AC. 439 (3) 1/ Mr O'Mata 5B 2/ Library FRI 36 Friern Barnet Arban District Council ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1958 WM. CLUNIE HARVEY, m.d., d.p.h. Medical Officer of Health FRIERN BARNET URBAN DISTRICT COUNCIL. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1958. WM. CLUNIE HARVEY, M.D.,D.P.H. Medical Officer of Health. Public Health Department, Town Hall, Friern Barnet, Middlesex. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1958. The year under review was once more uneventful. No epidemics or outbreaks of infectious diseases occurred. The matter of infectious diseases will, of course, be discussed in greater detail in the section of the report which deals with prevalence and control. The vital statistics were also satisfactory. The birth rate rose very slightly, from 11.2 in 1957 to 11.5 in 1958. The death rate, apart from those deaths which occurred in Friern Hospital, rose slightly, from 9.5 to 10.4. It is once again very pleasing to be able to report that no maternal death has been recorded in Friern Barnet within the past 12 years, during which period 4,340 births have taken place. The Infant Mortality Rate, i.e. the number of infants dying under one year per thousand live births, was 12.2 representing four infant deaths. The pattern of Public Health in Friern Barnet has not altered materially during recent years. The point of emphasis may vary from year to year, as one or another phase of preventive medicine predominates. But on the whole, the picture has remained more or less the same. Fortunately, it is a happy one, free from garish highlights or arresting questionable shadows. The important questions of the demolition of unfit houses and clean air - both of supreme importance in promoting health - are dealt with in the body of the report. Suffice to say here that both these matters received careful attention in 1958, and that they figured from time to time in the reports submitted to the Public Health Committee and to the Council. 1 Health education has once again been prominently featured in the health services of Friern Barnet, In this connection the remarks set out in the introduction to my Annual Report for 1957 still stand. Although the cost of providing a health education programme in a district such as Friern Barnet is extremely small, we have never lost any opportunity which is likely to promote a better understanding, both of the value of positive health and of the health services provided either by the Urban District Council or by the County Council in Friern Barnet. I would particularly mention the excellent work put in by Mr. Jackaman and the Public Health Staff in arranging regular exhibits in the kiosk outside the Town Hall. I am aware that I have mentioned this before, but I am equally sure that the Council would wish me to pay tribute once again to what has become a permanent and very live feature of health education in Friern Barnet. During the year, I had the privilege of being appointed a member of the Medical Advisory Committee to Friern Hospital. This allowed me to gain an extremely useful insight into the working of this large mental hospital which, together with its ancillary hospital (Halliwick Hospital), provides in such large measure for the specific needs of the district in the field of mental illness. As will be known, the new Mental Health Act which will shortly be placed on the statute book envisages a much closer liaison between mental hospitals and local authorities. We are all watching this aspect of the expanding problem of mental health with the keenest interest. I will therefore report any fresh developments from time to time to the Public Health Committee. Meanwhile, I will maintain the closest possible liaison with Friern Hospital. As I am also a member of the Medical Advisory Committee to the Northern Group of Hospitals, I am equally able to learn at first hand what is going on in the general hospital world in this Area and am able to establish a closer link than would otherwise be possible between our hospitals and the local authority. I feel most strongly that this link is in every way essential. 2 The value of the liaison which I have been able to develop between my duties as Medical Officer of Health for Friern Barnet and Area Medical Officor for Area No. 2., County of Middlesex, has been maintained, if not intensified during 1958. As the Council will be aware, we have a very close link between the Public Health Department and the immunisation sessions at Holly Park Clinic. It was also possible to arrange the closest and most harmonious co-operation between the Public Health Department and the Area Health Office in the matter of propaganda for vaccination against poliomyelitis. This was of quite inestimable value, and has undoubtedly been a very potent factor in establishing the fact that the vaccination against poliomyelitis rate for Friern Barnet children must now be among the highest in the County. It is a great personal pleasure to be privileged to correlate the work of the Public Health Department with that of the Area Health Office, ever having in mind that health is quite literally indivisible. It would be quite impossible in such a report as this to elaborate the many ways in which these links nave been forged, although one might mention the constant interchange of information and of views which takes place almost day by day. Altogether, the part which is being played by the Urban District Council in promoting the personal health services of the inhabitants of Friern Barnet is by no means inconsiderable. And that is almost certainly an understatement. More and more emphasis is being placed, and very rightly placed, each year on the risks which accompany the increasing use of radio-active materials. It must certainly be admitted that Friern Barnet is not a district in which radio-activity is likely to present itself as a serious hazard. None the less, the position remains unsatisfactory. I am personally convinced that at least a proportion of the Public Health staff should be made fully aware, not only of any sources of radio-active waste or fission products which exist within the Urban