AC 439(1) 23 OCT 1962 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1961 Wm. CLUNIE HARVEY, M.D. D.P.H Medical Officer of Health SOUG 46 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1961 Wm. CLUNIE HARVEY, MD. 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 1961. As Medical Officer of Health for the Borough, I feel that I am extremely fortunate in having been able to state in so many Annual Reports that "the year under review was once again uneventful." This may have made my yearly survey less interesting and undoubtedly less exciting than might otherwise have been. None the less, it clearly points to the happy position in which Southgate has found itself for so many years. It is here that one finds clear evidence of the planning which has gone into the shaping of the Borough; of the vigilance which past Councils have lovingly exercised over so many years. Our present duty is equally clear, and could be reduced to the single, time worn phrase: "that which we have, we hold." I have said this many times before, and make no apology for saying it again. If for one moment the staff of the Public Health Department (to mention only the Department for which I am responsible) were to flag in its efforts, were to take things for granted, were to assume that the march of time could be stayed merely by referring to past glories or by waving an invisible wand; if any of these contingencies were to come about, the results might not be immediately obvious, but they would be none the less far-reaching and, eventually, disastrous. If Southgate ever neglects these basic truisms—and I sincerely hope it never does—the proud place which the Borough at present holds will forever have disappeared. This may appear a gloomy prognostication. Yet we must never allow ourselves to forget that the birthright we enjoy today is at once precious, in many ways unique, but at the same time extremely viable. I cannot prevent a feeling of nostalgia when I remember the ground which the Annual Reports produced before the war in Southgate used to cover. I certainly carry out the same work, but much of this work—indeed the most fascinating portion of the work i.e. the personal health services—is undertaken on behalf of the Middlesex County Council. It is no part of my duty to 3 speculate on the changes which may come about within the next few years, especially as I am drawing near the time when my retirement would normally be due. None-the-less, I must express the hope that, whatever London Borough is finally formulated, the Medical Officer of Health will have the privilege of looking after the public health of the district in the widest possible sense. The vital statistics for 1961 were again satisfactory, and compare well with those of preceding years. The death rate was 10.8 as against 11.0 in 1960, a rate which is virtually unaltered. The birth rate fell from 14.7 in 1960 and 13.0 in 1959 to 14.14 in 1961. This fall is very small, perhaps too small to have any significance. Nevertheless, it should be noted. The infantile mortality rate, i.e. the number of infants who died during the first year of life per thousand live births, was 16.0 as against 14.80 in 1960 and 15.30 in 1959. There was therefore a very slight rise, yet it can be said that, for three years running, Southgate must have enjoyed one of the lowest infantile mortality rates in the country. There were no deaths from puerperal sepsis ; indeed no deaths took place during childbirth. In point of fact, during the past ten years only four deaths took place during childbirth, none of which were due to sepsis. This is a highly satisfactory situation, due to a variety of causes; better midwifery, better ante-natal care, and the almost incredible advances in the use of antibiotics. The number of infectious diseases notified during 1961 was considerably in advance of those notified during the previous year, 915 as against 336. This was more than due to the fact that 1961 was a 'measles year,' 753 cases of measles being reported as against 41 in 1960. The infectious sickness rate for the year was, for this reason, 12.78 as compared with 4.80 during 1960. Since the increase in measles notifications accounted for more than the total increases, these figures have little significance in themselves. More important, much more important, is the fact that the type of infectious disease met with during 1961, indeed since the war, is very much milder on the whole than previously. It is also worthy of note that no cases of poliomyelitis were notified during the year, the last case of this particular disease occurring in 1959. The infectious diseases picture will be more fully discussed in the portion of the Annual Report which deals with the prevalence and control of infectious diseases. I will therefore make no further comments at this stage. Year by year, I have stressed the importance of housing as it affects the entire pattern of Public Health ; or, to use what is perhaps a better expression in this context, the pattern of preventive medicine. I have often felt that, more than ever as the years go by, pure public health and housing are inseparable. Those 4 authorities which have a 'Health and Housing Committee,' where matters appertaining to housing as a major problem are dealt with by the Health Committee, are in some respects adopting a wholly logical attitude. As the Council will be aware, a good deal of the time of my Inspectors is taken up, not only in dealing with housing queries, e.g. overcrowding, the need for council housing because of the existence of conditions detrimental to the health of one or more members of the family, etc., but also with the abatement of nuisances, most often by the issue of informal notices and occasionally but never by choice, by having to resort to the issuing of statutory notices, sometimes followed by Court procedure. The Public Health Department considers this to be an integral part of its duty, since problems associated with housing remain at the root of so many social evils. It is specially pleasing to see the work which is being carried out in Southgate in relation to the erection of new houses and flatlets, especially when this accommodation is being made available for tenants displaced from slum clearance areas. Although in 1934, a white paper described Southgate as a 'White Area' because of the very small amount of overcrowding present within the Borough, I doubt whether this fact would still hold good. One must admit and be extremely thankful for the fact that over' crowding is still not a serious problem in Southgate. None the less, when I remember