EBAR 2 SIXTY-FOURTH ANNUAL REPORT of the HEALTH AND SANITARY CONDITION of the East Barnet Urban Sanitary District 1937 SIXTY-FOURTH ANNUAL REPORT of the HEALTH AND SANITARY CONDITION of the East Barnet Urban Sanitary District for the YEAR 1937 by ǼE. ROSE, M.A., M.B., Ch.B., Medical Officer of Health to the Council and Assistant School Medical Officer, together with THE ANNUAL REPORT of E. HOUGHTON, A.R.San.l., &c., Chief Sanitary Inspector. 2 East Barnet turban district Council. LIST OF MEMBERS. MARCH, 1937 TO DECEMBER, 1937. Chairman: Mr. Councillor A. J. Monro, J.P. Vice-Chairman : Mr. Councillor F. G. Bennett. Members : Mr. Councillor A. Beauchamp Vialou, C.C. „ ,, F. L. Snow. „ „ H. A. Judge, J.P. ,, ,, S. E. Frusher. „ „ L. J. Pearson. ,, ,, R. K. Allen. ,, ,, W. H. R. Blankley. „ „ G. I. C. Marchand, M.A. „ ,, E. Aberdeen. „ „A. J. Brickwell, C.B.E. „ „ E. J. Hogan. „ ,, E. A. Nash. „ ,, A. E. Tizzard. 3 East Barnet Urban District Council, ANNUAL REPORT of the Medical Officer of Health for the year 1937. To the Chairman and Members of the East Barnet Urban District Council. Gentlemen, I have the honour to present to you my Report for the year 1937. The subjects dealt with in the Report fall under the following main headings:— Statistics and Social Conditions of the Area. General provision of Health Services in the Area. Sanitary Circumstances, including Water Supply, Drainage, Sewerage, etc. Prevalence of, and Control over, Infectious Diseases. Housing. Inspection and Supervision of Food. 4 These subjects are reviewed in the order in which they are mentioned, particular attention being given to those which have chiefly concerned the Sanitary Inspector and myself during the past year, and to those which from one year to another continue to occupy the attention of every sanitary officer. Milk Supply. At the Milk Board Inquiry held at the Middlesex Guildhall on the 15th December, 1936, it was stated by a representative of the tuberculin tested milk producers that one cow in every three in this country reacted to a tuberculin test. This statement has a direct bearing on the admitted fact that 2,000 children die annually in this country from tuberculous infection of bovine origin, and points to the urgent necessity in all cases of boiling the milk or pasteurising it before consumption. Boiling the milk reduces the risk of tuberculosis and other milk borne infections to the vanishing point. Tuberculosis, Enteric Fever, Scarlet Fever and Diphtheria are all infectious diseases which are readily conveyed by milk. Yet all these infections are largely preventable by taking the above simple precautions, apart from those affecting the individual consumer such as Prophylactic Immunisation. Numerous samples of the milk retailed for sale in the district during the year have been taken and sent for bacteriological examination to the laboratory at Hill End Hospital. Details are given in the Chief Sanitary Inspector's report. It should be pointed out that milk being a specially suitable medium for the growth of pathogenic organisms is very liable to occasional contamination. It is not, however, necessary to take any drastic action in the case of an isolated sample being discovered to be slightly below the prescribed standard ; such cases are always immediately dealt with by a visit and warning from the Chief Sanitary Inspector. Only in the event of a number of samples showing that the conditions are not habitually observed would it be necessary to take extreme measures, and this of course we have power to do in accordance with the Ministry's memorandum to the Milk (Special Designations) Order, 5 Water Supply. In view of the serious outbreak of Enteric Fever at Croydon, which proved to be a water borne infection, special attention has been given to this subject and frequent conferences have taken place between Mr. Haseldine the Engineer of the Barnet Water Company, the Chief Sanitary Inspector, the Surveyor, Mr. Barnes, and myself. Visits have been paid to several of the wells and pumping stations and in particular to the well at North Mymms near which is a "swallow hole" which provides a possible source of contamination. Here there is a well equipped laboratory with a fully qualified chemist in charge and Mr. Haseldine has kindly afforded myself and other Medical Officers of Health in the County every facility for making a thorough examination of the methods of purification in daily use throughout the year, viz. sedimentation, filtration and chlorination. Daily samples are examined by the Water Company's Chemist at the laboratory and daily samples are also taken from the main on the way to Barnet. Independent analyses are made monthly by Dr. Beale and Dr. Suckling of the Counties Public Health Laboratories and an additional sample of the water is taken by us each month and submitted to the Clinical Research Association for bacteriological examination. Reports on these various analyses prove that the water supplied to this district is of a very high standard of purity. Housing and Overcrowding. The benefits of the 1936 Housing Act will be very apparent to any one who cares to pay a visit to the new houses in St. Wilfrid's Road. No one who was familiar with the appalling conditions under which these people were previously living could fail to be satisfied with their new environment or to approve most warmly of the wise and far-reaching provisions laid down in the Act. With regard to the Act of 1936, I attended, along with the Chief Sanitary Inspector, the annual conference of the Hertfordshire Medical Officers of Health held at St. Albans in