District or in the vicinity; but should also have adequate training in the measures which would have to be taken in an emergency. Neither of these essential safeguards has yet been provided. We are certainly told that the most careful watch is being 3 kept by the Medical Research Council, and that we will at once be informed if and when the general level of radio-activity approaches the danger point. This, of course, is a statement which one would not attempt to contradict. Nevertheless, I still feel that the Public Health Department should be in possession of the fullest possible information, and that responsible members of the staff should know exactly what they have to do should a sudden emergency arise. I would once again conclude this report by expressing my sincere thanks to the Public Health Committee and to the Urban District Council for the unfailing courtesy and assistance extended to me as Medical Officer of Health. I would also extend my grateful thanks to every member of the Public Health Department, with particular reference to my Deputy Dr. Janet Campbell, the Chief Public Health Inspector, Mr. W. Jackaman, and Mr. J. Wilson, Chief Clerk in the Public Health Department. I need scarcely say that Mr. Jackaman is and always has been a tower of strength. But, ever since I took up my duties as Medical Officer of Health in 1953, I have had the privilege of leading a first class team, without whose unfailing help my task would have been much more difficult. I remain, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, W. C. Harvey Medical Officer of Health. August 1959 4 PUBLIC HEALTH COMMITTEE. at 31st. December, 1958. Cr. J. Foley, F.F.S., F.V.I. (Chairman) Cr. K. J. Allan (Vice-Chairman) Cr. W. H. Tangye, J.P.,F.R.I.C.S., F.A.I. (Chairman of the Council) Cr. E. Fergusson Taylor, F.V.I. (Vice-Chairman of the Council) Cr. S. P. Esom, M.I.M I. Cr. G. H. Flesher, F.I.O.B. Cr. K. J. Norman. Cr. Mrs. M. C. Pugh. Cr. R. F. Pugh, J.P. Cr. Miss M. J. Richards, J.P.,B.A. PUBLIC HEALTH STAFF. Medical Officer of Health W. Clunie Harvey, M.D.,Ch.B.,D.P.H. Deputy Medical Officer of Health Janet R. Campbell M.B.,Ch.B.,D.P.H. Chief Public Health Inspector W. R. Jackaman. Public Health Inspector J. K. Harris. Public Health Inspector R. L. R. Beswick. Chief Clerk J. Wilson. Assistant. Miss E. M. Glasscock, Rodent Operative E. T. Crawshaw. 5 STATISTICS OF THE AREA. Area (in acres) 1,340 Population (Registrar General's estimate 1958) 28,540 (District - 26,120) (Friern Hospital - 2,420) Number of inhabitated houses 8,117 Rateable Value (31st. December, 1958) £430,292 Sum represented by a penny rate £1,725 EXTRACTS FROM VITAL STATISTICS. LIVE BIRTHS. Male. Female. Total. (Legitimate) 150 159 309 (Illegitimate) 13 6 19 Total 163 165 328 BIRTH RATE (live births per 1000 population) 11.5 STILL BIRTHS. Male. Female. Total. (Legitimate) 1 5 6 (Illegitimate) - - - Total 1 5 6 STILL BIRTH RATE(per 1000 total (live and still) births)18.3 TOTAL BIRTHS 334 6 INFANT DEATHS (under 1 year of age.) Male. Female. Total. (Legitimate) 1 2 3 (Illegitimate) 1 - 1 Total 2 2 4 INFANT DEATH RATE ( per 1000 live births) 12.2 INFANT DEATH RATE ( per 1000 legitimate births) 9.7 INFANT DEATH RATE ( per 1000 illegitimate births) 52.6 NEO-NATAL DEATH RATE (under 4 weeks per 1000 live births) 3.0 NEO-NATAL DEATH RATE (under 1 week per 1000 live births) 3.0 PERINATAL DEATH RATE (stillbirths and deaths under 1 week per 1000 total live and still births) 20.9 PERCENTAGE OF ILLEGITIMATE LIVE BIRTHS OF TOTAL BIRTHS 6.1% MATERNAL DEATHS (excluding abortion) 0.0 MATERNAL DEATH RATE (including abortion per 1000 births live and still) 0.0 DEATHS. Male. Female. Total. District 126 147 273 Friern Hospital 41 90 131 Total 167 237 404 DEATH RATE (per 1000 population including Friern Hospital) 14.1 (" " " District only) 10.4 7 BIRTHS. The number of births assigned to the district was 328, giving a Birth-Rate of 11.5 per 1000 of the population. The correcting factor for age and sex distribution so far as Friern Barnet is concerned is 1.12. so that the rate for comparative purposes was 12.9. The corresponding Birth-Rate for England and Wales was 16.4. Births and Birth-Rates for the past five years have been: Year. No. of Births. Birth-Rates. Friern Barnet. England & Wales. 1954 274 10.1 15.2 1955 318 11.7 15.0 1956 332 12.2 15.6 1957 318 12.5 16.1 195# 328 12.9 16.4 DEATHS. There were 404 deaths during the year. Of these, 131 occurred in Friern Hospital and 273 in the district. This provides an un-corrected Death-Rate of 14.1 per 1000 for the total population, and 10.4 per 1000 for the district excluding Friern Hospital. The correcting factor for age and sex distribution is O.64, providing a Death-Rate for comparative purposes of 9.0. The corresponding rate for England and Wales was 11.7. An analysis of the various causes of death will be found at the end of the Report. From this table it will be seen that deaths due to diseases of the heart and circulation made up more than 3 50% of the total deaths recorded during 1958. This merely repeats the findings of the past few years. The continuous appearance in our mortality statistics of deaths from coronary diseases, together with other diseases of the heart and circulation, especially among males during what should be the prime of life, is most disturbing. Various reasons have been advanced to explain these catastrophies, although no single explanation would seem to meet the case. The increasing stress and strain of modern life and errors in diet have both been accused, although there may well be some other factor or factors which have not yet come to light. Whatever the cause, this is obviously a matter which calls for the most profound study. For the same reason, the alarming increase in deaths from cancer of the lung provides another avenue which should be explored, must be explored as a matter of urgency. Although one cannot say that there are any specific factors peculiar to Friern Barnet which encourage coronary disease or lung cancer, it is quite evident that health education should play its part in providing the necessary advice and guidance, at least along general lines. The Deaths and Death-Rates for the past five years have been: Year. No. of Deaths. Death-Rates. Friern Barnet. England & Wales. 