East Barnet Urban district Council. SEVENTY-SECOND ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945. To the Chairman and Members of the East Barnet Urban District Council. I have the honour to present to you my Report for the year 1945. 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 present 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 af a fully qualified chemist. During the year 1,377 examinations were made 99.3 per cent, being b. coli free in 100 c.c.'s. Samples are also sent periodically to independent analysts in London for their examination and the following report is characteristic of such examinations.:— 2 "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. The position remains reasonably satisfactory. A careful estimate of numbers immunised showed 49.5% in the under 5 group and 88% in the 5-15 year group. Health Visitors have been actively engaged in propaganda and the number of positive refusals to accept this treatment are gratifyingly small. The birthday card scheme promises good results in the under 5 group. The district has shared in the country wide decrease in Diphtheria, which position is, in my opinion, mainly attributable to the immunisation campaign. Efforts are continuing to increase the number immunised and I am not satisfied that we have yet reached the total that could, and should, be protected. Scabies. During the year some 320 cases and contacts have been treated. Little persuasion is now needed to get people to undergo treatment and recurrences have been infinitesimal in number. Ambulance. During the year 1945, the Ambulance Service returned to the control of this department, pending completion of the County Ambulance Scheme. The number of cases dealt with in 1945 was 589 and we have reason to believe that the service is well appreciated in the district. Infectious Diseases. Comparable figures over the past five years show little marked variation in incidence, although 1945 provided us with a medium outbreak of Measles. Fortunately no deaths were ascribed to infectious diseases and the one case of Diphtheria was a nonimmunised case. By arrangement with the East Barnet District Nursing Association, the department utilises the services of their nurses in many public health activities, notably in the follow up of cases notified as suffering from infectious diseases. The arrangement continues to work well. 3 Deaths. The only notable variation in figures for the year is the rise in the number of cases ascribed to accident. Infantile Mortality. A fall can be recorded in the net total deaths under 1 year, the fall being most marked in the groups above the 1 month age. This I think can be taken as indicating the increasing value of child welfare work generally. Tuberculosis. This table shows a small but satisfactory fall both in incidence of new cases and of deaths ascribed to this disease. Although the figures in an area of this size cannot be taken as of great importance, it was thought the time had arrived to begin the introduction of comparative figures, this helping to show the present position compared with the past five years average. Finally may I draw particular attention to the amount of work covered in the report of the Chief Sanitary Inspector, and express the opinion that in view of conditions generally the number of nuisances and sanitary defects needing attention is likely to increase still further. Although the figures and visits to various premises re rats shows such a large increase, this does not indicate an increase in rat infestation. As conditions tend slowly to become more normal it is hoped that this report may be enlarged to something more like the prewar size. Your obedient Servant, C. M. SCOTT, m.r.c.s. (Eng.), l.r.c.p. (Lond.), Medical Officer of Health to the Council and AI Assistant School Medical Officer. 