C.439 2nd Copy sitrary BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1960 Wm, CLUNIE HARVEY, M.D. D.P.H Medical Officer of Health SOUG 45 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1960 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 my Annual Report for 1960. The year under review has been once again uneventful. I hasten to add that this does not mean either that nothing has happened or that nothing has been done. The amenities of Southgate, those which were provided by nature and those, by far the greater part, which were built up by the careful, loving care of past Councils, must be jealously guarded. Every year the Borough grows older, houses reach their anticipated life or even over-run that period. Although the population of Southgate has not increased over the past years, we find more and more houses being occupied by multiple families ; while almost every inch of available space has now been built upon. What is happening in Southgate today, and what has been happening virtually since the end of the war, requires constant vigilance. The fact that I can say in my Annual Report that nothing sensational has happened during 1960 is in itself a most satisfactory statement ; provided, of course, as I have already suggested, that the work of preserving Southgate at the level which it has already reached is being carried out. And that, I feel I can truthfully say, has been done and is still being done to the best of our ability. The vital statistics for 1960 are satisfactory, although it must once again be emphasised that a year's statistics for an area with a population of approximately 70,000 can only be regarded as important for comparative purposes. The death rate was 11.0, as compared with 10.9 for 1959. The birth rate rose from 13.0 in 1959 to 14.7 in 1960. The infant mortality rate, i.e. the number of infants who died during the first year of life per thousand live births, was 14.80 as against 15.30 in 1959, a very slight drop. There were no deaths from puerperal sepsis, indeed no deaths took place during childbirth. 3 The year 1960 was particularly placid in regard to infectious diseases. The total number of cases notified during the year fell from 894 in 1959 to 336 in 1960. The infectious sickness rate for the year was therefore 4.80, as compared with 11.02 during the previous year. This drop was, of course, due in large measure to the decline in measles notifications. As I have commented before, however, epidemiology is no longer concerned merely with infectious diseases, but embraces in addition a variety of conditions prejudicial to health, or to put this in another way, conditions which are capable of causing impaired health or actual disease. Thus, it is our duty to make a careful search for any conditions, hidden or disclosed, which are detrimental to the health and well'being of the community. I need scarcely emphasise that it is much more easy to prevent the setting up of such conditions than to remove them once they have become established. For this reason, I have always pursued a policy of bringing before the Public Health Committee all matters affecting the health of the Borough, whether these matters concern environmental or personal hygiene. In this connection, I count myself extremely fortunate that the Public Health Committee has always studied my statements and returns with the care which one has come to expect from the Southgate Borough Council. It is, I feel, true to say that, unless the Public Health Committee can be supplied with the fullest information, the Medical Officer of Health cannot expect that constant support without which success can never be attained. The work of slum clearance, if that is the correct term to use —and I very greatly doubt that it is—still continues. Side by side, the problem of houses in multiple occupation is constantly under review, although this fortunately does not present a serious problem in Southgate. I need scarcely say that housing itself plays a vital part in any programme of public health. This applies to all sections of the community, more especially to young married couples and the aged. For this reason the building projects which have taken place or are being contemplated in Southgate are particularly pleasing. The work of smoke control is proceeding according to plan. It will be many years yet before the whole of the Borough can be made a smoke controlled area, but we are working steadily towards this aim. Food hygiene, as always, received considerable attention during the year. This will be evidenced by the number of infringements which have been brought to the notice of the Public Health Committee, and upon which legal action was necessary in appropriate cases. The work of ensuring the cleanliness of our food 4 supplies must not, however, be judged solely or even largely on the number of infringements brought to the notice of the Public Health Committee, or by the number of Court actions which were taken. The very fact that our Inspectors constantly visit food premises ensures a very necessary measure of control. This is not to say that food manufacturers or food retailers within the Borough are especially prone to infringe