November, and with him opened the discussion on overcrowding, pointing out several apparent anomalies affecting what is known as the "permitted number" of occupants of houses. These apparent anomalies are due to the fact that two different standards are laid down, one for houses already occupied, and another, totally 6 different, for houses specially erected to accommodate the displaced families. The object in laying down the different standard for new houses is, of course, to provide for the natural increase of the family. Owing to the extensive development which has taken place in the urban district considerable difficulty has been experienced by the Council in obtaining land which would be suitable for the erection of houses for the abatement of overcrowding. After considerable negotiations the Council has been successful in acquiring a site three acres in extent situated at the junction of Church Hill Road and Avondale Avenue, and it is anticipated that it will be possible to rehouse all overcrowded families in the near future. Epidemic Disease. It is very important that in all epidemics the district sanitary authority should be in a position to deal with them at the outset. Without compulsory notification this is not always possible, and in the case of Measles widespread infection may occur before effective measures can be taken to stop or limit the spread of the disease. I have had several conferences on the subject with the Senior Medical Officers of the Ministry and I am glad to say that this year they have permitted us to impose compulsory notifications in cases under 5 years of age. A serious and widespread epidemic of this disease appeared at the end of the year and I again found it necessary to go to the Ministry to press for compulsory notification at all ages. It had previously been pointed out that in children over 5 years of age the necessary notification could be made through the schools but as this particular epidemic was raging during the school holidays no notifications from this source could be made. I am glad to say that this aspect of the case received very sympathetic consideration from the Ministry and I hope that next year Measles will be made compulsorily notifiable at all ages. In this connection it is hoped to obtain the co-operation of the District Nursing Association and that the services of a nurse will be available in any future epidemic, her whole time being placed at our disposal for the whole duration of the epidemic. I have the honour to be, Gentlemen, Your obedient Servant. Ǽ. ROSE. 7 Statistics and Social Conditions of the Area. Following the suggestion in the Ministry of Health's Memorandum of 4th October, 1937, I omit in this report the detailed description of the area under Section A and give instead a brief record of alterations, improvements or developments which have taken place during the year. It is gratifying to record that the Council's policy of obtaining as large an area of open space as possible for the use of the public has continued with success during the year. The public now have access to 415 acres, comprising Hadley Woods (186 acres), Hadley Green (26 acres), Highlands Gardens (2½ acres), Cromer Road Recreation Ground (5 acres), Victoria Recreation Ground (14 acres), Oak Hill Park (77 acres), Belmont Open Space (2 acres), Open Spaces at the side of Pymmes Brook (32 acres) New Southgate Recreation Ground (14 acres), and Hadley Open Space (57 acres). In addition to the above the Council has, during the year, acquired the Tudor Sports Ground (23½ acres). Area and Population. The area of the district is 2,644 acres. Registrar-General's estimate of resident population, 1937, 31,340. Number of inhabited houses (end of 1937) according to rate books, 9,538. Rateable Value (at 31st December, 1937) £330,957. Estimated product of a penny rate for 1937, £1,220. Vital Statistics. Total. M. F. Live Births. Legitimate 470 257 213 Illegitimate 10 2 8 Birth Rate per 1,000 of the estimated resident population (For 1936 the rate was 15.66) —15.34 8 Total. M. F.[/$$$] Stillbirths 13 7 6 Rate per 1,000 Total (live and still births) births—26.3. (For 1936 the rate was 28.5) Total. M. p. Deaths 292 141 151 Death Rate per 1,000 of the Estimated Resident population— - 9.4 (adjusted). Deaths from puerperal causes Rate per 1000 total (live and stillbirths) Deaths. Puerperal sepsis 0 0 Other puerperal causes 1 2.02 Total 1 2.02 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 45.8 Legitimate Infants per 1,000 Legitimate live births 46.8 Illegitimate Infants, per 1,000 Illegitimate live births Nil Deaths from Cancer (all ages) 43 ,, Measles (all ages) 2 ,, Whooping Cough (all ages) 1 ,, Diarrhoea (under 2 years of age) 0 Birth Rate. There were 480 births (10 illegitimate) during the year. The birth rate is a little lower, 15.34 per 1,000 of the estimated resident population, as compared with 15.66, last year. The birth rate for England and Wales in 1937 was 14.9. Death Rate. There were 292 deaths. The crude death rate is higher (9.31) than last year's figure (7.6) and is not influenced to any material extent by the comparability factor which makes it 9.4. This justifies the claim that 9 East Barnet is really a very healthy district, although it must be remembered that a large proportion of the increased population consists of healthy lives, i.e. young married couples coming into the district to settle down. The Death Rate for England and Wales for the year is 12.4. There were 43 deaths from Cancer as compared with 27 in 1936. In the cardio-vascular group, including cerebral haemorrhage and arterio sclerosis