AC439 (1) Ackuonters BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1959 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health SOUG 44 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1959 Wm. CLUNIE HARVEY, M.D., D.P.H. Medical Officer of Health TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE Mr. Mayor, Ladies and Gentlemen I beg to present by Annual Report for 1959 It is fast becoming a standard introduction to this Report for me to say that the year under review was more or less uneventful. At the risk of repetition, however, I must once again state that this has, in fact, as far as 1959 was concerned, been the case. I hasten to add, of course, that this does not mean that the Public Health Department was able to pass into a state of coma, or to rest on its oars. The same amount of patient, unpublicised work has to be done year after year if the fruits of the past are to be properly garnered and if adequate safeguards are to be laid down for the future. This is the aim towards which the Public Health Depart' ment continually strives. To deal first of all with the incidence of infectious disease, 1959 was a particularly happy year. A full report on this subject will be found in the section which deals specifically with infectious diseases. I will therefore leave any further remarks until I am able to deal with this particular problem. The vital statistics for 1959 were also satisfactory, although I must once again enter a caviat against placing too much emphasis on the vital statistics which apply to only one year and to a population of approximately seventy thousand. None the less, the figures give rise to satisfaction, especially when studied over a period of several years. The death rate was 10.9, exactly the same rate as that recorded for 1958. The birth rate rose from 11.4 in 1958 to 13.0 in 1959. In actual fact, the birth rate was relatively constant from 1955 to 1958, the only significant rise having taken place last year. Once again, there were no deaths from puerperal sepsis. Unfortunately, one woman did die in childbirth, but the cause of death, after very careful investigation, was found to be due to embolism. The infant mortality rate, i.e. the number of infants who died during the first year of life per thousand live births, was 15.3, as against 21.0 in 1958. These matters will, however, be discussed in greater detail in the part of the Report which deals with statistics and social conditions of the Area. 3 Housing still plays a very important part in the programme of Public Health. Indeed, as has been so often said, there can be few aspects of preventive medicine with which a Borough Council such as Southgate is more intimately concerned. We have already dealt with the greater part of our slum clear ance programme and are still continuing this work. The problem of houses in multiple occupation is at present under review throughout the country, as this presents quite a serious problem in many parts. It is already clear, however, that this is not a major problem in Southgate. As the matter is still under careful investigation, this would appear to be a matter which would be better reported at a later date. The specific problem of the provision of suitable accommodation for the elderly is dealt with in the section of the Report which deals with care of the aged. The position in regard to the setting up of smoke control areas in Southgate is proceeding according to the plan submitted to the Public Health Committee and to the Council, and duly agreed. This is, of course a long-term policy, but I think it can be said that Southgate has not in any way neglected its obvious duties. Food hygiene once again received considerable attention during the year. The Chief Public Health Inspector and his staff of Public Health Inspectors have carried out many visits to food premises, and have investigated all complaints arriving at the Public Health Department. Many talks on clean food were given to local organisations throughout the year, stressing particularly the part which members of the public can play in what is undoubtedly a sizeable problem. Although the Borough Council possesses the powers of law enforcement in regard to infringements of the Clean Food Acts, and although the Council has taken action in this field when action was required, this only represents a comparatively minor solution to the problem. In the United States of America, they have adopted an excellent slogan "Protect yourself, yourself." This means, of course, that unless and until we all work together to effect much-needed improvement in food hygiene, we cannot expect success. No one would suggest that we should become a nation of priers or snoopers. None the less, it will readily be appreciated that Public Health Inspectors, with their multifarious duties and small numbers can, with the best will in the world, only devote a limited amount of time to food hygiene. The general public can and should insist on the highest standards at all times and in all places, should cease to trade with those establishments where conditions are in any way below standard, and should let us know of any conditions which they consider a danger to the consumer. If this co-operation was one hundred per cent, there can be little doubt that conditions would improve. This is merely a matter of simple 4 common sense, yet we know that conditions are still tolerated by the general public which should never be allowed to exist and which may never come to our notice. Relations between the Public Health Department and the burgesses of Southgate have always been good. Our aim is to try and impress upon the public that we are here to help, but that we need their help. The fact that conditions in Southgate are good, should never be allowed to stand in the way of further progress. We all know that Southgate is a place in which it is pleasant to live; we would also like to think that Southgate is equally a place in which food hygiene is beyond reproach. But, as I have already said, until we can be assured of the fullest co-operation from every burgess in the district, this happy state of affairs will still remain beyond our reach. My remarks this year on health education have been incorporated in Appendix 1, at the end of this Report. It has been very rightly said that a Medical Officer of Health must concern himself with every known factor in his Area which may affect the health of the community. For this reason, the Public Health Department has been intimately connected with campaigns to promote clean food, to control the spread of infectious diseases, to remedy housing defects, indeed with all matters which come within the purview of environmental hygiene. As will also be known, we have associated ourselves with the prevention of accidents in the home, a very urgent and increasing problem; with health education, a function which we share with the Middlesex County Council; and have also keenly watched the very rapid progress made in the field of vaccination and immunisation. But there is one other health hazard which has recently been given considerable prominence and in which the Public Health Department must of necessity be interested. I refer to radiation. Radiation, in other words the hazards which can arise from the use or disposal of radio-active substances, has presented a problem not only in this country but throughout the civilised world. It has been said that the hazards associated with radio-active substances are not nearly so great as those associated either with accidents on the road or accidents in the home. While this may well be true, there is a vast difference between accidents which occur on the road or in the home and accidents or even fatalities due to radiation. We can all see the disastrous results of careless driving, burns, scalds or falls in the home; but radiation still remains a vast, complicated and terrifying subject which yet remains beyond the understanding of many even highly intelligent people. When a child pulls a kettle of water on himself and is scalded, we can see the unhappy result; 5 when someone is knocked down by a car, the result is again only too obvious. But the effect of gamma rays on our body may not be known for a very long period. We cannot see these rays, we cannot smell them, unless and until we are duly warned, we do not know that they are in the vicinity. Yet we know that they are highly dangerous both to ourselves and to our progeny. Is it therefore any wonder that the general public is becoming alarmed, is asking to know the full facts and is demanding adequate protection ? I have attended a number of conferences which discussed this intriguing subject. On the whole, these conferences have produced statements to the effect that the Central Government has the matter well under control, that the public need have no fear, and that adequate steps would be