AC 439 (3) FRI 42 I Friern Barnet Arban District council ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1964 JANET R. CAMPBELL, m.b., ch.b., d.p.h. Medical Officer of Health. FRIERN BARNET URBAN DISTRICT COUNCIL. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1964. JANET R. CAMPBELL M.B., Ch.B. 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 the Annual Report for the year 1964. This will be my last annual report and the last report for the Urban District of Friern Barnet. My work in Friern Barnet commenced 33 years ago as Assistant Medical Officer for Schools and Maternity & Child Welfare under Middlesex County Council and it has been a great satisfaction to me to serve finally in the capacity of Medical Officer of Health. On an occasion such as this - in a sense a farewell to the Urban District of Friern Barnet - one is irresistibly drawn to look back over the years so far as the health records go, and this takes us with certain gaps to the year 1884. Over these 80 years the advances in knowledge and understanding of infection, the saving of infant life and the greatly increased life span are achievements which must have seemed beyond the dreams of the Medical Officers of Health of these early days. I have done a series of graphs to illustrate some of these advances and, together with explanatory notes, they will be found on pages 35, 36, & 37, at the end of this report. To return to this year's report, although substantially complete, a few items, e.g. the number of illegitimate births, etc., are not yet to hand from the Registrar General. The outstanding feature of the report is the very satisfactory drop in infant mortality. With only 4 infant deaths the infant death rate per 1000 births fell from last year's figure of 21.3 to the very low figure of 9.8. The birth rate with 410 live births was 15.7 per 1000 population, slightly higher than last year's figure of l4.5. The crude death rate was 11.0 compared with 12.1. Again there were no maternal deaths, and it is a matter for great satisfaction that there has been no such death in the past 17 years. The number of infectious diseases notified during 1964 was 78 compared with 379 last year. Measles notifications fell from 314 to 46 and dysentery from seven last year to one this year. -1- Again in 1964 there were no notifications of diphtheria, which puts the last such notification at a distance of 9 years. The last death from diphtheria occurred 18 years ago. Notifications of whooping cough were 10, 13 less than in 1963. Tetanus Immunisation of Urban District Staff. One of the most satisfactory features of our work in 1964 was the immunisation against tetanus of 35 of the Council's outdoor staff, including the Parks, Building, Roads, Sewers and Refuse Collection and Disposal Staffs. This is the first opportunity of such protection that these groups have had and I am pleased that so many have availed themselves of it. My thanks are due to the County Medical Officer for permission to use the facilities and staff of our clinics for this purpose. Health Education. Our scheme to hold meetings throughout the area with parents and staff associations has made good progress. At these meetings we have shown various films for discussion with parents and teachers, and subsequently the School Medical Officers have attended at the schools for the showing of the films and have been available for questions and discussion. This seems to be a reasonable line of progress and has met with a good reception. Once again my warm thanks are due especially to Dr. Mary Douglas, my deputy, and to Mr. W. Jackaman, Chief Public Health Inspector and also to Mr. Hedges and Mr. Quin. We were very sorry to lose the services of the Chief Clerk, Mr. J. Wilson, on his appointment as chief clerk to the Public Health Department of Hendon. I would thank Mrs. K. Wilson who was appointed in his place and Mass E. Glasscock for coping so well with the heavy load of work these last few months. Finally, I should like very sincerely to thank the Council and especially the Chairman and Members of the Public Health Committee for their encouragement and support which have made my term of office a very pleasant one. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, Janet R. Campbell. Medical Officer of Health. -2- PUBLIC HEALTH COMMITTEE. at 31st. December, 1964. Cr. S. P. Esom, M.I.M.I. (Chairman) Cr. J.O. Blake (Vice-Chairman) Cr. D. Plaskett Marshall,F.R.I.B.A., J.P. (Chairman of the Council) Cr. M. Shaw (Vice-Chairman of the Council) Cr. L. F. Bannister Cr. E. C. George Cr. G. H. Flesher F.I.O.B. Cr. R. F. Pugh, J.P. PUBLIC HEALTH STAFF. Medical Officer of Health Janet R. Campbell, M.B.,Ch.B.,D.P.H. Deputy Medical Officer of Health Mary C. Douglas, M.B., Ch.