there were 109 deaths. Last year there were 88. In the respiratory group, excluding pulmonary tuberculosis, there were 27 deaths compared with 17 deaths last year. There were six deaths from Influenza, an epidemic of which began to develop towards the beginning of the year. There were 16 deaths from abdominal disease. There were three deaths after operation for perforated gastric and duodenal ulcers. There was one death from puerperal causes, two from measles, one from whooping cough and no deaths from diphtheria or infantile diarrhoea. Infantile Death Rate. There were 22 deaths of children under one year, a death rate per 1,000 live births of 45.8. The Infantile Death Rate for England and Wales for the year is 58. GENERAL PROVISION OF HEALTH SERVICES. The Public Health Staff consists of a Medical Officer of Health (part time) who is also Assistant School Medical Officer; a Chief Sanitary Inspector (full time) who is also Housing Inspector; an Additional Sanitary Inspector, Mr. S. C. Smith, who commenced duty on the 1st April; one Clerk, Miss N. O'Callaghan; and two temporary assistants Messrs. L. Batty and R. Sharp for the purposes of the overcrowding survey and whose 10 appointments terminated at the end of March, the work upon which they were engaged having been completed. There are no Health Visitors or special nurses employed by the Authority. Ambulance Facilities. An Ambulance for accidents and non-infectious cases is provided and during the year a new Austin ambulance was put into commission to replace the existing one. An Ambulance for infectious cases is provided by the Isolation Hospital Committee for the combined districts of Barnet Urban, Barnet Rural and East Barnet Urban. Hospitals. Fever hospital accommodation is provided by the Joint Hospital Authorities at the Isolation Hospital, Mays Lane, Barnet, and beds are available for smallpox cases in the hospital at Cheshunt. A considerable increase in the accommodation at the Barnet Isolation Hospital is urgently required owing to the rapid increase in the population. There is an Infant Welfare Centre at 12, St. Wilfrid's Road, New Barnet, under the management of the District Nursing Association with five resident nurses supplied by the local Nursing Association. There is a school Dental Clinic at St. Wilfrid's Road in association with the Infant Welfare Centre. LEGISLATION IN FORCE. Adoptive Acts. There are no local Acts. The following are the Adoptive ' Acts in force in the District:— Public Health Acts Amendment Act, 1890. Infectious Disease (Prevention) Act, 1890. Public Health Acts Amendment Act, 1907. Public Health Act, 1925, Part II except sec. 22, Part III and Part IV. Private Street Works Act, 1892, 11 Byelaws and Regulations. New Streets and Buildings and Alterations to existing Buildings (14th November, 1932). Public Health Act, 1875, with respect to:— Nuisances arising from snow, filth, dust, ashes and rubbish, and for the prevention of keeping animals on any premises so as to be injurious to health, (1st October, 1935). Removal of House Refuse (1st October, 1935). Removal of Offensive or Noxious Matters (1st October, 1935). Slaughter Houses (1st October, 1935). Common Lodging Houses (1st October, 1935). Drainage Existing Buildings (14th March, 1933). Pleasure Grounds (November 14th, 1932). Advertisements (11th March, 1933). Hadley Green (1st December, 1935). Hertfordshire County Council Act, 1935, with respect to Hairdressers' and Barbers' Premises (1st March, 1937). Public Health Act, 1875, Sect. 112, as amended by Sect. 51 of the Public Health Acts Amendment Act, 1907, with respect to:— Offensive Trades (November 14th, 1932), as follows:— Blood Boiler and Blood Drier; Bone Boiler; Tanner; Soap Boiler; Tallow Melter and Fat Extractor; Tripe Boiler; Glue Maker and Size Maker; Gut Scraper; Rag and Bone Dealer; Fish Frier. 12 SANITARY CIRCUMSTANCES OF THE AREA. Water. The water is obtained from deep wells sunk into the chalk. The wells are at New Barnet, East Barnet, Potters Bar, Tyttenhanger, Roestock, Northaw, Hatfield and North Mimms. It is pumped direct into the mains or into reservoirs at New Barnet and Rowley Green. It is of great purity, pleasant to drink, and free from organic matter or objectionable bacteria. Like all London water, it is of considerable hardness varying in the different wells from 22 to 26 degrees of hardness (1 degree pf hardness is equal to 1 in 100,000 parts, 0.7 grains of carbonate of lime in 1 gallon of water). Much of the hardness might be remedied by boiling; this process precipitates the lime, but at the same time by boiling out the oxygen renders the water less pleasant to the taste. So far as is known, the hardness has no deleterious effect, such as causing disease of the blood vessels or the so-called rheumatic affections of joints. On the other hand, those who use it are free from the diseases associated with the consumption of softer water obtained from upland drainage sources such as lead poisoning, etc. The only possible source of contamination of water obtained from the chalk would be through "swallow-holes," which are cavernous openings commonly found at the junction of the Reading beds and the chalk, into which streams disappear. One of these "swallow-holes" is found near North Mimms, where water from nearly 20 square miles of land disappears. The whole of the water from North Mimms station is treated by the most modern purification methods of sedimentation, filtration and chlorination, and no contaminated water therefore can find its way into the supply mains. The Water Company have an up-to-date chemical and bacteriological