FRI 27 FRIERN BARNET URBAN DISTRICT COUNCIL. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1949 W.W. MILLEN. M. B.Ch.B. JUDICAL OFFICER OF HEALTH. FRIERN BARNET URBAN DISTRICT COUNCIL. PUBLIC HEALTH DEPARTMENT, TOWN HALL, N.11. The Chairman, and Members of the Friern Barnet Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my report upon the health conditions and sanitary circumstances of the district for the year ending 31st. December, 1949. The report is again drawn up in an abbreviated form in accordance with circular 2/50 issued by the Ministry of Health. It is little more than a factual record of statistics, although opportunity has been taken to make such comments as are called for throughout the report. Viewing 1949 from the broad aspects of health, the year can be considered satisfactory. The birth and death rates have not materially altered. The infantile mortality rate, although higher than last year, compares favourably with the figure for the whole country. The infectious sickness rate has fallen, but it must bo noted that a considerable decrease in Whooping Cough notifications over the previous year was almost entirely responsible for the reduction. A noteworthy feature of the year was that for the first time on record no casus of Diphtheria were notified. Four cases of Polio-myelitis were notified, but no source of infection was traced, nor were any of the cases known contacts. Once again there was an increase in the number of new cases of Tuberculosis. I would take this opportunity of expressing my 1 thanks to the Council, and to the Chairman and Members of the Public Health Committee, for their support and consideration during the year under review. I should also like to thank the members of the Public Health Department for the manner in which they have carried out their many and difficult tasks. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, W.W. MILLEN M.B. , Ch.B. Medical Officer of Health. 2 PUBLIC HEALTH COMMITTEE. At_31st. December, 1949. Councillor A. C. Hanry " M. R. Tarlton " L. W. McClane J.P. " R P. Matthews " J. Foley " Mrs. H.E. McCarthy " R. F. Pugh " C. F. Simmonds " C..A. Sparks (Chairman) (Vice-Chairman) (Chairman of the Council) (Vice-Chairman of the Council) PUBLIC HEALTH STAFF. Medical Officer of Health. Chief Sanitary Inspector. Sanitary Inspector. Sanitary Inspector. Chief Clerk. Assistant. Rodent Operative. W. W. Millen, M.B. ,Ch.B. W. R. Jackaman. S. Caine. J. J. Wisdom. J. Wilson. Miss E. Glasscock. E. T. Crawshaw. STATISTICS OF THE AREA. Area (in acres) 1341.2 Registrar General's estimate of population 29,120 (District- 27,020) (Friern Hospital - 2,100) Number of separate dwellings 7,577 Rateable Value (31.12.49) £286,314 Sum represented by a penny rate £1,145 3 EXTRACTS FROM VITAL STATISTICS. LIVE BIRTHS. Male. Female. Total. (Legitimate) 196 177 373 (Illegitimate) 10 5 15 (Total) 206 182 388 BIRTH RATE per 1000 of the estimated population 14.4 Male. Female. Total. STILL BIRTHS (LegitimateP 2 2 4 (Illegitimate) - 1 1 (Total) 2 3 5 STILL BIRTH RATE per 1000 Births (Live and Still) 12.9 Male. Female. Total. DEATHS. (From all causes end at all ages) 114 138 252 DEATH RATE per 1000 of the estimated population 9.2 DEATHS OF WOMEN IN CHILDBIRTH. From Puerperal Sepsis 0 From other maternal causes 0 Total 0 DEATH RATE per 1000 births (Live and Still) 0.0 DEATHS OF INFANTS (under 1 year of age). Ma1e. Female. Total. Legitimate 5 3 8 Illegitimate 1 1 2 6 4 10 DEATH RATE OF INFANTS (Under 1 year per 1000 births) 26.0 DEATHS FROM MEALSES (all ages) 0 DEATHS FROM WHOOPING COUGH (all ages) 1 DEATHS FROM DIARRHOEA (under 2 years of age) 0 4 BIRTHS. The total of births during the year was 388, an increase of 13 compared with the preceding year. Of these 206 were males and 182 females. The Birth-Rate for the year was 14.4 per 1000 of the population. The corresponding Birth-Rate for England and Wales was 16.7, and for London 18.5. Births and Birth- Rates for the past five years have been as follows:- Year. No. of Births. Friern Barnet. Birth- Rates. England & Wales. London. 