AC. 439 (1) BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1958 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health SouG- 43 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1958 Wm. CLUNIE HARVEY, M.D„ D.P.H. Medical Officer of Health MAYOR, ALDERMEN AND COUNCILLORS OFTHE BOROUGH OF SOUTHGATE Mr. Mayor, Ladies and Gentlemen, I beg to present the Annual Report for 1958. The year under review was once more relatively uneventful. I have, of course, opened my Annual Report with this phrase for several years. Need I say that it is an extremely felicitous phrase, since it at least means that our Borough has been spared anything in the nature of an epidemic or other calamity. And it also has the additional merit of truth. The incidence of infectious diseases will receive more detailed attention in the section of the Report which deals with the pre' valence and control of infectious diseases. We cannot, of course, avoid the occurrence of these diseases. Indeed, when the illnesses are mild, and when there is a marked absence of complications and aftereffects, as was the case during 1958, one might say that the pattern of life, so far as infectious diseases are concerned, gives no cause for alarm. If one could say the same about accidents in the home and on the roads, accidents which kill and cripple the young to an ever-increasing extent, one would feel a great deal happier than it is possible to feel at the moment. The vital statistics for 1958 were satisfactory, and show very little change from the figures which applied to 1957. The birth rate fell from 12.1 to 11.4. The death rate was 10.9, as against 10.5 in 1957. Once again, there were no deaths from puerperal causes. The infantile mortality rate, i.e. the number of infants who died during the first year of life per thousand live births, was 21.0, as against 20.1 in the previous year. These matters will also be discussed more fully in the part of the Report which deals specifically with the statistics and social conditions of the area. I feel, however, that I must once again emphasize the known limitations of figures, which can be most misleading. More important are the trends, studied over a period of years. In this connection there is nothing to indicate that these trends are significant, apart from the fact that the vital statistics today, as compared with the statistics 3 for, say, fifty or even twenty-five years ago, present a very pleasing picture. The remarks which appeared in the Annual Report for 1957 relating to work under the Housing Acts will be fully dealt with in the appropriate section of the Report. It will only be necessary to say here that it is now clear that houses or flats will presumably soon be available to provide alternative accommodation for the occupants of unfit houses. It should therefore be possible to continue our work in this significant field in the very near future, work which must be pressed forward until the problem of unfit houses within the Borough is finally resolved. With this, of course, must be included the provision of suitable accommodation for the elderly. The position in regard to the setting up of smoke control areas in Southgate proceeded according to plan during 1958. Here again, this important question will be dealt with in greater detail in the body of the Report. The value of the liaison which I have been able to develop between my duties as Medical Officer of Health of Southgate and Area Medical Officer, Area No. 2, County of Middlesex, was maintained, indeed intensified, during 1958. It would be quite impossible in a Report such as this to elaborate the many ways in which these links have been forged. One might, however, mention two specific instances : The closest and most harmonious co-operation has been maintained between the Public Health Department and the Area Health Office in the important matter of propaganda for vaccination against poliomyelitis. This has proved of quite inestimable value, and has undoubtedly been an extremely potent factor in establishing the fact that the vaccination against polio rate for Southgate children was shown to be amongst the highest in the county. Although the vaccination rate as applied to the 15/26 age group is not so high as the rate for the younger age groups, it would still appear that the Southgate rate is at least as high, if not appreciably higher, than that returned by the country as a whole. Here again, the co-operation received from the Borough Council has been in no small measure responsible for this happy result. I would again mention the constant inter-change of information, and views which takes place almost daily between the two departments, both housed in the same Town Hall. This interchange is, of course, relatively easy, as I am both Medical Officer of Health and Area Medical Officer. But it is nevertheless a very great pleasure to me to be able to report that the staffs of both Departments work in the closest harmony. Altogether, the part which is being played by the Borough Council in promoting the personal health of the burgesses of Southgate is 4 by no means inconsiderable. And that is almost certainly an understatement. More and more emphasis is being placed, and very rightly placed, each year on the risks which accompany the increasing use of radio-active materials. It must certainly be admitted that Southgate is not a district in which radio-activity is likely to present itself as a serious hazard. None the less the position remains unsatisfactory. I am personally convinced that at least a proportion of the Public Health staff should be made fully aware, not only of any sources of radio-active waste or fission products which exist within the Borough or in the vicinity ; but should also have adequate training in the measures which would have to be taken in an emergency. Neither of these essential safeguards has yet been provided. We are certainly told that the most careful watch is being kept by the Medical Research Council, and that we will at once be informed if and when the general level of radio-activity approaches the danger point. This, of course, is a statement which one would not attempt to contradict. Nevertheless, I still feel that the Public Health Department should be in possession of the fullest possible information, and that responsible members of the staff should know exactly what they have to do should a sudden emergency arise. As I have said before, housing remains, will almost certainly remain, the basis upon which the structure of environmenatl health is erected. To this must now be added clean air, another factor of fundamental importance in the field of preventative medicine. These and other matters will, of course, be dealt with in the body of the Report. One might say a special word here relative to health education. Without health education the work of any Public Health Department will clearly be stultified. I think it can honestly be said that Southgate's reputation in the field of health education has always been extremely high. We certainly have no excuse for neglecting that inviting avenue. The people of Southgate, especially our parents, have always been ready to listen to advice ; our local press could not have been more co-operative over the years. Be this as it may, it would be foolish in the extreme to rest on our laurels. Health education must never be allowed to flag. There is always a message which must be broadcast, advice which is both topical and of the greatest value. It will be our object to continue to pass these messages on, using all the media which lie to hand. In