AC 439(3) Library FR 139 Friern Barnet Urban District Connril ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1961 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 1961. 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 beg to present my Annual Report for 1961. As Medical Officer of Health for the Urban District, I feel that I am extremely fortunate in having been able to state in so many Annual Reports. that "the year under review was once again uneventful". This has certainly made my yearly survey less excitingand undoubtedly less interesting- than would otherwise have been the case. None the less, it clearly points to the happy position in which Friern Barnet has found itself for so many years. This has been largely due to the careful planning which has gone into shaping the Urban District, and to the vigilence which my predecessors as Medical Officers of Health have exercised. Our present duty is equally clear, and could be reduced to the single, time-worn phrase, "that which we have, vie hold". This certainly typifies the duty of the Public Health Department, a duty which the Department has always accepted and will continue to accept. The vital statistics for 1961 were again satisfactory - with one exception - and compare well with those of preceding years. The death-rate was up, being 11.3 as against 9.5 in I960, but is still lower than that for the country as a whole (12.0). The birth-rate rose from 13.8 in 1960 and 13.4 in 1959 to 14.1 in 1961. The rise here is relatively insignificant, although itshould be noted. The infantile mortality rate, i.e. the number of infants who died during the first year of life per thousand live births, was 44.7 as against 14.1 in I960 and 43.6 in 1959. This will be referred -1- to later in the Report. There were no deaths from puerperal sepsis, indeed, no deaths took place during childbirth. In point of fact, during the past 10 years no deaths took place during childbirth. This is a highly satisfactory situation, due to a variety of causes, better midwifery, better ante-natal care, and the almost incredible advances made in the use of antibiotics. The number of infectious diseases notified during 1961 was considerably in advance of those notified during the previous year, 489 as against 120. This was more than due to the fact that 1961 was a "measles year", 453 cases of measles being reported, as against 18 in 1960. The infectious sickness rate for the year was, for this reason, 17.2 as compared with 4.18 during 1960. Since the increase in measles notifications accounted for more than the total increase! these figures have little significance in themselves. More important, much more important, is the fact that the type of infectious disease met with during 1961, indeed since the war, is very much milder on the whole than previously. It is also worthy of note that no cases of poliomyelitis were notified during the year, the last case of this particular disease occurring in 1957. The infectious diseases picture will be more fully discussed in the portion of the Annual Report which deals with the prevalence and control of infectious diseases. I will therefore make no further comments at this stage. Year by year, I have stressed the importance of housing as it affects the entire pattern of Public Health; or, to use what is perhaps a better expression in this context, the pattern of preventive medicine. I have often felt that, more than ever as the years go by, pure public health and housing are inseparable. Those authorities which have a "Health and Housing Committee", where matters appertaining to housing as a -2- major problem are dealt with by the Health Committee, are in some respects adopting a wholly logical attitude. As the Council will be aware, a good deal of the time of the Public Health Inspectors is taken up, not only in dealing with housing queries, e.g. overcrowding, the need for council housing because of the existence of conditions detrimental to the health of one or more members of the family, etc., but also with the abatement of nuisances, most often by the issue of informal notices, and occasionally- but never by choice- by having to resort to the issuing of Statutory notices, sometimes followed by Court procedure. The Public Health 'Department considers this to be an integral part of its duty, since problems associated with housing remain at the root of so many social evils. It is especially pleasing to see the work which is being carried out in Friern Parnet in relation to the erection of new houses and flatlets, especially when this accommodation is being made available for tenants displaced from slum clearance areas. This problem in the tackling of houses unfit for human habitation is making good progeess in Friern Barnet. It is even more pleasing to see the work which has been undertaken in Friern Barnet in relation to the provision of houses and flatlets specifically designed for elderly persons. This age group has long been overlooked and is in urgent need of special consideration. I cannot let this opportunity pass without reminding the Council that the work which has fallen to the lot of Public Health Inspectors is increasing with.