BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1955 J. L. PATTON, MB., Ch.B., D.P.H. Medical Officer of Health BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1955 J. L. PATTON, M.B., Ch.B., D.P.H. Medical Officer of Health BOROUGH OF HENDON With the Compliments of the Medical Officer of Health TOWN HALL. HENDON, N.W.4 Telephone: Hendon 8282 CONTENTS OF REPORT Page Members of Borough Council and Public Health Committee 3 Introductory Remarks of Medical Officer of Health 4 SECTION A: STATISTICS AND SOCIAL CONDITIONS OF THE AREA: General 5 Births, Birth Rate, Stillbirths, Stillbirth Rate 6-7 Deaths, Death Rate 7 Maternal Mortality 7 Infantile Mortality 7-9 Summary of Vital Statistics for the year 1955 10 Table showing Vital Statistics for the years 1932-1955 11 Table showing certain Vital Statistics for the County of Middlesex for 1955 12 Table showing causes of death during 1955 13 Table showing age distribution of deaths during 1955 14 Notes on Vital Statistics 14-15 Deaths from Cancer of the Lung and Bronchus 16 Road Traffic Accidents 18-19 SECTION B: PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES: Notifications 20 Age and Ward Distribution of Infectious Diseases 21-22 Notes on Infectious Diseases 23-25 Diphtheria and Diphtheria Immunisation 27-29 Smallpox and Vaccination 29 Tuberculosis 30-31 Report of Chest Physician 32-33 Mass X-Ray 34-36 SECTION C: GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA Establishments for Massage and Special Treatment 37 Action under Section 47, National Assistance Act, 1948 37 Section 50, National Assistance Act, 1948 - Public Burials 38 Hospital Facilities 38 Health services provided by Middlesex County Council 39 Medical Practitioner Service 39 Laboratory Facilities 40 Medical Examinations 40 Welfare of Old People 40 SECTION D: SANITARY CIRCUMSTANCES OF THE AREA: Water Supply 4 3 Housing - Report of Housing Officer 43-45 Summary of Inspections carried out by Sanitary Inspectors 45-4,6 Notices Served 46 Inspection of Dwellinghouses 46 Legal Proceedings under Public Health Act, 1936 46 Housing Act, 19 36 - Action under 46-47 Housing Repairs and Rents Act, 1954 47 Cinemas and Places of Entertainment and Licensed Houses 48 Smoke Abatement 48 Cesspools 48 Disinfestation and Disinfection 48 Swimming Baths 48-49 Rag Flock and Other Filling Materials Act, 1951 49 Pet Animals Act, 1951 49 Hairdressers and Barbers 49 Rodent Control 49-50 Administration of Factories Acts, 1937 and 1948 51-52 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Food and Food Premises 53 Action taken in c cnnection with Food Stores and Shops 53 Number and type of food premises in the area 54 Food and Drugs Act, 1938 - Section 14 54 Registration of Hawkers and Premises 54 Milk Supply 55 Unsound Food 56-58 Food and Drugs Act, 1938 - Sampling 59 Merchandise Marks Act, 1887-1926 59 Labelling of Food Order 1953 Slaughterhouses 3 COUNCIL of the BOROUGH (31-12-55) Mayor: COUNCILLOR DUDLEY A. DAVIS, J.P. Deputy Mayor: ALDERMAN S. E. SHARPE Aldermen: W. R. CLEMENS, J. P. , F.C.A. R. J. KNOWLES, M. M., J. P., M. I.W.M. J. J. COPESTAKE, .P., A. A. NAAR, M.B. E. A, W. CURTON. F.R. S. A., M. Inst. B.E. C. H. SHEILL J. L. FREEDMAN. J.P., M. A., LL. B. S. R. C. SUMPTER, F.B.A. A. Councillors: S. E. ARRIDGE (MRS.) G. McCALL W. G. BARNES R. J. MOWATT A. G. BRAND. A.A.C. C. A. K. G. PAMPLIN H. D. E. CARTER A. PAUL. J.P. L. C. CHAINEY M. POUNDER J. K. CONNOLLY R. T. REED (MISS) M. EATON D. F. SIMONS A. P. FLETCHER J. W. SHOCK. M. A., F.C.A. B. E. FLETCHER, B.Com. A. V. SULLY, M. C. , J.P., F.C.A. J. D. GORDON-LEE (MRS.) D. THORNYCROFT, M.A. S. D. GRAVES, F. R. I.C.S. F.A.I. (MRS.) C. THUBRUN L. A. HILLS C. V. L. VEGRASS. A.R. I.C.S. M. R. San. I. W. LLOYD-TAYLOR H. E. WILSON PUBLIC HEALTH COMMITTEE (31-12-55) Chairman COUNCILLOR A. V. SULLY, M.C., J.P., F.C.A. Vice-Chairman COUNCILLOR (MRS.) C. M. THUBRUN Aldermen: A. A. NAAR, M. B. E. C. H. SHEILL S. R. C. SUMPTER. F.B.A. A. Councillors: A. G. BRAND, A. A. C. C. A, (MRS.) D. THORNYCROFT, M.A. W. LLOYD-TAYLOR C. V. L. VEGRASS,, A.R.I.C.S., M.R.San.I. (MRS. ) G. McCALL H. E. WILSON A. PAUL, J P ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 5 5 To the Mayor, Aldermen and Councillors of the Borough of Hendon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1955. The vital statistics for the year show a satisfactory state of affairs with an estimated slight decrease in the total population. The infant mortality rate, which for many years has been accepted as a delicate measure of the standard of public health in the community, is maintained at the low figure of 20.7 per 1,000 live births. The statistics show that Hendon has experienced the same gradual increase in the number of cases of deaths from cancer of the lung, with the same preponderance of males.that has been the experience throughout the country generally. The number of cases of poliomyelitis in 1955 was the highest ever recorded in Hendon since the disease was first made notifiable in 1900. The number of road accidents shows an increase on the last year's record total. The Mass X-Ray Unit made three visits to Hendon during the year, including an intensive road-by-road survey of the Watling Estate. The results of these tours were very encouraging and the Chest Physician has suggested that most of the cases of active pulmonary tuberculosis in the Borough are probably known to the Chest Clinic and attending for observation or treatment, During the year nearly 2,000 inspections of food premises were carried out by the Sanitary Inspectors of the Department. When the Food Hygiene Regulations 1955 become operative, a further improvement in food hygiene can be expected. The Housing Repairs and Rents Act 1954, made provision for the landlord to increase the rent of a house on condition that the house is in a good state of repair and reasonably suitable for occupation. The tenant was given the right to apply to the Local Authority for a Certificate of Disrepair, but since the legislation was introduced the number of applications for these certificates has gradually decreased and one must assume either that the landlords are not asking for the permitted increase in rent or that the tenants are satisfied with the conditions under which they are living. In the report I have included the observations of the Housing Officer and an abstract of the report of the Hon. Secretary of the Old People's Welfare Committee. 4 In last year's report I mentioned the completion of the flatlet homes for old people and this year has seen more progress towards satisfying their housing needs in the completion of the home at Church Walk House by Hendon Old People's Housing Soc ie ty. I would like to thank the Members of the Council for their support and encouragement and also the members of the staff for their loyal and conscientious service during the year. I have the honour to be, Mr, Mayor, Ladies and Gentlemen, Your obedient servant, J. L. PATTON Medical Officer of Health. 