the law or to indulge in wrong practices. None the less, whether we like it or not, we know that food handlers are sometimes apt to be careless, and that regular visits from competent, tactful Public Health Inspectors can do a great deal, if only by way of advice, to raise the standard of food handling. This practice has so far been successful in Southgate, and will be continued. The significance of health education in the vast field of public health is now an established fact. The public, generally speaking, is still to a great extent oblivious of the work being carried out in the sphere of public health on its behalf. That is why health education has such a vital part to play. The fruits of this work are shown by the very large numbers of the public who have taken advantage of poliomyelitis immunisation. Every method of bringing to the public factors of topical interest must be pursued ; and every endeavour, by all means available, must be made to stress the fundamental principles upon which the healthy individual and community are based. Health education is as far as possible projected at those age groups and sections of the community which are most in need of it, without making the cardinal mistake of always speaking to the converted, and so neglecting those groups which are most difficult to reach. Our programme of health education in Southgate is, I venture to say, reasonably compre' hensive. Once again, I am very happy to state that relations between the Public Health Department and the burgesses of Southgate have remained extremely pleasant. I think it can truthfully be said that the Southgate burgesses now appreciate to the full that the Public Health Department exists to help them, that our sole aim is to ensure conditions within the Borough which will favour sound health and well-being. By the same token, the relations of the Public Health Department with general practitioners have remained on a very high level. This is equally important, since we must always depend upon the general practitioner, with his intimate relations with families and individuals. I cannot speak too highly of the co'operation which I have received from the general practitioners in Southgate, and would take this opportunity of expressing to them my grateful thanks. 5 I must also mention the co-operation which exists between the Public Health Department and the Middlesex County Council. Our work must of necessity be closely inter-related. It must also be harmonious if maximum results are to be achieved. This interrelationship and harmony have been a feature of preventive medicine in Southgate since 1948, and have undoubtedly produced most beneficial results. In conclusion, I would express my most sincere 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 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 6 PUBLIC HEALTH COMMITTEE From 1st January, 1960 to 16th May, 1960 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 24th May, 1960 to 31st December, 1960 Alderman Richard Prior (Chairman) Councillor H. S. Beardow (Vice-Chairman) Councillor Mrs. H. J. Emsden Councillor R. A. Gray 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. 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 M. A. Bond (resigned 30th September, 1960) Mr. R. R. Hart (appointed 3rd October, 1960). General Assistant : B. Latter. Driver : J. L. Arnold. Rodent Operator : W. Dowsett. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,765 Registrar-General's Estimate of Resident Civilian Population, 1960 69,880 Number of Inhabited Houses 1st April, 1960 (excluding Shops assessed with private dwelling accommodation) 22,572 Effective Rateable Value on 1st April, 1960 £1,516,514 Sum represented by 1d. rate (1960-61 Revised Estimate) £6,230 8 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Male Female Total Live Legitimate 461 436 897 Births Illegitimate 21 26 47 482 462 944 Birth Rate per 1,000 of the esti' mated population 14.7 Still Legitimate 6 5 11 Births Illegitimate 6 5 11 Rate per 1,000 live and still births 11.46 Deaths from all causes and at all ages 929 Death Rate per 1,000 of the estimated population 11.0 Deaths from Puerperal causes nil From Puerperal Sepsis nil From Other Causes nil Deaths of Infants under 1 year of age : Male Female Total Legitimate 9 4 13 Illegitimat 1 — 1 10 4 14 Infant Death Rate : All infants per 1,000 births 14.80 Legitimate—per 1,000 legitimate live births 14.50 Illegitimate-—per 1,000 illegitimate live births 21.27 Deaths from measles—all ages nil Deaths from pertussis—all ages nil 9 POPULATION The Registrar-General's estimated population of the Borough at the middle of 1960 was 69,880, a decrease of 800 as compared with 1959. BIRTHS —BIRTH RATE The total nett births for the year accredited to the district was 944, an increase of 93 on the preceeding year. Of these, 482 were males and 462 females (21 males and 26 females being illegitimate). The birth rate for the year was 14.7 per 1,000 of the population. The birth rate for England and Wales for 1960 was 17.1. The births and birth rates for the past five years were as follows:— Year No. of Births Birth Rates Southgate England and Wales 1956 800 11.2 15.7 1957 798 11.2 16.1 1958 809 11.4 16.4 1959 851 13.0 16.5 1960 944 14.7 17.1 During the year, the number of births recorded was 15 more than the number of deaths, as compared with 91 less in 1959. 