4 Area and Rateable Value. The area of the district is 2,644 acres. Registrar-General's estimate of resident population, 1945, 35,270. Rateable Value (at 31st December, 1945), £383,044. Estimated product of a penny rate for 1945, £1560. Vital Statistics. Total. M. F. Live Births. Legitimate 571 299 272 Illegitimate 26 11 15 Birth rate per 1,000 of the estimated resident population 16.9 (The birth rate for England and Wales was 16.1). Stillbirths 11 6 5 Rate per 1,000 (live and still) births 18.0 Total, M. F. Deaths 363 174 189 Death rate per 1,000 of the estimated resident population 10.2 (The death rate for England and Wales was 11.4). There was one death from puerperal causes. Death Rate of Infants under one year of age:— All Infants per 1,000 live births 25.1 Legitimate Infants per 1,000 Legitimate live births 22.7 Illegitimate Infants per 1,000 Illegitimate live births 76.9 Deaths from Cancer (all ages) 72 ,, Measles (all ages)' 0 ,, Whooping Cough (all ages) 0 ,, Diarrhoea (under 2 years of age) 1 Birth Rate. There were 597 births (26 illegitimate) during the year. The birth rate is lower, 16.9 per 1,000 of the estimated resident population, as compared with 20.4 last year. The births last year numbered 708 including 20 illegitimate. Death Rate. There were 363 deaths, (377 last year) giving a rate of 10.2 compared with 10.8 last year. Infantile Death Rate. There were 15 deaths of children under one year as compared with 25 last year, a death rate per 1,000 live births of 25.1. Last year the figure was 35.3 and for 1943 25.7. For England and Wales the rate was 46 for 1944, and the same for 1943. 5 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. 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 1945. 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 1945. DISEASE. Total Cases Notified. Under 1 year. 1—2 years. 2—4 years. 5—10 years. 15—20 years 35—45 years. 65 and over. Cases admitted to Hospital. Total Deaths. Average for 5 years, 1940—1944. Diphtheria 1 1 1 6 Scarlet Fever 123 8 23 75 7 10 96 68 Chicken Pox 70 1 2 6 37 22 2 105 Whooping Cough 59 4 13 16 26 145 Measles 409 12 66 76 237 16 2 398 Pneumonia 36 5 8 7 9 7 0 20 Para Typhoid 1 1 1 1 Erysipelas 8 5 3 10 Puerperal Pyrexia 1 1 2 Total 708 22 89 121 384 53 29 10 100 — 755 6 TABLE II. Causes of, and Ages at, Death during the year 1945. CAUSES OF DEATH. 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 Institutions in the Barnet District. Cancer 72 ... ... ... ... ... 4 20 48 29 Heart Disease 125 2 ... ... ... 2 4 22 95 55 Arterio Sclerosis 7 ... ... ... ... ... 2 5 4 Cerebral Thrombosis 18 ... ... ... ... ... ... 3 15 10 Cerebral Haemorrhage 19 ... ... ... ... ... ... 9 10 7 Meningitis 1 ... ... ... ... ... ... 1 ... 1 Cerebral Tumour 2 ... ... ... ... ... ... 2 ... ... Pneumonia 15 4 ... 1 ... ... ... 3 1 9 Bronchitis 16 ... ... ... ... ... 1 6 9 3 Tuberculosis 14 ... ... ... ... ... 8 3 3 5 Influenza 3 ... ... ... ... ... ... 2 1 2 Gastric Ulcer 6 ... ... ... ... ... ... 4 2 2 General Peritonitis 1 ... ... ... ... ... 1 ... ... 1 Appendicitis 1 ... ... ... ... ... 1 ... ... 1 Nephritis 7 ... ... ... ... ... ... 3 4 2 Uraemia 4 ... ... ... ... ... ... ... 4 4 Myelongenous Leukaemia 1 ... ... ... ... ... ... ... 1 ... Status Epilepticus 1 ... ... ... ... ... 1 ... ... ... Diabetes 3 ... ... ... ... ... 1 2 ... ... Septicaemia 1 ... ... ... ... ... 1 ... ... Haemorrhage (operation) 9 ... ... ... 1 ... 1 ... 2 Shock 1 ... ... ... ... ... ... 1 ... 1 Gastro Enteritis 1 1 ... ... ... ... ... ... ... ... Diarrhoea 1 ... 1 ... ... ... ... ... ... ... Premature Birth 3 3 ... ... ... ... ... ... ... 2 Inattention at Birth (Inquest) 1 1 ... ... ... ... ...... ... ... 1 Congenital Malformation 1 1 ... ... ... ... ... ... ... 1 Spina Bifida 1 1 ... ... ... ... ... ... ... Puerperal Causes 1 ... ... ... ... 