EBAR 8 East Barnet Urban District Council. SEVENTY-THIRD ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946. 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 1946. 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. It will be noticed from the report of the Chief Sanitary Inspector that the percentage of unsatisfactory milk samples has fallen steadily for the past few years. Every care is taken to ensure that clean milk only is sold in this area, but this depends on constant vigilance and supervision, and even so the human factor occasionally fails. 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 1,280 examinations were made 98.5 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:— "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. 2 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 greater share of the responsibility has now been taken over by the County and I am at the moment unable to give accurate percentages of numbers immunised. A start has been made in the further protection of school children of the 8—10 year old age group. It is noteworthy that prejudice against immunisation is steadily decreasing and we are in process of being a well protected district. Scabies. During the year some 191 cases and contacts have been treated. A steady decrease. 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 1946, was 606, and we have reason to believe that the service is well appreciated in the district. Infectious Diseases. Except for a marked increase in incidence of chicken pox in 1946, comparable figures over the past five years show little marked variation. Fortunately no deaths were ascribed to infectious diseases and the two cases of Diphtheria were non-immunised cases. During the year we, in common with other surrounding districts, had some few cases of Poliomyelitis. Fortunately these cases were mild and the district escaped lightly. 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. Tuberculosis. Figures compare closely with previous year. The housing problem is closely linked with the tuberculosis problem and I would wish that it were possible to give more priority in adequate accommodation to cases of tuberculosis. i 3 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. The work of this department continues to increase both in amount and importance and I would like express my most sincere thanks to the members of my staff for their untiring patience and perseverance throughout the year. 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. Registrar-General's estimate of resident population, 1946, 39,160 Rateable Value (at 31st December, 1946, £382,849. Estimated product of a penny rate for 1946, £1,550. Vital Statistics. Total. M. P. Live Births. Legitimate 742 383 359 Illegitimate 21 8 13 Birth rate per 1,000 of the estimated resident population 19.4 (The birth rate for England and Wales was 19.1). Stillbirths 17 10 7 Rate per 1,000 (live and still) births 21.7 Total. M. F. Deaths 372 176 196 Death rate per 1,000 of the estimated resident population 9.4 (The death rate for England and Wales was 11.5). There were no deaths from puerperal causes. Death rate of Infants under one. year of age :— All Infants per 1,000 live births 36.6 Legitimate Infants per 1,000 Legitimate live births 36.3 Illegitimate Infants per 1,000 Illegitimate live births 47.6 Deaths from Cancer (all ages) 75 ,, Measles (all ages) 0 ,, Whooping Cough (all ages) 0 ,, Diarrhoea (under 2 years of age) 1 Birth Rate. There were 763 births (21 illegitimate) during the year. The birth rate is higher, 19.6 per 1,000 of the estimated resident population, as compared with 16.9 last year. The births last year numbered 597 including 26 illegitimate. Death Rate. There were 372 deaths, (363 last year) giving a rate of 9.4 compared with 10.2 last year. Infantile Death Rate. There were 28 deaths of children under one year as compared with 15 last year, a death rate per 1,000 live births of 36.6. Last year the figure was 25.1 and for 1946 35.3. For England and Wales the rate was 43 for 1946 and 46 for 1945. 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. 5 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 1946. 