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 Chief Clerk J. Wilson (Resigned 13.7.64) Mrs. K. Wilson (Appointed 21.9.64) Secretary /Typist Miss E. M. Glasscock Rodent Operative E. T. Crawshaw (Resigned 24.8.64) T. Yeoman (Appointed 13.7.64) -3- STATISTICS OF THE AREA. Area (in acres) 1,340 Population (Registrar General's estimate 1964) 28,280 (District - 26,150) (Friern Hospital 2,130) Number of inhabitated houses 8,449 Rateable Value (31st. December 1964) £1,052507 Sum represented by a penny rate £5,280 EXTRACTS FROM VITAL STATISTICS. LIVE BIRTHS. TOTAL 410 BIRTH RATE (live births per 1000 population) 15.7 STILL BIRTHS. TOTAL 5 STILL BIRTH RATE (per 1000 total live and still births) 12.05 TOTAL BIRTHS (Live and still) 415 -4- INFaNT DEaTHS (under 1 year of age) TOTAL 4 INFaNT DEATH RATE (per 1000 live births) 9.76 \ NEO-NaTAL DEATH RATE (under 4 weeks per 1000 live births) 7.32 EARLY NEO-NATAL DEaTH RATE (under 1 week per 1000 live births) 7.32 PERINATAL DEaTH RaTE (stillbirths and deaths under 1 week per 1000 total live and still births) 19.28 MaTERNaL DEATHS (excluding abortions) 0.0 MaTERNAL DEATH RATE (including abortions per 1000 births live and still) 0.0 DEATHS. MALE. FEMALE. TOTAL. District 117 171 288 Friern Hospital 55 112 167 Total 172 283 455 DEaTH RATE (per 1000 population) 11.0 -5- BIRTHS. The number of births assigned to the district was 410, giving a Birth-Rate of 15.7 per 1000 of the population. Birth and Birth-Rates for the past five years have been:- Year. No. of Births. Birth-Rates. Friern Barnet. England & Wales. 1960 354 13.8 17.1 1961 358 14.1 17.4 1962 349 13.8 18.0 1963 376 14.5 18.2 1964 410 15.7 — MORTALITY. General Mortality and Death Rate. There were 455 deaths during the year. Of these 167 occurred in Friern Hospital and 288 in the district. This provides an uncorrected Death-Rate of 16.1 per 1000 for the total population, and 11.0 for the district excluding Friern Hospital. The Deaths and Death-Rates for the past five years have been:- Year. No. of Deaths. Death-Rates. Friern Barnet. England & Wales. 1960 373 9.5 11.5 1961 466 11.3 12.0 1962 445 11.0 11.9 1963 527 12.1 12.2 1964 455 11.0 (un-corrected) -6- Mortality of Persons over the age of 65. 338 deaths, or 74.3% of the total deaths during the year occurred in persons over the age of 65 years. Of these 230 were over the age of 75• There were 254 deaths from diseases of the heart and circulatory system, 47 fewer than last year. Deaths from cancer of the lung, however, rose from 16 to 19. Those from bronchitis fell from 28 to 15. Infant Mortality. There were 4 deaths of infants under 1 year of age. This gives an infant death rate of 9.76 per 1,000 live births as compared with 8 deaths and a rate of 21.3 in the preceeding year. Of the 4 infants who died in Friern Barnet during 1964 3 died under one week, and one at 10 weeks. These very early deaths now constitute the hard core of all infant deaths and are under the most careful scrutiny. 5 stillbirths were accredited to the District for 1964. This is equal to a death rate of 12.05 (live and stillbirths) the corresponding figures for 1963 being 10 stillbirths with a rate of 25.9. No maternal deaths were reported during the year. GENERAL PROVISION OF HEALTH SERVICES. Care of the Aged. Fortunately the residents of Friern Barnet continue to live as a rule to a ripe old age - and in most cases to an active and happy old age. There are however a considerable number of elderly people who are lonely and out of touch with the services which are provided to help them and it is towards these people that our efforts are especially directed. The Old People's Welfare Committee are continually expanding their services and the recently opened Old Peoples' Centre beside the Town Hall is a tremendous asset. The Elderly Persons Advice Clinic is now functioning and sessions are held once a month at the Old Peoples' Centre. Dr. Douglas has been in charge of these sessions and has also given a talk at the Club on one or two occasions. Already it is evident that this Advice Clinic will be a welcome additional service and that full advantage will be taken of it. -7- Laundry Service for Aged Incontinent Persons. This service was set up in Wood Green in 1963 to serve the Boroughs of Wood Green and Southgate and the Urban District of Friern Barnet. It is an excellent example of co-operation between three local authorities, all of whom have this service closely at heart. With the formation of the new Boroughs other arrangements have had to be made and this laundry for Friern Barnet has now been transferred to Finchley. There will of course, be no interuption or change in the service so far as the patients are concerned. I am grateful to the three councils and to the officers, particularly of the Engineer's Department in Wood Green who have made the scheme work so smoothly and efficiently and also to Mrs. Mitchell, the Area Home Help Organiser, for the extra work she has willingly put into this service. Chiropody Service. Throughout the year chiropody sessions have been held three times a week at Holly Park Clinic and domicilary visits are also made as necessary. It is hoped that this service will continue with no curtailment. Hospitals. The general hospital services available to the people of Friern Barnet continue in the main as in previous years. The acute shortage is in Maternity beds, and the scheme for "planned early discharge" must inevitably continue until the shortage is met. In all these cases a very careful investigation is made to ensure that the home is a suitable one to which the mother may safely return 48 hours after her confinement in hospital. Laboratory Facilities. I would again record my appreciation and thanks to the staff of the Public Health Laboratory Service both at Colindale and Coppetts Wood Hospital for their unfailing assistance during the year. I feel that we are very highly privileged in having available their expert advice to call upon at any time. -8- Summary of the work carried out at the Public Health Laboratories for the year: Throat and nose swabs 84 Faeces 62 Sputum 2 Ice cream 43 Milk 132 National Assistance Act 1948. Section 50. Burial or cremation of the dead The Act requires the local authority to cause to be buried or cremated the body of any person who has died or been found dead in its area where it appears that no suitable arrangements are otherwise being made for the disposal of the body. Arrangements were made for the cremation of one body during the year. PREVALENCE aND CONTROL OF INFECTIOUS DISEASES. From the table of infectious diseases set out on Page 28 it will be seen that 78 cases of infectious disease were notified during the year, as against 379 in 1963. The Infectious Sickness Rate for the year was therefore 2.7 compared with 13.4 for the previous year. Last year was a "measles year" which explains the higher rate in 1963. The following table sets out the infectious diseases notified during 1964 as compared with those received during 1963. 