1954 434 14.2 11.3 1955 474 15.6 11.7 1956 505 9.7 11.7 1957 483 9.6 11.5 1958 404 9.0 11.7 9 GENERAL PROVISION OF HEALTH SERVICES. Hospitals. The remarks contained in my Annual Report for 1957 relating to the provision of hospital services remain more or less unaltered. No difficulty has been encountered in the admission of maternity cases to hospital, either on social or on medical grounds. The admission of infectious diseases cases, mostly to Coppetts Wood Hospital, together with the admission of acute medical or surgical cases to general hospitals, also presented no real problems. Unfortunately, the obstacles in the way of the admission of the type of case commonly known as the "elderly chronic sick" have not yet been wholly overcome. As I have said before, Friern Barnet is rather fortunate in this respect, as the hospitals to which our geriatric cases are referred have excellent geriatric services. until this problem is finally solved, however, - and it is a problem which is increasing year by year - we cannot and should not abate our efforts to ensure that beds are readily available for old people who require admission to hospital. This is a gap, an increasing gap, in our social services which must, on every ground, be closed. Care of the Aged. I have once again been privileged to take part in the work of the Friern Barnet Old People's Welfare Committee. As Medical Officer of Health, I cannot speak too highly of the work of this Committee, which, in my submission, is in many ways a model of its kind. As Medical Officer of Health and Area Medical Officer, I endeavour, in every way practicable to link the statutory services of which I am in control with the work of the Old People's Welfare Committee. On the other hand, I am very sensible that the Old People's Welfare Committee has been able in many ways to assist the statutory services, by providing those little extras which do not lie within the province either of the local authority or of the local health authority. Year by year, I realise more forcibly the value of old People's 10 Welfare Committees. Indeed, I consider it a very real pleasure to be allowed to attend the meetings of the Friern Barnet Committee and to assist its quite invaluable work so far as lies within my power. National Assistance Act 1948. Section 47. Removal to suitable premises of persons in need of care and attention. No formal action was taken under this section during the year. Section 50. Burial or cremation of the dead. No action was necessary under this section during 1958. Laboratory Facilities. Once again we did not have to call upon the Laboratory to any extent during 1958 owing to the absence of major outbreaks of infectious disease or any other untoward happenings. Summary of examinations carried out at Public Health Laboratories for the year 1958. Throat and nose swabs 1 Faeces 119 Sputum 4 Ice cream 31 Milk 69 Sweets 1 Meat 44 11 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. From the table of infectious diseases set out in Table 1, it will be noted that 193 cases of infectious disease were notified during the year as against 587 in the previous year. The decrease in the total number of infectious diseases notified during the year was, of course, almost entirely due to the fact that 1958 was not a "measles year". I can add little to the paragraphs contained in my Report for 1957 which dealt with the notification of infectious diseases and with the question of epidemiology as a socialogical entity. I must, however, repeat that, after very careful consideration, I am of opinion that the present system of notification should be reviewed in its entirety in the light of present knowledge and experience. Although it is very right that e should continue - at least for the time being - to receive notifications of even the milder type of infectious disease, two facts are becoming increasingly obvious. There is at least a proportion of dead wood which could profitably be removed. More important, much more important, certain diseases, some of them noninfectious, might well be added to the list of diseases which are reported to the Public Health Department. This is not, of course, a matter which has any local significance, but rather falls within the designation of a national problem. If the Public Health ment and the Urban District Council are concerned with all matters which affect the health of the inhabitants of the district - and this has been clearly established then it follows logically that we should have the fullest possible information, not only of conditions which are likely to affect health, but of diseases which are materially affecting not only the health but the lives of young and old. Thus, although we know at any time how many cases of scarlet fever or measles are occurring in the district, we usually have to wait until the receipt of a death certificate before we are aware of cases of cancer, acute fatal rheumatism and heart diseases. Yet, in the category of the common infectious diseases, scarlet fever is an extremely mild disease today; while in the case of measles, we do little more 12 than act as a post office I No one denies that the infectious diseases picture to-day is radically different from what it was only a few decades ago. One has only to look at the use which is being made of our old isolation hospitals to realise this fact. Yet the pattern of notification has altered very little. One appreciates that tnis is an enormous problem with many ramifications. But it surely represents a problem which can and should be vigorously tackled on a national level. Diphtheria. No cases of diphtheria were notified in the district during 1958. The last death took place approximately eleven years ago. Our campaign of immunisation against diphtheria has been carried on throughout the year along the general lines set out in my Annual Report for 1957. We are still continuing to give separate protection against diphtheria and pertussis (whooping cough), in the belief that the protection afforded by vaccination