laboratory in charge of a fully qualified chemist; there is complete bacteriological control and during the year 615 examinations have been made, 94.3 per cent. being B.coli free in 100 c.c. Samples are sent periodically to independent analysts in London for their examination, and the following report is characteristic of such examinations:— 13 "This is a clear and bright water free from odour and taste and neutral in re-action. It is hard in character, free from metals, and contains no excess of saline matter. Both organically and bacteriologically the water is of a high degree of purity and is pure and wholesome water suitable for public supply purposes." Sewerage and Drainage. The district is generally sewered on the separate system, the foul sewage being treated at the Sewage Disposal Works at Brunswick Park Road and the surface water drainage taken to Pymmes Brook by a number of brooklets or watercourses. Sewage Disposal. The sewage is delivered at the Sewage Disposal Works which are situated at the junction of Brunswick Park Road and Osidge Lane by five main sewers and two rising mains from pumping stations. The new Disposal Works, designed for a dry weather flow of 1,250,000 gallons a day, is about to commence full treatment. They consist of Screen and Detritus Tank with Mechanical Dredger, Preliminary Settlement Tanks with Mechanical Scrapers, Secondary Settlement Tanks, Aeration Tanks (Simplex Surface Aeration System), Final Settlement Tanks and Percolating Filters, the effluent passing into Pymmes Brook. The sludge is pumped to Primary and Secondary sludge Digestion Tanks from whence it gravitates to Sludge Drying Beds before being disposed of on the land. Samples of the effluent are taken by the Lee Conservancy Board. Refuse Collection and Disposal. Everything possible is done to control the conditions unfavourable to health and so prevent the outbreak or spread of disease. 14 A weekly collection of domestic and trade refuse is made over the whole of this district. Producers of offal and offensive trades receive three collections a week. In October, 1934, three new refuse collecting vehicles were brought into operation to replace the old system of tractor and trailers, and in August, 1936, a fourth vehicle was purchased. The vehicles are of 15 cubic yards capacity, rear loading and fitted with moving floors. Since the introduction of these vehicles a very considerable improvement has been effected in the method and cleanliness of the collection. The method of disposal is "Controlled Tipping" at Oak Hill Park, East Barnet. Since the inception of the scheme about 23,000 tons of refuse have been disposed of without a complaint of any description. No vermin or flies have been found since the controlled tip was begun in April, 1933. In October, 1934, a scheme of waste paper collection was started in conjunction with the refuse collection, and since the scheme was begun the quantity collected and sold is approximately 700 tons. The roads are regularly swept and the road gullies cleaned out and the road surfaces are treated in a manner to reduce the production of dust to a minimum. Sanitary Inspection. This is dealt with in detail in the Chief Sanitary Inspector's Report. Schools. The Public Elementary schools were regularly visited during the year and all children found in the course of medical inspection to be in any way defective are promptly visited by the district nurses. These visits with few exceptions are welcomed by the parents and medical defects promptly attended to. This work of the district nurses is highly important and the local nursing 15 association is in my opinion to be congratulated on the very efficient manner in which this most valuable assistance to the work of the Public Health department is being rendered. Prevalence of, and control over, Infectious Diseases. With the exception of Mumps and Measles over 5 years of age all cases of infectious Disease are notifiable in the area, and particulars of those cases notified are given in Table 1. With regard to Diphtheria every facility for prompt diagnosis and treatment is placed at the disposal of local doctors, swabs for examinations of throat, etc., and a supply of antitoxin are kept in readiness at the Council Offices. In addition the Council has now given facilities for the supply of immunising serum. This is available in necessitous cases on the application of local doctors. It is to be regretted that more advantage is not being taken of the facilities now provided for preventive immunisation. In the case of Measles there is more difficulty in obtaining the convalescent and adult serum, but in time it is to be hoped that the extended use of preventive immunisation will reduce the chances of a fatal termination in both these diseases to the vanishing point. Similar facilities for bacteriological diagnosis are available in cases of Tuberculosis and other infectious diseases, and full advantage is taken of them. During the year, reports on the following swabs and sputa sent for bacteriological examination were received:— Swabs taken from suspicious cases of Diphtheria, positive 12, negative 131. Sputa taken from suspicious cases of tuberculosis, positive 3, negative 15. In all infectious cases where patients are removed to isolation or special hospitals, the patient's home is visited and disinfection thoroughly carried out. 16 Smallpox. No cases of this disease were notified during the year. Tuberculosis. A table is given showing new cases and mortality during 1936. Whenever possible all cases of Pulmonary Tuberculosis likely to benefit are sent to the County Sanatorium at Ware. In every case thorough disinfection of premises, etc., is carried out as soon as the patient has been removed. Measles. The employment of a temporary nurse for dealing with cases of difficulty and distress during Measles and other epidemics is very desirable. In view of the possibility of having supplies of convalescent and adult serum at our disposal in the near future I would strongly urge the District Council to include measles at all ages in the list of notifiable diseases. Reference has already been made to the additional measures we propose to adopt in dealing with outbreaks of epidemic disease. 