taken if the permissible limits of radioactivity were ever passed. One has no reason to doubt these statements, or to doubt that the government has set up an efficient system to keep the situation under constant review. There are, however, two aspects of the problem about which many people still feel certain misgivings. The Radio-active Substances Bill, which is at present going through Parliament, has made provisions for the passing on of essential information, especially regarding the disposal of radioactive waste, to local authorities. This is certainly a step in the right direction, but many Medical Officers of Health would still like to see provision made for the training of their staff, or at least a proportion of their staff, in all matters appertaining to the use or disposal of radio-active substance. It may be that the Radio-active Substances Bill will cover this point adequately, but that is a matter which still remains to be seen. The second point about which many of us feel certain misgivings is the constant use of the term "re-assurance" when any discussion takes place on radiation. I have very little doubt that this word is used in the best possible sense, but none the less, when one is constantly told that the public must be re-assured, there is still of necessity a doubt left in the public's mind that they are not being given all the facts of the case. Indeed, the public should either be told quite clearly that the whole subject of radiation is one which is best left in the hands of those most competent to deal with it; or they should be given the fullest possible information and be allowed to judge for themselves. Whether we like it or not, the problems of radiation are with us, and are causing a good deal of perturbation among those who take the trouble to think 6 about the problems raised by radiation. And, after all, who does not fall within this category ? The fact that the Royal Commission for Local Government in Greater London sat for many months during 1959 and is expected to make its Report in the Autumn of 1960, may well affect the future of Public Health in a Borough such as Southgate. It would be unwise to anticipate the contents of this Report, but one must envisage the possibility that, some time in the relatively near future, such matters as mental health and the operation of the personal health services might well come within the ambit of the Borough Council. Until the Report is received, however, it would certainly be injudicious to make any such assumptions. The fact that, for the past twelve years, I have been Area Medical Officer for No. 2 Health Area under the Middlesex County Council, and this Area includes the Borough of Southgate, has certainly helped me in establishing the necessary liaison between the environmental health services undertaken by the Borough Council and the personal health services under the control of the County Council. I also hope that this dual appointment has been of use to the Borough Council in integrating work which is of the greatest importance to the burgesses of Southgate. I cannot close this introduction without making special reference to a subject which has always been very close to my heart, the matter of harmonious co-operation. In Southgate, it has always been my pleasure to think that the co-operation established; between the Public Health Department and other bodies and organisations, not to mention individuals, has been close and harmonious. Thus, we have exerted the utmost efforts to promote the closest liaison between the Department and general practitioners a liaison without which success in the field of Public Health would never be fully attained. We have also co-operated to the full with the Area Health Office, with other branches of the Middlesex County Council such as the Welfare Department, the Children's Department, Food 6? Drugs Department, etc., and with the many excellent voluntary organisations within the Borough which are carrying out such wonderful work. I would also refer here to the very happy relations which have always existed between the Public Health Department and the local press. I cannot speak too highly of the wonderful help we have received from the local press on so many occasions, and would pav my humble tribute to this invaluable assistance. The lack of this cordial co-operation which still seems to exist in some areas, has always surprised me. It seems so much easier to co-operate with other people, rather than to act in a non-co-operative manner. I am completely satisfied that the existence of this co-operation in Southgate over the many years during which I have acted as 7 Medical Officer of Health for the Borough, has played no small part in achieving results which otherwise would have been wholly impossible. I would also like to think the burgesses of Southgate know that the Public Health Department exists for one reason only, to help promote better health in the community. I think one can honestly say that this is the case, and that no burgess feels that a visit or letter to the Public Health Department will ever pass unnoticed. Accidents in the home—a menace which is assuming quite alarming proportions—have continued to occupy our attention. I have contributed articles on the subject to the local press, while we have mentioned the importance of accidents in the home and the ways in which these accidents can be avoided, at various talks given throughout the year. It will be appreciated, however, that this is a matter which affects the personal health services rather more than the environmental health services. Most of the work has therefore been carried out by members of the Area Health Staff, particularly Health Visitors at clinics. Apart from the display of posters and leaflets, a comparatively minor contribution to this enormous subject, we have particularly stressed the importance of the use of non-inflammable material. I have been particularly concerned in trying to persuade the makers of non-inflammable material to have this material stocked at as many stores in the district as is possible. In order to encourage mothers to use non-inflammable material for the making of children's frocks, we have had several frocks made by voluntary workers and staff at our clinics, so that the mothers might see how attractive the material is and how it can be made up into suitable dresses, particularly party dresses for their young children. In addition, as I mentioned in last year's Annual Report, we have visited Old People's Clubs to demonstrate the use of non-inflammable material, since burns in the home most often occur among the very young and the very old. Although this may not seem at first sight to be a subject which should come under the heading of Public Health, it is none the less a vital issue. When one considers what is being done in the field of immunisation and vaccination, and when one remembers the quite appalling number of serious, often fatal, accidents which occur in the home, due either to burns or to other types of accident, one realises that anything we can do to reduce this great and increasing risk will be well worth while. In conclusion, I would express my sincerest thanks to the Public Health Committee and to the Borough Council for the continued courtesy and assistance which I have come to expect as Medical Officer of Health. I would also express my grateful thanks to every 8 member of the Public Health Department, and in particular to my Deputy Dr. Janet Campbell, and to Mr. A. E. Gooday, Chief Public Health Inspector. Any Medical Officer of Health is fortunate when he knows that he has a loyal, conscientious and efficient staff. That, I am extremely glad to say, has always been my own position. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. C. HARVEY, Medical Officer of Health Town Hall, Palmers Green, N.13. 9 PUBLIC HEALTH COMMITTEE From 1st January, 1959 to 11th May, 1959 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 From 20th May, 1959 to 31st December, 1959 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 Healh Inspector: R. L. Burkill, M.A.P.H.I., Cert. R.S.H., 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. Senior Typist : Miss E. W. Barratt. Clerk : Miss A. G. Alcock. Junior Clerk : Miss K.P.A. Burling (resigned 7th November, 1959) Miss M. A. Bond (appointed 28th December, 1959). General Assistant : B. Latter. Driver : J. L. Arnold. Rodent Operator : W. Dowsett. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,765 Registrar-General's Estimate of Resident Civilian Population, 1959 70,680 Number of Inhabited Houses 1st April, 1959 (excluding shops assessed with private dwelling accommodation) 22,373 Effective rateable value on 1st April, 1959 £1,507,344 Sum represented by 1d. rate (1959-60 Revised Estimate) £6,190 11 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Male Female Total Live Legitimate 415 404 819 Births Illegitimate 21 11 32 436 415 851 Birth rate per 1,000 of the estimated population 13.0 Still Legitimate 8 6 14 Births Illegitimate 1 — 1 9 6 15 Rate per 1,000 live and still births 17.32 Deaths from all causes and at all ages 942 Death Rate per 1,000 of the estimated population 10.9 Deaths from Puerperal causes 1 Deaths From Puerperal Sepsis nil From other causes 1 Deaths of Infants under 1 year of age: Male Female Total Legitimate 8 4 12 Illegitimate — 1 1 8 5 13 Infant Death Rate: All infants per 1,000 births 15.30 Legitimate—per 1,000 legitimate live births 14.66 Illegitimate—per 1,000 illegitimate live births 31.25 Deaths from measles—all ages nil Deaths from pertussis—all ages nil POPULATION The Registrar-General's estimated population of the Borough at the middle of 1959 was 70,680, a decrease of 260 as compared with 1958. BIRTHS—BIRTH RATE The total nett births for the year accredited to the district was 851, an increase of 42 on the preceeding year. Of these, 436 were males and 415 females (21 males and 11 females being illegitimate). The birth rate for the year was 13.0 per 1,000 of the population. The birth rate for England and Wales for 1959 was 16.5. The births and birth rates for the past five years were as follows: Year No. of Births Birth Rates England Southgate and Wales 1955 776 11.8 15.0 1956 800 11.2 15.7 1957 798 11.2 16.1 1958 809 11.4 16.4 1959 851 13.0 16.5 During the year, the number of births recorded was 91 less than the number of deaths, as compared with 134 less in 1958. MORTALITY General Mortality and Death Rate. The nett number of deaths accredited to the district was 942, 1 less than in 1958. This gives a crude death rate of 13.30 per 1,000 of the population and a corrected death rate of 10.9 (the rate for 1958 being 13.30). From the table which sets out the causes of death for 1959 (page 16) it will once again be seen that diseases of the heart and circulation made up by far the greatest single cause of death. This is in keeping with the national situation, and is a most disturbing feature of modern life. The causes of coronary occlusion— the disease with which we are particularly concerned—are complex and not yet fully understood. It was formerly thought that the stresses and strains associated with life today were the main factors. Nowadays, although these factors are still believed to play a significant part, the role of essential fatty acids in producing atherometa or plaques in the tiny coronary arteries which feed the heart are also considered to have great significance. Much work is being done in this field, in order to establish more clearly the precise causes of coronary disease and the steps which can be taken to reduce the appalling loss of life which occurs in middle and late middle age, especially among males. Once again, deaths from cancer of the lung and cancer of the bronchus have increased, another factor which gives rise to much anxiety. So much has been said and written on this subject that it would appear unnecessary to dwell on the factors which may be contributing to this unhappy rise. One certainly cannot say that there are any specific factors existing in Southgate which encourage coronary thrombosis or lung cancer. But as I said in the Annual Report for 1958, it is quite clear that health education has an important part to play in providing advice and guidance which will help to reduce the two most serious types of fatality which our generation has to face. Infant Mortality. There were 13 deaths of infants under 1 year of age, which gives an infant death rate of 15.3 per 1,000 live births, as compared with 17 deaths and a rate of 21.0 in the preceding year. Among the 13 infants who died in Southgate during 1959 before they had reached the age of twelve months, 11 were under the age of one month. Of these, 10 failed to survive one week. Although these figures are considerably better than they were not so many years ago, we must strive, are indeed striving to 14 cover the precise factors which produce each infant death. To this end, every infant death is carefully scrutinised and examined in all its aspects. Still Births. 15 still births, 14 legitimate and 1 illegitimate were accredited to the Borough for 1959. This is equal to a death rate of 17.32 (live and still births), the corresponding figures for 1958 being 11 still births with a rate of 13.41. Maternal Mortality. One maternal death was reported during 1959. As mentioned in the introduction to this Report, this death was due to embolism and was not associated in any way with puerperal sepsis or infection. The death occurred in hospital. Mortality of Persons over the age of 65. Six hundred and seventy-five deaths, or 71.65 of the total deaths during the year occurred in persons over the age of 65 years. Of these, 251 died between the ages of 80 and 90, while a further 15 females and 7 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 1959 Causes of Death Male Female Total Rates per 1,000 of population All causes (civilians only) 433 509 942 13.32 1. Tuberculosis, Respiratory 2 — 2 0.02 2. Tuberculosis, Other — — — — 3. Syphilitic Disease 1 — 1 0.01 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infection — — — — 7. Acute Poliomyelitis — — — — 8. Measles — — — — 9. Other Infective and Parasitic Diseases 2 4 6 0.08 10. Malignant Neoplasm—stomach 15 7 22 0.31 11. Malignant Neoplasm, Lung, Bronchus 43 8 51 0.72 12. Malignant Neoplasm, Breast — 29 29 0.41 13. Malignant Neoplasm, Uterus — 7 7 0.09 14. Other malignant and lymphatic Neoplasms 41 61 102 1.44 15. Leukaemia, Aleukaemia 2 2 4 0.05 16. Diabetes 4 3 7 0.09 17. Vascular Lesions of Nervous System 39 77 116 1.64 18. Coronary Disease, Angina 97 80 177 2.50 19. Hypertension with Heart Disease 10 12 22 0.31 20. Other Heart Disease 38 78 116 1.64 21. Other Circulatory Disease 22 25 47 0.66 22. Influenza 3 2 5 0.07 23. Pneumonia 25 25 50 0.70 24. Bronchitis 37 16 53 0.75 25. Other Diseases of Respiratory System 5 1 6 0.08 26. Ulcer of Stomach and Duodenum 4 4 8 0.11 27. Gastritis, Enteritis and Diarrhoea 1 5 6 0.08 28. Nephritis and Nephrosis 4 2 6 0.08 29. Hyperplasia of Prostate 3 — 3 0.04 30. Pregnancy, Childbirth, Abortion — 1 1 0.01 31. Congenital Malformation 2 1 3 0.04 32. Other Defined and Ill-Defined Diseases 20 37 57 0.80 33. Motor Vehicle Accidents 3 2 5 0.07 34. All Other Accidents 7 14 21 0.29 35. Suicide 3 6 9 0.12 36. Homicide — — — — 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 1959 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 0.42 0.06 9 0.96 0.12 13 1.38 0.18 1-5 years — — — — — — — — — 5-15 years — — — 1 0.10 0.01 1 0.10 0.01 15-25 years 5 0.53 0.07 4 0.42 0.05 9 0.96 0.12 25-45 years 17 1.80 0.25 14 1.49 0.19 31 3.29 0.44 45-65 years 88 9.35 1.35 123 13.05 1.62 211 22.40 2.95 65-75 years 98 10.41 1.38 132 14.01 1.86 230 24.42 3.25 Over 75 years 297 31.53 4.08 150 15.93 2.26 447 47.45 6.32 Totals 509 54.04 7.19 433 45.96 6.11 942 100.00 13.30 17 TABLE III INFANTILE MORTALITY 1959:Nett deaths from stated causes at various periods under 1 year of age Causes of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total under 1 year 1. Smallpox 2. Chickenpox 3. Measles 4. Scarlet Fever 5. Pertussis 6. Diphtheria and Croup 7. Erysipelas 8. Tuberculous Meningitis 9. Abdominal Tuberculosis 10. Other Tuberculosis 11. Meningitis (not Tuberculous) 12. Convulsions 13. Laryngitis 14. Bronchitis — — — — — 1 — — — 1 15. Pneumonia 16. Diarrhoea 17. Enteritis 18. Gastritis 19. Syphilis 20. Rickets 21. Suffocation 22. Want of Attention and Injury at Birth 23. Atelectasis 3 — — — 3 — — — — 3 24. Congenital Malformation — — — 1 1 — — — 1 2 25. Premature Birth 7 — — — 7 — — — — 7 26. Atrophy, Debility and Marasmus — — — — — — — — — — 27. Other Causes — — — — — — — — — — Total 10 — — 1 11 1 — — 1 13 18 TABLE IV Vital Statistics for Whole District during 1959 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 live births 1951 72,840 819 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 11.40 943 13.30 17 21.00 1959 70,680 851 12.00 (crude) 13.00 (corrected) 942 13.30 (crude) 10.90 (corrected) 13 15.15 19 GENERAL PROVISION OF HEALTH SERVICES Hospitals. There is little I can add to the remarks which I made last year in regard to the Hospital Services available to the burgesses of Southgate. The position in regard to the Medical Officer of Health, how ever, so far as admissions to hospital are concerned, is still not entirely clear, either to patients or even to certain members of the medical profession. Briefly, the Medical Officer of Health has no power to admit a person to hospital, except in special circumstances. We can certainly arrange for the admission of a case of infectious disease to hospital, where admission to hospital is required. As this eventually seldom arises, except in cases of overcrowding or where both breadwinners go out to work, this is a problem which