FINC 37 Borough of Finchley ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1956 A. W. HAY, M.B., B.S., D.P.H. Medical Officer of Health FINC 37 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 MEMBERS OF THE PUBLIC HEALTH COMMITTEE as at 31st December, 1956 Chairman : Councillor Miss E. M. KILLIP Vice-Chairman : Councillor G. H. T. WATSON THE MAYOR (Councillor G. T. BRUNSKILL, J.P.) THE DEPUTY MAYOR (Councillor W. G. Hart) Alderman C. P. GROBEL „ A. T. PIKE, O.B.E.,J.P. „ L. G. SNELLING Councillor Major K. M. CAVE, M.C. „ R. N. CHESTERTON „ W. J. ENRIGHT „ E. GRANT „ Mrs. G. I. WILSON, M.A. „ R. YORKE MEMBERS OF THE COUNCIL APPOINTED TO VARIOUS BODIES CONCERNED WITH PUBLIC HEALTH WORK (as at 31st December, 1956) Middlesex County Council Local Area (Health) Committee Alderman L. G. SNELLLNG Councillor W. J. ENRIGHT „ Miss E. M. KILLIP „ G. H. T. WASON „ Mrs. G. I. WILSON, M.A. Barnet Group (No. 5) Hospital Management Committee Councillor Mrs. G. I. WILSON, M.A. Napsbury Hospital Management Committee Councillor G. W. REED Finchley Hospital Committee Councillor E. GRANT 2 Royal Free Hospital (Teaching) Group County Councillor H. J. TREBY The Council of the National Smoke Abatement Society Councillor Miss E. M. KILLIP London and Home Counties Smoke Abatement Advisory Council Councillor R. YORKE Middlesex Old People's Welfare Committee Alderman P. LAWRENCE „ Mrs. M. E. LEGGE, M.B.E. Finchley Old People's Welfare Committee THE MAYOR (Councillor G. T. BRUNSKILL, J.P.) Alderman P. LAWRENCE „ Mrs. M. E. LEGGE, M.B.E. „ L. G. SNELLING Councillor E. GRANT Finchley Guild of Social Service THE MAYOR (Councillor G. T. BRUNSKILL, J.P.) Alderman P. LAWRENCE „ Mrs. M. E. LEGGE, M.B.E. „ L. G. SNELLING Councillor E. GRANT „ Captain C. H. KITCHIN STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health : A. W. HAY, M.B., B.S., D.P.H. Deputy Medical Officer of Health: CHRISTINA RUSSELL, M.B., Ch.B., D.P.H. Chief Public Health Inspector: J. GRAY, M.B.E., F.R.S.H., F.A.P.H.I. 3 Deputy Chief Public Health Inspector : J. YATES, Cert.R.S.H. District Public Health Inspectors : W. H. NICHOLLS, Cert.R.S.H., K. J. MILLEN, Cert.R.S.H., E. A. SELLAR, Cert.R.S.H., J. P. DAVIES, Cert.R.S.H. Each of the Public Health Inspectors holds the special diploma of the Royal Society of Health for the inspection of meat and other foods. Chief Clerk: D. J. LEGGE (resigned 17/6/56, re-apointed 22/10/56) Clerks: Miss K. M. NICHOL A. G. FORSYTH Mrs. E. M. WELLS (resigned 28/5/56) Miss B. HENEGAN (appoined 18/6/56) Miss J. G. BACON (appointed 16/7/56, resigned 18/8/56) Miss E. J. STANLEY (appointed 17/9/56) Miss C. A. BURGE 4 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF FINCHLEY. October, 1957. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Report for the year 1956. The overall picture indicates that the health of the people of Finchley is good, and is improving. For the newly-born, the chances of survival and good health have never been better. The infantile mortality rate which shows the deaths of children in the first year of life, was 13.2 deaths per 1,000 live births. This compares favourably with a rate of 19.1 in the County of Middlesex as a whole and a rate of 23.8 in England and Wales. It is not so many years ago since the infantile mortality rate in Finchley was many times the rate shown for this year, for instance, in 1934 there were 59 deaths per 1,000 live births in Finchley. The neo-natal death rate, which indicates the number of deaths in the first month of life per 1,000 births, fell during the year to 8.8, the national average for the country being 16.9. During the first year of life, 7 out of 12 deaths occurred in the first month and were caused by congenital defects which cannot be avoided by treatment. There are many reasons for this great improvement in the chances of a baby's survival in the first year of life. Improved standards of living, better diet, and education of the mother as well as improved medical services and modern drugs, all play a part. Turning to the causes of death for those surviving the first year of life we find the statistics reflect the fact that Finchley has an ageing population. The most striking item in all the statistics is the prominence of deaths caused by diseases of the heart and circulation. Of the 831 deaths in the Borough, more than half (442) were from this cause, and the vast majority of persons affected (368) were over the age of 65. Neverthless, the standardised death rate of 10.9 is less than the national average for the country of 11.7. The care of the aged continues to be a problem for General Practitioners, Hospitals, the Welfare Services, and Voluntary Organisations. The main difficulty is in the care of those who are regarded as "Chronic sick" who cannot look after themselves properly at home, but whom the Hospital Authorities are naturally reluctant to admit as they prefer to use the beds for more acute cases. The 5 Welfare Officer is similarly reluctant to admit them to welfare hostels as their medical condition renders them more infirm than the hostel can cope with. These old people can become acutely ill quickly and are a source of continual anxiety for those caring for them in their own homes. Although they do not always require nursing attention, there appears to be a need for them to be admitted to some form of old people's home attached to a hospital where they can be visited by the hospital Specialist and transferred if necessary to the hospital proper. In the Finchley area these cases are dealt with jointly by the Hospital Geriatric Specialist, the Area Welfare Worker and the Medical Officer of Health, who frequently visit the old person's house in order to decide whether hospital, hostel or home treatment is the best in any particular case. The common infectious diseases are no longer an important cause of death. During the year there were no deaths from Diphtheria, Whooping Cough, Measles, Typhoid Fever or Poliomyelitis. Indeed there has been no case of Diphtheria in the Borough since 1946. It should be remembered that before immunisation of children against this disease began, cases were numerous. In 1940 there were 42 cases, and in 1930, there were 96 cases. The continuation of immunisation is obviously most important. Deaths still occur from Tuberculosis, but the case rate of 5.44 per 10,000 population is the lowest recorded in the Borough. The Mass Radiography Unit helps to discover early cases and enables successful treatment to be undertaken. The statutory change in the designation from Sanitary Inspector to Public Health Inspector has been made to conform with the gradual change in the employment and increasing responsibilities of these officers in environmental health. Their statutory duties were added to during the year by the introduction of new Food Hygiene Regulations which came into operation in January. The Regulations are aimed at preventing the spread of food poisoning, the rapid increase in which has caused concern during the last few years. The Regulations enforce higher standards of cleanliness in all food establishments and include the provision of hot water and hand washing basins in premises selling open food. Although this involved the owners in some expenditure, I am pleased to report that Finchley traders accepted the new requirements conscientiously. To survey the premises covered by the Regulations, the Public Health Inspectors 6 made 478 visits to food shops, cafes, etc., and found that in 461 cases some modification was required. It is an indication of a desire among food traders themselves to protect the health of the public, that only two owners made serious objections to carrying out necessary alterations. I would like to thank the staff of the Health Department for the way in which they have carried out their work during the year, and also to express my gratitude to the Chief Officers of other Council Departments for the ready co-operation they have shown. I acknowledge the continued interest and assistance of the Chairman and Members of the Public Health Committee of the Borough Council in all measures aimed at promoting and protecting the health of the people of Finchley. I am, Mr. Mayor, Ladies and Gentiemen, Your obedient Servant, A. W. HAY, Medical Officer of Health. 7 STATISTICS Area (in acres) 3,478 Population, 1956 (Registrar-General's Estimate) 69,800 Number of Inhabited Houses (at 1st April, 1956) 20,100 Rateable Value (at 1st April, 1956) £1,422,233 Product of a Penny Rate, year 1956/57 £5,820 Total Live Births 910 Birth Rate per 1,000 home population 13.0 Birth Rate per 1,000 population (England and Wales) 15.7 Total Stillbirths 13 Stillbirth Rate per 1,000 (live and still) births 14.1 Stillbirth Rate per 1,000 (live and still) births (England and Wales) 23.0 Total Deaths 831 Crude Death Rate per 1,000 home population 11.9 Standardised Death Rate 10.9 Death Rate per 1,000 population (England and Wales) 11.7 Infant Deaths 12 Infant Mortality Rate 13.2 Infant Mortality Rate (England and Wales) 23.8 Neo-Natal Deaths 8 Neo-Natal Mortality Rate 8.8 Neo-Natal Mortality Rate (England and Wales) 16.9 Maternal Deaths 1 Maternal Mortality Rate 1.08 Maternal Mortality Rate (England and Wales) 0.56 Live Births 2 Males Females Total Legitimate 447 435 882 Illegitimate 13 15 28 460 450 910 Birth rate 13.0 per 1,000 estimated home population. Males Females Total Stillbirths 6 7 13 Rate 14.1 per 1,000 (live and still) births. 