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 1946. CAUSES. Total Causes 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. Average for 6 years, 1940—1946. Diphtheria 2 ........ ........ ........ ........ ........ ........ 1 ........ 1 ........ ........ ........ 2 ........ 1 Scarlet Fever 67 ........ ........ 1 10 6 20 18 8 4 ........ ........ ........ 42 ........ 123 Chicken Pox 275 4 17 12 14 78 88 50 6 6 ........ ........ ........ 1 ........ 70 Whooping Cough 144 8 22 28 16 53 14 1 ........ 2 ........ ........ ........ 1 ........ 59 Measles 333 12 61 76 86 85 10 ........ 1 2 ........ ........ ........ 2 ........ 409 Pneumonia 13 2 1 ........ ........ ........ ........ ........ 1 ........ ........ 3 6 6 ........ 36 Erysipelas 5 ........ ........ ........ ........ ........ ........ ........ 1 ........ ........ 2 2 1 ........ 8 Para-Typhoid 1 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ 1 ........ 1 ........ 1 Cerebro Spinal Fever 1 ........ ........ ........ ........ ........ ........ ........ 1 ........ ........ ........ ........ 1 ........ ........ Poliomyelitis 3 ........ ........ ........ ........ ........ ........ 1 ........ 2 ........ ........ ........ 3 ........ ........ Dysentry 3 ........ ........ ........ ........ ........ ........ 1 ........ ........ 1 1 ........ 3 ........ ........ Total 847 26 101 117 126 222 132 72 18 17 1 7 8 63 — 707 6 TABLE II. Causes of, and Ages at, Death during the year 1946. CAUSES OF DEATH. All Ages. Under 1 year. 1—2 years. 2—5 years. 5—15 years. 15—25 years. 25—45 years. 45—65 years. 65 and over. Total Deaths in Public Institutions in the District. Cancer 75 ...... ...... ...... ...... ...... 3 16 56 32 Heart Disease 106 ...... ...... ...... ...... 2 4 11 99 51 Arterio Sclerosis 2 ...... ...... ...... ...... ...... ...... 1 1 2 Hyperpiesis 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Coronary Thrombosis 11 ...... ...... ...... ...... ...... ...... 3 8 8 Cerebral Thrombosis 23 ...... ...... ...... ...... ...... ...... 3 10 16 Cerebral Haemorrhage 17 2 ...... ...... ...... ...... ...... 1 14 5 Cerebral Abscess 5 ...... ...... ...... ...... 1 1 3 ...... 5 Tumour of Spinal Cord 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Pneumonia 14 5 ...... ...... 1 ...... 2 4 2 14 Bronchitis 16 3 ...... ...... ...... ...... 1 2 10 6 Influenza 5 ...... ...... ...... ...... ...... 1 1 3 2 Pleurisy 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Tuberculosis 14 ...... ...... ...... ...... 1 6 6 1 10 Pulmonary Oedema 2 ...... ...... ...... ...... ...... ...... 1 1 2 Pulmonary Embolism 3 ...... ...... ...... ...... ...... ...... 1 2 3 Premature Birth 10 10 ...... ...... ...... ...... ...... ...... ...... 8 Congenital Collapse of Lung 1 I ...... ...... ...... ...... ...... ...... ...... ...... Inanition 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Septicaemia 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Congenital Malformation of Bowel 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Icterus Gravis Neonatorum 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Debility 1 1 ...... ...... ...... ...... ...... ...... ...... ...... Pernicious Anaemia 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Hodgkins Disease 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Leukaemia 1 ...... ...... ...... ...... ...... 1 ...... ...... ...... Cerebral Tumour 1 ...... ...... ...... ...... ...... 1 ...... ...... 1 Appendicitis 2 ...... ...... ...... ...... ...... 1 ...... 1 2 Peritonitis 3 ...... ...... ...... ...... ...... ...... ...... 3 3 Intestinal Obstruction 2 ...... ...... ...... ...... ...... 1 ...... 1 2 Nephritis 7 ...... ...... ...... 1 ...... 2 ...... 4 6 Pyelonephritis 3 1 ...... ...... ...... ...... ...... ...... 2 3 Uraemia 5 ...... ...... ...... ...... ...... 1 1 3 ...... Cachexia 3 ...... ...... ...... ...... ...... ...... ...... 3 3 Erysipelas 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Cholaemia 1 ...... ...... ...... ...... ...... 1 ...... ...... 1 Gastric Ulcer 3 ...... ...... ...... ...... ...... ...... 1 2 3 Duodenal Ulcer 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Gastro Enteritis 1 1 ...... ...... ...... ...... ...... ...... ...... 1 Gangrene of Arm 1 ...... ...... ...... ...... ...... ...... ...... 1 1 Parkinsons Disease 1 ...... ...... ...... ...... ...... ...... 