— these factors are also quite important. We are indeed fortunate that, in Southgate, any passing through the district could not help but be impressed by what they saw. I am fully convinced that this feeling of proper pride is also engendered among our burgesses, that it has a psychological effect on health which, although perhaps not of major significance, should not be despised or forgotten. It also shows— and this is equally important— that there is, in Southgate, a sense of civic responsibility, of pride in one's possessions and in one's Borough, all of which auger well for the future. Just as the mind can influence the body, so does the appearance of the place which we regard as our communal home exercise a distinct influence on our outlook. I would again stress that this may not be a factor of profound importance, but its effect is none the less woven into the pattern which makes up the life and equally the health of Southgate. The second point to which I would draw the Council's attention is the importance of cultural activities. Here again Southgate is extremely fortunate. Within the Borough, the leisure time of the burgesses is fully catered for in a manner befitting the population of the district. We have reason to be proud of the various organisations, societies and means of securing the right type of entertainment which exist within our boundaries. This may again appear to be a comparatively minor point. It actually is not. Our cultural back' ground should be part of our very existence, and therefore deserves attention. It has been very rightly said that everything which affects health comes within the province of the Medical Officer of Health. It is for this reason that I raise these points. The fact that the name of Southgate is associated with a Borough possessing unequalled amenities, where the civic spirit is high, where the burgesses can enjoy a full and pleasant life has, in my submission, contributed in no small measure to the fact that I am able to submit such an encouraging Annual Report. 10 EXTRACT FROM VITAL STATISTICS OF THE YEAR Male Female Total Live Legitimate 421 378 799 Births Illegitimate 8 8 16 429 386 815 Birth Rate per 1,000 of the esti' mated population 12.3 Still Legitimate 3 7 10 Births Illegitimate — — — 3 7 10 Rate per 1,000 (live and still) births 12.12 Deaths from all causes and at all ages 813 Death Rate per 1,000 of the estimated population 8.8 Deaths from puerperal causes : Rate per 1,000 total (live and still) Deaths Births from puerperal sepsis From other causes 1 1.21 Deaths of Infants under 1 year of age : Male Female Total Legitimate 9 4 13 Illegitimate — 9 4 13 Infant Death Rate : All infants per 1,000 births 16.00 Legitimate—per 1,000 legitimate live births 16.27 Illegitimate—per 1,000 illegitimate live births nil Deaths from Measles—all ages nil Deaths from Pertussis—all ages nil 11 POPULATION The Registrar-General's estimated civilian population of the Borough at the middle of 1954 was 72,290, an increase of 180 as compared with 1953. BIRTHS—BIRTH RATE The total nett births for the year accredited to the district was 815, an increase of 55 on the preceding year. Of these, 421 were males and 378 were females (8 males and 8 females being illegitimate). The birth rate for the year was 12.3 per 1.000 of the population. The birth rate for England and Wales for 1954 was 15.2. The births and birth rates for the past five years were as follows : Birth Rates Year No. of Births Southgate England and Wales 1950 860 11.46 15.8 1951 839 11.17 16.7 1952 775 10.37 15.3 1953 760 11.48 15.5 1954 815 12.3 15.2 During 1954, the number of births recorded was 2 more than the number of deaths, as compared with 78 less in 1953. The total number of births actually recorded in the district during the year amounted to 197, of which 4 were unnotified. The percentage of births notified was therefore 97.96, as compared with 98.9 in 1953. It will be noted that the birth-rate in Southgate was higher during 1954 than in any year since 1950. It is extremely doubtful whether this has any real significance, as the yearly variations have been slight and could not be said to amount to anything like an upward trend. 12 MORTALITY General Mortality and Death-rate. The nett number of deaths accredited to this district was 813, 25 less than in 1953. This gives a crude death-rate of 11.2 per 1,000 of the popula tion and a corrected death-rate of 8.8 (the rate for 1953 was 9.18) Death Rates Year No. of Deaths South gate England and Wales 1950 868 10.06 11.6 1951 951 11.09 12.5 1952 900 11.55 11.3 1953 838 9.18 11.4 1954 813 8.8 11.3 Infant Mortality. There were 13 deaths of infants under 1 year of age, which gives an infantile death-rate of 16.00 per 1,000 births, as compared with 21 deaths and a rate of 27.63 in the preceding year. The infant deaths and rates for the past five years were as follows : Year Death Rates No. of Deaths Southgate England and Wales 1950 20 23.25 29.8 1951 13 15.49 29.6 1952 9 11.61 27.6 1953 21 27.63 26.8 1954 13 16.00 25.5 As noted in the introduction to this Report, the infantile mortality rate fell appreciably during the year. I would again stress, however, that the totals are too small to justify any worth-while conclusions being drawn. I might, however, stress that each infant death is very carefully investigated, so that steps can be taken where practicable to avoid a similar recurrence. In considering the infantile mortality rate for any district, it is vitally important that, at the same time, the neo-natal mortality 13 should be studied. The neo-natal mortality is defined as the number of infants who died during the first four weeks of life for every thousand children born. Broadly speaking, having regard to our existing knowledge, it might be said that the most neo-natal deaths are not at present preventable, being due to such conditions as congenital defects or prematurity. If, therefore, the number of neo-natal deaths is high as compared with the number of children who die during the first year of life, but after the end of the first four weeks, and if these latter deaths are decreasing while the neo-natal mortality either shows a comparable decrease or does not rise, it might be assumed that what used to be termed infant welfare, together with ante-natal supervision, post-natal supervision and the practice of midwifery, is of adequate standard so far as the district is concerned. Of the 13 infant deaths which took place in Southgate during 1954, no less than 12 were neo-natal. The neo-natal figure has not risen recently, while the remaining infant deaths have shown a substantial decline. From these two facts, we might at least claim that our infantile mortality rate was satisfactory. It is still our duty, of course, to take all practicable steps to reduce the infant mortality as a whole and to use such knowledge as is available to reduce the neo-natal hazards. This is being done. Still-Births. Ten still-births, all legitimate, were accredited to the Borough for 1954. This is equal to a death rate of 12.12 (live and still births) the corresponding figures for 1953 being 13 still births with a rate of 16.81. The rate per thousand of the population was 0.14, the rates for England and Wales being 0.36 and for London 0.35. The still-birth rate for 1954 continues the slight downward trend of the past few years and is the lowest recorded for the Borough. Maternal Mortality. One maternal death was reported during 1954. As noted in the introduction to this Report, this maternal death was the first recorded in Southgate since 1949, 4,049 births having been recorded in the intervening period. All maternal deaths are carefully scrutinised and investigated, a final assessment being made by a specially designated obstetrician. The fact that maternal mortality has been so radically reduced within recent years is a source of tremendous satisfaction. I have alluded to the causes contributing to this decline in previous Annual 14 Reports, and would merely repeat that an all-round improvement in midwifery services, more thorough ante-natal supervision, and the introduction of antibiotics represent the salient factors. Mortality of Persons over the Age otf 65. Five hundred and sixtyfour, or 69.40 of the total deaths during the year occurred in persons over the age of 65. Of these, 185 died between the ages of 80 and 90, while a further 15 females were over the latter age, the oldest being 101. Following the trend of previous years, diseases of the heart and circulation were responsible for more deaths in this age-group than any other cause. 15 TABLE I. Causes of Death during the year 1954. Causes of Death Male Female Total Rates per 1,000 of population All causes (Civilians only) 415 398 813 11.2 1. Tuberculosis, Respiratory 3 3 6 0.08 2. Tuberculosis, Other — — — —. 