AC 4394 SOUTH GATE BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1956 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health 1 2 SOUG 41 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1956 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health 1 2 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE Mr. Mayor, Ladies and Gentlemen, I beg to present the Annual Report for 1956. The year under review was uneventful. No epidemics or even outbreaks of infectious diseases occurred, the total number of infectious diseases notified during the year (349) being one of the smallest recorded for a considerable period. This matter will receive more detailed attention in the section of the Report dealing with the Prevalence and Control of Infectious Diseases. The vital statistics for 1956 were satisfactory. The birth rate fell from 11.8 per 1,000 to 11.2. The death rate was 9.9 as against 8.9 in 1955. There were no deaths from puerperal causes. Indeed, only one woman has died during or immediately after child-birth since 1949, during which time 6,569 births were recorded. The Infantile Mortality Rate, i.e. the number of infants who died during the first year of life was 13.8, one of the lowest rates recorded in Southgate. I would again stress that it would be useless, indeed quite fallacious, to draw any lasting conclusions from the statistics appertaining to one year. One must review the situation over a number of years to see whether or not there are any trends which are affecting the population. So far as Southgate is concerned, the birth rate is lower than that for England and Wales, and is likely to remain so. As might be expected, the death rate is not much lower than that for the country as a whole. This is scarcely surprising, bearing in mind the excessive weighting towards the older age groups which has so long been a feature of the Borough. The Infantile Mortality Rate is also appreciably lower than that for the country as a whole, and has followed the downward trend which has been apparent during the post-war years. In short, what might be termed our basic statistics are quite uncomplicated. It must be admitted, of course, that the statistics available to a Medical Officer of Health are still by no means complete. It is certainly easy to compute such rates as the birth rate, the over-all death rate, the infantile mortality death rate and rates appertaining to deaths from individual infectious diseases. On the other hand, 3 our knowledge of morbidity as opposed to mortality still leaves much to be desired. We do not, for instance, have accurate information as to the amount of sickness occurring among the population as a whole, apart from notifiable infectious diseases. We are dependent for this knowledge on information received from general practitioners, from the Ministry of National Insurance and from schools. It will be appreciated that this information must, of necessity, be sketchy and that it would be quite impossible to present an accurate, composite picture from such data as comes the way of the Public Health Department. Unfortunately, there is at present no machinery to overcome this difficulty. It is sincerely to be hoped that this omission will one day be rectified, and that the Medical Officer of Health, who should be in possession of this information, will eventually be able to collect, collate and present a series of comprehensive statistics which will enable the health of the district to be adequately assessed. Until that day arrives, we must make the best possible use of such information as is at present available. It is for this reason that close and cordial contact with general practitioners is so very significant. 1956 saw the beginning of slum clearance projects. Work under this heading was initiated by the passing of the Housing Repairs and Rents Act 1954. The work carried out during the past year will be dealt with in more detail later in the Report, but it may now be said that Southgate has tackled this problem actively and with decision. The longer I continue as Medical Officer of Health, the more do I come to realise that housing is one of the most important factors which affect the health of any district. The unhealthy environmental conditions under which so many people are compelled to live and work obviously have a very significant bearing on the occurrence of disease, not only infectious diseases but also illnesses in general. More important still, overcrowding, a social menace of the first order, not only affects health; the happiness and contentment of families which have to contend with overcrowded conditions are placed in immediate jeopardy. I am only too well aware that the solution is difficult. The Council must be equally well aware, however, that this problem must be given the highest priority if the health of the district is to be maintained at the level which has been such a feature of Southgate's corporate existence for so many years. The close liaison which has existed for so long between the Health Committee and the Housing Committee has done much to maintain this problem at a reasonable minimum. Unhappily—and this is a fact which we must all recognise—there is no prospect of the problem decreasing. Indeed, every year brings added problems, problems which affect an increasing proportion of the population. As I have already said, the problem must be faced with the greatest 4 resolution if the high standing of Southgate among the Boroughs of this country is to continue. And who would dare to say that this will not continue ? The work carried out under the Food & Drugs Act 1955 will be reviewed in detail in the appropriate section of the Report. This is yet another instance of the increased responsibilities which have been placed on the shoulders of the Public Health Inspectors over the past year. These responsibilities have been willingly, indeed cheerfully accepted, although it is unfortunate that the additional Public Health Inspector, appointed by the Council in 1955, resigned after a short stay in Southgate, leaving us one short of our complement. Needless to say, all possible steps are being taken to make good the vacancy. Mention might be made of yet another addition to what could very rightly be described as environmental hygiene. This concerns the passing of the Clean Air Act 1956. It will be appreciated that work in this field belongs to 1957 rather than to 1956, but the matter of clean air and all its implications were fully considered during the year under review, so that we would be ready to take positive action when the proper time arrived. Although Southgate could scarcely be regarded as a "black" area, I know that the Public Health Committee and the Council as a whole will wish to play their part in what must very rightly be a national effort. As always, Health Education has played a prominent part in our public health programme. The usual approach has been made, i.e. articles in the press, talks and film shows, posters, the distribution of leaflets, pamphlets, etc., through the Public Health Department, the Area Health Office, libraries and clinics. A handbook entitled "Home Health and Safety Handbook" was also prepared for distribution throughout the Borough. After careful consideration, it was decided that the time was not opportune to stage any special campaigns, e.g. a Clean Food Exhibition, although, as already mentioned, special articles appeared in the local press by courtesy of the editors on subjects which had topical interest. As hitherto, the magazine "Better Health" continued to circulate, and received a good reception. Too much emphasis cannot be placed on health education. Health education costs merely a fraction as compared with other health services yet the results, though perhaps intangible for a time, are none the less far reaching. It will also be obvious that Southgate is in many ways an ideal district in which to practise health education. 5 It must readily be admitted that we are very often preaching to the converted. On the other hand, I have found that the burgesses of Southgate, especially parents with young children, are very anxious to have up-to-date and understandable information on matters which affect their own health and the health and well-being of their families. We are only too anxious to supply this information, at any time and by any means. I count it a privilege that I have been invited to talk to so many organisations in the Borough over the past years, and that members of my staff are entering more and more into this work. We are not only enabled in this way to put across information which is at the same time topical and of real practical value; we have a golden opportunity to get to know the various organisations which are doing so much to foster community spirit within the Borough. I am fully convinced that this contact is valuable, and that it is no less than our duty to take all opportunities available to us to forge the closest and most durable links. There is one other topic which I should like briefly to discuss. This concerns the vital matter of mental health. It will be understood that mental health is the concern of the County Council as local health authority. None the less, the Borough Council cannot and, I know, has no wish to divorce itself from consideration of such a significant problem. Indeed, one hopes that, in the not-too-distant future, the duties under the heading "Mental Health" may be delegated to the Borough Council. It need scarcely be explained that the state of the mind exerts a most profound influence on happiness, well-being and physical health. It has now been clearly recognised that a growing proportion of the ills which affect the human body have their origin in the mind. That is not to say that most of our troubles are imaginary or that we are becoming a nation of hypochondriacs. Yet, whether we like it or not, we must appreciate that the difficult times through which so many people are passing not only aggravate physical imperfections but may set in motion a chain reaction which can and does result in active ill-health. Indeed, as we are coming to know more and more every day, chain reactions are by no means confined to an atomic explosion ! What contribution can the Borough Council make to what is now a gigantic problem ? The treatment of diseases of the mind does not concern us. Yet it must never be forgotten that prevention is infinitely better than cure. Our task should be to ensure, so far as lies within our 6 power, that conditions which disturb the life of the community are reduced to the absolute minimum. We have provided more than our share of delightful parks, open spaces, playing fields, town planning of the highest order and wide, pleasant streets. But although these amenities are literally invaluable, they are still not enough. We return once again to the stark menacing problem of housing. There can be little doubt that conditions under which so many of our burgesses have to live, even in a district such as Southgate, are among the prime factors which lead to mental ill-health. When one uses the expression "mental ill-health," one does not refer to actual insanity but to that unfortunate state, that gloomy hinterland into which so many people are plunged when the conditions under which they live are sufficiently unpleasant as to render life unhappy, frustrated and beset with innumerable problems. It is this, perhaps more than anything else, which gives rise