1 ...... 1 Syphillis 2 ...... ...... ...... ...... ...... 1 1 ...... 2 Diarrhoea 1 ...... 1 ...... ...... ...... ...... ...... ...... 1 Diabetes 3 ...... ...... ...... ...... ...... ...... 2 1 3 Senility 5 ...... ...... ...... ...... ...... ...... ...... 5 4 Suicide 4 ...... ...... ...... ...... 2 1 1 ...... 2 Accident 7 ...... ...... ...... 1 2 ...... ...... 4 6 Totals 373 28 1 ...... 3 8 28 62 242 220 Comparable figures for 1945 363 15 1 1 4 6 34 90 212 147 7 TABLE III. Infantile Mortality, 1946. 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 10 ...... ...... ...... 10 ...... ...... ...... ...... 10 Pneumonia 1 ...... 1 1 3 2 ...... ...... ...... 5 Bronchitis 1 ...... 1 ...... 2 ...... 1 ...... ...... 3 Congenital collapse of lung 1 ...... ...... ...... 1 ...... ...... ...... ...... 1 Inanition 1 ...... ...... ...... 1 ...... ...... ...... ...... 1 Cerebral Haemorrhage 2 ...... ...... ...... 2 ...... ...... ...... ...... 2 Septicaemia ...... 1 ...... ...... 1 ...... ...... ...... ...... 1 Congenital Maldevelopment of Bowel ...... 1 ...... ...... 1 ...... ...... ...... ...... 1 Icterus gravis Neonatorum 1 ...... ...... ...... 1 ...... ...... ...... 1 Debility 1 ...... ...... ...... 1 ...... ...... ...... ...... 1 Pyelonephritis ...... ...... ...... 1 1 ...... ...... ...... ...... 1 Gastro Enteritis ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 Totals 18 2 2 2 24 2 2 — — 28 1945 13 — — — 13 2 — — 15 TABLE IV. Tuberculosis. New Cases and Mortality during Year 1940. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0— ...... ...... ...... ...... ...... ...... ...... ...... 1— 2 ...... 1 ...... ...... ...... ...... ...... 5— 2 ...... 1 ...... ...... ...... ...... ...... 15— 2 1 ...... 1 ...... ...... ...... ...... 25- 10 12 ...... ...... ...... ...... ...... ...... 35— 11 6 ...... ...... 6 ...... ...... ...... 45— 4 2 ...... ...... 4 1 ...... ...... 55— 2 ...... ...... ...... 1 1 ...... ...... 65 and over 2 1 ...... 1 ...... 1 ...... ...... Totals 35 22 2 2 11 3 — — 1945 33 24 5 3 6 8 — — East Barnet Urban District Council. ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1946. 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 :— 1946 1945 Nuisances and sanitary defects 5,514 4,958 Infectious Diseases 682 566 Restaurants, Snack Bars, etc. 86 44 Water Supply 56 98 Schools 68 65 Verminous Premises 126 126 Fish Shops 49 36 Butchers' Shops 173 121 Other Food Shops 209 226 Various Premises re rats 912 1,862 Visits in connection with Scabies cases 10 111 Inspections for dilapidated dustbins 292 112 Inspections of Factories 203 142 Inspections of Outworkers' Premises 53 32 Inspections of Bakehouses 43 37 Inspections of Cowsheds and Dairies 200 108 Under the Milk (Special Designations) Regulations, 1936-41 including visits for purchase of samples) 155 135 Inspection of Dwelling Houses 182 238 Visits to Houses to ascertain permitted numbers 28 4 Inspections in Connection with Overcrowding 120 75 Visits to homes of applicants for Council Houses. 1,248 9 Carried forward 10,409 9,105 9  1946 1945 Brought forward 10,409 9,105 Other Shops 95 75 Food Inspections 271 155 Dwelling Houses re the Rent Restrictions Acts — 6 Inspections under the Byelaws relating to Hairdressers' and Barbers' Premises 15 22 Inspections of A.R.P. Shelters — 194 Inspections of Brooks and Streams 76 34 Smoke observations and visits 32 27 Total 10,898 9,618 Number of Notices Served during the Year. 1946 1945 Informal Notices . . 456 372 Statutory Notices 57 6 The result of the service of these Notices was as follows :— Preliminary Notices. Statutory Notices. 1946 1945 1946 1945 Complied with 371 264 50 6 Work in progress at end of year 25 17 2 — Not yet complied with 60 91 5 — Improvements effected as a result of Notices served. The following is a list of repairs executed or work done as a result of inspections made or notices served :— No. of Houses 1946 1945 Roofs repaired and made weathertight 127 67 Spouts and downspouts cleaned and repaired or renewed 95 53 Interior walls repaired or replastered 99 39 Ceilings repaired or replastered 94 35 Walls and Ceilings cleansed and distempered 40 35 Exterior brickwork repaired or repointed 44 23 Damp walls remedied 87 42 Stairs or staircases repaired 9 4 Broken