1963. 1964. Measles 314 46 Pertussis 23 10 Scarlet Fever 11 14 Pneumonia 4 – Dysentery 7 l Food Poisoning 6 - Tuberculosis 12 6 Erysipelas 2 l 379 78 -9- From this table the following facts emerge:- 1. Scarlet Fever notifications totalled 14 in 1964 an increase of 3 on the 1963 figures. 2. Diphtheria the last case of diphtheria notified was 9 years ago and it is 18 years since this was a cause of death. 3. Measles notifications fell from 314 in 1963 to 46 this year. 4. Pertussis notifications were 10 compared with 23 last year. 5. One case of Dysentery was notified and no cases of Food Poisoning compared with 13 cases of Dysentery and 6 of Food Poisoning last year. 6. No cases of poliomyelitis were notified. 7. Six cases of Tuberculosis were notified during 1964, only half last year's figure. One of these was a case in Friern Hospital. 8. International certificates. The number of certificates of successful vaccination or re-vaccination brought to the Department for authentication by persons proceeding overseas was 116. Immunisation and Vaccination in the control of Infectious Diseases. The following table gives a rough estimate of the extent to which the population of Friern Barnet is protected by immunisation from the various infectious diseases. This is based on our knowledge of the rate of immunisation obtaining in children from infancy to fifteen years of age covering the period from 1935 to the present date. (The figures do not however take account of movement of population into or out of the Borough with the exception of young children under 2 years). Disease. Age range of population of Friern Barnet estimated to possess useful protection conferred by vaccination or immunisation. Diphtheria From infancy to approximately age 40. During 1964 93% of children reaching the age of 2 years had been immunised. -10- Whooping Cough From infancy to age 40 Tetanus From infancy to age 20. (Plus 35 of staff of Friern Barnet Urban District Council) Smallpox From infancy to approximately 10 years, very fully protected and to 15 or 20 years fairly fully protected. Varying numbers in ages beyond this. During 1964 74% of children reaching the age of 2 years had been successfully vaccinated. Tuberculosis Ages 13 - 24 very fully protected. This is the group who have received B.C.G. vaccination in school. (The consent rate to B.C.G. vaccination for 1964 was 53%. Measles 38 children aged 1 to 2 years were vaccinated against measles during 1964 under the Research scheme of the Medical Research Council. 1965 is expected to be an epidemic year for measles and this will test the efficacy of the vaccine in those children whose parents volunteered to take part in the trial. Poliomyelitis From infancy to age 25 very fully protected and also to a lesser extent up to age 50 or over. -11- SANITARY SERVICES. Summary of inspections of District. Visits in connection with complaints 302 Visits in connection with infectious diseases 139 Visits to shops and other places where food is prepared, stored or sold 523 Visits to other shops, offices, etc. 38l Visits to factories 69 Visits to petrol installations 106 Visits in connection with housing and the repair of dwelling houses 1,947 Visits in connection with the Rent Act 17 Visits in connection with the Clean Air Act 2,510 Visits in connection with rodent control 935 Appointments and special visits 376 Miscellaneous visits 139 Total 7,444 Summary of complaints received. Housing defects 69 Defective drainage 23 Offensive accumulations or smells 24 Insect pests 93 Rat or mouse infestations 119 Unsound food 7 Noise nuisance 10 Other complaints 13 Total 358 Notices served. Informal notices served 128 Statutory notices served 17 -12- Legal Proceedings. Proceedings were taken in three instances where there was failure to comply with notices served under the Public Health Acts requiring the abatement of nuisances. In two instances the Magistrates made Nuisance Orders and the third case was adjourned. The matters requiring attention in this latter case were remedied prior to the adjourned hearing. HOUSING. Inspection of dwellings during the year. 1. Number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 232 2. Number of dwelling houses which were inspected and recorded under the Housing (Consolidated) Regulations 1925 and 1932) 29 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for habitation 13 4. Number of dwelling houses (exclusive of those referred to in 3 above) found not to be reasonably suitable for occupation) 104 Remedy of defects during the year without the service of formal notice Number of defective dwelling houses rendered fit as a consequence of informal action 79 Action under statutory powers during the year (l) 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 - -13- (2) Proceedings under Public Health Act 