this way, and in this way alone, can we be sure that our burgesses are fully informed of developments in the field of health, that they know what services are available to them, that they know where, when and how these services can be obtained. I have already mentioned the fact that accidents in the home 5 and on the roads now represent a very much more serious problem than do all the know infectious diseases considered together. Accidents on the roads do not, of course, fall within the province of the Public Health Department. But we are interested, extremely interested in studying and in taking steps to prevent accidents in the home. It is not so long ago, for instance, that a special Home Safety Handbook was produced, a handbook which we have found of the greatest use throughout the Borough. I have prepared special articles for insertion in the local press ; while we continually display suitable posters and have leaflets available in our clinics, in the Public Health Department and in the Area Health Office. Members of the staff of the Public Health Department and Area Health Office have co-operated in giving talks on the value of home safety, especially to mothers with young children, and to old people. In this latter connection, an invitation was extended to all Old People's Clubs in Southgate, offering to send a Health Visitor to one of their meetings, so that the great value of non-inflammable clothing materials could be demonstrated. We have also co-operated with the hospitals serving Southgate in this field. The hospitals are now sending me a list of accidents admitted from the Borough especially accidents due to burns and scalds. We are thus in a position to visit the homes from which these cases came—most of them, of course, young children or old persons—and to see whether there is any way in which we can prevent a repetition of the unfortunate accident. Altogether, home safety is a very good example of the way in which health education can be shared between the Public Health Department and the Area Health Office, i.e. between the Borough Council and the County Council. Accidents in the home represent a menace about which we must never be complacent. It is surely illogical that we should be spending millions of pounds and using an enormous number of staff to deal with the question of vaccination against poliomyelitis, immunisation against diphtheria and vaccination against smallpox, all three of which diseases do not account for more than a few hundred deaths every year throughout the country: yet, although there are many thousands of deaths annually from accidents in the home, not to mention the countless number of non-fatal injuries, we still seem to accept this fact as more or less inevitable. I would again conclude this Report by expressing my sincere thanks to the Public Health Committee and to the Borough Council for the unfailing courtesy and assistance extended to me as Medical Officer of Health. I would also express my grateful thanks to every member of the Public Health Department, with particular reference to my Deputy Dr. Janet Campbell and to Mr. A. E. Gooday, Chief 6 Public Health Inspector. I would be failing in my duty if I did not express my especial gratitude to Mr. Gooday who, not only during 1958 but since his appointment as Chief Public Health Inspector, has been quite literally a tower of strength. Altogether, I am extremely glad to think that I have the privilege of leading a first'dass team, a team without whose unfailing help my work would prove much more difficult. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health. Town Hall, Palmers Green, N.13. 7 PUBLIC HEALTH COMMITTEE From 1st January, 1958 to 12th May, 1958 Alderman Richard Prior (Chairman) Councillor G. D. Payne (Vice-chairman) Councillor F. J. V. Brown Councillor R. A. Gray Councillor S. C. Jenner Councillor P. W. Lansten Councillor A. V. Stapleton From 21st May, 1958 to 31st December, 1958 Alderman Richard Prior (Chairman) Councillor H. S. Beardow (Vice-Chairman) Councillor R. A. Gray Councillor S. C. Jenner Councillor P. W. Lansten Councillor G. D. Payne 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. *Deputy Chief Public Health Inspector : R. L. Burkhill, A.R.S.H., M.A.P.H.I., Cert. R.S.H. Meat Inspection, Cert. R.S.H. Smoke Inspector. *Public Health Inspector : W. Shackcloth, A.R.S.H., M.A.P.H.I., Cert. R.S.H. Meat Inspection. ♦Public Health Inspector : J. C. Noble, M.A.P.H.I., Cert R.S.H., Cert. R.S.H. Meat Inspection. *Public Health Inspector : E. T. Jephcott, M.A.P.H.I., Cert. R.S.H. Cert. R.S.H. Meat Inspection (re-appointed 27th January, 1958). Senior Typist : Miss E. W. Barratt. Clerk : Miss A. G. Alcock. Junior Clerk : S. Fenn (resigned 16th August 1958) Miss K. P. A. Burling appointed 25th August, 1958). 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. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,765 Registrar'General's Estimate of Resident Civilian Population, 1958 70,940 Number of inhabited houses 1st April 1958 (excluding shops assessed with private dwelling accommodation) 22,237 Effective rateable value on 1st April 1958 £1,450,421 Sum represented by Id. rate (1958/59 Revised Estimate) £5,910 9 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Male Female Total Live Legitimate Births Illegitimate 443 11 345 10 788 21 454 355 809 Birth rate per 1,000 of the estimated population i 11.4 Still Legitimate Births Illegitimate 7 4 11 7 4 11 Rate per 1,000 live and still births i 13.41 Deaths from all causes and at all ages 943 Death Rate per 1,000 of the estimated populatior i 10.9 Deaths from Puerperal causes nil Deaths From Puerperal Sepsis nil From other causes nil Deaths of Infants under 1 year of age : Male Female Total Legitimate 12 3 15 Illegitimate 1 1 2 13 4 17 Infant Death Rate : All infants per 1,000 births 21.0 Legitimate—per 1,000 legitimate live births 19.03 Illegitimate—per 1,000 illegitimate live births 95.22 Deaths from measles—all ages nil Deaths from Pertussis—all ages nil 10 POPULATION The Registrar-General's estimated population of the Borough at the middle of 1958 was 70,940, a decrease of 310 as compared with 1957. BIRTHS—BIRTH RATE The total nett births for the year accredited to the district was 809, an increase of 11 on the preceding year. Of these, 454 were males and 355 females (11 males and 10 females being illegitimate). The birth rate for the year was 11.4 per 1,000 of the population. The birth rate for England and Wales for 1958 was 16.4. The births and birth rates for the past five years were as follows : Year No. of Births Birth Rates Southgate England and Wales 1954 813 12.3 15.2 1955 776 11.8 15.0 1956 800 11.2 15.7 1957 798 11.2 16.1 1958 809 11.4 16.4 During the year, the number of births recorded was 134 less than the number of deaths, as compared with 103 less in 1957. 