BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1963 J. R. CAMPBELL, ma, ch.B., d.p.h Medical Officer of Health 5046 48 BOROUGH OF SOUTHGATE ANNUAL REPORT of the Medical Officer of Health for the Year 1963 J. R. CAMPBELL, m.b., ch.b., d.p.h Medical Officer of Health TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SOUTHGATE Mr. Mayor, Ladies and Gentlemen I have the honour to present the Annual Report for the year 1963. A highly satisfactory feature of the vital statistics for 1963 is the sharp drop in infant mortality. The Birth Rate with 1,012 live births, was 15.63 per 1,000 of population. The Death Rate was 10.78, slightly lower than last year's figures of 11.6 and lower than that for the country as a whole—12.2. There were no maternal deaths during 1963. The Infantile Mortality rate, i.e. the number of infants who died during the first year of life per 1,000 live births fell from 14.8 to the record low figure of 8.89. Two trends referred to in last year's Report, a rising Birth Rate, and an increase in the illegitimate Birth Rate, are again evidenced this year as is shown in the following tables :— Year No. of Births Birth-rates Illegitimate Birthrate as a percentage of Total Live Births Southgate England and Wales 1959 851 13.0 16.5 3.76 1960 944 14.7 17.1 4.98 1961 937 14.4 17.4 5.98 1962 947 14.4 18.0 4.64 1963 1,012 15.63 18.2 6.63 2 The number of infectious diseases notified during 1963 was 1,560 as against 188 last year. This was accounted for largely by an increase in the number of cases of measles. Our last notification of diphtheria was in 1947—16 years ago. Notifications of whooping cough were 72. The pattern of health problems developing today drives home the importance of Health Education as a vital part of local authority Health Services. Two important factors in health education are:— (a) Impact on young people—and this must involve co-operation between parents, teachers and medical staff and (b) Timing. (a) There have recently been produced some excellent films on smoking and on sex education, and several of our Head Teachers have expressed a wish that we should show these films in the schools. As a preliminary to this, meetings have been arranged with parents and staff. This affords the parents particularly an opportunity of seeing the films and of discussing the appropriateness of their use in the schools concerned. Obviously if the parents have full knowledge of the instruction being given in school they will be in a much stronger position to add their influence to that of the teachers and the medical staff, and I hope that a greater measure of success may be achieved. (b) The advantage gained by timing in health education was illustrated when, during the recent Aberdeen typhoid epidemic every school in Southgate, secondary, junior and infants, was visited by a Medical Officer, Health Visitor or Public Health Inspector and a very brief but very downright talk given on the method of spread of typhoid fever, which is the same as that in dysentery and poliomyelitis. The importance of proper hand-washing after visiting the toilet and before eating and preparing food was driven home. In every case the children showed a lively interest and the school staff were not only welcoming but very appreciative. At the same time a display of posters, leaflets, etc., was staged in the Town Hall. 3 I need hardly emphasise the increasing amount of work falling upon the Public Health Inspectors particularly in the field of smoke control and housing. With our seriously depleted staff of Public Health Inspectors, it is greatly to their credit that no vital part of the work has suffered neglect and that the volume of work covered is so impressive. With the coming merger of the personal and environmental health services in the new Borough of Enfield, the close and friendly co-operation of the staffs of the Borough and the County Area is particularly fortunate. Especially is this so in relation to the care of the aged and in health education. To the great sorrow of his staff and, I am sure, of the Council, Dr. Harvey, after a year's sick leave, resigned his appointment in October. His interest, however, in the staff and in the work of the Council still continues. In April Dr. Harvey was created a Freeman of the Borough—a fitting reward for his great service to Southgate. On Dr. Harvey's retirement, Dr. Leonora Crawford was appointed as my Deputy. To her and to Mr. A. E. Gooday, my Chief Public Health Inspector my very special thanks are due, also to Miss Barratt and indeed to every member of the Public Health Department. In conclusion I would once again express my thanks to the Council particularly to the Chairman and Members of the Public Health Committee for their unfailing courtesy and support. I am, Mr. Mayor, Ladies and Gentlemen Your obedient Servant JANET R. CAMPBELL Medical Officer of Health Town Hall Palmers Green, N.13 4 PUBLIC HEALTH COMMITTEE From 1st January, 1963 to 13th May, 1963 Alderman Richard Prior (Chairman) Alderman H. S. Beardow (Vice-chairman) Councillor S. C. Jenner Councillor John Lindsay Councillor G. D. Payne Councillor A. V. Stapleton Councillor H. O. Thomas From 21st May, 1963 to 31st December, 1963 Alderman Richard Prior (Chairman) Alderman H. S. Beardow (Vice-Chairman) Councillor S. C. Jenner Councillor L. F. Lafitte Councillor G. D. Payne Councillor A. V. Stapleton Councillor H. O. Thomas PUBLIC HEALTH STAFF Medical Officer of Health: W. Clunie Harvey, M.D., Ch.B., D.P.H. (retired 19.10.63). Medical Officer of Health: Janet R. Campbell, M.B., Ch.B., D.P.H. (appointed 19.10.63). Deputy Medical Officer of Health: Leonora A. Crawford, M.B., B.S., D.P.H., D.C.H. (appointed 19.11.63). 