1936. (a) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 13 (b) Number of dwelling houses in which defects were remedied after service of formal notices:– (l) by owners 9 (11) by Council in default of owners - (3) Proceedings under section 17 of the Housing Act, 1957. (a) Number of dwelling houses in respect of which Demolition Orders were made or undertakings accepted 2 (b) Number of dwelling houses demolished – (c) Number of dwelling houses in respect of which Closing Orders were made 4 (d) Number of dwelling houses in respect of which Demolition Orders were determined, the dwellings having been rendered fit – (4) Proceedings under sections 42 and 43 of the Housing Act, 1957. (a) Number of Clearance Areas declared - (b) Number of unfit dwellings included in Clearance Areas - (c) Number of unfit dwellings in Clearance Areas previously declared, demolished - Unfit Houses. Closing Orders were made in respect of four houses during the year, and undertakings that the premises would not be used for human habitation were accepted in respect of two other properties as an alternative to making Demolition Orders. -14- With the exception of six houses, which remain to be dealt with in the final phase of The Avenue redevelopment plan, the Council's slum clearance programme under the Housing Act, 1957, has been completed. The original estimate which envisaged the demolition of 76 houses has been added to as individual unfit houses have come to light and no doubt further cases will be revealed as surveys of housing conditions and routine inspections proceed. The following action has been taken in giving effect to the programme:- Twelve Clearance Areas have been declared involving the demolition of 83 houses. Demolition Orders have been made in respect of 6 houses. Closing Orders have been made affecting 12 houses. Undertakings that premises would not be used for human habitation have been accepted in respect of 3 houses. Houses in multiple occupation The Housing Act, 1961, contains provisions enabling a local authority to require the person in control of a house let in multiple occupation to provide adequate facilities to meet the needs of the families or individuals accommodated. A direction may also be made imposing a limit on the number of persons who may occupy such premises having regard to the facilities available. These powers were widened during the year by the Housing Act, 1964, whereby a local authority is enabled to take over the control of a multi-occupied house summarily if the living conditions are so bad that immediate intervention is considered necessary in order to protect the health, safety or welfare of the residents. Six instances of multiple occupation wore investigated during the year bringing the total number of properties in the district found to be so used to twenty-eight. Ten of these are no longer occupied in this manner. With the exception of two properties, where notices have not yet been complied with, the remainder have been provided with the additional facilities required. -15- The problem of multiple occupation in Friern Barnet does not at present appear to be serious in terms of numbers but it is likely to remain a continuing problem and one which will require constant attention. Certificates of Disrepair. Two applications for certificates of disrepair under the provisions of the Rent Act, 1957 were received and both were approved. Subsequently the owners gave undertakings that the defects of repair referred to in the applications would be remedied and these undertakings were accepted. The Act permits certain increases in the rent of properties subject to rent control and enables a tenant to apply for a certificate of disrepair if not satisfied that the premises are being kept in a proper state of repair. If granted the certificate entitles the tenant to withold the increase of rent until such time as the defects have been remedied. The following table shows the numbers of applications for certificates submitted since the Act was introduced:- 1957 56 1958 36 1959 10 1960 6 1961 1 1962 5 1963 5 1964 2 Improvement Grants. The number of applications for the grant which is available to assist with the improvement of older properties increased slightly during 1964. There were twleve applications for the standard grant, which is available for the installation of the five amenities (bath, wash-basin, hot water supply, internal W.C., and food store,) and two applications for a discretionary grant, which may be sought in respect of a much wider range of improvements. All these applications were approved. Three only were in respect of rented dwellings. -16- Housing Applications. The staff of the Public Health Department work in close liaison with that of the Housing Department and I myself frequently receive letters from general, practitioners and hospitals regarding cases to be considered for medical priority. INSPECTION AND SUPERVISION OF FOOD. Food Premises. There are 137 premises in Friern Barnet where food is either stored, prepared for sale, or sold, and these can be classified as follows:- 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 12 – 9 Cafes and restaurants 16 9 – Confectioners 30 29 – Fishmongers 6 1 – Greengrocers 21 3 – Grocers 39 26 11 Milkshops 4 4 – Total 137 73 20 In addition there are twelve hawkers who sell food from vehicles and from door to door. They are engaged in the following trades:- Greengrocers 8 Fishmongers 3 Grocers 1 -17- These hawkers are required to be registered for the purpose under the provisions of the