8 Males Females Total Deaths 401 430 831 Rate 11.9 per 1,000 estimated home population. Deaths from disease and accidents of pregnancy and childbirth : From Sepsis — Other maternal causes 1 Death Rate of infants under one year of age : All infants per 1,000 live births 13.2 Legitimate infants per 1,000 legitimate live births 12.47 Illegitimate infants per 1,000 illegitimate live births 35.71 Deaths from Cancer (all ages) 152 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) — Population The Registrar-General has estimated the home population to be 69,800 which is 60 less than in 1955. Births There were 910 registered live births in 1956 as compared with 894 in the previous year while the birth rate was 13.0 as compared with 12.8. The rate for England and Wales was 15.7. Stillbirths There were 13 stillbirths and all except two took place in hospital or nursing home. The stillbirth rate for the Borough was 0.19 per 1,000 of the home population, and for England and Wales it was 0.37. Infantile Mortality There were twelve deaths of infants under one year of age giving an infantile mortality rate of 13.2 per 1,000 live births. The corresponding rate for England and Wales was 23.8. 9 Maternal Mortality There was one maternal death in 1956. Deaths There were 831 deaths in 1956, some 85 more than in 1955. The standardised death rate was 10.9 and that for England and Wales was 11.7. There were 33 deaths from cancer of the lung. This figure was the same as in the previous year. Motor car accidents accounted for 10 deaths, other accidents for 15 deaths, and there were 10 suicides. In addition, 1 death was due to homicide and 1 to operations of war. Of the total deaths 630 were of persons over 65 years of age. Mortuary One hundred and forty-six bodies were received in the Mortuary, and of these 24 were from Friern Barnet, and 30 from Potters Bar. Post-mortem examinations were carried out in all cases. 10 11 12 BIRTH AND DEATH RATES SINCE 1925 Rates per 1,000 Population INFANTILE MORTALITY DURING THE YEAR 1956 Deaths from stated causes at various ages under one year of age CAUSES OF DEATH Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3-6 months 6-9 months 9-12 months TOTAL Smallpox - - - - - - - - - - Chicken Pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - - - - Diphtheria & Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - Convulsions - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - - - - - Pneumonia (all forms) - - - - - - - - - - Diarrhoea - - - - - - - - - - Enteritis — — — 1 1 — — — — 1 Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, Overlying - - - - - - 1 - - 1 Injury at Birth - - - - - - - - - - Atelectasis 2 — — - 2 — — — — 2 Congenital Malformations 1 - - - 1 - - - 1 2 Premature Birth 3 — — — 3 — — - — 3 Atrophy, Debility and Marasmus - - - - - - - - - - Other Causes 1 — — 1 2 — - 3 TOTALS 7 — — 1 8 — 3 1 1 12 13 VITAL STATISTICS FOR THE PAST 25 YEARS Year Total Births Birth Rate Total Deaths Death Rate Total Infant Deaths Infantile Mortality Rate Deaths from Measles Deaths from Whooping Cough Deaths from Diarrhoea (under 2 years) 1932 698 11.6 621 10.3 35 50.0 4 3 3 1933 671 11.0 592 9.7 27 40.2 — 3 6 1934 712 11.5 658 10.7 42 59.0 1 13 4 1935 807 12.9 656 10.5 39 48.5 — — 17 1936 833 13.0 643 10.0 36 43.2 2 1 6 1937 895 13.8 704 10.8 36 40.2 - 1 7 1938 927 14.2 662 10.2 33 35.6 4 1 5 1939 951 14.5 705 11.1 35 36.8 — — 3 1940 725 12.1 806 12.9 27 38.0 1 — 2 1941 721 12.4 734 12.7 15 21.8 — 3 1 1942 891 14.9 751 12.5 48 53.9 1 7 3 1943 1035 17.1 790 13.0 57 55.1 1 2 4 1944 1037 17.4 830 13.9 34 32.8 — 5 5 1945 987 16.1 725 11.8 36 36.4 1 — 1 1946 1207 17.6 774 11.3 30 24.9 1 1 5 1947 1319 18.7 830 11.7 27 20.5 — 1 4 1948 1086 15.3 763 10.8 30 27.6 — 1 2 1949 981 13.9 834 11.8 19 19.3 — — 2 1950 962 13.6 819 11.6 16 16.6 — — — 1951 915 13.0 877 12.5 22 24.0 — — — 1952 953 13.6 782 11.1 11 11.5 — — — 1953 902 12.9 765 10.9 20 22.2 — — — 1954 877 12.5 747 10.7 16 18.2 — — — 1955 894 12.8 746 10.7 19 21.3 — — — 1956 910 13.0 831 11.9 12 13.2 — — — 14 15 16 INFANT DEATH AND NEONATAL DEATH RATES SINCE 1925 Rates per 1,000 Live Births ' - CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1956 No. CAUSES OF DEATH. NET DEATHS AT THE SUBJOINED AGES OF " RESIDENTS " WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT. All Ages Under 4 months 4 months and under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards 1. Tuberculosis, Respiratory 8 ...... ...... ...... ...... ...... 1 1 5 1 2. Tuberculosis, Other ...... ..... ...... ...... ...... ...... ...... ...... ...... ...... 3. Syphilitic Disease 1 ...... ...... ...... ...... ...... ...... ...... 1 ...... 4. Diphtheria ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 5. Whooping Cough ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 6. Meningococcal Infections 1 ...... 1 ...... ...... ...... ...... ...... ...... ...... 7. Acute Poliomyelitis ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 8. Measles ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 9. Other Infective and Parasitic Diseases 4 ...... ...... ...... 1 ...... 1 ...... 2 ...... 10. Malignant Neoplasm, Stomach 13 ...... ...... ....... ...... ...... ...... 6 5 2 11. Malignant Neoplasm, Lung, Bronchus 33 ...... ...... ...... ...... ...... 1 17 13 2 12. Malignant Neoplasm, Breast 22 ...... ...... ...... ...... ...... 1 11 7 3 13. Malignant Neoplasm, Uterus 2 ....... ...... ...... ...... ...... 2 ...... ...... ...... 14. Other Malignant and Lymphatic Neoplasms 82 ...... ...... ...... ...... ...... 3 19 28 32 15. Leukaemia, Aleukæmia 2 ...... ...... ...... ...... ...... ...... ...... 1 1 16. Diabetes 3 ...... ...... ...... ...... ...... ...... ...... 1 2 17. Vascular Lesions of Nervous System 117 ...... ...... ...... ...... ...... 1 14 40 62 18. Coronary Disease, Angina 132 ...... ...... ...... ...... ...... ...... 33 44 55 19. Hypertension with Heart Disease 27 ...... ...... ...... ...... ...... ...... 5 6 16 20. Other Heart Disease 124 ...... ...... ...... ...... ...... 1 13 17 93 21. Other Circulatory Disease 42 ...... ...... ...... ...... ...... 2 5 10 25 22. Influenza 2 ...... ...... ...... ...... ...... ...... ...... 1 1 23. Pneumonia 30 ...... ...... ...... ...... ...... ...... 1 5 24 24. Bronchitis 55 ....... ...... ...... ...... ...... ...... 8 18 29 25. Other Diseases of Respiratory System 5 ...... ...... ...... ...... ...... ...... 2 ...... 3 26. Ulcer of Stomach and Duodenum 9 ...... ...... ...... ...... ...... ....... 1 4 4 27. Gastritis, Enteritis and Diarrhoea 3 1 ...... ...... ...... ...... ...... ...... 2 - 28. Nephritis and Nephrosis 2 ...... ...... ...... ...... ...... ...... 1 ...... 1 29. Hyperplasia of Prostate 11 ...... ...... ...... ...... ...... ...... ...... 1 10 30. Pregnancy, Childbirth, Abortion 1 ...... ...... ...... ...... ...... 1 ...... ...... - 31. Congenital Malformations 2 1 1 ...... ...... ...... ...... ...... ...... - 32. Other Defined and Ill-Defined Diseases 61 5 1 ...... ...... ...... 4 14 13 24 33. Motor Vehicle Accidents 10 ...... ...... ...... 2 2 ...... 3 2 1 34. All Other Accidents 15 2 ...... ...... ...... ...... ...... 3 4 6 35. Suicide 10 ...... ...... ...... ...... ...... 4 3 2 1 36. Homicide and Operations of War 2 ...... ...... ...... ...... 1 ...... 1 ...... - Totals 831 9 3 ...... 3 3 22 161 232 398 17 18 INFECTIOUS DISEASES The following table shows the number of cases notified during the past five years:— 1952 1953 1954 1955 1956 Diphtheria - - - - - Scarlet Fever 93 69 68 59 34 Smallpox — — — — — Enteric Fever — — — — — Meningococcal Infection 2 — — — 1 Poliomyelitis 3 11 1 7 5 Pneumonia 48 49 38 47 37 Measles 577 857 99 1,087 172 Whooping Cough 273 165 91 18 78 Diphtheria Once again it is pleasing to record here that there were no cases of Diphtheria in Finchley during the year. It may be of interest to note that the last case in the Borough occurred in 1946. During the year 15 children were immunised by General Practitioners and 27 by Medical Officers of the Local Health Authority. In addition, 749 children were immunised with a combined diphtheria and whooping cough prophylactic, 326 by General Practitioners and 423 by the Local Health Authority. Five hundred and nineteen children were given " booster " doses of diphtheria prophylactic alone, and 21 children were given "booster" doses of combined diphtheria and whooping cough prophylactic. Scarlet Fever There were 34 cases of Scarlet Fever, 25 less than in the previous year. The known cases were mild in character and there is little doubt that in a number of others the illness was so slight as to escape detection altogether. There were no deaths. Poliomyelitis During the year, five cases of Poliomyelitis were notified to me, and of these, 4 were found to be suffering from the paralytic form. There were no deaths from the disease and in only one case was there any severe residual paralysis. 