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, F.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, Dip. Smoke Inspector, P.H.I. Education Board (resigned 28.2.63). Public Health Inspector: J. C. Noble, M.A.P.H.I., Cert. R.S.H., Cert. R.S.H. Meat Inspection. 5 Public Health Inspector: D. G. Ring, M.A.P.H.I., Cert. P.H.I., Dip. Meat and Food Inspection, Dip. Smoke Inspector, P.H.I. Education Board (appointed 24.6.63). Senior Typist : Miss E. W. Barratt Clerk: Miss G. R. Edwards. Junior Clerk : R. R. Hart (resigned 17.3.63). G. R. Manley (appointed 29.4.63). General Assistant : B. Latter (retired 8.1.63). J. L. Arnold (appointed 1.2.63). Rodent Operator: W. Dowsett. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,765 Registrar-General's Estimate of Resident Civilian Population, 1963 71,210 Number of Inhabited Houses and Flats 1st April, 1963 (excluding Shops assessed with private dwelling accommodation) 23,249 Effective Rateable Value on 1st April, 1963 £4,262,602 Sum represented by Id. rate (1963-64 Revised Estimate) £17,495 6 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Male Female Total Live Legitimate 500 445 945 Births Illegitimate 40 27 67 540 472 1,012 Birth Rate per 1,000 of the esti' mated population 15.63 Still Legitimate 5 6 11 Births Illegitimate — — — 5 6 11 Rate per 1,000 live and still births 10.75 Deaths from all causes and at all ages 965 Death Rate per 1,000 of the estimated population 10.98 Deaths from Puereral cuses — From Puerperal Sepsis — From Other Causes — Maternal Death Rate per 1,000 live and still births - Deaths of Infants under I year of age: Male Female Total Legitimate ...... ...... 7 2 9 Illegitimate ...... ...... — — — 7 2 9 Infant Death Rate: All infants per 1,000 births 8.89 Legitimate—per 1,000 legitimate live births 9.52 Illegitimate—per 1,000 illegitimate live births nil Deaths from Measles, all ages nil Deaths from Pertussis, all ages nil 7 BIRTH, DEATH and INFANT MORTALITY RATES Comparison of National and Local Rates Birth-rates Death-rate Infant Mortality Rate Live Still England & Wales 18.2 17.3 12.2 20.9 Southgate 15.63 10.75 10.98 8.89 POPULATION The Registrar-General's estimated population of the Borough at the middle of 1963 was 71,210, a decrease of 160 as compared with 1962. BIRTHS—BIRTH RATES The nett total births for the year accredited to the district were 1,012, an increase of sixty-five on the preceding year. Of these, 540 were males and 472 were females (40 males and 27 females being illegitimate). The birth rate for the year was 15.63 per 1,000 of the population. The birth rate of England and Wales was 18.2. During the year, the number of births recorded was 47 more than the number of deaths, as compared with 37 less in 1962. 8 MORTALITY General Mortality and Death Rate The net number of deaths accredited to the district was 965, 19 less than in 1962. This gives a crude death rate of 13.55 per 1,000 of the population and a corrected death rate of 10.75 (the rate for 1962 being 11.6). The Deaths and Death Rates for the past five years have been: Year Number of Deaths Death Rates Southgate England & Wales 1959 943 10.9 11.6 1960 929 11.0 11.5 1961 921 10.8 12.0 1962 1,084 11.6 11.9 1963 965 10.98 12.2 Deaths from bronchitis and cancer of lung and bronchus totalling 100 were very similar to those of last year which totalled 102. Deaths from diseases of the heart and circulation, however, show a welcome drop from 530 to 505. Infant Mortality Of the 9 infant deaths recorded for Southgate in 1963, 8 did not survive beyond one month. 7 died in the first week and of these 3 died on the day of birth. Still Births Eleven still-births, all legitimate, were accredited to the Borough in 1963. This is equal to a death rate of 10.75 live and still-births, the corresponding figures for 1962 being 9 still-births and a rate of 9.4. Maternal Mortality There were no maternal deaths in 1963. Mortality of Persons over the age of 65 Seven hundred and twenty-eight deaths, or 75.44,% of the total deaths during the year occurred in persons over the age of 65 years. Of these, 308 died between the ages of 80 and 90, while a further 32 females and 1 male were over 90 years, the oldest being 97. 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. 