5 SECTION A: STATISTICS AND SOCIAL CONDITIONS OF THE AREA. STATISTICS General. WARDS (9) AREA IN ACRES. Edgware 2,327 Burnt Oak 477 Mill Hill 2,695 West Hendon 1,143 Central 1,139 Park 580 Golders Green 748 Garden Suburb 667 Childs Hill 593 Area of Borough (in acres) 10,369 Population figure supplied by Registrar General 154,000 Density of Population, i e., number of persons per acre 14.85 Number of inhabited houses at 31st December, 1955 (according to Rate Book) 43,200 Rateable Value at 31st December, 1955 £2,077,681 Sum represented by a Penny Rate £8,400 Births, Live Births: Male. Female. Total. Legitimate 934 898 1,832 Illegitimate 65 37 102 Total 999 935 1,934 Live Birth Rate per 1.000 Home Population 12.55 Birth Rate corrected for comparison with other areas 11.80 Comparability factor supplied by Registrar General 0.94 Corrected Birth Rate per 1,000 Home Population, County of Middlesex 12.60 Birth Rate per 1,000 Home Population, England & Wales 15.00 Corresponding Rate for the Borough of Hendon for the year 1954 12.19 6 Stillbirths Male. Female. Total. Legitimate 10 20 30 Illegitimate - 1 1 10 21 21 Stillbirth Rate per 1,000 Total Births 15.77 Stillbirth Rate per 1,000 Home Population .20 Stillbirth Rate per 1,000 Total Births, England & Wales 23.10 Stillbirth Rate per 1,000 Home Population, England and Wales .35 Deaths. Male. Female. Total. 743 816 1,559 Death Rate per 1,000 Home Population 10.12 Death Rate corrected for comparison with other areas 10.52 Comparability factor supplied by Registrar General 1.04 Corrected Death Rate per 1,000 Home Population, County of Middlesex 10.30 Death Rate per 1,000 Home Population, England and Wales 11.70 Corresponding Rate for the Borough of Hendon for the year 1954 9.35 Maternal Mortality. Number of women dying in consequence of childbirth 1 Maternal Mortality Rate per 1,000 total births .51 Comparative figure for the County of Middlesex .47 Comparative figure for England and Wales .64 Infantile Mortality. Deaths of infants under 1 year of age:- Male. Female. Total. Legitimate 15 24 39 Illegitimate 1 - 1 16 24 40 Death Rate of infants under 1 year of age per 1,000 live births 20.7 Death Rate of infants under 1 year of ageper 1, 000 live births, County of Middlesex 19.4 Death Rate of infants under 1 year of ageper 1,000 live births, England and Wales 24.9 7 Deaths of infants under the age of 4 weeks:- Male. Female. Total Legitimate 11 19 30 Illegitimate 1 - 1 12 19 31 Neo-natal Mortality Rate per 1,000 live births 16.0 Neo-natsl Mortality Rate per 1,000 live births, County of Middlesex 14.1 Neo-natal Mortality Rate per 1,000 live births, England and Wales 17.3 An analysis of the causes of death and the age at time of death reveals the following figures:- Causes of death as certified Age at time of death Under 1 day 1-7 days 1-2 weeks 2-3 weeks 3 weeks to 1 month TOTAL UNDER 1 MONTH 1-3 months 3-6 months 6-9 months 9-12 months TOTAL UNDER 1 YEAR Prematurity 5 4 1 1 - 11 1 - - - 12 Atelectasis & Prematurity 4 1 - - - 5 - - - - 5 Atelectasis 2 1 - - - 3 - - - - 3 Broncho-Pneumonia & Prematurity 1 1 1 - - 3 - - - - 3 Broncho Pneumonia & Atelectasis - - - - - - - - -- 1 1 Acute Enteritis & Prematurity - - - - - - - 1 - - 1 Haemorrhagic Pneumonia - 1 - - - 1 - - - - 1 Asphyxia & Pulmonary Congestion - 1 - - - 1 - - - - 1 Pyelonephritis - - - - - 1 - - - 1 Cerebral Irritation & Tentorial Tear - 1 - - - 1 - - - - 1 Meningitis & Spina Bifida - - 2 - - 2 - - - - Broncho-Pneumonia & Idiopathic Gastro-Enteritis - - - - - - - - - 1 1 Hepatic Failure & Gastro-Enteritis - - - - - - - 1 - - Intrauterine Asphyxia 1 - - - - 1 - - - 1 Heart Disease - - - - - - - 1 - 1 Pulmonary Oedema & Oesophageal Atresia - 1 - - - 1 - - - - 1 Cardiac Failure & Fallots Tetralogy - - - - - - - - 1 - 1 Uraemia Renal Aplasia - - - - - - - - 1 - 1 Congenital Absence of Kidneys 1 - - - - 1 - - - - 1 Respiratory Infection - 1 - - - 1 - - - - 1 TOTAL 14 12 4 1 - 31 2 3 2 2 40 8 The infant deaths were distributed throughout the wards of the Borough as follows:- Burnt Oak 12 Garden Suburb 5 Childs Hill 5 West Hendon 4 Mill Hill 3 Central 3 Golders Green 3 Edgware 3 Park 2 40 TABLE I. The following table shows the Infantile Mortality Rates over various years Year. Death rate of infants under one year of age per 1,000 live bixths. 1900 133 1910 80 1920 47 1930 50 1940 54 1941 57 1942 34 1943 39 1944 32 1945 29 1946 29 1947 27 1948 21 1949 22 1950 16 1951 22 1952 21 1953 16 1954 21 1955 21 9 SUMMARY OF VITAL STATISTICS FOR THE YEAR 1955. England and Wales Borough of Hendon. Rates per 1,000 Hone Population Births Live births 15.00 11.8 Still births 0. 35 0.20 23.1 (a) 15.77 (a) Deaths. All causes 11.7 10.52 Typhoid & Paratyphoid Fever 0.00 - Whooping Cough 0.00 - Diphtheria 0.00 - Tuberculosis 0.15 0.07 Smallpox - - Acute Poliomyelitis & Polioencephalitis 0.00 0.01 Pneumonia 0.51 0.58 Influenza 0.07 0.05 Rates per 1,000 Live Births All causes under 1 year of age 24.9 20.7 NOTIFICATIONS (CORRECTED) Rates per 1,000 Home Population Typhoid Fever 0.00 - Paratyphoid Fever 0.02 0.00 Meningococcal Infection 0.03 0.00 Scarlet Fever 0.73 0.61 Mhooping Cough 1.78 1.27 Diphtheria 0.00 - Erysipelas 0.10 0.13 Smallpox 0.00 - Measles 15.61 12.67 Pneumonia 0.63 0.71 Acute Poliomyelitis Paralytic 0.08 0.19 Non-Paralytic 0.06 0.16 Food Poisoning 0. 29 0.19 Puerperal Pyrexia 17.79 (a) 55.5 (a) 24.4 * (a) (a) Per 1,000 Total (Live & Still) Births. *This is the rate when the figure relating to Hendon residents only is taken. 10 TABLE II VITAL STATISTICS FOR THE YEARS 1932-1955. Year Population Live Births Live Birth Rate per 1,000 Population Deaths Death Rate per 1,000 Population Deaths of Infants under 1 year of age Infantile Mortality Rate Maternal Deaths Materna1 Mortality Rate per 1 000 Total Births 1932 123, 200 1,688 13,70 1,036 8.40 86 51 8 4.62 1933 127,600 1,673 13.11 1,013 7.93 65 38 3 1.74 1934 131,075 1,643 12.53 1,065 8. 