11 MORTALITY General Mortality and Death Rate. The nett number of deaths accredited to the district was 943, 42 more than in 1957. This gives a crude death rate of 13.30 per 1,000 of the population and corrected death rate of 10.9 (the rate for 1957 being 12.6). From the table which sets out the causes of death during 1958 (page 14), it will be seen that deaths due to diseases of the heart and circulation made up slightly more than 50% of the total deaths recorded during the year. This repeats the findings of the past few years. The continued appearance in our mortality statistics of deaths from coronary occlusion, together with other diseases of the heart and circulation, especially among males during what should be the prime of life, is most disturbing. Various reasons have been advanced to explain these catastrophes, although no single explanation would seem to meet the case. The increasing stress and strain of modern life, together with errors of diet, have both been accused, although there may very well be some other factor or factors which have not yet come to light. Whatever the cause, this is obviously a matter which calls for the most profound study. For the same reason, the increase in deaths from cancer of the lung provides another avenue which should be explored, must be explored as a matter of real urgency. Although one cannot say that there are any specific factors particularly to Southgate which encourage coronary thrombosis or lung cancer, it is clearly evident that health education has an important part to play in providing the necessary advice and guidance, at least along general lines. Infant Mortality. There were 17 deaths of infants under 1 year of age, which gives an infant death rate of 21.0 per 1,000 live births, as compared with 16 deaths and a rate of 20.1 in the preceding year. Among the 17 infants who died in Southgate during 1958 before they had reached the age of twelve months, no fewer than 14 were under the age of one month. Of these 14, 13 failed to survive one week. These deaths make up what is very often known as the neo-natal mortality. Although it would be wrong to say that the death of any infant cannot be prevented, it is a known fact that deaths up to the age of one month depend upon a variety of circumstances, many of which are, at the moment, virtually outwith our control. A great deal of work is being done in an attempt to reduce neo-natal mortality. Indeed we all look forward to the day when the neo-natal mortality rate will have dropped as 12 sensationally as the death rate of infants during the latter eleven months of their first year. Meantime, every infant death continues to be very carefully scrutinised in an effort to discover any factor or factors which might have contributed to the tragic fatality. Still Births. 11 still-births, all legitimate, were accredited to the Borough for 1958. This is equal to a death rate of 13.41 (live and still births), the corresponding figures for 1957 being 12 stillbirths with a rate of 14.81. As with infant mortality, a great deal of work is being carried on throughout the country, in an endeavour to itemise the various causes which lead to still-birth, and to remove, or at least minimise the impact of those factors. Although many still-births, under present circumstances cannot be prevented, we are none the less certain that the still-birth rate can, and should be, materially reduced. Maternal Mortality. There were no maternal deaths reported during 1958. Only one maternal death has been recorded in Southgate since 1949, since which time 8,176 births have been accredited to the Borough. Mortality of Persons over the Age of 65. Seven hundred and five deaths, or 66.25 of the total deaths during the year occurred in persons over the age of 65 years. Of these, 191 died between the ages of 80 and 90, while a further 31 females and 4 males were over the latter age, the oldest being 99. 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. 13 TABLE I. Causes of Death during the year 1958 Causes of Death Male Female Total Rates per 1,000 of population All causes (civilians only) 393 550 943 13.30 1. Tuberculosis, Respiratory 7 1 8 0.11 2. Tuberculosis, Other — 2 2 0.02 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 8 14 22 0.39 11. Malignant Neoplasm, Lung, Bronchus 24 9 33 0.46 12. Malignant Neoplasm, Breast — 16 16 0.28 13. Malignant Neoplasm, Uterus — 5 5 0.07 14. Other malignant and lymphatic Neoplasms 34 45 79 1.11 15. Leukaemia, Aleukaemia 4 2 6 0.08 16. Diabetes 3 5 8 0.11 17. Vascular Lesions of Nervous System 31 91 122 1.71 18. Coronary Disease, Angina 91 91 182 2.56 19. Hypertension with Heart Disease 5 6 11 0.15 20. Other Heart Disease 37 92 129 1.81 21. Other Circulatory Disease 17 28 45 0.63 22. Influenza 4 1 5 0.07 23. Pneumonia 24 37 61 0.85 24. Bronchitis 23 19 42 0.59 25. Other Diseases of Respiratory System 4 3 7 0.09 26. Ulcer of Stomach and Duodenum 7 3 10 0.14 27. Gastritis, Enteritis and Diarrhoea 4 4 8 0.11 28. Nephritis and Nephrosis 3 5 8 0.11 29. Hyperplasia of Prostate 7 — 7 0.09 30. Pregnancy, Childbirth, Abortion — — — — 31. Congenital' Malformation 6 0 6 0.08 32. Other Defined and Ill-Defined Disease 30 37 67 0.94 3 3. Motor Vehicle Accidents 3 3 6 0.08 34. A11 Other Accidents 11 19 30 0.42 3 5. Suicide 5 11 16 0.28 36. Homicide — — — — 14 TABLE IL 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. 1958 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 0.43 0.05 13 1.38 0.18 17 1.8U 0.23 1-5 years 1 0.10 0.01 1 0.10 0.01 2 0.21 0.02 5-15 years 1 0.10 0.01 — — — 1 0.10 0.01 15-25 years 1 0.10 0.01 1 0.10 0.011 2 0.21 0.02 25-45 years 5 0.53 0.07 5 0.53 0.07 10 1.06 0.14 45-65 years 88 9.34 1.24 118 12.52 1.67 206 21.85 2.91 65-75 years 124 13.15 1.76 116 12.31 1.63 240 25.45 3.39 Over 75 years 326 34.57 4.60 139 14.74 1.98 465 49.31 6.58 T otals 550 58.32 7.75 393 41.68 5.55 943 100.00 13.30 15 TABLE III. INFANTILE MORTALITY 1958 : 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 I. Smallpox 2. Chickenpox 3. Measles 4. Scarlet Fever 5. Pertussis 6. Diphtheria and Croup 7. Erysipelas 8. Tuberculous Meningitis 9. Abdominal Tuberculosis 10. Other Tuberculosis 11. Meningitis (not Tuberculous) 12. Convulsions 13. Laryngitis 14. Bronchitis — — — — 1 — — — 1 15. Pneumonia 2 — — — 2 — — — — 2 16. Diarrhoea 17. Enteritis 18. Gastritis 19. Syphilis 20. Rickets 21. Suffocation — — — — — — — 1 — 1 22. Want of Attention and Injury at Birth 1 — — — 1 — — — — 1 23. Atelectasis 4 — — — 1 — — — — 4 24. Congenital Malformation t — 1 — 3 — — — 1 4 25. Premature Birth 3 — — — 3 — — — — 3 26. Atrophy, Debility and Marasmus 27. Other Causes . . 1 — — — 1 — — — — 1 Total 13 — 1 14 1 — 1 1 17 16 TABLE IV. Vital Statistics of Whole District during 1958 and eight preceding 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 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 11.30 813 11.20 13 16.00 1955 71,870 776 10.80 809 11.30 15 19.30 1956 71,670 800 11.20 844 11.80 11 13.80 1957 71,250 798 11.20 901 12.60 16 20.10 1958 70,940 809 11.40 (crude) 12.30 (corrected) 943 13.30 (crude) ,10.90 (corrected) 17 21.00 17 GENERAL PROVISION OF HEALTH SERVICES Hospitals. The remarks contained in my Annual Report for 1957 relating to the provision of health services remain substantially unaltered, although on the whole, the position is now more satisfactory. Thus very little difficulty has been encountered in the admission of maternity cases to hospital, either on social or on medical grounds. The admission of infectious diseases cases, either to South Lodge Hospital or to Coppetts Wood Hospital, together with the admission of acute medical or surgical cases to general hospitals, also presented no real problems. Unfortunately the obstacles in the way of the admission of the type of cases commonly known as the " elderly chronic sick " have not been fully overcome. It would certainly be true to say that Highlands Hospital has extended its coverage over a greater part of the Borough ; while the admission of elderly patients to the North Middlesex Hospital and to St. Michael's Hospital, Enfield, has been somewhat easier. We still look forward, however, to the setting up of a true geriatric service at the North Middlesex Hospital, a service which will undoubtedly be of the greatest value to the Borough of Southgate. I never fail to raise our needs at