&rhythm which is sometimes frightening. Smoke control- and a great deal of work has been done in this field in Friern Barnet- food hygiene and housing itself, have all either presented new problems, or problems which have been considerably magnified. I count myself extremely fortunate that I have an excellent -3- team of Public Health Inspectors in Friern Barnet. And this is not only fortunate for me but is a matter of good fortune for the Council. The Public Health Inspectors are keenly alive to the fact that the duties which they perform are closely allied to the continued prosperity of the Urban District, that the role which they1 pla^ should never be under-estimated. The time has almost come when I may have to ask for an additional Inspector. That, however, will be a matter of report to the Establishment Committee in due course. Work in the formation of smoke control areas under the Clean Air Act 1956, continues. A more detailed account of this work will be found in the section which deals specifically with clean air. It will be some years yet before the whole of the district will be smoke free, but we continue to work steadily towards this goal. It is perhaps not always realised that the Public Health Inspectors in Friern Barnet are also Shops Inspectors. This is a happy arrangement, since the duties appertaining to both fields must be closely integrated, Because of the pressure of other duties, the Public Health Inspectors are not always able to visit as many shops as they would like. They are very well aware, however, of the shops which call for frequent inspection and see to it that this supervision is supplied. I have very little to add to the paragraph on Health Education which appeared in my Annual Report for I960. As the Council will be aware, I am a frequent contributor to the local press, whenever I consider that an article is required on a subject of topical importance. In this connection, I would once again like to thank the Editors of our local press for their unfailing helpfulness and courtesy. Nothing has been of greater help to me over the past years. We also readily accede to any request for a health talk by a local organisation, with -4- or without an accompanying film show. Health education in Friern Barnet is closely bound up with the work carried out by the staff of the Middlesex County Council, Health Visitors, Dr. Campbell, my Deputy, or myself, according to the type of talk required and the special abilities of each section of the staff to undertake these duties. Abundant leaflets, bookmarks, etc., on health matters are available both in the Public Health Department, in the Area Health Office, and also in our Clinics and County Libraries. When any particular subject calls for the display of posters, this method of propaganda is utilised to the full. Altogether, as I have said so often, the neglect of health education is a major blunder. Fortunately, Friern Barnet has never fallen into this pitfall. As the Council may be aware, I have been a regular monthly contributor to the magazine "Better Health" since 1%S. I like to think that these articles are extensively read and that, as the articles are syndicated in many parts of the world, the name of Friern Barnet is being widely publicised outside this country. This may appear in many ways a trivial matter, but it still gives me great pleasure to think that so many articles, which carry my name and the designation of the three districts for which I act as Medical Officer of Health, are being so widely circulated. Although the vital significance of the connection between smoking and health, not only lung cancer but also bronchitis, coronary thrombosis and such diseases as gastric ulcers, has only exploded into the public consciousness within the past few months, this problem has been before us for many years, certainly since the issue of the Registrar General's statistical report which proved conclusively that such a connection did exist. A full report on this subject more properly belongs to the Annual Report for 1962, but I make no apology for mentioning such an extremely important -5- matter at this juncture. Although actual deaths from lung cancer have very substantially and tragically increased in this country since 1940, the local picture is fortunately not so striking, as the following tables will show: Deaths from Cqncer of the Lung and Bronchus. Male Female 1952 20 20 1953 22 21 1954 40 22 1955 27 39 1956 29 28 1957 30 35 1958 28 27 1959 32 29 I960 46 25 1961 34 35 Deaths from Bronchitis. 1952 7 5 1953 2 3 1954 22 6 1955 34 19 1956 20 23 1957 22 10 195S 9 10 1959 11 20 I960 12 7 1961 15 12 From this table it will be seen that deaths from cancer and bronchitis have not increased in Friern Barnet within the past ten years to the same extent as has been evident in the country as a whole, although the increase is there to be seen, more evident- and this is unusual- in females. The comparatively small numbers involved should in no way prevent us from continuing our efforts to -6- discourage smoking, especially among children and young people. As I have said, however, the measures which we have already taken and are still taking to achieve this end belong to the Annual Report for 1962. It is interesting to note that, although the year 1952 was the year in which 'smog' was so prevalent in Greater London, the deaths from bronchitis in Friern Barnet - especially female fatalities - were not unduly heavy. I have already remarked on the fact that the Friern Burnet Public Health Department is extremely fortunate in its staff. I am equally happy to repeat the statement which I made last year, that our relations with the residents as a whole are extremely pleasant. We have never abated our efforts to show, and clearly show, that our aim is to help, that red tape and officialdom form no part of our armament, or at least as small a part as is practicable. The same remarks apply to the relations between the Public Health Department and general practitioners, which have been extremely cordial since I took up my duties as Medical Officer of Health. Finally, it is again worthy of mention that our relations with the Middlesex County Council have always been of the best, and have permitted an integration of work which would otherwise have been quite impossible. In conclusion, I would express my most sincere thanks to the Public Health Committee and to the Urban District Council for the continued courtesy and assistance which I have come to expect as Medical Officer of Health. I would also express my grateful thanks to every member of the Public Health Department, and in particular to -7- Dr. Janet Campbell, my Deputy; and to Mr. W. R. Jackaman, Chief Public Health Inspector. It is a fortunate Medical Officer of Health who knows that he has a loyal, conscientious and efficient staff. That, I am very glad to say, has always been my own position. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, W.C. Harvey. Medical Officer of Health. -3- PUBLIC HEALTH COMMITTEE. at 31st, December, 1961. Cr. Mrs. W.D.M. Mackrill. (Chairman) Cr. H. Berry. (Vice-Chairman) Cr. S.P.Esom, J.P.,M.I.M.I. (Chairman of the (Council) Cr. G.H-. Flesher, F.I.O.B. (Vice-Chairman of the Council) Cr. Mrs, E. Constable, J.P. Cr. Mrs, M, E. Haverly. Cr. N.L.G. Lingwood. Cr. K. J. Norman. Cr. R. F. Pugh, J.P. Cr. Miss M.J. Richards, J.P.,B.A. Cr. W.H. T^ngye, J.P.,F.R.I.C.S.,F.A.I. PUBLIC HEALTH STAFF. Medical Officer of Health W.Clunie"Harvey M.D.,Ch.B.rD.P.H. Deputy Medical Officer of Health Janet R.'Campbell, M.D.£h.B.,D~.P.H. Chief Public Health Inspector W.R. Jackaman. Deputy Chief Public Health Inspector R.N. Hedges,D.M.A. Public Health Inspector V.C. Quin. Technical Assistant F.G.Saunders ed 15.5.61) Chief Clerk J. Wilson. Assistant Miss E.M.Glasscock. Rodent Operative E.T.Crawshaw. -9- STATISTICS OF THE ARE . Area (in acres) 1,340 Population (Registrar General's estimate 196l) 23,460 (District - 26,230) (Friern Hospital - 2,230) Number of inhabitated houses 3,237 Rateable Value (31st. December 1961) £460,$41 Sum represented by a penny rate £1,390 EXTRACTS FROM VITAL STATISTICS. LIVE BIRTHS. Male. Female. Total. (Legitimate) 167 170 337 (Illegitimate) 6 15 21 Total 173 135 353 BIRTH RATE (live births per 1000 population) 14.1 STILL BIRTHS. Male. Female. Total. (Legitimate) 4 5 9 (Illegitimate) - - 1 Total 4 5 10 STILL BIRTH RATE (per 1000 total (live and still) births 27.2 TOTAL BIRTHS 363 -10- INFANT DEATHS (under 1 year of age). Male. Female. Total. (Legitimate) 8 8 16 (Illegitimate) - - - Total 8 8 16 IMF."NT DE"TH R TE (per 1000 live births) 44.7 INFANT DE/'TH R:;TE (per 1000 legitimate births) 47.5 INFANT DEATH RATE (per 1000 illegitimate births).... 0.0 NE0-NATAL DEATH RATE (under 4 weeks, per 1000 live births) 30.7 NEO-NATAL DEATH RATE (under 1 week per lOOO live births) 30.7 PERINATAL DEATH RATE (stillbirths and deaths under 1 week per 1000 total live and still births) 57.1 PERCENTAGE OF ILLEGITIMATE LIVE BIRTHS OF TOTAL BIRTHS 5.7% MATER DEATHS (excluding abortion) 0.0 INTERNAL DEATH RATE (including abortions per 1000 births live and still) 0.0 DEATHS. Male. Female. Total. District 146 147 293 Friern Hospital 60 113 173 Total. 206 260 466 DEATH RATE (per 1000 population) 11.3 -11- BIRTHS. The number of births assigned to the district was 35$, giving a Birth-Rate of 12.6 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 14.1. The corresponding Birth-Rate for England and Wales was 17.4. Birth and Birth-Rates for the past five years have been: Year. No .of Births. Birth-Rates. Friern Barnet. England & Wales. 1957 318 12.5 16.1 1958 328 12.9 16.4 1959 344 13.4 16.5 I960 354 13.8 17.1 1961 358 14.1 17.4 DEATHS. There were 466 deaths during the year. Of these 173 occurred in Friern Hospital and 293 in the'district. This provides an un-corrected Death-Rate of 16.4 per 1000 for the total population, and 11.2 per 1000 for the district excluding Friern Hospital. The correcting factor for age and sex distribution is 0.69, providing a Death-Rgte for comparative purposes of 11.3. The corresponding rate for England and Wales was 12.0. The Deaths and Death-R^tes for the past five years have been:- -12- Death-Rates. Year. No. of Deaths. Friern Barnet. England & Wales. 1957 483 9.6 11.5 195S 404 9.0 11.7 1959 425 10.5 11.6 1960 373 9.5 11.5 1961 466 11.3 12.0 MORTALITY. General Mortality and Death Rate. The nett number of deaths accredited to the district was 466, 93 more than in i960. Of these deaths, 173 occurred in Friern Hospital. This gives a crude death rate of 16.4 for the total population, and 11.2 for the district, excluding Friern Hospital, with a corrected death rate of 11.3. The corresponding rate for i960 wa s 9.5. I have already made mention in the introduction to this Report of the established connection between smoking and health. This, I need scarcely say, is reflected in the deaths from cancer of the bronchus and lungs, bronchitis, coronary thrombosis and psycho-somatic diseases such as gastric and duodenal ulcers. I will say nothing more here relating to smoking and health, since this is a matter which has received very great publicity during 1962, and should be a matter for more detailed survey in the Annual Report for that year. So far as coronary thrombosis is concerned, diseases of the heart and circulation still make up the -13- single cause of mortality in the District. Year after year I have mentioned the fact that, although diseases such as coronary thrombosis and lung cancer take an appalling toll of life, particularly the lives of men at the height of their power, "epidemiology" as we know the term is still closely linked with infectious illnesses. This is not to say that infectious illnesses should not receive careful attention. The fact that most infectious diseases are now mild in nature, especially such diseases as pertussis and scarlet fever, by no means implies that this mildness will continue. None the less , the sooner it is realised that such diseases as hearo disease call for much more careful study, and until the causes of heart and similar diseases are discovered and the appropriate remedies applied, death rates will continue to be much higher than most of us would like to see. As I have remarked before, there are no conditions actually existing within the Urban District which one can point to as contributing to cardiac disease. It is a fact, however, tint Friern Barnet shares with the rest of the country the strain of modern life, which is clearly having an effect upon so many families. The journey which so many of our residents have to take to and from London every day, is