3. Syphilitic Disease 1 1 2 0.02 4. Diphtheria — — — — 5. Pertussis — — — — 6. Meningococcal Infection — — — — 7. Acute Poliomyelitis — — — — 8. Measles — — — — 9. Other Infective and Parasitic Diseases 2 3 5 0.06 10. Malignant Neoplasm, Stomach 9 9 18 0.26 11. Malignant Neoplasm, Lung, Bronchus 35 6 41 0.56 12. Malignant Neoplasm, Breast — 17 17 0.20 13. Malignant Neoplasm, Uterus — 7 7 0.09 14. Other Malignant and Lymphatic Neoplasms 47 45 92 1.27 15. Leukaemia, Aleukaemia 4 — 4 0.05 16. Diabetes 2 4 6 0.08 17. Vascular Lesions of Nervous System 51 54 105 1.45 18. Coronary Disease, Angina 93 51 144 1.99 19. Hypertension with Heart Disease 7 7 14 0.19 20. Other Heart Disease 41 66 107 1.48 21. Other Circulatory Disease 17 24 41 0.56 22. Influenza 1 3 4 0.05 23. Pneumonia 9 17 26 0.35 24. Bronchitis 19 11 30 0.41 25. Other Diseases of Respiratory System 5 1 6 0.08 26. Ulcer of Stomach and Duodenum 7 10 17 0.20 27. Gastritis, Enteritis and Diarrhoea 2 1 3 0.04 28. Nephritis and Nephrosis 4 6 10 0.13 29. Hyperplasia of Prostate 6 —- 6 0.08 30. Pregnancy, Childbirth, Abortion — 1 1 0.01 31. Congenital Malformations 1 2 3 0.04 32. Other Defined and Ill-defined Diseases 33 40 73 1.10 33. Motor Vehicle Accidents 6 1 7 0.09 34. AH Other Accidents 6 2 8 0.11 35. Suicide 4 6 10 0.13 36. Homicide and Operations of War — - - — 16 TABLE H. 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. 1954 Age FEMALES 'MALES 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 9 1.12 0.11 4 0.52 0.04 13 1.64 0.15 1' 5 years 2 0.25 0.02 - - - 2 0.25 0.02 5-15 years 3 0.39 0.03 4 0.52 0.04 7 0.91 0.07 15-25 years 4 0.52 0.04 3 0.39 0.03 7 0.91 0.07 25-45 years 12 1.49 0.15 16 1.74 0.20 28 3.23 0.35 45-65 years 118 14.54 1.60 74 9.12 1.01 192 23.66 2.61 Over 65 years 267 32.86 3.65 297 36.54 4.10 564 69.40 7.75 Totals 415 51.17 5.60 398 48.83 5.42 813 100.00 11.02 17 TABLE III Infantile Mortality. 1954. Nett Deaths from stated causes at various periods under 1 year of age. Causes of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total 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 Tuberculous) 12. Convulsions 13. Laryngitis 14. Bronchitis 1 - - - 1 - - - - 1 15. Pneumonia 16. Diarrhoea 17. Enteritis 18. Gastritis 19. Syphillis 20. Rickets 21. Suffocation 22. Want of Attention and Injury at Birth 23. Atelectasis 2 - - - 2 - - - 2 24. Congenital Malformation 2 — - — 2 - — 1 3 25. Premature Birth 4 - 1 - 5 - - - - 5 26. Atrophy, Debility and Marasmus - - - - - - - - - - 27. Other causes 2 - - - 2 - - - - 2 Total 11 - 1 - 12 - - - 1 13 18 TABLE IV. Vital Statistics of Whole District during 1954 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 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 72,480 839 11.17 951 11.09 13 15.49 1952 72,480 775 10.37 900 10.55 9 11.61 1953 72,110 760 10.54 838 11.62 21 27.63 1954 72,290 815 11.3 (crude) 12.3 ( corrected) 813 11.2 (crude) 8.8 (corrected) 13 16.00 Comparison of the Rates of Southgate with those of England and Wales and London for the year 1954 Rate per 1,000 total Population Live Births Rate per 1,000 total Population Deaths Rate per 1,000 live Births Under 1 year England and Wales 15.2 11.3 25.5 160 County Boroughs and Great Towns, including London 16.8 12.0 29.1 160 Smaller Towns (1931 Census Populations 25,000—30,000) 15.4 11.3 23.7 Southgate 11.3 ( crude) 12.3 (corrected) 11.2 (crude) 8.8 (corrected) 16.00 19 GENERAL PROVISION OF HEALTH SERVICES Hospitals. The provision of hospital beds for Southgate residents has shown no material alteration since my last Report was issued. On the whole, from what I can learn, the admission of acute cases to hospital, both medical, surgical and gynaecological, has shown a tendency to ease, although it could not yet be said that the situation is entirely satisfactory. Until recently, most hospitals had comparatively lengthy waiting lists for children requiring admission to hospital for the removal of tonsils and adenoids. I am informed that these waiting lists have been quite drastically reduced, although it must be admitted that many of us are still not satisfied that the removal of tonsils and adenoids is always confined to those cases where operative treatment is definitely indicated. That, however, is a matter over which I have little control, either as Medical Officer of Health or as Area Medical Officer. The demand for maternity beds in hospitals has started to fall, and will continue to fall in almost direct proportion to the availability of adequate housing. Where a hospital bed was required, little difficulty was found during the year in arranging for this to be provided. When it comes to the admission to a chronic hospital or to an institution of elderly, infirm persons, the position is still extremely gloomy. It must be appreciated that, when hospital beds are at a premium, these beds should be available for acute cases who require careful nursing and supervision, possibly with an operation. On the other hand, we know only too well that a number of elderly, infirm persons have to remain at home, receiving only such attention as can be provided by the Home Nursing and Home Help Services, and by charitable neighbours and voluntary organisations. We are quite aware that our domiciliary services are designed to reduce the demand on hospital beds; indeed, that is the principle which we always have before us. There must still, however, be a percentage of elderly persons who should be in a chronic hospital because they cannot receive adequate attention in their own homes. In many cases these unfortunate individuals are virtually left alone for lengthy periods, both by day and by night, since the most that can be arranged is periodic visits from one or more of the sources indicated above. This is far from satisfactory, and must surely be regarded as a stigma on the social services available to the most vulnerable section of the community. Southgate is particularly unfortunate in this respect. The largest general hospital in Southgate, Highlands Hospital, covers a wide catchment area, including South Islington. I am creditably informed the Highlands Hospital is only able to admit elderly persons from Southgate, either to the hospital itself or to one or 20 other of its special annexes, when the needs of South Islington have been fully met. As this is seldom, if ever, the case, the tragic situation which so often arises need not be elaborated. I have raised this matter on several occasions, both at the Liaison Committee set up by the North Middlesex Division of the British Medical Association, and at the Medical Advisory Committee of the Northern Group Hospital Management Committee, being privileged to serve on both Committees. I have always received a very sympathetic hearing from my colleagues. Indeed the matter has been forwarded to higher quarters, with a very strong recommendation that the position be reviewed as a matter of urgency. I now await the result of these recommendations, which will be communicated to the Public Health Committee as and when they are received. Although, as I have just said, I am a member of several committees which are intimately concerned with the hospital services, and although my numerous protests have always been sympathetically received, it is still obvious that liaison between the services provided by the Regional Hospital Board and the needs of the local authority presents many serious gaps. The situation has certainly improved, while we must remember that the present system has only been in operation since 1948. Those of us engaged in the public health service feel very strongly that the emphasis placed on curative rather than preventive medicine in the National Health Service Act is not entirely in the national interest. No one would deny the wonderful work being carried out by Hospital Boards throughout the country, nor can one shut one's eyes to the obvious difficulties presented by a vast new social system. One could have hoped, however, that, during the seven years over which the National Health Service has been operating, the obvious drawbacks might have been noted and an adequate remedy devised. A freer change of information is quite obviously required, together with frank discussions, where the problems of both sides might be thoroughly ventilated. Few would deny that this could do other than good. I must conclude this section by paying a personal tribute to the hospitals serving this Area. The broad principles may require adjustment but my own personal relations with the hospital staffs concerned and the co-operation which I invariably receive, have always been most cordial. This, however, is not enough. So long as the principles are suspect, the machinery set up to put these principles into operation cannot be expected to function smoothly. Care of the