17 TABLE I. Notifications of Infectious Disease (other than Tuberculosis) received during the year 1937. INFECTIOUS DISEASE. At all ages. Under 1 year. 1—4 years. 5—14 years. 15—19 years. 20—34 years. 35—64 years. 65 and upwards. No. of cases removed to Hospital. Deaths. Scarlet Fever 69 ..... 4 46 10 7 2 ..... 47 ..... Diphtheria 14 2 8 ..... 2 2 ..... 14 ..... Pneumonia 31 4 3 3 2 4 15 ..... ..... ..... Chicken Pox 82 ..... 12 48 16 5 1 ..... ..... ..... Whooping Cough 42 1 8 32 1 ..... ..... ..... ..... 1 Measles 47 2 41 4 ..... ..... ..... ..... ..... 2 Acute Poliomyelitis 2 ..... ..... 1 ..... ..... 1 ..... 2 ..... Encephalitis Lethargica 1 ..... ..... ..... ..... 1 ..... ..... 1 ..... Paratyphoid 3 ..... ..... ..... 2 ..... 1 ..... 3 ..... Puerperal Pyrexia 3 ..... ..... ..... ..... 3 ..... ..... 3 ..... Ophthalmia Neonatorum 2 2 ..... ..... ..... ..... ..... ..... 2 ..... Erysipelas 9 1 ..... ..... ..... ..... 7 1 4 ..... Totals 305 10 70 142 31 22 29 1 76 ..... Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 2 — 2 2 — — — 18 TABLE II. Causes of, and Ages at, Death during the year 1937. CAUSES OP DEATH. Net Deaths at the subjoined ages of Residents whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Total Deaths in Public Institutions in the District. Cancer 43 ...... ...... ...... ...... ...... 1 9,9 13 43 Heart Disease 87 1 ...... ...... ...... 1 3 48 34 75 Aneurysm 2 ...... ...... ...... ...... ...... ...... 2 ...... 1 Cerebral Haemorrhage 9 ...... ...... ...... ...... ...... ...... 2 7 9 Cerebral Tumour 2 ...... ...... ...... ...... ...... ...... 1 1 2 Arterio-Sclerosis 13 ...... ...... ...... ...... ...... ...... 5 8 11 Uræmia 9 ...... ...... ...... ...... ...... ...... 2 7 9 Bright's Disease 1 ...... ...... ...... ...... ...... 1 ...... ...... 1 Bronchitis 6 ...... ...... ...... ...... ...... 3 2 1 4 Pneumonia 17 6 ...... 1 ...... 2 1 5 2 17 Tuberculosis 13 ...... ...... 1 1 3 4 3 1 13 Abscess of Lung 1 ...... ...... ...... ...... ...... 1 ...... ...... 1 Influenza 6 ...... ...... ...... ...... ...... 2 4 ...... 3 Premature Birth 7 7 ...... ...... ...... ...... ...... ...... ...... 7 Marasmus 2 2 ...... ...... ...... ...... ...... ...... ...... 2 Atelectasis (Pulmonary) 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Congenital Pulmonary Stenosis 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Asphyxia (Confinement) 2 1 ...... ...... ...... ...... 1 ...... ...... 2 Acute Gastro Enteritis 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Gastric Ulcer (Haemorrhage) 6 ...... ...... ...... ...... ...... 2 4 ...... 6 Appendicitis (Operation) 3 ...... ...... ...... ...... ...... 1 2 ...... 3 Enlarged Thyroid Gland 2 1 ...... ...... 1 ...... ...... ...... ...... 2 Measles 2 2 ...... ...... ...... ...... ...... ...... ...... 2 Acute Interstitial Nephritis 14 ...... ...... ...... ...... ...... 1 5 8 16 Diabetes 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Suicide 8 ...... ...... ...... ...... ...... 5 9, 1 ...... Accidents 18 ...... 1 ...... 1 4 3 6 3 18 Septicaemia 6 ...... 1 ...... 1 ...... 1 ...... 3 6 Whooping Cough 1 ...... ...... 1 ...... ...... ...... ...... ...... 1 Epilepsy 1 ...... ...... 1 ...... ...... ...... ...... ...... 1 Addison's Disease 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Adenoma of Prostate 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Toxic Goitre 1 ...... ...... ...... ...... ...... 1 ...... ...... 1 Empyema (Operation) 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Myxcedema 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Strangulated Hernia 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Senility 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Totals 292 23 2 4 4 10 31 129 89 266 19 TABLE III. Infantile Mortality, 1937. Net Deaths from stated causes at various ages under 1 year. CAUSE OF DEATH. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total under 1 year. Premature Birth 7 ...... ...... ...... 7 ...... ...... ...... ...... 7 Broncho Pneumonia 1 ...... 1 1 3 ...... 1 2 ...... 6 Marasmus ...... ...... ...... ...... ...... 1 1 ...... ...... 2 Congenital Pulmonary Stenosis 1 ...... ...... ...... 1 ...... ...... ...... ...... 1 Asphyxia 1 ...... ...... ...... 1 ...... ...... ...... ...... 1 Acute Gastro Enteritis ...... ...... ...... ...... ...... ...... ...... 1 ...... 1 Enlarged Thymus Gland ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 Heart Failure ...... ...... ...... ...... ...... 1 ...... ...... ...... 1 Measles ...... ...... ...... ...... ...... ...... ...... 2 ...... 2 Pulmonary Atelectasis 1 ...... ...... ...... 1 ...... ...... ...... ...... 1 Totals 11 – 1 1 13 2 3 5 — 23 20 TABLE IV. Tuberculosis. New Cases and Mortality during 1937 AGE PERIODS. NEW CASES. DEATHS. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year ............... ............... ............... ............... ............... ............... ............... ............... 1—5 ............... ............... 