Southgate as it was in 1931 when I took up my position as Medical Officer of Health, and when I compare the position then with the position as it is today, one has no reason to be complacent. In 1931 it was extremely rare to find houses in multiple occupation: nowadays, roads where one would have been literally amazed to find this happening are literally full of houses occupied by two and sometimes three families. This may be inevitable, but it is none the less unfortunate. Even more unfortunate is the fact that the remedy is extremely hard to find. It is truly pleasant to be able to report that Southgate has taken energetic steps to deal with housing for the elderly, a problem which is increasing in intensity year by year. This age group of the population has been neglected for too long. Still more work is required but it is obvious that Southgate appreciates the situation —indeed, with a problem such as ours it must do—and means to do what it can to effect amelioration. I cannot let this opportunity pass without reminding the Council that the work which has fallen to the lot of Public Health Inspectors is increasing with a rhythm which is sometimes frightening. Smoke control—and a great deal of work has been done in this field in Southgate—food inspection, food hygiene and housing itself have all either presented new problems or problems which have been considerably magnified. I count myself extremely 5 fortunate that I have an excellent team of Health Inspectors in Southgate, and this is not only fortunate for me but a matter of good fortune for the Council. The Inspectors are keenly alive to the fact that the duties which they perform are closely allied to the continued prosperity of the Borough, that the role which they play should never be under-estimated. The time has almost come when I may have to ask for an additional Inspector. That, however, will be a matter of report to the Establishment Committee in due course. As will be seen from the paragraph entitled "Air Pollution" which appears later in my report, good progress was made during 1961 in the further implementation of the Council's programme under the Clean Air Act in respect of Smoke Control Areas. In the early part of the year, much of the detailed work was carried out in connection with the Council's No. 2 Smoke Control Area. In order to give full information to residents in the Area and to obtain details required for the formulation of a report to the Council, nearly two thousand dwellings were visited by the Public Health Inspectors. Personal approach of this kind, in my opinion, is invaluable in establishing good relations with residents, serving to ensure that all are fully informed and, so far as the Council is concerned, ensuring the accuracy of the information required by the Ministry of Housing and Local Government when the Order is submitted for confirmation. It is, I think, true to say that the lack of objection to the Order and the smoothness with which it proceeded to eventual confirmation by the Minister in September was brought about in no small measure, by the care with which the preparation work was carried out by the staff, inspectorial and clerical alike. Immediately following confirmation of the Order, many residents put in hand necessary conversions and adaptations to their fireplaces in order to obtain the utmost benefit in the approaching winter months from the improvements effected. The actual date of operation of the Order is not until 1st October, 1962. At the close of the year, preparation work had commenced in connection with the Council's No. 3 Smoke Control Area. Regarding industrial premises in the Borough, it is pleasing to note that these gave little or no cause for complaint throughout the year in the matter of air pollution. It is perhaps not always realised that the Public Health Inspectors in Southgate are also Shops Inspectors. This is a happy arrangement, since the duties appertaining to both fields must be 6 closely integrated. Because of the pressure of other duties, our Inspectors are not always able to visit as many shops as they would like. Fortunately, however, our staff of Public Health Inspectors has changed very little over the past years. The Inspectors therefore know the shops which require more frequent attention, and see to it that this attention is duly applied. I have very little to add to the paragraph on Health Education which appeared in my Annual Report for 1960. As the Council will be aware, I am a frequent contributor to the local press, whenever I consider that an article is required on a subject of topical importance. In this connection, I would once again like to thank the Editors of our local press for their unfailing helpfulness and courtesy. Nothing has been of greater help to me over the past thirty-one years. We also readily accede to any request for a health talk by a local organisation, with or without an accompanying film show. As should be the case, health education in Southgate is closely bound up with the work carried out by the staff of the Middlesex County Council, so that talks are given by Health Inspectors, Assistant Medical Officers, Health Visitors or myself, according to the type of talk required and the special abilities of each Section of the staff to undertake these duties. Abundant leaflets, bookmarks, etc. on health matters are available both in the Public Health Department and in the Area Health Office ; and also in our Clinics and in the County Libraries. When any particular subject calls for the display of posters, this method of propaganda is also utilised, to the full. Altogether, as I have said so often, the neglect of health education is a major blunder. Fortunately, Southgate has never fallen into this pitfall. As the Council may be aware, I have been a regular monthly contributor to the magazine "Better Health" since 1948. I like to think that these articles are extensively read and that, as the articles are syndicated in many parts of the world, the name of Southgate is being widely publicised outside this country. This may be in many ways a trivial matter, but it still gives me great pleasure to think that so many articles, which carry my name and the designation of the three districts for which I act as Medical Officer of Health, are being so widely circulated. Although the vital significance of the connection between smoking and health, not only lung cancer but also bronchitis, coronary thrombosis and such diseases as gastric ulcers, has only exploded into the public consciousness within the past few months, this problem has been before us for many