Aged. Few subjects have received more attention within recent years than the care of the aged. We know that two new words have 21 been introduced into our vocabulary, geriatrics and gerontology, both having to do with the process of growing old and the grevious afflictions which old age so often brings with it. We also know that people's minds have been increasingly turned, not only to the urgent, often tragic, problems which face an elderly individual, but to the broader picture as it relates to the community and even to the country as a whole. I would require an entire document to do justice to this enormous problem. That is not possible, although I feel that the Annual Report of the Medical Officer of Health should contain detailed references to an aspect of health which affects a large and rapidly increasing section of the community. Old age comes to many people in many ways. Some are relatively unaffected, retaining both their mental and physical powers until an advanced age. Others remain in the care of relatives or sympathetic friends and do not present a social problem of any magnitude. Still more are affected by old age at a relatively early period, and may require medical and nursing care, either in their home or in a hospital or institution. To some elderly patients money is no object; others are wholly dependent on national assistance. Some elderly persons prefer to eat out where they can be assured of congenial company; others are confined to their houses or to one room, and welcome the meals provided by Meals-on-Wheels Service. These various examples are given, merely to show the diverse often unrelated factors which go to make up the quite gigantic problem contained within the two words "old age". No one would be so stupid or so churlish as to deny that much has been done in Southgate for elderly persons. Apart from help provided by such statutory bodies as the Borough Council, the Middlesex County Council through the Area Medcial Officer and the Area Welfare Officer, and the National Assistance Board, the help furnished by voluntary organisations, churches and by charitable individuals is much too great, both in volume and in variety, to be discussed in detail. This is all very well, but it is by no means enough. It has long been obvious that the problem must be studied as a whole, not as an aggregation of individual units. In this way and in this way alone can we be reasonably sure that all aspects of the problem are receiving attention, that energy is not being uselessly expended, that there is no duplication and re-duplication, that gaps are not being left waiting to be filled. I am very happy to be able to report that, during the year, steps were taken to form an Old People's Co-ordinating Committee. 22 These steps were initiated by the late Alderman Cooper, and have already resulted in an ahhoc organisation being set up to study and deal with this tremendous problem. As Joint Hon. Secretary, a position which I was very happy to accept, I have the privilege of being in constant touch with the work of the Co-ordinating Committee. I have no doubt that, when local needs have been fully assessed, the Committee will be able to integrate the various activities already being carried out, directing effort into the most effective channels, and expanding or even creating new services when these seem to be required. The most urgent service is probably the setting up of a central bureau or clearing house which will receive requests for assistance and pass them on to the proper quarters. This is receiving attention. From a humanitarian point of view, it is a truism to say that the aged are our responsibility, both as individuals and as a community. There is surely no slur, no stigma in growing old; it is and always should be considered an honoured estate, deserving of privilege, demanding our sympathetic understanding and assistance. If, to look on the matter from the most mundane angle, it is equally true that, unless the problem of the aged can be solved, the national economy is quite certain to suffer. Our country has an ageing population, a fact which is nowhere apparent more than in Southgate. But surely there is no need to look beyond our duties as Christian citizens. Let us think of those aged individuals, alone in their tiny rooms, without friends, without company, sometimes without comforts, without even the barest necessities of life. Such thoughts will surely awaken in us a deep sense of responsibility, a firm determination to see that everything possible is done for a section of the community which, through no fault of it own, has lagged behind in the race of life. Southgate has never yet failed in its obligations. The challenge has already been accepted; with good-will, energy and enterprise, the problem, great though it be, will surely be solved. Laboratory Facilities. I would again record my appreciation and thanks to the staff of the Central Public Health Laboratory, both at Colindale and at Edmonton for their unfailing assistance during the year. Once again, we did not have to call upon the Laboratory to any great extent during 1954, owing to the absence of major outbreaks of infectious disease. It is, however, very satisfactory to remember that the Public Health Laboratory Service is available to us, and that any calls we make upon it will be readily and sympathetically met. 23 Summary of work carried out at Central Public Health Laboratories for the year 1954: Positive Negative Swabs for diphtheria bacilli — 235 Sputa for tubercle bacilli — 89 Throat and Nose 552 Faeces 670 Urine 44 Blood 78 Others 79 Mortuary. The position in regard to the Council mortuary at the rear of the Town Hall is still as set out in the Report for 1946. 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 ASSISTANT ACT 1948 Section 47.—Removal to suitable premises of persons in need of care and protection. No action was taken by the Council in 1954 under this Section. 24 SANITARY SERVICES Summary of Visits, 1954. Inspections re complaints received 1,115 Visits in connection therewith 4,301 Visits to Food Premises (including butchers, houses, cafes, restaurants, grocers and fish shops) 1,567 Inspections re Shops Act, 1950 378 Inspections re Factories 253 Visits re housing conditions and overcrowding (applications for housing accommodation) 75 Visits re Infectious Diseases 533 Visits re Places of Public Entertainment 40 Visits re Prevention of Damage by Pests Act, 1949 1,469 Visits re Smoke Observations 27 Visits re Heating Appliances (Fireguards) Act 1952 10 Miscellaneous Visits 3,938 13,706 Service of Notices. Total Informal Notices served 484 Total Informal Dustbin Notices served 305 Total Informal Notices served 789 Total Informal Notices complied with 768 Total Statutory Notices served 80 Total Statutory Notices complied with 72 Repairs to Houses. Considerable work has been carried out by the Sanitary Inspectors during the year in connection with repairs to houses. As a result of their efforts, repairs were carried out to 492 houses. Of these, the repairs to 122 houses were of a major character. At the remaining 370 houses, the repairs were not of such an extensive character but were necessary to abate specific nuisances. The repairs above referred to were carried out mainly as a result of informal action on the part of the Inspectors. In 8O instances only was it found necessary to follow-up informal notices by the service of Statutory Notices. 25 Owing to non-compliance with 24 of the above-mentioned Statutory Notices, legal proceedings were instituted against the respective owners. Nuisance Orders were made by the Court and, subsequent to these being made, the works required were carried out. During 1954, three houses, viz 80 Springfield Road, N.11, and 34 and 36 Palmers Road, N.ll, in respect of which in 1953 the Council made Demolition Orders under the Housing Act 1936, were demolished. The Council made a Demolition Order in 1954 in respect of 61 Ivy Road, N.14, and a Closing Order in respect of two basement rooms at 17 Lower Park Road, N.11 following inspections which revealed them to be unfit for habitation. In Circular No. 28/54, received from the Minister of Health in December, 1954, a request is made for the re-introduction into this Report of information in tabular form, as required under Article 31 of the Housing Consolidated Regulations 1925, which, owing to wartime conditions, was curtailed, in 1940. The information required is as follows: (i) The number of houses which on inspection were considered to be unfit for human habitation 122 (ii) The number of houses, the defects in which were remedied in consequence of informal action by the Local Authority or their officers 117 (iii) The number of representations made to the Local Authority with a view to (a) the serving of