the various Committees of which I am a member. As I have said so often before, Southgate is in an unfortunate position. The North Middlesex Hospital does not lie within the area covered by the North-West Regional Hospital Board, although I must at once say that this Hospital has always provided the maximum help available. The difficulty lies in the fact that the North Middlesex Hospital, Highlands Hospital and St. Michael's Hospital, Enfield, cover a very much wider area than the Borough of Southgate. In short, there is no one hospital to which general practitioners in Southgate can apply, knowing that that hospital is concerned solely with the elderly population of the Borough. I would again stress, however, that the position has eased and that the establishment of a geriatric service at our largest hospital, the North Middlesex Hospital, will ease the position still further. The whole subject of geriatrics should not, of course, be confined to the admission of the elderly chronic sick to hospital. Much more can and should be done in this most important field. For instance, all possible steps should be taken to ensure that the health of our old people is maintained at the highest practicable level, so that admission to hospital can at least be postponed. Here, the setting up of geriatric clinics may prove the answer. At the moment this lies within the province of the County Council, which is very carefully watching the situation—an experimental clinic has 18 already been set up—so that action can be extended as and when this seems desirable. Much work can also be done in the rehabilitation of elderly persons admitted to hospital. The aim should surely be to return these patients to their homes with reasonable celerity in such a condition that they are able to fend for themselves and cease to become what is very often an intolerable burden on their relatives. I would also mention the important part which our Home Helps and Home Nurses are playing. In this connection, Area No. 2 recently set up a Night Home Help Service. This Service is designed to provide a Home Help who will sit up with a seriously ill elderly person, and thus gives relatives who are almost exhausted, the opportunity of well-earned rest. This Service was very widely publicised and is already being used extensively. Care of the Aged. I have once again been privileged to play a part in the work of the Southgate Old People's Welfare Committee. As Medical Officer of Health I cannot speak too highly of the work of this Committee, which is doing a very great deal to provide amenities and services which cannot be provided by a statutory authority. As Medical Officer of Health and Area Medical Officer I endeavour, in every way possible, to link the statutory services of which I am in control with the work of the Old People's Welfare Committee. On the other hand, I am only too sensible that the Old People's Welfare Committee has been able, in many ways, to assist these statutory services, by providing those little extras which do so much to lighten the burdens of old age. As I write this report, the admirable scheme designed to provide an Old Persons' Centre in Southgate will already be known. This marks a truly significant step forward in the fight to deal with what is an increasingly difficult problem. Although this does not strictly speaking belong to the Report for 1958, the fact that the Minister of Health has extended the chiropody provisions will also be known. This represents another advance in what must now be regarded as a continuous struggle. Old age, with its many varied problems, is something a community must accept, something we should cheerfully accept as a willing obligation. Until this gigantic problem, for it truly is gigantic, is recognised on a national level, our Borough will, I am sure, continue to make its own contribution to the welfare and happiness of old people resident within our boundaries. Laboratory Facilities. Once again we did not have to call upon the Laboratory to any great extent during 1958, owing to the absence of major outbreaks 19 of infectious disease or any other untoward happenings. None the less, I would place on record my personal appreciation of the great help extended to the Public Health Department by the Director and Staff of the Central Public Health Department at Colindale, and also by Dr. Thomas, the Bacteriologist in charge of the Branch Laboratory at Edmonton. This help has invariably been forthcoming in generous measure. It has not only been of practical assistance, but remains a safeguard upon which we know we can always rely. 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 1958 two Southgate patients received treatment. 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 1958 under this Section. 20 Summary of work carried out at the Central Public Health Laboratories for the year : Positive Negative Swabs for diphtheria bacilli — 413 Sputa for tubercle bacilli 1 95 Throat and Nose 676 Faeces 552 Blood 85 Urine 53 Others 99 SANITARY SERVICES Summary of Visits. Visits re housing defects (Public Health Act. 1936) 3,748 Visits re housing defects (Housing Act, 1957) 386 Visits re drainage and building works 263 Visits re dustbins (Public Health Act, 1936) 49 Visits re Housing conditions and overcrowding (applications for housing accommodation) 28 Visits re Rent Act, 1957 258 Visits re food premises (including butchers, bakehouses, confectioners, restaurants, grocers and fish shops) 1,252 Visits re milk and ice-cream sampling 149 Visits re food hawkers 14 Visits re Shops Act, 1950 1.040 Visits re factories 158 Visits re Infectious Diseases 803 Visits re Clean Air Act, 1956 575 Visits re Prevention of Damage by Pests Act, 1949 1,192 Visits re Heating Appliances (Fireguards Act,) 1952 39 Visits re places of public entertainment 45 Visits re other matters 3,169 13,168 Service of Notices. Informal Notices served : re Housing repairs 406 re Dustbins 33 re Food Premises 94 re Shops and Factories 139 Total Informal Notices served 672 Total Informal Notices complied with 619 Total Statutory Notices served 45 Total Statutory Notices complied with 42 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 426 houses, the repairs varying from those of a major character to minor repairs necessary to abate specific nuisances. 21 The repairs referred to above were carried out mainly as a result of informal action on the part of the Inspectors. Only in 45 instances was it found necessary to follow-up informal Notices by the service of Statutory Notices. It was found necessary for the Council to institute legal proceedings against the respective owners of six houses in order to enforce compliance with Statutory Notices requiring repairs. In each case, a Court Order was obtained and, subsequently, the works were carried out. With the staff of the Public Health Inspectors back to full strength, it was found possible towards the close of the year to re-commence house to house inspections of older rented houses in the Borough, a useful and worthwhile task in arresting deterioration and improving the state of repair of these houses. Rent Act, 1957. The following is a summary of the action taken by the Council during 1958 under the Rent Act, 1957 : APPLICATIONS FOR CERTIFICATES OF DISREPAIR 1. Number of applications for certificates 44 2. Number of decisions not to issue certificates 1 3. Number of decisions to issue certificates : (a) in respect of some but not all defects 24 (b) in respect of all defects 21 4. Number of undertakings given by landlords under graph 5 of the First Schedule 29 