years, certainly since the issue of the Registrar-General's statistical report which proved 7 conclusively that such a connection did exist. A full report on this particular subject more properly belongs to the Annual Report for 1962, but I make no apology for mentioning such an extremely important matter. Although actual deaths from lung cancer have very substantially and tragically increased in this country since 1940, the local picture is fortunately not so striking, as the following tables will show : Deaths from Cancer of the Lung and Bronchus Male Female 1952 31 5 1953 20 6 1954 35 6 1955 35 9 1956 28 9 1957 39 9 1958 24 9 1959 43 8 1960 42 5 1961 30 9 Deaths from Bronchitis 1952 31 13 1953 34 19 1954 19 11 1955 27 16 1956 21 12 1957 27 14 1958 23 19 1959 37 16 1960 20 14 1961 31 13 From this table it will be seen that deaths arising from cancer and bronchitis have not increased in Southgate within the past 10 years to any substantial extent. This should in no way prevent us from continuing our efforts to discourage smoking, especially among children and young people. As I have said, however, the measures which we have already taken, and are still taking, to achieve this end belong to the Annual Report for 1962. It is interesting to note that, although the year 1952 was the year in which 'smog' was so prevalent in Greater and Central London, the deaths from bronchitis in Southgate were not unduly heavy. I have already remarked on the fact that the Southgate Public Health department is extremely fortunate in its staff. I am equally happy to repeat the statement which I made last year, that our relations with the burgesses as a whole are extremely pleasant. 8 We have never abated our efforts to show, and clearly show, that our aim is to help, that red tape and officialdom form no part of our armament, or at least as small a part as is practicable. The same remarks apply to the relations between the Public Health Department and general practitioners, which have been extremely cordial since I took up my duties as Medical Officer of Health. Finally, it is again worthy of mention that our relations with the Middlesex County Council have always been of the best, and have permitted an integration of work which would otherwise have been quite impossible. 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 Dr. Janet Campbell, my Deputy, and to Mr. A. E. Gooday, my Chief Public Health Inspector. It is a fortunate Medical Officer of Health who knows that he has a loyal conscientious and efficient staff. That, I am very 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, 1961 to 15th May, 1961 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 From 23rd May, 1961 to 31st December, 1961 Alderman Richard Prior (Chairman) Alderman H. S. Beardow (Vice-Chairman) Councillor Mrs. H. J. Emsden Councillor P. W. Lansten Councillor G. D. Payne Councillor F. A. Rule 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: R. R. Hart. 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, 1961 71,490 Number of Inhabited Houses and Flats 1st April, 1961 (excluding S'hops assessed with private dwelling accommodation) 22,845 Effective Rateable Value on 1st April, 1961 £1,529,791 Sum represented by 1d. rate (1961-62 Revised Estimate) £6,320 11 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Male Female Total Live Legitimate 455 426 881 Births Illegitimate 26 30 56 481 456 937 Birth Rate per 1,000 of the estimated population 14.14 Still Legitimate 5 6 11 Births Illegitimate — — — 5 6 11 Rate per 1,000 live and still births 11.6 Deaths from all causes and at all ages 921 Death Rate per 1,000 of the esti' mated population 10.8 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 13 2 15 Illegitimate — — — 13 2 15 Infant Death Rate : All infants per 1,000 births 16.0 Legitimate—per 1,000 legitimate live births 17.0 Illegitimate—per 1,000 illegitimate live births nil Deaths from Measles all ages 0.01 Deaths from pertussis all ages nil 12 POPULATION The Registrar-General's estimated population of the Borough, at the middle of 1961, was 71,490, an increase of 1,600 as compared with 1960. BIRTHS —BIRTH RATES The total nett births for the year accredited to the district was 937, a decrease of seven on the preceding year. Of these, 481 were males and 456 females (26 males and 30 females being illegitimate). The birth rate for the year was 14.14 per 1,000 of the population. The birth rate for England and Wales for 1961 was 17.4. The births and birth-rates for the past five years were as follows Birth Rates Year No. of Births Southgate England and Wales 1957 798 11.2 16.1 1958 809 11.4 16.4 1959 851 13.0 16.5 1960 944 14.7 17.1 1961 937 14.14 17.4 During the year, the number of births recorded was 16 more than the number of deaths, as compared with 15 more in 1960. 13 MORTALITY General Mortality and Death Rate The nett number of deaths occurring in the district was 921, eight less than in 1960. This gives a drude death rate of 12.9 per 1,000 of the population and a corrected death rate of 10.8 (the rate for 1960 being 11.0). I have already made mention in the introduction to this Report of the established connection between smoking and health. This, I need scarcely say, is reflected in the deaths from cancer of the bronchus and lungs, bronchitis, coronary thrombosis and psychosomatic diseases such as gastric and duodenal ulcers. I will say nothing more here relating to smoking and health, since this is a matter which has received great publicity during 1962, and should be a matter for more detailed survey in the Annual Report for that year. So far as coronary thrombosis is concerned, diseases of the heart and circulation still make up the largest single cause of mortality in the Borough. Year after year I have mentioned the fact that, although diseases such as coronary thrombosis and lung cancer take an appalling toll of life, particularly the lives of men at the height of their power, "Epidemiology" as we know it, is still closely linked with infectious illnesses. This is not to say that infectious illnesses should not receive careful attention. The fact that most infectious diseases are now mild in nature, especially such diseases as pertussis and scarlet fever, by no means implies that this mildness will continue. None the less, the sooner it is realised that such diseases as heart disease call for more careful study and until the causes of heart and similar diseases are discovered and the appropriate remedies applied, death rates will continue to be much higher than most of us would like to see. As I have remarked before, there are no conditions actually existing within the Borough which one can point to as contributing to cardiac disease. It is a fact, however, that Southgate shares with the rest of the country the strain of modern life, which is clearly having an effect upon so many families. The journey which so many of our residents have to take to and from London every day is presumably a factor which must be taken into account. Finally, Southgate, as a built-up area, even if not a congested area, leaves its population more vulnerable than the population of rural areas, where the tempo and strain of life are not so hectic, and where, incidentally, a smoke-laden atmosphere does not constitute a real health hazard. 