Middlesex County Council Act, 1950, and their food storage premises must have the approval of the local authority for the district in which they are located. In four cases the hawkers have their storage premises in Friern Barnet, the remainder being in the districts of other authorities. All food traders and their premises are subject to regulations (Food Hygiene (General) Regulations, 1960), which prescribe general standards for the condition and cleanliness of premises, and of the equipment and apparatus used, and for the hygienic handling of food. Five hundred and twenty-three visits were made in connection with these matters and always to encourage improvements in the premises and food hygiene. Six complaints were received concerning the condition of food sold at local shops, and five of these related to the presence of mould, in meat pies, a cream cake, and packaged suet. In each case investigations showed that staff had failed to appreciate the importance of proper storage and regular rotation of stocks of perishable goods in order to avoid loss of quality. Following these enquiries the sale of meat pies at one shop was discontinued, while at the others visual coding systems were introduced to ensure correct rotation of stocks. Food Inspection. There are no slaughterhouses in the district and the greater part of the local meat supply comes from the London and other nearby meat markets. The following food, examined at shops and stores, was found to be unfit for human consumption and disposed of by burial or incineration at the Council's former Sewage Works. Beef 162 lbs. Liver 62 lbs. Tinned Soup 23 tins Tinned meat 24 tins Tinned fish 15 tins Tinned vegetables 52 tins Tinned fruit 296 tins Tinned rice 4 tins Tinned milk 12 tins -18- Frozen fish 20 packets Frozen vegetables 122 packets Frozen fruit 12 packets Frozen pastry 32 packets Frozen chips 14 packets Frozen beef-burgers 2 packets. Milk Supply. The number of persons registered to sell milk in the district is seventeen, two less than last year. They include the large dairy companies delivering milk daily and the occupiers of shops retailing sterilised milk in association with some other business. There is one dairy where milk is pasteurised and bottled. One hundred and thirty seven samples of the milk supplied in Friern Barnet were taken during the year and all were reported on as being of a satisfactory standard. No complaints were received as to the quality of the milk supplied but there was one complaint of milk being supplied in a dirty bottle. In this instance there was a mould growth on milk debris left in the bottle from previous us© and not removed during the normal washing process. This incident was dealt with by a warning to the dairy company concerned. Ice cream. The number of premises registered to sell ice cream was reduced by four to seventy-three, about half of all food premises in Friern Barnet. One person makes his own ice cream but otherwise the retailers obtain their supplies from the nationally known manufacturers. Forty-five samples of the different products offered for sale were examined during the year and without exception satisfied the standard test for bacterial cleanliness. -19- FACTORIES. The number of factories on the register is fifty-seven and most of these are of the light industrial kind. The larger premises include a scientific instrument works and a bag-making factory. The Council is responsible for administering the provisions of the Factories Act, 1961, relating to cleanliness, overcrowding, temperature, ventilation and the drainage of floors in factories where no mechanical power is used and in all other cases these matters are dealt with by H.M. Inspectorate of Factories. The Council has the duty to ensure that all factories are provided with adequate sanitary facilities. A small number of defects were found during the year and these were remedied without occasion to take any legal proceedings under the net. Inspection of Factories Premises. No. on Register. Inspections. Number of Written Notices Occupiers Prosecuted. (l) Factories without mechanical power. 7 17 1 - (2) Factories with mechanical power. 50 52 1 - (3) Other premises i.e. building or engineering works. _ - - – Total 57 69 2 - -20- Defects found in factories Number 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 l 1 - Total 8 8 – Occupiers of factories are required to notify to the Council the names and addresses of persons employed by them to carry out certain classes of work in their own homes. This information is required to enable control over work which might otherwise be carried out in unsatisfactory premises or under conditions which might lead to the spread of infection. Notification was received during the year of thirty outworkers who were engaged in the following occupations:- Making wearing apparel 17 Making boxes 11 Making brushes 2 It was not found necessary to restrict outwork in any case. SHOPS AND OFFICES. The Shops Act, 1950, which deals with the closing hours of shops, Sunday trading, and matters relevant to the comfort and welfare of shop assistants, is administered by the Council and enforcement is a function of the public health department. There are some 300 shops in Friern Barnet, many -21- of them small family businesses, and 4l2 visits were made during the course of the year in connection with the various provisions of the Act. A result was that a number of minor infringements were revealed and remedied but the need to institute proceedings under the Act did not