Notices requiring the execution of works or (b) the making of Demolition or Closing Orders 13 (iv) The number of Notices served requiring the execution of works 5 (v) The number of houses which were rendered fit after service of formal notices 5 (vi) The number of Demolition or Closing Orders made 2 (vii) The number of houses in respect of which an undertaking was accepted under subsection (3) of Section 11 of the Housing Act 1936 1 (viii) The number of houses demolished 3 26 Housing Repairs and Rents Act 1954. On 30th August, the Housing Repairs and Rents Act 1954, was brought into operation to make further provision for the clearance and re'development of areas of unfit housing accommodation, and for securing or promoting the reconditioning and maintenance of houses; and otherwise to amend the enactments relating to housing, the excersise of certain powers relating to land, and rent control. Under Section 1 of the Act, the Council is required within one year after the commencement of the Act, i.e. by 30th August, 1955, to submit to the Minister of Housing and Local Government proposals for dealing with houses in the Borough which appear to the Council to be unfit for habitation. In June, 1954, in anticipation of the Act coming into operation, I submitted a preliminary report to the Public Health Committee, outlining the position in regard to unfit houses so far as Southgate is concerned. To ascertain information for this Report, a preliminary survey of the Borough was carried out. The number of unfit houses could not be assessed at all accurately at this stage, however, owing to a fact, known at the time, that a new standard of fitness by which houses had to be judged, was to be included in the provisions of the new Act. As soon, however, as the Act came into operation, a more detailed survey was undertaken to determine the number of houses unfit by the new standard, in order to provide the Council with the information necessary on which to formulate proposals for dealing with the unfit houses, for submission to the Minister in 1955. This survey was in progress at the close of 1954. A full report on the matter will, therefore, be included in my Annual Report for 1955. Recognising that the work in relation to housing generally will inevitably increase as a result of the passing of the new Act, and, in addition, for other reasons outlined in a report I submitted to the Public Health Committee in July, 1954 (which will be found in Appendix 3 of this Report) regarding the need for an additional Sanitary Inspector, the Committee recommended the Council to make such an appointment. Towards the close of 1954, the Council advertised the appointment and an additional Sanitary Inspector was appointed early in 1955. The addition of another Inspector has already been of tremendous assistance in the work of the Department. Increase of Rent Certificates. From 30th August, 1954, the date of the passing of the Housing Repairs and Rents Act, 1954 until 31st December, 1954, twenty-one applications were received from tenants for Certificates of Disrepair following Notices from their landlords concerning increases 27 of rents. Following inspections of the houses, twenty-one Certificates of Disrepair were granted. During the same period, the repairs necessary to put one of the houses concerned in good repair were carried out and an application was received from the landlord for a Notice of Revocation of the Certificate of Disrepair. A Notice of Revocation was granted. Housing Applications. Visits by the Sanitary Inspectors to applicants for housing accommodation and the preparation of reports as to living conditions was continued in 1954. The number of visits for this purpose was 75, as against 117 in 1953. The close liaison between the Public Health Department and the Housing Department has been maintained in 1954, 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, 1,567 visits were made to food premises in the Borough as against 1,880 in 1953. As a result of these visits, it was found possible to bring about improvements and generally to encourage a higher standard of food hygiene. No special Clean Food Campaign was held during 1954. It will be appreciated that a continuous campaign has been carried on throughout the year in regard to food hygiene, both during the visits paid to food premises by the Sanitary Insepctors, and by talks and film shows given by members of the Public Health Staff. In my report to the Public Health Committee at their meeting on 11th January, 1955, I submitted, for consideration, preliminary details for a Clean Food Fortnight to be held in May or June, 1955. A full report on this Campaign will be included in my Annual Report for 1955. The Food & Drugs Amendment Act, 1954, which amends the Food & Drugs Act, 1938 and the Food & Drugs (Milk, Dairies and Artificial Cream) Act, 1950, received the Royal Assent towards the end of 1954. The Act, however, does not come into operation until a date fixed by the Minister. This date has not yet been fixed. It is dependent, to a great extent, upon the compilation by the Minister of regulations regarding food hygiene. These regulations are awaited with interest. In the meantime, however, our efforts towards a higher standard of food hygiene continue. 28 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 25 stone Carcase Meat 2,098 lbs. Offal 161 lbs. Rabbits 206 lbs. Sausages 208 lbs. Bacon 56 lbs. Liver Sausage and Black Pudding 9 lbs. Canned Meats (various) 655 lbs. Canned Foods (various) 2,063 cans Meat Pies 13 Butter 6 lbs. Cheese 84 lbs. Processed Cheese 41 cartons Cake 53 lbs. Cake Mixture 5 packets Biscuits 14 lbs. Cereals 35 lbs. Fruit (Dried) 30 lbs. Fruit (Bottled) 21 bottles Jam and Marmalade 91 lbs. Tea 12 lbs. Calves Foot Jelly 5 jars Pickles 13 jars Fish and Meat Paste 8 jars Sweets ½ lb. Christmas Pudding 2 lbs. Frozen Foods (meat, vegetables and fruit) 160 packets 29 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 37 Butchers 60 Grocery and Provisions 116 Fruit and Greengrocery 63 Wet Fish 4 Fried Fish 8 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 109 Confectionery and Sweets 80 487 In the Borough there are 285 premises registered under Section 14 of the Food and Drugs Act 1938, 196 in respct of ice-cream and 89 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 79 hawkers on the register at the end of 1954. Of these, 17 have storage premises in the Borough and 62 have their storage premises in other areas. Post-Mortem Inspection of Animals. No slaughtering of animals took place in the Borough during 1954. Milk Regulations and Milk Sampling. During 1954, 85 samples of milk as against 79 in 1953 were obtained and submitted to the Public Health Laboratory for bacteriological examination. Only one of the samples taken gave an unsatisfactory result on examination. This was taken up immediately with the purveyor concerned. A check sample was taken and proved satisfactory. Ice Cream Sampling. During 1954, 166 samples of ice cream as against 75 in 1953 were obtained and submitted for bacteriological examination. The results of examination of the 166 samples were: Grade 1 133 „ 2 17 „ 3 8 „ 4 8 166 30 Of the 16 samples giving Grades 3 and 4 results, 10 were from one firm. In July, 1954, in view of unsatisfactory conditions at this firm's premises in respect of the manufacture of ice cream, the Council revoked registration of the premises for this purpose, in accordance with their powers under Section 14, Food and Drugs Act 1938. Investigations made by the Sanitary Inspectors concerning the other 6 unsatisfactory samples, and the advice the Inspectors were able to give, resulted in subsequent samples being found satisfactory. Establishments for Massage or Special Treatment. Under the Middlesex County Council Act, 17 existing licences were renewed, and 1 new licence was granted. Swimming Bath. The figures for attendances at the Barrowell Green Open Air Swimming Bath for the last two years were: 1954 1953 Adults (Mixed and Spectators) 9,720 20,126 Children (Mixed and Spectators) 19,593 35,036 From Schools 2,468 2,647 Season Tickets 5,797 10,651 35,578 68,460 Costumes, etc., hired 76 138 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. 31 Prevention of Damage by Pests Act 1949. During 1954, 465 complaints of rats and mice were received and dealt with, as against 464 in 1953. In March, 1954, a baiting and poisoning treatment was carried out by the Borough Engineer's Department on the Council's soil sewers. 293 manholes were baited. In 100 of these, complete or part takes of bait were noted. At the conclusion of the treatment, takes of poison were recorded. 