14 Altogether, although many explanations for the increase in cardiac fatalities over the past few years have been advanced, and although a great deal of research is going on in this and other countries, the situation is still far from satisfactory. It is most unfortunate that, although we are continually being pressed to carry out research and investigations, the staff of such an area as the Borough of Southgate finds precious little time to indulge in more than its share of routine work. Sometime in the future, this pattern may be reversed. When it is, it will be all to the good. Infant Mortality There were 15 deaths of infants under one year of age. This gives an infant death rate of 16.0 per 1,000 live births as compared with 14 deaths and a rate of 14.8 in the preceding year. Among the 15 infants who died in Southgate during 1961 before they had reached the age of 12 months, nine failed to survive one week and two died under four weeks. Every infant death is carefully scrutinised. Although the infant mortality figures for the last few years continue to be very much more satisfactory than was the case not so many years ago, it is obvious that we must still continue our efforts to eliminate all cases of infant death, whether the deaths occur in the first week, in the first month, or in the first year. Still Births Eleven still births, all legitimate, were accredited to the Borough for 1961. This is equal to a death rate of 11.6 (live and still births), the corresponding figures for 1960 being 11 still births and a rate of 11.46. Maternal Mortality No maternal deaths were reported during 1961. Mortality of Persons over the age of 65 713 deaths, or 77.41 of the totals deaths during the year occurred in persons over the age of 65 years. Of these, 244 died between the ages of 80 and 90, while a further 28 females and 13 males were over the latter age, the oldest being 103. 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 1961 Causes of Death Male Female Total Rates per 1,000 of population All cases (civilians only) 435 486 921 12.90 1. Tuberculosis, Respiratory 1 — 1 0.01 2. Tuberculosis, Other — — — — 3. Syphilitic Disease 1 — 1 0.01 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infection — — — — 7. Acute Poliomyelitis — — — — 8. Measles 1 — 1 0.0l 9. Other Infective and Parasitic Diseases 2 1 3 0.04 10. Malignant Neoplasm—stomach 6 9 15 0.21 11. Malignant Neoplasm, Lung, Bronchus 30 9 39 0.55 12. Malignant Neoplasm, Breast — 21 21 0.29 13. Malignant Neoplasm, Uterus — 10 10 0.14 14. Other malignant and lymphatic Neoplasms 45 45 90 1.26 15. Leukaemia, Aleukaemia 4 2 6 0.08 16. Diabetes 2 3 5 0.07 17. Vascular Lesions of Nervous System 42 72 114 1.59 18. Coronary Disease, Angina 103 83 186 2.60 19. Hypertension with Heart Disease 10 12 22 0.30 20. Other Heart Disease 56 83 139 1.93 21. Other Circulatory Disease 21 30 51 0.74 22. Influenza 1 3 4 0.05 23. Pneumonia 20 29 49 0.68 24. Bronchitis 31 13 44 0.60 25. Other Diseases of Respiratory System 3 — 3 0.04 26. Ulcers of Stomach and Duodenum 9 5 14 0.19 27. Gastritis, Enteritis and Diarrhoea . 2 6 8 0.10 28. Nephritis and Nephrosis 5 4 9 0.12 29. Hyperplasia of Prostate 7 — 7 0.09 30. Pregnancy, Childbirth, Abortion — — — — 31. Congenital Malformation 3 1 4 0.05 32. Other Defined and Ill-Defined Diseases 22 30 52 0.78 33. Motor Vehicle Accidents 2 2 4 0.05 34. All Other Accidents 3 9 12 0.16 35. Suicide 3 4 7 0.09 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 1961 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 2 0.22 0.02 11 1.19 0.15 13 1.41 0.17 1-5 years — — — 2 0.22 0.02 2 0.22 0.02 5-15 years — — — — — — — — — 15-25 years 1 0.12 0.01 2 0.22 0.02 3 0.34 0.03 25-45 years 8 0.88 0.11 12 1.30 0.18 20 2.18 0.30 45-65 years 71 7.74 0.99 99 10.75 1.39 170 18.49 2.38 65-75 years 136 15.77 1.91 120 13.04 1.69 256 28.81 3.59 Over 75 years . 268 28.03 3.75 189 20.52 2.66 457 48.55 6.41 Totals 486 52.76 6.79 435 47.24 6.11 921 100.00 12.90 17 TABLE III INFANTILE MORTALITY 1961: Nett deaths from stated causes at various periods under one 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 — — — — — — — — 1 1 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 — — — — — — — — — — 15. Pneumonia — — 1 — 1 1 — — — 2 16. Diarrhoea — — — — — — — — — — 17. Enteritis — — — — — — — — — — 18. Gastritis — — — — — — — — — — 19. Syphilis — — — — — — — — — — 70, Rickets — — — — — — — — — — 21. Suffocation — — — — — — — — — — 22. Want of Attention and Injury at Birth — — — — — — — — — — 23. Atelectasis 3 — — — 3 — — — — 3 24. Congenital Malformation 1 1 — — 12 — 1 1 4 25. Premature Birth 5 — — — 5 — — — — 5 26. Atrophy, Debility and Marasmus — — — — — — — — — — 27. Other Causes — — — — — — — — — — Total 9 1 1 — 11 1 1 1 1 15 18 TABLE IV Vital statistics of whole district during 1961 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 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 13.50 929 13.30 14 14.80 1961 71,490 937 13.10 (crude) 921 12.90 (crude) 15 16.00 14.14 (corrected) 10.80 (corrected) 19 GENERAL PROVISION OF HEALTH SERVICES Care of the Aged Quite apart from the admission to hospital of the aged infirm, there are many problems associated with old age which increasingly demand more and more attention. The Public Health Department is, as always, prepared to help in every possible way, while our Health Visitors, Home Nurses and Home Helps continue to assist the aged by every means within their power. Once again the Old People's Welfare Committee has been able in many ways to assist the statutory services, by providing those little extras which do not lie within the province either of the local authority or of the local health authority. The Clinic for Old Persons which I mentioned in my Annual Report for 1960 and which is being held at the Old People's Centre, was not opened until early in 1962. The operation of this Clinic therefore falls within the Annual Report for that