12 71 43 3 1.77 1935 134,160 1,724 12.85 1, 146 10.07 87 50 3 1.69 1936 140,650 1,835 13.04 1,166 9.78 81 44 4 2.10 1937 143,800 1,792 12.46 1, 291 10.59 81 45 5 2.69 1938 145, 100 1,877 12.93 1,153 9.38 72 38 4 2.06 1939 142,000 1,837 12.94 1,184 8.41 63 34 5 Not available 1940 132,490 1,601 12.08 1.417 12.41 92 54 3 1941 125,360 1,410 11.65 1,408 11.20 81 57 4 1942 132,200 2,081 15.74 1,298 9.82 70 34 5 1943 133,970 2,223 16.95 1,387 10.35 86 39 4 1944 132, 360 2,245 16.96 1,347 10.18 72 32 4 1345 137,770 2,239 16.25 1,379 10.01 65 29 3 1.30 1946 153,820 2,651 17.23 1,481 9.63 77 29 3 1.10 1947 158,670 2,671 16.83 1,522 9.59 77 27 4 1.45 1948 156,400 2,292 14,65 1,406 8.90 47 21 6 2.56 1949 158,430 2,251 14.36 1,522 10.56 50 22 5 2.17 1950 158,200 2,261 14.29 1,501 9.49 36 16 2 .87 1951 155,700 2,082 13.36 1,635 10.50 47 22 2 94 1952 156,400 1,981 12.66 1,598 10.22 41 21 1 -49 1953 155,500 2,008 12.91 1.479 9.51 32 16 1 .49 1954 154,800 2,008 12.97 1, 392 8.99 42 21 2* .98* 1955 154,000 1,934 12.55 1,559 10.12 40 21 1 .51 * The interval between the maternal condition and the date of death in one case exceeded 1 year. 11 TABLE III. COUNTY COUNCIL OF MIDDLESEX. CERTAIN VITAL STATISTICS FOR THE YEAR 1955. District Population mid-1955 Birth rate per 1.000 population Death rate per 1,000 population Specific death rates per 1,000 population Infant mortality per 1,000 live births Maternal mortality per 1.000 total births Crude Adjusted Crude Adjusted Pulmonary tuberculosis Cancer Infant Neo-natal (a) (a) (a) (a) (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 66,720 12.7 11.8 10.4 10.2 0. 16 (11) 2.3 (151) 20.0 (17) 9.4 (8) - (-) Brentford & Chiswick 58,750 13.4 12.5 10.9 10.4 1.12 (7) 2.3 (136) 12.7 (10) 10.2 (8) - (-) Ealing 184,600 12.4 11.9 10.2 10.7 0.09 (17) 2.0 (369) 22.7 (52) 15.3 (35) 0.43 (1) Edmonton 99,200 12.1 11.5 8.6 9.5 0. 08 (8) 1.7 (165) 17.5 (21) 14.2 (17) 1.63 (2) Enfield 109,000 12.5 12.4 10.7 11.6 0.13 (14) 2.0 (223) 19.1 (26) 16.9 (23) 0.72 (1) Feltham 48,870 16.0 15.8 7.1 10.5 0.10 (5) 1.2 (61) 15.3 (12) 7.7 (6) - (-) Finchley 69,860 12.8 12.2 10.7 9.5 0.10 (7) 2.1 (146) 21.3 (19) 16.8 (15) - (-) Friern Barnet 28,560 11.1 11.7 16.6 15.6 0.14 (4) 2.4 (69) 25.2 (8) 18 9 (6) - (-) Harrow 217,100 12.7 13.0 9.0 10.3 0.06 (13) 1.9 (413) 17.1 (47) 12.0 (33) 0.36 (1) Hayes & Harlington 65,400 14.2 13.3 7.4 11.1 0.17 (11) 1.5 (96) 21.5 (20) 15.0 (14) 1.05 (1) Hendon 154,000 12.6 11.8 10.1 10.5 0.07 (11) 2.1 (326) 20.7 (40) 16.0 (31) 0.51 (1) Heston & Isleworth 105,500 11.0 10.9 10.6 10.9 0.13 (14) 2.0 (209) 24.1 (28) 17.2 (20) - (-) Hornsey 97,600 13,9 12.8 10.8 9.5 0.03 (3) 2.1 (203) 18.5 (25) 13.3 (18) 1.45 (2) Potters Bar 17,790 13.6 13.1 8.0 9.0 0.06 (1) 1.5 (27) 8.3 (2) 4.1 (1) - (-) Ruislip & Northwood 72,700 12.7 12.8 8.1 9.5 0.11 (8) 2.0 (142) 22.8 (21) 18.5 (17) - (-) Southall 53,840 13.0 12.9 11.9 12.7 0.15 (8) 2.0 (109) 17.2 (12) 10.0 (7) - (-) Southgate 71,870 10.8 11.8 11.3 8.9 0.11 (8) 2.3 (168) 19.3 (15) 11.6 (9) - (-) Staines 42,330 17.3 16.6 8.4 9.3 0.09 (4) 1.6 (67) 19.1 (14) 12.3 (9) 1.32 (1) Sunbury 25,460 17.8 16.7 8.1 9.1 0.16 (4) 1.5 (37) 19.9 (9) 17.7 (8) - (-) Tottenham 122,100 12.4 11.8 10.9 11.2 0.19 (23) 2.5 (305) 16.5 (25) 13.2 (20) 0.65 (1) Twickenham 104,300 12.1 12.3 11.1 10.2 0.14 (15) 2.2 (231) 22.9 (29) 17.4 (22) - (-) Uxbridge 57,940 17.1 15.9 8.7 10.4 0.16 (9) 1.9 (108) 14.2 (14) 11.1 (11) - (-) Wembley 129,000 10.8 10.8 8.1 8.9 0.04 (5) 1.8 (234) 17.2 (24) 14.3 (20) 0.70 (1) Willesden 176,000 14.9 13.4 9.6 10.4 0.14 (25) 2.1 (366) 20.2 (53) 14.5 (38) 0.37 (1) Wood Green 50,610 11.7 11.5 10.3 9.5 0.12 (6) 2.1 (105) 23.6 (14) 16.9 (10) - (-) Yiewslety & W. Drayton 22,900 16.9 15.5 6.9 8.9 0.13 (3) 1.3 (29) 23.2 (9) 18.0 (7) 2.50 (1) COUNTY 2,252,000 13.0 12.6 9.8 10.3 0.11 (244) 2.0(4495) 19.4 (566) 14.1(413) 0.47 (14) (b) Notes: (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison. (b) The interval between the maternal condition and the date of death in two cases exceeded 1 year. 12 TABLE IV. CAUSES OF DEATH DURING YEAR ENDED 31ST DECEMBER 1955 Cause of death. Male. Female, TOTAL Tuberculosis, respiratory 7 4 11 Tuberculosis, other - - - Syphilitic disease 1 - 1 Diphtheria - - - Whooping Cough - - - Meningococcal infections - - - Acute Poliomyelitis 1 1 2 Measles - 1 1 Other infective and parasitic diseases - 1 1 Malignant neoplasm, stomach 19 12 31 Malignant neoplasm, lung, bronchus 56 13 69 Malignant neoplasm, breast - 48 48 Malignant neoplasm, uterus - 10 10 Other malignant and lymphatic neoplasms 78 90 168 Leukaemia, aleukaemia 2 2 4 Diabetes 4 6 10 Vascular lesions of nervous system 77 129 206 Coronary disease, angina 156 127 283 Hypertension with heart disease 17 18 35 Other heart disease 56 116 172 Other circulatory disease 40 43 83 Influenza 1 7 8 Pneumonia 47 43 90 Bronchitis 48 25 73 Other diseases of respiratory system 7 5 12 Ulcer of stomach and duodenum 10 9 19 Gastritis, enteritis and diarrhoea 1 5 6 Nephritis and nephrosis 8 4 12 Hyperplasia of prostate 17 - 17 Pregnancy, childbirth, abortion - 1 1 Congenital malformations 7 8 15 Other defined and ill-defined diseases 54 63 117 Motor vehicle accidents 13 8 21 All other accidents 11 11 22 Suicide 5 6 11 Homicide and operations of war - - - All causes TOTAL 743 816 1,559 13 TABLE V AGE DISTRIBUTION OF DEATHS DURING THE YEAR ENDED 31ST DECEMBER, 1955, Age Group Male Female Total Percentage 0-5 years 17 30 47 3,00 5-10 years - 1 1 . 06 10— 15 years - 2 2 . 13 15 — 20 years 5 4 9 .58 20—30 years 4 6 10 .60 30—40 years 15 4 19 1.28 40—50 years 40 43 83 5.32 50—60 years 98 55 153 9.80 60—70 years 176 162 338 21.7 70—80 years 230 243 473 30.33 80 years and over 158 266 424 27.2 TOTAL 743 816 1,559 100.00 VITAL STATISTICS Population. According to the figure supplied by the Registrar General the estimated mid-year population for 1955 was 154,000. This is 800 less than the Registrar General's estimate of population for 1954, and 1875 less than the Census figure for 1951, Births. The number of live births recorded during the year fell, 1,934 occurring compared with 2,008 in 1954 The birth rate, therefore, continued its downward trend and the corrected birth rate of 11.8 per 1,000 population is the lowest rate recorded since 1941, Still births declined, 31 compared with 32 in 1954, but owing to the fact that there were fewer births in 1955 the still birth rate per 1,000 total births was higher than in 1954, namely, 15.77 compared with 15.68, If, however, the population figure is taken the still birth rate per 1,000 home population is slightly less than that for 1354, 0.20 compared with 0.21, 14 Deaths. There was an increase of 67 in the number of deaths. This, coupled with the fact that the population figure was less than that for last year, gives an increased corrected death rate of 10.52 per 1,000 home population compared with 9.35 in 1954. This rate is slightly higher than that for the County of Middlesex which is 10.3per 1,000 home population but less than that for England and Wales which is 11.7. As in previous years, heart and associated diseases accounted for the largest number of deaths, 573 people dying from these causes. Second in the principal causes was cancer. In 1955, 326 people died from all forms of cancer compared with 295 in 1954. Deaths from motor vehicle and other accidents increased, six more people dying from these causes than in 1954 Fewer people committed suicide, 11 persons taking