3 ............... ............... ............... ............... 1 6—10 ............... ............... 4 ............... ............... ............... ............... 1 11—15 ............... ............... ............... ............... ............... ............... ............... ............... 16-20 ............... 3 ............... ............... 1 2 ............... ............... 21—25 2 6 ............... ............... ............... 1 ............... ............... 26—30 5 2 ............... ............... ............... ............... ............... ............... 31—35 1 ............... ............... 1 1 1 1 ............... 36-40 2 4 ............... ............... ............... 1 ............... 1 41—45 3 ............... ............... ............... ............... ............... ............... ............... 46—50 ............... 3 ............... ............... 1 ............... ............... ............... 51—55 ............... ............... ............... ............... ............... ............... ............... ............... 56—60 ............... ............... ............... ............... ............... ............... ............... ............... 61 and over 1 ............... ............... ............... 1 ............... ............... ............... Totals 14 18 7 1 4 5 1 3 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken or found necessary under these Regulations. Public Health Act, 1925, Section 62, and Section 66. No action was taken or found necessary under these Sections. Rag Flock Acts, 1911 and 1928. There are no premises in this district in which Rag Flock is manufactured, used or sold. 21 Cast Bavnet Urban Distnct Council. ANNUAL REPORT of the Chief Sanitary Inspector for the year 1937. To the Chairman and Members of the East Barnet Urban District Council. Gentlemen, The following is a detailed list of repairs executed as a result of the inspection of house property during the past year:— % Houses. Roofs repaired and made weathertight 25 Spouts and downspouts cleaned and repaired or renewed 31 Interior walls and ceilings repaired or replastered 21 Walls and ceilings cleansed and distempered or papered 41 Exterior brickwork repaired or repointed 15 Damp walls remedied 30 Stairs or staircases repaired 5 Handrails provided to stairs 4 Broken sash cords renewed (number of houses) 18 Window frames repaired 21 Kitchen ranges repaired or renewed 7 Fireplaces repaired 8 Doors repaired 11 Door steps repaired or replaced 5 22 Dilapidated washing coppers repaired 10 Floors repaired or relaid 11 Scullery sinks renewed 4 Sink waste pipes repaired or renewed 6 Yard surfaces repaired or repaved 4 Dilapidated fences repaired 3 Defective window sills repaired 14 Dilapidated dustbins renewed 145 Flues and chimneys repaired 5 Defective sub-floor ventilation remedied 5 Skirting boards repaired or replaced 7 Verminous rooms dealt with 12 Exterior cement rendering repaired 8 Drainage. Choked drains cleared 19 Drains tested 8 Defective vent pipes repaired 4 Broken inspection chamber covers replaced 12 Drains repaired or relaid 17 Rainwater pipes disconnected from drains 4 W.C. Cisterns repaired or renewed 13 Basins renewed 6 Seats renewed 6 Insufficient conveniences 2 Water Supply. Cisterns cleansed 25 New covers provided to cisterns 6 Cisterns repaired or renewed 9 Supply re-installed after being cut off 14 Water pipes repaired 11 Insufficient supply 6 Miscellaneous. Accumulations of refuse removed 21 Nuisances arising from keeping of animals, poultry, etc. 6 Nuisances from burning refuse 5 Rat infested premises 17 23 Many complaints have been received regarding the dumping of refuse on vacant plots of land in various parts of the district. Where the refuse was of such a nature that it was likely to cause a nuisance the owner of the land was requested to have it removed, but in many cases the refuse consisted mainly of old bedsteads, oil drums and other similar innocuous material, and although this gave the land an untidy appearance, if the owner refused to do anything we had no power to insist on its removal. In addition to the serving of notices for repairs to property many owners and agents were interviewed in cases of difficulty, and every effort was made to get the required work executed without undue delay. The number and nature of the inspections made were as follows:— Under the Public Health Acts (nuisances, sanitary defects, water supply, infectious diseases, etc.) 1755 I Under the Factory and Workshops Acts (inspections of factories, workshops and workplaces) 94 Ditto (inspections of outworkers' premises) 32 Under the Milk and Dairies Order, 1926 (inspections of cowsheds and dairies) 80 Under the Housing Acts and the Housing Consolidated Regulations, 1925 (Inspection of dwelling houses) 336 Under the Housing Act, 1935, for the purposes of the Overcrowding Survey 624 Under the Shops Act 70 Food Inspections 487 Under the byelaws relating to Hairdressers' and Barbers' premises 36 Total number of Inspections 3,514 Number of notices served during the year. Informal Notices 250 Statutory Notices 15 24 The result of the service of these notices was as follows:— Preliminary Notices. Statutory Notices. Complied with 220 14 Work in progress at end of year 14 — Not yet complied with 16 1 Infectious Diseases. In all cases of Scarlet Fever and Diphtheria the homes of the patients were visited, full inquiries were made and reports submitted to the Medical Officer of Health. The premises were also inspected for sanitary defects, dampness, defective drainage, lack of cleanliness, etc., the necessary steps being taken immediately to remedy all such defects discovered. 