presents little difficulty. I should, however, like to express my thanks to Coppetts Wood Hospital, South Lodge Hospital and St. Ann's Hospital for the help which they invariably provide in arranging for a case to be taken into hospital when asked to do so. The other step which can be taken by a Medical Officer of Health is for the admission to hospital of patients who are in need of care and attention, who may be a danger to themselves or to other persons and who refuse admission to hospital. Such action is taken under Section 47 of the National Assistance Act, 1948. Fortunately, as action under this Act is by no means a pleasant procedure, and seldom yields satisfactory results, we have so far always been able to deal with the matter in other ways. Tact and persuasion can do a lot, and have invariably enabled us to secure the consent of even the most stubborn patient who, up till then, had adamantly refused the care and attention required in hospital. There still seems to be a very live belief, however, that the Medical Officer of Health can arrange for the admission of cases to hospital in any circumstances. That is far from being the case. The duty of arranging the removal to hospital of a patient lies fairly and squarely with the family doctor, and not with the local authority. I have, however, been able to help in many cases, by supporting the general practitioner in regard to removal to hospital, especially in the case of the chronic sick. I can only do so, however, when the family doctor has made an application for the removal of a patient to a specific hospital and has been told that this removal coult not be effected. I then add my weight and have, as I have just said, secured the Co-operation of the hospital concerned in almost every case with which I was asked to deal. I am always only too happy to take this action as, although it is not the duty of the Medical Officer of Health to arrange for 20 the admission of a patient to hospital, other than those cases already mentioned, we obviously cannot dissociate ourselves from such an important aspect of preventive medicine. This, of course, is one of the drawbacks produced by the National Health Act 1948, when hospitals previously under the control of local authorities were brought under the direction of Regional Hospital Boards. Previous to 1948, our relations with local authority hospitals—and we operated one of these ourselves—were close and cordial. I must add, of course, that my own relations with the staff of surrounding hospitals—I would especially mention Highlands Hospital—leave nothing to be desired. But there must come a time when the present generation of Medical Officers of Health have passed, and when, presumably, the gap between local authorities and the hospitals serving their districts is not so close as it still is today. One can only hope that this day is still distant, but it is a possibility which one cannot logically avoid. Care of the Aged. It would indeed be a truism to say that care of the aged is assuming a significance which demands the most urgent attention. In a district such as Southgate, with its ageing population—the fact that 71.65% of total deaths occurred in persons over the age of 65 is evident of this situation—care of the aged assumes particular importance. The Public Health Department is always prepared to help in every way possible while, of course, the Area Health Office is intimately associated through its Health Visitors, Home Helps and Home Nursing Service, with aged persons. I personally look forward eagerly to the day when the Old People's Centre in Southgate will be functioning. In this connection, I have for some time been considering the possibility of setting up an Old Persons Clinic in Southgate a proiect for which the Old Persons Centre might be ideally suited. Old Persons Clinics, at which advice can be given and even certain simple medical examinations carried out, have already proved their worth, especially when run in conjunction with an established geriatric service. I am of opinion that this type of project calls for careful consideration, although I do not yet know whether or not the Old People's Centre could be used for such a purpose. This is a matter which would naturally require discussion and consultation at a later date. In the meantime, the Public Health Department and the Area Health Office are continuing their efforts to alleviate distress and ill-health among the aged. It is quite obvious that much remains to be done. Housing for the aged — and Southgate is already 21 making its contribution—admission of the chronic sick to hospital, an adequate service of Home Helps, by no means an easy matter, the provision of Home Nurses, visits from Health Visitors and Public Health Inspectors—these are the obvious ways in which we can be of practical help. I would make it clear, however, that care of the aged is a problem intimately associated with public health and preventive medicine, and that we are always ready and willing to be of assistance at any time and in any way. Laboratory Facilities. As in past years, the Central Public Health Laboratory Service has been of the greatest assistance to us, not only the Central Laboratory at Colindale, but also the Laboratory housed in Edmonton Town Hall. I gratefully acknowledge the assistance afforded throughout the year, and the close Co-operation which has continued for so many years between the Public Health Department and the Laboratory Service. Summary of the work carried out at the Central Public Health Laboratory for the year:— Positive Negative Swabs for diphtheria bacilli — 170 Sputa for tubercle bacilli — 90 Throat and Nose 370 Faeces 460 Blood 85 Urine 60 Others 57 Mortuary. The mortuary arrangements remain as set out fully in my Report for 1946, with the addition mentioned in last year's Annual Report, that we now have a firm agreement with Prince of Wales's Hospital to accept Southgate bodies. Last year 115 bodies were sent to the mortuary at the Prince of Wales's Hospital. Scabies and Lice. Our procedure in regard to the treatment of scabies and infestation by lice remains as set out in previous Annual Reports. 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 1959 under this Section. 22 SANITARY SERVICES Summary of Visits. Visits re housing defects (Public Health Act, 1936) 3,046 Visits re housing defects (Housing Act, 1957) 718 Visits re drainage and building works 245 Visits re dustbins (Public Health Act, 1936) 31 Visits re housing conditions and overcrowding (applications for housing accommodation) 144 Visits re Rent Act, 1957 126 Visits re food premises (including butchers, bakehouses, confectioners, restaurants, grocers and fish shops) 1,485 Visits re milk and ice-cream sampling 150 Visits re food hawkers 29 Visits re factories 116 Visits re Shops Act, 1950 666 Visits re Infectious Diseases 723 Visits re Clean Air Act 2,888 Visits re Smoke Observations 52 Visits re Prevention of Damage by Pests Act, 1949 1,131 Visits re Heating Appliances (Fireguards) Act, 1952 14 Visits re places of public entertainment 41 Visits re other matters 3,662 15,267 Service of Notices. Informal Notices served: re Housing Repairs 397 re Dustbins 19 re Food Premises 80 re Shops and Factories 77 Total Informal Notices served 573 Total Informal Notices complied with 558 Total Statutory Notices served 45 Total Statutory Notices complied with 44 Repairs to Houses. Considerable work has been carried out by the Public Health Inspectors during the year in connection with repairs to houses. Their efforts have resulted in repairs being carried out at 410 houses, the repairs varying from those of a major character to minor repairs necessary to abate specific nuisances. 