presumably a factor which must also be taken into account. Finally Friern Barnet, as a built-up area, even if not in any sense of the word a congested area, leaves its population more vulnerable than the population of rural areas, where the tempo and strain of life are not so hectic, and where, incidentally, a smoke-laden atmosphere does not constitute a real health hazard. Altogether, although many explanations for the increase in cardiac fatalities over the past few years have been advanced, and although a great deal of valuable research is going on in this and other countries, the -14- situation is still far from satisfactory. It is perhaps unfortunate that, although we are continuallybeing pressed to carry out research and investigation, the Public Health staff of such an area as the Urban District of Friern Bnrnet finds precious little time to indulge in more than its share of routine work. Sometime in the future, this pattern may be reversed. tyJhen it is, it will be all to the good. Infant Mortality. There were 16 deaths of infants under 1 year of age. This gives an infant death rate of 44.7 per 1,000 live births as compared with 5 deaths and a rate of 14.1 in the preceding year. Among the 16 infants who died in Friern Barnet during 1961, before they had reached the age of 12 months, 11 failed to survive one week and 11 died under four weeks. Every infant death is carefully scrutinised. The infant mortality rate for Friern Barnet was unusually high during 1961. This happened before, only a few years ago, and is a clear indication that these rates are of little value when one is dealing with such a small number of infant deaths. One would not for a moment suggest that every infant deaths is not a tragedy. None the less, as I have just indicated, an infant mortality rate which covers only a comparatively small number of births has little significance. Still Births. 10 stillbirths, nine legitimate and one illegitimate, were accredited to the District for 1961. This is equal to a death rate of 27.2 (live and still births), the corresponding figures for I960 being 4 stillbirths with a rate of 11.2. -15- Maternal Mortality. As mentioned in the introduction to this Report, no maternal deaths were reported during 1961. GENERAL PROVISION OF HEALTH SERVICES. Care of the Aged. Quite apart from the admission to hospital of the aged sick, there are many problems associated with old age which increasingly demand more and more attention. The Public Health Department, is, as always, prepared to help in every possible way, while our Health Visitors, Home Nurses and Home Helps continue to assist the aged by every means within their power. Once again 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. It would be foolish to state that the geriatric situation is satisfactory, either in Friern Barnet or in North London as a whole. I hasten to add that I invariably obtain what assistance is available from the various hospitals which ser/e the Area. None the less, it is a tragic fact that the admission of the elderly sick to hospital presents an increasingly urgent problem, a problem which at the moment seems virtually unsolvable. It is admittedly a fact that the Ministry of Health has issued a ten year Command Plan which visualises the re-building and extension of existing hospitals and the provision of new hospitals. If this scheme includes the provision of a great many additional geriatric beds, this will be a worth-while contribution. Unless, -16- however, this substantial contribution is forthcoming, the gradual ageing of the population of these islands will continue to present a problem, a pitiable problem, which none of us can afford to neglect. Hospitals. The remarks contained in my Annual Report for 1959 relating to the hospital services available to Friern Barnet remain more or less unaltered The admission of infectious diseases cases mostly to Coppetts Wood Hospital, together with the admission of acute medical or surgical cases to general hospitals, present no real problem. Unfortunately, a I have just remarked, it is still difficult to obtain the admission to hospital of aged persons who are' not acutely ill. I endeavour to assist any general practitioner who asks for help, and am happy to say that the support which I have been able to give has, in many instances, proved successful. So far as other hospital admissions are concerned, I would repeat that little difficulty exists, except that the admission to hospital of pregnant women presents something more of a problem than was the case a few years ago. This is not so much due to the lack of beds, as to a lack of staff, a difficulty which has tended to increase year by year. Here again, the provision of adequate housing would go very far towards solving this problem. Laboratory Facilities. As in past years, the Central Public Health Laboratory Service has been of the greatest assistance to us, not only the Central Laboratory at -17- Colindale, but also the Laboratory at Coppetts Wood Hospital. I gratefully acknowledge the assistance afforded throughout the year, and the close co-operation which has continued for so many years between the Public Health Department and the Laboratory Service. Summary of the work carried out at the Public Health Laboratories for the year: Throat and nose swabs, 1 Faeces 97 Sputum 2 Ice cream 42 Milk 156 Sausages 1 Biscuits 1 Minced meat 60 National Assistance Act 1948. Section 50. Burial or cremntion of the dead. No action was necessary under this section during 1961. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. From the table of infectious diseases set out on page 38 it will be seen that U.