137 visits and revisits were made. 66 library books were taken from infected houses and these were specially disinfected before being returned to their respective libraries. 108 houses were disinfected after removal of the patients to the Isolation Hospital or, in the case of patients treated at home, on the certificate of the doctor attending the case, and, where necessary, instructions given for the thorough cleansing of the rooms' afterwards. The method of disinfection is by spraying the rooms with a solution of formalin. 80 notices of exclusion of children from school on account of infection were sent to head teachers of schools. Slaughter Houses. 378 visits were made to the five slaughterhouses. Two of these slaughterhouses are registered and three licensed, the latter being subject to annual renewal under section 29 of the Public Health Acts Amendment Act, 1890. Offensive Trades. There are seven fish frying establishments, one more than last year. Consent was given for a new business which was opened at Park Parade, East Barnet. Hairdressers' and Barbers' Premises. The byelaws made by the Council under the Hertfordshire County Council Act, 1935, came into operation on the 1st of March, 1937. 36 visits were made to the hairdressers' shops and premises. A few minor infringements discovered on first inspection were found to have been remedied on a subsequent visit. 25 HOUSING STATISTICS 1. Inspection of Dwelling Houses during the Year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 262 (b) Number of inspections made for the purpose 885 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 105 (b) Number of inspections made for the purpose 296 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 44 2. Remedy of Defects during the Year without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 42 3. Action under Statutory Powers during the Year. (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 2 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (а) By owners Nil (b) By Local Authority in default of owners 1 26 (B) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 12 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By owners 12 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (D) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or rooms having been rendered fit Nil 4. Housing Act, 1936. Overcrowding:— (ia) (i) Number of dwellings overcrowded at the end of the year 21 (ii) Number of families dwelling therein 33 (iii) Number of persons dwelling therein 194 (b) Number of new cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding relieved during the year 15 (ii) Number of persons concerned in such cases 94 27 (d) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding None It will be seen from the foregoing figures that the number of cases of overcrowding again show a reduction. 15 cases were abated but six new cases arose giving a net reduction of nine in the total number from last year. These new cases occurred entirely through the increase in the ages of children and increase of family. Of these 21 cases two are in Council houses the remainder being in privately-owned houses. No cases of overcrowding were abated in 1937 as a result of slum clearance operations, as the transfer of tenants from clearance areas took place the previous year. The work of measuring the rooms of working class dwellings in order to fix the permitted number for insertion in rent books was completed by the end of March when the employment of the two temporary assistants engaged on this work terminated. A large number of applications for the permitted numbers were received from owners and agents and the necessary information was, in every case, supplied. SMOKE ABATEMENT. All the factory and works' Chimneys have been kept under observation. One works' chimney was found to be discharging black smoke occasionally. I had an interview with the Chief Engineer at the works who explained the alterations that were being made to the boilers and furnaces in an endeavour to abate the nuisance. Later there was an improvement noticed as regards the volume and density of the smoke emitted. SHOPS ACT, 1934. 70 inspections were made under this Act. One shop was found to be insufficiently ventilated and another shop not to have sufficient sanitary conveniences attached. Complaints were made to the respective owners and subsequently these defects were remedied. 28 SWIMMING BATHS. There are no public or privately owned swimming baths open to the public in the district. ERADICATION OF BED BUGS. No Council houses were found to be infested during 1937, but eight other privately-owned houses were found bug-infested and these were disinfested by owners and tenants under our supervision. Fumigation by sulphur, "Cimex" or "Fumoids" together with the use of a proprietary liquid insecticide "Pyagra" as well as the stripping and burning of wallpaper, the removal or loosening of picture rails, skirting boards, architraves, etc., were the methods adopted with, as subsequent inspections proved, very satisfactory results. As regards the methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses, I visited the homes of all selected applicants for Council houses before they were interviewed by the Housing Sub-Committee, and in no case was vermin found. It was not necessary during the year to take any special measures by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Number of Cowkeepers on the register 3 ,, ,, Retailers on the register 20 ,, ,, Registered Premises