10 MORTALITY General Mortality and Death Rate The nett number of deaths accredited to the district was 929, 13 less than in 1959. This gives a crude death rate of 13.30 per 1,000 of the population and a corrected death rate of 11.0 (the rate for 1959 being 10.90). Once again, diseases of the heart and circulation made up the greatest single cause of death in the Borough. Deaths from cancer made up the second largest cause, the most alarming feature being, of course, the continued increase in cancer of the lung and cancer of the bronchus. This bears out what I have already said, that modern epidemiology must take into account all the factors which affect health or which produce death. These matters are, I need scarcely say, of national rather than local importance. So far as can be ascertained, there are no conditions existing in Southgate which specially encourage either coronary thrombosis or lung cancer, at least as compared with other parts of the country. Health education must still remain our most powerful weapon in the fight against these two very serious diseases. I myself have written on coronary thrombosis on a number of occasions, while the County Health Education Officer is paying particular attention to schools in an attempt to persuade children to resist the temptation to start smoking. This would seem to be the most profitable line of approach, and it is sincerely to be hoped that efforts made in this direction will have their effect on future generations. Infant Mortality There were 14 deaths of infants under 1 year of age, which gives an infant death rate of 14.8 per 1,000 live births as compared with 13 deaths and a rate of 15.3 in the preceding year. Among the 14 infants who died in Southgate during 1960 before they had reached the age of 12 months, nine failed to survive one week, one died at seven weeks, and the remaining four died at the age of two months. Every infant death is carefully scrutinised. Although the infant mortality figures for the last few years are very much better than was the case not so many years ago, it is obvious that we must continue our struggle to eliminate all cases of infant death, whether the deaths occur in the first week, in the first month, or in the first year. 11 Still Births Eleven still births, all legitimate, were accredited to the Borough for 1960. This is equal to a death rate of 11.46 (live and still births) the corresponding figures for 1959 being 15 still births with a rate of 17.32. Maternal Mortality No maternal deaths were reported during 1960. Mortality of Persons over the age of 65 Six hundred and sixty-six deaths, or 71.69 of the total deaths during the year occurred in persons over the age of 65 years. Of these 241 died between the ages of 80 and 90, while a further 24 females and 8 males were over the latter age, the oldest being 101. 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. 12 TABLE I Causes of Deaths during the year 1960 Causes of Death Male Female Total Rates per 1,000 of population All cases (civilians only) 456 473 929 13.30 1. Tuberculosis, Respiratory 5 — 5 0.07 2. Tuberculosis, Other — - — — 3. Syphilitic Disease — — — — 4. Diphtheria ' — — — — 5. Whooping Cough — — — — 6. Meningococcal Infection — — — — 7. Acute Poliomyelitis — — — 8. Measles • — — — 9. Other Infective and Parasitic Diseases 1 4 5 0.07 10. Malignant Neoplasm—stomach 8 5 13 0.18 11. Malignant Neoplasm, Lung, Bronchus 42 5 47 0.67 12. Malignant Neoplasm, Breast — 21 21 0.30 13. Malignant Neoplasm, Uterus — 3 3 0.04 14. Other malignant and lymphatic Neoplasms 49 56 105 1.50 15. Leukaemia, Aleukaemia 3 2 5 0-07 16. Diabetes 1 1 2 0.03 17. Vascular Lesions of Nervous System 48 79 127 1.81 18. Coronary Disease, Angina 121 79 200 2.86 19. Hypertension with Heart Disease 9 18 27 0.38 20. Other Heart Disease 50 73 123 1.71 21. Other Circulatory Disease 22 19 41 0.58 22. Influenza 1 — 1 0.01 23. Pneumonia 14 20 34 0.48 24. Bronchitis 20 14 34 0.48 25. Other Diseases of Respiratory System 4 4 8 0.11 26. Ulcer of Stomach and Duodenum 5 4 9 0.13 27. Gastritis, Enteritis and Diarrhoea 1 2 3 0.04 28. Nephritis and Nephrosis — 2 2 0.03 29. Hyperplasia of Prostate 6 — 6 0.08 30. Pregnancy, Childbirth, Abortion — — — — 31. Congenital Malformation 2 1 3 0.04 32. Other Defined and Ill-Defined Diseases 14 6 20 0.28 33. Motor Vehicle Accidents 18 37 55 0.78 34. All Other Accidents 6 11 17 0.24 35. Suicide 5 7 12 0.17 36. Homicide 1 — 1 0.01 13 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 1960 Age FEMALES MALES TOTALS No. % of total deaths Rate per 1,000 No. % of total deaths Rate per 1,000 No. % of total deaths Rate per 1,000 0.1 year 4 0.43 0.05 10 1.07 0.15 14 1.50 0.20 1.5 years 1 0.11 0.02 1 0.11 0.02 2 0.22 0.03 5.15 years — — — 4 0.43 0.05 4 0.43 0.05 15.25 years 2 0.22 0.03 6 0.64 0.08 8 0.86 0.11 25.45 years 8 0.86 0.12 12 1.29 0.17 20 2.15 0.29 45.65 years 80 8.61 1.14 135 14.54 1.94 215 23.15 3.09 65.75 years 120 12.92 1.73 122 13.13 1.74 242 26.05 3.47 Over 75 years 258 27.78 3.69 166 