year, although it may now be said that the Clinic is performing a very useful purpose. One of my Assistant County Medical Officers (Dr. E. Waterhouse), together with a competent nurse, attend this Clinic every alternate week, since the Clinic alternates on Friday afternoons with the session held in Wood Green. At the request of the Local Medical Committee, I attended a session of the Committee in London, so that the object of the Clinic might be more fully discussed and the co-operation of local general practitioners obtained. The meeting was entirely successful, all the points were mutually agreed upon, and I am extremely happy to be able to report that general practitioners are cooperating with us to the full. It would be foolish to state that the geriatric situation is satisfactory, either in Southgate or in North London as a whole. I hasten to add that I invariably obtain what assistance is available from the various hospitals which serve the Area. None-the-less, it is a tragic fact that the admission of the elderly sick to hospital presents an increasingly urgent problem, a problem which at the moment seems virtually unsolvable. It is certainly a fact that the Ministry of Health has issued a ten-year Command Plan which visualises the re-building and extension of existing hospitals and the provision of new hospitals. If this scheme includes the provision of a great many additional geriatric beds, this will be a worthwhile contribution. Unless, however, this substantial contribution is forthcoming, the gradual ageing of the population of these islands will continue to present a problem, a pitiable problem, which none of us can afford to neglect. 20 Hospitals I need add little to the remarks which I made in recent Annual Reports relating to the hospital services available to the people of Southgate. In the section which deals with care of the aged, I particularly mention the difficulty which exists in providing the necessary geriatric services. So far as other hospital admissions are concerned, little difficulty exists, except that the admission to hospital of pregnant women presents something more of a problem than was the case a few years ago. This is not so much due to the lack of beds, as to a lack of staff, a difficulty which has tended to increase year by year. Here again, the provision of adequate housing would go very far towards solving this problem. Laboratory Facilities I would again record my appreciation and thanks to the staff of the Central Public Health Laboratory, both at Colindale and at Edmonton, for their unfailing assistance during the year. We did not have to call upon the Laboratory to any great extent during 1961 owing to the absence of major outbreaks of infectious disease. It is, however, very satisfactory to remember that the Public Health Laboratory Service is available to us, and that any calls we make upon it will be readily and sympathetically met. Summary of the work carried out by the Laboratory Service for the year is: Positive Negative Swabs for diphtheria bacilli — 119 Sputa for tubercle bacilli — 32 Throat and Nose 162 Faeces 432 Urine 172 Blood 122 Others 127 Mortuary The mortuary arrangements remain as set out fully in my Report for 1946, with the addition mentioned in the 1960 Annual Report that we now have a firm agreement with Prince of Wales's Hospital to accept Southgate bodies. In 1961, 148 bodies were sent to the mortuary at the Prince of Wales's Hospital. 21 Scabies and Lice Our procedure in regard to the treatment of scabies and infestation by lice remains as set out in previous Annual Reports. During 1961, three cases of scabies were reported, and arrangements were made for these people to receive treatment. NATIONAL ASSISTANCE ACT, 1948 Section 47—Removal to suitable premises of persons in need of care and attention No action was taken by the Council in 1961 under this Section. SANITARY SERVICES Summary of Visits Visits re housing defects (Public Health Act, 1936) 3,311 Visits re housing defects (Housing Act, 1957) 417 Visits re drainage and building works 257 Visits re dustbins (Public Health Act, 1936) 37 Visits re housing conditions and overcrowding (applications for housing accommodation) 66 Visits re Rent Act, 1957 28 Visits re food premises (including butchers, bake houses, confectioners, restaurants, grocers and fish shops) 1,199 Visits re ice cream sampling 62 Visits re food hawkers 5 Visits re factories 380 Visits re Shops Act 1950 736 Visits re infectious diseases 930 Visits re Clean Air Act, 1956 2,056 Visits re Prevention of Damage by Pests Act, 1949 925 Visits re other matters 3,471 13,880 Service of Notices Informal Notices served : re Housing Repairs 373 re Dustbins 38 re Food Premises 90 re Shops and Factories 86 Total Informal Notices served 587 Total Informal Notices complied with 571 Total Statutory Notices served 33 Total Statutory Notices complied with 32 22 Repairs to Houses During the year under review, repairs have been carried out at 441 houses as a result of the efforts of the Public Health Inspectors. The repairs varied from those of a major character to those minor repairs necessary to abate specific nuisances. The repairs referred to were carried out mainly as a result of informal action on the part of the Inspectors. Only in 33 instances was it found necessary to follow-up informal action by the service of Statutory Notices. It became necessary for the Council in one instance to institute legal proceedings to secure compliance with a Statutory Notice requiring the carrying out of repairs. A Court Order was obtained and the works were subsequently carried out. Unfit Houses During 1961, further progress was made in the implementation of the Council's programme for dealing with unfit houses. 225-235 Tottenhall Road, N.13 The above six houses, which previously had been acquired by the Council following the declaration of a Clearance Area, were demolished. The land is being developed by the Council for housing. 142 Ivy Road, N.14 The forty'two houses were demolished by the Council in June. They were the subject of a Clearance Area declared in 1960. Nineteen of them not in the ownership of the Council were acquired by way of a Compulsory Purchase Order. The land is to be developed by the Council for housing purposes. 3, 4, 5, 6 Simmons Cottages, Winchmore Hill Road, N.14 Following confirmation in 1960 by the Minister of Housing and Local Government of a Clearance Order in respect of these houses, the Council rehoused the tenants and the houses were demolished by the owners in November 1961. 