EBAR4 East Barnet Urban District Council. SIXTY-NINTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1942. it man and Members of the Barnet Urban District Council. I have the honour to present to you my Report for the year 1942. In accordance with the Ministry of Health's instructions, the annual report is presented again in tabular form and it is not possible to include the comparable figures that make so much of the value of an annual report. Milk Supply. There are now only two very small farms in the district at which milk is produced and the milk at these farms is primarily for consumption by their own households, only a very small quantity indeed being sold to a dairy company. Due allowance must be made for the fact that under war conditions it is very difficult to exact the high standard of cleanliness to which we have become accustomed, but taking all circumstances into consideration the proportion of unsatisfactory milk is small. Water Supply. The water which is obtained from deep wells sunk into the chalk is supplied by the Barnet District Gas and Water Company. The Company have an up-to-date chemical and bacteriological laboratory in charge of a fully qualified chemist. During the year 1509 examinations were made 98.7 per cent, being b. coli free in 100 c.c.'s. 2 Samples are also sent periodically to independent analysts in London for their examination and the following report is characteristic of such examinations:— "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 a pure and wholesome water suitable for public supply purposes." Diphtheria Prophylaxis. Diphtheria immunisation is steadily progressing throughout the district and it is hoped that publicity may make every mother realise the folly of neglecting to have this safe and simple procedure carried out on her child. There is now no doubt that the mortality rate from diphtheria in children could be reduced tremendously if immunisation was sufficiently widespread, but to achieve such a result the percentage immunised must be very high. Clinics have now been established for the free provision of immunisation on the second Tuesday in each month at 151, East Barnet Road, and the fourth Tuesday at Monkfrith Hall. The numbers have been satisfactory but towards the end of the year there was a distinct falling off in attendances, despite a considerable amount of publicity by means of the press, posters and cinema advertisments. It cannot be to strictly emphasized that the ideal time for immunisation is soon after the child's first birthday, the process is safe, practically free from pain and/or after effects and gives a high degree of protection. We cannot rest until at least 75 per cent, of children are protected especially in the 1-5 year group. Scabies. A clinic is now held at Church Farm where all uncomplicated cases of Scabies are efficiently treated. This year some 508 cases have been dealt with and only a very small number have needed re-treating after the normal course of two treatments. In repeating my thanks for the assistance freely given by the Barnet Isolation Hospital in the necessary disinfection of bedding, etc., I would add that we are now preparing to deal with the bulk of the material by means of a Sack Disinfector at Church Farm. Most of the Scabies cases have been detected in the course of routine school examination and the subsequent visits to homes of infected people and the interviewing of contacts. A considerable amount of extra work has been thrown on the Public Health Department in this connection. 