17.86 2.37 424 45.64 6.06 Totals 473 50.93 6.78 456 49.07 6.52 929 100.00 13.30 14 TABLE III INFANTILE MORTALITY 1960 : 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 - - - - - 2 - - - 2 16. Diarrhoea - - - - - - - - - 17. Enteritis - - - - - - - - - - 18. Gastritis - - - - - - - - - - 19. Syphilis - - - - - - - - - - 20. Rickets - - - - - - - - - - 21. Suffocation - - - - - - - - - - 22. Want of Attention and Injury at Birth - - - - - - - - - - 23. Atelectasis 1 - - - 1 - - - - 1 24. Congenita] Malformation 2 - - - 2 1 - - - 3 25. Premature Birth 4 — - - 4 - - - - 4 26. Atrophy, Debility and Marasmus - - - - - - - - - - 27. Other Causes 2 - - - 2 1 - - - 3 Total 9 - - - 9 5 - - - 14 15 TABLE IV Vital Statistics of whole district during 1960 and eight preceding years Year Population estimated at Middle of each Year Nett Births belonging to the 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 1952 72,480 775 10.37 960 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 70,840 809 11.40 943 13.30 17 21.00 1959 70,680 851 12.00 943 13.30 13 15.15 1960 69,880 944 13.50 (crude) 929 13.30 (crude) 14 14.80 14.70 11.00 (corrected) (corrected) 16 GENERAL PROVISION OF HEALTH SERVICES Hospitals I can add little to the remarks which I have made in the last few Annual Reports relating to the hospital services available to the Burgesses of Southgate, particularly the comments which I made in the Annual Report for 1959. The situation has altered very little, and it is still particularly difficult to obtain admission to hospital of aged persons who are not acutely ill. I invariably try to assist any general practitioner who asks for my help, and am happy to say that the support which I have been able to give general practitioners has, in many instances, proved successful. Care of the Aged It is extremely pleasing to be able to report that the Old People's Centre in Southgate is now open. I am quite sure that this Centre will prove of the greatest value to old people, and that in many ways it will add considerably to their comfort and well-being. As the Council will be aware, I am hoping, as Area Medical Officer, to institute a clinic for old persons at the Old People's Centre. Up to the present, however, the project has had to be held up, as I am extremely anxious to ensure the full co-operation of all general practitioners before any further steps are taken. I have done my best to make it clear that this Old People's Clinic will be much more social than medical. Although simple medical examinations may be undertaken by the Medical Officer in charge, i.e. urine testing, sight testing, blood pressure examination, etc., no attempt will be made to carry out any more elaborate examinations. On the other hand, we will try to help the old people by suggestions as to future employment, hobbies, diet and the like. In short, our aim will be to try to keep old people healthy, and to obviate the need for a visit to their general practitioner. As will be seen by what I have just said, we should not in any way encroach on general practitioners' preserves but should actually help them in their work. I have every hope that the problems which exist at present will be resolved within the near future, and am quite sure that we will have the goodwill of all the general practitioners within the Borough. As I have mentioned in previous reports, our Health Visitors, Home Nurses and Home Helps continue to assist the aged in every possible way. 17 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 188 Sputa for tubercle bacilli 62 Throat and Nose 482 Faeces 967 Urine 102 Blood 106 Others 103 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, 120 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 1960 under this Section. 18 SANITARY SERVICES Summary of Visits Visits re housing defects (Public Health Act, 1936 2,825 Visits re housing defects (Housing Act, 1957) 708 Visits re drainage and building works 357 Visits re dustbins (Public Health Act, 1936) 43 Visits re housing conditions and overcrowding (applications for housing accommodation) 203 Visits re Rent Act 39 Visits re food premises (including butchers, bake houses, confectioners, restaurants, grocers and fish shops) 1,086 Visits re milk and ice cream sampling 132 Visits re food hawkers 4 Visits re factories 270 Visits re Shops Act, 1950 729 Visits re infectious diseases 1,003 Visits re Clean Air Act, 1956 3,537 Visits re Prevention of Damage by Pests Act, 1949 680 Visits re other matters 4,351 15,967 Service of Notices Informal Notices served: re Housing Repairs 378 re Dustbins 23 re Food Premises 77 re Shops and Factories 92 Total Informal Notices served 570 Total Informal Notices complied with 563 Total Statutory Notices served 36 Total Statutory Notices complied with 35 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 401 houses, the repairs varying from those of a major character to minor repairs necessary to abate specific nuisances. The repairs referred to above were carried out mainly as a result of informal action on the part of the Inspectors. Only in 36 instances was it found necessary to follow-up informal action by the service of Statutory Notices. 