44-60 and 75-79 Ivy Road, N.14 In March, I made representations to the Council in respect of the unfitness of all these houses and two Clearance Areas were declared by the Council under Part III of the Housing Act 1957. In order to effect clearance, the Council resolved to acquire the houses and land. At the close of 1961, acquisition was being proceeded with. 23 64-82 (inc.) High Street, N.14 Following inspections of the above houses, I made representations in July regarding their unfitness for habitation and the Council declared the area to be a Clearance Area. In October the Council resolved to effect clearance by way of a Clearance Order under Part III of the Housing Act 1957. With regard to individual unfit houses, the Council, during the year under review, made Closing Orders in respect of 20 Lee Street, N.ll, and 19 Springfield 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. Rent Act, 1957 The following is a summary of the action taken by the Council during 1961 under the Rent Act, 1957 : Part I—Applications for Certificates of Disrepair (1) Number of applications for certificates 1 (2) Number of decisions not to issue certificates nil (3) Number of decisions to issue certificates: (a) in respect of some but not all defects nil (b) in respect of all defects 2 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule nil (5) Number ctf undertakings refused by local Authority under proviso to paragraph 5 of the First Schedule nil (6) Number of Certificates issued 2 Part II—Applications for cancellation of Certificates (7) Application by landlords to Local Authority for cancellation of certificates 3 (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 2 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 1961. The number of visits for this purpose was 66, as against 203 in 1960. 24 The close liaison between the Public Health Department and the Housing Department has been maintained in 1961, as in previous years. On many occasions I have been asked by the Town Clerk to advise as to the degree of urgency on medical grounds applicable to particular applications. Food Hygiene During 1961, 1,199 visits were made by the Public Health Inspectors to food premises in the Borough. In continuance of the work of promoting and maintaining a high standard of food hygiene, these personal visits of the Inspectors, coupled with the advice and supervision they are able to give, contribute in large measure to the achievement of the objective desired. 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, 90 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 3 food premises. Regulation 9 (Personal cleanliness) In 14 instances, warnings were given regarding smoking whilst handling food. Regulation 14 (Sanitary conveniences) At 24 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, wash-hand basins were renewed at 2 food premises, and constant hot water was provided to fittings at other food premises. In addition nail brushes and soap were required to be provided at 3 food premises. Regulation 23 (General clealiness and repair, etc., of food premises) Cleansing and repair work was carried out at 23 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. 25 Legal proceedings, however, were instituted by the Council under the Food and Drugs Act, 1955, in respect of the following offences: Fish vendor persistently smoking Fined £10 while handling fish Fruiterer and greengrocer failing to Fined £5 plus refrain from the use of tobacco £2 2s. 0d. costs while handling open food Sale of loaf containing a cigarette end Firm fined £10 plus £3 3s. 0d. costs Sale of minced meat containing Firm discharged. Emportion of a cigarette ployee, joined in proceedings, fined £10 Food Inspection The following is a summary of food surrendered and 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 14 stone Carcase Meat 73 lbs. Offal 63 lbs. Ham (canned) 79 lbs. Ham (cooked) 15 lbs. Canned Meats (various) 68½ lbs. Canned Foods (various) 205 cans Frozen vegetables 39 packets Rabbit 50 lbs. Chicken 21½ lbs. 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 56 Grocery and Provisions 111 Fruit and Greengrocery 60 Wet Fish 14 Fried Fish 7 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 118 Confectionery and Sweets 81 476 26 In the Borough, there are 330 premises registered under Section 16 of the Food and Drugs Act, 1955, 235 in respect of ice cream and 95 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 96 hawkers on the register at the end of 1961. Of these, 24 have storage premises in the Borough and 72 have their storage premises in other areas. Post-Mortem Inspection of Animals No slaughtering of animals took place in the Borough during 1961. Ice Cream Sampling During the year under review, 55 samples of ice cream were obtained and submitted to the Public Health Laboratory for bacteriological examination. The results were : Grade 1 51 „ 2 3 „ 3 1 „ 4 - 55 Generally, these results are good. The one sample which gave the Grade 3 result was taken from an itinerant vendor. The matter was taken up with the firm concerned and the method of distribution by the vendor checked. A subsequent sample, taken four days later, proved satisfactory. Establishments for Massage or Special Treatment Under the Middlesex County Council Act, 1944, fifteen licences were renewed and two new licences were granted in respect of establishments for massage, chiropody or similar treatment. Pet Animals Act, 1951 Four licences were granted by the Council during 1961 under the above-mentioned Act in respect of pet animal shops in the Borough. 27 Swimming Bath The figures for attendances at the Barrowell Green Open Air Swimming Bath for the past two years were : 1961 1960 Adults (Mixed and Spectators) 11,970 9,627 Children (Mixed and Spectators) 30,987 28,875 From Schools 5,672 6,270 Season Tickets 8,672 10,272 57,301 55,044 Costumes, etc., hired 44 50 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 1961 were uniformlysatisfactory. 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. Rivers and Streams During the year under review, one complaint was received concerning a minor nuisance from a brook in the Borough. The matter was investigated and dealt with. Prevention of Damage by Pests Act, 1949 During 1961, 398 complaints of rats and mice were received and dealt with, as against 341 in 1960. In April 1961, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 360 manholes were baited. The poison bait used for this treatment was pinhead oatmeal plus warfarin. In 35 of the manholes baited, complete or part takes of bait were noted. In October, 1961, a further baiting and poisoning treatment was carried out in the Council's soil sewers. On this occasion, the treatment was preceded by a 10 per cent test of the manholes on the soil sewers. Following this test baiting, 389 manholes were baited with pinhead oatmeal plus warfarin. In 54 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. 