arise. The Offices, Shops and Railway Premises Act, 1963, came into force in the middle of 1964. The Act, which provides standards of health, safety and welfare for workers in offices, shops and certain railway premises, covers a wide range of matters including, for example, cleanliness, overcrowding, room temperature, ventilation, lighting, toilet facilities, safety, first-aid facilities and fire precautions. For office workers the provisions are the first of their kind while for shop workers the existing protection provided by the Shops Act is extended. The Act does not apply to premises where only selfemployed persons or members of their immediate family work, or to small offices or shops where paid help is only occasionally employed. Enforcement, in which the factory inspectorate, the fire authorities, and local authorities, all have their part to play, will undoubtedly involve a great deal of worthwhile work. So far as our own staff were concerned the demands of other public health work left little opportunity for a planned programme of enforcement during the year and our efforts were in the main limited to the registration of premises. By the end of the year the following registrations had been completed:- Class of workplace. Number. Number of persons employed. Offices 29 279 Retail shops 107 432 Wholesale shops or warehouses 4 27 Catering establishments 13 78 Fuel storage depots 1 4 -22- WATER SUPPLY. The water supply for the district is provided by the Lee Valley Water Company with the exception of a portion of the South Ward which is supplied from the mains of the Metropolitan Water Board. All the houses in the district have an internal supply and no complaints were received during the year concerning the quality of the water, Four hundred and seventy-five bacteriological and nine chemical samples of the water supplied to Friern Barnet were examined by the Water Company and were reported as conforming to standards of purity suitable for public supply purposes. The water has no plumbo-solvent action. PEST CONTROL. The Prevention of Damage by Pests Act, 1949, imposes a responsibility on occupiers to keep their premises free of rats and mice, and the Council has the duty to see that this is done. From the outset, however, the Council has provided a free service to the occupiers of private dwellings and this arrangement has proved of value in control by encouraging householders to report infestations which are then dealt with by trained staff. Moreover, where, as is so often the case, more than one property is involved the treatments can be effectively co-crdinated. The number of complaints received during the year concerning rats was ninety-nine. The actual number of infestations found in investigating these reports and as a result of routine surveys throughout the district was seventy-one. These figures are very similar to those recorded in 1962 and 1963 and shew a significant reduction - of more than 50% compared with previous years. For the first time since 1947 it was not possible to undertake treatments against rats in the district sewers because of the shortage of labour. Eighteen premises were freed of mice. Complaints were received of nuisance arising from -23- the congregation of large numbers of feral pigeons in the Oakleigh Road North area and investigations indicated that some, at least, of these birds were nesting in the spire of a nearby church. The church authorities co-operated and engaged a specialist firm to deal with the pigeons in the spire and this action coupled with a request to all residents in the area not to feed the birds resulted in a considerable lessening, if not the complete elimination, of the nuisance. A number of requests for advice and aid to deal with a variety of insect pests were dealt with, the most numerous being in respect of wasps nests, of which sixty-three were destroyed. CLEAN AIR. Two further areas came under smoke control during 196'+. Smoke Control Order No. 5 was confirmed by the Minister of Housing and Local Government in February and came into operation on the 1st. October; Order No. 6 was confirmed in April and took effect on the 1st. November. Originally the national clean air programme had been based on the abundant supply of gas coke as a suitable smokeless fuel to replace household coal but during 1963 it became clear that because of technological changes in the gas industry the future production of such coke would not keep pace with the increasing demand. The position varied in different parts of the country and it became necessary for each local authority to consult with manufacturers and suppliers of the smokeless fuels as to the availability of supplies in their own area. To make sure the supplies of easily burned solid smokeless fuels continued to be available to those householders who had already fitted improved type open inset grates the Minister proposed to encourage the use of a wider range of fuels and the grant in respect of adaptations was made available for the installation of such appliances as closed or openable stoves, underfloor draught grates, gas fires and electric storage heaters. A schedule of prices for these various appliances was agreed by the Council in March and grants based on these revised allowances were made in respect of all adaptations in No. 6 area and for the greater number in No. 5 area. The number of applications for grant increased considerably during the year. In the case of Smoke Control Area No. 5, 4l per cent of the occupiers of premises shewn by