3 Contacts were required to undergo treatment or to produce a medical certificate that they were free from the disease. Written notices were served upon four persons to present themselves for medical examination. Three persons, a mother and two daughters, failed to comply with notices to submit to medical examination. A prosecution was authorised and summonses were issued. The cases were heard at the Barnet Police Court on the 18th March. The defendants did not appear. After hearing the evidence the magistrate imposed a fine of £2 on the mother with one guinea costs and a fine of £1 on each of the two daughters. Mr. E. Parkes, Solicitor, prosecuted for the Council. It is perhaps regrettable that such a prosecution was found necessary but it may be presumed to have a salutary effect on the very small proportion of contacts and infected people who might refuse to undergo treatment after having had the necessity pointed out to them. The treatment is short and efficient, it entails two visits to the clinic and these have usually been arranged so as not to upset normal school or working hours. All cases treated have been followed up to make sure that the treatment has been successful. Bedding and clothing from 188 houses were removed for steam disinfection at the Isolation Hospital after patients had undergone treatment for the disease. The general health of the district remains good and free from any serious epidemics. It is noticeable that, probably owing to the pre-occupation of so many parents in war work, there has been a slight decline in cleanliness particulary of children, caused by the lack of time for complete parental supervision. Under war time conditions it is all the more essential that cleanliness should be enforced to the utmost if we wish to avoid epidemics. But at the same time it must be recorded that the interest of the population in general questions of health has quickened considerably and that people will gladly avail themselves of any help or suggestion towards the maintenance of better health. I have the honour to be, Gentlemen, Your obedient Servant, C. M. SCOTT, m.r.c.s,. (Eng.), l.r.c.p. (Lond.), Medical Officer of Health to the Council and A/ Assistant School Medical Officer. 4 Area and Rateable Value. The area of the district is 2,644 acres. Rateable Value (at 31st December, 1942), £382,647. Estimated product of a penny rate for 1942, £1,500. Vital Statistics. Total. M. F. Live Births. Legitimate 586 303 283 Illegitimate 13 7 6 Stillbirths 17 8 9 Total, M. F. Deaths 317 159 158 There were no deaths from puerperal sepsis or other puerperal causes. Death Rate of Infants under one year of age:— All Infants per 1,000 live births 33.3 Legitimate Infants per 1,000 Legitimate live births 34.1 Illegitimate Infants per 1,000 Illegitimate live births Nil Deaths from Cancer (all ages) 60 ,, Measles (all ages) 0 „ Whooping Cough (all ages) 2 „ Diarrhoea (under 2 years of age) 2 Infantile Death Rate. There were 20 deaths of children under one year as compared with 23 last year, a death rate per 1,000 live births of 33.3. Last year the figure was 48.9. Prevalence of, and Control over, Infectious Diseases. With the exception of Mumps, all cases of infectious disease are now 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 Town Hall. In addition, the Council has now given facilities for the supply of immunising serum. 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:— 5 Swabs taken from suspected cases of Diphtheria, Positive, 3 Negative, 85. Sputa taken from suspected cases of Tuberculosis, Positive, 1. Negative, 16. In all infectious cases where patients are removed to isolation or special hospitals, the patient's home is visited and disinfection thoroughly carried out. Smallpox. No cases of this disease were notified during the year. Tuberculosis. A table is given showing new cases and mortality during 1942. Whenever possible, all cases of Pulmonary Tuberculosis likely to benefit are sent to the County Sanatorium at Ware. In every case thorough disinfection of the premises, etc., is carried out as soon as the patient has been removed. TABLE I. Notifications of Infectious Disease (other than Tuberculosis) received during the year 1942. causes. Total Cases Notified. Under 1 year. 1—2 years. 2—3 years. 3—4 year8. 4—5 years- 5—10 years. 10—15 years. 15—25 years. 25 —35 years. 35—45 years. 45—65 years. 