their own lives compared with 14 last year. The number of deaths from influenza, pneumonia and bronchitis was 171. an increase of 57 over the number for 1954. Infantile Mortality. There was a reduction of two in the number of children dying in the first year of life, giving an infantile mortality rate of 20.7 per 1,000 live births which is one of the lowest on record. This compares favourably with the rate for England and Wales of 24 9 per 1,000 live births but is higher than that for the County of Middlesex which is 19.4. One illegitimate child died under the ageofl year giving an infantile mortality rate for this group of 9.8 per 1,000 illegitimate live births. Thirty one children died under the ageofone month, giving a neo-natal mortality rate of 16.0 per 1,000 live births compared with 17.3 for England and Wales and 14.1 for the County of Middlesex. Maternal Mortality. One woman died as a result of childbirth, giving a maternal mortality rate of 051 per 1,000 total (live and still) births. The rate for England and Wales is 0.64 per 1,000 total (live and still) births and that for the County of Middlesex 0.47. 15 Deaths from Cancer of the Lung and Bronchus. In 1950 the Registrar General added to the list of causes of death "Cancer of the lung and bronchus". Prior to 1950 these deaths were included in "Cancer of all other sites". Since that date 356 deaths from lung cancer have occurred in the Borough of Hendon. Over the same period the number of deaths from respiratory tuberculosis was 125. An increase in the number of deaths from cancer of the lung and bronchus and a gradual diminution in the number of deaths from respiratory tuberculosis has been a feature of the Registrar General's statistics for England and Wales during the last six years and it is of interest to realise that here in Hendon the Graph shows a similar trend. Approximately 80% of the persons dying from cancer of the lung and bronchus are men and 20% women and medical research suggests that those who have smoked 200,000 cigarettes are more liable to lung cancer than non-smokers. During the year deaths from cancer of the lung increased by 9. sixty-nine persons, 56 males and 13 females, dying from this cause compared with 58 in 1954, 16 BOROUGH OF HENDON DEATHS FROM CANCER OF LUNG AND BRONCHUS NUMBER OF DEATHS DEATHS FROM RESPIRATORY TUBERCULOSIS. 17 ROAD TRAFFIC ACCIDENTS. The following tables show the road traffic accidents and casualties occurring within the Borough of Hendon during the year 1955 and the comparative figures and casualties for the five year period 1951 - 1955. It should be noted that the figures shown refer not only to Hendon residents but also to persons living in other areas who were involved in accidents within the Borough. The figures for fatalities shown in these tables may not agree, therefore, with those in the list of causes of death supplied by the Registrar General. The RegistrarGeneral's figures refer to Hendon residents only, and the death may have occurred within the Borough of Hendon or outside the district. TABLE VI ROAD TRAFFIC ACCIDENTS 1955 WITHIN THE BOROUGH OF HENDON. Adults. Children. Month Not of Accidents Killed Seriously Injured SIightly Injured Killed Seriously Injured Slightly Injured TOTAL J anuary 51 - 24 35 - 1 3 63 February 57 - 18 46 - - 6 70 March 71 3 14 62 - - 8 87 April 77 1 23 56 - 4 11 95 May 84 1 13 77 - - 15 106 June 77 - 16 71 - 2 11 100 July 82 2 10 73 - 3 10 98 August 68 - 13 52 - 1 12 78 September 75 1 13 80 - 1 5 100 October 83 2 12 93 - 1 12 120 Novembe r 100 3 22 87 1 3 13 129 December 105 4 18 98 11 131 TOTAL 930 17 196 830 1 16 117 1,177 18 table vii borough of hendon. comparative figures of accidents and casualties for the five year period 1951-1955. 1951 1952 19 53 1954 1955 Total number of road accidents involving personal injury 706 714 695 776 930 Accidents per mile of road 4. 41 4.37 4.17 4.64 5.57 Casualty Figures Adults. Killed 18 15 13 17 17 Seriously injured 116 115 117 148 196 Slightly injured 609 592 584 706 830 totals 743 722 714 871 1,043 Children (0-15 years) Killed Nil 1 Nil 1 1 Seriously injured 14 21 20 28 16 Slightly injured 117 110 114 92 117 totals 131 132 134 121 134 Combined Adults and Children. totals 874 854 848 992 1,177 Casualties per mile of road 5.46 5.23 5.09 5.94 7.05 i am indebted to the Borough Engineer and Surveyor for supplying me with the above figures. 19 section b. prevalence of, and control over infectious and other diseases. table viii The following table shows the total number of corrected notifications, other than tuberculosis, received during the year. Disease Total number of cases notified Cases removed to hospital Scarlet Fever 108 47 Whooping Cough 196 6 Measles 1952 59 Acute Poliomyelitis Paralytic 30* 29 Non-Paralytic 25 23 Pneumonia 110 41 Dysentery 28 5 Paratyphoid Fever 1 1 Erysipelas 21 5 Meningococcal Infection 1 1 Food Poisoning 30 11 Puerperal Pyrexia 109 107 Ophthalmia Neonatorum 18 16 Malaria (contracted abroad) 2 2,631 2 353 *One case originally notified as meningococcal infection was subsequently diagnosed as paralytic poliomyelitis. 20 table ix age distribution Disease Under 1 year 1-2 years 3-4 years 5-9 years Age Groups 25 years and over Age not known total 10 - 14 years 15 - 24 years Scarlet Fever M. F. M. F. M. F, M. F. M. F. M. F. M. F. M. F. 108 - - 7 1 16 7 30 30 6 7 3 - 1 - - - Whooping Cough 7 10 9 26 31 25 34 45 1 1 - - 2 1 1 3 196 Acute Poliomyelitis Para lytic 1 1 1 1 1 1 12 5 2 1 1 2 1* - - 30 Non-Paralytic 1 - 2 - 6 2 1 2 2 2 1 2 - 5 - - 25 Measles 16 15 139 177 265 233 521 504 11 27 6 8 7 9 7 7 1,952 total 25 26 158 205 319 268 598 586 20 39 11 10 12 16 8 10 2,311 * One case notified as meningococcal infection was subsequently diagnosed as paralytic poliomyelitis, Disease Under 5 years 5-14 years Age Groups 65 years and over Age not known total 15-44 years 45-64 years Pneumonia M. F. M, F. M. F. M. F. M. F. M. F. 110 5 5 3 6 12 12 18 12 12 24 1 - Dysentery 6 3 2 8 2 6 - 1 - - - - 28 Erysipelas - - - - 5 2 4 5 3 2 -- - 21 Meningococcal Infection - - - 1 - - - - - - - 1 Food Poisoning 2 6 3 4 5 9 1 - - - - - 30 Puerperal Pyrexia - - - - - 109 - - - - - - 109 Ophthalmia Neonatorum 11 7 - - - - - - - - - - 18 Malaria (Contracted abroad) - - - - 2 - - - - - - - 2 Paratyphoid Fever - - 1 - - - - - - - - - 1 total 24 21 9 19 26 138 23 18 15 26 1 - 320 21 TABLE X WARD DISTRIBUTION. NUMBER OF CASES OF INFECTIOUS DISEASE NOTIFIED IN EACH WARD OF THE BOROUGH. Disease Mill Hill Burnt Oak West Hendon Centra 1 Ward. Park Golders Green Garden Suburb Childs Hill Edgware TOTAL Scarlet Fever 32 18 20 10 13 5 2 4 4 108 Whooping Cough 22 15 24 15 14 36 4 30 36 196 Acute Poliomyelitis Paralytic 5 4 5 6 2 3 2 1 2 30 Non-Paralytic 3 7 4 2 1 2 - 2 4 25 Measles 430 309 198 144 132 