19 The Council have continued to grant to the North London Branch of the Infantile Paralysis Fellowship the use of the Squires Lane Bath on alternate Sundays for "old" cases of Poliomyelitis. The cases are collected from a wide area by ambulances and cars and they are assisted in changing and also in the water by voluntary helpers. All cases are certified by a doctor to be free from infection. Vaccination against Poliomyelitis Vaccination of children in certain age groups between the ages of 2 and 9 years was started early in May and was continued until the end of June. During these two months, 243 Finchley children were vaccinated. Those selected for vaccination were from the following age groups:— Children born in August and November (1947—1954). Children born in March (1951—1954). The vaccine is tested to very high standards and the Ministry of Health are satisfied that no adverse complications can result from the 2 injections which are given at monthly intervals. Indeed it is to be hoped that the benefit of protection against Poliomyelitis will be extended in the near future to all children and will become accepted as a routine measure for the protection of health in the same way as we have come to accept immunisation against Diphtheria. Measles The number of notifications was 172 compared with 1,087 in 1954. There were no deaths. Whooping Cough The notifications numbered 78 in 1956 and there were no deaths. During the year, 2 children were immunised by Medical Officers of the Local Health Authority. Pneumonia Thirty-seven cases were notified in 1956 and there were 30 deaths. All except one were persons of 65 years of age and over. 20 Puerperal Pyrexia The total number of cases notified during the year was 21, all of which occurred at the North Middlesex Hospital Annexe in The Bishop's Avenue. Food Poisoning Seven cases of Food Poisoning were notified during the year. All were single cases, the agents of four were discovered, but those for the others remained unidentified. Dysentery Nineteen cases of Dysentery were notified during the year, all of these being affected during an outbreak of Sonne Dysentery at an Infants' School, which began at the end of May. On the 30th May, 19 children attending a particular Infants' School developed symptoms and it was necessary to admit 2 of them to hospital. Investigations failed to reveal that school meals or milk were responsible, but bacteriological examinations showed the cause of the outbreak to be this particular type of dysentery bacteria which had been passed from one child to another. The children affected used a common set of lavatories, and as recent outbreaks of this disease in other parts of the country have been found to be caused by poor toilet hygiene, special instructions were given at the school. It was an interesting coincidence that the caretaker responsible for cleaning and disinfecting the toilet seats and fittings had been off work for two weeks before the epidemic began. With the co-operation of the teachers, strict instructions were given to the children with regard to toilet hygiene, especially hand washing, and frequent disinfection of the lavatories was carried out. A circular was sent to all doctors in the area giving them information of the type of disease and asking them to co-operate in certain measures in the homes of children affected to prevent the spread of infection. Numerous cases continued to occur among children during June, but by the co-operation of General Practitioners in the treatment of home cases, and school teachers in hygiene measures in the school, the number of cases rapidly diminished and the epidemic ceased at the beginning of July. During the outbreak, 119 suspected cases of Dysentery were investigated, of whom 47 were found to be suffering from the disease. All of these were carefully followed up and investigated after treatment to ensure that no children remained carriers of the disease. 21 Typhoid Fever One case was notified during 1956, being the first to occur in the Borough for many years. The person concerned was a Doctor who worked in a London hospital doing bacteriological research. When he first developed symptoms, he was actually working with cultures of the typhoid bacteria and he therefore diagnosed his illness with speed and accuracy. He was admitted to hospital where he made an uneventful recovery and no doubt made use of the opportunity for practical study of the clinical aspects of the disease. Precautions were taken among all members of his family to ensure that no further cases arose. This incident was a reminder of the danger of typhoid infection which nowadays because of modern sanitation and water purification is no longer one of the commoner infectious diseases. Paratyphoid Fever One case was disovered in the Borough during the year, and occurred in a girl aged 12 who had just returned from her summer holidays a week previously. As this is a disease which is passed from one person to another, usually in food, and there were no other cases in the Finchley area, I communicated with the Medical Officer of Health for the district of Sussex where the girl spent her holiday. Bacteriological investigations carried out on the persons in the house where the girl had stayed showed that although neither the man nor his wife had been unwell, they were nevertheless carriers of the Paratyphoid bacteria. Phage typing showed it to be the same type as that which had caused the illness, and both persons were subsequently given modern drug treatment until they were no longer carriers of the infection. Members of the public are not always aware that they can be disease carriers and yet remain without symptoms themselves, and the work of tracing such persons is one in which the Health Department is continually engaged to protect the health of the population. Influenza Although not a notifiable disease, the Ministry of Health advised the setting up of an Influenza Spotting Scheme, both to give warning of an outbreak, and also to carry out virus typing investigations. Close liaison was kept with General Practitioners, schools and pharmacists for this reason, and in addition, 2 local Doctors agreed to keep daily 22 records of all Influenza cases seen by them. These Doctors also helped by submitting specimens of blood from selected patients suffering from Influenza in order that Influenza virus typing could be done. Typing was carried out at Colindale Public Health Laboratory throughout the winter under the direction of Dr. C. E. D. Taylor. Although no epidemic of Influenza occurred, much useful information was obtained and the co-operation of the 2 local Doctors was greatly appreciated, especially so, as the winter months give the General Practitioner his busiest time and he can ill-afford to make reports and carry out special investigations in addition to his normal duties. Miscellaneous The following cases were also notified:— Erysipelas 4 Ophthalmia Neonatorum 3 Vaccination against Smallpox The number of persons vaccinated for the first time by General Practitioners and Medical Officers of the Local Health Authority was seven hundred and sixty-nine. Two hundred and sixty-four persons were re-vaccinated. International Certificates of Vaccination Persons travelling to certain foreign parts have to provide themselves with certificates of vaccination or inoculation which must have been completed by their own medical practitioners before proceeding. In several parts of the world certificates are not accepted unless they are endorsed by a medical officer in the Government or local authority of the country of issue. A form of authentication which has been accepted by the health authorities abroad is that given by public health authorities and identified by a rubber stamp impression placed by them on the certificate. The rubber stamp in this office bears the words" Finchley Corporation—Signature of doctor authenticated." The purpose of the authentication is to provide proof to those health authorities abroad who desire it that the signature of the person issuing the certificate is that of a registered medical practitioner. During the year some 500 certificates were stamped for this purpose. 23 Bacteriological Work The following table shows the number and nature of the specimens examined at the Central Public Health Laboratory, Colindale, during 1956:— Throat/Nose Swabs: Diphtheria Bacilli Positive Negative - 104 Hæmolytic Streptococci 51 Vincent's Angina 6 Fæces: Sonne Dysentery 100 372 Salmonella 25 Clostridium Welchii 2 Esch. Coli 1 B. Coli 1 Coagulase Pos. Staph. 13 Sputum: T.B. Smear 6 68 Other Organisms 1 Whooping Cough: Cough Plate — 5 Post-nasal Swab 2 208 549 24 Tuberculosis Eight persons died from tuberculosis during 1956, giving a death rate of 0.115 per 1,000 population. Thirty-eight new cases were notified, and this number is the lowest on record. The case rate per 10,000 population was 5.44. Only one child of school age was found to be suffering from tuberculosis of the lungs. Close co-operation between the Public Health Department, the Area Health Office and the Chest Clinic in the constant search for possible sources of infection in new cases of tuberculosis continues. TUBERCULOSIS (ALL FORMS) 25 26 The following table shows the number of notifications and the number of deaths during the past 10 years :— 27 Year New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 1947 54 36 1 4 18 9 2 1948 37 26 4 5 5 7 3 2 1949 41 37 2 4 10 8 1 4 1950 37 21 2 7 9 5 2 — 1951 37 30 2 6 6 10 1 2 1952 43 21 4 6 15 2 — — 1953 29 33 1 2 7 4 — — 1954 29 23 1 2 2 4 — — 1955 27 20 2 3 6 1 1 1 1956 22 10 2 4 6 2 —— — Mass Radiography Chest X-Ray examinations by the Mass X-Ray Unit 5B were limited in 1956 to the staff of one firm in North Finchley. 