to family quarrels, "problem families," delinquency and many other social ills too numerous to mention. I have already said that the solution to these problems will never be easy. None the less, the alarming increase in mental ill-health, severe or even slight, the break-up in families, the work of our divorce and Juvenile Courts and the fact that more and more individuals are living under a greater and greater strain points surely and inevitably to the need for this problem to be tackled as a matter of first priority. Quite recently, a valuable book by an American author was published in this country. This book, entitled "The Stress of Life," sets out very clearly the factors which contribute to what I have described as lack of positive health, factors which often lead to a breakdown in health, sometimes with far-reaching consequences. The author has described this as the "adaptation syndrome." In simple terms, this means that conditions are being set up in families and in individuals which exert a most profound influence on the health and well-being of increasing numbers of the population. The great value of this book lies in the fact, that possibly for the first time an attempt is made to assess these factors at their proper value, and to suggest ways in which the brake might be applied. We have still a very long way to go before we find a solution to what is one of the more serious problems facing us today. But a solution must be found. These serious matters are neither solely theoretical nor the vapourings of abstract sociology. I mention them here because the Public Health Department has a most signicant part to play. I feel confident that the Council will afford us full support in the efforts which we are taking to try to bring this problem under adequate control. 7 For many years, I have concluded this Report by expressing my thanks to the Public Health Committee and to the Borough Council for the courtesy extended to me as Medical Officer of Health. I would like to make it clear that this thanks is no mere lip-service. I am only too conscious of the help which I receive in my work, and am sincerely grateful for it. I would also express my thanks to the members of the Public Health Department for yet another year's excellent service. Although I would particularly mention my Deputy, Dr. Campbell, and Mr. Gooday, Chief Public Health Inspector, every member of the Department has fully played his or her part as a true member of the team. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. Town Hall, Palmers Green, N.13. 8 PUBLIC HEALTH COMMITTEE From 1st January to 14th May, 1956 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 P. W. Lansten From 23rd May to 31st December, 1956 Councillor G. D. Payne (Chairman) Councillor H. S. Beardow (Vice-Chairman) Alderman G. Peverett (Resigned from Council 18.12.56) Councillor R. A. Clarke Councillor R. A. Gray Councillor P. W. Lansten Councillor A. V. Stapleton PUBLIC HEALTH STAFF Medical Officer of Health: W. Clunie Harvey, M.D., Ch.B., D.P.H. Deputy Medical Officer of Health: Janet R. Campbell, M.B., Ch.B., D.P.H. *Chief Public Health Inspector: A. E. Gooday, M.R.S.H., F.A.P.H.I., Cert.R.S.H. Meat Inspection. *Public Health Inspector (No. 1 District): R. L, Burkill, A.R.S.H., M.A.P.H.I., Cert.R.S.H. Meat Inspection, Cert.R.S.H. Smoke Inspector. *Public Health Inspector (No 2 District): E. T. Jephcott, M.A.P.H.I., Cert.R.S.H., Cert. R.S.H. Meat Inspection. *Public Health Inspector (No. 3 District): W. Shackcloth, M.R.S.H., M.A.P.H.I., Cert.R.S.H. Meat Inspection. *Public Health Inspector (No. 4 District): R. N. Hedges, M.A.P.H.I., Cert.R.S.H., Cert. R.S.H. Meat Inspection (appointed 16th January, resigned 11th July, 1956). Senior Typist: Miss E. W. Barratt. Clerk: Miss A. G. Alcock. Junior Clerk: D. Beanlands (resigned 10th November, 1956). General Assistant: B. Latter. Driver: J. L. Arnold. Rodent Operator: W. Dowsett. * These Officers' salaries are repaid to the Council in part by the Middlesex County Council. 9 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,765 Registrar-General's Estimate of Resident Civilian Population, 1956 71,670 Number of Inhabited Houses (end of 1956) according to Rate Books 22,408 Rateable Value £1,482,730 Sum represented by 1d. Rate (1956) £5,950 There is little I can add to the remarks set out in the introduction to this Report. As a dormitory borough on the fringes of Outer London, our problems may not be so great or so pressing as those districts which are already overcrowded and over-built to quite an alarming extent. That does not mean, of course, that we do not have problems of our own. The standard set in Southgate has always been high; it must surely be our aim to maintain that standard and to ensure that the character of the Borough is never allowed to despreciate. In this great task, the Public Health Department has an important role to play. We fully appreciate the magnitude of this task, which is perhaps greater than is sometimes realised. The years ahead are not likely to lessen our difficulties. It is for this reason that I have continually stressed the true significance of maintaining an efficient staff at full strength. Only in this way can we hope to tackle our health problems in a realistic and adequate manner. 10 EXTRACT FROM VITAL STATISTICS OF THE YEAR Male Female Total Live Legitimate 407 370 777 Births Illegitimate 14 9 23 421 379 800 Birth Rate per 1,000 of the estimated population 11.2 Still Legitimate 7 4 11 Births Illegitimate — — — 7 4 11 Rate per 1,000 (live and still) births 13.44 Deaths from all causes and at all ages ... ... 844 Death Rate per 1,000 of the esti' mated population 9.9 Deaths from puerperal causes nil Rate per 1,000 total (live and Deaths still) Births From Puerperal 5 speses ... ... — — From other cause; ... ... - — Deaths of Infants under 1 year of age : ... ... Male Female Total Legitimate ... ... 8 3 11 Illegitimate ... ... — — — 8 3 11 Infant Death Rate: All infants per 1,000 births 13.8 Legitimate—per 1,000 legitimate live births 23.06 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 1956, was 71,670, a decrease of 200 as compared with 1955. BIRTHS —BIRTH RATE The total nett births for the year accredited to the district was 800, an increase of 24 on the preceding year. Of these, 421 were males and 379 were females (14 males and 9 females being illegitimate) . The birth rate for the year was 11.2 per 1,000 of the population. The birth rate for England and Wales for 1956 was 15.7. The births and birth rates for the past five years were as follows: Birth Rates Year No. of Births Southgate England and Wales 1952 775 10.37 15.3 1953 760 11.48 15.5 1954 815 12.3 15.2 1955 776 11.8 15.00 1956 800 11.2 15.7 During the year, the number of births recorded was 44 less than the number of deaths, as compared with 33 less in 1955. The total number of births actually recorded in the district during the year amounted to 186, of which 40 were unnotified. The percentage of births notified was therefore 78.49, as compared with 99.45 in 1955. 12 MORTALITY General Mortality and Death-Rate. The nett number of deaths accredited to the district was 844, 35 more than in 1955. This gives a crude death rate of 11.8 per 1,000 of the population and a corrected death rate of 9.9 (the rate for 1955 being 8.9). Death Rates Year No. of Deaths Southgate England and Wales 1952 900 11.55 11.3 1953 838 9.18 11.4 1954 813 8.8 11.3 1955 809 11.3 11.7 1956 844 11.8 11.7 In the Annual Report for 1955 I stated that, so far as could be ascertained, there were no factors operating specifically in Southgate which had an appreciable effect on the local death rate. I can add little to this statement. Incidentally, as already indicated, we have started the task of slum clearance, a term which I have never particularly liked. We also look forward to setting up our first smoke control area in the near future. Meantime, we shall continue to take such steps as are practicable to ensure that conditions which might be regarded as dangerous to health and life itself are reduced, if not eliminated from the Borough. With regard to the major causes of death as shown by the Registrar-General's return—deaths from diseases of the heart and circulation and lung cancer—I am convinced that these matters should not be given too great publicity, at least locally. These problems are national, and must be tackled on a national level. I have never had any hesitation in dealing with these problems, particularly by way of question and answer. I cannot help feeling, however, that sufficient publicity is given by means of the national press, radio and television. Any local campaign designed to focus attention on these major causes of death might, in my submission, have an unfortunate result. It is for this reason that I have avoided focussing the spotlight of publicity on these two particular problems. Infant Mortality. There were 11 deaths of infants under 1 year of age, which gives an infant death rate of 13.8 per 1,000 births, as compared with 15 deaths and a rate of 19.3 in the preceding year. 13 The infant deaths and rates for the past five years were as follows : Death Rates Year No. of Deaths Southgate England and Wales 1952 9 11.61 27.6 1953 21 27.63 26.8 1954 13 16.00 25.5 1955 15 19.3 24.9 1956 11 13.8 23.8 As already noted, the infant mortality rate for Southgate has fallen, is, indeed, one of the lowest yet recorded in the Borough. It is also worth noting that six of the eleven infant deaths recorded during 1956 occurred during the first four weeks of life (neo natal mortality). These deaths are, more often than not, non-preventable. We do not accept of course that infant deaths occurring during the first weeks of life need be taken for granted. Much work is going on in this field, work which one hopes will eventually result in reducing the neo-natal mortality to the same extent as has been possible with infant mortality as a whole. In this connection, the Council might like to know that I have already approached local hospitals, general practitioners and midwives in the hope that they may be able to persuade mothers of infants who have died to allow a post-mortem examination to be carried out in all cases. It is hoped that valuable information may be obtained in this way, information which can be put to great practical use in saving infants in the future. Still-Births. Eleven still-births, all legitimate, were accredited to the Borough for 1956. This is equal to a death rate of 13.44 (live and stillbirths), the corresponding figures for 1955 being 15 still-births with a rate of 18.83. The rate per 1,000 of the population was 0.15, the rate for England and Wales being 23. Maternal Mortality. No maternal deaths were reported during 1956. As noted in the introduction to this Report, only one maternal death has been recorded in Southgate since 1949, during which time 6,569 births 14 have occurred. All maternal deaths continue to be carefully scrutinised and investigated. Mortality of Persons over the Age of 65. Five hundred and seven, or 71.97 of the total deaths during the year occurred in persons over the age of 65 years. Of these, 228 died between the age of 80 and 90, while a further 25 females and 15 males were over the latter age, the oldest being 100. Following the trend of recent 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 1956. Causes of Death Male Female Total Rates per 1,000 of population All causes (civilians only) 392 452 844 11.8 1. Tuberculosis, Respiratory 2 - 2 0.02 2. Tuberculosis, Other — — — — 3. Syphilitic Disease — — — — 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infection — — — — 7. Acute Poliomyelitis — — — 8. Measles — — — — 9. Other Infective and Parasitic Diseases 1 1 2 0.02 10. Malignant Neoplasm—stomach 6 16 22 0.27 11. Malignant Neoplasm, Lung, Bronchus 28 9 37 0.53 12. Malignant Neoplasm, Breast 1 29 30 0.41 1 3. Malignant Neoplasm, Uterus — 4 4 0.05 14. Other malignant and lymphatic Neoplasms 45 46 91 1.26 15. Leukaemia, Aleukaemia 3 5 8 0.11 16. Diabetes — 3 3 0.04 17. Vascular Lesions of Nervous System 39 68 107 1.49 18. Coronary Disease, Angina 96 64 160 2.23 19. Hypertension with Heart Disease 10 13 23 0.32 20. Other Heart Disease 48 69 117 1.63 21. Other Circulatory Disease 17 25 42 0.58 22. Influenza — 1 1 0.01 23. Pneumonia 14 15 29 0.40 24. Bronchitis 21 12 33 0.46 25. Other Diseases of Respiratory System 2 4 6 0.08 26. Ulcer of Stomach and Duodenum 2 4 6 0.08 27. Gastritis, enteritis and Diarrhoea 2 4 6 0.08 28. Nephritis and Nephrosis 1 3 4 0.05 29. Hyperplasia of Prostate 5 — 5 0.06 30. Pregnancy, Childbirth, Abortion — — — — 31. Congenital Malformation 4 3 7 0.09 32. Other Defined and Ill-Defined Diseases 19 34 53 0.78 3 3. Motor Vehicle Accidents 7 2 9 0.12 34. All Other Accidents 11 16 27 0.37 35. Suicide 8 2 10 0.14 36. Homicide and Operations of War - - - - 16 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. 