140 134 116 349 1,952 Pneumonia 21 17 9 18 7 3 1 24 10 110 Dysentery 3 4 1 1 - 1 1 2 15 28 Paratyphoid Fever 1 - - - - - - - - 1 Erysipelas 7 2 1 2 3 1 - 5 - 21 Meningococcal Infection 1 - - - - - - - - 1 Food Poisoning 3 2 1 6 - 2 5 10 1 30 Puerperal Pyrexia 7 67 6 7 4 4 3 7 4 109 Ophthalmia Neonatorum 1 11 2 - 1 1 - 1 1 18 Malaria (Contracted Abroad) - - 1 - - - 1 - - 2 TOTAL 536 456 272 211 177 198 153 202 426 2,631 22 notifications other than tuberculosis. Poliomyelitis, The poliomyelitis epidemic in Hendon in 1955 was the worst since the disease was made notifiable, fifty-five cases occurring compared with three cases in the previous year. The last serious outbreak of poliomyelitis occurred in 1949 when thirty-seven cases of the disease were notified. Of the fifty-five cases two were fatal, thirty cases were paralytic and twentyfive cases non-paralytic. The outbreak was confined to the second half of the year with the exception of two cases notified in June. The monthly distribution of the cases was as follows:- June - 2 July - Nil August - 4 September - 13 October - 17 November - 15 December - 4 Forty-three of the cases occurred in children under the age of 14 years. Twenty of these were in the age group 5-9 years. Tne cases were widely distributed throughout the Borough and the ward distribution was as follows:- Burnt Oak - 11 West Hendon - 9 Mill Hill - 8 Central - 8 Edgware - 6 Golders Green - 5 Park - 3 Childs Hill - 3 Garden Suburb - 2 There are two schools of thought about the spread of poliomyelitis. Some authorities consider that when the disease is epidemic cases are widespread in the community and most of these cases are undiagnosed because they are so mild and free from symptoms. The wide geographical distribution of the disease in the Borough would support this theory. On the other hand, in recent years many authorities consider that the disease is spread from case-to-case through a narrow stream of contacts and that close association appears to be the most important factor. The link established between the first two cases would support this alternative view. 23 The first case was a boy aged 5½ who had a definite paralysis of the leg muscles, he was admitted to hospital on the 2nd June. He had been sitting at a table in school with three other children, one of whom, a boy, developed tonsilitis on the 2nd June. Another child at the same table attended her own doctor for treatment for acute otitis media on the same date. Her illness responded to chemotherapy, and was not in any way suggestive of poliomyelitis, nevertheless, a home contact of this girl, a domestic servant, who became the second notified case, was admitted to hospital on the 6th June with polioencephalitis. The homes of all the notified cases were visited and contacts were advised on the best known methods of preventing the spread of the disease and school children who were intimate contacts were excluded for twenty-one days. It was decided to regard the disease as epidemic in a ward of the Borough when more than two cases per 10,000 population were notified during the previous three weeks in the ward concerned. When the disease was considered epidemic, the Area Medical Officer stopped immunisation and the general hospitals in the Borough were notified so that they could select cases for tonsillectomy from those wards where the disease was less prevalent. Research into the methods of preventing poliomyelitis by vaccination has made progress during recent years and during 1956 we can look forward with interest to the progress of the children who have been vaccinated against poliomyelitis with the new vaccine. Puerperal Pyrexia, There was a reduction in the number of cases of puerperal pyrexia, 109 cases occurring compared with 147 in 1954. Of the 109 cases, 48 only were Hendon residents. This is due to the fact that situated within the Borough is a Maternity Hospital which provides accommodation not only for the Borough of Hendon but also for the surrounding districts. When puerperal pyrexia is notified in residents from these outside districts who enter the hospital for their confinements, the notifications have to be accepted by the Borough of Hendon and not by the authority within whose area the patient is normally resident. In consequence the notification rate for puerperal pyrexia in respect of the Borough of Hendon is high. The rate for the year 1955 is 55.5 per 1,000 total (live and still) births. If the figure for the Hendon residents only is taken the rate is 24.4 per 1,000 total (live and still) births. The rate for England and Wales is 17.79. 24 Scarlet Fever, There was a reduction in the number of cases of scarlet fever notified during the year, 108 cases occurring compared with 142 in 1954. Forty-seven of these were removed to hospital. This was the lowest number to be notified since 1923 when 66 cases of scarlet fever occurred. At that time the population of the Borough was approximately one third of the present figure. Measles, Measles tends to occur in epidemic form every two years and as was anticipated, in the absence of an epidemic in 1954, the disease assumed epidemic proportions in 1955. An outbreak of measles may be expected, therefore, about Easter 1957. Of the cases notified, 537 occurred in the first quarter and 1243 in the second quarter of the year. Whooping Cough, This disease showed an increase on the 1954 figure, 196 cases being notified compared with 144 last year. Malaria. The two cases of malaria notified were contracted abroad. Paratyphoid Fever. The case of paratyphoid fever was a boy aged 9 years. Ten days previous to his illness he had been on holiday at the seaside. The disease may have been contracted there, but this is doubtful. His only symptom was a high temperature. The patient was admitted to the Isolation Hospital on the 9th August, 1955, and discharged on 20th September, 1955, the final diagnosis being para-typhoid B. Ophthalmia Neonatorum. There was a reduced incidence of ophthalmia neonatorum, 18 cases being notified compared with 30 in 1954. Sixteen of these cases were admitted to hospital. Food Poisoning, Thirty notifications of food poisoning were received during 1955, an increase of 10 over the number for 1954. The cases were distributed throughout the year as follows:- First Quarter Second Quarter Third Quarter Fourth Quarter TOTAL 4 4 19 3 30 25 In four cases the type of the infection was unknown and in 26 cases was identified as follows:- Salmonella Typhi Murium 17 Staphylococcal 7 Salmonella Enteritidis 1 Salmonella Reading 1 Of the thirty cases, seven occurred in one household, and three in another, the others being single cases spread throughout the district. FOOD POISONING OUTBREAK IN A GRAMMAR SCHOOL IN THE BOROUGH. An outbreak of