137 persons were X-Rayed. Medical Examinations Thirty-one persons were examined on appointment to the Council's staff and 11 workmen were examined with a view to their admission to the Councils' Sickness Pay Scheme. National Assistance Act, 1948 (a) Section 47 Cases continued to be brought to the notice of the Department of persons who were living in insanitary surroundings and who were not receiving proper care and attention. In one instance it was necessary to take emergency action in respect of an elderly lady, aged 91 years, and a Magistrate's order for her removal to Barnet General Hospital was obtained. An Extension Order was found not to be necessary as she was declared fit for discharge and arrangements were made for her to live with a relative in the South of England. In all other cases it was possible to make satisfactory arrangements for these persons without having to resort to compulsory removal to suitable premises under the provisions of the above section. (b) Section 50 Two burials were carried out by the Council under the provisions of this Section, one a male aged 72 years, and the other an unknown newly-born child. Rainfall The following table shows the amount of rainfall recorded at Avenue House grounds during the year:— 1956 Rainfall (in inches) January 4.33 February 0.55 March 1.02 April 1.47 May 0.56 June 2.92 July 4.82 August 6.22 September 4.26 October 1.70 November 0.46 December 3.96 Total 32.27 28 The average annual rainfall over a period of 35 years recorded at the Air Ministry's Meteorological Station at Camden Town was 24.47 inches. Housing Throughout the year housing applications, accompanied by medical certificates, were submitted by the Borough Housing and Town Planning Officer to ascertain if additional points (up to 5) could be recommended on medical grounds. The following shows how the applications were dealt with :— Applications Points Awarded in each Case 10 0 12 2 5 3 5 5 Total number of applications — 32. On receipt of these applications, it was often necessary to visit the family concerned and to discuss various aspects of each case with the family doctor and with the Housing Officer. I am indebted to the doctors for their co-operation in this matter. In addition, a number of applications were considered on account of overcrowding and sanitary defects. Much work is involved in investigating these cases in order to be certain that deserving cases are given full consideration. In some cases the issue was complicated by friction between tenants sharing a house either with relatives or other tenants. (In many cases of special difficulty the Chairman of the Housing Lettings Committee, together with the Housing Officer and myself held special meetings to decide upon a just recommendation.) In special cases where the medical condition of the applicant merited urgent rehousing but the award of extra "points" would not give immediate help the case was brought before the Housing Lettings Committee of the Council, for their decision, and in every instance the medical reports were taken into account. Circular Letters to General Practitioners During the year circular letters on a variety of subjects have been sent to 65 General Practitioners in Finchley. These have included information concerning Poliomyelitis, Vaccination against Poliomyelitis, Dysentery and the Central Public Health Laboratory's arrangements for the collection of specimens for bacteriological examination. In all, 520 letters were despatched. Health Education Reference is made elsewhere in this Report to educational activities in connection with Food Hygiene. Apart from these, talks were given by members of the staff to Student Teachers and Health Visitors on the work of the Public Health Department. 29 ROAD ACCIDENTS During the year,10 deaths occurred as a result of road accidents as compared with 5 deaths in the previous year.6 deaths occurred in persons aged 45 years or over and only 2 in persons of school age. 4 of the fatal accidents involved pedestrians and 2 involved pedal cyclists, and it is interesting to note that in these 6 cases, 3 were knocked down by lorries, 2 by vans and one by a trolley bus. In no case was a private car involved. On the general question of road accidents, I would refer here to a report received from the Secretary of Finchley Road Safety Committee, who reports as follows:— " CHILDREN : The increase in road accidents is mainly to children under 7 years of age as pedestrians (generally unaccompanied by an adult) and to child cyclists under 10 years of age. Every effort should be made to ‘educate' parents of young children but this is not an easy matter. Children of school age receive instruction at school and the Road Safety Committee arrange Film Shows for parents in School Halls with the fullest co-operation of Head Teachers. "Child cyclists: Analysing the figures, there is an increase to young cyclists, most of them are given bicycles at an early age, e.g., 7, but there is a continued decrease in the age group 10—16. Finchley has one of the finest child cycling schemes in the country—each child is given 2 lessons prior to taking the Cycling Proficiency Test and it is noted that machines are in a much better condition than between 1948—1950 (schemes started in 1948) and most of the senior schools do not permit a pupil to cycle to school unless he or she has taken the test. This cannot be insisted upon in the Grammar Schools which cater for children outside the Borough owing to the limited facilities. In the summer term, each year, the top forms of Junior Schools have this training so that the majority of Finchley children proceeding to a senior school in September have passed the test. The interest of parents has increased so that Saturday morning classes for children resident in the Borough but attending schools outside are extremely well attended. Children as passengers in trolley buses now seldom meet with an accident, due to their education on not boarding or alighting other than at recognised stopping places. 30 "OLDER PEOPLE : The Committee arranges Film Shows and talks for the Old People's Clubs and through the Churches and receive the utmost co-operation from the older people. The 2 types involved in accidents are pedestrians, and trolley bus passengers. Pedestrians still do not cross on the zebra crossings, or if they do so, fail to understand that they are masked by stationary vehicles and also, they do not realise stopping distances of motor vehicles. Too many of the older people continue to dismount at traffic lights in spite of warning by conductors, and to get on to vehicles as they leave a stopping place. Traffic lights also present a hazard as some of the older people do net understand these and forget about turning traffic." 31 SANITARY CIRCUMSTANCES OF THE AREA Sanitary Inspectors (Change of Designation) Act, 1956 As a result of the passing of the above Act, the designation "Sanitary Inspector" was altered to "Public Health Inspector" as from the 2nd August, 1956. The following are particulars of the work of the Public Health Inspectors during the year 1956:— 32 Housing Statistics 1.Inspection of Dwelling-houses: (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,946 (b) Number of inspections made for the purpose 4,845 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 - (b) Number of inspections made for the purpose - (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 573 2. Remedy of defects during the year without service of formal notices: Number of defective dwelling-houses rendered fit in consequence of informal action 410 3. Action under Statutory Powers during the year: A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 9 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 3 (b) By Local Authority in default of owners 2 "B. Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 11 (2) Number rendered fit: (a) By owners 9 (b) By Local Authority in default of owners 1 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 — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — Slum Clearance Only one small Clearance Area comprising 2 houses, namely, 84 and 86, Swan Lane, N.20, was dealt with during the year and the Council compulsorily acquired the site for the building of Council Flats. The owner appealed against the acquisition of the site but the appeal was later withdrawn. The Slum Clearance programme was delayed because of the difficulty in providing alternative accommodation for the tenants. Therefore, some of the Areas scheduled to be dealt with during the year have had to be delayed. No individual unfit houses were dealt with during the year. 33 Housing Repairs and Rents Act, 1954 Repairs increase and Certificates of Disrepair. The above Act, which came into force on the 30th August, 1954, imposed a duty on Local Authorities to issue Certificates of Disrepair where the landlord claimed a repairs increase in rent and the tenant felt that the house was not in good repair and was not reasonably fit for occupation. A charge of one shilling was made for a certificate, or for the revocation thereof. The following table shows the particulars of applications received during the year:— Applications received 9 Certificates granted 7 Certificates refused 1 Applications withdrawn 1 Revocations 2 It will be seen from the above-mentioned figures, that only a small number of applications for certificates was received, the total being about half the number for the previous year. Inspections The total number of inspections made during the year was 12,594. At 674 of the houses and other premises visited, defects or nuisances to the number of 2,236 were discovered, and at the end of the year 1,629 including a number outstanding at the end of 1955 had been remedied or abated. The work in connection with 239 was in hand and 1,850 were outstanding. In order to ascertain that the sanitary defects were being properly remedied, 594 visits were paid to the respective premises while the work was in progress. The total number of inspections made in regard to each section of work is recorded below, together with a summary of the sanitary improvements carried out:— Inspections under Housing Acts 35 Other Inspections including Inspections under Public Health Act, 1936 3,538 Re-inspections 2,305 Housing Repairs and Rents Act, 1954 12 Inspections of Works in Progress 594 34 Inspections of Factories and Workplaces (including Bakehouses and Restaurant Kitchens) 410 Visits to Slaughterhouses 280 Inspections of Cowsheds, Dairies and Milkshops 4 Inpections of Ice Cream Premises 5 Inspections of Meat, Fish and Other Food Shops 872 Inspections of Shops (Shops Act) 89 Visits re Infectious Disease and Vermin 678 Visits re Rodent Control 3,037 Visits re Overcrowding 56 Visits re Hawkers 18 Visits to Hairdressers' Premises 24 Visits re Pet Animals Act, 1951 9 Visits re Heating Appliances—Fireguards 31 National Assistance Act 6 Miscellaneous 591 12,594 35 Summary of Sanitary Improvements carried out Drainage Premises re-drained 1 Repairs or amendments to existing drains 57 Drains or gullies unstopped or cleansed 295 Length in yards of stoneware