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil 6. Number of Certificates issued 16 APPLICATIONS FOR CANCELLATION OF CERTIFICATES 7. Applications by landlords to Local Authority for cellation of Certificates 10 8. Objections by tenants to cancellation of Certificates 5 9. Decisions by Local Authority to cancel in spite of tenant's objection Nil 10. Certificates cancelled by Local Authority 10 Housing Applications. Visits by the Public Health Inspectors to applicants for housing accommodation and the preparation of reports as to living 22 ditions were continued in 1958, The number of visits for this purpose was 28, as against 36 in 1957. The close liaison between the Public Health Department and the Housing Department has been maintained in 1958, as in previous years. On many occasions I have been asked by the Town Clerk to advise as to degree of urgency on medical grounds applicable to particular applications. Food Hygiene. Actively continuing in 1958 work under the Food Hygiene Regulations commenced in 1956, the Public Health Inspectors made 1,415 visits in this connection and were able to bring about the implementation of the Regulations in many food premises and further, by their visits to ensure the maintenance and use of improvements already made. In order to secure compliance with the Regulations, 94 Notices were served and the following improvements were achieved : Regulation 8. (Food to be protected from risk of contamination.) Improvement in this connection was effected at five food premises. Regulation 9. (Personal Cleanliness.) In fourteen instances, warnings were given regarding smoking whilst handling food. Regulation 10. (Carrying of food and wrapping etc. of open food.) In one case warning was given concerning the unsatisfactory manner of wrapping open food. Regulation 14. (Sanitary Conveniences.) At fifteen 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 five food premises. In addition, nail brushes, soap and towels were provided at ten food premises. 23 Regulation 17. (First'aid materials.) Adequate first-aid equipment was provided at five food premises. 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 four 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 replacement of sinks at two food premises. I am pleased to be able to report that all improvements were secured without recourse by the Council to legal proceedings. In the matter, however, of a loaf containing a cigarette end, the Council instituted legal proceedings against the baker concerned, under Section 2 of the Food and Drugs Act, 1955, and a fine of forty shillings was imposed. Food Inspection. The following is a summary of the food condemned during the year as unfit for consumption. With the exception of one comparatively large quantity of carcase meat which was destroyed in the incinerator of a neighbouring Borough, the food, all of which was in smal quantities, was carefully mixed-in with house hold refuse at the Council's Refuse Collection Works and disposed of at the controlled-tipping site used by the Council. Fish 15 lbs. Carcase meat 216 lbs. Offal 45½ lbs. Ham (canned) 71¼bs. Canned meats (various) 209¼ lbs. Canned foods (various) 51 cans Margarine 2 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 31 Butchers 59 Grocery and Provisions 115 24 Fruit and Greengrocery 62 Wet Fish 17 Fried Fish 7 Restaurants and cafes (including schools canteens, works canteens, clubs etc.) 108 Confectionery and sweets 82 481 In the Borough there are 303 premises registered under Section 16 of the Food and Drugs Act, 1955, 211 in respect of ice-cream and 92 in respect of preserved foods. There was until early in December one dairy in the Borough registered under the Milk and Dairies Regulations, 1949-54. The premises changed hands in December, and are now operated by the new occupiers as a distributing depot only. Under the provisions of the Middlesex County Council Act, 1950, relating to hawkers of food and their premises, there were 90 hawkers on the register at the end of 1958. Of these 21 have storage premises in the Borough, and 69 have their storage premises in other areas. Post-Mortem Inspection of Animals. No slaughtering of animals took place in the Borough during 1958. Milk Regulations and Milk Sampling. During the year under review, 55 samples of milk were obtained and submitted to the Public Health Laboratory for bacteriological examination. All samples gave satisfactory results. Ice-Cream Sampling. During the year under review, 61 samples of ice-cream were obtained and submitted for bacteriological examination. The results were : Grade 1 59 „ 2 1 „ 3 1 „ 4 nil 61 25 Investigations were made by the Public Health Inspectors concerning the two samples giving Grade 2 and 3 results respectively. Following advice the Inspectors were able to give, subsequent samples gave satisfactory results. Establishments for Massage or Special Treatment. Under the Middlesex County Council Act, 1944, 18 existing licences were renewed and 2 new licences were granted. Pet Animals Act, 1951. Two licences were granted by the Council during 1958 under the above-mentioned Act in respect of two pet animal shops in the Borough. Swimming Bath. The figures for attendances at the Barrowell Green Open Air Swimming Bath for the last two years were : 1957 1958 Adults (Mixed and Spectators) 17,791 10,757 Children (Mixed and Spectators) 31,756 27,960 From Schools 3,042 2,261 Season Tickets 8,729 6,811 61,318 47,789 Costumes etc. hired 84 65 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 1958 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. The 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 health-giving service. I am always delighted to visit the Bath and to see the excellent manner in which the premises are being maintained. Rivers and Streams. During the year under review, one complaint was received concerning a minor nuisance from a stream in the Borough. This was dealt with immediately. 26 Prevention of Damage by Pests Act, 1949. During 1958, 404 complaints of rats and mice were received and dealt with, as against 414 in 1957. In March 1958, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 304 manholes were baited. In 131 of these, complete or part takes of bait were noted. In October, 1958, test baiting was carried out by the Borough Engineer's Department to 275 manholes, representing approximately 15 per cent. of the total manholes on the Council's soil sewers. On the results obtained from this test, a baiting and poisoning treatment followed, during which 304 manholes were baited. Of these, 145 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 officer 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. 17 public conveniences are available in the Borough, situated as follows : Broomfield Park (3). Amos Park. Bramley Sports Ground. Oakwood Park. Tottenhall Sports Ground. North Circular Road, Palmers Green. Triangle, Palmers Green. Fords Grove, Winchmore Hill. " Cherry Tree " Hotel, N.14. " 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. Grovelands Park. Conveniences provided by London Transport Executive at Southgate and Oakwood Underground Stations are also available to the public. 27 All public conveniences in the district are inspected by mem bers 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. With the approaching full development of the Borough, many small areas of vacant land are being built upon. The problem of dumping of rubbish on these areas, therefore, is gradually dis appearing. 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 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. 