65 and over. Cases admitted to Hospital. Total Deaths. Scarlet Fever 68 1 ... ... 6 7 44 3 2 3 2 ... ... 50 ... Diphtheria 6 ... 2 ... ... ... 2 1 ... 1 ... ... ... 6 ... Chicken Pox 166 2 6 10 11 100 26 8 3 ... ... ... ... ... Whooping Cough 120 7 6 17 17 21 48 1 ... 2 1 ... ... 2 2 Measles 335 6 8 32 18 37 210 15 6 2 1 ... ... 8 ... Pneumonia 14 ... ... ... ... ... 3 ... ... 3 ... 5 3 ... ... Erysipelas 14 ... ... ... ... ... 1 ... ... 1 4 6 2 1 ... Puerperal Pyrexia 3 ... ... ... ... ... ... ... ... 2 1 ... ... 2 ... Cerebro-Spinal Fever 2 ... 1 ... ... ... ... ... ... 1 ... ... ... 2 ... Relapsing Fever (Typhoid) 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... Total 729 10 17 55 51 76 408 46 17 18 9 11 5 72 2 6 Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treatment. At Home. In Hospital. - - - - - - - TABLE II. Causes of, and Ages at, Death during the year 1942. CAUSES OF DEATH. All Ages. Under 1 year. 1 to 2 years. 2 to 5 years. 5 to 15 years. 15 to 25 years. 25 to 45 years. 45 to 65 years. 65 and over. Total Deaths in Public Institutions in District. Cancer 59 ... ... ... ... ... ... 11 48 40 Rodent Ulcer of Cheek 1 ... ... ... ... ... ... ... ... ... Cerebral Tumour 2 ... ...... ... ... 1 ... 1 1 Compression Trauma of Brain 1 1 ... ... ... ... ... ... I Meningitis 1 1 ... ... ... ... ... ... 1 Heart Disease 110 1 ... ... ... ... b 40 bl 89 Coronary Thrombosis 14 ... ... ... ... ... ... 2 12 9 Cerebral Haemorrhage 6 ... ... ... ... ... ... 2 4 4 Cerebral Thrombosis ... ... ... ... ... ... ... ... ... ... Tuberculosis 18 2 1... ... 6 5 3 1 7 T.B. Meningitis 2 1 1 2 Pneumonia 19 5 1 ... 3 2 8 16 Whooping Cough 2 ... 2 ... ... ... ... 2 Bronchitis 19 ... ... ... ... ... ... 5 13 6 Uraemia 2 ... ... ... ... ... ... 2 ... ... Pyelonephritis 1 ... ... ... ... ... ... 1 ... 1 Diabetes Mellitus 4 ... ... ... ... ... ... 2 Duodenal Ulcer 2 ... ... ... ... ... ... 1 1 2 Perforated Pyloric Ulcer 1 ... ... ... ... ... ... 1 ... General Peritonitis 4 ... ... ... ... ... 3 1 ... 4 Appendix Abscess 1 ... ... ... ... ... 1 ... ... Actinomycosis of Cæcum 1 ... ... ... ... ... ... 1 ... ... Pulmonary Atelectasis 1 1 ... ... ... ... ... ... ... 1 Premature Birth 2 2 ... ... ... ... ... ... ... 2 Convulsions 1 1 ... ... ... ... ... ... ... 1 Diarrhoea 2 2 ... ... ... ... ... ... ... Acute Intussusception 1 1 ... ... ... ... ... ... ... ... Asphyxia 1 1 ... ... ... ... ... ... ... ... Spina Bifida 1 1 ... ... ... ... ... ... ... ... Septicaemia ... ... ... ... ... ... 2 ... 2 Toxaemia 4 2 ... ... ... 1 ... 1 ... 4 Adenoma of Prostate 1 ... ... ... ... ... ... ... 1 ... Internal Haemorrage (Appendix Op.) 1 ... ... ... ... ... ... ... Intestinal Obstruction (Op. Shock) 1 ... ... ... ... ... 1 ... ... 1 Status Lymphaticus (Appendix Op.) 2 ... ... ... 2 ... ... ... ... 2 Lymphadenoma 1 ... ... ... ... ... ... ... ... Senile Decay 4 ... ... ... ... ... ... ... 4 2 Accident 13 ... ... ... ... 1 2 4 6 10 Suicide 2 ... ... ... ... ... 1 1 ... ... Due to War Operations 7 ... ... ... 1 1 2 3 ... 2 Totals 317 20 6 - 3 11 28 83 166 220 7 TABLE III. Infantile Mortality, 1942. Net Deaths from stated causes at various ages under 1 year. CAUSES 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. 2 ... ... ... 2 ... ... ... ... 2 Convulsions ... ... ... ... ... ... 1 1 Broncho Pneumonia 1 1 ... ... 2 ... ... 3 ... 5 Spina Bifida ... ... ... 1 1 ... ... ... ... 1 Acute Intussusception ... ... ... ... ... ... ... ... 1 Cardiac Failure ... ... ... ... ... 1 ... ... ... 1 Toxaemia 1 ... ... ... 1 ... 1 ... ... 2 Meningitis ... 1 ... ... 1 ... ... ... ... 1 T.B. Meningitis ... ... ... ... ... 1 1 Pulmonary Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Acute Miliary T-B ... ... ... ... ... 1 1 ... 2 Asphyria 1 ... ... ... 1 ... ... ... ... 1 Compression Trauma of brain 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Totals 7 2 - 1 10 2 3 3 2 20 TABLE IV. Tuberculosis. New Cases and Mortality during 1942. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 ... ... 