drains laid 263 Length in yards of iron drains laid 4 Manholes provided 19 Manholes repaired 6 Manhole covers provided 32 Intercepting traps fixed 18 Fresh air inlets provided or repaired 9 New gully traps fixed 26 Gully curbs provided or repaired 6 New soil pipes and ventilating shafts fixed 4 Soil pipes and ventilating shafts repaired 6 Water tests applied 63 Smoke tests applied 60 Air tests applied 3 Water Closets and Sanitary Fittings New W.C. Basins fixed 71 W.Cs. unstopped, cleansed or repaired 16 New flushing boxes fitted to W.Cs. 14 Existing flushing boxes repaired 19 New W.C. accommodation provided 9 New W.C. apartments provided 3 W.C. apartments cleansed 3 Urinals cleansed or repaired 3 Lavatory basins provided 28 Baths provided 3 New impervious sinks provided 14 New waste pipes fixed 19 Waste pipes trapped, repaired or unstopped 18 Ventilated lobbies provided 3 Miscellaneous New roofs provided 2 Roofs repaired 122 Eaves gutters renewed, cleansed or repaired 53 Stack pipes provided, repaired or unstopped 36 Damp walls remedied 91 Walls repointed, repaired or underpinned 41 Ventilation under floors provided or unstopped 2 Yards paved 1 Paving of yards repaired 9 Floors of rooms relaid 2 Floors of rooms repaired 37 Rooms cleansed, distempered or repapered 259 Plasterwork repaired 163 Windows repaired and/or made to open 77 New windows provided 5 New sash cords provided 85 Window sills repaired or provided 12 Doors provided or repaired 29 Doorsteps provided or repaired 5 Ventilated food stores provided 8 Staircases repaired 6 New stoves and ranges provided 3 36 Stoves and ranges repaired 19 Cisterns provided 3 Cisterns repaired, cleansed and covered 10 Water service pipes repaired 47 Movable sanitary dustbins provided 22 Nuisances from keeping of animals abated 1 Smoke nuisances abated 4 Accumulations of refuse removed 24 Hot water supply provided 21 Various 58 Notices Served Informal Notices 626 Statutory Notices 20 37 Enquiries—Outstanding Sanitary Notices One thousand four hundred and thirty-three letters were received during the year from the Town Clerk enquiring whether or not there were any outstanding notices with respect to certain properties in the district. The necessary searches were made and the required information furnished. Housing Act, 1949—Section 4 (Power of Local Authorities to make advances for increasing housing accommodation including the converting, altering and enlarging of houses.) Two hundred and twelve enquiries were dealt with regarding premises which were the subject of applications for advances under Section 4 of the Housing Act, 1949. Disinfection and Disinfestation Number of rooms disinfected after infectious disease 48 Number of articles disinfected 604 Six hundred and seventy-eight visits were made by inspectors and disinfectors in connection with cases of infectious disease and verminous premises and the necessary investigations were made in order to obtain the detailed information required. The following is a summary of disinfestation work carried out during the year:— Premises Bugs 7 Cockroaches 8 Ants 3 Wasps 54 Beetles 3 Miscellaneous 5 38 The number of verminous rooms which were dealt with was 14 compared with 33 in 1955. Complaints continued to be received regarding the infestation of dwellings by wood beetles, and considerable damage was found to be caused by the larvae (woodworm). These infestations appear to be on the increase and are a matter of great concern. Although help and advice is given when sought, many cases are not notified or escape detection in the early stages. In a number of cases where the Valuation Officer has made a survey arising from an application for a loan under the Housing Act, 1949, this trouble has been found and the inspectors have assisted in giving advice and supervising the remedial work. Sanitary Conveniences There are 31 conveniences attached to public houses within the Borough. These premises are inspected periodically. There are 14 public conveniences in the Borough, including those in recreation grounds. Thirteen of these conveniences provide accommodation for both sexes and one for males only. Complaints One thousand four hundred and sixty-seven complaints were received with reference to the following matters, viz:— Absence of, or defective condition of, dustbins 9 Accumulations of refuse and manure 22 Blocked or defective drains 240 Defective roofs 90 Defective W.Cs. 57 Defective water service pipes 42 Dirty milk bottles 3 Flooding 8 Foreign matter in food 6 Insanitary or defective condition of houses 158 Noise 8 Non-removal of refuse 6 Nuisances from dampness 69 Nuisances from the burning of refuse 16 Nuisances from the keeping of animals or poultry 9 Premises infested with insects 70 Premises infested with rats or mice 445 Smells from public sewers 5 Smoke nuisances 15 Unsatisfactory Housing Conditions, including Overcrowding 12 Unsound food 19 Verminous condition of houses 3 Wasps' Nests 56 Other complaints 99 39 The complaints were investigated promptly and in those cases in which the Council had power to intervene the necessary steps were taken to remove the cause of the complaint. Middlesex County Council Act, 1956 The above-mentioned Act which came into operation on the 2nd August, 1956, contains many new useful provisions especially in relation to the power to repair drains and private sewers, to remedy stopped up drains, etc., to the supply of water to premises where the supply has been cut off and to the cleansing or destruction of filthy or verminous articles. Places of Public Entertainment The cinemas, dance halls and other places of public entertainment have been inspected, special attention being given to the condition and adequacy of the sanitary accommodation. The defects discovered as a result of these inspections were remedied after notice had been given to the persons responsible. Eighteen premises were inspected and a report was submitted to the Middlesex County Council which is the licensing authority. 40 Factories Acts, 1937-1948 1. Inspections for purposes of provisions as to health made during the year. Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 148 102 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 216 259 5 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) - - - - TOTAL 364 361 5 — 2. Cases in which Defects were found 41 Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) 6 6 — — — Overcrowding (S.2) — — — — — Unreasonable Temperature (S.3) Inadequate ventilation — — — — — (S.4) Ineffective drainage of —— - —- — — floors (S.6) Sanitary Conveniences - - — — — (S.7)— (a) Insufficient 4 3 _ _ _ (b) Unsuitable or defective 9 10 - - - (c) Not separate for sexes - - _ _ Other offences against the Act (not including offences relating to Outwork) — — — — — TOTAL 19 19 — — — The total number of Factories and Workplaces on the Register is 364, made up as follows:— Bakehouses 23 Boot Repairers 25 Builders' Workshops 21 Cycle Makers and Repairers 3 Farriers and Blacksmiths 3 General Engineers and Motor Engineers 65 Glass Blowers 2 Laundry 1 Monumental Masons 4 Plant Propagation 1 Plastic Manufacturers 3 Prepared Meat Factories 7 Printers and Printers' Accessories 11 Restaurant Kitchens 94 Shopfitters 1 Tailors and Dressmakers 17 Temperature Recording Instrument Manufacturers 1 Timber Merchants and Sawyers 9 Tyre re-treading 3 Upholsterers 9 Watch and Clock Repairers 4 X-Ray Apparatus 1 Other Trades 56 These premises have been visited from time to time and,as a result of action taken by the Department, the following works have been carried out:— W.C. apartments provided or reconstructed 3 W.C. apartment screened 1 Ventilated lobbies provided 2 Artificial lighting provided to W.C 4 New W.C. pans provided 4 W.Cs. cleansed or repaired 11 Urinals provided 1 Joints between flush pipe and W.C. pan repaired 1 Flushing cisterns repaired 2 New sinks provided 3 New sink wastepipes provided 3 Drains unstopped or repaired 5 Smoke nuisance abated 5 Premises cleansed 4 Dust nuisance abated 1 Miscellaneous 1 42 Outworkers Visits have been made by the Public Health Inspectors to the homes of persons notified as outworkers to the department from adjoining local authorities. It has been found that the home conditions are quite satisfactory. The following table shows, by trades, the number of outworkers residing in the district:— Wearing apparel 25 Artificial flowers 1 Lampshades 4 Paper boxes 1 Textile Fabric 1 Handbags 1 43 FOOD 44 FOOD & DRUGS ACT, 1955 FOOD HYGIENE REGULATIONS, 1955 The above Act and Regulations, which came into force on 1st January, 1956, introduced many new provisions with regard to food, food handlers and food premises. There is an extension of the type of food premises to which the Act and the Regulations apply and the subjects covered include Regulations as to hygiene, the power of a Court to disqualify a caterer, authority for the Ministers to make additional Regulations as regards the registration of different classes of business and the licensing of vehicles, stalls, etc., used for the preparation, exposure or offer for sale of food for human consumption. Food Hygiene Regulations The food hygiene regulations lay down requirements in respect of the cleanliness of food premises and stalls, and of apparatus and equipment, the hygienic handling of food, the cleanliness of persons engaged in the handling of food and of their clothing, and the action to be taken where they suffer from or are carriers of certain infections; the construction of food premises, their repair and maintenance and the facilities including sinks and wash basins to be provided ; and the temperature at which certain foods are to be kept. The operation of certain of the regulations which may require alterations to premises or changes in practices came into force on 1st July, 1956. A letter explaining the principal requirements, etc., of the Regulations, together with a summary of the Regulations and a poster suitable for showing in a prominent place for the guidance of employees was sent to every trader in the district. 