1 ... ... ... Asphyxia (Inquest) 4 2 ... ... ... ... ... 2 ... 2 Accident 13 ... ... ... 1 3 5 ... 4 2 Suicide 2 ... ... ... ... 1 1 ... Due to War Operations 15 ... ... ... 2 1 4 4 4 1 Totals 363 15 1 1 4 6 34 90 212 147 7 TABLE III. Infantile Mortality, 1945. 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. Heart Disease 1 ... ... ... 1 ... 1 ... ... 2 Pneumonia 4 ... ... 4 ... ... ... ... 4 Premature Birth 3 ... ... 3 ... ... ... ... 3 Inattention at Birth (Inquest) 1 ... ... 1 ... ... ... ... 1 Asohvxia (Inquest) 2 ... ... 2 ... ... ... 2 Gastro Enteritis ... ... ... 1 ... ... 1 Congenital Malformation 1 ... ... 1 ... ... ... ... 1 Spina Bifida 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... Totals 13 — — — 13 — 2 ... ... 15 1944 11 — — 1 12 4 4 3 2 25 TABLE IV. Tuberculosis. New Cases and Mortality during 1945. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0— 1— 1 5— 1 1 15— 1 5 2 1 25- 9 9 3 1 1 5 35- 7 3 1 2 45— 4 4 1 1 55— 6 2 1 65 and over 4 1 2 Totals 33 24 5 3 6 8 — — 1944 44 28 4 7 11 6 1 — East Barnet Urban District Council. ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR To the Chairman and Members of the East Barnet Urban District Council. 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:— Nuisances and sanitary defects 4,958 Infectious diseases 566 Restaurants, Snack Bars, etc. 44 Water Supply 98 Schools 65 Verminous Premises 126 Fish Shops 36 Butchers' Shops 121 Other Food Shops 226 Various Premises re rats 1,862 Visits in connection with Scabies cases 111 Inspections for dilapidated dustbins 112 Inspections of Factories 142 Inspections of Outworkers' Premises 32 Inspections of Bakehouses 37 Inspections of Cowsheds and Dairies 108 Under the Milk (Special Designations) Regulations, 1930-41 (including visits for purchase of samples) 135 Inspection of Dwelling Houses 238 Visits to Houses to ascertain permitted numbers 4 Inspections in connection with Overcrowding 75 Visits to homes of applicants for Council Houses 9 Carried forward 9,105 9 Brought forward 9,105 Other Shops 75 Food Inspections 155 Dwelling Houses re the Rent Restrictions Acts 6 Inspections under the Byelaws relating tc Hairdressers' and Barbers' Premises 22 Inspections of A.R.P. Shelters 194 Inspections of Brooks and Streams 34 Smoke Observations and visits 27 Total 9,618 Number of Notices Served during the Year. Informal Notices 372 Statutory Notices 6 The result of the service of these Notices was as follows:— Preliminary Notices. Statutory Notices. Complied with 264 6 Work in progress at end of year 17 — Not yet complied with 91 — Improvements effected as a result of Notices served. The following is a list of repairs executed or work done as aresult of inspections made or notices served No. of Houses. Roofs repaired and made weathertight 67 Spouts and downspouts cleaned and repaired or renewed 53 Interior walls repaired or replastered 39 Ceilings repaired or replastered 35 Walls and ceilings cleansed and distempered 35 Exterior brickwork repaired or repointed 23 Damp walls remedied 42 Stairs or staircases repaired 4 Broken sash cords renewed 15 Window frames repaired 29 Kitchen ranges repaired or renewed 6 Fireplaces repaired 11 Doors repaired 10 Door steps repaired or replaced 6 Dilapidated washing coppers repaired 4 Floors repaired or relaid 27 10 Scullery sinks renewed 4 Waste pipes repaired or renewed 10 Defective window sills repaired 10 Dilapidated dustbins renewed 90 Defective sub-floor ventilation remedied 7 Skirting boards repaired or replaced 4 Verminous premises fumigated, etc. 15 Choked drains cleared 56 Defective vent pipes repaired 5 Broken inspection chamber covers replaced 4 Drains repaired or relaid 9 W.C-.'s., fittings repaired or renewed 40 Storage cisterns cleansed 7 Cisterns repaired or renewed 10 Water supply re-instated after being cut off 8 Water pipes