food poisoning occurred in a Grammar School during the week ending 17th September, when some 409 pupils, 24 teaching staff and 7 of the kitchen staff were affected during the Thursday evening and night. Most cases recovered quickly and only 68 pupils failed to attend school on Friday the 18 th. The symptoms of the illness were abdominal colic, followed by diarrhoea but without any vomiting, and as no cases were actually notified by General Practitioners, the illness can be considered a mild one. The type of illness suggested a food poisoning due to infection with Clostridium Welchii, outbreaks of which are usually associated with the practice of re-heating previously cooked meat. The meat served on Thursday mid-day, 15th September, to some 591 persons, was suspected because the illness in most instances started some 9 to 15 hours afterwards. Specimens of the cooked meat were examined and showed the presence of the organism Clostridium Welchii (Provisional Serological Type 3). The same organism was also found in a sample series of 15 stools taken from some of the affected pupils and staff. The organism was not found in any other items of the menu but 75 lb. of meat which had been prepared for dinner on Monday, the 19th, was removed for destruction as it was thought that it might have been infected and a subsequent bacteriological report proved that this was so. Contamination could have occurred either from the raw meat as a result of slaughterhouse contamination, or from a human source due to a fault in personal hygiene. A specimenof the fresh meat from the butcher's shop showed no Clostridium Welchii, although that does not definitely prove that the meat was not infected at this source. The meat suspected was 10 imported lsgs of New Zealand Mutton, each weighing about 6 or 7 lb., delivered on the morning of the 14th and boiled within an hour of arrival for three hours. The meat was then removed from the boiler and placed on trays away from the main heat of the kitchen to cool for about an hour before being put into the 26 refrigerator. At the same time a large metal vessel was filled with the liquid in which the mutton had been boiled and this was allowed to cool for about an hour and then it was placed in the refrigerator. It will be seen, therefore, that both joint and stock were in a large volume and that quick cooling would be unlikely. The meat was removed from the refrigerator about 11 a.m. on the following day, cut into slices and then re-heated for 15 minutes in the gravy prepared from the stock. This meat was probably slightly contaminated with Clostridium Welchii after boiling on Wednesday, 14th September, when it remained for some considerable time at a temperature suitable for large scale culture of the organism. If the meat had been eaten on the same day it was cooked the opportunity for culture would not have occurred. In order to minimise the risk of this type of outbreak in the future, the following practice has been adopted in school kitchens. 1. No meat is to be cooked and reheated before it is served. 2. If butchers meat or ham is to be cooked and served cold the following day, the meat must be cooked. rapidly cooled, and placed in the refrigerator only when it is cold. 3. In some cases it is advisable to break down the larger joints to enable them to cool rapidly. The outbreak caused only a mild illness but it aroused the interest of the pupils in food poisoning and food hygiene to such an extent that it was thought appropriate to show them the film "Another case of food poisoning". This film show was followed by a very interesting discussion in which the pupils, staff, Senior Sanitary Inspector and Medical Officer of Health participated. Diphtheria. No case of diphtheria was notified during the year. The following table shows the number of cases and the deaths from diphtheria since the inception of the immunisation scheme in 1935:- 27 TABLE XI Year Number of cases of Diphtheria. Number of Deaths from Diphtheria. 1935 189 9 1936 89 2 1937 121 7 1938 195 4 1939 150 3 1940 70 3 1941 58 1 1942 38 2 1943 31 2 1944 17 - 1945 20 1 1946 8 - 1947 8 - 1948 8 1 1949 4 - 1950 - - 1951 - - 1952 - - 1953 1 - 1954 - - 1955 - - DIPHTHERIA IMMUNISATION. The following table, the figures for which I am indebted to the Area Medical Officer, shows the number of children resident in the Borough of Hendon who received immunising injections during 1955:- 28 table xii number of children resident in the borough of hendon who received immunising injections during 1955. Age at time of injection Primary Inoculations Reinforcing Injections Diphtheria only Combined Diphtheria/ Whooping Cough Whooping Cough Diphtheria only Combined Diphtheria/ Whooping Cough Under 1 year of age 96 901 2 - - 1 year of age 1 56 241 4 1 - 2-4 years of age 44 58 13 205 15 5-14 years of age 64 12 2 1,837 33 15 years and over - - - 2 - total 260 1,212 21 2,045 48 smallpox VACCINATION. The following table, the figures for which I am indebted to the Area Medical Officer, shows the number of persons vaccinated or re-vaccinated in the Borough of Hendon during 1955:- TABLE XIII Age at 31st December 1955. Under 1 year 1-4 years 5-14 years 15 years or over. TOTAL Number vaccinated 1,010 84 29 99 1,222 Number re-vacc inated - 16 88 679 783 29 tuberculosis. Notification, The following table shows the number of cases of tuberculosis notified for the , : first time during the year 1955 and transfers into the district. table xiv Age Group in years. Respiratory Non-Respiratory total Male Female Male Female New Cases Transfers into District New Cases Transfers into District New Cases Transfers into District New Cases Transfers into District 0-1 - - - - - - 1 - 1 1-5 - - - - - - 2 - 2 5-10 1 - 2 1 - 1 - 1 6 10 - 15 2 - - 1 - - 1 - 4 15 - 20 2 1 5 1 2 - 1 - 12 20-25 12 4 6 4 - - - - 26 25 - 35 10 13 12 12 1 - 3 1 52 35 - 45 9 7 - 5 1 - 2 - 24 45 - 55 15 - 4 2 1 - 1 2 25 55 - 65 5 - 4 1 - - - - 10 65 and over 2 1 - - - 2 - 5 Age unknown - - - - - ' - - - - total 58 25 34 27 5 1 13 4 167 The ward distribution of tuberculosis for the year 1955 is shown below. The figures refer to primary notifications only and do not include cases transferred into the district. table xv WARD TOTAL Mill Hill Burnt Oak West Hendon Cent ra1 Park Golders Green Garden Suburb Childs Hill Edgware Respiratory 16 11 11 8 10 8 5 14 9 92 Non- Respiratory 8 1 2 2 2 - - - 3 18 total 24 12 13 10 12 8 5 14 12 110 30 The following table shows the primary notification of tuberculosis, excluding inward transfers, for the ten year period 1946-1955. table xvi. Year Respiratory Non-Respiratory TOTAL M. F. M. F. 1946 84 65 14 12 175 1947 109 80 7 10 206 1948 84 86 13 10 193 1949 112 81 16 10 219 1950 81 71 8 11 171 1951 81 52 12 11 156 1952 82 47 9 8 146 