9 manholes showed complete takes of poison, and 59 showed part takes. In September, 1954, test baiting was carried out by the Borough Engineer's Department to 206 manholes, representing approximately 11.5 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 405 manholes were baited. Of these, 131 showed complete or part takes of bait. In accordance with recommendations of the Ministry of Agriculture and Fisheries, an alternative bait base and poison was used for this treatment and no recording of poison takes was undertaken at the conclusion of the treatment. All work done in the sewers was carried out in accordance with the recommendations of the Ministry of Agriculture and Fisheries (Infestation Control Division). An official of the Ministry visited the Borough on both occasions, 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. 18 public conveniences are available in the Borough, situated as follows: Broomfield Park (3) 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 32 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 includes conveniences provided for the use of the public in public houses and hotels. Defects are brought to the notice of the Borough Surveyor's Department, or are notified to the proprietors of the premises in which the public conveniences are situated. In connection with the paragraphs in my Report for 1952 concerning the provisions of an additional convenience within the Borough, this matter is still under consideration by the Public Health Committee. 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 1953, 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, in spite of an acute shortage of labour towards the end of the year, a weekly collection service was maintained. The tonnage of refuse dealt with at the Refuse Disposal Works amounted to 19,216 tons. On the resumption of work after the Easter Holiday, it was found that the Destructor chimney had collapsed. The Destructor was closed for five weeks and repairs were carried out. During this time, Southgate's refuse was disposed of by our good neighbours Edmonton Borough Council and Enfield Urban District Council. 33 Items such as tins, rags, bottles, etc., which are normally recovered as the refuse passes through the plant were unfortunately lost during this period. The following table gives tonnage of salvaged materials sold during the year: Tons Cwts. Qrs. Paper 866 15 3 Cullet 2 11 0 Metals 1 7 1 Rags 32 17 3 Carpets and Gunny 21 14 3 Tins 485 5 0 Bottles 21 4 2 Mixed Scrap Iron 95 15 3 Miscellaneous 5 3 1 The value of this material amounted to £10,782 17s. 2d. Waste Paper. Waste paper is the material from which most of the income is derived, and in this direction our efforts as a Council depend to a great extent on the co-operation of the burgesses. Householders are urged to keep clean waste paper and cardboard separate from refuse. A sack will be supplied on application to the Borough Engineer, and this will be emptied and returned by the Refuse Collector on his weekly call. Kitchen Waste. At the beginning of the year, the Compulsory Order requiring the Council to collect kitchen waste was rescinded. For many years the cost of providing the domestic collection service has considerably exceeded the income from sales, and the Council, therefore, decided to discontinue the house-to-house collection with effect from August. The service providing for the collection of large accumulations from schools, canteens and restaurants, continued to show a profit and has therefore been maintained. 34 FACTORIES ACTS, 1937 AND 1948 Details of Work Carried Out During the Year 1954 1. INSPECTIONS for purposes of provisions as to health (including Inspections made by Sanitary Inspectors). Premises M/c. line No. Number on Register Number of M/c. line No. Inspections Written Notices Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 1 60 74 7 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 163 159 13 - 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 - - - - 3 Total 223 253 20 - - 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on 2, 3 or more separate occasions, they should be reckoned as 2, 3 or more cases). Particulars M/c. line No. No. of cases in which defects were found Number of cases in which prosecutions were instituted M/c. line No. Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.1) 4 12 12 - - - 4 Overcrowding (S.2) 5 - - - - - 5 Unreasonable temperature (S.3) 6 1 1 - 1 - 6 Inadequate ventilation (S.4) 7 - - - - - 7 Ineffective drainage of floors (S.6) 8 - - - - - 8 Sanitary Conveniences (S.7) (a) insufficient 9 - - - - - 9 (b) unsuitable or defective 10 19 19 - 3 - 10 (c) not separate for sexes 11 2 2 - - - 11 Other offences against the Act (not including offences relating to Outwork) 12 - - - - - 12 Total 60 34 34 - 4 - 60 35 36 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 list to the Council No. of instances of work in some premises Notices Served Prosecutions M/c. Line No. Wearing Apparel— Making, etc. 13 104 - - - - - - Cleaning and washing 14 - - - - - - - Curtains &Furniture Hangings 17 - - - - - - - Furniture and Upholstery 18 - - - - - - - Fur Pulling 22 1 - - - - - - Artificial Flowers 28 3 - - - - - - Paper Bags 33 - - - - - - - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 4 - - - - - - Brush making 35 1 - - - - - - Feather sorting 37 3 - - - - - - Carding, etc. of Buttons, etc. 38 1 - - - - - - Stuffed Toys 39 - - - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 42 1 - - - - - - Total - 118 — - - - - - PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 46, it will be observed that 276 cases of infectious disease were notified during the year, as against 1,579 in 1953. The infectious sickness rate for the district was therefore 3.81, as compared with 21.89 during the previous year. As noted elsewhere, the marked decline in the infectious diseases notified during the year was due almost entirely to the decrease in the notifications of measles (28 as against 1,053). The decrease in the number of cases of pertussis notified (55 as against 138), scarlet fever (51 as against 128) and dysentery (52 as against 95) also contributed to the fall, while the decrease in tuberculosis cases notified (42 as against 62) might also be mentioned. Altogether, the total of 276 infectious diseases notified during the year is the smallest I can remember as having been recorded in Southgate. In the introduction to this Report, I once again mentioned the fact that the term epidemiology has now taken on a new significance. We must no longer confine our attention to infectious diseases per see, but must concern ourselves with any disease or contributory cause of disease which makes itself apparent among the population. So far as Southgate is concerned, this more or less reduces itself to the investigation of unusual illnesses which may have sprung from quite unexpected sources. Here, of course, one is very largely dependent on the information received from general practitioners. Thus, in the past, I have been informed of cases of infective hepatitis among school children some time before the information could have been obtained from the schools concerned; while family doctors and schools have been very helpful in letting us know of outbreaks of such diseases as winter vomiting. I am most grateful for this assistance, and have communicated my thanks both to general practitioners and to head teachers. Altogether, as I say, Southgate is not the type of district in which it could be said that conditions favourable to the spread of disease exist, we must continue to search for such conditions which may well be latent; we must also strive to take such measures as are possible to prevent these disease-producing factors from arising, to destroy any weeds which may take root, however tenuous, in our garden. This is the true meaning of epidemiology in its widest, its most modern sense. 