against poliomyelitis is not yet sufficiently advanced to remove the possible danger of provocation poliomyelitis. I am very pleased to be able to report that Friern Barnet mothers have freely accepted our advice and are attending with their infants as often as is necessary at clinics or at their own doctors' surgeries, to have their children protected against diphtheria and pertussis (whooping cough) separately, and also vaccinated against smallpox. As the necessary number of visits, including vaccination against poliomyelitis, does not entail more than One visit each month to a clinic or to the family doctor, it can scarcely be said that an intolerable burden is being placed on the shoulders of mothers or children. Detailed records kept in the Area Health Office show that 93% of Friern Barnet children who had reached the age of 2 years by the end of 1958 had been fully protected against diphtheria. These figures are eminently satisfactory, and speak for themselves. Indeed, they represent levels of 13 immunisation which, not so many years ago, would have been considered quite unattainable. They obviously redound to the credit and intelligence of our mothers, who appreciate to the full the advantages which protection against such diseases as diphtheria, pertussis (whooping cough), poliomyelitis and smallpox will convey to their infants. Immunisation figures for 1958. Children immunised against diphtheria or diphtheria and whooping cough combined 306 (a) At County Council Clinics 194 (b) By family doctors 112 Children giving re-inforcing injections 679 Scarlet Fever. Thirty-nine cases of scarlet fever were notified during 1958 as against thirty-seven in 1957. The notifications for the previous three years were 37, 22 and 12 respectively. I remarked in the Annual Report for 1957 that it was no longer considered necessary to exclude home contacts of scarlet fever from school. The fact that the exclusion of contacts results merely in a loss of school time, without in any way materially reducing the risk of spreading scarlet fever in schools, is shown by the fact that the new policy has not resulted in any increase in the number of scarlet fever cases reported from our schools. Scarlet fever continues to be an extremely mild disease; indeed, it is so mild that one often wonders whether anything like 100% of the cases which occur in any given year are reported to us. As I have remarked so many times before, however, we must remain on our guard in case the more virulent type of scarlet fever which we -all remember so well before the war should return. 14 Acute Anterior Poliomyelitis. No cases of poliomyelitis were notified in Friern Barnet during 1958. This is, of course, extremely satisfactory, although it must be remembered that the drop in poliomyelitis cases which was such a welcome feature of 1958, was nation-wide. I have reported to the Public Health Committee from time to time on the scheme of vaccination against poliomyelitis which is now in force within the Urban District as part of the County Council's immunisation and vaccination programme. This scheme operated with remarkable smoothness during the year. It is not possible in this report to detail the number of Friern Barnet children who have been given either one, two or three injections against poliomyelitis, as these figures are not yet available. As soon as the numbers have been tabulated, howeve" , I will report the year's totals to the Public Health Committee. At the moment, it can be said that the percentage of children up to the age of 15 who have been vaccinated against poliomyelitis is most gratifying and must be one of the best reported in the County. This again is a tribute to the foresight of parents, who have not hesitated to take advantage of the facilities provided. The response to the offer of vaccination against poliomyelitis among the 15 - 26 age group was not so high, although here again our preliminary survey tends to show that the rate was and still is considerably higher than that reported from the country as a whole. We all know that the policy of vaccination against poliomyelitis has been altered from time to time, and that it has not yet been entirely stabilised. Many people feel, for instance, that a fourth inoculation will be required before full protection can be guaranteed. It is certianly known that the third injection is vital; that without the third injection, given after a minimum of seven months following the second injection, no one is fully protected. In view of the changing picture, I intend to keep the Public Health Committee fully informed of variations in policy and progress made. 15 Friern Barnet co-operated with the Central Public Health Laboratory at Colindale in collecting and sending for examination, every week, the stools of selected infants. This was part of an extensive enquiry into the possible existence of carriers of the poliomyelitis virus. No virus was discovered among all the specimens sent for examination. Measles. One hundred and six cases of measles were notified during the year as against 441 in 1957. As with scarlet fever, severity was extremely mild, admission to hospital not being required in any of these cases. This contrasts very favourably with the position not so very long ago, when serious complications such as broncho-pneumonia and middle ear disease were all too common. Pertussis. (Whooping Cough). Sixteen cases of pertussis were notified during the year, as against 42 in 1957. It is too soon yet to say whether our policy of advising parents to have their children immunised against pertussis during the first six months of life is having a substantial effect. The decrease in notifications over the past few years, however, does give us reason to believe that this is, in fact, the case. We also know that, even when a case of pertussis (whooping cough) occurs in a child who has been immunised, the disease is mild, complications, once so very serious, being virtually unknown. I have always been a very strong believer in immunisation against pertussis. I am glad to think that this policy may now be paying handsome dividends. Puerperal Pyrexia No cases of puerperal pyrexia were notified during 1958. 