&9 cases of infectious diseases-were notified during the year, as against 120 in 1960. The Infectious Sickness Rote for the year was therefore 17.2 as compared with 4.18 for the previous year. The increase in the number of infectious diseases during the year was entirely due to the fact that 1961 was a "measles year". -18- The following table sets out the infectious diseases notified during 1961, as compared with the notifications received during 1960:- 1960 1961 Measles 18 453 Pertussis 31 5 Scarlet Fever 8 5 Pneumonia 10 7 Dysentery 39 2 Food poisoning 1 3 Tuberculosis 11 13 Erysipelas 1 - Opthalmia- Neonatorum 1 - Typhoid Fever — 1 120 489 It is always dangerous to draw any lasting conclusions from limited statistics relating only to a two-yearly period. None the less, it is extremely interesting to compare the Friern Barnet figures relating to I960 and 1961, since very obvious differences are immediately apparent. 1. Scarlet Fever, notifications fell from 8 in i960 to 5 in 19ol. Once again, as I have said so often before, the type of scarlet fever met with was extremely mild, so mild that admission to hospital was only necessary when no one remained at home to look after the affected child. 2. For the sixth year in succession no case of diphtheria occurred in the District. The last death took place approximately 14 years ago. The fact that cases of diphtheria are still occurring in various parts of the country, however, once again means that we dare not relax our precautions. This particularly -19- applies to immunisation, either against diphtheria alone or against diphtheria, pertussis and tetanus combined. The fact that 96.4% of infants under the age of two years are protected against diphtheria, either alone or by the use of the triple antigen, is extremely pleasing. Indeed, so far as I am aware, this immunisation rate is perhaps the highest in these islands. 3. Measles notifications rose from 18 in 1960 to 453 in 1961. This was to be anticipated, as 1961 was, as I have already remarked, a "measles year". As in the case of scirlet fever, severity was extremely low. 4. Pertussis notifications fell from 31 in 1960 to 5 in 1961. There is no valid, concrete evidence that immunisation against pertussis, a policy which is actively pursued in the District, is having an appreciable effect on the incidence of pertussis. Although approximately 93% of children under the age of two have been protected against pertussis by immunisation - and surely this must be having an effect a few infants still remain unprotected, in spite of the stringent efforts which are made, especially by our Health Visitors, to persuade parents to accept immunisation. 5. The incidence of food poisoning; and dysentery fell from a combined total of 40 in 1960 to a total of 5 during 1961. The measures which we have taken, particularly the control of dysentery and food poisoning among school children, remains as before, and appear satisfactory. Although only 5 cases were notified during the year, it must be remembered that dysentery, particularly Sonnei dysentery and food poisoning, are now epidemic in this country, a fact which we must regretfully accept. It must also be remembered that these cases have little more than nuisance value, the disease being quickly recovered -20- from and leaving, so far as we are aware, no illeffects. All cases of dysentery and food poisoning, particularly Salmonellae typhimurium infections, are carefully investigated. Where any cause is discovered the matter is actively pursued, even when the original took place somewhere outside the District. 6. No case of poliomyelitis was notified during 1961. As in the case of immunisation against diphtheria, our programme of vaccination against poliomyelitis is something of which I think we can be justly proud, more than 86.5% of Friern Barnet children under the age of 2 years having been protected against poliomyelitis. As will be known, we are now using the Sabin vaccine, a method of oral vaccination which recently superseded the giving of Salk vaccine by injection. Sabin vaccine is administered by mouth, the method of administration varying according to the age of the person concerned. It need scarcely be said that this method is proving extremely popular, as aftereffects are virtually nil and the disadvantage of a prick eliminated. It is important to remember that several outbreaks of poliomyelitis have recently occurred within Great Britain, one at least being extensive. This proves that the virus is still with us and requires careful supervision. As in previous years, we have co-operated with the Central Public Health Laboratory, Colindale, in obtaining specimens from children who have not been in known contact with poliomyelitis, so that their stools can be examined. 7. Thirteen cases of tuberculosis were notified during 1961, as against 11 in 1960. Three of these were from Friern Hospital. -21- The Mass Radiography Unit did not visit Friern Barnet during 1961, since this is considered to be an area in which tuberculosis does not constitute a major problem. I fully expect however, the Unit to visit the District during 1962. Our scheme for the B.C.G. vaccination of school children has been actively continued and is working extremely well. This work is undertaken by the School Health Service. -22- SANITARY SERVICES. Summary of inspections of District. Visits in connection with complaints 456 Visits in connection with infectious disease 283 Visits to shops and other places where food is prepared, stored or sold 495 Visits to other shops 214 Visits to factories 139 Visits to petrol installations 90 Visits in connection with housing and the repair of dwelling houses 1688 Visits in connection with the Rent Act 4 Visits in connection with the Clean Air Act 1430 Appointments and special visits 330 Visits in connection with rodent'control 2095 Miscellaneous visits 51 Total 7275 Summary of complaints received. Housing defects 73 Defective drainage 19 Offensive accumulations or smells 27 Insect pests 84 Rat or mouse infestations 216 Unsound food 6 Noise nuisance 6 Other complaints 26 Total 457 -23- HOUSING. The survey of housing conditions in The Avenue area in connection with proposals for the