9 TABLE 1 Causes of Death during the year 1963 Causes of Death Male Female Total Rates per 1,000 of population All cases (civilians only) 456 509 965 13.55 1. Tuberculosis, Respiratory 2 — 2 0.03 2. Tuberculosis, Other — — — — 3. Syphilitic Disease 1 1 2 0.03 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infection — — — — 7. Acute Poliomyelitis — — — — 8. Measles — — — — 9. Other Infective and Parasitic Diseases 2 — 2 0.03 10. Malignant Neoplasm—stomach 15 18 33 0.46 11. Malignant Neoplasm, Lung, Bronchus 44 11 55 0.77 12. Malignant Neoplasm, Breast — 15 15 0.21 13. Malignant Neoplasm, Uterus — 4 4 0.06 14. Other malignant and lymphatic Neoplasms 42 38 80 1.12 15. Leukaemia, Aleukaemia 5 8 13 0.18 16. Diabetes 1 6 7 0.10 17. Vascular Lesions of Nervous System 48 78 126 1.77 18. Coronary Disease, Angina 127 94 221 3.10 19. Hypertension with Heart Disease 4 6 10 0.14 20. Other Heart Disease 27 65 92 1.29 21. Other Circulatory Disease 20 36 56 0.79 22. Influenza 1 2 3 0.04 23. Pneumonia 31 49 80 1.12 24. Bronchitis 25 20 45 0.53 25. Other Diseases of Respiratory System 4 1 5 0.07 26. Ulcers of Stomach and Duodenum 2 4 6 0.09 27. Gastritis, Enteritis and Diarrhoea 1 4 5 0.07 28. Nephritis and Nephrosis 2 1 3 0.04 29. Hyperplasia of Prostate 8 — 8 0.11 30. Pregnancy, Childbirth, Abortion - — — — 31. Congenital Malformation 5 4 9 0.13 32. Other Defined and Ill-Defined Diseases 25 28 53 0.74 33. Motor Vehicle Accidents 3 1 4 0.06 34. All Other Accidents 7 12 19 0.27 35. Suicide 3 2 5 0.07 36. Homicide 1 1 2 0,03 10 TABLE 11 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 1963 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 2 0.21 0.03 7 0.72 0.10 9 0.93 0.13 1-5 years 4 0.41 0.05 2 0.21 0.03 6 0.62 0.08 5-15 years 2 0.21 0.03 1 0.10 0.01 3 0.31 0.04 15-25 years — — — 6 0.62 0.08 6 0.62 0.08 25-45 years 11 1.19 0.15 10 1.01 0.14 21 2.20 0.29 45-65 years 68 7.05 0.96 124 12.85 1.74 192 19.90 2.70 65-75 years 95 9.84 1.34 106 10.97 1.43 201 20.81 2.82 Over 75 years . 327 33.89 4.59 200 20.72 2.82 527 54.61 7.41 Totals 509 52.80 7.15 456 47.20 6.40 965 100.00 13.55 11 TABLE III INFANTILE MORTALITY 1963 : Net 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 I — 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. Other Tuberculosis - - - - - - - - - - 10. Abdominal Tuberculosis - - - - - - - - - - 11. Meningitis (not Tuberculous) - - - - - - - - - - 12. Convulsions - - - - - - - - - - 13. Laryngitis - - - - - - - - - - 14. Bronchitis - - - - - - - - - - 15. Pneumonia - - - - - - - - - - 16. Diarrhoea - - - - - — — — — - 17. Enteritis - - - - - - - - - - 18. Gastritis - - - - - - — — — - 19. Syphilis - - - - - - - — - - 20. Rickets - - - - - - - — — - 21. Want of attention and Injury at Birth - - - - - - - - - - 22. Suffocation - - - - - — — - - - 23. Atelectasis 1 - - - 1 - - - - 1 24. Congenital Malformation 5 - - - 5 - 1 - — 6 25. Premature Birth 2 - - - 2 — - - - 2 26. Atrophy, Debility and Marasmus - - - - - - - - - - 27. Other Causes - - - - - - - - - - Total 8 - - - 8 - 1 - - 9 12 TABLE IV Vital statistics of whole district during 1963 and eight preceding years Year Population estimated at Middle of each Year Net Births belonging to the District Net 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 1955 71,870 776 10.30 809 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 13.10 921 12.90 15 16.00 1962 71,370 947 13.30 984 13.80 14 14.80 1963 71,210 1,012 14.21 (crude) 965 13.55 (crude) 9 8.89 15.63 (corrected) 10.98 (corrected) 13 GENERAL PROVISION OF HEALTH SERVICES Care of the Aged The increasing number of elderly people in the community entails a constant increase in the scope and size of the problems relating to the aged. Much of the time and thought of the Medical Officer of Health is spent dealing with such problems, and in this field there is particularly close contact between the Health Visitors, Home Nurses, Home Help Supervisors and Public Health Inspectors. The members of the Old People's Welfare Committee continue to give generously of their time and effort in this service. The Retired Persons Advice Clinic, which was initiated last year, continues to serve a useful function. It is held at Ruth Winston House on alternate Friday afternoons and is staffed by one of the County Assistant Medical Officers, together with a member of the nursing staff. The multitude of social problems which adversely affect the health of the elderly make such an informal consultative clinic a valuable asset in preventive medicine. Laundry Service for Sick Aged Persons In February, 1963, in conjunction with the Wood Green Borough Council, and the Friern Barnet Urban District Council, the Council agreed to participate in a joint scheme for providing a service for the laundering of bedclothes belonging to aged and incontinent persons. The service commenced in May. The whole of the work is done at the laundry attached to the Wood Green Borough Council's Swimming Bath in Western Road. N.22. I am pleased to report that the arrangements made have worked admirably, that the service provided has been a success, and, furthermore, that I am satisfied it has supplied the solution to a very difficult problem. Chiropody Service In the Chiropody Service also there is some progress to be reported. We have obtained the additional services of a part-time chiropodist on the Area staff and are now able to hold three sessions of chiropody per week at de Bohun Clinic, N.14. Additional time has also been made available for home treatment. Hospitals The General Hospital services available to the people of Southgate continue as in previous years. The appointment last