23 The repairs referred to 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. Non-compliance with six of the above-mentioned Statutory Notices necessitated legal proceedings being instituted against the respective owners. In each case a Nuisance Order was made by the Court and the necessary repairs were subsequently carried out. House-to-house inspections of older rented houses in the Borough, which it was found possible to recommence towards the close of 1958, continued throughout 1959. Unfit Houses. During 1959, inspections were made of 9, 10, 11 and 13 Park Cottages, N.11, and 1 and 2 Hive Cottages, N.11, and all were found to be unfit for human habitation and incapable at reasonable expense of being made so fit. No undertakings or offers of works being received from the owners, the Council made Closing Orders in repsect of 9, 10, 11 and 13 Park Cottages, and Demolition Orders in respect of 1 and 2 Hive Cottages in accordance with the provisions of the Housing Act 1957. Rent Act 1957. The following is a summary of the action taken by the Council during 1959 under the Rent Act 1957:— Part I—Applications for Certificates of Disrepair (1) Number of applications for certificates 20 (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 11 (b) in respect of all defects 8 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 9 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule nil (6) Number of Certificates issued 10 24 Part II—Applications for Cancellation of Certificates (7) Application by landlords to Local Authority for cancellation of certificates 8 (8) Objections by tenants to cancellation of certificates 1 (9) Decisions by Local Authority to cancel in spite of tenants' objection nil (10) Certificates cancelled by Local Authority 6 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 1959. The number of visits for this purpose was 144, as against 28 in 1958. The close liaison between the Public Health Department and the Housing Department has been maintained in 1959, 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. During 1959, 1,485 visits were made by the Public Health Inspectors to food premises in the Borough. These visits, in my opinion, are invaluable in promoting and maintaining a high standard of food hygiene. In this the third year since the Food Hygiene Regulations came into force, it is true to say that much of the spade-work towards improved conditions has already been done. It is equally true to say, however, that routine visits are essential to ensure the maintenance of these conditions. In order to secure compliance with the Regulations, 62 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 8 food premises. Regulation 9 (Personal cleanliness). In six instances, warnings were given regarding smoking whilst handling food. Regulation 14 (Sanitary Conveniences). At four food premises, it was found necessary to improve 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, constant hot water was provided to fittings at three food premises and a wash-hand basin 25 and hot water supply at each of two other food premises. In addition, nail brushes and towels were provided at nine food premises. Regulation 17 (First-aid materials). Adequate first-aid equipment was provided at two food premises. Regulation 18 (Accommodation for clothing). Accommodation for clothing was improved in one instance. Regulation 19 (Facilities for washing food and equipment). In compliance with this Regulation, it was found necessary to require the replacement of a sink. Regulation 23 (Cleanliness and repair, etc., of food premises). Cleansing and repair work was carried out at fifteen food premises to comply with the requirements of this Regulation. 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 piece of glass, 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 human consumption. The food, all of which was in small quantities, was carefully mixed-in with household refuse at the Council's Refuse Collection Works and disposed of at the controlled tipping site used by the Council:— Fish 3½stone Offal 34 lbs. Carcase Meat 190 lbs. Ham (canned) 117 lbs. Canned Meats (various) 158 lbs. Canned Foods (various) 55 cans Poultry 214 lbs. Bacon 14 lbs. 26 Number and Glasses of Food Premises in the Borough. Below is a summary of the food premises classified under type of business: Bakers and Confectioners 30 Butchers 57 Grocery and Provisions 117 Fruit and Greengrocery 61 Wet Fish 17 Fried Fish 7 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 117 Confectionery and sweets 81 487 In the Borough, there are 314 premises registered under Section 16 of the Food & Drugs Act, 1955, 221 in respect of ice cream and 93 in respect of preserved foods. Under the provisions of the Middlesex County Council Act, 1950, relating to hawkers of food and their premises, there were 93 hawkers on the register at the end of 1959. Of these 23 have storage premises in the Borough and 70 have their storage premises in other areas. Post-Mortem Inspection of Animals. No slaughtering of animals took place in the Borough during 1959. Milk Regulations and Milk Sampling. During the year under review, seventy 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, seventy two samples of ice cream were obtained and submitted for bacteriological examination. The results were: Grade 1 67 „ 2 3 „ 3 2 „ 4 - 72 27 Investigations were made by the Public Health Inspectors concerning the samples giving Grade 2 and 3 results. Subsequent samples were taken and gave satisfactory results. Establishments for Massage or Special Treatment. Under the Middlesex County Council Act, 1944, sixteen existing licences were renewed. Pet Animals Act, 1951. Three licences were granted by the Council during 1959 under the above-mentioned Act in respect of 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: 1958 1959 Adults (Mixed and Spectators) 10,757 24,733 Children (Mixed and Spectators) 27,960 48,530 From Schools 2,261 5,696 Season Tickets 6,811 10,278 47,789 89,237 Costumes, etc., hired 65 115 The arrangements whereby samples of the water from the Swimming Bath are taken at regular intervals has been continued. The results of the samples taken during 1959 were uniformly satisfactory. A notice continues to be posted at the Bath informing the public of the results of these samples. The attendance at the Bath of a Member of the St. John Ambulance Brigade has also been continued. This assistance is greatly appreciated. There is nothing I can add to the remarks which I have made in previous Annual Reports relating to the use of our Open Air Swimming Bath. This was especially noticeable last summer, when full advantage was taken of the excellent weather. During the summer months, Barrowell Green Swimming Bath not only proved itself a first class amenity, but what is even more important, showed itself to be a means of providing health-giving exercise in the open air. 28 One matter which has been exercising me, particularly as District School Medical Officer, has been the increasing incidence of plantar warts (verrucas) among school children. Although it is quite obvious that swimming baths are by no means the only way in which verrucas can be spread, it is equally obvious that the wet surrounds of swimming baths, either open air or closed, provide an excellent means of allowing the virus which causes verrucas to pass from one child to another. In order to try to obviate this particular means of spreading verrucas, I addressed the letter set out below to the Superintendent of our swimming Bath: "I have been worried for some considerable time about the matter of the exclusion of children from the Swimming Bath who are a danger to other children—and even to adults—by reason of the spread of infectious diseases. I am thinking particularly of that great nuisance, the plantar wart or, as it is usually known, the verruca, even when the wart is covered by adhesive plaster. As we are all aware, adhesive plaster has a nasty habit of coming off in water. "We know that these warts can be and are being spread to quite an extent on swimming bath surrounds. The reason is very simple. Swimming bath surrounds are one of the few places where large numbers of children persistently walk for fairly long periods with bare feet. If a child with a verruca walks on a swimming bath surround with bare feet, the virus which causes a verruca can be left behind on the surround and may be picked up by any child who follows shortly afterwards. As you will see ,it is not the swimming bath itself which has anything whatsoever to do with the spread of verrucas; it is simply and solely the fact that children do use the surrounds in bare feet. "If we could be sure that children with verrucas on the sole of the foot were excluded from swimming baths, I am perfectly certain that the incidence of verrucas would very considerably diminish. As you may be aware, I have tried, by articles in the press, by letters to head teachers, by talks to parents, etc., to instil into everyone concerned the vital importance of ensuring that children do NOT visit swimming baths when they are suffering from a verruca. Unfortunately, in spite of all we have done, some parents are still sufficiently careless as to allow their children to visit our swimming baths, knowing perfectly well that they have a verruca. And it is here that we would very much like your continued help. "I know how very helpful you have been in the past. Indeed I am more than delighted at the number of times the Public Health Department has been telephoned, enquiring as to whether or not a particular child should be excluded, either because of a verruca or 29 for any other reason. This always gives us very great pleasure as it is a clear sign of the co-operation which is so essential and which we all desire so much. Please do not hesitate to exclude any child from the swimming bath when, in your opinion, this could be justified on health grounds. A telephone message to the Public Health Department will then clear the matter up, if any difficulty still remains. "I