clearance and redevelopment of this part of the District was continued during the year. In March five small clearance areas were declared. The properties involved were Nos. 29,30,31,35,37; 38,39,41,42,43,44,45 and 46, The Avenue, and Nos. 69,71,73,77,79,81,83,85 and 87 Oakleigh Road South, a total on twenty-two houses. In the same month the Council made a compulsory purchase order in respect of the lands comprised in these clearance areas and a further eleven adjacent properties. There were four objections to the compulsory purchase order and a public local Inquiry was held in July. The order was subsequently confirmed by the Minister of Housing and Local Government with the modification that two of the houses (Nos. 69 and 71 Oakleigh Road South), declared to be unfit for habitation and in respect of which objections had been made, were held not to be unfit. Four houses, i.e., Nos. 1434,1436,1438 and 1440 High Road, N.20., which were subject to Demolition orders previously made, were pulled down and the site cleared. Two houses which had been closed to human habitation on account of their condition, i.e., Nos. 83 and 126, Cromwell Road, were repaired and improved and the closing orders were determined. As a result of action taken by the Department repairs were effected at 141 dwellings where the standard of accommodation was found to be unsatisfactory. -24- Inspections of dwellings during the year. 1. Number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 229 2. Number of dwelling houses which were inspected and recorded under the Housing (Consolidated) Regulations 1925 and 1932) 51 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for habitation 35 4. Number of dwelling houses (exclusive of those referred to in 3 above) found not to be reasonably suitable for occupation 177 Remedy of defects during the year without the service of formal notices. Number of defective dwelling houses rendered fit as a consequence of informal action 126 Action under statutory powers during the year. (1) Proceedings under sections 9,10 and 16 of the Housing Act 1957. (a) Number of dwelling houses in respect of which'notices were served requiring ' repairs - (2) Proceedings under Public Health Act 1936. (a) Nutaber of dwelling houses in respect of which notices were served requiring defects to be remedied 20 -25- (b) Number of dwelling houses in which defects were remedied after service of formal notices (1) By owners 15 (11) By Council in default of fowners 1 (3) Proceedings under section 17 of the Housing Act 1957. (a) Number of dwelling houses in respect of which Demolition Orders were made - (b) Number of dwelling houses demolished 4 (c) Number of dwelling houses in respect of which Closing Orders were made - (d) Number of dwelling houses closed - (g) Number of dwelling houses in respect of which Closing Orders were determined, the dwellings having been rendered fit 2 (4) Proceedings under sections 42 and 43 of the Housing Act 1957. (a) Number of Clearance Areas declared 5 (b) Number of unfit dwellings included in Clearance Areas 22 (c) Number of unfit dwellings in Clearance Areas demolished - Certificates of disrepair. Only one application for a certificate of disrepair under the provisions of the Rent Act 1957, was received and this was subsequently withdrawn when the defects of repair were remedied. One certificate of disrepair issued in I960 was cancelled, the defects to which it referred having been remedied. -26- Improvement Grants. Seventeen enquiries regarding the schemes of grant aid which are available to assist in providing a bathroom, hot water supply, etc., in dwellings which still lack these facilities were received. After investigation of the various proposals seven applications for grant aid were received and approved. By the end of the year the improvements had been completed in five instances. INSPECTION AND SUPERVISION OF FOOD. Food premises. There are 145 premises in the district in which food is either stored, prepared for sale, or sold. These premises are used in the following trades:- Type. Number. Registered under Food and Drugs Act 1955. For sale of ice cream. For manufacture of sausages or preserved food. Bakers 9 1 — Butchers 13 — 9 Cafes and Restaurants 20 9 - Confectioners 30 29 - Fishmongers 6 1 - Greengrocers 22 2 - Grocers 41 29 11 Milkshops 4 4 - Total 145 75 20 Eleven hawkers are registered under the provisions of the Middlesex County Council Act and are engaged in the following trades:- -27- Fishmongers 2 Greengrocers 8 Grocers 1 The preparation, storage and sale of food are controlled by regulations and byelaws made under the Food and Drugs Act. These deal with matters such as the construction, repair and maintenance of premises, the cleanliness of apparatus and equipment, and hygienic methods in the handling of the food. 495 visits were made to the various premises to ensure that the requirements of the regulations and byelaws were satisfied and generally to encourage better standards of food hygiene. Improvements were effected to premises as follows:- Structurally improved 5 premisi Cleanliness improved 1" Floors provided or repaired 8 " Sinks provided 4 " Washbasins provided 4 " Hot water provided 2 " Lighting improved 2 " Ventilation improved 5 " Sanitary accommodation improved 12 " Lockers for clothing provided 2 " First-aid equipment provided 3 " Equipment improved 5 " Food inspection. Five complaints were received during the year concerning foodstuffs which were not in a sound condition when purchased or which contained foreign bodies. In one case proceedings were taken resulting in a fine of £25 with £5. 5. 