16 Smallpox. No case of smallpox occurred during 1958. In view of the limited outbreak of smallpox in Tottenham during 1957, the fact that the vaccination rate among Friern Barnet children (the most recent figure was 79%), is most encouraging. Food Poisoning, including Sonne Dysentery. Six cases of dysentery and three cases of food poisoning were reported during the year, as against 7 cases of dysentery and two cases of food poisoning during the previous year. I can add little to the paragraph contained in the Annual Report for 1957. The policy there set out has been continued, and seems to be proving effective. Evidence has been accumulating that Salmonellae food poisoning is on the increase. For that reason, the most careful enquiries are made into every case reported to the Public Health department, in an effort to trace the cause and to eliminate any hazard which exists, either in Friern Barnet or elsewhere. Although cases of Sonne dysentery are reported from time to time, especially from our schools, no part of the district and no school was particularly affected during 1958. Tuberculosis. Fifteen cases of tuberculosis (ll pulmonary and 4 non-pulmonary) were notified during the year, compared with 21 cases during 1957. In addition 10 persons who had previously been notified as suffering from tuberculosis whilst living in other areas came to live in the district during the year. The total number of cases added to the register was therefore 25, eight less than in the previous year. 17 The distribution of the new cases throughout the various Wards was as follows:- North. South. Central. East. West. Friern Hospital. 3 2 5 - 1 4 A general classification of the new cases notified during the past three years (excluding those notified from Friern Hospital) in relation to their employment was: 1956. 1957. 1958. Clerical 2 3 1 Housewives 2 3 - Children 1 - 2 Professional Classes 1 2 - Factory Workers - 1 5 Manual Workers 2 1 1 Hairdressing - Food Trades - Nurses 1 Unclassified 1 4 2 It should again be stressed that these totals are not sufficiently large to allow significant conclusions being drawn. They can, however, be used as a means of practical comparison, if, for instance, one compares the Ward distribution as set out in the Annual Report for 1957, with the Ward distribution as set out above, it will be seen that no Ward was specifically affected each year. Thus, although five cases were reported from the South Ward in 1957, this figure had dropped to two in 1958; while the figure for the Central and West Wards were one and six in 1957, and five and one respectively in 1958. In other words, it does not appear that any particular part of the Urban District is specifically affected. The scheme for B.C.G. vaccination of Friern Barnet school children continues to make excellent 18 progress. As I write this report, information has been received that the schemo is to be extended both to younger children and to older adolescents. We welcome this extension, and are already taking steps to put the new proposals into operation. I must explain, of course, that this work is carried out through the School Health Service. Mass Radiography Unit 5B did not visit Friern Barnet during 1958. SANITARY SERVICES. Summary of inspections. Visits to premises on complaint 453 Visits in connection with infectious disease 244 Visits to shops and other places where food is prepared, stored or sold 429 Visits to other shops 240 Visits to factories 123 Visits to petrol installations 133 Visits in connection with housing and the repair of dwelling-houses 1701 Visits in connection with the Rent Act 311 Visits in connection with the Clean Air Act 253 Appointments and special visits 554 Visits re infestations and disinfestations 42 Visits in connection with rodent control 2167 Notices served. Informal Notices 201 Statutory Notices 30 19 HOUSING. Unfit houses. In June the occupants of 89-107 Oakleigh Road South, a group of ten houses included in a Clearance Area dealt with in 1957, were re-housed and the buildings were subsequently demolished. By the end of the year thirty-six of the seventysix houses included in the five year programme of 1955 to deal with unfit houses in the District had been pulled down. Repairs to houses. The investigation of housing conditions generally was continued with as much vigour as the many other tasks of the Department permitted. As a result repairs were carried out to 182 dwellings where the standard of accommodation was found to be unsatisfactory. The following is a summary of the defects which were remedied as a result of action taken by the Department. Water Supply. Store cisterns provided, repaired or covers provided 6 Fittings or services repaired 7 Drainage . Drains cleared or repaired 36 Inspection chambers reconstructed or repaired 3 Soil or vent pipes provided 2 New sinks provided 2 Sink waste-pipes provided or repaired 8 Sanitary accommodation W.C. basins and traps provided or repaired 7 W.C. seats, doors, windows, floors repaired or renewed 6 Walls and ceilings repaired and redecorated 6 Flushing cisterns provided, repaired or regulated 12 20 Floors. Floors repaired or renewed 16 Roofs. Roofs repaired 62 Gutters and downspouting renewed or repaired 40 Cleansing. Walls repaired, cleansed and redecorated 32 Ceilings renewed or repaired 21 Windows. Sashes and frames renewed or repaired 24 Sills renewed or repaired 14 Sashcords provided(number of houses) 12 Brickwork. Brickwork rebuilt 18 Chimney stacks rebuilt or repaired 6 Walls re-pointed or rendered 35 Woodwork. Doors renewed, repaired or re-hung 10 Staircases repaired 6 Yards. Yard pavings renewed or repaired 4 Heating. Ranges or grates renewed or repaired 11 Wash-boilers renewed or repaired 2 Refuse. Dustbins provided 35 Accumulations of refuse removed 6 General. Other defects remedied 89 Certificates of Disrepair. There were fewer applications for certificates of disrepair during 1958 than in the six months of 1957 immediately following the coming into operation of the Rent Act 1957. In those six months there were 56 applications whilst in 195# the number fell to 36. 