19 It was not found necessary for the Council during 1960 to institute legal proceedings to secure compliance with any of the above-mentioned Statutory Notices. Unfit Houses During 1960, considerable progress was made in the implementation of the Council's programme for dealing with unfit houses. Following my representations concerning the unfitness for habitation of the houses, the Council declared the following areas to be Clearance Areas in accordance with the provisions of Part III of the Housing Act, 1957, and they were dealt with in the following manner : 1-14 Park Cottages, N.ll Clearance Order made. Confirmed by Minister of Housing and Local Government. Following the rehousing of the tenants by the Council, the houses were demolished by the owners. 225-235 Tottenhall Road, N.13 Council acquired the houses and land by agreement and rehoused the tenants. Demolition of the houses is to be arranged in the early part of 1961, following which it is the Council's intention to develop the site for housing purposes. 1-42 Ivy Road, N.14 Of these houses, 23 were already in the ownership of the Council, having been acquired in 1955. During 1960, the Council proceeded to acquire the remaining 19 houses and land by way of a Compulsory Purchase Order. This Order was confirmed by the Minister of Housing and Local Government towards the close of 1960. The tenants of all the houses in the Clearance Area were rehoused by the Council. It is the Council's intention to demolish the houses in 1961 and subsequently to develop the land for housing purposes. In addition, following the rehousing of the tenants, the Council effected the demolition of 37 houses in two previously declared Clearance Areas in New Southgate. The properties concerned were : 3-35 Palmers Road, N.ll 1-14 Curtis Road, N.ll 24 Lower Park Road, N.ll 36 High Road, N.l1 37-43 Palmers Road, N.l1 20 In December, 1960 the Council received confirmation from the Minister of Housing and Local Government of a previously made Clearance Order in respect of : 3, 4, 5, 6 Simmons Cottages Winchmore Hill Road, N.14 and these houses are to be demolished by the owners subsequent to the tenants being rehoused by the Council. With regard to individual unfit houses, the Council, during the year under review, made Demolition Orders in respect of 37, 39 and 47 Highfield Road, N.21, and a closing Order in respect of 102 Palmers Road, N.ll, under the relevant provisions of the Housing Act, 1957, the houses having been found on inspection to be unfit for human habitation and incapable of being made so fit at reasonable expense. Also during 1960, the demolition took place of 1 and 2 Hive Cottages, N.ll, which were the subject of Demolition Orders made previously by the Council, the two houses having been found on inspection to be unfit for human habitation and incapable at reasonable expense of being made so fit. In respect of those of the six houses referred to above which were occupied at the time the Council took action, all the tenants were rehoused by the Council. Rent Act, 1957 The following is a summary of the action taken by the Council during 1960 under the Rent Act, 1957: Part I—Applications for Certificates of Disrepair (1) Number of applications for certificates 5 (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 1 (b) in respect of all defects 3 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 2 (5) Number of undertakings refused by Local Authority nil (6) Number of Certificates issued 1 Part II—Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 1 21 (8) Objections by tenants to cancellation of certificates 1 (9) Decisions by Local Authority to cancel in spite of tenant's objection nil (10) Certificates cancelled by Local Authority 4 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 1960. The number of visits for this purpose was 203, as against 144 in 1959. The close liaison between the Public Health Department and the Housing Department has been maintained in 1960, 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 1960, 1,086 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. While it is true to say that much work towards improved conditions has been done since the Food Hygiene Regulations came into force in 1956, it is equally true to say that routine visits are essential to ensure the maintenance of these conditions. In order to secure compliance with the Regulations, 77 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 5 food premises. Regulation 9 (Personal cleanliness) In 7 instances, warnings were given regarding smoking whilst handling food. Regulation 14 (Sanitary Conveniences) At 13 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 4 food premises and a wash-hand basin 22 was provided at other food premises. In addition, nail brushes and soap were required to be provided at 7 food premises. Regulation 17 (First'aid materials) Adequate first-aid equipment was provided at 4 food premises. Regulation 18 (Accommodation for clothing, etc.) Accommodation for clothing was provided at 4 food premises. Regulation 19 (Facilities for washing food and equipment) In compliance with this Regulation, it was found necessary to require a sink to be provided. Regulation 23 (Cleanliness and repair, etc., of food premises) Cleaning and repair work was carried out at 18 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. Legal proceedings, however, were instituted by the Council under the Food and Drugs Act, 1955, in respect of the following offences : Sale of toffee containing glass Firm fined £10 Sale of bun containing a cigarette end Firm fined £20 Sale of bread containing tobacco Firm fined £40 plus £5 5s. 0d. costs Sale of milk containing glass Firm fined £5 plus £3 3s. 0d. costs Smoking while handling open food Fined £10 plus £3 3s. 0d. costs 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 4½ stone Fish (frozen) 6 lbs. Meat (carcase) 505 lbs. Meat (offal) 37 lbs. Potatoes 35 cwt. Ham (canned) 216 lbs. Ham (cooked) 8 lbs. Canned Meats (various) 74 lbs. Canned Foods (various) 358 cans 23 Number and Classes of Food Premises in the Borough Below is a summary of the food premises in the Borough, classified under type of business: Bakers and Confectioners 29 Butchers 57 Grocery and Provisions 117 Fruit and Greengrocery 62 Wet Fish 16 Fried Fish 7 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 116 Confectionery and sweets 80 484 In the Borough, there are 321 premises registered under Section 16 of the Food and Drugs Act, 1955, 228 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 1960. 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 1960. Report on Slaughterhouse Facilities In October, 1960, notification was received of acceptance by the Minister of Agriculture, Fisheries and Food of the Council's report on slaughterhouse facilities. The report, prepared in accordance with the provisions of the Slaughterhouse Act, 1958 and the Slaughterhouse (Reports) Direction, 1959, after consultation with the organisations as appeared to the Council to represent the interests concerned, was to the effect that no slaughtering facilities are required in Southgate. Milk Regulations and Milk Sampling During the year under review, fiftynine samples of milk were obtained and submitted to the Public Health Laboratory for bateriological examination. All samples gave satisfactory results. 24 Ice Cream Sampling During the year under review, fifty-eight samples of ice cream were obtained and submitted to the Public Health Laboratory for bacteriological examination. The results were: Grade 1 57 „ 2 1 „ 3 – „ 4 – 58 These results can be regarded as most satisfactory. Establishments for Massage or Special Treatment Under the Middlesex County Council Act, 1944, fifteen licences were renewed and one new licence granted in respect of establishments for massage, chiropody or similar treatment. Pet Animals Act 1951 Four licences were granted by the Council during 1960 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 past two years were: 1960 1959 Adults (Mixed and Spectators) 9,627 24,733 Children (Mixed and Spectators) 28,875 48,530 From Schools 6,270 5,696 Season Tickets 10,272 10,278 55,044 89,237 Costumes, etc., hired 50 115 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 1960 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. 25 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. Prevention of Damage by Pests Act, 1949 During 1960, 341 complaints of rats and mice were received and dealt with, as against 438 in 1959. In April 1960, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 346 manholes were baited. The poison bait used for this treatment was pinhead oatmeal plus warfarin. In 84 of the manholes baited, complete or part takes of bait were noted. In November 1960, a further baiting and poisoning treatment was carried out in the Council's soil sewers. On this occasion, the treatment was preceeded by a 10% test of the total manholes on the soil sewers. Following this test baiting, 348 manholes were baited with pinhead oatmeal plus warfarin. In 58 of the manholes baited, complete or part takes of bait were noted. All work in the sewers was carried out in accordance with the recommendations of the Ministry of Agriculture, Fisheries and Food. 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 26 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. 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. The quantity of refuse dealt with at the Refuse Disposal Works amounted to 20,872 tons. A noticeable change in recent years has been the considerable increase in the bulkiness of refuse. This can be attributed to many factors not the least among them being greater consumption of packaged food, more generous use of wrapping paper, and a reduction in the use of solid fuel for domestic use which has reduced the ash and cinder content of refuse. Bulky packages and wrapping materials, in the absence of a domestic boiler, are placed in the dustbin. Sale of salvage recovered from the refuse during the year realised an income of £15,070, an increase of £2,295 over the previous year. Tonnages of materials sold were as follows : Paper 1,217 Non-ferrous metals 4 Rags 24 Tins 571 Bottles 8 Carpet 18 Scrap Iron 107 Sundries 8 27 At the commencement of the year under review, the Council adopted a garden refuse collection service. A small charge is made for the service which is available by