0. costs. -28- There are no licensed slaughterhouses in the District and therefore no post-mortem inspection of food animals. Of the various foodstuffs examined at shops and stores the undermentioned was certified to be unfit for human consumption:- Beef 381 lbs Lamb 15 lbs. Kidney 69 lbs. Fish 84 lbs. Turkeys 28 lbs. Chickens 54 lbs. Tinned meat 18 tins Tinned fish 8 tins Tinned vegetables 26 tins Tinned fruit 71 tins Pickles 21 jars. This unsound food was disposed of by incineration or by burial at the Sewage Works. Milk. There are twenty persons or companies registered to distribute milk in Friern Barnet. There is one dairy at which milk is pasteurised and bottled. All the milk sold in the District is either pasteurised, sterilised or tuberculin-tested. One hundred and fifty-six samples of the various grades of milk were examined all of which were satisfactory. Samples of the washed bottles from the dairy were also examined and found to be of a satisfactory standard of cleanliness. Ice cream. Seventy-five premises are registered for the sale of ice cream. Forty-two samples of the different products offered for sale were examined bacteriologically and all were found to be satisfactory. -29- CLEAN AIR. Smoke Control Areas. The survey of the second smoke control area was completed during the year. The area which is bounded by Friern Barnet Lane, Myddleton Park, Manor Drive and the boundary with East Barnet, contains 7$6 dwellings and a number of shop premises. The work involved in establishing a smoke control area is considerable. Letters and informatit by way of booklets and leaflets are prepared and delivei to each house or flat in the proposed area, followed by a personal call to explain the scheme and to discover the type of heating in use and the fuel being burned. In all, nearly one thousand and three hundred visits were made, many because residents were not at home on the first occasion. Cards are left for appointments to be made in many such cases. The hulk of the inspections have been made by the newly appointed technical assistant who commenced duties in May. Although he was appointed to assist with the general work of the department it has been necessary for him to devote the whole of his time to smoke control. The work of the clerical staff has also considerably increased. However, a good start has been made in ridding the district of coal smoke and work proceeds smoothly. The Friern Barnet Smoke Control Order No.2 was made by the Council in December and submitted to the Ministry of Housing and Local Government for confirmatio The Order will come into effect on the 1st. October 19& National Survey of Air Pollution. Friern Barnet has been selected by the Department of Scientific and Industrial Research as typifying one of a range of industrial and residential -30- areas to provide measurements of smoke and sulphur dioxide for a survey concerning the whole country. The survey is intended to assess the remedial effect of the Clean Air Act 1956, to enable plans for industrial development to be considered, and to assist in medical investigations into connections between air pollution and disease. The Council agreed to establish two further measuring stations in addition to the one already operating at the Town Hall. It is hoped to install one station in the north of the district and the other in the south. Pictorial representation of the figures obtained at the Town Hall are shown. Approval of Neiv Furnaces etc. Nine notifications were received during the year of intention to install furnaces or boilers and each case was investigated and the installations approved. The majority of notifications were concerned with the provision of central heating in domestic premises. One was in respect of the installation of oil fired boilers totalling 1,105,000 B.Th.U's, capacity in a factory. Approval of chimney height was also sought in this case and although this was considered to be inadequate as at first proposed agreement was reached on a satisfactory height having regard to adjacent residential premises. -31- -32- FACTORIES AND SHOPS. Factories. There are 74 factories in the district the majority of which are of the small and light industrial type, Among the larger premises are an Electricity Board depot, a London Transport garage, a bag-making factory; a scientific instrument works and a dry-cleaning works. Inspection of factories. Premises. No. on Register. Inspections . Number of Written Notices. Occupiers Prosecuted. (l) Factories without mechanical power. 15 32 - - (2) Factories with mechanical power. 59 107 3 - (3) Other premises i.e. building or engineering works. - - - - Total. 74 139 3 - Defects found in factories No. of cases-in which defects were found. Particulars. Found. Remidied. Prosecutions. Want of cleanliness. 1 1 - Sanitary conveniences unsuitable or defective. 2 2 - Other offences against the Act. 2 2 — Total. 5 5 - -33- Outwork. The Factories Act requires thnt occupiers of factories carrying out certain classes of work to send to the Council twice yearly lists of.the persons employed by them as outworkers. This information enables control to be exercised over work which mi ht otherwise be carried out in unsatisfactory premises or in conditions which are likely to lead to the spread of infection. Notific tion was received of 59 outworkers who are engaged in the following occupations:- Making wearing apparel 33 Making artificial flowers 3 Box making 17 Brush making 3 Carding buttons 2 Making lampshades 1 It was not necessary during the year to restrict outwork in any instance. Shops. There are some 314 shops in Friern Barnet. The Shops Act 1950, which is administered by the Council deals with matters such 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 fourteen visits were made to the various shops. No serious defects or infringements were observed and such matters as required attention were remedied without the necessity for legal proceedings under the Act. -34- WATER SUPPLY. The water supply of the district is provided by the Lee Valley Water Company, except for a small part of the South Ward which is supplied from the mains of the Metropolitan Water Board. All the houses in the district have a piped internal supply. The supply is adequate and