1945 366 14.2 16.1 15.7 1946 491 18.9 19.1 21.5 1947 510 19.0 20.5 22.7 1948 375 14.1 17.9 20.1 1949 388 14.4 16.7 18.5 DEATHS. The total number of deaths during the year was 256, giving a crude Death- Rate of 9.47. However, since the preparation of the Death-Table, the Registrar General has assigned only 252 deaths to the district, and this will give the uncorrected Death- Rate of 9.32 per 1000. The correcting factor for age and sex distribution is 0.99, and this gives a corrected Death- Rate for comparative purposes of 9.2 per 1000. The corresponding Death- Rate for England & Wales was 11.7, and for London 12. 2. The total number of deaths was 20 higher compared with the preceding year, and 114 were males and 138 females. 174 deaths or 68% were of persons above the ago of 65. The chief causes of death at all ages were Heart Disease 101, Oncer 44, and Pneumonia 32. The Deaths and Death-Rates for the past five years have been:- Year. No. of Deaths. Friern Barnet. Death-Rates. England & Wales. London. 194.5 233 9.4 11.4 13.8 1946 261 10.0 11.5 12.7 1947 264 9.9 12.0 12.8 1948 232 9.0 10.8 11.6 1949 252 9.2 11,7 12.2 There were 10 deaths of infants under 1 year of age, giving an Infantile Death-Rate of 26 per 1000 births, compared with 7 deaths and a rate of 19 in 1948. The comparative rates for England & Wales and for London were 32 and 29 respectively. Of the 10 infant deaths 7 occurred during the first week of life. 5 sanitary services. sanitary inspections. Visits to premises on complaint 623 Visits in connection with infectious disease 75 Visits to shops and places where food is prepared, stored or sold 217 visits to dairies and milkshops 53 Visits to factories 48 Visits to petroleum installations 15 Visits under Housing Act, works in progress and re-inspections 2755 Visits for appointments and special visits 302 Visits re infestation and disinfestation of verminous premises 9 Visits for the purpose of rodent control 10 Visits to piggeries 52 Attendances at Court 3 4162 Visits by Rodent Operative in connection with rodent control 2082 TOTAL 6244 service of notices. Total number of informal notices served 446 Total number of informal notices complied with 383 (a) Served during 1949 303 (b) Outstanding from previous year 80 Total number of statutory notices served 31 Total number of statutory notices complied with 22 6 The following is a summary of the sanitary improvements and defects remedied during the year as a result of action by the Public Health Department:- Water. Store cisterns provided, repaired, cleansed or covers provided 11 Fittings and services repaired 18 Drainage. Drains cleared or repaired 18 Inspection chambers reconstructed or repaired 7 Inspection covers provided 8 Soil and vent pipes provided or repaired 4 Sinks provided or repaired 17 Sink waste-traps provided or repaired 30 W. C's. W. C. pans and traps provided or repaired 34 W. C. seats, doors, windows floors renewed or repaired 27 Walls and ceilings cleansed and distempered 45 Flushing cisterns provided, repaired or regulated 29 Floors. Floors renewed or repaired 104 Roofs. Roofs repaired 195 Gutters and downspouting renewed or repaired 92 Cleansing. Walls repaired, cleansed and redecorated 602 Ceilings renewed or repaired 613 Windows. Sashes and frames renewed or repaired 233 Sills renewed or repaired 151 Sashcords provided (number of houses) 56 Brickwork. Damp-proof courses provided 12 Brickwork repaired 33 Chimney stacks rebuilt or repaired 9 Walls re-pointed or rendered 131 Woodwork. Doors renewed, repaired or re-hung 47 Staircases repaired 19 Yards. Yard paving repaired or renewed 23 Refuse. Dustbins provided 19 Accummulations of refuse removed 2 General. Ranges or