request. Two hundred collections were made during the year. Fumes and Noise During 1960, three complaints were received from residents concerning alleged nuisances from 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 abated. Also thirteen complaints were received from residents in relation to three respective industrial premises concerning alleged noise nuisances. With reference to two of these premises, action taken resulted in abatement of the noise nuisance. In regard to the third, a potato washing and packing factory, the matter was still under consideration at the close of the year. Air Pollution During the year under review, twenty-nine 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's first Smoke Control Order came into operation on 1st July, 1960 and covered an area of 502 acres in the north-west part of the Borough. Conversions and adaptations of fuel appliances carried out by residents to enable them to avoid contravening the Order, proceeded smoothly and were completed or well in hand by the date of operation of the Order. At the close of the year, preliminary work in connection with the Council's second Smoke Control Area was well in hand. 28 FACTORIES ACTS, 1937 TO 1959 Details of work carried out during the year 1960 1. INSPECTIONS for purposes of provisions as to health (including Inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 35 49 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 175 221 11 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Total 210 270 11 — 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 Found No. of cases in which defects were found Number of cases in which prosecutions were instituted Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) 17 17 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 3 3 — 3 — (b) Unsuitable or defective 33 32 — 2 — (c) Not separate for sexes 2 2 — 2 — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 55 54 — 7 — 29 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.) 72 — — — — — Fur Pulling 1 — — — — — Artificial Flowers 1 — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 2 Carding etc. of buttons 13 — — — — — Cosaques, Christmas crackers, stockings, etc. 7 — — — — — Lampshades 2 — — — — — Total 98 — — — — — PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 35, it will be seen that 336 cases of infectious disease were notified during the year as against 894 in 1959. The Infectious Sickness Rate for the year was therefore 4.80 as compared with 11.02 during the previous year. The following table sets out the infectious diseases notifications during 1960, as compared with the notifications during 1959: 1960 1959 Scarlet fever 57 33 Measles 41 732 Pertussis 60 9 Pneumonia 18 55 Erysipelas 3 4 Food Poisoning 21 3 Dysentery 104 31 Meningitis 1 — Poliomyelitis — 1 Typhoid fever — 1 Encephalitis 1 — Puerperal Pyrexia 1 — Ophthalmia Neonatorum 1 — Tuberculosis 28 25 336 894 From the table set out above, the following points emerge : 1. Scarlet fever notifications rose from 33 in 1959 to 57 in 1960. Once again, the type of scarlet fever met with was extremely mild. 2. For the thirteenth year in succession, no case of diphtheria occurred in the Borough. The last death took place approximately 18 years ago. The fact that small outbreaks of diphtheria are still occurring throughout the country, however, means that we cannot relax our precautions in any way. This particularly applies to immunisation, which is now normally carried out by the triple method, i.e. diphtheria, pertussis and tetanus combined. The addition of tetanus vaccination is a welcome addition to our armamentarium. 31 3. Measles notifications dropped from 732 in 1959 to 41. This was to be expected, as 1960 was not a "measles year." As in the case of scarlet fever, severity was extremely low. 4. Pertussis notifications rose from 9 to 60. This was in some ways surprising, since the incidence of measles and pertussis usually run together. Of the 60 cases of pertussis notified during the year, 11 had been vaccinated. In this connection, it must be remembered that vaccination against pertussis does not guarantee complete protection against the disease. What we hope, and what indeed we have found, is that when a vaccinated child develops pertussis, the illness is usually mild. 5. The incidence of food poisoning and dysentery rose during the year from a combined total of 34 during 1959 to a total of 125 during 1960. Sonne dysentery is now endemic in this country, and control measures must be rigidly applied. These include an adequate provision of hot water, soap and towels in schools—this is a matter we are constantly taking up—the teaching of all children to wash their hands after using the toilet and before eating food, the supply of disinfectants to schools when the incidence either of food poisoning or dysentery increases, and the use of letters excluding children who have recently suffered or are suffering from diarrhoea from school for one week, when more than a few cases have been reported from that particular school. These precautions are very necessary because, although neither food poisoning nor Sonne dysentery can be said to be a particularly dangerous illness in school children, we know only too well that such diseases as poliomyelitis may be spread in precisely the same way. 6. No cases of poliomyelitis were notified during 1960. Our immunisation campaign against poliomyelitis has continued without abatement. Our present figures show that more than 90% of Southgate children have been protected against poliomyelitis by vaccination, a figure of which we are particularly proud. 