would assure you that I am always prepared to take responsibility for advising you on exclusions, and that you may ask for my advice or the advice of my Department at any time whatsoever. "It is not, of course, verrucas only which may cause the exclusion of a child from the swimming bath. Children with sores on the feet and body—impetigo or any other skin infection which is contagious—heavy infestation which can actually be seen (fortunately this is extremely rare indeed) or any other condition which is apparent or which is admitted and which might be liable to spread infection in the swimming bath, should be excluded. And here again I am not thinking so much of people swimming in the water as to their mixing together on the surrounds or while sun bathing. "It is not really possible to detail all the types of infectious or even non infectious illnesses which may necessitate exclusion. But once again, the Public Health Department will give you advice at any time. In this connection, I was particularly glad to receive an enquiry from a attendant at one of our swimming baths. The attendant had noted that a child had arrived for swimming at a time when the schools were in session. She asked the child why he was not at school, and was informed that his sister was suffering from Sonne dysentery. Very properly the attendant telephoned the Public Health Department, when we verified that she was perfectly correct in not allowing this child to enter the swimming bath, I merely give this as an example of the excellent co-operation which has been in existence for so very long and which we feel quite sure will continue. "While writing, might I mention the annual subject of making quite sure that children do not remain too long in the swimming bath, even when no cases of polio have been reported in the neighbourhood. As you well know, exhaustion is one of the most potent factors in turning what might very well be a mild case of polio into a serious illness, even a great disaster. I would therefore be very glad if, as always, you will have no hesitation in restricting the time during which children remain in the bath. If you have any difficulty in enforcing this order—or, indeed, any order at all— I would once again state that we will give you all the help within our power. 30 "It would be quite impossible to prepare a notice which would draw all the pertinent facts relating to exclusion from swimming baths to the attention of parents and children. I feel that any such notice would have to be condensed, I have therefore drafted a brief statement, which I very strongly feel should be prominently displayed at the swimming bath. I would be most grateful to have your opinion on the wording, size of notice, position where it should be displayed, etc. Please do not hesitate to make any criticisms or suggestions. These, I am quite sure, would be really valuable." NOTICE CHILDREN WITH ANY SKIN INFECTION OR WITH A VERRUCA ON THE SOLE OF THE FOOT WILL NOT BE ADMITTED TO THE SWIMMING POOL. W. C. HARVEY, Medical Officer of Health. The notice mentioned in the letter was duly prepared, and has been exhibited at the Bath. It is too soon yet to say what effect this action will have, but I have every hope that what is fast becoming a real nuisance among school children will be decreased by what we have done. Rivers and Streams. During the year under review, two complaints were received concerning minor nuisances from a stream in the Borough. These were dealt with immediately. Prevention of Damage by Pests Act, 1949. During 1959, 438 complaints of rats and mice were received and dealt with, as against 404 in 1958. In March, 1959, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 306 manholes were baited. The poison bait used for this treatment was sausage rusk plus zinc phosphide. In 146 of the manholes baited, complete or part takes of bait were noted. 31 In the period from June to September, 1959, permission was given by the Council to the Ministry of Agrictulture, Fisheries and Food to carry out experimental treatment in two sections of the Council's soil sewers, using poison bait containing respectively sodium fluoroacetate and fluoracetamide. All work was done by Ministry personnel. From the report subsequently received, it was clear that the experiments were successful. When submitting it, the Ministry expressed their thanks to the Council for help given. Public Conveniences. 17 public conveniences are available in the Borough, situated as follows: Broomfield Park (3). Arnos Park. Bramley Sports Ground. Oakwood Park. Tottenhall Sports Ground. North Circular Road, Palmers Green. Triangle, Palmers Green. Fords Grove, Winchmore Hill. "Cherry Tree" Hotel, The Green, 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. 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. With the approaching full development of the Borough, many small areas of vacant land are being built upon. The problem of dumping rubbish on these areas, therefore, is gradually disappearing. 32 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. Quantity of refuse dealt with at the Refuse Disposal works amounted to 19,303 tons, an increase of 321 tons on last year. Following conversion of the Refuse Disposal Works at Barrowell Green, disposal in bulk by road following the extraction of salvage was commenced on 1st January, 1959. The new system has worked extremely well with a considerable improvement in conditions both in the works themselves and in the immediate neighbourhood due to the elimination of smoke from the furnaces. A further stage in the provision of dust extraction plant was commenced in 1959 with the erection of hoods over the tipping hopper, the elevating conveyor and the tin baling plant. This work is virtually complete at the time of writing and when the new plant is in operation, the entire works will be as dust-free as it is possible to be. Sale of salvage recovered from the refuse during the year realized an income of £12,775. The following table gives the tonnages of the materials sold: Paper 1,141 Non-ferrous metals 3 Rags 18 Tins 527 Bottles 10 Carpet 18 Scrap Iron 100 Sundries 12 33 Fumes and Noise. During 1959, six 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. During the year under review, fifty-two observations were made by the Public Health Inspectors in connection with emission of smoke from industrial premises. No contravention of the Dark Smoke (Permitted Periods) Regulations, 1958 was observed. With regard to domestic premises, the Council, in April, gave consideration to the establishment of Smoke Control Areas over the next five years. Arising out of this, the Council submitted to the Ministry of Housing and Local Government information required by Circular 5/59 in respect of four Smoke Control Areas which the Council propose to establish during the afore mentioned period. In June, 1959, the Council resolved to make its first Smoke Control Order and to submit the Order, in accordance with the provisions of the Clean Air Act, 1956, to the Ministry of Housing and Local Government for confirmation. The date of operation of the Order was fixed as 1st July, 1960. In October, 1959, the Council received confirmation of the Order from the Ministry of Housing and Local Government. Preliminary work in connection with the Council's second Smoke Control Area was commenced towards the close of the year. 34 FACTORIES ACTS, 1937 TO 1959 Details of work carried out during the year 1959 1. INSPECTIONS for purposes of provisions as to health (including Inspections made by Public Health Inspectors). Premises Number of Number on Register Inspections Written Notices Owners Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 63 36 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 177 80 14 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - Total 240 116 14 — 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 No. of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) 6 6 - 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate Ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient - - - - - (b) Unsuitable or defective 9 9 - 3 - (c) Not separate for sexes 1 1 - 1 - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 16 16 — 5 — 35 36 OUTWORK—(Sections 110 and 111) Nature of Work Section 110 Number of prosecutions for failure to supply lists Section 111 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 Wearing Apparel (Making etc.) 82 - - - - - Fur Pulling 1 — — — — — Artificial Flowers 1 — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 1 — — — — — Carding etc. of buttons 20 — — — — — Cosaques, Christmas crackers, stockings, etc. 8 — — — — — Lampshades 2 — — — — — Total 115 — — — — — PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 43, it will be seen that 894 cases of infectious diseases were notified during the year, as against 384 in 1958. The Infectious Sickness Rate for the year was therefore 11.02, as compared with 5.41 during the previous year. The rise in the number of infectious diseases during the year was due almost entirely to the fact that 1959 was a "measles year." As regards the infectious diseases picture as a whole, I cannot do better than to quote in full the report which I made to the meeting of the Public Health Committee held on 23rd February, 1960: "The following table sets out the infectious diseases notifications during 1959, as compared with the notifications during 1958: 1959 1958 Scarlet fever 33 56 Measles 732 207 Pertussis 9 12 Pneumonia 55 23 Erysipelas 4 5 Food Poisoning 3 9 Dysentery 31 39 Meningitis - 2 Poliomyelitis 1 — Paratyphoid fever — 1 Typhoid fever 1 — Tuberculosis 25 30 894 384 The table set out above is particularly interesting for the following reasons: 1. Scarlet fever notifications have dropped, this time to one of the lowest totals recorded for many years. 