year of a Geriatrician has certainly eased some of the difficulties in the 14 hospital admission of elderly patients. The outstanding shortage is in maternity bed accommodation and this whole question is at present under review. Laboratory facilities I would again record my appreciation and thanks to the staff of the Public Health Laboratory Service, 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 1963 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 — 110 Sputa for tubercle bacilli — 16 Throat and Nose 238 Faeces 1,751 Urine 155 Blood 126 Others 90 Mortuary The mortuary arrangements remain as set out fully in the Annual Report for 1946, with the addition mentioned in the 1960 Annual Report that we now have a firm agreement with Prince of Wales' Hospital to accept Southgate bodies. In 1963, 144 bodies were sent to the mortuary at the Prince of Wales' Hospital. Scabies and Lice Our procedure in regard to the treatment of scabies and infestation by lice remains as in previous years. In cases requiring treatment at a Cleansing Station, it is our practice to arrange with the Medical Officer of Health of Edmonton for treatment to be carried out at the Edmonton Cleansing Station. During 1963, seven persons were treated for Scabies at the Edmonton Cleansing Station. 15 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 1963 under this Section. SANITARY SERVICES Summary of Visits Visits re housing defects (Public Health Act, 1936) 1,791 Visits re housing defects (Housing Act 1957-61) 119 Visits re drainage and building works 30 Visits re dustbins (Public Health Act, 1936) 7 Visits re housing conditions and overcrowding (applications for housing accommodation) 83 Visits re Rent Act, 1957 28 Visits re food premises (including butchers, bake' houses, confectioners, restaurants, grocers and fish-shops) 626 Visits re ice cream sampling 30 Visits re factories 170 Visits re Shops Act, 1950 167 Visits re infectious diseases 1,347 Visits re Glean Air Act 2,829 Visits re Prevention of Damage by Pests Act, 1949 224 Visits re other matters 3,929 11,380 Service of Notices Informal Notices served re Housing Repairs 358 re Dustbins 3 re Food Pnemises 33 re Shops and Factories 30 Total Informal Notices served 424 Total Informal Notices complied with 421 Total Statutory Notices served 57 Total Statutory Notices complied with 57 16 Repairs to Houses During the year under review, repairs have been carried out at 392 houses as a result of the efforts of the Public Health Inspectors. The repairs varied from those of a major character to 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. In only 57 instances was it found necessary to follow-up informal action by the service of Statutory Notices. In no instance did it become necessary for the Council to institute legal proceedings to secure compliance with Statutory Notices requiring the execution of repairs. Unfit Houses During 1963, further progress was made in the implementation of the Council's programme for dealing with unfit houses. 9-19 (odd) Springfield Road, N.ll 1-23 (consec.) Upper Park Road, N.ll 74-84 (even) High Road, N.ll 15-41 (odd) Lower Park Road, N.ll Following upon representations made to the Council by Dr. Harvey in 1962 under the Housing Act, 1957, in respect of the unfitness for habitation of the above-mentioned houses, the Council declared the two areas to be Clearance Areas under Part III of the Act. The majority of the houses were acquired by the Council by agreement with the owners. In order to effect clearance of all the houses in the two Clearance Areas, the Council resolved to acquire the remaining few by way of a Compulsory Purchase Order. Objections were made to the Ministry of Housing 6? Local Government by owners in respect of the Compulsory Purchase Order and, in October, 1963, a local public inquiry was held by the Ministry. At the close of the year, the decision of the Minister concerning the Compulsory Purchase Order was still awaited. Rent Act, 1957 The following is a summary of the action taken by the Council during 1963 under the Rent Act, 1957:— Part I—Applications for Certificates of Disrepair (1) Number of applications for certificates 4 (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 4 17 (4) Number of Undertakings given by landlords under paragraph 5 of the First Schedule 4 (5) Number of Certificates issued nil Part II—Applications for Cancellation of Certificates (6) Applications by landlords to Local Authority for cancellation of certificates 5 (7) Objections by tenants to cancellation of Certificates 3 (8) Decisions by Local Authority to cancel in spite of tenants' objections nil (9) 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 1963. The number of visits for this purpose was 83 as against 82 in 1962. The close liaison between the Public Health Department and the Housing Department has been maintained in 1963, as in previous years. From time to time I have been asked by the Town Clerk to advise as to the degree of urgency on medical grounds with reference to particular applications. Food Hygiene As in previous years, considerable attention has been given by the Public Health Inspectors to the storage, distribution and sale of