1956 FEMALES MALES TOTALS Age 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 4 0.47 0.06 7 0.82 0.10 11 1.30 0.16 1- 5 years 1 0.12 0.01 — — — 1 0.12 0.01 5-15 years 2 0.23 0.03 — — — 2 0.23 0.03 15-25 years 2 0.23 0.03 3 0.35 0.05 5 0.58 0.07 25-45 years 10 1.18 0.15 15 1.77 0.20 25 2.95 0.35 45-65 years 81 9.59 1.15 112 13.27 1.60 193 22.85 2.71 65-75 years 102 12.12 1.42 56 6.60 0.77 158 18.72 2.20 Over 75 years 250 29.50 3.52 199 23.75 2.71 449 53.25 6.27 Totals 452 53.44 6.37 392 46.56 5.43 844 100.00 11.8 17 TABLE III. INFANTILE MORTALITY 1956 : 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. Chicken pox 3. Measles 4. Scarlet Fever 5. Pertussis 6. Diphtheria and Croup 7. 8. Erysipelas Tuberculous Meningitis 9. Abdominal Tuberculosis 10. Other Tuberculosis 11. Meningitis (not Tuberculous) 12. Convulsions 13. Laryngitis 14. Bronchitis 1 - - - 1 1 - - - 2 15. Pneumonia 16. Diarrhoea 17. Enteritis 18. Gastritis 19. Syphilis 20. Rickets 21. Suffocation 22. Want of Attention and Injury at Birth 23. Atelectasis 24. Congenital Malformation 2 - - - 2 2 2 - - 6 25. Premature Birth 3 - - - 3 - - - - 3 26. Atrophy, Debility and Marasmus 27. Other Causes Total 6 - - - 6 3 2 - - 11 18 TABLE IV. Vital Statistics of Whole District during 1956 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 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 10.54 838 11.62 21 27.63 1954 72,290 815 11.3 813 11.2 13 16.00 1955 71,870 776 10.8 809 11.3 15 19.3 1956 71.670 800 11.2 (crude) 12.2 (corrected) 841 11.8 (crude) 9.9 (corrected)' 11 13.8 19 GENERAL PROVISION OF HEALTH SERVICES Hospitals. The situation in regard to the availability of hospital beds is still more or less the same as that recorded in my Annual Reports for the last few years. Difficulties met with still centre round the provision of sufficient beds for the chronic sick, particularly the elderly chronic sick. Difficulties have also tended to increase in regard to the provision of maternity beds, although these latter difficulties have been more or less associated with the temporary closure of maternity blocks, due to infection and other causes. So far as the provision of beds for the chronic elderly sick is concerned, this is a matter which I have continued to pursue with the utmost vigour, for quite a time. I have never hesitated to make it known to such Committees as the North Middlesex Liaison Committee (British Medical Association) and the Northern Group Medical Advisory Committee, both of which committees are intimately concerned in this matter, that the position in Southgate is very far from satisfactory. The main difficulty seems to lie in the fact that the hospital which should act as a geriatric reservoir for Southgate (Highlands Hospital) is never able fully to do so because of its commitments in inner London. Bearing in mind the fact that Highlands Hospital is becoming increasingly known as the general hospital which serves Southgate residents, and remembering the very high proportion of old people living in Southgate, the position becomes even more intolerable. I am sometimes told that Southgate is a wealthy district, that poverty is not one of our major problems, that we must remember the hardship of such a poor district as Islington, the area from which many geriatric cases are admitted to Highlands Hospital My reply is always the same. We have a very high percentage of old people; many of our old folk are living on a pension, and although they do not flaunt their difficult position, it needs very little imagination to appreciate their situation. We have in Southgate a hospital which we regard with affection and high esteem; this hospital is prepared to admit our cases but is unable to do so because of its other heavy commitments. As this Report is written, I understand that some alteration in the catchment areas so far as geriatric cases are concerned is being made, that there is every likelihood of Highlands Hospital being able to give us a very much better service. We can only hope that this will, in fact, prove to be the case. We at least know that Highlands Hospital, with which we maintain the most cordial relations, is only too anxious to assist us in the solution of our geriatric problems. 20 Apart from the admission to hospital of old persons who are sufficiently infirm to require a hospital bed or who are extremelyfeeble, there is the other problem, the problem which concerns the admission to a home or institution of an old person who is not necessarily bedridden. It will be appreciated that this problem is not one over which the Borough Council has direct control. The matter of homes for the aged is one which comes under the super' vision of the County Welfare Department. As Area Medical Officer, I keep in very close touch with the Area Welfare Officer, bringing deserving, very often deperate, cases to his notice. Unfortunately, the number of places available in homes or even institutions is merely a fraction of that required to meet the needs of a county such as Middlesex. We are, therefore, left with many old persons who should be looked after in a home or in an institution but who remain in their own homes, with a minimum of attention. The lot of these unfortunate old people can indeed be tragic. More often than not, they are dependent for their meals on the W.V.S. or on the kindly help of neighbours. They receive few, if any visitors; their relatives have either forgotten them or are dead. Some manage to struggle along to an Old People's Club; others are not able to get to a Club, even with the help of the wagon which the youth of Southgate so generously presented to the Old People's Welfare Co-ordinating Committee. Need it be said that the physical condition of these old people is very often such that neither their homes nor their persons could be described as hygienic. This, of course, is very often no fault of the old person concerned, but merely an indication of the quite intolerable social conditions which dominate and direct their lives. The Public Health Department plays its part, in conjunction with the Area Health Office, in trying to arrange for the admission of the most deserving old folk to a home or institution, when this is the only course available. The co-operation between the two departments is close and has certainly resulted in easing the burden of quite a number of old people. We are only too conscious of our limitations but we can, at least, take up the cudgels on behalf of every old person whose needs are brought to our notice. This we invariably do. The problem is increasing, rapidly increasing. This is a fact which must be faced, and faced with the utmost determination. Care of the Aged. It would be a truism to say that care of the aged now has an established place in the public health programme of the Borough. More and more is being done to help those who have reached the eventide of life and who, through no fault of their own, are dependent on others, very often strangers or mere acquaintances, 21 for little more than the bare necessities of" life. I have said that more and more is being done each year for our old people. This does not mean to say, however, that sufficient is being done, or that all the efforts are being directed into the proper channels. Nor does it mean that both gaps and duplication do not still exist. It is increasingly obvious that the need for co-ordination stands out as a clamant problem. As I see it and the Medical Officer of Health has many opportunities to study this subject at first hand the whole situation must be carefully reviewed so that adequate attention is being paid to those aspects of the problem which call for priority. Many people still alive will remember the days when what was then known as maternity and child welfare was carried on by a band of devoted women who considered it essential that the problems of motherhood and infancy required more detailed attention than was being paid to them by local authorities. From these beginnings has sprung the vast, complicated machine which deals with the care of mothers and children. And who can gainsay the fact that the results obtained in this field over the past thirty years have not justified and more than justified the time and money spent on this invaluable work ? Is not the time rapidly approaching when the same attitude should be adopted towards our old folk ? It must be admitted that much can be done by voluntary effort; it cannot be denied that much is, in fact being done in Southgate. But are we yet sure that the entire field is being covered, that too much effort is not being spent on certain aspects of the problem to the detriment of other factors ? Until we can be content that the welfare of the older age groups of the population, age groups which are growing every year, remains in the forefront of our minds; that all practicable steps are being taken to give this matter the attention it demands, we should not, indeed we cannot stand aside. Although a great deal has been said and written on this subject, I cannot yet think that the plight of some of these unfortunate old folk is properly understood. This brings us back once again to the need for a careful evaluation of the problem, when its extent and ramifications will be clearly known and when our forces can be fully mobilised. The older age groups of the population have every right to expect special consideration. I am fully convinced that the burgesses of Southgate would wish them to receive this consideration. The old folk themselves would be the last to seek publicity. That is one of my main reasons for ventilating this matter in my Annual Report. The Old People's Co-ordinating Committee has already met on many occasions, has considered this problem, and is taking steps to effect Co-ordination. I can think of no type of work which would confer greater benefits on a section of the community which mutely cries aloud for our sympathy and understanding. 