21 The action taken in respect of these applications is set out below:- (1) Landlords notified of the Council's proposal to issue a certificate of disrepair:- (a) In respect of all defects 7 (b) In respect of some defects 29 Total 36 (2) Undertakings given by landlords to remedy defects 28 (3) Certificates of disrepair issued 8 Total 36 At the end of the year all the certificates of disrepair remained operative. Improvement grants. Although in most instances the maximum grant of half the cost has been offered the improvement provisions of the Housing Act 1957 attracted few applications. Fifteen tentative enquiries were investigated but for various reasons the majority of these were not proceeded with. Six proposals were submitted to the Council for decision in principle and the proposers were informed that their schemes were acceptable. Applications in respect of three of these were subsequently received and approved for grant aid but by the end of the year the improvement works had been carried out to one dwelling only. INSPECTION AND SUPERVISION OF FOOD. Food premises. The number of food premises in Friern Barnet is 160. Many of these are small general shops in which trading is not confined to the sale of food. According to the principal business carried on these food premises are engaged in the following trades:- 22 Registered under Food and Drugs Act 1955. Type. dumber. For sale of ice cream. For manufacture of sausages or" preserved food. Bakers 9 1 - Butchers 13 - 9 Cafes and Restaurants 26 8 - Confectioners 32 31 - Fishmongers 7 - - Greengrocers 23 3 - Grocers 46 26 11 Milkshops 4 4 - Total 160 73 20 There are also fourteen food hawkers trading in the District, four of whom have their storage premises in Friern Barnet. The remainder have their stores in the areas of neighbouring authorities. These hawkers are registered under the provisions of the Middlesex County Council Act in respect of the undermentioned trades:- Fishmongers 3 Greengrocers 10 Grocers 1 Visits were made to all these food traders as often as possible to encourage high standards of hygiene and to see that the Food Hygiene Regulations and Byelaws relating to the handling of food were observed. Displays on various aspects of food hygiene were also exhibited from time to time in the Kiosk outside the Town Hall. A consequence was that premises and equipment were improved, and probably benefit also resulted from the contacts and conversations with food handlers during the course of visits. The following briefly summarises the defects 23 remedied and improvements carried out to food premises:- Structurally improved 11 premises Cleanliness improved 20 " Floors provided or repaired 3 " Sinks provided 4 " Washbasins provided 6 " Hot water provided 7 " Lighting improved 3 " Ventilation improvded 5 " Sanitary accommodation improved 12 " Lockers for clothing provided 3 " First-aid equipment provided 7 " Equipment improved 34 " Legal proceedings. Proceedings under the Food and Drugs Act were taken against a firm of bakers for selling a loaf of bread which contained pieces of glass. The defendants pleaded guilty and the magistrates imposed a fine of £5 with £3. 3. 0d. costs. Food inspection. There are no licensed slaughterhouses in Friern Barnet and consequently no post-mortem examination of food animals except after the emergency slaughter of a sick or injured animal at one or other of the piggeries in the District. This was not necessary during the year. Of the food examined at the various food shops and stores the following was condemned as unfit for human consumption:- Beef 32 lbs. Lamb 4 lbs. Liver 41 lbs. Bacon 16 lbs. Pork 15 lbs. Sausage Meat 50 lbs. Suet 8 lbs. Fish 27 lbs. 24 Tinned Meat 37 tins. Tinned Vegetables 30 tins. Tinned Fish 6 tins. Tinned Fruit 172 tins. This unsound food was disposed of by incineration or by burial at the Sewage Works. Bacteriological examination of food. Details of the milk and ice cream samples examined appear under their respective headings. In addition 44 samples of uncooked moat were obtained from local butchers and sent to the Central Public Health Laboratory for examination. No significant organisms were found in any of the samples thus examined. Ice cream. There are now seventy-three premises in the District which are registered for the sale of ice cream. This number includes three premises which were approved for the purpose for the first time during the year. Thirty-one samples were examined, all of which were satisfactory. Milk. The milk distributed in the District is either pasteurised, sterilised, or tuberculin-tested, as Friern Barnet is in a 'specified area' in which all milk sold must be of one or other of these grades. The number of distributors of milk is twenty, and there is also one dairy where milk is pasteurised and bottled. The following licences were granted by the Council:- 25 Dealers' Licence. Supplementary Licence. To sell pasteurised milk 3 9 To sell sterilised milk 19 11 To sell tuberculin- tested milk 4 10 A dealer's licence authorises the distributor to sell milk from premises in Friern Barnet, and a supplementary licence authorises a distributor to sell milk in Friern Barnet from premises outside the District. Sixty-nine samples of the various grades of milk were examined to check bacterial cleanliness and the efficiency of any heat treatment process to which they had been subjected. All these sampler were satisfactory. Samples were also taken of washed bottles from the dairy where milk is bottled and these were of a satisfactory standard. WATER SUPPLY. The water supply of the District is provided by the Barnet Urban District Water Company, except for a few houses in the South Ward which are supplied from the mains of the Metropolitan Water Board. All the houses in the District have a piped supply. No complaints concerning the water supply were received. Bacteriological and chemical examinations of the water were made at frequent intervals, and the following is typical of the reports received:- "This is a very satisfactory sample. It is clear and bright in appearance and of the highest standard of bacterial purity indicative of a wholesome water suitable for public supply purposes." 