28 Public Conveniences 16 public conveniences are available in the Borough, situated as follows: Broom field 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 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. 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. 29 Refuse Collection and Disposal A weekly collection service was maintained throughout the year. The quantity of refuse dealt with at the Refuse Disposal Works amounted to 20,953 tons. Householders continue to take advantage of the scheme for the collection of garden refuse. Two hundred and seventy collections were made during the year, an increase of seventy over the previous year. The sale of salvage recovered from the refuse during the year realised an income of £17,047, an increase of £1,977 over the previous year. Tonnages of materials sold were as follows : Paper 1,377 Non-ferrous metals 3 Rags 34 Tins 616 Bottles 5 Carpet 28 Scrap Iron 103 Sundries 20 Street Cleansing Towards the end of the year under review, four new Pedestrian Controlled Electric Street Orderly Trucks came into service. The introduction of such mechanical aids to street cleansing work has become a vital necessity to counteract the extreme difficulty in recruiting suitable manual staff for this service. The control of weed growth on pavements has also become a mechanical operation. Spraying of the weeds with a suitable chemical solution has been found to be an economical and effective method of dealing with this aspect of street cleansing work. Seventy miles of pavement were treated in this way during the year. Fumes and Noise During 1961, four complaints were received from residents concerning alleged nuisance from fumes from industrial premises. Each complaint was investigated by the Public Health Inspectors, observations were made and steps taken to obtain the co-operation of the firms concerned with the result that the nuisances were abated. 30 Also, twelve complaints were received from residents in relation to three respective industrial premises concerning alleged noise nuisance. Of these, ten were in respect of noise associated with the operation of a potato1 washing and packing factory. This matter resolved itself when the firm vacated the factory and moved away from the Borough. With regard to the other two, informal action resulted in the abatement of the noise nuisances. In addition, complaint was received from residents concerning noise made during the night by pumping operations at the site of the new technical college. Action taken by the contractors following advice from the Public Health Inspector resulted in the noise being considerably reduced. Air Pollution During the year under review, forty-five 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, preliminary work in connection with the Council's second Smoke Control Order, an extension of the No. 1 Order and covering an additional 416 acres and containing 2,731 dwellings, 27 industrial premises, 154 commercial premises and 43 other premises, was completed in the first part of the year. The date of operation of the Order was fixed at 1st October, 1962. The Order was confirmed by the Ministry of Housing and Local Government on 28th September, 1961. Conversions and adaptations of fuel appliances, carried out by residents to enable them to avoid contravention of the Order, had commenced by the close of the year. In addition, the preliminary work on the Council's third Smoke Control Area had also been commenced by the end of the year. 31 FACTORIES ACTS, 1937 TO 1959 Details of work carried out during the year 1961 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 33 55 2 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 174 3 2'5 11 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 207 380 13 - 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) 5 5 — — — Overcrowding (S.2) —. — — — — Unreasonable temperature (S.3) — — — — — Inadequate Ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — Sanitary Conveniences (S.7) (a) Insufficient 3 3 1 (b) Unsuitable or defective 13 13 — 2 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 21 21 — 3 32 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 N otices served Prosecutions Wearing Apparel (Making etc.) 82 — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 — — — — — Carding etc. of buttons 14 — — — — — Cosaques, Christmas crackers, stockings, etc. 8 — — — — — Lampshades 1 — — — — — Total 109 — — — — — 33 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 37 it will be seen that 915 cases of infectious disease were notified during the year as against 336 in 1960. The Infectious Sickness Rate for the year was therefore 12.80 as compared with 4.80 during the previous year. The following table sets out the infectious diseases notified during 1961, as compared with the notifications received during 1960 : 1961 1960 Scarlet fever 21 57 Pertussis 6 60 Measles 733 41 Pneumonia 23 18 Dysentery 88 104 Encephalitis 1 1 Food poisoning 13 21 Erysipelas 2 3 Meningitis — 1 Puerperal pyrexia — 1 Ophthalmia neonatorum — 1 Tuberculosis 28 28 915 336 From the table set out above, the following facts emerge : 1. Scarlet fever notifications fell from 57 in 1960 to 21 in 1961. Once again, as I have said so often before, the type of scarlet fever met with was extremely mild, so mild that admission to hospital was only necessary when no one remained at home to look after the affected child. 2. For the fourteenth year in succession, no case of diphtheria occurred in the Borough. The last death took place approximately 19 years ago. The fact that cases of diphtheria are still occurring in various parts of the country, however, once again means that we dare not relax our precautions. This particularly applies to immunisation, either against diphtheria alone or against diphtheria, pertussis and tetanus combined. The fact that 93.4% of infants under the age of two years are protected against diphtheria, either alone or by the use of the triple antigen, is extremely pleasing. Indeed, so far as I am aware, this immunisation rate is perhaps the highest in these islands. 