22 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 1956, 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. Summary of Work carried out at Central Public Health Laboratories for the year: Positive Negative Swabs for diphtheria bacilli 131 Sputa for tubercle bacilli 99 Throat and Nose 344 Faeces 583 Blood 126 Urine 65 Others 136 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, except that we now have a firm agreement with the Prince of Wales Hospital to accept Southgate bodies. 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. During 1956, three Southgate patients received treatment at the Cleansing Station, Fore Street, Edmonton, N.9 by arrangement with Edmonton Borough Council. 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 1956 under this Section. It is never pleasant, and very often most unprofitable, to take action under Section 47 of the National Assistance Act, 1948. 23 sons, almost invariably very aged persons, removed to an institution against their will seldom seem to derive much benefit from the removal. Indeed, the result of this removal very often seems to be early death. For this reason, every effort is made to persuade individuals who are either a danger to themselves or to other people, and who should be cared for in a home or institution, to agree to voluntary removal. This is seldom an easy job, taking up a great deal of time and requiring infinite patience. But one must remember that these old people, however elderly and infirm, are not units but human beings with feelings and opinions. I am certainly satisfied that, however much time we spend on this matter, that time will be amply repaid. 24 SANITARY SERVICES Summary of Visits. Inspections re complaints received 1,082 Visits in connection therewith 4,002 Visits to food premises (including butchers, bakehouses, cafes, restaurants, grocers and fish shops) 2,082 Inspections re Shops Act, 1950 674 Inspection re Factories 126 Visits re housing conditions and overcrowding (applications for housing accommodation) 44 Visits re infectious diseases 603 Visits re places of public entertainment 40 Visits re Prevention of Damage by Pests Act, 1949 673 Visits re smoke observations 46 Miscellaneous visits 3,402 12,774 Service of Notices. Total of Informal Notices served: re Housing repairs 378 re Dustbins 131 re Food premises 332 re Shops and factories 111 Total Informal Notices served 952 Total Informal Notices complied with 862 Total Statutory Notices served 73 Total Statutory Notices complied with 70 Repairs to Houses. During the year under review, the Public Health Inspectors have been actively engaged on work in connection with repairs to houses. Their efforts have resulted in repairs being carried out at 421 houses, the repairs varying from those of a major character to minor repairs necessary to abate specific nuisances. The repairs referred to above were carried out mainly as a result of informal action on the part of the Inspectors. Only in 59 instances was it found necessary to follow-up 'informal notices by the service of Statutory Notices. Non-compliance with four of the above-mentioned Statutory Notices necesitated legal proceedings being instituted against the respective owners. Nuisance Orders were made by the Court in respect of all these and the necessary repairs were subsequently carried out. 25 Unfit Houses. During 1956, two houses, viz 5 Crown Terrace, N.14, and 52 Eversley Park Road, N.21, were demolished subsequent to Demolition Orders under the Housing Act 1936 made by the Council in 1955. In connection with the implementation of the five-year programme for dealing with 84 unfit houses by clearance and demolition under Part III of the Housing Act, 1936, the Council declared two areas, comprising a total of 38 houses, to be Clearance Areas, and resolved to deal with the Areas by way of a Compulsory Purchase Order. A public local enquiry was held in October before an Inspector of the Ministry of Housing and Local Government to consider objections from persons interested. The Minister's decision in the matter had not been received at the close of 1956. Increase of Rent Certificates. During 1956, eleven applications were received from tenants for Certificates of Disrepair following notices from their landlords concerning increases of rent. Following inspections of the houses, eleven Certificates of Disrepair were granted. During the year, six applications were received from landlords for Notices of Revocation of Certificates of Disrepair on the grounds that they had put their houses into good repair. Six Notices of Revocation were granted. Housing Applications. Visits by the Public Health Inspectors to applicants for housing accommodation and the preparation of reports as to living conditions were continued in 1956. The number of visits for this purpose was 44 as against 67 in 1955. The close liaison between the Public Health Department and the Housing Department has been maintained in 1956, as in previous years. On many 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. On 1st January, 1956, there came into operation the Food & Drugs Act, 1955, and the Food Hygiene Regulations, 1955. This legislation was welcomed by all in the public health field as a positive step forward towards improvement of hygiene in the manufacture, handling and distribution of food. I think it is true to say that Southgate was among the first of local authorities to implement the provisions of the Act and the Regulations. 26 The Public Health Inspectors carried out a survey in the early part of the year of all privately owned food premises in the Borough. They made known to traders the requirements of the new legislation, particularly of the provisions of the Food Hygiene Regulations. They offered advice and help to traders on the interpretation of the Regulations and concerning practical problems arising in the carrying out of the provisions of the Regulations. Generally speaking, I am pleased to report, their efforts were appreciated. Several provisions of the Regulations, necessitating additional fittings and alterations, did not come into operation until 1st July, 1956. The Inspectors took the opportunity, however, of preparing and advising traders on those things it would be necessary for them to do by 1st July. Throughout 1956 the Inspectors have been very actively engaged in this work, 2,082 visits were made to food premises. Arising out of these visits 332 informal notices were served to secure compliance with the Regulations. As a result of their efforts and, it must be added, the willing response in many instances of the food traders themselves, the following results were achieved: Regulation 8. (Food to be protected from risk of contamination). Improvements were made at 57 food premises to protect food from risk of contamination. Regulation 9. (Personal cleanliness). At 78 food premises the attention of food traders was directed to the importance of personal cleanliness, smoking, etc., with consequent improvement. Regulation 10. (Carrying of food and wrapping, etc., of open food). In 23 instances it was found necessary to require improvement in respect of the carrying of food and wrapping of open food. Regulation 14. (Sanitary Conveniences). At 40 food premises it was found necessary to effect improvements to the sanitary conveniences in order to bring them into compliance with this Regulation. Regulation, 16. (Washing facilities for food handlers). In compliance with this Regulation wash-hand basins with constant hot and cold water were provided at 92 food premises. In addition, constant hot water was provided to existing wash- 27 hand basins at 52 other premises where previously only a cold water supply had been available and where means of providing hot water were inadequate. Nail brushes, soap, etc., were provided at 131 premises. Regulation 17. (First-aid materials). Adequate first-aid equipment was provided at 254 premises in compliance with this Regulation. Regulation 18. (Accommodation for clothing, etc.) Adequate accommodation for clothing and footwear, not worn during working hours, of persons engaged in the handling of food was provided at 134 food premises in compliance with this Regulation. Regulation 19. (Facilities for washing food and equipment). In compliance with this Regulation it was found necessary to require the provision of sinks with constant hot and cold water for the washing of equipment at 45 food premises. In addition, it was found necessary to require the provision of constant hot water to existing sinks, used for the washing of equipment, at 47 food premises were previously only a cold water supply had been available and where means of providing hot water were inadequate. All work in this connection at the 92 premises had been completed by the close of 1956. Regulation 23. (Cleanliness and repair, etc., of food rooms). Improvements in the cleanliness and repair of food rooms in compliance with this Regulation were required at 73 food premises. All the necessary works in this connection were completed by the end of 1956. This I feel is creditable, having regard to the fact that the Department was short of one Inspector for almost half of 1956. In addition to the survey of privately owned food premises, inspections were carried out at all the school kitchen/dining rooms and mobile dining centres. A high standard of food hygiene is maintained in all these premises. There were, however, certain structural improvements and additions required by the Regulations. These matters were communicated to the Borough Education Officer and at the close of the year by far the majority had received attention. Further to the above, inspections were carried out at the Council's cafes in the parks and sports grounds. Improvements found to be required have now been carried out. 28 It was found necessary in one instance for the Council to institute legal proceedings against a food trader in respect of contraventions of the Regulations. The contraventions referred to were concerned with the dirty and obstructed condition of the water closets, lavatory basins and sink, and the dirty condition of the walls and ceilings of the bakehouse and bread store. The Court imposed fines totalling £28 and allowed the Council 5 guineas costs. 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 by incineration at the Council's Refuse Destructor Works: Fish 35½ stone Carcase Meat 496 lbs. Offal 74 lbs. Bacon 1 lb. Ham 21 lbs. Sausages 29 lbs. Canned Meats (various) 162 lbs. Canned Foods (various) 209 cans Jam and Marmalade 8 lbs. Christmas Puddings 4½ lbs. Rolled Oats 15 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 32 Butchers 59 Grocery and Provisions 117 Fruit and Greengrocery 58 Wet Fish 15 Fried Fish 8 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 108 Confectionery and Sweets 75 472 29 In the Borough there are 291 premises registered under Section 16 of the Food and Drugs Act, 1955, 201 in respect of ice-cream and 90 in respect of preserved foods. There is one dairy in the Borough registered under the Milk and Dairies Regulations, 1949-1954. Under the provisions of the Middlesex County Council Act, 1956, relating to hawkers of food and their premises, there were 84 hawkers on the register at the end of 1956. Of these, 19 have storage premises in the Borough and 65 have their storage premises in other areas. Post-Mortem Inspection of Animals. No slaughtering of animals took place in the Borough during 1956. Milk Regulations and Milk Sampling. During the year under review, 60 samples of milk were obtained and submitted to the Public Health Laboratory for bacteriological examination. One sample 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 the year under review, 59 samples of ice-cream were obtained and submitted for bacteriological examination. The results of examination of the samples were: Grade 1 50 „ 2 6 „ 3 3 „ 4 nil 59 Investigations were made by the Public Health Inspectors concerning the three samples giving Grade 3 results. As a result of advice the Inspectors were able to give, subsequent samples gave satisfactory results. Two samples of ice lollies were obtained and submitted for bacteriological examination. The result in each case was satisfactory. Establishments for Massage or Special Treatment. Under the Middlesex County Council Act 1944, 18 existing licences were renewed. 