food at the various food premises in the Borough. For this purpose, the Inspectors made 626 visits to food premises during 1963. Generally speaking. the standard of food hygiene maintained by the food traders is good. Arising out of these visits, however, it was found necessary in 33 instances to require the occupiers of food premises to remedy matters which were in contravention of the Food Hygiene Regulations. In all cases, I am pleased to be able to report the matters were attended to 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 offence: Sale of loaf containing a surgical Firm fined £15 plus dressing £3 3s. Od. costs 18 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 comparatively 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 3 stone Carcase meat 581 lbs Offal 104 lbs Ham (canned) 188 lbs Ham (cooked) 5 lbs Canned Meats (various) 184 lbs Canned Foods (various) 176 cans Poultry 710 lbs Vegetables 60 lbs Frozen Foods—Vegetables 564 lbs Meat 212 lbs Fish 343 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 35 Butchers 53 Grocery and Provisions 114 Fruit and Greengrocery 61 Wet Fish 14 Fried Fish 7 Restaurants and cafes (including school canteens, works canteens, clubs, etc.) 118 Confectionery and sweets 86 488 In the Borough there are 333 premises registered under Section 16 of the Food and Drugs Act 1955, 238 in respect of ice-cream and 95 in respect of preserved foods. 19 Under the provisions of the Middlesex County Council Act 1950, relating to hawkers of food and their premises, there were 99 hawkers on the register at the end of 1963. Of these, 25 have storage premises in the Borough and 74 have their storage premises in other areas. Post-Mortem Inspection of Animals No slaughtering of animals took place in the Borough during 1963. Ice-cream Sampling During the year under review, 30 samples of ice-cream were obtained and submitted to the Public Health Laboratory for bacteriological examination. The results were:— Grade 1 27 „ 2 1 „ 3 2 „ 4 - 30 For the most part these results are eminently satisfactory. The sample which gave the Grade 2 result was taken from a confectioner's shop. Of the two samples giving Grade 3 results, one was taken at a cafe and the other from an itinerant vendor. In each case the matter was taken up with the firm concerned and the method of distribution checked. Subsequent samples proved satisfactory. Establishments for Massage or Special Treatment Under the Middlesex County Council Act, 1944, one new licence was granted and 15 licences were renewed in respect of establishments for massage, chiropody or similar treatment. Pet Animals Act, 1951 Five licences were granted by the Council during 1963 under the above-mentioned Act in respect of pet animal shops in the Borough. 20 Swimming Bath The figures for attendances at the Barrowell Green Open Air Swimming Bath for the past two years were:— 1963 1962 Adults (Mixed and Spectators) 11,816 7,235 Children (Mixed and Spectators) 19,809 23,679 From Schools 3,056 2,774 Season Tickets 3,938 5,834 Costumes, etc., hired — 24 38,619 39,546 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 1963 were uniformly satisfactory. A notice continues to be posted at the Bath informing the public of the result of these samples. Prevention of Damage by Pests Act, 1949 During 1963, 458 complaints of rats and mice were received and dealt with, as against 362 in 1962. In late May and early June, a baiting and poisoning treatment was carried out by the Borough Engineer's Department in the Council's soil sewers. 531 manholes were baited. The poison bait used for this treatment was pinhead oatmeal plus warfarin. In 15 of the manholes baited, complete or part takes of bait were noted. In November, 1963, a further baiting and poisoning treatment was carried out in the Council's soil sewers. On this occasion, 531 manholes were baited with pinhead oatmeal plus warfarin. In 21 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 & Food. Public Conveniences Sixteen 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 High Road, New Southgate, N.l 1 21 Fords Grove, Winchmore Hill "Cherry Tree" Hotel, The Green, 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. It was not considered necessary to carry out any bacteriological or chemical examinations 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—this in spite of the severe inclement weather which prevailed in the early part of the year. The quantity of refuse from all sources dealt with at the Refuse Disposal Works amounted to 22,773 tons, an increase of 1,104 tons over the previous year. During the past ten years there has been a noticeable change in the character of refuse, the main results being a considerable increase in the volume of refuse in relation to weight. A number of factors have brought this about- -more pre-packaging of foods and other consumer goods, increased application of gas, electric and oil heating, and restriction on the burning of refuse imposed by Smoke Control Orders. The increased volume or bulkiness of refuse has influenced the Council in its choice of collection vehicles. Three replacement vehicles purchased during the year were of considerably greater effective capacity from the types hitherto purchased. This is achieved by incorporating a compression device in the design of the vehicle. 