LIBRARY EBAR5 East Barnet Urban District Council. SEVENTIETH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943. 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 1943. 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 three farms in the district at which milk is produced and the milk at two of 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 1554 examinations were made 98.9 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." 12 samples were also taken by us and submitted for examination. The reports were in every case satisfactory. Diphtheria Prophylaxis. Immunisation proceeds steadily but slowly. At the end of the year a careful estimate of the number immunised showed 74% in the under 5 group, and 77% in the 5-15 year group. This may be considered satisfactory, but by no means the best result that can be achieved. Clinic attendances are a little disappointing but it is hoped that further efforts by the Health Visitors may produce bigger attendances once again. The utilisation of the local doctors in the immunising campaign has, thanks to the Council's decision, been of considerable value. One difficulty we have to face is that Diphtheria has been so, little prevalent in this district of recent years that people are apt to forget the serious mortality rate of this disease when cases occur, but under war conditions one should not anticipate remaining comparatively free of such diseases. Scabies. The Clinic at Church Farm has continued to function efficiently, thanks to the willing co-operation of Civil Defence Personnel. During the year some 513 cases have been treated, the total number of treatments being 1,026. There is now little difficulty in persuading infected people or contacts to undergo treatment and this may in fact be taken as a tribute to the efficiency of the Clinic becoming more widely known. Infectious Disease. During the early part of the year the district suffered from an epidemic of measles, the vast majority of the cases being mild in type. V.D. Campaign. A lecture was given by Dr. Ashkin to C.D. Personnel and others and was much appreciated. It would appear that there is an audience for such lectures and I think they are of value in rousing further interest. 3 Influenza Epidemic. A full scheme was prepared for Home Nursing and Domestic help during this epidemic, with the co-operation of C.D. services, Head Teachers, W.V.S., J.W.O. (B.R.C.S. and St. John) and others. Although the service was called upon in only a few instances, a valuable skeleton remains which can be rapidly clothed should a similar emergency arise. 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 decline in cleanliness particularly 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, 1943), £384,246. Estimated product of a penny rate for 1943, £1,520. Vital Statistics. Total. M. F Live Births. Legitimate 647 329 318 Illegitimate 14 8 6 Stillbirths 8 6 2 Total, M. F. Deaths 378 181 197 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 25.7 Legitimate Infants per 1,000 Legitimate live births 26.2 Illegitimate Infants per 1,000 Illegitimate live births Nil Deaths from Cancer (all ages) 76 „ Measles (all ages) 0 „ Whooping Cough (all ages) 1 ,, Diarrhoea (under 2 years of age) 2 Infantile Death Rate. There were 17 deaths of children under one year as compared with 20 last year, a death rate per 1,000 live births of 25.7. Last year the figure was 33.3 and for 1941, 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 sent for bacteriological examination were received :— 5 Swabs taken from suspected cases of Diphtheria, Positive, 1 Negative, 52. 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 1943. 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 1943. CAUSES. Total Cases Notified. Under 1 year. 1—2 years. 2—3 years. 3—4 years. 4—5 years- 5—10 years. 10—15 years. 15—20 years. 20—35 years. 35—45 years. 45—65 years. 65 and over. Cases admitted to Hospital. Total Deaths. Scarlet Fever 61 ...... ...... 1 2 8 29 6 4 7 4 1 ...... 43 ...... Diphtheria 2 ...... ...... ...... ...... ...... 1 1 ...... ...... ...... ...... ...... 2 ...... Chicken Pox 159 6 4 9 3 10 92 27 4 4 ...... ...... ...... 1 ...... Whooping Cough 178 16 8 15 18 24 95 ...... 1 1 ...... ...... ...... ...... 1 Measles 539 12 18 56 44 85 265 31 14 10 4 ...... ...... 9 ...... Pneumonia 29 4 ...... ...... 1 1 2 ...... 1 3 3 8 6 ...... ...... Erysipelas 12 ...... ...... ...... ...... 