30 Swimming Bath. The figures for attendances at the Barrowell Green Open Air Swimming Bath for the last two years were:— 1955 1956 Adults (Mixed and Spectators) 26,041 8,242 Children (Mixed and Spectators) 45,697 21,632 From Schools 2,058 3,092 Season Tickets 7,692 9,456 81,488 42,422 Costumes, etc., hired 228 39 The arrangements whereby samples of the water in the swimming bath are taken at regular intervals has been continued. The results of the samples taken during 1956 were satisfactory in every case. 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. Attendance at the Bath of members of the St. John Ambulance Brigade during crowded sessions has been continued. This assistance is greatly appreciated. I can add nothing to the remarks which I made in my previous Annual Report regarding the usefulness of our Open-air Swimming Bath, not only as a very pleasant amenity, but as a truly healthgiving service. I am always delighted to visit the Bath and to see the excellent manner in which the premises are being maintained. Flooding. As the Council will be aware, considerable flooding took place in parts of the Borough on three occasions as a result of the abnormally heavy rains which occurred during the summer of 1956. All possible measures were taken to safeguard public health on each occasion. Rivers and Streams. Apart from the matter of flooding referred to above, there is nothing particular to report under this heading. One complaint was received during the year concerning a minor nuisance from Pymmes Brook and was immediately dealt with. Prevention of Damage by Pests Act 1949. During 1956, 382 complaints of rats and mice were received and dealt with, as against 531 in 1955. 31 In April, 1956, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 279 manholes were baited. In 97 of these, complete or part takes of bait were noted. In October, 1956, test baiting was carried out by the Borough Engineer's Department to 203 manholes, representing approximately 11.5 percent. 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 baited. Of these, 53 showed complete or part takes of bait. 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: Bromfield 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. 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 1955, improvement in respect of the dumping of rubbish on undeveloped land was effected. Fumes and Noise. During 1956, long and continued observations were made by the Public Health Inspectors concerning complaints of noise and fumes from two factories in the Borough, viz The Metal Box Co. Ltd., Chequers Way, N.13, and W. M. Still & Sons Ltd., Old Farm Avenue, N.14. The position regarding The Metal Box Co. Ltd. will be wellknown to the Council. With regard to Messrs. W. M. Still & Son, the Public Health Committee have been kept informed of the results of the observations. The conditions found, however, have not been such as to warrant statutory action-by the Council. 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 the 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. 33 Refuse Collection and Disposal. The Borough Engineer and Surveyor reports that a weekly collection service was maintained throughout the year. Tonnage of refuse dealt with at the Refuse Disposal Works amounted to 19,987 tons, an increase of approximately 500 tons on last year. Disposal of refuse has been by incineration since the existing works were completed in 1909. The plant is now in a state of disrepair, and inadequate to deal efficiently with the daily intake of refuse. In addition there is the nuisance created by the emission of dust and smoke. A scheme to convert the existing works into a Transfer and Salvage Depot, whereby the refuse, after the extraction of materials of salvage value, would be carted by road transport to a tipping site in Hertfordshire has been prepared by the Borough Engineer. The scheme has been approved by the Council, but the sanction of the Minister to proceed has yet to be obtained. 34 The following table gives tonnage of salvaged materials sol during the year: T C Q Paper 957 18 - Cullet 2 11 - Non-Ferrous Metals 1 8 - Rags 22 - 2 Carpet 16 10 3 Tins 721 7 1 Bottles 13 15 1 Scrap Iron 87 5 - Kitchen Waste 138 - 3 The value of this material amounted to £14,241 13s. l1d. FACTORIES ACTS, 1937 AND 1948 Details of Work Carried Out During the Year 1956 1. INSPECTIONS for purposes of provisions as to health (including Inspections made by Public Health Inspectors). Premises M/c. line No. Number on Register Number of M/c line No. Inspections Written Notices Owners Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 1 60 42 2 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 173 84 16 - 2 (iii) Other premises in which Section 7 is inforced by the Local Authority (excluding out-workers' premises) 3 - - - - 3 Total 233 126 18 - 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 defect were found Number of cues 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 19 19 - — - 4 Overcrowding (S.2) 5 — — - — - 5 Unreasonable temperature (S.3) 6 - - - - - 6 Inadequate Ventilation (S.4) 7 - - - - - 7 Ineffective drainage of floors (S.6) 8 - - - - - 8 Sanitary Conveniences (S.7) (a) Insufficient 9 - - - - - 9 (b) Unsuitable or defective 10 5 5 - - - 10 (c) Not separate for sexes 11 - -- - - 11 Other offences against the Act (not including offences relating to Outwork) 12 12 12 3 - - 12 Total 60 36 36 3 - - 60 35 OUTWORK—(Sections 110 and 111) Nature of Work Section 110 Section 111 M/c Line No. Number of Outworkers in August list required by Section 110(1)(c) Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions M/c Line No. Wearing Apparel— Making, etc. 13 96 - - - - - — Cleaning and Washing 14 — — — — — — — Fur Pulling 22 1 — — — — — — Artificial Flowers 28 5 — • — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 1 - - - - - - Carding, etc., of Buttons, etc. 38 25 - - - - - - Stuffed Toys 39 1 — — — — — — Lampshades 55 1 — — — — — — Total 130 — — — — — — 36 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 47, it will be seen that 349 cases of infectious disease were notified during the year, as against 1,073 in 1955. The Infectious Sickness Rate for the district was therefore 4.87, as compared with 14.92 during the previous year. Although this figure is very satisfactory, it must be remembered that 1956 was a year in which measles was non-epidemic. This is the main reason why the total number of infectious diseases notified during the year has fallen so considerably. Apart from the fall in measles notifications (43 as against 888), there is very little to which detailed attention need be drawn. Scarlet fever notifications fell from 30 in 1955 to 19 in 1956; pertussis notifications rose from 25 to 150, a surprising figure when the comparable figures relating to measles are remembered. Food poisoning (including Sonne dysentery) notifications rose from 34 to 54, while tuberculosis notifications remained almost stationery (47 cases in 1955, 49 cases in 1956). Poliomyelitis notifications rose from 3 in 1955 to 7 in 1956. All these matters will be considered in greater detail in the subsequent paragraphs of this section. I have drawn attention in a number of previous Annual Reports to the fact that the severity of infectious diseases as a whole has appreciably decreased. This is very clearly manifested by the small percentage of cases which now have to be admitted to hospital. When one remembers that many of these cases are only sent to hospital because of home conditions or because both the mother and the father go out to work, it will be more than ever apparent that the picture has completely altered. Indeed, it is now considered by many authorities that the need for ad hoc isolation hospitals has almost passed. Many existing isolation hospitals are now being used for multiple purposes, of which the treatment of infectious diseases is only one. We must, of course, remember that the virulence of infectious diseases has been known to change in the past, so that we can never be sure that the conditions which many of us still remember only too vividly will not return. It is mainly for this reason that sufficient beds can still be made available for the treatment of infectious diseases in hospital should circumstances change. Our policy with regard to the exclusion of contacts of infectious diseases from school has recently been revised. It is now virtually certain that a child suffering from an infectious disease does not remain infective for anything like the length of time previously 37 believed. We have, therefore, been able to reduce the exclusion period in the case of contacts of many infectious diseases, especially the milder type of infectious disease such as scarlet fever and measles. Needless to say, of course, the period of exclusion of contacts of such diseases as poliomyelitis, where the duration of infectivity is still not clearly known and where the disease itself can be very serious, remains more or less as before. Broadly speaking, the Medical Officer of Health is given a wide latitude in the matter of school exclusion. I have referred to this matter on several occasions in submitting detailed reports to the Public Health Committee, and will continue to keep the Committee informed of any changes in policy. Our present system aims at obviating unnecessary loss of school attendance, while adopting such safeguards as are obviously necessary. It is certainly a fact that our present policy has not resulted, so far as we know, in any increase in infectious diseases generally or in the spread of outbreaks or epidemics in schools. Diphtheria. For the ninth year in succession, no case of diphtheria was notified in the Borough. The last death took place approximately fourteen years ago. These figures would appear to indicate that diphtheria can no longer be considered a serious menace. Or perhaps it would be more true to say that for the time being, diphtheria has lost its terrors. The fact that several cases of diphtheria have been notified from various parts of the country within the past year, and that some of these cases were extremely serious, points to the fact, however, that the possibility of diphtheria returning as a major infectious disease can still not be dismissed. Every now and again we receive a laboratory report which suggests that the causative organism may be the diphtheria bacillus. We also hear of cases admitted to an isolation hospital which clinically resemble diphtheria. Up to the present, none of these cases has been substantiated. But we know only too well that, should the rate of immunisation among children fall to any appreciable