reports on samples taken at frequent intervals by the Water Company shewed that the water was of a high standard of bacterial purity suitable for public supply purposes. The water is not plumbo-solvent. RODENT CONTROL. Four hundred and forty-seven premises were visited during the year either following complaints or during routine inspection of the district for unsuspected or unreported infestations by rats. Infestations were found at 220 premises and these were all dealt with by the Department. Two treatments of the district sewers were undertaken. The level of infestation found was very much the same as last year. MISCELLANEOUS. Rag flock and other filling materials. The conditions under which rag flock and other filling materials are used in upholstering etc., particularly the cleanliness of the materials, are controlled by the Rag Flock and Other Filling Materials Act. There is only one trader in the district whose business comes within the scope of the Act and the ' premises used have been registered and were visited. -35- Henting appliances and fireguards. The Heating Appliances( Fireguards) Act makes it compulsory for all gas, electric and oil fires offered for sale to the public to be fitted with adequate guards. Visits were made to shops to ensure that all such fires offered for sale were of the required standard of safety. Petroleum spirit and mixtures. Twenty-five licences were granted during the year, for the storage of a total quantity of 45,540 gallons of petroleum spirit, of which 45,300 gallons were kept in underground tanks, each holding 500 gallons or more, and 230 gallons in smaller containers. During the year three 500 gallon underground tanks were taken out of use and were waterfilled as a safety measure. Following complaints of petrol smells a defective and leaking tank and pump installation was found. The necessary repairs were carried out and the pump was subsequently brought back into use. Ninety visits were made to the stores in connection with the safekeeping of petroleum spirit. Local land charges registration. 550 enquiries concerning properties within the district were dealt with by the department during the year. -36- APPENDIX 1. (a) Letters to Doctors. Letters on the following subjects were circulated to Friern Burnet practitioners in 1961, some under ray signature as Medical Officer of Health, others either as Area Medical Officer or District School Medical Officer: January l6th. - Health Education. March l6th. - Laundry Service for Old People. April 14th. - Bank Holiday Arrangements for Collection of Laboratory Specimens. July 11th. - Plantar Warts (Verrucas) December lSth. - Christmas Holiday Arrangements for Collection of Laboratory Specimens. It has been our consistent practice to keep general practitioners in touch with recent developments in the field of preventive medicine, so that integration can be achieved. This policy is showing useful dividends. (b) Medical Examinations. During 1961, 34 medical examinations were carried out in respect of the new entrants to the Council's service. -37- TAELE 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 453 10 199 244 - - - - WhoopingCough 5 - - 5 - - - - ScarletFever 5 - 1 4 - - - - Pneumonia 7 1 - - - - 1 5 Dysentery 2 — - - 1 - 1 - Tuberculosis 12 - - 1 1 3 3 4 Other Tuberculosis 1 - - - - - 1 - Food Poisoning 3 1 - - 1 1 - - Typhoid Fever 1 - - - 1 - - - PuerperalPyrexia - - - - - - - - OpthalimaNeonatorura - - - - - - - - TOTAL 489 12 200 254 4 4 6 9 -33- NOTIFIED DURING THE YEAR ENDING 31st. DECEMBER 1961. CASES IN EACH WARD. Friern Hospital. No.Removed to Hospital North. South. Central. East. West. 67 160 89 36 101 - 4 2 - 1 - 2 - - 2 1 - 1 1 - - - 2 1 — — 4 1 1 1 — — — - - 4 1 2 1 1 3 - — — 1 - - - - - 1 1 1 - - - 1 - - - - - - - - - - - — — ' - — — — - - 77 166 95 39 105 7 5 -39- TABLE 2. analysis of cases of tuberculosis notified during 1961 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 - - - - - - - - 5-10 - - - - - - - - 10 - 15 - 1 - - - - - - 15 - 20 - 1 - - - - - - 20 - 25 - - - - - - - - 25 - 35 1 2 - - - - - - 35 - 45 - - - - - - - - 45 - 55 1 1 - - - - - - 55 - 65 1 - 1 - 1 - - - 65 & Over 4 - - - 2 - - - TOTAL 7 5 1 - 3 - - - -40- TABLE 3. REGISTER OF TUBERCULOSIS. PULMONARY. NON-PULMONARY. TOTALS. Male. Female. Male. Female. Cases on Register at 1.1.61. 112 68 6 17 203 Cases notified for first time 1961 7 5 1 - 13 Other cases added to the Register 1961 3 3 - 1 7 Cases rer?\pved from Register 1961 19 14 3 - 36 Cases remaining on Register 1961 103 62 4 18 187 -41- 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 - 1 - - 1 3 Bronchitis. 2 — — — — — 4 9 12 Cancer. - - — — — 2 27 17 23 Diseases of heart and circulatory system. - - - 1 1 5 38 63 140 Gastro-enteritis. 2 — — — - — - - - Leukaemia. — - - - - - 2 - - Misadventure. - — - — - — - 1 - Other defined diseases. 2 - - - 3 1 10 7 11 Pneumonia. 1 — — — - 1 9 20 29 Prematurity. 9 — — — — — - - - Senility. - - — — — — — — 3 Suicide. - - - - - 1 - 1 - Tuberculosis(Resp) — — — - - - 1 1 1 TOTALS 16 - 1 1 5 10 91 120 222 -42- DURING THE YEAR 1961 FOR THE WHOLE DISTRICT. WARDS. Male. Fem. No. Reg. In Tran. Total. Nth. Sth. Cent. East. West. Friern Hosp. - - 2 - 1 3 2 4 4 2 6 6 3 1 3 1 13 15 12 22 5 27 11 13 13 5 15 12 34 35 32 37 69 41 31 33 20 31 92 105 143 158 90 248 1 - 1 - — — - 2 1 1 2 2 - - - - — 1 1 — 2 2 — — — - - 1 1 - 1 - 1 5 1 5 1 8 14 11 23 16 18 34 2 5 7 4 5 37 28 32 41 19 60 1 6 - 1 1 - 5 4 - 9 9 - - - 2 - 1 - 3 2 1 3 - - 1 1 — - 1 1 2 — 2 1 1 1 - — - 3 - - 3 3 70 60 64 37 62 173 206 260 279 187 466 -43- TABLE 5. IN FANTILE MORTALITY. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE 1961. 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. 11 — — — 11 3 1 - 1 16 Un-Certified. — - — — — — - - - - Bronchitis. - - - - - 1 1 - - 2 Gastro-enteritis. - - - - - 1 - - 1 2 Other defineddiseases. 2 - - — 2 — — — - 2 Pneumonia. — — — — — 1 — — — 1 Prematurity. 9 - - - 9 - - - - 9 -44-