1953 71 51 6 8 136 1954 62 47 2 14 125 1955 58 34 5 13 110 Deaths. According to the figures supplied by the Registrar-General the following deaths occurred from tuberculosis during the year. Tuberculosis of Respiratory System. Other Forms of of Tuberculosis. All forms of Tuberculosis. Male. Female. Total. Male. Female. Total. Male. Female. Total 7 4 11 _ - - 7 4 11 The number of cases of tuberculosis remaining on the Register at the end of the year is as follows:- Respiratory Non-Respiratory Total M. F. M. F. M. F. 747 605 88 88 835 693 1,352 176 1,528 31 Dr. H J. Trenchard, Physician-in-Charge of the Edgware Chest Clinic has provided me with the following report on the work of the Clinic during the year:- "'Edgware Chest Clinic serves primarily an area which includes the Borough of Hendon and parts of the Boroughs of Harrow and Wembley. The volume of work has remained high, but there has been some change in the character of the attendances. More new cases are being referred, while refill treatments on out-patients are declining in number. In keeping with the general trend for the country, new cases of tuberculosis are declining slightly, while deaths have decreased markedly. The net result of this is that there are more living patients requiring supervision. Modern methods of treatment have lead to a shortening of the average stay in hospital of a tuberculous patient, and this has been reflected in a shorter waiting time for admission. The problem with which the medical staff was faced five or six years ago when a patient might even die while waiting for a bed is no longer with us. The N.W. Metropolitan Regional Hospital Board has now closed the ward for tuberculosis at Hendon Isolation Hospital which was administered in association with the clinic. In addition to the consultative work of the clinic, certain preventive services of the Middlesex County Council are administered through the Physician-in-Charge. The Chest Clinic staff includes health visitors and welfare officers of the County Council. Various surveys have been carried out at local schools by the clinic staff working in conjunction with the school health service. These surveys have shown a low level of tuberculinization of the pupils. The chest clinic also co-operated with the Medical Officer of Health and the Mass X-Ray Unit in a survey of the Watling Estate which was carried out in the autumn of 1955. It is gratifying to record that this survey also showed a low incidence of tuberculosis in the area, and suggests that existing case finding organisation is working fairly well. Many local people have been referred for X-ray at the chest clinic by their general practitioners. Certain times of the day are set aside for this type of work for which the Odelca camera unit is used. The annual X-ray of the chest of members of the staff of the Hendon Group Hospital Management Committee is also largely undertaken by the clinic. The appointments system continues in force, and no doubt saves a great deal of time for patients attending the clinic. Unfortunately at times, unforeseen circumstances lead to delays, but on the whole the scheme works well. Considerable discomfort, amounting to hardship in severe weather, is encountered by patients owing to the failure of the heating system. It is understood tnat steps are in hand to improve the supply of heat to the radiators. Che hopes that this will not be long de layed. 32 A multiple layer tomography unit has been installed and has been found to work satisfactorily. It not only saves time but diminishes considerably the amount of radiation to which patients are submitted. Attention is being given to certain chronic chest conditions such as bronchial carcinoma and chronic bronchitis which cause much ill health. Liaison with the Thoracic Surgical Units at Clare Hall, Harefield and St. Charles Hospitals has been maintained, and surgeons from these units now hold out-patient consultative sessions at the clinic. The medical staff also co operate with the assistant radiotherapist from the Middlesex Hospital who visits Edgware General Hospital. A number of doctors holding fellowships of the World Health Organisation and postgraduate scholars of the National Association for the Prevention of Tuberculosis have attended the clinic for long or short periods during the year. There have been about. 30 such visitors from overseas during 1955. statistics for 1955. General. 1951 1952 1953 1954 1955 New patients referred to clinic. 6,107 7,133 8,295 8,459 9,439 Total attendances. 30,046 30,183 30,644 30,841 32,454 Total attendances for refills. 12,214 11,443 10,114 9,523 8,652 Number of persons X-rayed. 14,552 18,388 16,537 17,096 16,544 Number of home visits by physicians. 294 300 383 415 286 CHEST CLINIC'S TUBERCULOSIS REGISTER New respiratory tuberculosis cases, 178 184 171 180 147 New non-respiratory tuberculosis cases. 24 28 16 26 24 Total new tuberculosis cases. 202 212 187 206 171 Tuberculosis cases on register at 31st December. 1,753 1.761 1,764 1,767 1,788 Removed from register because of death. 40 47 44 32 24 Removed from register as recovered. 66 72 54 89 57 Number of tuberculous patients awaiting hospital admission on 31st December. 91 95 48 16 1 I am indebted to Dr. Trenchard for submitting this report. 33 Mass X-Ray. The Mass X-Ray Unit visited the Borough of Hendon on three occasions during the year. (1) Central Hendon on 26th, 27th and 31st May, 1955. The sessions were open to the general public without appointment. The success of a public session is dependent on two factors, (i) the publicity given and (ii) the willingness of the informed person to attend. Publicity was carried out by the Public Health Department and a study was made of the value of different methods of publicity. The methods used were as follows:- (i) Advertisement, three inch double column, in two weekly local papers, two weeks prior to the visit of the Unit. (ii) Letter from Medical Officer of Health in local papers. (iii) Letter and leaflets to private practitioners in Central Hendon area. (iv) Leaflets distributed through:Education Officer - Schools Borough Librarian - Libraries Area Medical Officer - Clinics Chief Officers - Town Hall staff and enquiry offices. (v) Double crown posters in shops. Library, Town Hall, Clinics. (vi) Banner advertising Mass X-ray displayed in Hendon Central Circus on the days of the Unit's visit. (vii) Three minute film "Also Coming Shortly" at two local cinemas in the Hendon Central Area, for the week 23rd to 28th May, 1955. During the various sessions a random sample of the persons attending for x-ray was taken and enquiries made as to how each one had FIRST become aware of the visit and which method of advertisement caused them to attend for x-ray. The result was as