26 FACTORIES AND SHOPS. Factories. There are 84 factories in the District, and in 63 of these mechanical power is used. The larger premises include a dry-cleaning works, a scientific instrument works, an Electricity Board depot, a bagmaking factory, and a London Transport garage and depot. The Council is responsible for enforcing the provisions of the Factories Act 1937 dealing with cleanliness, overcrowding, temperature, ventilation, drainage of floors, and sanitary conveniences in factories in which mechanical power is not used, In factories in which mechanical power is used the Council's function is limited to securing the provision of adequate sanitary conveniences. The Council also has the duty to ensure that certain classes of factory are provideu with adequate means of escape in case of fire and of issuing certificates to this effect. Two certificates were issued during the year. Occupiers of factories are required to send to the Council, twice yearly, lists of the persons employed by them as outworkers in certain types of work. This information enables control over work carried out either in unsatisfactory premises or in conditions which are likely to lead to the spread of infection. Notifications were received of 58 outworkers who were engaged in the following occupations. Making wearing apparel 32 Making artificial flowers 3 Box making 20 Brush making 1 Carding buttons 1 Making lampshades 1 It was not found necessary to restrict work in any instance. 27 Inspection of Factories. Premises. No. on Register. Number of Inspections . Written Notices. Occupiers Prosecuted. (l) Factories without mechanical power. 21 22 1 - (2) Factories with mechanical power. 63 101 5 - (3) Other premises i.e. building or engineering works. - - - - Total 84 123 6 - Cases in which defects were found. No. of cases in which defects were found. Particulars. Found. Remedied. Prosecutions. Want of cleanliness 3 3 - Sanitary conveniences unsuitable or defective. 4 4 - Other offences against the Act. 3 3 - Total. 10 10 - 28 Shops. There are 318 shops, including a number of family businesses in which no assistants are employed. The whole of the Shops Act 1950 is administered by the Council and includes such matters as closing hours, the early closing day, Sunday trading, the employment of young persons, and the comfort and welfare of shop assistants. Two hundred and fifty visits were made to shops in connection with these various matters. Some minor infringements were found and remedied, and it was not necessary to take any legal proceedings under the Act. HEATING APPLIANCES AND FIREGUARDS. By the Heating Appliances (Fireguards) Act 1952, gas and electric fires and oil heaters which are offered for sale for use in residential premises, must be fitted with guards to prevent risk of injury by burns. Standards for such guards are laid down in regulations made under the Act. Visits were made to shops selling heating appliances, and no contraventions of the Act were revealed. The Department co-operated with the Home Safety Committee of the Council of Social Service at the end of the year in a campaign to publicise the dangers of inadequately guarded fires. RODENT CONTROL. Complaints of rats during the year numbered 184. Of the 6l8 premises examined either in connection with these complaints or during inspection of the District for unreported or unsuspected infestations 212 were found to be infested to some degree. All these infestations were dealt with, so far as private 29 dwelling-houses were concerned without cost to the occupiers, except inasmuch as structural or other works ware found necessary to make good damage caused by rats, or to reduce the likelihood of re-infestation. Charges, based on labour and materials used, were made in respect of treatments carried out at business premises. Treatments of the district sewers were undertaken twice during the year. This work consisted of laying harmless food baits in the sewer manholes and the substitution of poison baits at points were the rats were found to be feeding. The number of manholes found to be used by rats on these two occasions, was 48 and 27 respectively, a few more than last year. Eighteen premises were cleared of mice. RAG FLOCK AND OTHER FILLING MATERIALS. The conditions under which rag flock and other filling materials are used in the making of mattresses, chairs and similar articles, and particularly the cleanliness of the materials, are dealt with in the Rag Flock and other Filling Materials Act 1951. There is one trader in the District whose business comes within the scope of the Act. The premises have been registered and were visited during the year to see that the requirements of the Act were being observed. PETROLEUM SPIRIT. With the exception of small quantities kept in compliance with special regulations, petroleumspirit may only be stored under licence granted by the Council and subject to conditions for its safekeeping. Twenty-five licences were granted during the year, in respect of a total quantity of 29,470 30 gallons, of which, 29,300 gallons were stored in underground tanks, each holding 500 gallons or more, and 170 gallons in smaller containers. One 500 gallon underground tank was found to be leaking and was removed, three other 500 gallon underground tanks were taken out of use and were water-filled as a safety measure, and two new 1000 gallon underground tanks were installed. Eight new electrically-operated petrol pumps were fitted. One hundred and thirty-nine visits were made to the various stores in connection with these matters and generally to see that the licence conditions were complied with. CLEAN AIR. During the year now under review the preliminary survey for the establishment of Friern Barnet's first smoke control area was completed and the proposal was submitted to the Minister of Housing and Local Government for approval in principle. An area in the South Ward was chosen which is the Council's post-war housing Site 5, the adjoining allotments, a school, and a number of houses fronting Colney Hatch Lane. The size of the area is 43.5 acres and it contains 2 50 dwellings. The Council's properties in the