2. As expected, measles notifications were high, 1959 being a "measles" year. Most of the cases were reported during the first half of the year, since the incidence of measles no longer coincides tidily with any particular year. Severity of the illness was extremely low, the need for removal to hospital being virtually confined to domestic reasons. 37 3. Once again there was a very low incidence of pertussis during the year. Although no statistical evidence is yet available, I am personally convinced that the intensive campaign for the protection of Southgate children against this disease by inoculation is having a beneficial effect. 4. The fact that 55 cases of pneumonia were notified during 1959 can presumably be attributed to the comparatively brief spell of extremely bad weather experienced during the early part of the year. Pneumonia is, however, no longer a serious illness. The introduction of the modern antibiotics has removed the terrors of this disease, except in the very old and very young. We still, of course, have to contend with the occasional case of virus pneumonia, against which the antibiotics are virtually powerless. Fortunately, these cases are comparatively rare. 5. The incidence of food poisoning and dysentery during the year showed a very slight decline. As I have remarked before, however, we know that the notifications of food poisoning and dysentery sent to the Public Health Department by no means account for all the cases which occur. 6. The one case of poliomyelitis notified during 1959 was an adult. This lady was admitted to hospital suffering from ? meningitis, later diagnosed as paralytic poliomyelitis. Fortunately, paralysis was slight and the recovery excellent. 7. The appearance of typhoid fever among the list of infectious diseases notified during the year shows that this disease, although rare these days, is still a potential danger. The only case notified during 1959 made a speedy and complete recovery. 8. The figures relating to tuberculosis are particularly interesting. In 1955, 47 cases were notified; in 1956 this number was 49. In 1957 the notifications had dropped to 42, and to 30 in 11958. In 1959 there was a further drop to 25. It may be too soon yet to congratulate ourselves on the decline in tuberculosis notifications within the Borough, having regard to the small numbers involved. None the less, it would appear that Southgate is sharing in the nation-wide improvement and that the number of yearly notifications in Southgate gives cause for satisfaction. Altogether the infectious diseases picture during 1959 was very satisfactory. In concluding this review of infectious diseases, I should like to make mention of the immunisation and vaccination programme which the Area Health Staff and family doctors carry out in Southgate. 38 Inoculation against diphtheria, pertussis and tetanus is now available at all our clinics. The use of this new "triple antigen" began on 1st January, 1960, and is already proving extremely popular with mothers. Less visits are now required either to a clinic or to the family doctor, while protection against tetanus is now available. As several cases of tetanus have occurred in North London within recent months, this appeared to be a logical addition to our preventive armour. The latest figures for Southgate children show that 95.2% of the children up to the age of 2 years were protected against diphtheria at the end of 1959, while approximately the same number were protected against pertussis. Figures for tetanus protection are, of course, not yet available. I think it would be right to claim that these figures could scarcely be bettered in any part of the country. Vaccination against smallpox is also available at all our clinics. Our latest figures show that 91.2% of children up to the age of two years, were vaccinated against smallpox at the end of 1959. This figure is quite remarkable, especially when it is remembered that, not so many years ago, little more than 20/25% of children were so protected. Our scheme for vaccination against poliomyelitis among children and adults is comprehensive. Vaccination against poliomyelitis is available at all our clinics, while special clinics have been arranged on Saturday mornings to cope with young adults up to the age of 26. We know that approximately 90% of children up to the age of 15 were protected against poliomyelitis by vaccination by the end of 1959. The figures relating to the age group 15/26 are not fully known, since many young adults were protected at their place of work or in the City. We have every reason to believe, however, that at least 50% of adults in this age group have been protected by vaccination. Here again I think it can be claimed with some confidence that these figures are as good as those produced in any other part of England and Wales. We are now, of course, offering vaccination to all adults up to the age of 40. Our publicity scheme in relation to all types of immunisation and vaccination is very complete in Southgate. This includes primary vaccination or immunisation, in addition to reinforcing injections given at schools. I think it could be said that we do more in this direction than most other areas in Middlesex; indeed, some of my colleagues seem to think that we do too much! None the less, I am firmly convinced that this type of publicity—a valuable piece of health education—is very largely responsible for producing the excellent results which we can show in Southgate. We also work in the closest harmony with general practitioners. I have made it a practice to keep general practitioners informed of 39 the latest developments in this field. I also try to ensure that we are all working along the same lines. I am very happy to be able to say that these efforts appear to have been successful." One or two other points relating to infectious diseases might be mentioned: For the twelfth year in succession, no case of diphtheria was notified in the Borough. The last death took place approximately 17 years ago. We must not, however, allow ourselves to be lulled into a sense of false security by such a happy statement. Only this year, a number of cases of diphtheria occurred in a Borough not many miles from Southgate. This limited outbreak was particularly interesting from two aspects. In the first place, it was found that those few children who had been immunised and who still developed diphtheria, developed the disease in a mild form, recovered quickly and. with no ill-effects. On the other hand, the single death which occurred took place in a child who had not been immunised at any time. In other words, the value of immunisation was strengthened since, although only a few cases were involved, it was clearly shown that the few children who developed diphtheria after immunisation came to no harm, but merely suffered a comparatively minor illness. The second lesson to be learnt from this outbreak of diphtheria —and it was not the only outbreak of diphtheria which occurred in England and Wales during 1959—points to the fact that the organism which causes diphtheria still exists and is quite able to strike. In short, although it may be true that many recently qualified general practitioners have never seen a case of diphtheria, our campaign of immunisation must be continued relentlessly. The fact that approximately 95% of Southgate children up to the age of 2 years were protected against diphtheria by immunisation at the end of 1959 is highly encouraging, since it is most unlikely that these figures can be bettered in any part of the country. Tuberculosis. 