37 Leaving aside the important question of epidemiology as we know it, the picture in regard to infectious diseases is still relatively fluent. In my Annual Report for 1953, I mentioned the reduction in severity, particularly as it affects a disease such as scarlet fever. These remarks still apply. We also know that virus diseases, many indeterminate and still being investigated, have shown a definite tendency to increase. Among these diseases, the complaint known as winter vomiting is particularly apparent. This disease has little more than a nuisance value, and has not shown itself capable of producing either a serious illness or dangerous after effects. None the less, the appearance of new virus diseases must be treated with great caution, since we know only too well the ravages which a virus disease such as poliomyelitis can produce. Unfortunately, only a proportion, virtually an unknown proportion of virus infections are at present notifiable. This is inevitable, as many of these diseases are extremely mild, while their relationship to other diseases and their precise position in the general pattern has not yet been fully established. In the meantime, therefore, we continue to hold a watching brief, prepared to change our attitude in the light of experience and information. I would conclude this section of the Report by making reference to influenza. Towards the end of 1953, the Ministry of Health asked us to supply information on the prevalence of influenza, particularly the type of influenza complicated by pneumonia and by cerebral complications. I communicated on several occasions with general practitioners, and obtained a miscellaneous bag of information which I correlated and transmitted to the Ministry. At that time, there did not appear any evidence that influenza was unduly prevalent. Later, however, the number of cases did increase, so much so that we might have had to put into operation certain emergency domiciliary nursing measures for which we were fully prepared. Fortunately, the number of serious complications and deaths gave no cause for alarm. This, however, is an example of the type of Co-operation which one heartily endorses. Only when the central authority, the local authority and the body of general practitioners concerned is prepared to work together, interchanging information to the fullest possible extent, can we say that we are ready to cope with any situation. The fact that special measures were never necessary in this particular instance should never be allowed to militate against this excellent principle. Diphtheria. For the seventh year in succession, no case of diphtheria was notified in the Borough. The last death took place approximately 12 years ago. 38 Our immunisation programme is, broadly speaking, the same as that set out in recent reports. Various minor modifications have been introduced particularly to ensure the use of the most efficient antigen and to lay down special precautions relating to infants and children who are likely to be allergic. I intend to embody our immunisation time-table in a memorandum which will set out in detail the programme upon which we have decided, together with those precautions considered necessary. When the time-table is ready, I will furnish each general practitioner with a copy, so that we will, so far as is possible, be working along the same lines. It was not necessary during 1954 to suspend the use of the combined type of antigen for immunisation against diphtheria and pertussis. As will be remembered, this was done during 1953 because of the occurence of cases of poliomyelitis in the neighbourhood. The immunisation figures relating to Southgate for 1954 might be summarised as follows: These figures show that 790 primary immunisations, either against diphtheria alone or against diphtheria and pertussis (whooping cough) were carried out in Southgate during 1954. During the same year, 1,727 children received reinforcing doses in the schools, while 67.8% 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. I think it can fairly be said that our scheme of immunisation, either against diphtheria alone or against diphtheria and pertussis, is comprehensive, and that, so long as the present level of immunisation is maintained, diphtheria will continue to be a comparatively rare disease. For some time I have been anxious to use the new triple antigen which protects children against diphtheria, pertussis and tetenus. The Ministry of Health has still not given its blessing to the use of the triple antigen however, and we must therefore wait until approval is forthcoming. It will not be necessary for me to say that the work of immunisation in Southgate is carried out by the County Council. I know, however, that the Borough Council is extremely interested in this vital weapon, and that it would wish to be fully informed on the precautions being taken in Southgate. 39 As regards propaganda, we have not been entirely satisfied with the literature available in respect of immunisation, paricularly immunisation against diphtheria. This especially applies to the time-table advocated in the various pamphlets and leaflets at present at our disposal. Indeed, it was becoming more and more obvious that the suggested time-table very often conflicted with the advice issued from the Area Health Office and given at our clinics. I raised this matter at the Middlesex Advisory Committee, and was invited to produce an up-to-date pamphlet which would be generally acceptable throughout the country. I duly prepared a statement, after which I had several consultations with the Principal of the Ealing School of Art, where most attractive illustrations have been drawn up. The general lay-out and wording is now awaiting consideration and will, it is hoped, provide us with a pamphlet which should be acceptable and of practical use to parents. Scarlet Fever. Scarlet fever notifications during 1954 again showed a marked decline over the figures for the previous year. The notifications for the past three years were 188, 133 and 51 respectively. The type of disease met with has been universally mild. Indeed, it is extremely doubtful whether more than a percentage of all the cases which occurred were ever seen by a doctor. I would, however, repeat the remarks which I made in last year's Annual Report, that scarlet fever may be going through a temporary phase of reduced virulence. We must therefore continue to watch the trend, and be prepared for a return at any time of the more severe type of infection previously encountered. Acute Anterior Poliomyelitis. Three cases of acute anterior poliomyelitis were notified during 1954, as against four during the previous year. 2 cases were paralytic, the remaining 1 being non-paralytic. Shortly before this Report was written, the news was received that an efficient vaccine against poliomyelitis was at last available in the United States. Since then, of course, further news has come to hand of actual cases of poliomyelitis occurring very shortly after vaccination; while it has been stated that parents have been affected, presumably as a result of intimate contact. I think it would be safe to say, however, that we can now look forward to the day, 40 in the near future, when a safe and efficient vaccine will be avail' able in this country, to protect children aginst poliomyelitis, just as they have been protected against diphtheria and, to a lesser extent, against pertussis. In the meantime, we must continue our general measures of protection, basing our actions on the knowledge available to us. I need scarcely point out that propaganda in regard to poliomyelitis is regularly carried out, mainly through the schools. I also make a point of informing general practitioners of any undue occurrences. This propaganda is extremely valuable, the one proviso being that any feeling of alarm must at all costs be avoided. Measles. Twenty-eight cases of measles were notified during the year, as against 1.073 during 1953. This is the lowest figure in Southgate since measles became notifiable in 1940. Admission to hospital was only required in 2 cases, an indication of the mild character of the disease. Once again we must remember that the character of measles may change from year to year, there being no guarantee that the present low virulence will be maintained. I am satisfied that the vast majority of Southgate parents appreciate the situation, and take the necessary precautions. This being so, it only remains to make certain that the possible dangers resulting from an attack of measles, especially in a young child, are made known from time to time. Pertussis. Fiftyfive cases of pertussis were notified during the year, as against 138 in 1953. It will thus be seen that the number of pertussis cases which occurred during the year was actually higher than the corresponding measles total. This could almost be described as a phenomenon. We have continued our policy of immunisation both against pertussis alone and against diphtheria and pertussis combined. Although pertussis immunisation does not give a full guarantee of protection, it is generally agreed that efficient immunisation will modify an attack. This modified attack, which represents merely a trifling illness, is then followed by life-long immunity. Although there is an obvious danger that these modified attacks may go unnoticed, thus helping to keep the infection alive and so passing 41 the infection on to other children, available evidence would seem to show that our present programme of immunisation, coupled with health education, is correct, and that it should be vigorously pursued. Food Poisoning (including Sonne Dysentery). Eleven cases of food poisoning and fifty-two cases of dysentery were reported in 1954, as against totals of 14 and 94 respectively during the previous year. I must again point out that these