on the register 11 ,, ,, Inspections 80 There was a decrease of three in the number of cowkeepers. There are now only three farms in the area engaged in milk production, the decrease being due to the development of the district. Two retailers also discontinued business. The farms and dairies have been regularly inspected. A high standard of cleanliness has been maintained and the requirements of the Milk and Dairies Order, 1926, have been complied with. 29 The following licences were granted to dealers to sell under the Milk (Special Designations) Order, 1936, viz. Tuberculin Tested 2 Accredited 1 Pasteurised 3 The following Supplementary licences under principal licences granted by other authorities to sell milk from premises outside this area were also granted, viz.: Tuberculin Tested 3 Accredited 1 Pasteurised 4 47 samples of milk have been taken at various times and sent to the laboratory at Mill End Hospital for bacteriological examination. These were considered to be satisfactory with the exception of two samples, and appropriate action was taken in the case of both samples. MEAT INSPECTION. The requirements of the Public Health (Meat) Regulations 1924, have been duly observed as regards the slaughterhouses and butchers' shops in the district. Notices of slaughtering have been given as required by the regulations and these have been followed up in every case by visits to the slaughterhouses, the carcases examined and all diseased or unsound meat condemned. The butchers' shops and implements have been maintained in a cleanly condition with the exception of a shop in Brunswick Park Road. In this case a verbal warning to the occupier was sufficient to effect the required improvement and no further action was necessary. Meat Marking. No carcases were stamped during the year as no requests for marking were received. 30 Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 30 8 33 458 13,985 Number inspected 30 8 33 458 13,056 All diseases except Tuberculosis: Whole carcases condemned — 1 — — 14 Carcases of which some part or organ was condemned – 2 – 2 121 Percentage of number inspected affected with disease other than tuberculosis – 37.5 – 0.4 1.0 Tuberculosis only: Whole carcases condemned – 1 — — 35 Carcases of which some part or organ was condemned 2 1 – – 212 Percentage of the number inspected affected with tuberculosis 6.6 25 – – 1.1 Total weight of meat condemned 3 tons 7 cwts. 16 lbs. No official seizures were necessary. The whole of the meat and other foods condemned were voluntarily surrendered, and certificates to this effect were given on request. Inspection of Other Foods. All the restaurants, snack bars, fried fish shops and other places where food is prepared have been visited and their kitchens and cooking utensils inspected for cleanliness. Some difficulty has been experienced with regard to the disposal of refuse from 31 greengrocers' shops as there is a tendency in some cases to allow this refuse to accumulate in the yard at the rear of the shop. Notices have had to be served and verbal instructions given for the more frequent removal of this refuse. Our demands have in every case been complied with. Other Foods Condemned. Kippers 14 lbs. Winkles 56 ,, Prawns 3½ ,, Herrings 28 ,, Herring roes 16 ,, 117½ Bakehouses. There are ten bakehouses. Two are underground. Limewashing twice yearly was carried out as required by the Factory and Workshops Act. Factory and Workshop Act, 1909. Particulars are appended of the work done in connection with this Act. Outworkers. Fifteen lists of outworkers were received for the first half of the year and twelve for the second half. There were no cases of infectious diseases in their homes, and no work was carried on in unwholesome premises. Rats and Mice Destruction Act. Numerous complaints have been received regarding ratinfested premises. Each complaint has been investigated and, where necessary, forwarded to the County Rat Officer, Mr. Dubbin. Under the Act it is the duty of owners and occupiers 32 of land and premises to get rid of rats and mice but assistance and advice is given by this department, and many visits have been made with Mr. Dubbin to various premises to deal with these complaints. The continued development of the district with its rapidly increasing population has resulted in a great increase of the work of this department. During the past year an additional sanitary inspector was appointed in place of the previous assistant who resigned to take up another appointment. It would be an advantage if the staff could be increased by a further additional or assistant inspector in order that the work may continue to be properly and efficiently performed. In conclusion I wish to tender my thanks to the other members of the staff for their assistance throughout the year. I am, Gentlemen, Your obedient Servant, EDWARD HOUGHTON, A.R.San.I., M.S.I.A., Chief Sanitary Inspector. 33 Inspections. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. FACTORIES (Including Factory Launderis 48 7 — WORKSHOPS (Including Workshop Laundries) 38 2 — WORKPLACES (Other than Outworkers' Premises) 8 2 — TOTAL 94 11 — Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect to which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. NUISANCES UNDER THE PUBLIC HEALTH ACTS— Want of cleanliness 8 8 Want of ventilation 1 1 Overcrowding Want of drainage of floors Other nuisances 2 2 Sanitary accommodation. Insufficient 2 2 Unsuitable or Defective 1 1 Not separate for Sexes OFFENCES UNDER THE FACTORY AND WORKSHOP ACTS— Illegal occupation of underground bakehouses (S. 101) Other offences TOTAL 14 14