1. Number of Inspections: Public Health Inspectors commenced a systematic survey of the food premises and at the end of the year 219 shops involving 478 visits had been inspected in order to ascertain compliance with the Regulations, and arising therefrom 461 contraventions were found, and 98 letters sent or verbal notices given in connection therewith. The following is a summary of the works done during the year:— Accumulation of refuse removed 2 Building work carried out 2 Chopping Block provided 1 Cloakrooms built 1 Closed shop front provided 1 Clothing lockers provided 14 Draining boards provided 2 Dustbins provided 3 First Aid Kits provided 8 Floors repaired 8 Food covers provided 1 Hood scraped 1 Hot water installed 49 Impervious table tops provided 9 Lavatory basins provided 51 Light provided 2 Lino laid 1 Nailbrushes provided 17 Redecorations carried out 30 Refrigerators installed 1 Sinks provided 23 Springs on W.C. doors provided 2 Towels and soap provided 7 Urinal provided 1 Ventilated lobbies provided 7 Walls repaired 1 W.Cs. altered 3 W.C. door provided 1 W.C. notices provided 14 W.C. pan provided 1 W.C. seat provided 1 Waste pipes and traps provided 11 Windows cleaned 1 Windows repaired 3 Yard paving repaired 7 45 2. The number and type of food premises:— (a) Bakers, etc. 33 (b) Butchers 47 (c) Confectioners 83 (d) Fishmongers 16 (e) Greengrocers 59 (f) Grocers and Provisions 120 (g) Restaurants, Cafes, etc. 94 Total 452 46 3. (i) The number and type of food premises registered under Section 16 of the Food and Drugs Act, 1955 (which repealed Section 14 of the Food & Drugs Act, 1938):— (a) Sale of Ice Cream 167 (b) Manufacture of Sausages 35 (c) Cooking of Hams 6 (d) Pickling of Meat 5 (e) Preparation of pickled and preserved food 6 Total 219 (ii) The number of dairies registered under the Milk and Dairies Regulations, 1949 9 4. Display of Dog Notices in Food Shops: Notices for exhibition have been supplied to all food shops in the district, pointing out that the presence of dogs is a danger to the health of the public. 5. School Kitchens: All school kitchens in Finchley were visited by the Public Health Inspectors and the Staffs are to be commended on the high standard of cleanliness attained. 6. Educational Activities: Lectures to classes of senior school children were arranged at one school in the early part of the year. Talks were given by a Public Health Inspector, after which films were shown and discussed. The lectures were attended by some 80 children. The Chief Public Health Inspector attended meetings of three local organisations and addressed them on various food hygiene topics. At one of the meetings, that of the Finchley and Barnet Master Bakers' Association, the whole lecture was devoted to an explanation of the Food Hygiene Regulations. Towards the close of the year, a film show was arranged at a school in North Finchley. The Chief Public Health Inspector presented the film and addressed the 46 School Meals organisers and kitchen staff present on food poisoning outbreaks. 7. Method of Disposal of Condemned Food : Condemned food is removed by the Public Health Department's van and is destroyed at the Council's Refuse Destructor. Inspection of Meat and Food The inspection of food and premises where food is prepared continued to receive special attention. Two new registrations of hawkers were granted during the year. Before registration is granted the Council insist upon satisfactory storage accommodation being provided and this is checked where necessary with the Local Authority concerned. The number of barrow boys operating in the district at the end of the year was 4. Slaughterhouses At the beginning of the year, there were two slaughterhouses in the district which have been regularly inspected. As will be seen under the heading "Legal Proceedings," the occupier of a slaughterhouse at which wholesale slaughtering was carried out, was fined about the middle of the year, for contraventions under the byelaws relating to slaughterhouses and the Public Health (Meat) Regulations, 1924, and his licence was cancelled. Up to this period, there had been a large increase in the number of pigs slaughtered at these premises, as is shown in the figures in the following table. The total number for that portion of the year was almost as large as for the whole of the previous year. It may be remembered that numerous complaints were received from occupiers of premises adjoining this slaughterhouse, with regard to noise, etc., and the slaughter of animals at week-ends, including Sundays. As the slaughterhouse has not been re-occupied for this purpose there has been no further cause for complaint. 47 Carcases and Offal Inspected and Condemned in Whole or in Part Cattle excluding Cows Cows Calve® Sheep and Lambs Pigs Horse Number killed (if known) 14 — 1 1,095 8,245 — Number inspected 14 — 1 1,095 8,245 — All Diseases except Tuberculosis and Cysticerci : Whole carcases condemned - - - - 3 - Carcases of which some part or organ was condemned - - - 8 494 _ Percentage of the number inspected affected with disease other than tuberculosis and cysticerci - - - 0.73 6.03 - Tuberculosis only : Whole carcases condemned - - _ - 2 _ Carcases of which some part or organ was condemned 4 - - - 162 __ Percentage of the number inspected affected with tuberculosis 28.57 - - - 1.99 - Cysticercosis : Carcases of which some part or organ was condemned - - - - - - Carcases submitted to treatment by refrigeration - - - - - - Generalised and totally condemned - - - - - - 48 UNSOUND FOOD CONDEMNED, 1956 (1) In Slaughterhouses TUBERCULOSIS Cattle Livers 1 Lungs 2 sets Mesenteries 1 Pigs Carcases 2 Heads 139 Lungs 6 sets Plucks 17 OTHER DISEASES Sheep and Lambs Hearts 1 (Pleurisy and Pericarditis) Livers 5 (Degenerated Cysticerci 1, Abscess 3, Cirrhosis 1) Lungs 1 set (Pleurisy and Pericarditis) Plucks 1 (Melanosis) Pigs Carcases 3 (Emaciation 1, Fevered 1, Moribund 1) Hindquarters 1 (Abscess) Hocks 2 (Bruising) Hearts 80 (Pericarditis 79, Pleurisy and Pericarditis 1) Kidneys 2 (Haemorrhagic Nephritis) Livers 156 (Abscess 1, Cirrhosis 127, Milk Spot 24, Parasites 1, Peritonitis 3) Lungs 195 sets (Congestion 61, Pleurisy 51, Pleurisy and Pericarditis 1, Pneumonia 82) 49 Plucks 55 (Abscess 6, Chronic Erysipelas 1, Congestion, Cirrhosis and Pericarditis 2, Inflammation 1, Peritonitis 2, Pleurisy and Pericarditis 20, Pleurisy, Pericarditis and Peritonitis 13, Pleurisy and Peritonitis 7, Pneumonia, Cirrhosis and Pericarditis 2, Pneumonia and Pericarditis 1) Spleens 3 (Trauma) (2) In Shops Cattle Beef 449½ lbs. Ox Liver 24 lbs. Ox Kidney 6 lbs. Sheep and Lambs Hindquarters 2 Lamb 25 lbs. Livers 61 lbs. Pigs Kidneys 36 lbs. TINNED ARTICLES Tins Tins Anchovies 5 Luncheon Meat (164½ lbs.) 120 Apples 2 Macedoine Vegetables 2 Apricot conserve 12 Mangoes 70 Apricot juice 2 Marmalade 76 Apricots 170 Meat Pudding 5 Asparagus 6 Milk 374 Baked Beans 5 Minced Beef Loaf 33 Beans 46 Mixed Vegetables 26 Beans and Sausages 1 Orange juice 29 Beans (Green) 1 Oranges 272 Beans (Broad) 5 Ox Broth 1 Beef Loaf (4½ lbs.) 6 Ox Tongue (14 lbs. 3 ozs.) 4 Beetroot 3 Peaches 147 Blackberries 18 Pears 70 50 Tins Tins Blackcurrants 9 Peas 231 Brisket Beef (4 lbs.) 4 Pease Pudding 5 Brisling 7 Pilchards 75 Butter Beans 1 Pineapple 270 Carrots 13 Pineapple cubes 1 Cheese 1 Pineapple juice 74 Chickette (7 ozs.) 1 Plums 55 Cherries 71 Pork Kidneys 5 Coconut 2 Potatoes 2 Corned Beef (196½ lbs.) 71 Prunes 18 Crab 54 Raspberries 13 Crabmeat 2 Ravioli 4 Crab paste 2 Rhubarb 1 Cranberries 3 Rice 2 Crawfish 3 Rice Pudding 128 Cream 66 Salmon 18 Creamed Rice 1 Sardines 35 Damsons 2 Sausages 5 Date Pudding 2 Sausages (Frankfurt) 25 Frozen Whole Egg (22 lbs.) 1 Shrimps 14 Fruit Cocktail 4 Sild 4 Fruit Salad 39 Soft Herring Roes 17 Gooseberries 18 Soup 42 Grapefruit 103 Spinach 1 Grapefruit juice 9 Steak and Kidney Pudding 10 Grapes 1 Stewed Steak 91 Greengages 4 Strawberries 18 Guavas 3 Sugar Corn 1 Ham (146 lbs. 7 ozs.) 21 Sweet Corn 12 Herring Roes 14 Tomatoes 169 Herrings 3 Tomato juice 137 Jam 54 Tomato paste 1 Jellied Veal (6 lbs.) 1 Tomato puree 10 Kidneys 1 Tuna 10 Kippered Herrings 9 Two-fruit 1 Lambs' Tongues (5 lbs. Vegetables 1 4 ozs.) 8 Vegetables (Mixed) 1 Loganberries 1 Vegetable Soup 1 51 MISCELLANEOUS Apricots 103 lbs. Bacon 8 lbs. Beef Cubes 72 Beef Cubes 36 tins Biscuits 29 lbs. Biscuits 428 packets Black Treacle 7 jars Blancmange 39 packets Bread Rolls 15 packets Breakfast Cereal 218 packets Butter 14½lbs. Cakes 12 Cakes 4 boxes Cakes 10 packets Cake Mixture 16 packets Caramel Pudding 1 packet Cheese 110 cartons Cheese 19 lbs. Cheese and Tomato Spread 1 carton Cheese Spread 22 cartons Chillies 2 lbs. Chocolate 375 bars Chocolates 41 boxes Cloves 2 lbs. 15 ozs. Cocoa 4 tins Coconut 7 lbs. Cooked Ham 8 lbs. Cornflour 15 packets Crab Paste 3 jars Currants 138 lbs. Dates 6 boxes Dates 2 packets Dates 84½ lbs. Dill Seeds I¾ lbs. Dried Fruit 14 packets Dripping 10 lbs. Eggs (Frozen) 44 lbs. Figs 1 packet 52 Fish 308 lbs. Flour 23 packets Fruit Salad 1 lb. Gammon 10½ lbs. Gooseberries 1 Jar Ground Almonds 10 lbs. Haricot Beans 16 lbs. Herbs 12 drums Jellies 5 packets Jelly Crystals 1 packet Lard 24 lbs. Liquid Frozen Egg 28 lbs. Macaroni 112 packets Mace 6 ozs. Matzos 87 packets Meringue 1 carton Mixed Fruit 21 packets Peaches 39 lbs. Peas 8 ozs. Pepper 1 carton Pepper 2 lbs. Pickle 1 jar Pimento 8 ozs. Pork ll½ lbs. Pork Sausages 10 lbs. Potato Crisps 6 packets Potatoes 10 packets Prunes 69 lbs. Puddings 4 tins Puff Pastry 5 packets Raising Powder 1 carton Raisins 8 packets