1 ...... ...... ...... ...... 4 7 ...... ...... ...... Puerperal Pyrexia 3 ...... ...... ...... ...... ...... ...... ...... ...... 3 ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Total 983 38 30 81 68 129 484 64 24 28 15 16 6 56 1 6 Ophthalmia Neonatorum. Cases. Notified. Treatment. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. InHospital. 1 – 1 1 – – – TABLE II. Causes of, and Ages at, Death during the year 1943. CAUSES OF DEATH. All Ages. Under 1 year. 1 to 2 years. 2 to 5 years. 5 to 15 years. 15 to 25 }ears. 25 to 45 years. 45 to 65 years. 65 and over. Total Deaths in Public Institutions in District. Cancer 76 ...... ...... ...... ...... ...... 4 28 44 59 Cerebral Tumour 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Meningitis 6 1 ...... 1 1 ...... 3 ...... ...... 6 Cerebral Thrombosis 3 ...... ...... ...... ...... ...... ...... ...... 3 2 Cerebral Haemorrhage 25 ...... ...... ...... ...... ...... 1 7 17 15 Hemiplegia 1 ...... ...... ...... ...... ...... ...... 1 ...... Heart Disease 107 ...... ...... ...... 1 1 4 49 52 81 Coronary Thrombosis 6 ...... ...... ...... ...... ...... ...... 2 4 4 Arterio-Sclerosis 1 ...... ...... ...... ...... ...... ...... ...... 1 ...... Lederers Disease 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Addisons Disease 1 ...... ...... ...... ...... ...... 1 ...... ...... ...... Septicemia 2 ...... ...... ...... ...... 1 1 ...... ...... 2 Tuberculosis 15 ...... 1 ...... 1 6 4 2 1 4 Pneumonia 11 3 ...... ...... ...... ...... J 2 4 8 Bronchitis 19 ...... ...... ...... ...... ...... 2 7 10 6 Acute Pleurisy 2 1 ...... ...... ...... 1 ...... ...... ...... 2 Pulmonary Oedema 2 ...... ...... ...... ...... ...... ...... 1 1 ...... Mutlple Lung Abscess 2 ...... ...... ...... ...... ...... 1 1 ...... 2 Influenza 10 ...... ...... ...... 1 ...... 2 4 3 4 Whooping cough 1 1 ...... ...... ...... ...... ...... ...... ...... ...... Premature Birth 3 3 ...... ...... ...... ...... ...... ...... ...... 3 Marasmus 1 1 ...... ...... ...... ...... ...... ...... ...... ...... Acute Gastro Enteritis 3 3 ... ... ... ... ... ... ... 2 Diarrhoea 2 2 ...... ...... ...... ...... ...... ...... ...... 2 Congenital Spina Bifida 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Hydrocephalus 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Jaundice 1 ...... ...... 1 ...... ...... ...... ...... ...... 1 Haematemesis 4 ...... ...... ...... ...... ...... 2 ...... 2 2 Duodenal Ulcer 3 ...... ...... ...... ...... ...... 2 1 ...... 8 Uræmia 5 ...... ...... ...... ...... ...... 1 ...... 4 1 Nephritis 11 ...... ...... ...... ...... ...... 1 6 4 5 Pyelitis 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 Lymphadenoma 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Intestinal Obstruction 5 ...... ...... ...... ...... ...... 1 ...... 4 5 Appendicitis (Op.) 1 ...... 1 ...... ...... ...... ...... ...... ...... 1 General Peritonitis 3 ...... ...... ...... ...... ...... ...... 2 1 3 Exhaustion (Op.) 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Pemphigus 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... Senility 7 ...... ...... ...... ...... ...... ...... ...... 7 2 Tetanus 1 ...... ...... 1 ...... ...... ...... ...... ...... 1 Syphilitic Diseases 3 ..... ...... ...... ...... ...... 2 1 ...... ...... Suicide 3 ...... ...... ...... ...... 1 1 1 ...... 1 Execution 1 ...... ...... ...... ...... ...... 1 ...... ...... ...... Other Violence 23 ...... ...... ...... 3 6 1 5 8 19 Totals 378 17 2 3 7 16 38 123 712 253 7 TABLE III. Infantile Mortality, 1943. 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. Premature Birth 3 ...... ...... ...... 3 ...... ...... ...... ...... 3 Marasmus ...... ...... ...... 1 1 ...... ...... ...... ...... 1 Broncho Pneumonia ...... 1 ...... ...... 1 2 ...... ...... ...... 3 Whooping Caugh ...... ...... ...... ...... ...... ...... ...... 1 1 Acute Gastro Enteritis ...... ...... ...... ...... ...... ...... 1 1 1 3 Meningitis ...... ...... ...... ...... ...... ...... ...... ...... 1 1 Lederers Anæmia ...... ...... ...... ...... ...... ...... 1 ...... 1 Acute Pleurisy ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 Congenital Spina Bifida ...... ...... 1 ...... 1 ...... ...... ...... ...... 1 Diarrhæa ...... ...... ...... ...... ...... 1 ...... 1 ...... 2 Totals 3 1 1 1 6 3 2 3 3 17 TABLE IV. Tuberculosis. New Cases and Mortality during 1943. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0— ...... ...... ...... 1 ...... ...... ...... ...... 1— ...... ...... ...... ...... ...... ...... ...... 1 5— 3 2 4 1 ...... ...... ...... ...... 15— ...... 2 ...... ...... 1 ...... ...... ...... 25- 6 6 3 3 3 3 ...... 35- 6 4 1 1 2 ...... ...... 1 45— 3 1 ...... ...... ...... ...... ...... ...... 55- 3 ...... ...... ...... 2 ...... ...... ...... 65 and over 2 ...... ...... ...... 1 ...... ...... ...... Totals 23 15 8 6 9 3 1 2 East Barnet Urban District Council. ANNUAL REPORT of the CHIEF SANITARY INSPECTOR FOR THE YEAR 1943. 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 and visits were as follows :— Under the Public Health Acts. Nuisances and sanitary defects 3,033 Infectious diseases 315 Restaurants, Snack Bars, etc. 22 Water Supply 60 Schools 53 Verminous Premises 218 Fish Shops 34 Butchers' Shops 71 Other Food Shops 86 Various Premises re rats 754 Visits in connection with Scabies cases 600 Inspections for dilapidated dustbins 510 5,756 Under the Factories Act. Inspections of Factories 169 Inspections of Outworkers' Premises 47 Inspections of Bakehouses 18 — 234 Under the Milk and Dairies Acts and Orders. Inspections of Cowsheds and Dairies 80 Under the Milk (Special Designations) Regulations, 1930-41 (including visits for purchase of samples) 88 — 168 Carried forward 6,158 9 Brought forward 6,158 Under the Housing Act, 1936. Inspection of Dwelling Houses 209 Visits to Houses to ascertain permitted numbers 9 Inspections in connection with Overcrowding 129 — 347 Miscellaneous Inspections. Under the Shops Acts 115 Food Inspections 116 Under the Rent Restrictions Acts 34 Inspections under the Byelaws relating to Hairdressers' and Barbers' Premises 31 Inspections of A.R.P. Shelters 127 Inspections of Fire Guard Posts 67 Visits re Food Decontamination 199 Smoke Observations and visits 45 Visits re Diphtheria Immunisation 2,626 Total 9,865 Number of Notices Served during the Year. Informal Notices 326 Statutory Notices 31 The result of the service of these Notices was as follows :— Preliminary Statutory Notices. Notices. Complied with 290 27 Work in progress at end of year 11 4 Not yet complied with 25 0 The Rent and Mortgage Interest Restrictions Acts. An application was received from a tenant for a certificate under these Acts that his house was not in a reasonable state of repair. On inspection and report a certificate was authorised and issued. At the request of the owner's solicitor a specification of the necessary works of repair was supplied and all repairs were subsequently carried out. An application was then received from the owner's solicitor for a certificate that the repairs necessary to put the property into a reasonable state of repair had been executed and this also was authorised and granted. 10 Rat Destruction. In accordance with the Direction made by the Ministry of Food pursuant to the Infestation Order, 1943, an inspection of the district was carried out to prepare a list of infestations and to classify them into three categories (a) "Reservoir" type, (b) " Major Primary " type and (c) " Minor Secondary " type. It was found after a careful and detailed examination of all places suspected of being infested, and after full inquiries together with a thorough investigation of all complaints, there were no " Reservoir " or " Major Primary " types of infestation and that all the infestations discovered could be classified under the " Minor Secondary " type,—"small infestations intermittent in character and with little real permanence." Steps were then taken to deal with all infestations in the area by visiting infested land and premises, interviewing occupiers, advising them of the most suitable methods of destruction and supervising the efforts made. Many cases were referred to the County Pests Officer to deal with under the Rats and Mice Destruction Act, and I wish to acknowledge the cordial co-operation and assistance given by Mr. Sharp and his Staff, as a result of which all subsequent complaints received were promptly and efficiently dealt with. The survey was carried out well within the time fixed, and a detailed report of the results was submitted to the Ministry as requested by them. Overcrowding. At the end of the year there were 14 known cases of overcrowding, judged according to the standard in the 5th schedule of the Housing Act, 1936. One particularly bad case (6 persons living in one room) was