survey to require some form of fireplace adaptation actually claimed the grant, in Area No. 6 this number increased to 57 per cent. These figures should be compared with an average of 30 per cent in those areas dealt with in previous years -24- The preliminary survey of Smoke Control Area No. 7 was carried out during the year but because of staff shortages and pressure of other work it was not possible to make any progress with Area No. 8., programmed to be dealt with at the same time. The target date for bringing the whole of Friern Barnet under smoke control was set for 1968, but to the extent that we failed to meet the programme planned for 1964 it is doubtful if this target could have been attained with existing staff, nonetheless the progress made is most satisfactory. At the end of 1964 smoke control orders covered 578 acres and 3,958 dwellings out of a total of 1,340 acres and 8,406 dwellings. Furthermore, Smoke Control Order No. 7 which has subsequently been made will apply to another 58 acres and 450 dwellings. Two notifications of the installation of boilers with a capacity in excess of 55,000 B.Th.U's., per hour were received, one of which related to plant for centrally heating new school buildings. Numerous smoke observations were made of the industrial chimneys in the district and of chimneys in smoke control areas but no offences were recorded. Discussions were held regarding the building of a new boiler house at Friern Hospital. Measurement of smoke and sulphur dioxide in the air in connection with the National Survey of air pollution by the Department of Scientific and Industrial Research continued during the year. It is regretted that the results cannot be shewn as in previous reports because readings are processed by a computer at the Warren Springs Laboratory and there is a delay of some months. However, the general indication in the London area is that smoke pollution is rapidly decreasing but the sulphur dioxide figure is not. This remains a problem for future administrations to resolve. MISCELLANEOUS. Storage of petroleum spirit and mixtures. Twenty-three licences were granted to store a total quantity of 56,230 gallons of petroleum spirit or mixtures, of which 56,000 gallons were kept in underground tanks each holding 500 gallons or more, and 230 gallons in small containers. -25- All licences were subject to conditions for the safe-keeping of petrol which conformed with those recommended by the Home Office. One hundred and six visits were made to the petroleum stores to ensure that conditions attached to the licences were complied with. Two underground storage tanks taken out of use in 1961 and filled with water as a safety measure were found to be no longer water-tight and were filled with concrete. One new installation, to store up to 10,000 gallons of petrol, was in course of construction at the end of the year. Anumal Boarding Establishments Act, 1963. This Act came into force at the beginning of the year and requires that no person shall keep a boarding establishment for cats or dogs except under a licence granted by the local authority. The object of the Act is to secure that the animals are kept in suitable accommodation, are suitably fed and exercised, and that proper precautions are taken to prevent and control the spread of infectious and contagious diseases. Conditions to achieve these objects may be attached to any licence granted. The licensee is required to keep a register of all animals boarded. One person was granted a licence to keep a boarding establishemnt for dogs. Places of entertainmant. At the request of the Middlesex County Council the usual annual reports of the sanitary facilities etc., at the eight premises in the district licensed for public entertainment were made. The matters found to require attention at the premises, all of a minor character, were adequately dealt with and it was not necessary to comment on any particular matter. Local Land Charges registration enquiries. Information was supplied in respect of 627 enquiries relating to properties in Friern Barnet. -26- APPENDIX 1 (a) Letters to Doctors. Letters on the following subjects were circulated to Friern Barnet practitioners in 1964, under my signature either as Medical Officer of Health, or as Area Medical Officer: March 1964 - Collection of Laboratory Specimens. 4th, May 1964 - Incontinence Pads 2nd. July 1964 - Tetanus Immunisation of Staff l4th.Sept. 1964 - Greater London Boroughs. l4th.Sept. 1964 - Home Nursing, Midwifery and Home Help Services. l8th. Dec. 1964 - Collection of Laboratory Specimens. (b) Medical Examinations. During 1964, 8 medical examination;, were carried out in respect of the new entrants to the Council's service and 18 for admission to the Council's Sickness Pay Scheme. -27- 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 46 1 25 18 1 1 – – WhoopingCough 10 – 6 4 – – – – ScarletFever 14 – 5 9 – – – – Dysentery 1 – – – 1 – – – Erysipelas 1 – – – – – 1 – Tuberculosis 5 – – – – 1 2 2 Other Tuberculosis 1 – – – – – – 1 Total 78 1 36 31 2 2 3 3 -28- NOTIFIED DURING THE YEAR ENDING 31st DECEMBER 1964 CASES IN EACH WARD. No. Removed to Hospital. North. South. Central. . East. West. Friern Hospital. 