extent, we might at any time be faced with quite a serious problem. Although immunisation is carried out in Southgate by the Middlesex County Council, this might be an opportune moment to refer in some greater detail to our immunisation programme. During 1956, our policy was altered only in minor respects. Thus, we decided to use the latest available type of diphtheria antigen (formol toxoid), this antigen having proved both efficient and safe. We also carried out most of our immunisation by the combined method, i.e. pertussis (whooping cough) and diphtheria, thus limiting the 38 number of visits which mothers would have to pay to clinics for the immunisation of their infants. We also found that general practitioners were themselves immunising children in increasing numbers, either against diphtheria alone, against diphtheria and pertussis, or by the triple method, i.e. against diphtheria, pertussis and tetanus. Incidentally, the County Council scheme of immunisation does not permit of the triple method being used. This was the position at the end of 1956, although even by that time we were beginning to become aware of certain difficulties. What has transpired since belongs rightly to a future report. It may, however, be stated briefly that an investigation carried out by the Medical Research Council has shown conclusively that immunisation by the combined method leaves the children so immunised at greater risk of contracting poliomyelitis than would otherwise be the case. The risk is admittedly not great, but the fact remains that immunisation by any combined method which contains the pertussis antigen raises this issue. By the time this report is written, we will have changed to the single type of inoculation, i.e. against diphetheria alone and against pertussis alone. General practitioners have been advised of the new policy. This will obviously mean more numerous visits to our clinics and to doctors' surgeries, where practitioners decide to adopt a similar procedure. There will thus be added inconvenience so far as mothers are concerned. We will await the results of our amended programme with interest, if not with apprehension. Fortunately, it is hoped that the Ministry of Health will shortly issue a statement which will clarify the situation and may eventually allow us to resume our previous policy. Scarlet Fever. Nineteen cases of scarlet fever were notified during the year, as against 30 cases in 1955 and 51 in 1954. From the number of scarlet fever cases notified during the two previous years, i.e. 1953 and 1952 (133 and 188 respectively) it will be seen that scarlet fever has declined progressively and substantially over the past five years. This does not mean that scarlet fever is becoming extinct. The whole character of this disease has altered materially, so much so that what was once a very serious illness now has seldom more than nuisance value. For this reason it may well be that very mild cases—and there must be many such—pass unnoticed. So long as scarlet fever maintains its present mild character, there is no reason for alarm. As I have said several times before, however, we must still assess the situation from time to time, in order to make quite sure that the virulence which formerly characterised scarlet fever is not returning. 39 Acute Anterior Poliomyelitis. Five cases of paralytic poliomyelitis and two cases of nonparalytic poliomyelitis were notified during the year, as against one paralytic case and two non-paralytic cases in 1955. The five cases notified in 1956 occurred during the latter half of the year, four being reported between October and December. It will be remembered that inoculation against poliomyelitis was offered to certain age groups in 1956 (children born between the years 1947 and 1954), this work being carried out by the Area Health Staff. 246 Southgate children were inoculated during May and June, the inoculations proceeding without incident. A further 50 children were inoculated towards the end of the year. This work will continue in 1957, when it is anticipated that more plentiful supplies of vaccine will be available. It is interesting to note that reactions reported following the inoculations—and these were very carefully scrutinised—were infinitesimal. No child inoculated developed poliomyelitis, nor did any other member of a family in which a child had been protected by inoculation. Although it is known that inoculation does provide what can at least be described as a reasonable measure of protection, it need scarcely be said that the more general measures designed to safeguard the population, both infants, children and adults alike, must not be in any way relaxed. I have taken the opportunity to provide our schools with notes on the simple safeguards which can and should be put into force. In my dual capacity as Medical Officer of Health for Southgate and District School Medical Officer, I have taken active steps to impress upon everyone concerned the vital need for the strictest measures of hygiene in schools ,above all else, the washing of children's hands after using the toilet. In this I have received the utmost co-operation from Mr. Healey, the Borough Education Officer, co-operation which I gladly acknowledge. The schools have also been most helpful. We look forward to the day when our children can and will be protected against poliomyelitis by means of vaccination. But until that day arrives, and even after that day arrives, we cannot afford to neglect any matter which will reduce the ravages of the responsible virus. In this connection, I would draw attention once again to the deplorable habit of children using the yachting ponds in our parks as unofficial bathing stations. The Parks Committee has given the Public Health Committee its full support in trying to bring this noxious practice to an end. The difficulties need not be stated. It appears almost unthinkable that parents, who must be aware of the risk their children are running, still allow them to use the yachting ponds for a purpose for which they were never intended. It has been said that children bathe and paddle in these ponds without their parents' knowledge or permission. When one 40 sees, however, numerous very young children, dressed only in bathing costumes, splashing about in these ponds, one wonders how they could have got there, dressed as they are, without parental supervision. One can only hope that the good sense of Southgate parents will make them appreciate the serious risks which these children are running. There is no wish to restrict either the liberty of parents or the pleasure of children. It is merely a matter of drawing the attention of parents to a safety measure which I feel quite sure they would wish to adopt. Indeed, I cannot think that any Southgate parents would wittingly expose their children to what is a quite unnecessary risk. The argument is sometimes used—not, I hasten to add, by the Southgate Borough Council—that children have entered these ponds for years without coming to any harm. That may be so. But less than ten years have elapsed since the virus which causes polio' myelitis first appeared in this country in any strength, since that time, poliomyelitis has become more or less indigenous in England and Wales. In short, the risk of contracting this disease is, whether we like it or not, very much greater now than was the case not so very long ago. It is for this reason that I stress, once again, the fundamental need for taking sensible precautions. Measles. As noted elsewhere, only 43 cases of measles were notified during the year, as against 888 cases in 1955. These facts indicate that 1956 was not a "measles" year. Once again, the disease itself was mild in the extreme. Pertussis. One hundred and fifty cases of pertussis were notified during the year, as against 25 in 1955. This figure is surprising, bearing in mind the low incidence of measles, which almost invariably runs parallel to that of pertussis ; and the fact that so many of our children have been immunised by the combined method, which includes an appreciable measure of protection against pertussis. It must be remembered, however, that inoculation against pertussis does not claim and never has pretended to claim full protection against this disease. Our only claim has been that many children inoculated against pertussis will remain fully protected for several years, at least until pertussis ceases to be a killing or even a dangerous disease; and that the remaining children inoculated, if they develop the disease, will only do so in a mild form. When the percentage of children in the Borough, inoculated against pertussis, is a 41 high as that protected against diphtheria, the results of inoculation will become increasingly apparent. Until that time arrives, there is evidence that our present policy is correct. We are endeavouring to persuade mothers to have their children inoculated against pertussis at or about the second month of life. As pertussis remains one of the major fatal diseases of infancy during the first six months of a child's life, early inoculation will, we believe, tide the child over that dangerous period. Thereafter, as I have already pointed out, the danger progressively diminishes. Food Poisoning (including Sonne Dysentery). Fifteen cases of food poisoning and 39 cases of dysentery were reported during the year, as against 17 cases of food poisoning and 17 cases of dysentery during 1955. I must again state that these figures are only useful for purposes of comparison, as we know perfectly well that many cases of food poisoning and dysentery are never brought to our notice or even to the notice of the general practitioner. The scheme set out in my Annual Report for 1954 relating to the exclusion from school of cases of diarrhoea, with or without sickness, continues to work satisfactorily. It would be too soon yet to state categorically that this scheme has reduced the incidence of dysentery among school children, but we certainly do know that it has eased the work of our already overburdened Public Health Inspectors, without appear' ing in any way to have increased the number of cases in our schools. It is also interesting to note that the hygienic precautions to which I referred when dealing with the spread of poliomyelitis in schools, apply equally to the spread of dysentery and that more recent bug-bear winter vomiting. All our schools are visited as soon as we receive information that multiple cases of dysentery or winter vomiting have occurred. In this connection, I would take this opportunity of thanking our head teachers for their prompt, invaluable co-operation. We are in this way enabled to take immediate action. In the spread of infectious diseases, immediate action may save endless trouble at a later date. This fact is particularly evident in the case of intestinal infection. Para-typhoid Fever. No case of para-typhoid fever was notified during 1956, as against four cases in 1955. The difficulty recorded in my Annual Report for 1955, relating to infected egg products, has therefore not recurred, although we are constantly on our guard against the occurrence of cases which can be ascribed to this or to a similar source. 