proposed area are already equipped with grates capable of burning smokeless fuels efficiently, but in the case of the privately-owned dwellings some alterations or conversions of existing appliances will no doubt be necessary. The Minister has subsequently intimated that the detailed survey of the area and the other arrangements should now be proceeded with as a preliminary to the making of a Smoke Control Order, Towards the end of the year apparatus was bought for measuring the daily level of atmospheric 31 pollution in Friern Barnet. This consists of a daily smoke and sulphur dioxide recorder, which has been installed in the Town Hall, and two deposit gauges to measure the total solid matter falling in the area, which have been sited in Colney Hatch Lane and the High Road. This apparatus is now operating continuously, but by the end of the year had not been in use for sufficient time for any reliable conclusions to be drawn. One notification under Section 3 of the Clean Air Act of a proposal to install a new furnace was received but there were no applications for prior approval. 32 APPENDIX 1. (a) Letters to Doctors. Letters on the following subjects were circulated to Friern Barnet practitioners in 1958, some under my signature as Medical Officer of Health and others either as Area Medical Officer or District School Medical Officer: 6th. January - Prompt notification of Infectious Diseases (doubtful or confirmed to Public Health Department, 10th. January - Poliomyelitis Vaccination - Extended Scheme 24th. January - Vaccine for "green card" registrations. l8th. March - Home Helps and Cancer cases. 27th. March - Easter Holiday arrangements - Home Nurses, Midwives &c. 18th. March - Old People in need of admission to Hospital, Institution or Old People's Homes. 31st. March - Second letter on same subject. 24th. April - Poliomyelitis Vaccination - Availability of Vaccine. 6th. May - " " " 20th. May - " " " 26th. June - Admission of Aged sick to Hospital. 20th. August - Poliomyelitis Vaccination - Extension of Scheme. I would again emphasise that the closest liaison is maintained between general practitioners and the Public Health Department. It is a most pleasing thought that the relationship between my colleagues in general practice and the Public Health Department is so very cordial. Without this co-operation, it need scarcely be said that maximum results in the field of health can never be expected. (b) Medical Examinations. During 1958 twenty-five medical examinations were carried out in respect of entrants to the Council's service. In addition six medical reports were issued relating to employees absent from duty for more than a short period through sickness. 33 TABLE 1. ANALYSIS OF CASES OF NOTIFIABLE INFECTIOUS DISEASES DISEASE. NUMBER OF CASES NOTIFIED. All. Un.l. 1-5 5-15 15-25 25-45 45-65 65 & 0 Measles. 106 2 66 38 — - - - WhoopingCough. 16 2 7 7 - - - - ScarletFever. 39 - 18 21 - — - - Pneumonia. 7 - - 1 - 1 3 2 Dysentery. 6 - - - — 2 3 1 Pulm.Tuberculosis . 11 - — 1 3 3 4 - Other Tuberculosis . 4 — 1 — 2 - 1 - Food Poisoning. 3 - - 2 — 1 - - Typhoid Fever. 1 - - — — 1 - - PuerperalPyrexia. — — - - - - - - OpthalmiaNeonatorum. - - - - - — — * TOTALS 193 4 92 70 5 8 11 3 34 NOTIFIED DURING THE YEAR ENDING 31st. DECEMBER. 1958. j CASES IN EACH WARD. Friern Hospital. No. Removed to Hospital. North. South. Central. East. West. 8 77 14 1 6 - - 9 3 1 2 1 - - 14 9 5 7 4 — 10 2 3 1 1 - - 2 1 - - 1 1 3 — 2 2 4 - - 3 - 1 - 1 - 1 1 - - 2 - 1 - - 1 - - - - - 1 - - - - - - - - - - - - - - - 37 96 26 13 13 8 13 35 TABLE 2. ANALYSIS OF CASES OF TUBERCULOSIS NOTIFIED DURING 1958 AND THE MORTALITY FROM THE DISEASE OVER THE SAME PERIOD. AGES. NEW CASES. DEATHS. PULMONARY. NON-PULMONARY. PULMONARY. NON-PULMONARY. M. F. M. F. M. F. M. F. 0-1 - - - - - - - - 1-5 - - - 1 - - - - 5 - 10 1 - - - - - - - 10 - 15 - - - - - - - - 15 - 20 1 1 - 1 - - - - 20 - 25 - - 1 - - - - - 25 - 35 2 1 - - - - - - 35 - 45 1 - - 1 - - - - 45 - 55 1 - - - - - - - 55 - 65 2 1 - - 1 - - - 65 & Over - - - - - - - - TOTALS 8 3 1 3 1 - - - 36 TABLE 3. REGISTER OF TUBERCULOSIS. PULMONARY. NON-PULMONARY. TOTALS'. Male. Female. Male. Female. Cases on Register at 1.1.58. 117 68 5 18 208 Cases notified for first time 1958 8 3 1 3 15 Other cases added to the Register 1958 5 5 - - 10 Cases removed from Register 1958 19 11 - 3 33 Cases remaining on Register 1958 111 65 6 18 200 37 TABLE 4. ANALYSIS OF THE CAUSES OF AND AGES AT DEATH CAUSE OF DEATH AT AGES 0 to 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 to 75 75 and Over. Accident. - - - 1 - - 3 4 5 Bronchitis. 1 — — — — — 4 2 12 Cancer. - — - - - 2 23 24 6 CongenitalMalformations 2 1 - - - - - - - Diabetes. - - — — — — - 1 1 Diseases of heart and circulatory system. - - - - - 4 36 57 127 Homicide. — — — — — 1 - - 1 Influenza. — — — — — — — 1 — Leukaemia. — — — 1 - 1 — — — Misadventure. — — — — 1 1 1 - 1 Nephritis. - - - - - - 1 2 1 Other defined diseases. - - - - - 1 4 5 13 Other diseases of respiratory system. - - - - - - 1 1 - Pneumonia. — — — — - 1 2 12 24 Prematurity. 1 - - - - - - - - Senility. - - - - - - - - 3 Suicide. - — — - — 2 2 — — Tuberculosis(Resp) — — — — — — 1 — — Ulcer of Stomach. - - - - - - 1 1 TOTAL 4 1 - 2 1 13 78 110 195 38 DURING THE YEAR 1958 FOR THE WHOLE DISTRICT. WARDS. Male. Fern. No. Reg. In Tran. TOTAL. ... Nth. Sth. Cent. East. West. Friern Hosp. - 5 2 - - 6 5 8 6 7 13 5 3 2 1 1 7 9 10 12 7 19 10 12 10 9 6 8 28 27 23 32 55 1 1 1 — - - — 3 2 1 3 1 1 — — — — 1 1 — 2 2 47 18 26 21 37 75 87 137 129 95 224 - - 2 - — - 2 - 2 — 2 - - - - 1 — 1 — 1 — 1 1 - 1 — — — 1 1 1 1 2 1 - - 2 - 1 2 2 1 3 4 — 2 1 — 1 - 2 2 - 4 4 4 - 4 2 5 8 6 17 9 14 23 - 1 - - 1 - 2 - - 2 2 2 5 4 - 7 21 15 24 22 17 39 1 - - - — - 1 - - 1 1 - 1 - - - 2 1 2 2 1 3 2 - 1 - - 1 1 3 2 2 4 - - - - - 1 1 - 1 — 1 — — — — 1 1 2 - 1 1 2 75 49 54 35 60 131 167 237 214 190 404 39 TABLE 5. INFANTILE MORTALITY. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE 1958. 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. 1 - - - 1 - 2 1 — 4 Un- Certified. - - - - - - - - - - Bronchitis. - - - - - - 1 — - 1 CongenitalMalformations . - - - - - — 1 1 - 2 Prematurity. 1 - — — 1 - - - - 1 40