cases represent notifications, and do not fully indicate the incidence either of food poisoning or of dysentery within the Borough. None the less they are extremely useful for comparative purposes, as it can presumably be accepted that the factors which militate against the complete notification of food poisoning and dysentery do not materially alter from year to year. It will be remembered that, in my Annual Report for 1953, I suggested that we might put into operation a modified procedure designed to discover the presence of "carriers", without throwing an unnecessary burden on the Sanitary Inspectors and, what is more important, without causing undue absences from schools. This procedure was, in fact, introduced during 1953 and is working very well. Broadly speaking, the system depends on the exclusion from school for one week of all children who have had diarrhoea or sickness, in any school where the incidence of diarrhoea and sickness has been clearly shown to be above the average. This procedure might mean, of course, that children are occasionally excluded for transient reasons which have no epidemiological significance. On the other hand, it has already been shown that the system has reduced the absence from school of "carriers" of Sonne dysentery or food poisoning organisms, and causes much less upset in a family than did our previous procedure. We have prepared special letters which are available to all Head Teachers, and which are used by Head Teachers as and when the occasion warrants such action being taken. As always, our Head Teachers have been most co-operative, and seem to appreciate the reason for the change. "Carriers" of food poisoning or Sonne dysentery organisms who are food handlers are still excluded in the usual way, until the requisite number of negative specimens has been obtained. Altogether this has been an extremely quiet year so far as food poisoning and dysentery are concerned. No outbreaks of food 42 poisoning were reported, while Sonne dysentery remained at a very low level. Puerperal Pyrexia. No cases of puerperal pyrexia were notified during the year, as against two in 1953. No deaths were attributable to puerperal causes. Having regard to the fact that, in the vast majority of cases, puerperal pyrexia is no longer a disease which either kills or even incapacitates, it has been claimed that notification is no longer required. It would certainly be true to say that most cases of puerperal pyrexia are due to such simple causes as constipation or a common head cold occurring shortly after childbirth. Against this we know that there are other causes for a rise in temperature during the peurperium, and that these causes may be highly significant. As midwives must be prevented at all costs from moving from one infected mother to another, it would seem highly proper that even the mild conditions now known as puerperal pyrexia should continue to be brought to our notice. Smallpox. No case of smallpox occurred in Southgate during the year. Indeed, only one doubtful rash was reported. It was necessary in this case to call for the services of one of the experts appointed by the Ministry of Health, as the illness had several features of a highly suspicious nature. Fortunately, the final diagnosis was chicken-pox. I am glad to be able to report that the number of mothers seeking vaccination for their infants at Child Welfare Clinics in Southgate shows a definite increase. I have communicated with general practitioners, asking them to advocate vaccination as strongly as possible, because of the extremely low vaccination state. prevailing throughout the country. Southgate practitioners will shortly be supplied with an attractive display card urging vaccination as well as immunisation. I have asked them to display this card in their waiting rooms, and have little doubt that they will co-operate. Tuberculosis. Forty-two cases of tuberculosis (35 pulmonary and 7 non-pulmonary) were notified during the year, as against 65 in 1953. Distribution of cases notified among the various wards was as follows: North-east North-west Middle South 9 7 9 17 43 A broad classification of the cases notified during the past five years in relation to employment was: 1950 1951 1952 1953 1954 Clerical 15 9 19 17 7 Housewives 12 24 10 12 6 Children 4 7 5 3 1 Manual Labour 8 - 5 8 6 Factory Workers 2 5 - 5 2 Professional Classes 3 3 5 2 1 Armed Forces 2 1 1 - - Domestic Service 1 - 1 - 3 Food Trades 2 - - - - Students 4 - 1 1 3 Shop Assistants 3 - 4 1 - Nurses - - 3 2 1 Non-manual Trades, other than food 7 15 7 9 Teachers - - 2 - - Unclassified 11 13 8 7 3 67 69 79 65 42 It will be seen that the total number of cases of tuberculosis notified each year over the past five yearly periods has been more or less consistent, except for a slight rise in 1952 and a rather greater fall in 1954. With regard to these totals, I have already emphasised that the period covered is too short and the totals too small to allow of any significant conclusions being drawn. Further to this, we know that the factors which contribute to the number of cases of tuberculosis notified in any district during a year are so diverse and so complex as to make proper analysis extremely difficult. Thus, families in which a case of tuberculosis has already occurred, and which may still contain an infected member, may very well move to Southgate because of the amenities to be found within the Borough. It is also worthy of note that the incidence of tuberculosis has not fallen in the country as a whole during the post-war period. This is undoubtedly due, in part at least, to the greatly improved facilities for discovering the disease in its early stages, more especially the work of Mass Radiography Units and Chest Clinics. There does not appear to be any reason to believe that Southgate has more than its share of fresh cases every year, or that any 44 unusual conditions exist within the Borough which favour the spread of tuberculosis. In passing, it should of course be mentioned that, although the incidence of tuberculosis has not shown any decrease, the death rate is falling quite rapidly. In other words, although just as many cases are occurring today as occurred, say, ten years ago, many more patients are being kept not only alive but fit, able to work and capable of leading a happy healthy life. Although we did not have a visit from a Mass Radiography Unit during 1954, a further visit has been scheduled for the early part of 1955. Indeed, this visit has already taken place, and was a great success. So many people attended that four further days are being spent in Southgate during June. The visits to be made by the Mass Radiography Unit in 1955 represents the first public sessions arranged in Southgate, with the full co-operation of the Public Health Department. As these visits come within the purview of the next year's Annual Report, full details will be supplied when that Report is presented to the Council. Arrangements have also been made for all school leavers to visit the Mass Radiography Unit at special sessions which will be held for children already attending our five secondary schools during July of this year. The advantages to be expected from a check-up of this nature need not be emphasised. I would conclude by making a special plea for the re-housing of families in which an open case of tuberculosis is shown to exist. I fully appreciate the difficulties which confront the Housing Committee and the Council in providing adequate housing accommodation, as well as the fact that housing needs are by no means confined to tuberculosis families. On the other hand, the needs of a patient suffering from tuberculosis iare not the only disideratum. If a tuberculosis family occupies premises which are overcrowded, the risk of spreading infection very greatly increases. No one can say how far the net will spread, or what the ultimate effect will be. Thus, not only on humanitarian but on strictly epidemiological lines, it is of paramount importance that the rehousing of families from which a case of tuberculosis has been notified, especially where the patient continues to live at home, should be granted high priority. I am very happy to think that the Housing Committee has always given the most sympathetic consideration to my representations. I am fully convinced that this is the proper coarse to adopt, and that not only the family but the Borough as a whole will very definitely benefit. 45 NOTIFICATION OF INFECTIOUS DISEASES, 1954 Jan.— March April— June JulySept. Oct.