7. Twentyeight cases of tuberculosis were notified during 1960, as against 25 in 1959. This number is lower than the figures for 1956, 1957 and 1958. The Mass X-ray Unit did not visit Southgate during 1960, but it is hoped that a visit will shortly be arranged. Distribution of cases of tuberculosis notified among the various wards was as follows : North-east North-west Middle South 9 4 6 9 32 A broad classification of the cases of tuberculosis notified during the past five years in relation to employment was: 1956 1957 1958 1959 1960 Clerical 5 1 3 3 3 Housewives 3 5 — 3 4 Children 1 2 1 — 5 Manual Labour 8 5 3 — 1 Factory Workers 5 5 3 — 4 Professional Classes 6 8 2 1 4 Armed Forces 1 1 — — 1 Domestic Service — — 1 — — Food Trades — — — 1 — Students 2 1 — 2 1 Shop Assistants 4 2 1 — 1 Nurses 1 1 — — 1 Non-manual trades other than food 4 1 4 5 1 Teachers 2 — — 3 — Unclassified 7 10 12 7 2 49 42 30 25 28 Our scheme for the B.C.G. vaccination of school children continues and is working extremely well. This work is undertaken by the School Health Service. As I have already stated, the infectious diseases picture in Southgate for 1960 makes very pleasant reading. Undoubtedly, the amenities and excellent planning which are a feature of Southgate must be held to have had a considerable effect on this excellent result. The fact that more than 90% of our children have been vaccinated or immunised, either against poliomyelitis or by the triple antigen, (diphtheria, pertussis and tetanus) must also have had its effect. This, as I have pointed out on numerous occasions, is an excellent example of the value of Co-operation between the Borough of Southgate (the local authority) and the Middlesex County Council (the local health authority). The Middlesex County Council is responsible for vaccination and immunisation, as an integral part of the personal health services. On the other hand, the Borough has made a particularly valuable 33 contribution in helping the County Council to display posters, distribute literature, etc. As the Council will be aware, the articles which I contribute to the local press are written as Medical Officer of Health, since I have always felt that my approach as Medical Officer of Health should be much more potent than any approach I can make as Area Medical Officer. In addition—and here I believe we are in many ways unique—a letter is addressed to every parent at least once a year, on the value of immunisation and vaccination, so that no parent can remain unaware of the advantages which vaccination and immunisation confer upon their children. We consider this personal approach particularly valuable, and are of the opinion that, very largely by this means, we have achieved the results already mentioned. 34 NOTIFICATION OF INFECTIOUS DISEASES, 1960 Disease Jan.— March April— June JulySept. Oct.— Dec. Totals Scarlet Fever 12 25 8 12 57 Pertussis 5 28 19 8 60 Measles 30 3 2 6 41 Pneumonia 5 3 2 8 18 Dysentery 4 45 16 39 104 Encephalitis — — — 1 1 Meningococcal Infection — — 1 — 1 Food Poisoning 12 6 2 1 21 Puerperal Pyrexia — — — 1 1 Erysipelas — — — 3 3 Ophthalmia Neonatorum — — 1 — 1 Tuberculosis, pulmonary 4 3 9 6 22 non-pulmonary 1 2 1 2 6 Total 73 115 61 87 336 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1.1.60 261 206 26 23 516 Cases notified for the first time in 1960 14 8 2 4 28 Cases Restored to Register — — — — — Other Cases Added 22 25 1 — 48 Cases Removed from Register 43 30 2 1 76 Cases Remaining on Register at 31.12.60 254 209 27 26 516 TUBERCULOSIS, 1960 Age *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 — 3 — — — — — — 10-15 years — — 1 — — — — — 15-20 years 3 — — 1 — — — — 20-25 years 2 8 — 1 — — — — 25-35 years 9 11 1 — — — — — 35-45 years 8 4 — 1 — — — — 45-55 years 6 1 1 — 4 — — — 55-65 years 4 4 — — 4 — — — Over 65 years 4 — — 1 3 — — — Unknown — 1 — — — — — — Total 36 3.3 3 4 11 — — — These figures include all cases previously notified and noted by the Tuberculosis Officer and others as having removed into the district. 35 APPENDIX 1 (a) Letters to Doctors Letters on the following subjects were circulated to Southgate practitioners in 1960, some under my signature as Medical Officer of Health, others either as Area Medical Officer or District School Medical Officer : January 20th Infective Hepatitis April 6th Collection of Laboratory specimens May 26th Collection of Laboratory specimens June 3rd Diarrhoea July 21st Collection of Laboratory specimens November 16th Anthrax December 16th Collection of Laboratory specimens (b) Medical Examinations During 1960, forty-six medical examinations were carried out in respect of the new entrants to the Council's service. In addtion 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, or from a hospital. 36