repaired 12 Accumulation of refuse removed 7 Nuisances arising from the keeping of animals, poultry, etc., remedied 7 Smoke nuisances remedied 1 Cases of overcrowding abated 1 Exterior paving repaired or relaid 6 Hot water systems repaired 3 Chimney pots and flues repaired 6 Insufficient water supply remedied 8 Defective covers to water tanks replaced 5 11 Full reports were supplied to the Ministry of Food as the work proceeded. A letter dated the 18th July, 1945, was then received from the Ministry, stating that the observations on the sewer position had been considered by their Technical Section, and they were of opinion that in view of the lightness of the infestations revealed by the sectional treatments already completed, we need not be pressed to undertake further sewer treatments. Verminous Houses. Fifteen 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 17 ,, Registered Premises 10 ,, Inspections 108 The cowsheds and dairies at two of the three farms were badly damaged by flying bombs in the early part of the year, and in consequence milk production was carried on with difficulty for a time, but satisfactory repairs were completed before the onset of winter. The following licences were granted to dealers to sell under the Milk (Special Designations) Regulations 1936-41 :— Tuberculin Tested 2 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 8 Pasteurised 8 One hundred and eighteen samples of milk were purchased and submitted for bacteriological examination to the Ministry of Health's Emergency Public Health Laboratory, at Hertford. 12 The following is a summary of the results of the examinations:— Designation. No. of Samples submitted. Test applied:— (a) Plate Count Result of Examination. (b) b. coli. (c) Methylene blue test. (d) Tubercle b. (e) Phosphatase test. Raw 27 (b) and (c) 4 Unsatisfactory. Tuberculin Tested 15 (b) and (c) 3 Unsatisfactory. T.T. (Pasteurised) 3 (a). (b) (c), and (e) Satisfactory. „ 5 (a), (c) and (e) Satisfactory. T.T. (Certified) 1 (a), (b) and (c) Satisfactory. „ „ 3 (b) and (c) Satisfactory. Accredited 9 (b ) and (c) Satisfactory. Pasteurised 3 (a), (b), (c) and (e) Satisfactory. „ 1 (b), (c) and (e) Satisfactory. „ 1 (c)and (e) Satisfactory. „ 19 (a), (c) and (e) Satisfactory. „ 1 (a) Satisfactory. „ 1 (a) and (e) Satisfactory. Homogenised 2 (a), (c) and (e) Satisfactory. „ 12 (b ) and (c) 2 Unsatisfactory. „ 1 (a), (b) and (c) Satisfactory. Sterilized 3 (b) and (c) Satisfactory. „ 1 (a), (c) and (e) Satisfactory. Jersey and Guernsey 7 (b) and (c) 3 Unsatisfactory. „ 3 (a), (c) and (e) Satisfactory. 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. The percentage of unsatisfactory samples was 10. The previous year it was 7%; in 1943, 9%; in 1942, 18%; and in 1941, 33%. 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 kitchens and cooking utensils inspected for cleanliness. 13 Food Condemned as unfit for Human Consumption. Cwts. lbs. Custard Powder 2 12 Apples 1 26 Cheese 1 211/4 Soya Flour 1 0 Dried Milk 1 0 Pea Flour 911/2 Ground Rice 84 Barley 84 Herrings 84 Coal Fish or Staithe 70 Soups 641/4 Semolina 64 Lentils 56 Dessert Powder 56 Eggs 523/4 Bacon 381/2 Spaghetti 30 Beef 31 Sausages 24 Pudding Mixture 161/2 Sultanas 141/2 Baking Powder 131/2 Marmite Cubes 91/2 Egg Substitute 81/4 Split Peas 8 Apple Rings 51/2 Margarine 5 Prunes 41/2 Boiled Sweets 4 Salt 4 Quaker Oats 4 Gravy Powder 31/2 Dried Eggs 31/2 Batter Flour 2 Cake Flour 2 Grapes 13/4 Pancake Mixture 13/4 Salad Powder 11/2 Cooking Fat 11/2 Mushrooms 11/4 Bean Flour 1 Coffee 1 Flaked Rice 1 Biscuits 1 722 tins of various foodstuffs 9 341/2 Total Cwts. 24 353/4 14 In conclusion, I wish to tender my thanks to other members of the staff for their assistance and co-operation throughout the year. Your obedient Servant, EDWARD HOUGHTON, A.R.San.I., Chief Sanitary Inspector.