22 The number of special collections of garden refuse, furniture, etc. carried out during the year was 1,901. The sale of salvage recovered from refuse realised an income of £15,539. Tonnages of the various materials were as follows:— tons Waste Paper 1,371 Scrap Metals 625 Rags 22 Bottles 3 Carpet 20 Gullet 83 Miscellaneous items 12 Street Cleansing The normal frequency of sweeping the streets in the Borough was as follows:— miles At least once daily 6 Three times weekly 12 Twice weekly 60 Once weekly 6 Many hundreds of loads of leaves were supplied to allotment holders during the autumn. Control of weed growths on pavements, etc., throughout the Borough was effected by the application of chemical weed killer. 10,484 gully cleansings were carried out during the year. Fumes and Noise During 1963, 10 complaints were received from residents concerning alleged nuisances from fumes arising in three instances from industrial premises and in seven instances at domestic premises. Each complaint was investigated by the Public Health Inspectors. In the case of the industrial premises, observations were made and steps taken to obtain the Co-operation of the firms concerned, with the result that the nuisances were abated. In the case of the domestic premises, the causes of the fumes complained of were investigated and the residents advised upon remedial action. Ten complaints were received from residents concerning alleged nuisances from noise. These included such varied noises as the crowing of cockerels, noise from shop-fitting work at night, a noisy refrigerator, and industrial noise. Informal action taken by the Inspectors resulted in the noises ceasing or being reduced in extent. 23 Towards the close of the year, the Public Health Committee had under consideration complaints from residents living in the vicinity of an industrial site in Chelmsford Road, N.14, concerning alleged noise nuisance. Air Pollution During the year under review, no contraventions of the Dark Smoke (Permitted Periods) Regulations were observed in any of the industrial premises in the neighbourhood. With regard to pollution from domestic premises, further progress was made in the implementation of the Council's programme in respect of Smoke Control Orders. The Council's No. 3 Smoke Control Order came into operation on 1st October. In this connection, much time and considerable effort were entailed during the greater part of the year in dealing with numerous applications from residents for financial grants under the Clean Air Act, 1956, towards the conversion or adaptation of their fireplaces to enable them to avoid contravening the Order by emitting smoke from the chimneys of their premises. All applications had individually to be examined, advice given to applicants on their choice of fuel appliance, information as to the amount of grant to which they were entitled, and in each case the conversions and adaptations inspected to ensure that they were carried out to the satisfaction of the Council. Despite reminders to residents that, in order to obtain a grant a firm order for works to be carried out had to be given by 30th September, many left their applications to the last few days. The effect of this was to place an extremely heavy burden on the staff coping with these late applications and at the same time causing inconvenience to the applicants themselves. Due to strenuous efforts on the part of the staff generally and in particular of Mr. R. L. Burkill, Deputy Chief Public Health Inspector, all applications were ultimately dealt with. A further step in the implementation of the Council's programme was the preliminary work done in the early part of the year in respect of the Council's No. 4 Smoke Control Order. This culminated in July in the submission of the requisite information by the Council to the Ministry of Housing Local Government for confirmation of the Order. The Minister's confirmation, without modification, was received on the 19th November. Between this date and the end of the year, many residents took advantage of the relatively mild winter and following submission of and approval to their applications for grant aid, put in hand the work of converting or adapting their fireplaces to enable them to conform to the Order. The date of operation of the Order is fixed at 1st October, 1964. 