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 18,982 tons, a decrease of 1,222 tons on last year. The disposal of refuse by incineration ceased to operate from 31st December, 1957. During the whole of the year 1958, reconstruction of the works was in progress. At the time of writing, the reconstruction is completed, the unloading of vehicles, extraction of salvage and reloading of refuse into large capacity vehicles for transporting to a tipping site in Hertfordshire is carried out entirely within closed buildings. Dust extraction plant will be installed at essential points further to reduce the dissemination of fine dust into the atmosphere, and to improve working conditions for the staff. 28 Sale of salvage recovered from the refuse during the year realised an income of £9,719. The following table gives the tonnages of the materials sold : Tons Paper 1,029 Cullet nil Non-Ferrous metals 2 Rags 11 Carpet 11 Tins 46 Bottles 4 Scrap Iron 64 Kitchen Waste nil Miscellaneous 33 Fumes and Noise. During 1958, seven complaints were received from residents concerning alleged nuisances from noise and/or fumes from industrial premises. Each complaint was thoroughly investigated by the Public Health Inspectors, observations made and steps taken to obtain the co-operation of the firms concerned, with the result that the nuisances were mitigated or abated. Air Pollution. With the coming fully into force of the Clean Air Act in June 1958, the Public Health Inspectors took active steps towards the implementation of applicable provisions. These included more frequent routine periodic observations on the emission of smoke from industrial premises, with full regard to the Dark Smoke (Permitted Periods) Regulations, 1958. Fifty-six observations were made in this connection. No contravention of the Regulations was observed. Regarding domestic premises, the Council, in February, gave instructions for a report to be prepared in connection with its first Smoke Control Area. The area selected was a residential one in the north-west of the Borough. A survey of representative houses and flats was made, amounting to 17 per cent. of the area, and, resulting from this survey, a comprehensive report was presented to the Council. Having considered this report, the Council resolved in December to submit the required information to the Minister of Housing and Local Government for his approval in principle to its proposed Smoke Control Area No. 1. 29 FACTORIES ACTS, 1937 AND 1948 Details of Work Carried Out During the Year 1958 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 68 49 2 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 178 109 15 - 2 (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers premises) 3 - - - - 3 Total 246 158 17 - 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on 2, 3 or more separate occasions, they should be reckoned as 2, 3 or more cases.) Particulars M/c. line No. No. of cases in which defects were found Number of cases in which prosecutions were instituted M/c. line No. Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) 4 12 12 — — — 4 Overcrowding (S.2) 5 — — — — — 5 Unreasonable temperature (S.3) 6 — — — — — 6 Inadequate Ventilation (S.4) 7 — — — — — 7 Ineffective drainage of floors (S.6) 8 — — — — — 8 Sanitary Conveniences (S.7) (a) Insufficient 9 1 — — — — 9 (b) Unsuitable or defective 10 '10 10 — — — 10 (c) Not separate for sexes 11 — — — 2 — 11 Other offences against the Act (not including offences relating to Outwork) 12 — — — — — 12 Total 60 23 22 — 2 — 60 30 31 OUTWORK—(Sections 110 and 111) Nature of Work Section 110 Number of prosecutions for failure to supply lists 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 instances of work in unwholesome premises Notices served Prosecutions M/c Line No. Wearing Apparel— Making, etc. 13 83 — — — — — 13 Fur Pulling 22 1 — — — — — 22 Artificial Flowers 28 3 — — — — — 28 Making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 2 — — — — — 34 Carding, etc., of Buttons, etc. 38 23 — — — — — 38 Stuffed Toys 39 1 — — — — — 39 Cosaques, Chistmas crackers, Christmas Stockings etc. 42 4 — — — — — 42 Lampshades 44 2 — — — — — 44 Total 70 119 — — — — — 70 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 39, it will be seen that 384 cases of infectious diseases were notified during the year as against 1,216 in 1957. The Infectious sickness Rate for the year was therefore 5.41, as compared with 16.92 during the previous year. The drop in the number of infectious diseases notified during the year was due almost entirely to the low incidence of measles, 1958 not being a "measles year". Indeed, apart from the decrease in measles notifications, the infectious diseases notifications for 1958 showed no material difference from those recorded during the previous year. I can add very little to the paragraphs contained in my Report for 1957 which dealt with the notification of infectious diseases, and with the question of epidemiology as a sociological entity. I am still of opinion that the existing system of notification should be reviewed in its entirety, in the light of present'day knowledge and experience. Two facts are becoming increasingly obvious : Although it is very right that we should continue—at least for the time being—to receive notification of even the milder type of infectious diseases, it would seem that there is at least a proportion of dead wood that could profitably be removed. What is more important, much more important, certain diseases, some of them non-infectious, might well be added to the list of diseases which are at present reported to the Public Health Department. This is not, of course, a matter which has only local significance, but rather falls within the category of a national problem. If the Public Health Department and the Borough Council are concerned with all matters which affect the health of the inhabitants of the Borough—and this has been clearly established—then it surely follows logically that we should have the fullest possible information, not only of conditions which are likely to affect health, but of diseases which are materially influencing not only the health and welfare but the lives of young and old. Thus, although we know at any time, at least with some degree of accuracy, how many cases of scarlet fever or measles are occurring in the district, we normally have to wait until the receipt of a death certificate before we are made aware of instances of diseases such as cancer, acute fatal rheumatism and heart disease. Yet, we are perfectly well aware that scarlet fever is an extremely mild disease today : while in the case of measles, as I have said before, we need do little more than act as a post office. 