grates renewed or repaired 1ll Wash-boilers renewed or repaired 13 Other defects (unclassified) remedied 113 7 WATER SUPPLY. The water which is obtained from deep wells sunk into the chalk is supplied by the Barnet District Water Company. Bacteriological and chemical examinations of the water were carried out at regular intervals, and the following is characteristic of reports received:- "This is a very satisfactory water. It is clear and bright in appearance and of the highest standard of bacterial purity, indicative of a pure and wholesome water suitable for the purpose of a public supply". All houses in the district have a piped supply, and there have been no complaints of unsatisfactory or insufficient supply. RATS AND MICE (DESTRUCTION) ACT, 1919. During the year 327 private and business premises were visited and investigated for infestation by rats, and treatment was carried out in 253 instances. In addition public undertakings such as the Sewage Works, Refuse Tip, Depots and Parks and other open spaces were regularly visited and treatment carried out whenever necessary. The fourth and fifth maintenance treatments of the district rowers were carried out during the year, and the number of manholes showing infestation was 17. These results were somewhat similar to these of last year and suggest that the extent of rat infestation in the sewers is slight. In addition to the above 65 premises were treated for infestation by mice. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. The following licences were issued under the Milk (Special Designations) Regulations 1936/46:- Pasteruriser's 1 Dealer's. Pasteurised 3 Tuberculin Tested 1 Supplementary. Pasteurised 6 Tuberculin Tested 5 The Milk (Special Designation)(Pasteurised and Sterilised Milk) Regulations 1949, and the Milk (Special Designation) (Raw Milk) Regulations, 1949, came into operation on the 1st. October 1949, and the following licences were issued under these Regulations:- 8 Dealer's. Sterilised. 9 Tuberculin Tested 1 Supplementary Pasteurised 5 Thirty samples of milk supplied in the district were taken. In the case of one source of supply two samples failed to satisfy the proscribed tests. The circumstances were fully investigated and the matter taken up with the retailer concerned. As a result of this action subsequent samples were satisfactory. During the course of the year it was necessary to bring to the notice of the Council three instances of dirt or other foreign matter in bottles of Milk. In one instance legal proceedings were taken against the supplier, when the Court imposed a penalty of £20. The investigations carried out in these cases and also during routine visits show that a large number of bottles are being returned by consumers in a disgusting condition. The wastage of bottles which ore no longer fit for use as milk containers is as a result very high. From time to time an unsatisfactory bottle slips through the elaborate system of sorting and cleansing, with the results referred to above. Without in any way removing from the milk distributors a very proper responsibility to put clean milk only in clean bottles, it is a fact that any failure to do so is indirectly the fault of a customer somewhere, and there is little doubt that if milk bottles were only used for the purpose for which they are intended, and were rinsed immediately after use, there would be an end to this typo of complaint. MEAT AND OTHER FOODS. Regular visits were made to butchers', fishmongers', grocers', bakers' shops, and other food premises. A very considerable quantity of food was examined of which the following was certified as unfit for human consumption:- Beef 33 lbs. Lamb 5 lbs. Sausages 3 lbs. Bacon 7 lbs. Fish 476 lbs. Cheese 18 lbs. Butter 1 lb. Fruit 537 lbs. Tinned Corned Beef/Mutton 30 tins. " Vegetables 85 tins. "Meat 62 tins. " Milk 189 tins. " Fish 47 tins. " Fruit 