— Dec. Totals Scarlet Fever 24 13 10 4 51 Pertussis 6 22 13 14 55 Poliomyelitis: Paralytic 1 - 1 - 2 Non-paralytic 1 - - - 1 Measles J 5 18 2 28 Diphtheria - - - - - Pneumonia 12 10 3 5 30 Dysentery 15 27 8 2 52 Smallpox - - - - - Encephalitis - - - - - Erysipelas 2 - - 1 3 Meningococcal Infection - - - - - Food Poisoning 1 1 4 5 11 Puerperal Pyrexia - - - - - Ophthalmia Neonatorum - - - - - Paratyphoid B. - - - - - Tuberculosis: Pulmonary 10 8 5 12 35 Non-Pulmonary 1 3 1 2 7 Total 76 89 64 47 276 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1/1/54 338 275 47 46 706 Cases notified for first time in 1954 22 13 2 5 42 Cases Restored to Register 3 1 — — 4 Other Cases added 15 15 1 — 31 Cases Removed from Register 25 20 — 1 46 Cases remaining on Register at 31/12/54 353 284 50 50 737 46 TUBERCULOSIS —1954 * New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year - 1 - - - - - - 1- 5 years - - - - - - - - 5-10 years 1 - - - - - - - 10-15 years 1 1 - - - - - - 15-20 years 2 2 - - - - - - 20-25 years 3 8 1 - - - - - 25-35 years 12 6 1 2 - - - - 35-45 years 6 2 1 2 - 1 - - 45-55 years 5 7 - - 2 1 - - 55-65 years 4 - - - 1 1 - - Over 65 years 3 - - 1 - - - - Unknown - 1 - - - - - - Total 37 28 3 5 - 3 - - * These figures include all cases previously notified and noted by the Tuberculosis Officer and others as having removed into the district. 47 APPENDIX 1 MISCELLANEOUS (a) Letters to Doctors. The following letters were sent to Southgate practitioners during 1954: 28th January: Infection and Exclusion from School. 1st February: Endorsement of International Vaccination Certificates. 7th April: Collection of Laboratory Specimens during Easter Holiday Period. 7th May: Demonstration of work at Collindale Public Health Laboratory. 31st May: Collection of Laboratory Specimens during Whitsun Holiday. 1st June: Exclusion from School. 30th June: Influenza particulars. 27th July: Collection of Laboratory Specimens during August Holiday Period. 15th September: Notification of Infectious Diseases. 28th October: Investigation into Salmonella Infections. 30th November: Influenza. I cannot emphasise too often or too strongly the need for close co-operation with general practitioners, without whose help the work of the Public Health Department would be so quickly stultified. Just as I try to keep the Public Health Committee informed of all matters in any way affecting health, I feel it my duty to acquaint general practitioners with changes in policy and with new developments, offering and quite frankly asking for co-operation. I said in my Annual Report for 1953 that we were indeed fortunate in Southgate in so far as this co-operation and exchange of information are concerned. This still represents the happy situation which exists today. (b) Medical Examinations. During the year, 9 medical examinations were carried out in respect of entrants to the Council's service. In addition, 20 medical reports were issued relating to employees absent from duty for more than a short period through sickness. Although visits were made on occasion to the homes of sick employees, such visits were only made after contact had been established with the family doctor so that misunderstandings would be avoided. In the vast majority of cases, it was only necessary to get into touch with the general practitioner concerned, 48 when full information was readily forthcoming. This is another example of the valuable co-operation which can and should exist between the Medical Officer of Health and the general practitioner. (c) Accidents in the Home. As the Public Health Department is keenly interested in any factors which influence health, or which are likely to be followed by a state of ill-health, the question of accidents in the home has received attention. After full consideration, I came to the conclusion that accidents in the home was a subject which properly belonged in the main to the personal health services, and which should primarily be considered as part of my duties as Area Medical Officer. Although the Borough Council has always shown a keen interest in this most important subject, it will be appreciated that, to avoid over-lapping, a problem of this nature and magnitude must of necessity be given the force of single direction. As I am Area Medical Officer as well as Medical Officer of Health for Southgate and could, therefore, easily correlate the campaign, this presented no difficulty. During the year, we accepted the offer of an attractive booklet setting out in considerable detail hazards in the home, what they were and how they could be avoided. This booklet was published on behalf of the Area Health Committee, but had a cover design incorporating the Coat of Arms of the Boroughs and Urban District Councils included in Area No. 2. Distribution of the booklet, which proved most acceptable to parents and to burgesses generally, was undertaken by the Public Health Department, the Area Health Office, clinics and libraries. I have also taken the opportunity to refer to accidents in the home, indeed to accidents generally, in various articles which I wrote for "Better Health" and which, with the usual courtesy of the Editors of our local press, have appeared from time to time in local papers. 49 APPENDIX 2 WELFARE OF THE AGED Although the National Health Service Act 1946 places the responsibility for care of the aged upon the County Council as local health Authority, this is quite obviously not a matter which should be divorced from the activities of the Borough Council. Indeed, the Southgate Borough Council, either directly or through those voluntary bodies in which it has evinced a constant interest, has long been active in the welfare of the aged. It is for this reason that I append herewith a brief report of action I have taken in this connection, primarily as Area Medical Officer. The action might be summarised as follows : (i) A letter to voluntary welfare organisations in the district. This letter asks voluntary organisations to let us have full information relating to any case of hardship occurring in an elderly person, where either the Public Department or the Area Health Office might be able to help. Although it would be true to say that voluntary bodies have been most co-operative in letting us have such information as came into their possession, I am still of opinion that occasional cases of hardship, sometimes of a most distressing nature, do occur among eldely people without the circumstances ever coming to our knowledge. It is this unfortunate happening which I hope at least to mitigate by the circular letter mentioned above. (ii) A medical memorandum addressed to the Superintendent Health Visitor, Superintendent of Home Nurses and Home Help Organiser. This memorandum asks the ladies mentioned above to make quite certain that members of their staffs are fully cognisant of the need to supply us with full information relating to old people, whenever additional help appears to be required. (iii) A circular letter to general practitioners. Here again, I have asked general practitioners to let us have such information as they obtain in regard to patients. (iv) A letter to the County Medical Officer, the Area Welfare Officer and Highlands Hospital. These letters bring to the notice of the County Medical Officer, the Area Welfare Officer and Highlands Hospital (the most co-operative hospital so far as Southgate is concerned) the various circular letters set out under (i), (ii) and (iii) above. This course was felt desirable, so that everyone might know what was going on and could therefore be in a better position to co-operate. 50 As I have already stated, the care of the aged is mainly the concern of the local health authority, by way of its Health Visiting, Home Nursing and Home Help services. None the less, the Borough Council has a responsibility in regard to premises and accommodation, as well as the moral, if not legal, responsibility of taking all possible steps to secure and safeguard the well-being of the community and the individuals who make up that community. Because of this, I have brought these facts to the notice of the Public Health Committee. It is also a fact that local publicity is likely to have a much better effect if it is organised by the local Public Health Department, rather than by the Area Health Office. I therefore propose to see that any material offered to the local newspapers carries the signature "Medical Officer of Health At the moment, I do not visualise the need for such publicity, although the matter will be kept in mind. Finally, I suggested in my circular letter addressed to local welfare organisations that it might be wise to think around the possibility of forming some sort of "clearing house" in Southgate. The idea of this "clearinghouse" would be a Committee in which it would be possible to exchange full information relating to old people, and to ensure that all bodies able ,to help were fully aware of existing needs. Should anything come of this suggestion, I will let the Committee know. 51 E. G. ELLIS & SONS Willow Street:: E.4.