32 When one considers the relative position of poliomyelitis and multiple sclerosis, perhaps the commonest of all nervous diseases occurring in this country today, an interesting fact emerges. We know that multiple sclerosis is directly responsible for approximately 800 deaths every year, while poliomyelitis usually accounts for something between 200 and 300 annual deaths. It is certainly a fact that we know a great deal about acute anterior poliomyelitis, while our knowledge of the aetiology and treatment of multiple sclerosis still presents a very great problem. Yet the obvious anomaly remains. I merely give this comparison to show that diseases which are not necessarily infectious in the commonly acepted sense of the term should not, merely because of their non-infectious nature remain unknown in the community. Even if we still have to wait until research and modern science have provided us with the weapons with which to deal with such diseases as coronary thrombosis, leukasmia, multiple sclerosis, cancer, to mention only a few of the more serious disorders in this category, we would still like to have some approximate idea of the magnitude of the problem, so that we can study it more fully. It is by no means certain, of course, that this study would bring forth the much-needed answers; but we would at least have the satisfaction of trying to establish whether or not there was any factor in the district which had significance. After all, the sum total of the facts ascertained in many districts might eventually be scientifically related to the vast amount of medical research which is taking place in so many hospitals and laboratories in this country and elsewhere. Diphtheria. For the eleventh year in succession, no case of diphtheria was notified in the Borough. The last death took place approximately sixteen years ago. Our campaign of immunisation against diphtheria has been carried on throughout the year along the general lines set out in my Annual Report for 1957. We are still continuing to give separate protection against diphtheria and pertussis (whooping cough), in the belief that the protection afforded by vaccination against poliomyelitis is not yet sufficiently advanced to remove the possible danger of provocation poliomyelitis. I am very pleased to be able to report that Southgate mothers have freely accepted our advice and are attending with their infants as often as is necessary at clinics or at their family doctors surgeries, to have their children protected against diphtheria and pertussis (whooping cough), and also vaccinated against smallpox. As the necessary number of visits, including vaccination against poliomyelitis does not entail more than one visit each month to a clinic or to the family 33 doctor, it can scarcely be said that an intolerable burden is being placed on the shoulders of mothers or children ! Detailed records kept in the Area Health Office show that 96% of Southgate children who had reached the age of 2 years by the end of 1958 had been fully protected against diphtheria. These figures are eminently satisfactory, and speak for themselves. Indeed they represent levels of immunisation which, not so many years ago, would have been considered virtually unattainable. They obviously redound to the credit and intelligence of our mothers, who appreciate to the full advantages which protection against such diseases as diphtheria, pertussis (whooping cough), poliomyelitis and smallpox, will impart to their infants. Scarlet Fever. 56 cases of scarlet fever were notified during the year, as against 69 cases in 1957 and 19 cases in 1956. I remarked in the Annual Report for 1957 that it was no longer considered necessary to exclude home contacts of scarlet fever from school. The fact that the exclusion of contacts results merely in a loss of school time, without in any way materially reducing the risk of spreading scarlet fever in schools, is shown by the fact that the new policy has not resulted in any increase in the number of scarlet fever cases reported from our schools. Scarlet fever continues to be an extremely mild disease ; indeed, it is so mild that one often wonders whether anything like 100% of the cases which occur in any given year are reported to us. As I have remarked so many times before, however, we must remain on our guard in case the more virulent type of scarlet fever which we all remember so well before the war should return. Acute Anterior Poliomyelitis. No cases of poliomyelitis were notified in Southgate during 1958. This is, of course, extremely satisfactory, although it must be remembered that the drop in poliomyelitis cases which was such a welcome feature of 1958, was nation-wide. I have reported to the Public Health Committee from time to time on the scheme of vaccination against poliomyelitis which is now in force within the Borough, as part of the County Council's immunisation and vaccination programme. This scheme operated with remarkable smoothness during the year. It is not possible in this report to detail the number of Southgate children who have been given either one, two or three injections against poliomyelitis, as these figures are not yet available. As soon as the numbers have been tabulated, however, I will report the year's totals to the 34 Public Health Committee. At the moment, it can be said that the percentage of children up to the age of 15 who have been vaccinated against poliomyelitis is most gratifying. Indeed, the initial figures showed that the percentage as applied to Area No. 2 was actually the highest in the County. This again is a tribute to the foresight of parents, who have not hesitated to take advantage of the facilities provided. The response to the offer of vaccination against poliomyelitis among the 15.26 age group was not so high, although here again our preliminary survey tends to show that the rate was and still is considerably higher than that reported from the country as a whole. We all know that the policy of vaccination against poliomyelitis has been altered from time to time, and that it has not yet been entirely stabilized. Many people feel, for instance, that a fourth inoculation will be required before full protection can be guaranteed. It is certainly known that the third injection is vital ; that without this third injection, given following a minimum of seven months after the second injection, no one is fully protected. In view of the changing picture, I intend to keep the Public Health Committee fully informed of variations in policy and progress made. Southgate co-operated with the Central Public Health Laboratory at Colindale in collecting and sending for examination, every week, the stools of selected infants. This was part of an extensive enquiry into the possible existence of carriers of the poliomyelitis virus. No virus was discovered among all the specimens sent for examination. Measles. As noted elsewhere. 207 cases of measles were notified during the year, as against 973 cases in 1957. These facts indicate that 1958 was not a "measles" year. Once again the disease in itself was mild in the extreme. This contrasts very favourably with the position not so very long ago, when serious complications such as broncho-pneumonia and middle ear disease were all too common. Indeed, the admission to hospital of a case of measles is now virtually confined to children whose home conditions are unsatisfactory—and there are very few of these in Southgate—or where there is no one at home to look after the child during the illness, however mild that illness may be. Pertussis (Whooping Cough). 