67 tins. " Bacon 1 tin. " Soup 7 tins. " Fruit Juice 28 tins. " Fish Paste 7 tins. " Sausages 24 tins. Jars Mustard Pickles 1920 jars. Pork Pies 88 9 ICE CREAM. Certificates of Registration were issued in respect of 10 premises during the year, making a total of 40 premises now registered in the district for the sale of ice cream. Inspections were paid to registered premises, and such minor improvements as were desirable carried out. FOOD POISONING. Two cases only, in the same family were notified during the year, and both made a rapid and satisfactory recovery. The causative agent was not traced, although the circumstances suggested that the offending food was fried fish. No other cases could be traced to the same source of supply. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. From Table 1st the end of this report it will be seen that 493 cases of infectious disease were notified during the year, as against 539 in 1948. Diphtheria. For the first time on record no cases of Diphtheria were notified. A decline in the incidence of this disease has been noted for a number of years, and it would appear reasonable to state that, provided the present level of immunisation is maintained, the disease need hold no future terrors. Scarlet Fever. Notifications of Scarlet Fever rose by 4 to 54 cases, which is no more then the average for the pest 10 years. The type of disease met with has been mild. Home treatment continued satisfactorily, and less then 50 per cent of the cases notified were removed to Hospital. Poliomyelitis. As noted in the introduction to this report, 4 cases were reported during the year - one female aged 18 years, and three males, aged 2 years, 18 years, and 42 years respectively. All made a satisfactory recovery. Measles. The number of cases notified during the year fell very slightly from 309 in 1948 to 304. The type of disease was again mild, admission to Hospital being necessary in only 4 cases. Whooping' Cough. There was a substantial decrease in the number of cases of Whooping Cough - 59 cases compared with 120 in 1948. Only in 3 cases was it necessary for Hospital treatment. Tuberculosis. Tuberculosis notifications rose from 30 in 1948 to 38 in 1949. In addition 7 persons, previously notified in other areas, also took up residence in the district. IMMUNISATION AGAINST DIPHTHERIA. During the year 273 children were immunised against Diphtheria - 183 at the Clinic, and 90 by medical practitioners under the National Health Scheme. On reaching school age, 145 children were given a re-inforeing injection. SCABIES. Only 1 cases was notified during the year, and the patient was supplied with medicament for home treatment. 10 LOCAL HEALTH SERVICES. The provisions of the Act relating to the care of expectant and nursing mothers and young children, the domiciliarly midwifery service, the health visiting service, the home nursing service, arrangements for vaccination and immunisation, the ambulance service, the arrangements for the prevention of illness, care and after -care, and the domestic help service, are administered by the Middlesex County Council as the Local Health Authority. Day to day administration of these services has been delegated to the area health committee on which your Council has been represented by the Chairman of the Public Health Committee, Councillor A.C.Henry, and by Councillor C.F. Simmonds. NATIONAL ASSISTANCE ACT 1948. SECTION 47. REMOVAL TO SUITABLE PREMISES OF PERSONS IN NEED OF CARS AND ATTENTION. This section has for its purpose the securing of proper care and attention for persons who - (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions, and (b) are unable to devote to themselves and are not receiving from other persons, proper care and attention. After consideration of a certificate issued by the Medical Officer or Health when ho is satisfied that in the interests of the