abated by requisitioning a house which the owner, a large property owner, very kindly offered to me during a conversation on other matters. This was accepted with thanks, the house was requisitioned with the consent of the Ministry of Health and after certain minor repairs were carried ,out by the Rehousing Department the family were transferred there. Most of the cases have become overcrowded by the children in the house growing older and by increases in the family. Under the Housing Act standard, (where two children under 10 count as 1) a family may become overcrowded, even though the number of persons remains the same, by reason of the children reaching the age of 10. Five are old cases all caused by a large family occupying a house too small, or with insufficient sleeping accommodation . 11 Food Decontamination. A Food Treatment Squad of 13 men for the Decontamination of Food has been recruited from the staffs of various food shops in the area. Lectures on decontamination work have been given and there were two practical exercises held at the treatment and decontamination centre at Folly Farm. The first was in the nature of a preliminary exercise but the second was a full scale exercise and was attended by representatives of the Ministry of Food, the Chairman of the Council, the Medical Officer of Health, the A.R.P. Controller and others. An empty shop in Station Road kindly lent to us for this purpose was stocked with a variety of foods, borrowed or purchased from local firms. The building and contents were contaminated by old engine oil representing mustard gas. The Decontamination service also turned out and removed the foodstuffs to the Food Treatment Centre at Folly Farm where they were subjected to the various decontamination methods by the Food Treatment Squad wearing full protective clothing. The Gas Liason Officer of the Ministry of Food expressed to me his complete satisfaction with the exercise and later addressed a letter to the Clerk in which he again expressed his satisfaction, complimenting us on the efficiency displayed, the organisation, and the arrangements made at the Treatment Centre. Shops and Offices. One hundred and fifteen inspections of shops were made under the Shops Act, 1934. Seven notices were served to remedy defects, and were duly complied with. Verminous Houses. Forty-five 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 sulphur of the infested rooms. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Number of Cowkeepers on the Register 3 „ Retailers on the Register 17 ,, Registered Premises on the Register 10 ,, Inspections 80 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. 12 There was an increase of one in the number of farms being used for milk production, i.e., that of Rectory Farm, Hadley, which has again come into use as a dairy farm. The following licences were granted to dealers to sell under the Milk (Special Designations) Regulations 1936-41 :— 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 :— Tuberculin Tested 6 Pasteurised 7 Accredited 1 Ninety-two 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 :— Nature of sample No. of Samples submitted. Examined for (а) Plate Count (b) b. coli. (c) Methylene blue test, (d) Tubercle b. (e) Phosphatase test. Result of Examination Raw 25 (b) and (c) 6 unsatisfactory. Tuberculin Tested 10 (b), (c) and (d) 1 unsatisfactory. T.T. Certified 7 (b), (e) and (d) Satisfactory. T.T. (Pasteurised 4 (a), (b) (c), (d) and (e) Satisfactory. Homogenised 9 (b) and (c) Satisfactory. Accredited 3 (b) and (c) Satisfactory. Pasteurised 3 (a), (b), (c) and (e) 1 unsatisfactory. „ 14 (a) and (e) Satisfactory. ,, 2 \b), (c) and (e) Satisfactory. Sterilised 6 (b) and (c) Satisfactory. Jersey and Guernsey 6 (b) and (c) Satisfactory. „ „ 1 (a), (c) and (e) Satisfactory. „ „ 1 (a) and (e) Satisfactory. ,, ,, 1 (a), (b), (c) and (e) Unsatisfactory. 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. It is very satisfactory to note that the number of unsatisfactory samples shows a decrease to 9 from 19 last year, or a reduction from 18% to 9%. 13 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 Unfit for Human Consumption. lbs. Haddocks 168 Skate 140 Winkles 128 Dogfish 70 Flour 112 Sausages 62 Margarine 54 Cheese 25 171 Eggs 21½ Bacon 18 Lamb 5½ 397 tins of various foodstuffs 624½ Total 1,428½ 12 cwts. 84½lbs. 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.