12 cases of pertussis (whooping cough) were notified during the year, as against 73 cases in 1957. It is perhaps too soon yet to state definitely that our policy 35 of advising parents to have their children immunised against pertussis during the first six months of life is having a beneficial effect, although the evidence accumulated each year points in this direction. The decrease in notifications over the past few years, certainly gives us reason to believe that this is, in fact, the case. We also know that, even when a case of pertussis (whooping cough) occurs in a child who has been immunised, the disease is mild, complications, once very serious, being virtually unknown. I have always been a very strong believer in immunisation against pertussis. I am glad to think that this policy may now be paying the expected dividends. Smallpox. No cases of smallpox occurred in 1958. In view of the limited outbreak of smallpox in Tottenham during 1957, the fact that the vaccination rate among Southgate children (the most recent figure was 90%) is most encouraging. Food Poisoning, including Sonne dysentery. During 1958, there were 39 cases of dysentery and 9 cases of food poisoning notified, as against 15 cases or dysentery and 8 cases of food poisoning during 1957. I can add little to the paragraphs contained in the Annual Report for 1957. The policy there set out has been continued, and seems to be proving effective. Evidence has been accumulating that Salmonella food poisoning is on the increase. For that reason, the most careful enquiries are made into every case reported to the Public Health Department, in an effort to trace the cause and to eliminate any hazard which exists, either in Southgate or elsewhere. Although cases of Sonne dysentery are reported from time to time, especially from our schools, no part of the district and no school was particularly affected during 1958. Tuberculosis. 30 cases of tuberculosis (28 pulmonary and 2 non-pulmonary) were notified during the year, as against 42 in 1957. Distribution of cases notified among the various wards was as follows : North-east North-west Middle South 4 6 8 12 36 It should again be stressed that these totals are not sufficientlylarge to allow of significant conclusions being drawn, although the drop in notifications during the year (from 42 to 30) is most pleasing. The figures are, however, useful as a means of practical comparison. If one compares the Ward distribution set out in the Annual Report for 1957, with the Ward distribution set out above, it will be seen that no Ward was specifically affected either year, apart from the fact that more cases occurred in the South Ward than any other Ward. This is, of course, to be expected, bearing in mind the built-up area of the South Ward when compared with the North-east, North-west and Middle Wards. A broad classification of the cases notified during the past five years in relation to employment was : 1954 1955 1956 1957 ] Clerical 7 12 5 1 3 Housewives 6 5 3 5 — Children 1 4 1 2 1 Manual Labour 6 — 8 5 3 Factory Workers 2 1 5 5 3 Professional Classes 1 3 6 8 2 Armed Forces — 1 1 1 — Domestic Service 3 — — — 1 Food Trades — 2 — — — Students 3 2 2 1 — Shop Assistants — 3 4 2 1 Nurses 1 2 1 1 — Non-manual trades other than Food 9 7 4 1 4 Teachers — — 2 — — Unclassified 3 5 7 10 12 42 47 49 42 30 It can once again be said that no factors of particular significance appeared in the yearly totals with any regularity. The Scheme for B.C.G. vaccination of Southgate school children continues to make excellent progress. As I write this report, information has been received that the scheme is to be extended both to younger children and to older adolescents. We welcome this extension, and are already taking steps to put the new proposals into operation. I must explain, of course, that this work is carried out through the school Health Service. Mass Radiography Unit 5B. visited Southgate during 1958. On this occasion, the Medical Director of the Unit, Dr. Brett, set 37 out to provide the best possible service. No less than six 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 cooperated 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, including in addition, on this occasion, the opportunity to win one of six valuable prizes kindly donated by local firms and subsequently graciously presented to the lucky recipients by the Worshipful the Mayor. It is equally obvious from the figures supplied by the Unit that good advantage was taken of the opportunity. Set out below is a summary of the results obtained. These figures were kindly supplied by Dr. Brett, to whom and to whose staff I would here record my grateful thanks. Total number X-rayed 5,250 Number of active cases of pulmonary tuberculosis found 4 (Rate per thousand—less than 1) Number of observation cases 5 (Rate per thousand—about 1) Pneumonias 2 Cancer of the Lung 1 Sarcoidosis 2 38 NOTIFICATION OF INFECTIOUS DISEASES, 1958 Disease Jan.— March April— June JulySept. Oct.— Dec. Totals Scarlet Fever 7 18 10 21 56 Measles 5 14 16 172 207 Pertussis 2 2 7 1 12 Pneumonia 12 1 1 9 23 Dysentery 7 — 19 13 39 Meningococcal Infection — 2 — — 2 Food Poisoning 1 2 5 1 9 Erysipelas 1 1 2 1 5 Para-typhoid — — — 1 1 Tuberculosis: Pulmonary 12 7 3 6 28 Non-Pulmonary — — 1 1 2 Total 47 47 64 226 384 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1.1.58 269 223 26 22 540 Cases notified for the first time in 1958 19 9 2 — 30 Cases Restored to Register 3 2 — — 5 Other Cases Added 11 14 — — 25 Cases Removed from Register 45 39 — — 84 Cases Remaining on Register at 31.12.58 257 209 28 22 516 TUBERCULOSIS— *New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1- 5 years — — — — — — — — 5-10 years — — — — — — — — 10-15 years 1 — — — — — — — 15-20 years 1 1 1 — — — — — 20-25 years 3 3 — — — — — — 25-35 years 8 9 1 — — — — — 35-45 years 4 4 — — — — — — 45-55 years 7 3 — — 2 1 — — 55-65 years 4 — — — 4 — — — Over 65 years 5 5 — — 1 2 — — Unknown — — — — — — — — Total 42 24 2 — 7 3 — — *These figures include all cases previously notified and noted by the Tuberculosis Officer and others as having removed into the district. 39 APPENDIX 1 MISCELLANEOUS (a) Letters to Doctors. Letters on the following subjects were circulated to Southgate practitioners in 1958, some under my signature as Medical Officer of Health and others either as Area Medical Officer or District School Medical Officer : 6th January Prompt notification of Infectious Diseases (doubtful or confirmed) to Public Health Department. 10th January Poliomyelitis Vaccination—Extended scheme. 24th January Poliomyelitis Vaccination—Vaccine for "green card" registrations. 18th March Home Helps and Cancer cases. 18th March Old People in need of admission to Hospital, Institution or Old People's Homes. 27th March Easter Holiday arrangements—Home Nurses, Midwives etc. 31st March Second letter on same subject (Old People's admission to Hospitals etc.) 24th April Poliomyelitis Vaccination—Availability of Vaccine. 6th May Poliomyelitis Vaccination—Availability of Vaccine. 20th May Poliomyelitis Vaccination—Availability of Vaccine. 26th June Admission of Aged Sick to Hospital. 20th August Poliomyelitis Vaccination — Extension of Scheme. I would once again emphasize that the closest liaison is maintained between general practitioners and the Public Health Department. It is a most pleasing thought that the relationship between my colleagues in general practice and the Public Health Department is so very cordial. Without this cooperation, maxi mum results in the field of health can never be expected. By 40 reason of the fact that I am a member of the Medical Advisory Committee of the Northern Group of Hospitals, a member of the Medical Advisory Committee of Friern Hospital, and a member of the North Middlesex Liaison Committee, my contacts, not only with general practitioners but with consultant and other hospital staffs can be readily maintained. I find that attendance at these Committees is extremely useful, since it allows me to gain an inside knowledge into the working of other branches of the medical profession, and also permits a free interchange of views. (b) Medical Examinations. During 1958, eighteen medical examinations were carried out in respect of entrants to the Council's services. In addition, 3 medical reports were issued to employees absent from duty for more than a short period through suckness. 41 Printed by E. G. Ellis & Sons, Willow Street, E.4.