42 Puerperal Pyrexia. Two cases of puerperal pyrexia were reported during 1956; both cases recovered with treatment. It is not so long ago since each case of pueperal pyrexia was regarded as a serious event. Indeed the death rate from puerperal pyrexia causes was tragically high only a few years ago. Nowadays, puerperal pyrexia is seldom due to septic causes, being normally attributable to some inter' current cause such as influenza, head cold or even constipation. This is an indication of the revolutionary change which has taken place within the last decade in the care of mothers during and after pregnancy. Several factors have contributed to this happy state—fundamentally advances in midwifery, closer supervision and liaison between general practitioner, hospital and clinic, and the introduction of antibiotics. Puerperal sepsis, as against a rise in temperature during the puerperium (the official description of "puerperal pyrexia") is seldom encountered. This explains why the death of a mother during or after childbirth is now regarded almost as a rarity. Smallpox. No case of smallpox occurred during 1956. Once again, I was not asked to see any doubtful cases within the Borough. It is once again my pleasure to report that the number of mothers bringing their infants to child welfare clinics in Southgate for vaccination, and the number of mothers requesting the same service from their family doctor, is still increasing. The latest figures show that the number of children under the age of two years who have been protected against smallpox by vaccination, either at clinics or by the family doctor, is now upwards of 80 per cent. When compared with the tiny percentage which held not so many years ago, these figures can be allowed to speak for themselves. Tuberculosis. Forty-nine cases of tuberculosis (43 pulmonary and 6 nonpulmonary) were notified during the year, as against 47 in 1955. Distribution of cases notified among the various wards was as follows :— North-east North-west Middle South 15 8 5 21 43 A broad classification of the cases notified during the past five years in relation to employment was :— 1952 1953 1954 1955 1956 Clerical 19 17 7 12 5 Housewives 10 12 6 5 3 Children 5 3 1 4 1 Manual Labour 5 8 6 — 8 Factory Workers — 5 2 1 5 Professional Classes 5 2 1 3 6 Armed Forces 1 — — 1 1 Domestic Service 1 — 3 — — Food Trades — — — 2 — Students 1 1 3 2 2 Shop Assistants 4 1 — 3 4 Nurses 3 2 1 2 1 Non-manual Trades, other than food 15 7 9 7 4 Teachers 2 — - — 2 Unclassified 8 7 3 5 7 79 65 42 47' 49 It is interesting to note from the table set out above that the number of tuberculosis cases occurring in clerical workers has fallen steadily over the past five years. It is doubtful whether tl>ns has any real significence, because of the small numbers involved. The same remarks apply to the decrease in tuberculosis among housewives. So far as clerical workers are concerned, of course, the difficulties in drawing any worth-while conclusions are increased when it is remembered that many of these individuals probably do not work within the Borough. The low incidence of tuberculoisis among shop assistants, consistent over the past five years, is at least encouraging. The fact that so few nurses develop tuberculosis may not be signficant so far as Southgate is concerned, but here it must be remembered that the extensive national schemes for B.C.G. vaccination are having a beneficial effect. It will already be known that the Middlesex County Council has instituted a scheme for B.C.G. vaccination of children in the 13 year age-group. Two schemes were prepared in the early part of 1956, and were put into effect for the first time in the Autumn of the same year. The first scheme was carried out as part of a Medical Research Council investigation, designed to assess the relative values of freese-dried and liquid vaccine. The purpose and details of this investigation were fully explained to the Southgate Education Committee, so that the objects of the scheme would be fully appreciated. It must not be thought that some children were given an inferior or unsatisfactory product. The Medical Research Council merely 44 wished to ascertain whether there would be any advantage in freeze-dried vaccine over liquid vaccine, and whether the freezedried product now being manufactured in this country could be used extensively. We were only too happy to co-operate with the Medical Research Council in this investigation, which has proceeded without incident in our secondary modern schools. Somewhat later in date, but still during 1956, we began what might be described as our normal B.C.G. programme in secondary grammar schools. Here again, vaccination has proceeded smoothly. The total number of cases of tuberculosis notified in Southgate over the past five years would seem to show that the incidence of this disease is decreasing in the Borough. That, however, is a conclusion which one would not be prepared to justify from the totals involved. It has often been pointed out that the figures relating to tuberculosis have never been strikingly out of the ordinary so far as Southgate is concerned. This may seem surprising when the nature of the Borough is taken into account. Quite obviously, however, many ancillary factors must be considered. One must remember, for instance, the position of Southgate, on the very edge of one of the largest cities in the world. One must also remember the migratory character of at least a proportion of the population, especially those moving into the Borough from areas and even from countries where the incidence of tuberculosis is probably very much higher than it is here. All this means that Southgate cannot possibly hope to avoid the appearance within its boundaries of fresh imported cases of tuberculosis ,each of which may act as a focus of infection. It is here, of course, that the admirable work carried out by the Finchley Chest Clinic in tracing and investigating cases and contacts is of such incalculable value. Even when this is given its full value, however, and when the work of the Mass Radiography Unit which visits Southgate is also remembered, it is abundantly clear that tuberculosis will still remain a problem with which the Borough must contend. In order to view the picture in its proper prospective, we must also bear in mind that, in company with many other infectious diseases, the character, especially the prognosis of tuberculosis, notably pulmonary tuberculosis, has altered considerably within recent years. One still remembers the shock which the word "tuberculosis" brought to so many families. Although the bacillus tuberculosis has not altered appreciably in virulence, and although there is little concrete evidence that it is less evident among the community as a whole, we do know that the methods of treatment available to those suffering from tuberculosis have improved beyond all recognition. It is this fact, together with the excellent early diagnostic work carried out by Chest Clinics and Mass Radiography Units in particular, which has reduced the terrors of tuberculosis so materially. Indeed, one tends to find that the pendulum occasionally 45 swings in the opposite direction, so that individuals who have been diagnosed as suffering from tuberculosis sometimes treat the matter much too lightly. This, of course, is a very wrong attitude, which should at once be corrected. Although the death rate from tuberculosis has fallen and continues to fall, it is still a killing and incapacitating disease which takes its toll year by year, month by month of all age groups of the population. As I have already said in this report, it is our duty to ensure that all conditions which might encourage ill-health or the spread of disease within the Borough are reduced to the absolute, practical minimum. In no field is this more important than in the fight against tuberculosis. It is here that the provision of adequate housing, slum clearance, the abolition of overcrowding are so vitally significant. As I have mentioned this fact on numerous occasions in the past, I do not think I need labour it now. Mass Radiography Unit 5B visited Southgate during 1956. On this occasion the Medical Director of the Unit, Dr. Mikhail, set out to provide the best possible service. No less than five sites were selected in various parts of the Borough, at each of which the Unit set up its headquarters for a number of sessions, most of them open to the public. As always, the Public Health Department co-operated wholeheartedly in the matter of publicity. There can be little doubt that the burgesses of Southgate were given the fullest possible opportunity to make use of this great diagnostic service. It is equally obvious from the figures supplied by the Unit that good advantage was taken of the opportunity. Set out below is a detailed summary of the results obtained. These figures were kindly supplied by Dr. Mikhail, to whom and to whose staff I would here record my grateful thanks. Total number X-rayed 2,976 Number not previously X-rayed 1,581 Percentage not previously X-rayed 53.12 Number not X-rayed within the last three years 2,179 Percentage not X-rayed within the last three years 73.21 Number of cases of active T.B. found 5 Rate per 1,000 1.68 Number of cases requiring occasional supervision 4 Percentage per 1,000 1.3 46 NOTIFICATION OF INFECTIOUS DISEASES, 1956 Disease Jan.— March April— June July— Sept. Oct.— Dec. Totals Scarlet Fever 7 7 5 - 19 Measles — 24 15 4 43 Pertussis 11 23 78 38 150 Pneumonia 10 4 3 2 19 Erysipelas 2 — 1 3 6 Poliomyelitis: Paralytic — — 2 3 5 Non-paralytic — — 1 1 2 Food Poisoning 3 — 6 6 15 Dysentery 18 13 7 1 39 Puerperal Pyrexia — — — 1 1 Malaria (contracted in Kenya) 1 — — — 1 Tuberculosis: Pulmonary 7 10 12 14 43 Non-Pulmonary 1 3 1 1 6 Total 60 84 131 74 349 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1/1/56 319 275 35 29 658 Cases notified for first time in 1956 27 16 4 2 49 Cases Restored to Register 1 3 1 - 5 Other Cases added 7 11 1 3 22 Cases Removed from Register 39 29 1 1 70 Cases Remaining on Register at 31/12/56 315 276 40 33 664 TUBERCULOSIS—1956 *New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1- 5 years — — — 2 — — — — 5-10 years — — — — — — — — 10-15 years — 2 — — — — — — 15-20 years — 9 — — — — — — 20-25 years 2 7 2 1 — — — — 25-35 years 9 6 2 — — — — — 35-45 years 5 — — — 1 — — — 45-55 years 11 1 1 1 — — — — 55-65 years 6 — — 1 — — — — Over 65 years 1 2 — — 1 — — — Unknown — — — — — — — — Total 34 27 5 5 2 — — — 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. Letters on the following subjects were circulated to Southgate practitioners during 1956, some being sent under my signature as Medical Officer of Health, others either as Area Medical Officer, District School Medical Officer or jointly. As all the matters covered in these letters have a direct bearing on the health of at least a section of the community and as it is extremely difficult to divide one's responsibility in such a vital matter as that of health, I have included all the topics covered :— Exclusion from school for Winter vomiting or dysentery. Winter vomiting, dysentery and poliomyelitis (hygienic precautions in schools). Acute Anterior Poliomyelitis (5 letters). Inoculation against Poliomyelitis (4 letters). Ante-Natal Supervision. Haemoplegia. Plantar Warts. Audiology. Collection of Laboratory Specimens over public holidays. Paratyphoid "B" fever. Notification of Poliomyelitis cases. Home Nurses and Midwives—Christmas Holidays. I have set out this list of letters in detail, as I hold very strongly that the transfer of information between the Public Health Department (and Area Health Office) and general practitioners is of the utmost importance. I am very happy to say that, as has been the case for so many years, the relationship between the Public Health Department and the general practitioner is close and cordial. We, on our part, try to keep general practitioners fully acquainted with changes in policy, and with any matters of topical importance. General practitioners reciprocate by letting me know of incidents occurring in their practice which may have epidemiological significance. This two-way traffic is most valuable. In this connection, I might also say that a great deal has been done within the past few years to strengthen the links between the local health services and 48 local hospitals. This is not always an easy matter, but my attendance on various committees, notably the North Middlesex (British Medical Branch) Liaison Committee and the Northern Group Medical Advisory Committee, my personal contacts with members of local hospital staffs and the visits which I pay to hospitals, have helped considerably. (b) Medical Examinations. During 1956, sixteen medical examinations were carried out in respect of entrants to the Council's services. In addition, sixteen medical reports were issued to employees absent from duty for more than a short period through sickness. 