1 ... ... ... 1 ... 1 ... ... 1 ... ... ... ... 1 5 1 2 ... ... ... ... ... 15 ... 8 ... ... 1 1 ... 1 25 5 9 2 1 1 2 1 35 9 5 1 ... 2 ... ... 45 5 2 ... 3 1 ... ... 55 3 1 ... ... 1 1 ... ... 65 and over 1 ... 1 ... ... 1 ... ... Totals 24 27 6 1 6 8 2 2 East Barnet Urban District Council. ANNUAL REPORT of the CHIEF SANITARY INSPECTOR FOR THE YEAR 1942, To the Chairman and Members of the East Barnet Urban District Council. Gentlemen, The following is a brief report on the sanitary inspection of the area during the year. The number and nature of the inspections were as follows:— Under the Public Health Acts. Nuisances and sanitary defects 3,474 Infectious diseases 359 Restaurants, Snack Bars, etc 37 Water Supply 117 Schools 87 Verminous Premises 196 Fish Shops 51 Butchers' Shops 128 Other Food Shops 126 Various Premises re rats 151 Visits in connection with Scabies cases 396 Inspections for dilapidated dustbins 1,143 6,265 Under the Factories Act. Inspections of Factories 147 Inspections of Outworkers' Premises 21 Inspections of Bakehouses 34 — 202 Under the Milk and Dairies Acts and Orders. Inspections of Cowsheds and Dairies 56 Under the Milk (Special Designations) Regulations, 1936-41 (including visits for purchase of samples) 64 — 120 Carried forward 6,587 9 Brought forward 6,587 Under the Housing Act, 1936. Inspection of Dwelling Houses 327 Visits to Houses to ascertain permitted numbers 17 Inspections in connection with Overcrowding 21 365 Miscellaneous Inspections. Under the Shops Acts 108 Food Inspections 160 Inspections under the Byelaws relating to Hairdressers' and Barbers' Premises 38 Inspections of A.R.P. Shelters 485 Inspections of Fire Guard Posts 65 Visits re Food Treatment Squad 122 Total 7,930 Number of Notices Served during the Year. Informal Notices 485 Statutory Notices 44 The result of the service of these Notices was as follows:— Preliminary Notices. Statutory Notices. Complied with 457 44 Work in progress at end of year 5 0 Not yet complied with 23 0 Prospect Road Flats.—Execution of Work in Owner's Default. The work of stripping and re-tiling the roofs of these three blocks of flats was commenced in January as a result of the Nuisance Orders made by the Magistrates not being complied with. The Ministry of Health gave consent under the Defence Regulations to the expenditure of £399, and the tender of a local contractor was accepted for the work. The contract was satisfactorily completed in April and the demand on the owner for the payment of the expenses incurred was made by the Deputy Clerk in accordance with section 291 of the Public Health Act, 1936. As no reply was received from the owner notices were served on the tenants requiring them to deduct monthly sums from the rent. The mortgagees of the property then obtained an Order for the appointment of a Receiver and arrangements were made by the mortgagees for the payment of the expenses by half-yearly instalments over a period of six years. 10 Shops and Offices. One hundred and eight inspections of shops were made under the Shops Act, 1934. Eight notices were served to remedy defects, and were duly complied with. Verminous Houses. Two Council houses and 42 privately owned houses were found to be infested with bed bugs. All were disinfested by stripping and burning wallpaper where necessary and spraying with "Zaldecide" liquid insecticide after loosening or removal of picture rails, skirting boards and architraves, followed by sealing and fumigation by " Fumoids " or sulphur of the infested rooms. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Number of Cowkeepers on the Register 2 „ Retailers on the Register 20 ,, Registered Premises on the Register 8 „ Inspections 56 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. There was a decrease of one in the number of farms being used for milk production, i.e., that of Rectory Farm, Hadley, which was sold and is not now in use as a dairy farm. An outbreak of suspected cowpox was notified from one farm. The necessary steps were taken to prevent the milk from being sold for human consumption and the County Medical Officer was informed. Four days later, after further examination of the cattle by Veterinary Surgeons, we were informed the milk could again be consumed and all restrictions removed, and, accordingly, this was done. The following licences were granted to dealers to sell under the Milk (Special Designations) Regulations 1936-41:— Tuberculin Tested 3 Accredited 1 Pasteurised 4 The following Supplementary licences under principal licences granted by other authorities to sell milk from premises outside this area were also granted:— Tuberculin Tested 5 Pasteurised 7 Accredited 1 One hundred and three samples of milk were purchased and submitted for bacteriological examination to the Emergency Public Health Laboratory. The following is a summary of the results of the examinations:— 11 Nature of sample. No. of Samples submitted. Examined for (a) Plate Count t of Examination. (b) b. coli. (c) Methylene blue test. (d) Tubercle b. Raw 25 (a), (b) and (c) 9 unsatisfactory. Tuberculin Tested 1 (a), (b), (c) and (d) Satisfactory. ,, 6 (b), (c) and.(d) 2 unsatisfactory. T.T. Certified 4 (a), (b), (c) and (d) 1 unsatisfactory. ,, 3 (b), (c) and (d) 1 unsatisfactory. T.T. (Pasteurised 1 (a), (b) and (c) Satisfactory. ,, 3 (a). (b). (c) and (d) Satisfactory. ,, 2 (a) and (d) Satisfactory. Vitamin D Irradiated 1 (a), (b) and (c) Satisfactory. Homogenised 12 (a), (b) and (c) 3 unsatisfactory. Accredited 5 (b) and (c) Satisfactory. Pasteurised 14 (a), (b) and (c) 2 unsatisfactory. ,, 12 (a). 1 unsatisfactory. Sterilised 4 (a), (b) and (c) Satisfactory. Jersey and Guernsey 10 (a), (b) and (c) Satisfactory. As regards test (d), tubercle bacilli were absent from all the samples tested. A copy of the report of each sample was supplied to the retailer or dairy proprietor. In the case of unsatisfactory samples, visits were paid to the premises of the dairy concerned and investigations made into the cause of the unsatisfactory report, or if the premises were outside our area a letter was sent to the particular person or firm pointing out that the report was not satisfactory and asking for their observations. Meat Inspection. The requirements of the Public Health (Meat) Regulations, 1924, have been duly observed as regards the butchers' shops in the district. Inspection of Other Foods. All restaurants, snack bars, fried fish shops and other places where food is prepared have been visited and their kitchen and cooking utensils inspected for cleanliness. Food Condemned as Unlit for Human Consumption. Cod lbs 8 Dogfish 84 Skate 119 Bacon 3 Flour 112 Biscuits 20 Sausage Meat 26 Pork Luncheon Meat 43 tins 170 Pork Sausage Meat 14 tins 201/2 Prepared Meat 2 tins 13/4 Carried forward 5641/4 12 Food Condemned as Unfit for Human Consumption—(continued). Brought forward lbs 5641/4 Beef Galantine 1 tin 3/4 Picnic Roll 1 tin 1 Ham Rissole 1 tin l Ox Tongue 1 tin 3/4 Stewed Steak 2 tins 2 Meat and Vegetables 7 tins 71/2 Chopped Ham 10 tins 333/4 Corned Meat Hash 4 tins 4 Chicken and Ham Roll 1 tin 3 Salmon 18 tins 111/2 Sardines 2 tins 1 Pilchards 12 tins 111/4 Herrings 1 tin 1 Pea Soup 147 tins 2841/2 Kidney Soup 3 tins 21/2 Oxtail Soup 3 tins 11/2 Lancashire Hot Pot 1 tin 1 Rabbits 19 tins 38 Golden Syrup 16 tins 16 Jam 45 jars 45 Condensed Milk 82 tins 115 Margarine 1 tin 2 Scotch Broth 1 tin 1/2 Beans 38 tins 35 Peas 18 tins 281/2 Spaghetti 2 tins 11/2 Pears 15 tins 18 Apples 31 tins 631/2 Apricots 2 tins 5 Pineapple 38 tins 37 Mixed Vegetables 9 tins 16 Tomatoes 36 tins 501/2 Pease Pudding 1 tin 1/2 Carrots 1 tin 2 Turnips 1 tin 1 Plums 4 tins 4 Beetroot 1 tin 2 Total 1,4131/4 12 cwts. 691bs. In conclusion, I wish to tender my thanks to other members of the staff for their assistance and co-operation throughout the year. I am, Gentlemen, Your obedient Servant, EDWARD HOUGHTON, Chief Sanitary Inspector.