person or to prevent injury to the health of, or serious nuisance to other persons, it is necessary to remove any such person from the premises, the local authority may apply to a Court of Summary Jurisdiction for an order to remove that person to a suitable hospital or other place, and his or her detention therein. Such on order is for a period not exceeding three months and can bo renewed at the discretion of the Court. There has been no need to take any formal action under this section. In those instances where persons were found to be in need of care and attention it was invariably the case that they were either quite amenable to leaving their squalid surroundings, or could be so persuaded, and formal action would only have hod the effect of creating on administrative delay to a desirable solution on which there was already agreement. The problem arose in securing the suitable accommodation. During the course of the year the circumstances of twelve persons, all of them aged, were investigated. These cases come to the knowledge of the Deportment either in the course of routine inspections, or as a result of information provided by neighbours or other interested persons. The procedure in such cases has been to trace, if possible, any relatives, who are then interviewed with the. object, and in the hope, that a new home may be found for the person amongst his or her own family. Unfortunately in may cases no relatives can be traced, and where they are, housing Conditions or other circumstances for the most part make such a solution impossible. The County Council as the local authority for the purposes of the National Assistance Act 1948 provide residential accommodation for persons who fay reason of age, infirmity or other circumstances, are in need of care and attention which is not 11 otherwise available to them. For the present, however, it is apparent that the demand for Home accommodation is greater than that available. Furthermore, many of the persons needing care and attention are chronic sick. Their conditions varies from day to day, and the solution, residential home accommodation or hospital bed must vary accordingly. Where, as often happens, there is a delay in obtaining suitable accommodation for these old folk, the particular case is discussed with persons or organisations connected or interested in this problem with the object of improving home conditions during the period of waiting. Grand help for example has been given by the Friern Barnet Council of Social Service, not only in homo visiting and provision of meals, but in seeking, and finding, accommodation in private Homes. Full advantage is also taken of the Nursing and Home Help services provided by the County Council. The activities of the old peoples' clubs in promoting meetings of, and friendships amongst, the older members of the community, undoubtedly play a very useful part in the avoidance of the creation of a set of circumstances whereby elderly people living alone, unknown, and without friends, can so easily become merely persons in need of care and attention. The position with regard to the twelve cases investigated during the year was as follows - (a) Removed to County Council Homes - 3 (of which one subsequently died). (b) Removed to private Homes - 2 (both of whom subsequently died). (c) Removed to Hospital - 4 of whom two subsequently died). (d) Removed to live with relatives - 1 (e) Died at home - 2 12 REPORT OF MEDICAL OFFICER REQUIRED BY SECTION 128 (3) OF THE FACTORIES ACT, 1937. 1. Inspections for purpose of provisions as to health. Number of Number on Register. Inspections. Written notices. Occupiers Prosecuted (1) Factories in which secs. 1,2,3,4 & 6 are to be enforced by Local authorities 14 12 1 - (2) Factories not included in (1) in which Sec. 7 is enforced by the Local Authority. 59 35 2 - (3) Other premises in which Sec.7 is enforced by the Local Authority. 