24 FACTORIES ACT, 1961 Details of work carried out during the year 1963 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 35 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 174 135 - - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 207 170 — — 25 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) 1 1 — 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate Ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) insufficient - - - - - (b) Unsuitable or defective 5 5 — — - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 6 6 — 1 — OUTWORK—(Sections 133 and 134) Nature of Work Section 133 Section 134 Number of Outworkers in August list required bv Section 13 3(1)(c) Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions Wearing Apparel 58 — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 2 - — — — — Carding etc. of buttons 21 — — — — — Cosaques, Christmas crackers, stockings, etc. 2 — — — — — Painting of toys, etc. 3 — — — — — Fancy goods 2 — — — — — Making of paper bags 1 — — — — — Making of artificial flowers 1 — — — — — Furrier 1 — — — — — Handbags 1 — — — — — Jewel and Instrument-case maker 1 — — — — — Total 93 — — — — — 26 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES From the table of infectious diseases set out on page 31, it will be seen that 1,560 cases of infectious disease were notified during the year against 188 in 1962. The Infectious Sickness Rate for the year was therefore 20.18 as compared with 2.62 during the previous year. The following table sets out the infectious diseases notified during 1963, as compared with the notifications received during 1962:— 1963 1962 Scarlet fever 20 14 Pertussis 72 11 Poliomyelitis (non-paralytic) — 1 Measles 1,164 98 Pneumonia 24 3 Dysentery 244 17 Food Poisoning 11 27 Puerperal Pyrexia 1 1 Erysipelas 6 — Typhoid 2 — Tuberculosis 16 16 1,560 188 From the table set out above, the following facts emerge 1. Scarlet fever notifications totalled 20, a rise of 6 on the 1962 figures. 2. There were again no cases of diphtheria notified. 3. Measles notifications rose from 98 to 1,164. 4. Pertussis notifications were 72, a rise of 61. 5. The incidence of Dysentery rose to 244. This was accounted for by two outbreaks which occurred during the early part of the year. Such outbreaks involve the department in a considerable amount of extra work involving many home and school visits. Thanks to the efforts of the Public Health Inspectors, within a few months the infection was brought under control. 6. No cases of poliomyelitis were notified in 1963. 27 7. Sixteen cases of Tuberculosis were notified in 1963, the same number as in 1962. The distribution erf these cases among the various wards was as follows:— North-east North-west Middle South 3 4 6 3 A broad classification of the cases of tuberculosis notified during the past five years in relation to employment was:— 1959 1960 1961 1962 1963 Clerical 3 3 7 5 1 Housewives 3 4 3 3 3 Children — 5 — — 2 Manual labour — 1 — 2 1 Factory Workers — 4 1 — — Professional Classes 1 4 1 1 1 Armed Forces — 1 1 — — Domestic Service - - - - - Food Trades 1 — — — — Students 2 1 — — — Shop Assistants — 1 — — 1 Nurses — 1 — — — Non-manual trades other than food 5 1 3 - - Teachers 3 — 1 — — Unclassified 7 2 11 5 7 25 28 28 16 16 IMMUNISATION AND VACCINATION IN THE CONTROL OF INFECTIOUS DISEASE I wish to mention a recent service made available in Southgate whereby Tetanus Immunisation has been offered to the Outdoor Staff employed by the Council. (Although this strictly belongs to the 1964 Report, I make no apology for introducing it here.) Absence of immunity to tetanus carries with it two hazards. The first, death from tetanus, may occur when the infection is not even suspected, e.g. from the prick of a rose thorn. The much commoner hazard, however, is severe reaction and shock from the giving of Anti-Tetanus Serum, particularly if this is repeated. 28 Certain employments more than others carry with them the risk of tetanus wound infection and any injury under these conditions will demand the giving of anti-tetanus serum. The only means of avoiding both the danger of contracting tetanus and the danger of serum reaction is by tetanus immunisation. In those so protected injury calls for simply a small boost dose of toxoid and there is no need for administration of serum. Tetanus Immunisation was first made available through local Health Authorities in 1960, and since then has been offered each year to all our infants, pre-school and school children. Accordingly by now most young people up to the age of 18 have had the opportunity of this protection and have widely availed themselves of it. This, however, leaves almost the entire adult population unprotected, including certain groups particularly at risk. Such groups employed by local authorities include parks, building, roads, sewer and refuse collection and disposal staff. An effort has been made in Southgate this year to put matters right in this respect, and all such staff have been offered tetanus immunisation. There has been a very good initial response and it is hoped that it may be possible to continue this measure as a local authority service. The changing pattern of infectious disease over the last few years leaves no room for doubt as to the efficiency of immunisation as a means of control. It is interesting to consider the age groups of our present population who are so protected from various infectious diseases. Smallpox. The population at all ages have had the opportunity of smallpox vaccination. The response of the adult population is directly related to any occurrence of smallpox in the vicinity. As regards the child population, however, fortunately the response is consistent and high. Every month, each Health Visitor records the vaccination state of all children currently reaching the age of 2. In the majority of cases, a vaccination record card is available and if not, a home visit is paid, so that records are accurate. In Southgate the percentage of children at 2 years old who have been successfully vaccinated has risen from 68% in 1955, when this method.' of followup was commenced, to 88.9% for 1963. Diphtheria. A very high percentage of the population from infancy to adults aged 38 to 40 years have received diphtheria immunisation. Diphtheria immunisation was carried out to some extent in the late 1930's but it was in 1940 that a campaign was launched in Middlesex offering immunisation to all children up to school-leaving age. There was an immediate massive response with soon afterwards a spectacular drop in the cases of diphtheria. 