25 cases of tuberculosis (24 pulmonary and 1 non-pulmonary) were notified during the year, as against 30 in 1958. Distribution of cases notified among the various wards was as follows:— North-east 14 North-west 1 Middle 2 South 8 40 A broad classification of the cases of tuberculosis notified during the past five years in relation to employment was: 1955 1956 1957 1958 1959 Clerical 12 5 1 3 3 Housewives 5 3 5 — 3 Children 4 1 2 1 — Manual Labour — 8 5 3 — Factory Workers 1 5 5 3 — Professional Classes 3 6 8 2 1 Armed Forces 1 1 1 — — Domestic Service — — — 1 — Food Trades 2 — — — 1 Students 2 2 1 — 2 Shop Assistants 3 4 2 1 — Nurses 2 1 1 — — Non manual trades other than food 7 4 1 4 5 Teachers — 2 — — 3 Unclassified 5 7 10 12 7 47 49 42 30 25 I have already mentioned the fact that tuberculosis notifications have shown a steady drop over the past few years. This is highly satisfactory, although it must be admitted that the figures involved are too small to carry any great significance. Our scheme for the B.C.G. vaccination of Southgate school children continues, and is working very well. As I explained in my Annual Report for 1958, of course, this work is undertaken by the School Health Service. Mass X-Ray Unit 5B did not visit Southgate during 1959. As Southgate cannot be said to be a district in which tuberculosis present a very serious problem, it is doubtful whether we can expect a visit from the Mass Radiography Unit more than once every three years. We therefore hope that arrangements can be made for the Unit to visit Southgate during 1961. Satisfactory as the infectious diseases picture is, not only in Southgate but throughout the country as a whole, few Medical Officers of Health are entirely happy on the question of notification. Notification is and must remain an essential part of our defence mechanics against the spread of infectious diseases. But times change, and infectious diseases with them. Recommendations have been made by the Public Health Committee of the British Medical Association and by the Society of Medical Officers of Health, relating to suggested changes in the general pattern of notification, designed to bring our procedure into line with modern conditions. 41 As this matter is being taken up and will presumably be considered by the Ministry of Health in due course, there would seem to be little point in discussing it further here. I would merely mention, once again, the anomaly which exists in regard to scarlet fever. As has been said, it is thoroughly illogical that a legal distinction continues to be drawn between a streptococcal infection which includes a rash, i.e. scarlet fever, and a streptococcal infection which does not include a rash. It may be that until everyone concerned is completely satisfied that the present mild form of scarlet fever is here to stay—and this is by no means certain—notification should continue. On the other hand, one cannot see why notification should be necessary so long as scarlet fever retains its present mild form, since steps could be very quickly taken to reintroduce the notification of scarlet fever if and when there was any indication that its virulence had changed. In the meantime, we continue to carry out the instructions which govern the notification of infectious diseases, so far as lies within our power. The fact that quite a number of especially mild cases of scarlet fever never seem to come to our notice, and the fact that an even greater number of cases of food poisoning and dysentery never even reach the doctor's surgery, does not seem to have made any appreciable impact upon the occurrence or spread of these diseases. 42 NOTIFICATION OF INFECTIOUS DISEASES, 1959 Disease Jan.— March AprilJune JulySept. Oct.— Dec. Totals Scarlet Fever 7 11 5 10 33 Measles 444 256 32 — 732 Pertussis — 2 5 2 9 Pneumonia 36 7 4 8 55 Dysentery 9 13 3 6 31 Food Poisoning — 1 1 1 3 Erysipelas — 2 — 2 4 Typhoid — 1 — — 1 Poliomyelitis (paralytic) — — — 1 I Tuberculosis: Pulmonary 8 7 7 2 24 Non-Pulmonary — — — 1 1 Total 504 300 57 33 894 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1.1.59 257 209 28 22 516 Cases notified for the first time in 1959 16 8 1 25 Cases Restored to Register 3 1 — — 4 Other Cases Added 21 19 — 1 41 Cases Removed from Register 36 31 2 1 70 Cases Remaining on Register at 31.12.59 261 206 26 23 516 TUBERCULOSIS—1959 *New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1- 5 years 1 - - - - - - - 5-10 years - - - - - - - - 10-15 years 1 - - - - - - - 15-20 years — 1 - - - - - - 20-25 years 6 4 - - - - - - 25-35 years 9 8 — 1 — — — — 3 5-45 years 8 6 — 1 — — — — 45-55 years 5 1 - - - - - - 55-65 years 4 3 - - - - - - Over 65 years 5 3 — — 2 — — — Unknown - - - - - - - - Total 39 26 — 2 2 — — — *These figures include all cases previously notified and noted by the Tuberculosis Officer and others as having removed into the district. 43 APPENDIX I Health Education. We are proud, and I think very rightly proud, of the work which is being carried out in Southgate in the field of Health Education. The cost of health education in Southgate has been infinitesimal, when compared with that of most other public services. Although the effect which health education has had on the occurrence of disease and, what is more important still, on the promotion of health is difficult to gauge, I have not the slightest doubt that our programme of health education has contributed in no small measure to the health and well-being of Southgate. As will be known, of course, we share the duties of health education with the Middlesex County Council, part being carried out by the Public Health Department and part by the staff of the Area Health Office. This is a particularly happy example of the benefit which accrues through the Medical Officer of Health being Area Medical Officer for the same Area. I am able to correlate the work, to ensure an even distribution, to make use of those officers best qualified and best able to carry out any particular function of health education. The April issue of the journal "The Medical Officer" contained a most interesting article by a Medical Officer of Health, in which the order of preference of various sections of the community in regard to health education was set out. The survey showed that the most popular means of propaganda were television programmes, closely followed by films. At the bottom of the list —and I was not at all surprised at this—came the distribution of pamphlets, a means of health education about which I have had increasing doubts. I was also interested to see that, of the eleven methods of health education listed, exhibitions came ninth on the list. Here again, this is what one might expect, since exhibitions, unless they deal with an urgent, topical problem, have singularly little effect upon the public. The fact that we have used our own sound film projector in Southgate for more than 20 years, indicates the wisdom which prompted the Council to purchase a projector in 1938 and to renew it six years ago, when the original machine was completely worn out. In concluding this brief report on health education, I would make special mention of the great assistance afforded by the Borough Council in promoting the display of propaganda material relating to vaccination against poliomyelitis. Without the help of the Borough Council, it is extremely doubtful whether we could have obtained sufficient sites to make known the fact that vaccination against polio was being carried out throughout the district, 44 and that this was a matter in which everyone must of necessity be interested. It would indeed be true to say that co-operation in projects such as this is absolutely essential. APPENDIX II (a) Letters to Doctors. Letters on the following subjects were circulated to Southgate practitioners in 1959, some under my signature as Medical Officer of Health, others either as Area Medical Officer or District School Medical Officer: January, 16th Old Persons' Welfare—Assistance in the Home, etc. February 26th List of useful addresses and telephone numbers. April 20th Polio Vaccine — temporary shortage of vaccine. June 5th Poliomyelitis — occurrence of cases in Islington. June 15th Poliomyelitis — continuance of Islington outbreak—vaccine in single dose containers. July 16th Poliomyelitis—limited outbreak in Wood Green. July 23rd Poliomyelitis — further information re Wood Green cases. July 29th Polio vaccine and penicillin sensitivity. August 4th Poliomyelitis—vaccination of contacts. September 24th Polio vaccination—Expectant Mothers. November 12th Immunisation and vaccination programme. December 4th Notification of cases of dysentry. December 18th Christmas Holiday Arrangements—-Laboratory. (b) Medical Examinations. During 1959, 23 medical examinations were carried out in respect of new entrants to the Council's service. 22 school teachers employed in Southgate were also medically examined. In addition to these medical examinations, quite a number of medical reports were obtained on employees absent from duty for more than a short period through sickness. These reports were obtained from the family doctor with whom, as I have already said, we have the most happy relations. 45 Printed by E. G. Ellis & Sons Willow Street, E.4