Raisins 32½ lbs. Rice 24 lbs. Rusks 2 packets Salt 27 packets Sausage Rusks 20 lbs. Sausages 3½ lbs. Semolina 24 lbs. 53 Semolina 15 packets "Smokers' Outfits" 3 Split Peas 42 lbs. Sugar 24 lbs. Suet 1 packet Sweets 3 lbs. Sweets 7 boxes Sweets 172 packets Tea 55 lbs. Toast 1 packet Vermicelli 12 lbs. Humane Slaughter of Animals In accordance with the provisions of the Slaughter of Animals Act, 1933, and the Slaughter of Animals (Amendment) Act, 1954, all animals, including sheep, slaughtered in a slaughterhouse within the district must be stunned by means of a mechanically operated instrument kept in good repair. This method of slaughter continues to prove satisfactory. Licensed Slaughtermen The Acts also provide that no animal shall be slaughtered or stunned by any person who is not the holder of a licence granted by the local authority. The licences granted by the Council have to be renewed annually. Five persons were licensed during 1956. Butchers' Shops There are 47 butchers' shops in the Borough. All the shops are provided with glass fronts. All these premises have been visited and the provisions of the Public Health (Meat) Regulations which provide for the cleanliness of the premises, apparatus, utensils and vehicles, the precautions to be taken against the contamination of meat, the storage and removal of refuse, etc., have generally been well observed. Bakehouses The number of bakehouses in the Borough is 23. At 22 bakehouses motive power is used. The bakehouses have been visited by the inspectors and steps 54 have been taken to cause them to be maintained in a proper sanitary condition. The periodical cleansing of these premises, as required by statute, has generally been carried out. Dairies, Cowsheds and Milkshops There are 9 registered premises within the district, and all have been inspected from time to time. Milk (Special Designation) Regulations Licences were granted by the Council in respect of designated milk for the year ended 31st December, 1956, as follows:— Dealers' Licences to sell milk as Tuberculin Tested 19 Dealers' Licences to sell milk as Pasteurised 18 Dealers' Licences to sell milk as Sterilised 26 Supplementary Licences to sell milk as Tuberculin Tested 8 Supplementary Licences to sell milk as Pasteurised 8 Supplementary Licences to sell milk as Sterilised 8 Food Sampling The following information has been furnished by the Middlesex County Council Public Control Department relative to samples taken in accordance with the provisions of the Food and Drugs Act, 1955 :— List of Samples procured in the Borough during the year Article Total Samples procured. Unsatisfactory. Milk, new 317 15 Milk, various 48 1 Butter 7 — Cakes and Biscuits 42 1 Cooked Meat 11 —- Cheese 4 — Cream 10 — Cyder 1 1 Drugs 8 —— Fish and Fish Products 7 — Fruit Squash 2 — Gherkins in Vinegar 1 1 55 Ice Cream 5 — Jelly 2 — Meat 13 — Meat Pie 4 — Miscellaneous 5 — Non-alcoholic Wine 1 1 Preserves 2 — Sausages 13 — Sweets 5 2 Victoria Plums 3 -- Vinegar 4 2 Wines and Spirits 10 — Total 525 24 Regarding the samples noted as unsatisfactory, the following comments are added:— Milk. Fifteen samples of new milk, procured from several different farmers, were all slightly deficient in fat or solids-not-fat. Associated and subsequent samples were genuine and no further action was taken. A bottle of milk contained a lump of mortar which had apparently escaped notice and passed through the cleansing plant without the mortar being dislodged. The processors were issued with an official caution. Cakes and Biscuits. A biscuit described as a " Cream Filled Wafer" did not contain milk-fat. The manufacturers were communicated with, when it was discovered that the wafer was old stock and the wrappers had been amended. No action was therefore taken. Cyder. A bottle of cyder was submitted by a private purchaser with the complaint that when it was opened it had a most offensive smell. Upon investigation a metal hair curler was found in the bottle. An official caution was sent to the manufacturers. Gherkins in Sweet Vinegar. The statement "... in sweet vinegar " was a false and misleading description, the liquid in question not being a genuine brewed vinegar but sweetened dilute acetic acid. An official caution was issued to the importers. 56 Non-alcoholic Wine. A non-alcholic wine had a misleading label describing it as"wine." Action in this case has been deferred pending a meeting between trade associations and the Ministry of Agriculture, Fisheries and Food. Sweets. A sample described as "Milk Gums" contained no milk. The manufacturers agreed to amend their labels. A confection, sold under the false and misleading description of "Swiss Milk Bars," was manufactured by a Scottish firm of confectioners. They have now withdrawn this sweet from sale in England. Vinegar. Two samples from the same retailer described and sold as "vinegar," were each found to be non-brewed condiment. An official caution was issued. The Public Control Department also reported upon the following matters. Food and Drugs Act, 1955, Section 47 This contains new provisions concerning the descriptions which can be applied to certain substances which resemble cream in appearance but are not cream. This has necessitated the making of many inspection visits and the giving of advice to all traders likely to be concerned to ensure that they were fully aware of these new requirements. Merchandise Marks Act, 1887-1926. 116 inspections of shops were undertaken to ensure that the Marking Orders relating to certain imported foodstuffs made under the Mechandise Marks Act, 1926, were complied with. 972 separate displays of meat, apples, tomatoes, poultry, dried fruit, bacon and butter were examined. Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. Seven summonses were issued against four butchers for failing to mark imported beef and offal sold, or exposed for sale, with a prescribed indication of origin. In two cases, English meat had been requested and unmarked imported meat supplied. There was a conviction in every case and the amount of fines and costs imposed totalled £25 8s. Od. Five fruiterers were prosecuted for offences arising from pears being wrongly sold and exposed for sale as "William" pears ; the varieties which were passed off as "Williams" were "Winter Nelis" and "Packham." There was a conviction in every case and the 57 amount of fines and costs imposed totalled £24 lis. Od. It was also necessary to prosecute one shop manager for obstructing our Inspector and for failing to give his name and address ; he was fined £4 and ordered to pay £2 2s. Od. I am pleased to be able to add that offences of obstruction only arise very occasionally. The Labelling of Food Order, 1953. This Order requires that, in general, pre-packed foods shall bear on a label a clear statement of the designation of the food and, in the case of compound foods, the ingredients. It also requires that the name and address of the packer or labeller appears. At 104 premises 658 articles of pre-packed food were examined. No proceedings were taken in respect of any of the infringements detected and manufacturers took immediate steps to correct unsatisfactory labels as soon as their attention was drawn to them. False or Misleading Descriptions. A considerable amount of work is carried out each year in scrutinising advertisements and the labelling of pre-packed food and taking such action as is possible to secure satisfactory amendments in those cases where a label or advertisement contains a false or misleading description of the food to which it relates. This work is of benefit to all districts of Middlesex, irrespective of where the offending advertisement or label is discovered, and during the year under review corrective action has been taken in respect of cherry wine, biscuits, chocolate Easter eggs, flour and sugar confectionery, imitation caviare, blackcurrant punch, fruit juice drinks and creme de menthe. Special Designated Milk. During the year in question a licence was issued by my Council in respect of the use of the special designation "sterilised" for milk sterilised within your area. The premises were inspected regularly and compliance with the requirements of the Act or Regulations was maintained. 79 samples were taken, all of which were certified as being satisfactory. Safe Milk. In addition to the foregoing, 61 samples of raw milk were procured within the Borough and submitted to test for the presence of tubercle bacilli. None was found contaminated. Ice Cream Premises The Ice Cream (Heat Treatment, etc.) Regulations, 1947, control the method by which ice cream should be manufactured. 