9 18 8 1 10 - - 4 2 - - 4 - - 6 5 - 3 - - - 1 – – – – – – 1 - - – – – 1 - – - 2 2 1 - – – – – 1 – – 21 25 8 6 17 1 1 -29- TABLE 2. ANALYSIS OF CASES OF TUBERCULOSIS NOTIFIED DURING 1964 AND THE MORTALITY FROM THE DISEASE OVER THE SAME PERIOD. NEW CASES. DEATHS. AGES. PULMONARY. NON-FULMONARY. PULMONARY. NON-PULMONARY. M. F. M. F. M. F. M. F. 0-1 – _ _ _ – – – — 1-5 - - - - - - - - 5-10 - - - - - - - - 10 - 15 - - - - - - - - 15 - 20 - - - - - - - - 20 - 25 - - - - - - - - 25 - 35 - - - - - - - - 35 - 45 - 1 - - - - - - 45 - 55 - - - - - 1 - - 55 - 65 1 – — - - - - - 65 & Over 2 1 – 1 – – – – TOTALS 3 2 - 1 - 1 - - TABLE 3. REGISTER OF TUBERCULOSIS. PULMONARY NON-PULMONARY TOTALS. Male. Female. Male. Female. Cases on Register at 1.1.64. 97 56 4 20 177 Cases notified for first time 1964 3 2 – 1 6 Other cases added to the Register 1964 3 2 – – 5 Cases removed from Register 1964 18 20 – – 38 Cases remaining on Register 1964 85 40 4 21 150 -31- 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 1 2 2 5 Bronchitis – - - - 1 - 3 2 9 Cancer - - - - - 2 28 15 26 Diseases of heart and circulatory system. 2 – – – – 3 45 57 147 Nephritis - - - - - - 2 - 1 Other defined diseases – – – – – 1 2 14 7 Other respiratory diseases – – – – – – 1 – – Other Tuberculosis - - - - - - - 1 - Pneumonia - - - - 1 1 11 15 27 Prematurity 1 - - - - - - - - Senility - - - - - - - 2 8 Suicide - - - - - 1 5 - - Tuberculosis(Resp) – – – – – – 1 – – Total 4 - - 1 3 9 100 108 230 -32- DURING THE YEAR 1964 FOR THE WHOLE DISTRICT. WARDS. Male. Fem. No. Reg. In Tran. Total. North. South. Cent. East, West. Friern Hosp. 5 1 5 – 1 1 4 9 5 8 13 2 4 – - 2 7 9 6 11 4 15 15 12 9 5 14 16 32 39 35 36 71 42 34 30 16 43 89 92 162 158 96 254 1 1 - - - 1 1 2 3 - 3 6 1 2 1 4 10 10 14 12 12 24 l – – – – – 1 – – 1 1 – – – – – 1 – 1 l - 1 6 - 6 3 5 35 16 39 39 16 55 - - 1 - - - - 1 - 1 1 l 2 - - - 7 3 7 9 1 10 3 - 3 - - - 4 2 3 3 6 – 1 – – – – – 1 – 1 1 82 56 56 25 69 167 172 283 276 179 455 -33- TABLE 5. INFANTILE MORTALITY. 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 3 - — – 3 1 – – – 4 Un-Certified – - - - – – - - - - Accident – – – – – 1 – – – 1 Birth injury 2 - - - 2 - - - - 2 Prematurity 1 — — – 1 — — – — 1 -34- GRAPH A. Incidence and deaths from diphtheria. Although the death rate was comparatively small in relation to the large number of cases, diphtheria is a crippling disease and leaves a trail of damage to heart etc., in its wake. The population to-day is approximately 4 times that of 1890 and but for immunisation the cases of diphtheria might also be 4 times greater in to-day's population, giving a 5 year figure of four to five hundred cases. The dramatic fall which started in 1942 was the result of a tremendous immunisation campaign which grew in momentum until by 1945 practically every child up to school leaving age had been immunised. It is a matter of great satisfaction that in this district even to-day there is no falling off in the immunisation rate for diphtheria. -35- Diphtheria 36 GRAPH B. Infant and Early Neo-natal Mortality. These rates over the years are completely comparable since they are in all cases rates per 1000 births. The graph shows that out of 1,000 babies born now, 100 are saved who would have died 60 years ago. The remarkable feature of the graph is the contrast between the almost dramatic fall in the total infant mortality rate, and the relatively small reduction in loss of life during the first 7 days of life. This "hard core" of deaths is accounted for by congenital defects, birth injury and prematurity. Intensive research is proceeding into factors, e.g. drugs, virus infections etc., which could produce damage to the developing child, particularly during the first three months of pregnancy. There is a clear case for strict control of all drugs administered to women of child-bearing age and for the giving of Gamma globulin to every expectant mother exposed to a virus infection. In addition a great effort must be made to obtain hospital admission for every mother starting in premature labour so that the child so greatly at risk shall have special skill immediately at hand, and means available to provide an atmosphere of the right temperature and humidity. B 37 GRAPH C. Percentage of total Annual deaths occurring under the age of 1 year recorded at 5 year intervals. The graph shows that up to the year 1900 approximately 40 out of 100 deaths occurring in Friern Barnet, i.e. 2 out of 5, were infants not yet aged one year. In 1964, 1 only out of each 100 deaths in the District was of an infant and 74% occurred in men and women over the age of 65. The killing diseases of infancy then were chiefly the diarrhoeal diseases and pneumonia which were no resnectors of class or person. Few families of any size had not suffered such a loss. A factor not shown in this graph is the present phenomenally low death rate between the ages of 1 and This means that having survived the first year of life there is now a veiy great expectation of living to 65 years or more. In fact in 1964 only 1% of the total deaths occurred between the ages of 1 and 25. In the early days not only was there a high infantile death rate but the loss of young lives from Tuberculosis and other infections meant that possibly only half the babies born lived to maturity. Of tremendous importance to the nation is this survival to maturity of 90 to 95% of children born, in contrast to the survival of only approximately 50% up to the year 1900. When one considers that Sir Winston Churchill, born 90 years ago, was a premature infant and greatly 'at risk', one realises how many great men and women must have been lost to the nation and to the world by this tragic loss of young life. Surely it is a heartening thought that, whatever potential for greatness exists in the nation, it now has the opportunity to mature and declare itself. c