49 APPENDIX 2 SPECIAL REPORTS TO PUBLIC HEALTH COMMITTEE (a) Winter Vomiting, Dysentery and Poliomyelitis. Copy of letter sent to Head Teachers of Southgate Schools on 26th November, 1956:— "Dear , Winter Vomiting, Dysentery and Poliomyelitis "I would like to bring to your attention a few facts relating to the present prevalence of Winter Vomiting, with or without diarrhoea, and the possible association of Winter Vomiting, dysentery and poliomyelitis. We know that Winter Vomiting is spread by a virus, just as is poliomyelitis. We also know that dysentery, although not usually caused by a virus, is spread in precisely the same way as poliomyelitis, i.e. following visits to the toilet, especially when the hands are not washed immediately and thoroughly thereafter. We feel very definitely that schools in which a number of cases of Winter Vomiting, again with or without diarrhoea, have occurred, or from which a number of cases of dysentery have been reported, must be regarded as potential danger spots so far as poliomyelitis is concerned. "With these issues in mind, I should like to raise with you the following points:— "(1) We should like to know as soon as possible, when more than a very few cases of Winter Vomiting or dysentery occur in any school. Such information should be passed to the Area Health Office, whether or not the two types of exclusion letters already known to Head Teachers are being used in the school concerned. I am sure you will appreciate that, even when these letters are being used, we are not always aware of this fact. It is for this reason, and because we want to take the prompt action set out below, that we would like to be informed whenever Winter Vomiting or Sonne dysentery is present to any extent in a school, quite apart from the use of exclusion letters. Needless to say, of course, we will be only too happy to supply a batch of either type of exclusion letter, on request. "(2) Although I know that Head Teachers are already aware of the value of adequate hygienic measures in their schools at all times, I am equally sure that you will appreciate the vital need for ensuring that these precautions are working one 50 hundred per cent, whenever there is evidence that Winter Vomiting, Sonne dysentery or a case of poliomyelitis has been reported from a school. These precautions have already been communicated to Head Teachers. May I repeat, however, that the thorough disinfection of lavatory seats, chains and door handles, i.e. anything with which children's fingers are likely to come into contact after having used the W.C., are most important. The thorough washing of their hands by children immediately after using the W.C. is almost certainly the most significant factor of all. I would be extremely glad if Head Teachers would take steps to see that all these measures are being strictly and continuously carried out. If, for any reason, it is impossible to have any of these measures put into force, I should be glad to know at once. (3) It is difficult to lay down any hard and fast rules as to how often disinfection should be carried out. Normally, even when school absences are at their mimimum, I would like to see disinfection such as outlined in the paragraph above, carried out once every day by Schoolkeepers. When any of the diseases to which reference has already been made are prevalent in a school, this disinfection should be carried out at least twice daily. I cannot emphasise too often or too strongly that any relaxation of this rule, or any carelessness on the part of the individual or individuals responsible for disinfection, may be followed by quite disastrous results. In the same way, strict insistence on the thorough washing of children's hands after using the W.C. is of incalculable importance. In this connection it has already been proved that hand inspections can be of the very greatest use. (4) I have asked my Public Health Inspectors to visit every school, so that we can make an up-to-date survey of sanitary and washing arrangements. Head Teachers will thus have the opportunity on the spot of consulting the Public Health Inspector responsible for the area in which their school is situated. I would assure you that my Inspectors are making these visits to help and advise, and for no other reason. If necessary, they are prepared to supervise the work of disinfection, for at least a time, so that we can all be sure that this vital work is being properly carried out. They are also prepared to advise you on the use of disinfectant sprays generally, not only in toilets, but in classrooms and the like. They will bring with them samples, so that you can decide which type of apparatus you would prefer to use. Unfortunately, neither 51 the Area Health Office nor the Public Health Department is able to supply sprays or aerosole apparatus, although we would be only too happy to let you have a supply of disinfectant, if required. "(5) I should think it is unlikely that poliomyelitis will continue to be prevalent if the present, colder type of weather lasts. On the other hand, Winter Vomiting will presumably persist, while any return to milder weather may result in a sudden rise in poliomyelities notifications. Head Teachers should therefore be on the look-out for any developments. On our part, we will see that all available information is in the hand of Head Teachers as quickly as possible. When poliomyelitis is prevalent in the area—and eight cases have already been reported from Wood Green and Southgate combined within the last eight/nine weeks— the parent of any child who arrives at school after an unexplained illness, should be interviewed. If a satisfactory explanation is not forthcoming, the parents should be advised to refer the child to the family doctor. Children who arrive at school obviously under-the-weather should immediately be sent home. The parent should again be advised to consult the family doctor. It is believed that this procedure would reduce 'missed' cases. It is known that cases are missed during even a limited outbreak of poliomyelitis, and that they materially help in keeping the disease alive. "I sincerely hope that you will not hesitate to call upon us at any time for advice or assistance. Either I myself or my Deputy, Dr. Campbell, or the Assistant Medical Officer attached to your school are at your disposal at all times. In the same way, my Chief Public Health Inspector (Mr. A. E. Gooday, telephone PALmers Green 0023) or any member of his staff, will be only too glad to help you in matters of hygiene, disinfection and the like. It is quite obvious that we must all pull together, if the nuisances of Winter Vomiting and dysentery, not to mention the much graver implications in regard to poliomyelitis, are to be kept in check. I feel sure that, as always, I can count on your full co-operation. Kind regards, Yours sincerely, W. C. HARVEY, Medical Officer of Health and District School Medical Officer." 52 (b) Flooding. (i) Wilmer Way/Ashndge Gardens Area. As the Committee, I am sure, will be aware, flooding of the houses and gardens of the houses in Wilmer Way and Ashridge Gardens in the vicinity of Arnos Park and Pymmes Brook occurred on August Bank Holiday Monday, 6th August. I visited the area in company with Mr. Gooday on Tuesday, the day following, in relation to any possible danger to public health. We inspected the area generally and visited some of the houses. In a number of instances, we found gardens completely under water, and it was evident that seepage of water had taken place through the ventilator gratings to the sub-floor space at a number of the houses. Whilst it was obvious that conditions for the occupants of the houses were, to say the least, extremely unpleasant, I was satisfied that there was no actual danger to public health. It was clear, however, that spraying with a disinfectant solution was required to obviate nuisance to the occupants from unpleasant odours as the water gradually subsided. This was carried out throughout the week. On a previous occasion, namely the early morning of Monday, 9th July, flooding occurred in this area, and, as on the later occasion, the area was visited by the public health inspectors and the necessary action taken to disinfect where necessary. The soil and surface water drains of the houses are in good order. Overflow from the surface water drains at the time of both occurrences was due entirely to the abnormal quantity of water. No evidence was found on either occasion of actual sewage pollution. Water from Pymmes Brook, of course, as the Committee will be aware, contains sewage effluent. (ii) Park Cottages, High Road, N.11. On August Bank Holiday Monday, serious flooding occurred at a number of these cottages. I visited the cottages in company with Mr. Gooday, and arrangements were made for the disinfection of houses. The Cleansing Superintendent arranged for removal of water soaked debris. Two of the houses under requisition by the Council had suffered the worst of the flooding, and the families, in one of which there were five young children, were evacuated temporarily in order that drying out and necessary repairs could be effected. The occupants of the other privately owned houses dealt with their own drying-out. The owners' agents were approached and agreed to carry out necessary repairs to the houses. No evidence of sewage pollution was found. 53 (iii) 119/141 (new houses) The Vale,N.14. On Wednesday, 29th August, during a period of very heavy rain, an overflow of sewage occurred in the gardens of some of the abovementioned houses, due to surcharge of the soil and surface water sewers. Visits were made by the public health inspectors in connection therewith, and the attention of the Borough Engineer has been directed to the matter. (iv) Deepdene Court, Green Dragon Lane, N.21. On Thursday, 30th August, a visit was made by the public health inspectors to the abovementioned premises in connection with an overflow of sewage on to a garden from one of the drain inspec tion chambers, due to surcharge of the soil and surface water sewers. The overflow occurred on the previous evening during a period of very heavy rain. The attention of the Borough Engineer has been directed also to this matter. 54