sash cords renewed 28 15 Window frames repaired 77 29 Kitchen ranges repaired or renewed 7 6 Fireplaces repaired 15 11 Doors repaired 22 10 Door steps repaired or replaced 3 6 Dilapidated washing coppers repaired 6 4 Floors repaired or relaid 52 27 10  No. of Houses 1946 1945 Scullery sinks renewed 2 4 Waste pipes repaired or renewed 22 10 Defective window sills repaired 27 10 Dilapidated dustbins renewed 125 90 Defective sub-floor ventilation remedied 16 7 Skirting boards repaired or replaced 3 4 Verminous premises fumigated, etc. 27 15 Choked drains cleared 36 56 Defective vent pipes repaired 8 5 Broken inspection chamber covers replaced 12 4 Drains repaired or relaid 37 9 W.C.'s., fittings repaired or renewed 64 40 Storage cisterns cleansed 4 7 Cisterns repaired or renewed 8 10 Water supply re-instated after being cut off 4 8 Water pipes repaired 14 12 Accumulation of refuse removed 4 7 Nuisances arising from the keeping of animals, poultry, etc., remedied 3 7 Smoke nuisances remedied 1 1 Cases of overcrowding abated — 1 Exterior paving repaired or relaid 14 6 Hot water systems repaired 9 3 Chimney pots and flues repaired 4 6 Insufficient water supply remedied 3 8 Defective covers to water tanks replaced 4 5 Lavatory basins renewed 3 — Rat Destruction. One hundred and thirty-four complaints of rat infestation were received, all of which were investigated and advice given as to the best methods of dealing with them. All the premises affected were repeatedly visited until finally cleared of rats. Many cases were also visited by the staff of the County Pests Officer at our request, and I must again acknowledge the valuable assistance and cordial co-operation of Mr. Sharp and his staff. There were no heavy infestations and all could be classed as belonging to the "Minor Secondary " type. Verminous Houses. Twenty-seven privately owned houses were found to be infested with bed bugs. All were disinfested by stripping and burning wallpaper and spraying with "Zaldecide" or Coopers D.D.T. liquid insecticide after loosening or removal of picture rails, skirting boards and architraves, followed where necessary by sealing and fumigation by sulphur of the infested rooms. 11 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Number of Cowkeepers on the Register 3 Retailers 23 ,, Registered Premises 10 ,, Inspections 200 The following licences were granted to dealers to sell under the Milk (Special Designations) Regulations 1936-43 :— 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 seventeen samples of milk were purchased and submitted for bacteriological examination to the Ministry of Health's Emergency Public Health Laboratory, at Hertford. The following is a summary of the results of the examinations :— Designation. No. of Samples submitted. Test applied :— (a) Plate Count (b) b. coli. (c) Methylene blue test. (d) Tubercle b. (e) Phosphatase test. Result of Examination. Undesignated 15 (b) and (c) 1 Unsatisfactory. Tuberculin Tested 20 (b) and (c) 5 Unsatisfactory. T.T. (Pasteurised) 12 (c) and (e) 1 Unsatisfactory. ,, ,, 1 (a), (c) and (e) Satisfactory. T.T. (Certified) 7 (b) and (c) Satisfactory. Accredited 3 (b) and (c) Satisfactory. Pasteurised 4 (a), (c) and (e) Satisfactory. ,, 24 (c) and (e) 1 Unsatisfactory. Homogenised 2 (a), (c) and (e) Satisfactory. ,, 1 (b) and (c) Satisfactory. ,, 12 (c) and (e) Satisfactory. Sterilized 4 (c) and (e) Satisfactory. Jersey and Guernsey 4 (b) and (c) Satisfactory. ,, ,, 2 (a), (c) and (e) Satisfactory. ,, ,, 6 (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 an investigation. The percentage of unsatisfactory samples was 6. The previous year it was 10% ; in 1944, 7% ; in 1943, 9% ; in 1942, 18% ; and in 1941, 33%. 12 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. Food Condemned as unfit for Human Consumption. Cwts. lbs. Fish 4 2 145 Rabbits 9 85 Beef 1 3¾ Sausage rusk 1 0 Potatoes 1 0 Ox Tongues 103½ Shrimps 98 Dates 79¼ Dried Peas 68 Cheese 53¼ Sultanas 42 Tripe 36½ Dried Beans 35 Seedless Raisins 30 Prunes 30 Sausages 25 Cocoa 20 Margarine 16 Cake Extender 14 Macaroni 12 Apple Crush 8 Miscellaneous (butter, sugar, cooking fat, etc.) 4 741 tins of various foodstuffs 10 96¾ Total 26 78 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.