29 The response over the years has continued at a high level and the primary protection is continued with "boost" injections to maintain continuing immunity. It follows that our present population adults up to the age of 38 or 40 come within the range of the protected group. In Southgate during 1963, 94.9% of children reaching the age of 2 years had been immunised. This compares with a percentage of 83% in 1955. The system of follow-up used is the same as that in smallpox vaccination. Whooping Cough. Our main concern in this disease is to protect the very young children in whom the condition can still be fatal. Immunisation therefore commences at two to three months. Protection is thus given over the first few years of life, but since in older children the disease tends to be mild, the regular immunisation of older groups is not considered necessary. Poliomyelitis. Polio vaccine was introduced in 1956 and led to a wide initial public response, which later fluctuated. Probably 80 per cent or more of young people up to the age of 24 years have been vaccinated against poliomyelitis. Older people up to the age of 50 years and over have also had the opportunity of this protection, although the percentage in this group will be considerably lower. B.C.G. Vaccination against Tuberculosis. In 1957, B.C.G. vaccination was first offered to all schoolchildren aged 13 years, i.e., prior to leaving school. This offer is made annually to all schools, both maintained and private schools. Thus, young people between the ages of 13 and 22 years have all had the opportunity of receiving B.C.G. vaccination in school, and in Southgate between 75 and 80 per cent have taken advantage of it. The consent rate for 1963 in Southgate was 81.35 per cent. Typhoid. A comparatively small percentage of the population are protected against Typhoid Fever. A growing number of our schoolchildren, however, are so protected prior to foreign travel, and it may be that the general public will profit by their example and also seek this safeguard before travelling abroad. 30 NOTIFICATION OF INFECTIOUS DISEASES, 1963 Disease Jan.— March April— June July— Sept. Oct.— Dec. Totals Scarlet Fever 7 5 2 6 20 Pertussis 5 11 40 16 72 Poliomyelitis, paralytic — — — —. — Poliomyelitis, non-paralytic — — — —. — Measles 608 529 25 2 1,164 Pneumonia 10 11 1 2 24 Dysentery 142 60 12 30 244 Food Poisoning 2 6 1 2 11 Puerperal Pyrexia — — 1 — 1 Erysipelas 2 2 1 1 6 Typhoid 2 — — — 2 Tuberculosis, pulmonary 4 7 2 2 15 non-pulmonary — 1 — — 1 Totals 782 632 85 61 1,560 REGISTER OF TUBERCULOSIS CASES Pulmonary NonPulmonary Totals M. F. M. F. Cases on Register at 1.1.63 235 192 22 25 474 Cases notified for the first time in 1963 10 5 - 1 16 Cases Restored to Register 1 2 — — 3 Other Cases Added 6 5 1 1 13 Cases Removed from Register 27 29 — 1 57 Cases Remaining on Register at 31.12.63 225 175 23 26 449 TUBERCULOSIS, 1963 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 2 - - - - - - 10-15 years - - - - - - - - 15-20 years — 1 - - - - - - 20-25 years — 1 - - - - - - 25-35 years 3 4 1 1 — — — — 3 5-45 years 2 1 - - - - - - 45-55 years 3 2 — — 1 2 — — 55-65 years 4 — — — 1 — — — Over 65 years 4 1 — 1 1 1 - — Unknown - - - - - - - - Total 17 12 1 2 3 3 — — • These figures include all cases previously notified and noted by the Tuberculosis Officer and others as having removed into the district. 31 APPENDIX I (a) Letters to Doctors Letters on the following subjects were circulated to Southgate practitioners in 1963, some under signature of Medical Officer of Health others either as Area Medical Officer or District School Medical Officer :— 28th February Smallpox Vaccination and Tetanus Immunisation 29th March Dysentery Notifications 29th March Collection of Laboratory Specimens 28th May Collection of Laboratory Specimens 16th July Collection of Laboratory Specimens 11th October Vaccination and Immunisation— Publicity Campaign 13th December Collection of Laboratory Specimens 30th December Incidence of Congenital Malformation (b) Medical Examinations During 1963, 68 medical examinations were carried out in respect of the new entrants to the Council's service. In addition to these medical examinations, a considerable number of medical reports were obtained from family doctors and hospital consultants concerning employees absent from duty through sickness for more than a short period. In this connection, it is a pleasure to acknowledge the courtesy and Co-operation which I have invariably received from the General Practitioners in Southgate. 32