58 Only one person makes ice cream within the Borough, and employs the method known as "complete cold mix" which only requires the addition of water. Most of the ice cream sold is manufactured outside the Borough. There are 167 premises registered for the sale of ice cream. Coffee Stalls At the end of the year there was only one remaining in the district. Fish Friers There were eight premises in the district where the business of fish frying was carried out. Game Licences Eighteen applications were received under Section 27 of the Local Government Act, 1894, from tradesmen in the Borough for licences to deal in game. A licence was granted in each instance. Shops Act, 1950 Inspection of shops in the Borough has been carried out and complaints and contraventions dealt with. Particulars in regard to shops on the Register are as follows:— Number on Register at beginning of 1956 942 Number closed 9 New shops 13 Number on Register at end of 1956 946 Changes of occupancy 28 The number of persons observing the Jewish Sabbath and registered in accordance with the provisions of Section 53 of the Act was eleven. Swimming Pools In co-operation with the Borough Engineer and Surveyor, samples of the water at the Adult and Children's Open Air Pools were taken during the summer months and all were satisfactory. Water Supply During the year the water supply of the Borough has been satisfactory in quality and in quantity. The bulk of the water is supplied by the Barnet District Water Company and copies of reports on 12 samples which were taken by the Company during the year and 59 submitted for bacteriological examination to the Counties Public Health Laboratory were forwarded to me. In all cases the results were satisfactory. Complaints were received from the occupiers of new flats alleging copper contamination in the water supply. This matter was taken up with the Chief Chemist and Bacteriologist of the Barnet District Water Company, to whom I am grateful for the following report:— "Complaints of this nature are quite commonly received by Water Authorities throughout the country, from the occupants of new houses which are provided with copper plumbing systems. "With regard to the water supplied by this Company, the water is non-aggressive towards copper. A protective carbonate film is slowly formed on the inside of new service pipes of this material, and this, in due course, effectively prevents the further passing of metal into solution. It may be several months before complete protection is obtained, but I emphasise that for the interim period, the copper taken up by the water is infinitely small in quantity, being of the order of fractional parts per million, despite intense green staining frequently observed. We combat the "nuisance value" of this green staining by advising consumers to flush the tap for a few moments, particularly first thing in the morning, before water is drawn off for boiling in kettles, etc., thereby fresh water from the main which does not contain copper is drawn into the service pipe. A flow for a few moments suffices to flush the normal service pipe. "In relation to health, I am firmly of the opinion that the amount of copper ingested from the water is harmless. Copper is not a cumulative poison and expert opinion is freely expressed that "cases of ill health or poisoning due to copper, have never arisen from the consumption of copper in water." All dwelling-houses in the Borough are supplied with water from public water mains direct to the houses with the exception of 4 houses serving a population of 9 which are served by a standpipe. Pollution of Streams and Watercourses Further investigations have been carried out regarding the pollution of streams in and adjoining the district and in connection therewith, a number of soil fittings were found to be connected to the surface water sewers and appropriate action was taken for these to be made to discharge into the soil sewers. 60 Smoke Abatement The factory chimneys in the area have been kept under observation and generally little nuisance from smoke or grit has occurred. Fifteen complaints were received during the year, a number of them relating to burning of garden and other refuse. A considerable number of installations, both industrial and domestic, are being converted or installed for oil burning. Many enquiries are received by the Petroleum Inspector from persons desirous of installing oil fired plant and for the safe storage of the oil and whilst advice is freely given it is sometimes refused in the absence of the necessary legislation to control this matter. Rag Flock and Other Filling Materials Act, 1951 There are two traders whose premises come within the definition of the Act and are registered. Pet Animals Act, 1951 The number of persons licensed at the end of the year was 6. All the premises have been inspected. Heating Appliances (Fireguards) Act, 1952 Thirty-one visits have been made to premises to ascertain that the provisions of the Act were being complied with. In one shop, an electric fire was found which did not comply with the regulations made under the Act. Legal proceedings were instituted and the hearing was to take place early in 1957. Burial Act, 1857 Licences for the removal of human remains under the above Act state, inter alia, "It is considered advisable that the Medical Officer of Health should be notified whenever such a licence is granted in order that he may be in a position to take (under his general powers) any action that may appear to him to be necessary in the interests of public health." Five copies of licences for such removals were received from the Home Office during the year. The exhumations were carried out in the early hours of the morning and were visited when necessary by one of the public health inspectors, in order to ascertain that the conditions of the licences were complied with. 61 Legal Proceedings Legal proceedings were taken in the following instances:— A firm of greengrocers was summonsed for selling a tin of soup on the weekly half-holiday, in contravention of the provisions of the Shops Act, 1950. They were granted an absolute discharge on payment of £3 3s. Od. costs. A grocer was prosecuted for selling and having exposed for sale, maggoty marshmallows. A fine of £5 0s. Od. and £1 Is. Od. costs were imposed on each of the two summonses. A fine of £5 0s. Od. with £5 5s. Od. costs was imposed on a firm of dairymen in respect of foreign matter in a quart bottle of milk. The occupier of a slaughterhouse was summonsed on two occasions, the first being for non-removal of offal and filth; lack of cleanliness and failure to notify intention to slaughter. He was fined £5 0s. Od. on each of 6 summonses. On the second occasion he was fined £5 0s. Od. on each of eight summonses relating to lack of cleanliness in the slaughterhouse, and an Order was made by the Magistrates for the recovery of the sum of £5 10s. Od., being the cost of removing offal and filth. In addition, £3 3s. Od. costs and £2 0s. Od. other expenses were allowed and his licence was cancelled. The occupier of a motor vehicle which was used for sleeping purposes by herself and her daughter was summonsed for failing to abate the nuisance and was fined £2 0s. Od. for non-compliance of the abatement notice and given 14 days to abate the nuisance. 62 RODENT CONTROL Complaints and Infestations Premises from which complaints have been received Premises where infestation was confirmed Premises where infestation was not confirmed 1956/7 1955/6 1956/7 1955/6 1956/7 1955/6 Rats 313 354 224 213 89 114 Mice 132 121 127 114 5 7 Total 445 475 351 327 94 121 Arising from complaints, 23 additional premises were found to be infested with rats and 5 infested with mice. At 72 premises infested with rats, poultry was being kept which represented 32.14% of the infestations. One Notice under Section 4 had to be served. Arising therefrom, the occupier carried out a successful treatment and then discontinued the keeping of poultry and removed all sheds. Smoke tests were applied to rat runs in 15 cases. Defects in connection with sewers or drains were revealed in 10 of these cases. All the necessary remedial work connected with the defects was carried out. 63 Summary of Work carried out from 1/4/56 to 31/3/57 Rats Mice Visits in connection with infestations 2,421 616 Number of confirmed infestations 224 127 Prebaits POISONS 795 — Zinc Phosphide 244 — Arsenic — — Red Squill — — A.N.T.U. — — Warfarin 2,217 1,075 Treatment of Sewers First Treatment Second T reatment Total number of manhole baited 560 503 Number of poison takes 35 6 The poison takes in each treatment amounted to 6.25% and 1.19% of the number of manholes baited. 64 INDEX Page Bacteriological Work 24 Bakehouses 54 Births and Birth Rate 8, 9, 11, 14 Burial Act, 1857 61 Burial of the Dead 28 Butchers' Shops 54 Carcases Inspected and Condemned 48 Certificates of Disrepair 34 Circular Letters to General Practitioners 29 Coffee Stalls 59 Committee Members 2, 3 Complaints 38 Dairies, Cowsheds and Milkshops 55 Deaths and Death Rate 8, 9, 10, 11, 13, 14, 15, 17 Diphtheria 19 Diphtheria Immunisation 19 Disinfection 37 Disinfestation 37 Dysentery 21 Enquiries—Outstanding Sanitary Notices 37 Factories 40 Fish Friers 59 Food Hygiene 44 Food Poisoning 21 Food Sampling 55 Game Licences 59 Health Education 29 Heating Appliances (Fireguards) Act, 1952 61 Housing 28 Housing Act, 1949 37 Housing Repairs and Rents Act, 1954 34 Housing Statistics 32 Ice Cream Premises 58 Infantile Mortality 8, 9, 13, 14, 15, 17 Infectious Diseases 19 Influenza 22 Inspections by Public Health Inspectors 34 International Certificates of Vaccination 23 Legal Proceedings 62 Mass Radiography 27 Maternal Mortality 8, 10 Measles 20 Meat and Food Inspections 47, 48 Medical Examinations 27 Page Members of Committees 2, 3 Middlesex County Council Act, 1956 39 Milk (Special Designation) Regulations 55 Mortuary 10 National Assistance Act, 1948 27 Neo-Natal Mortalit 8, 13, 15 Notices Served 37 Outworkers 42 Paratyphoid Fever 22 Persons in Need of Care and Attention 27 Pet Animals Act, 1951 61 Places of Public Entertainment 39 Pneumonia 20 Poliomyelitis 19 Pollution of Streams and Watercourses 60 Population 8, 9 Puerperal Pyrexia 21 Rag Flock and Other Filling Materials Act, 1951 61 Rainfall 28 Road Accidents 30 Rodent Control 63 Sanitary Circumstances of the Area 32 Sanitary Conveniences 38 Sanitary Improvements carried out 35 Sanitary Inspectors (Change of Designation) Act, 1956 32 Scarlet Fever 19 Shops Act, 1950 59 Slaughter of Animals 54 Slaughterhouses 47 Slaughtermen 54 Slum Clearance 33 Smoke Abatement 61 Staff 3, 4 Statistics 8, 14 Stillbirths 8, 9 Swimming Pools—Water Sampling 59 Tuberculosis 24, 25 Typhoid Fever 22 Unsound Food 49 Vaccination against Poliomyelitis 20 Vaccination against Smallpox 23 Vital Statistics 14 Water Supply 59 Whooping Cough 20 Printed by HEND0N PRINTING WORKS LTD. 42-44 Victoria Road. London, N.W.4 Tel.: SUNnyhill 1004 & S006