34 3. Measles notifications rose from 41 in 1960 to 733 in 1961. This was to be anticipated, as 1961 was a " measles year." As in the case of scarlet fever, severity was extremely low. 4. Pertussis notifications fell from 60 in 1960 to 6 in 1961. As I have said before, there is no valid, concrete evidence to prove that immunisation against pertussis, a policy which is actively pursued in Southgate, is having an appreciable effect on the incidence. Nonetheless, although approximately 91 per cent of children under the age of two years have been protected against pertussis by immunisation—and surely this must be having an effect—a few infants still remain unprotected, in spite of the stringent efforts which are made, especially by our Health Visitors, to persuade parents to accept immunisation. This is proved by the fact that, of the 6 cases of pertussis which occurred in 1961, 5 infants had either not been immunised at all or had not completed their course of injection. 5. The incidence of food poisoning and dysentery fell from a combined total of 125 in 1960 to a total of 101 in 1961. The measures which we have taken, particularly in the control of dysentery and food poisoning among school children, remains as before, and appears to be satisfactory. Although 101 cases did occur during the year, it must be remembered that dysentery, particularly Sonne dysentery and food poisoning are now epidemic in this country, a fact which we must regretfully accept. It must also be remembered that these cases have little more than nuisance value, the disease being quickly recovered from and leaving, so far as we are aware, no ill effects. All cases of dysentery and food poisoning, particularly Salmonella typhi-murium infections, are carefully investigated. Where any cause is discovered, the matter is actively pursued, even when the original infection took place somewhere outside the Borough. 6. No case of poliomyelitis was notified during 1961. As in the case of immunisation against diphtheria, our programme of vaccination against poliomyelitis is something of which I think we can be justly proud, more than 91.6% of Southgate children under the age of two years having been protected against poliomyelitis by vaccination. As will be known, we are now using the Sabin vaccine, a method of oral vaccination which has now supersed;d the giving of Salk vaccine by injection. Sabin vaccine is administered by mouth, the method of administration varying according to the age of the person concerned. It need scarcely be said that this method is proving extremely popular, as after-effects are virtually nil and the disadvantage of a prick is eliminated. 35 It is important to remember that several outbreaks of poliomyelitis have recently occurred within Great Britain, one at least being extensive. This proves that the virus is still with us and requires careful supervision. As in previous years, we have co-operated with the Central Public Health Laboratory, Colindale, in obtaining specimens from children who have not been in known contact with poliomyelitis, so that their stools can be examined. 7. Twenty-eight cases of tuberculosis were notified during 1961, the same number as during 1960. The Mass Radiography Unit did not visit Southgate during 1961, since this is considered to be an area in which tuberculosis does not constitute a major problem. I hope, however, that I will be able to persuade the Unit to visit Southgate in the near future. The distribution of cases of tuberculosis notified among the various wards was as follows : North-east 7 North-west 5 Middle 6 South 10 A broid classification of the cases of tuberculosis notified during the past five years in relation to employment was : 1957 1958 1959 1960 1961 Clerical 1 3 3 3 7 Housewives 5 — 3 4 3 Children 2 1 — 5 — Manual Labour 5 3 — 1 — Factory Workers 5 3 — 4 1 Professional Classes 8 2 1 4 1 Armed Forces 1 — — 1 1 Domestic Service — 1 — — — Food Trades — — 1 — — Students 1 — 2 1 — Shop Assistants 2 1 — 1 — Nurses 1 — — 1 — Non-manual trades other than food 1 4 5 1 3 Teachers — — 3 — 1 Unclassified 10 12 7 2 11 42 30 25 28 28 Our scheme for the B.C.G. vaccination of school children is actively continuing and is working extremely well. This work is undertaken by the School Health Service. 36 NOTIFICATION OF INFECTIOUS DISEASES, 1961 Disease Jan.— March April— June JulySept. Oct.— Dec. Totals Scarlet Fever 10 6 2 3 21 Pertussis 2 1 1 2 6 Measles 346 339 47 1 733 Pneumonia 15 7 — 1 23 Dysentery 43 31 9 5 88 Encephalitis 1 — — — 1 Food Poisoning 2 3 7 1 13 Erysipelas — 2 — — 2 Tuberculosis, pulmonary 4 5 5 9 23 non-pulmonary 1 2 2 — 5 Totals 424 396 73 22 915 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1.1.61 254 209 27 26 516 Cases notified for the first time in 1961 16 7 1 4 28 Cases Restored to Register 1 1 — — 2 Other Cases Added 17 9 — 1 27 Cases Removed from Register 41 31 6 6 84 Cases Remaining on Register at 31.12.61 247 195 22 25 489 TUBERCULOSIS, 1961 Age *New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1- 5 years — — — — — — — — 5-10 years 1 — — — — — — — 10-15 years — — — — — — — — 15-20 years 1 — — — — — — — 20-25 years 3 2 — — — — — — 25-35 years 7 4 1 2 — — — — 35-45 years 8 6 — 2 — — — — 45-55 years 5 1 — — — — — — 55-65 years 4 — — — 3 — — — Over 65 years 5 3 — 1 5 1 1 1 Unknown — 1 — — — — — — Total 34 17 1 5 8 1 1 1 * These figures include all cases previously notified and noted by the Tuberculosis Officer and others as having removed into the district. 37 APPENDIX 1 (a) Letters to Doctors Letters on the following subjects were circulated to Southgate practitioners in 1961, some under my signature as Medical Officer of Health, others either as Area Medical Officer or District School Medical Officer:— January 16th Poliomyelitis Vaccination January 20th Tetanus Vaccination March Laundry Service for Old People April 18th Chiropody Service April 18th Polio Vaccinations—4th injections May 12th Collection of Laboratory Specimens May 23rd Penicillin-free Poliomyelitis Vaccine August August holiday arrangements August 1st Collection of Laboratory specimens August 11th Poliomyelitis Vaccine Supplies October 25th Sabin Polio Vaccine November 2nd Sabin Vaccine and Salk Vaccine November Changes in Midwifery Staff November 24th Retired Persons Advice Clinics December 15th Collection of Laboratory Specimens December Christmas Holiday Arrangements and Marie Curie Memorial Foundation Scheme It has been our consistent practice to keep general practitioners in touch with recent developments in the field of preventive medicine, so that integration can be achieved. This policy is showing useful dividends. (b) Medical Examinations During 1961, 41 medical examinations were carried out in respect of the new entrants to the Council's service. 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, or from a hospital. 38