4 1 - - Total 77 48 3 - 2. Cases in which defects were found. No. of cases in which defects were found. Found. Remedied. Referred Prosecutions. To H,M. Inspector. By H.M. Inspector. Want of cleanliness 3 3 - - - Sanitary conveniences (a) Insufficient 1 1 - - - Other offences. 1 1 - - - Total 5 5 - - - OUTWORKERS (Sections 110 end 111). Section 110. Section 111. No. of outworkers on lists received. No. of instances of work in unwholesome premises. Notices served. 38 - - 13 TABLE 1. ANALYSIS OF CASES OF NOTIFIABLE INFECTIOUS DISEASES NOTIFIED DURING THE YEAR ENDING 31st. DECEMBER. 1949. DISEASE. NUMBER OF CASES NOTIFIED. CASES IN EACH WARD. Friern Hosp. NO. REMOVED TO HOSP. All. , Un .l. 1-5. 5-15. 15-25. 25-45. 45-65. 65&0 North. South. Cent. East. West. Measles. 304 12 169 118 4 1 - - 58 150 44 12 40 - 4 Whooping Cough. 59 3 28 26 - 2 - - 8 8 18 6 19 - 3 Scarlet Fever. 54 - 6 45 2 1 - - 12 17 6 6 13 - 22 Pneumonia. 26 - 1 4 3 6 7 5 7 8 8 - 1 2 - Poliomyelitis. 4 - 1 - 2 1 - - 3 - - - 1 - 3 Erysipelas. 4 - - - - 1 1 2 2 1 - - 1 - 1 Dysentery. 3 - 1 - - l 1 - 1 - - - - 2 - Cerebro-spinalmeningitis. 1 - - 1 - - - - 1 - - - - - 1 Pulm. Tuberculosis. 34 - - - 12 12 10 - 5 9 5 3 3 9 - Non-Pulmonary- Tuberculosis. 4 - - - - - 4 - 3 - 1 - - - - TOTALS. 493 15 206 194 23 25 23 7 100 193 82 27 78 13 34 TABLE 2. ANALYSIS OF THE CAUSES OF AND AGES AT DEATH DURING THE YEAR 1949 FOR THE WHOLE DISTRICT. Cause of Death. No. Reg. In Trans. At Ages Wards. M. F. Nett Deaths. 0-1 1-2 2-5 5-15 15-25 25-45 45-65 65 & 0. N. S. C. E. W. Accident. 3 4 - - - - - 2 3 2 3 - 1 - 3 4 3 7 Arterio-sclerosis. 4 - - - - - - - - 4 2 2 - - - 3 1 4 Bronchitis. 2 1 1 - - - - - 2 1 1 - - 1 1 2 3 Cancer. 28 16 - - - - - 2 16 26 11 5 13 1 14 21 23 44 Cerebral-haemorrhage 18 8 1 - - - - - 7 18 8 3 5 1 9 7 19 26 Congenital debility. 1 4 5 - - - - - - - - 3 2 - - 3 2 5 Epilepsy. - 1 - - 1 - - - - - - - - - 1 1 - 1 Heart Disease. 70 31 - - - - - 2 16 83 31 13 27 4 26 49 52 101 Nephritis. 4 5 - - 1 - - - 1 7 3 2 2 1 1 4 5 9 Other circulatory diseases. 2 - - - - - - - 1 1 - 1 - - 1 - 2 2 Other defined dis. - 5 - - - - 1 - 3 1 2 2 1 - - 3 2 5 Other digestive dis. 1 3 - - - - - - - 4 1 1 2 - - 2 2 4 Pneumonia. 13 19 3 - - - - 1 7 21 11 7 8 1 5 12 20 32 Syphillis. 1 - - - - - - - - 1 - - - - 1 - 1 1 Senility. 3 - - - - - - - - 3 1 - - - 2 2 1 3 Suicide. 1 1 - - - - 1 - - 1 - 1 2 - 1 - 2 2 Tuberculosis(Pulm) 5 1 - - - - 3 - 3 - 1 4 1 - - 4 2 6 Whooping Cough. - 1 - 1 - - - - - - - - - - 1 1 - 1 TOTAL. 156 100 10 1 2 - 5 7 57 174 75 44 64 8 65 117 139 256 table 3. ANALYSIS OF CASES OF TUBERCULOSIS NOTIFIED 1949, AND THE MORALITY FROM the DISEASE OVER THE SAME PERIOD. AGES NEW CASES DEATHS. PULMONARY NON-PULMONARY PULMONARY NON-PULMONARY. MALES. FEMALES. MALES. FEMALES. MALES. FEMALES. MALES. FEMALES. 0-1 - - - - - - - - 1-5 - - - - - - - - 5-10 - - - - - - - - 10 - 15 - - - - - - - - 15 - 20 3 4 - - 1 1 - - 20 - 25 2 3 - - 1 - - - 25 - 35 3 5 - - - - - - 35 - 45 2 2 - - - - - - 45 - 55 6 1 - 1 1 1 - - 55 - 65 1 2 1 2 1 - - - 65 & 0. - - - - - - - - TOTAL. 17 17 1 3 4 2 - - TABLE 4. REGISTER OF TUBERCULOSIS. PULMONARY. NON-PULMONARY. TOTALS. MALE. FEMALE. MALE. FEMALE . Cases on Register at 1.1.49. 94 62 6 20 182 Cases notified for first time 1949. 17 17 1 3 38 Other cases added to Register 1949 2 - 3 2 7 Cases removed from Register 1949 18 3 15 1 37 Cases remaining on Register 31.12.49. 95 4 67 24 190 TABLE 5. INFANTILE MORTALITY. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. 1949. Under 1 week. 1—2 weeks, 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total under 1 year.  All Causes:- Certified. 7 1 - 8 1 - 1 - 10 Un-Certified. - - - - - - - - - - Asphyxia. 1 - - - 1 - - - - 1 Atelectasis. 1 - - - 1 - - - - 1 Bronchitis. - - - - - - - 1 - 1 Cerebral-haemorrhage. 1 - - - 1 - - - - 1 Pneumonia. 2 - - - 2 1 - - - 3 Prematurity. 2 1 - - 3 - - - - 3