follows:- Number of persons interviewed 53 Mass x-ray first brought to their notice as follows:- Posters 22 Advertisement in Papers 17 Leaflets 9 Banne r 2 Film 1 51 Sent by employers 2 53 34 The same 53 people were also asked if they had seen the visit of the X-Ray Unit advertised elsewhere in addition to the advertisement first seen and they replied as follows:- Posters 30 Advertisement in papers 22 Leaflets 12 Banner 11 Films 2 Letter of Medical Officer 2 of Health. This investigation is of some value in demonstrating the effectiveness of the various methods of publicity. Although the three minute film "Also coming shortly" was mentioned by only one out of the 53 interviewed, and the banner by two, they must have been seen by hundreds of people and it was disappointing to realise how small a number was influenced by either. The Editor of the local newspaper was kind enough to insert a letter from the Medical Officer of Health stressing the value of mass x-ray but not one of the 53 persons in the random sample was persuaded by it to attend although 17 of them had seen the advertisement in the same paper and had attended for mass x-ray. Twenty-two persons in the sample attended as a result of having seen the posters. The second analysis, although it does not show the method instrumental in causing the people to visit the unit, indicates that the posters and the advertisement in the local paper were noticed by the largest number of people. It would appear therefore that well displayed posters and prominent press advertisement is the most effective means of getting people to attend for x-rays. A report on the Mass X-Ray survey is given below:- Number x-rayed 1,371 Number re-called for large film 24 No further action 11 Referred far further action 12 Person did not attend 1 (2) The Riding and Temple Fortune, Golders Green. The Mass X-Ray Unit visited The Riding, Golders Green Road and the Odeon Car Park, Temple Fortune, from 5th to 8th September and 13th to 16th September, 1955. 35 The number of people attending at The Riding was 861, 22 being recalled for further investigation. At Temple Fortune, 1,109 people were X-rayed and 16 were recalled for further examination. (3) Tuberculosis Survey on The Watling Estate. A survey of tuberculosis on The Watling Estate was carried out during September, when the mobile x ray unit made a street by street tour and a chest x ray was offered to all persons over the age of 14 years. The survey was carried out in conjunction with the Director of the Mass Radiography Unit, the Chest Physician at Edgware Chest Clinic and the Area Medical Officer, Area No. 4, Middlesex County Council. At the same time a Mantoux skin test was offered to all children attending infant and junior schools on the Estate. The success of the survey depended first of all on the publicity and secondly on the willing co operation of the residents. The visit of the mobile x-ray was widely advertised by posters and handbills and was given considerable prominence in both the local newspapers and "The Watling Resident . A film on tuberculosis and its prevention together with a speaker, were offered to several organisations at the Watling Community Centre and both were accepted by the Old People's Club, The Burnt Oak Townswomen's Guild, the Youth Club, the Youth Hostels Association and the Women's Adult School. The film was also shown at the Young Wives Club at Woodcroft Hall. Wien the X-ray Unit visited, a door-to-door canvass was carried out, largely by voluntary workers recruited from several women's organisations but mainly from the Burnt Oak Townswomen's Guild. The survey was very successful as 2,242 people were x-rayed. This total included a large number of older people and housewives who attended for the first time. Out of the total number x-rayed, 54 were referred to the Chest Clinic for further examination and of these, three cases were found to be suffering from tuberculosis in an infectious form. I am indebted to Dr. J. R. Mikhail, Medical Director of Mass X-Ray Lhit 5B, for his co-operation and for supplying me with the figures showing the results of the survey. 36 section c. general provision of health services for the area. Establishments for Massage and Special Treatment. middlesex county council act, 1944. sections 353 - 363. The Council continued to exercise its functions as the licensing authority under the provisions of the above-mentioned Act. A person requiring a licence or renewal of a licence under this part of the Act must make application to the Local Authority giving certain information, such as age, nationality, technical qualifications and the nature of the establishment and the business conducted thereat. The Council considered the following number of applications:New Licences 6 Renewals of Licences 26 Certificates lodged under Section 363 by members of the Chartered Society of Physiotherapy 5 Licences Refused Nil. NATIONAL ASSISTANCE ACT- 1948- NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951. SECTION 47. This section deals with securing the necessary care and attention for persons who (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. During the year under review it was not found necessary to take formal action in any case. Twenty-four cases, however, where it was thought that the person might be in need of some attention, were brought to the notice of the Public Health Department. Each case was visited and considered separately and where necessary advised how they could best be helped by the existing voluntary and statutory services. Che case, an old lady of 80 years, was brought to the notice of the department towards the end of November and all efforts to persuade her to enter a home failed. 37 In December she became ill and action under Section 47 of the National Assistance Act, 1948. as amended by the National Assistance (Amendment) Act, 1951, was taken in January, 1956. NATIONAL ASSISTANCE ACT, 1948 SECTION 50 - PUBLIC BURIALS Under Section 50 of the National Assistance Act, 1948, the Borough Council is required to arrange for the burial or cremation of any person who has died or been found dead in their area if in such cases it appears to the Council that no suitable arrangements for the disposal of the body have been or are being made. During the year burial was carried out by the Council in 5 cases - 3 men and 2 women. The necessary steps were taken to recover the cost in all cases. GENERAL HOSPITAL FACILITIES Edgware General Hospital. Hendon District Hospital. INFECTIOUS DISEASES - HOSPITAL ACCOMMODATION, Hendon Isolation Hospital. Neasden Isolation Hospital, Willesden. Any other Infectious Disease Hospital controlled by the North-Western Metropolitan Regional Hospital Board. TUBERCULOSIS TREATMENT AND HOSPITAL ACCOMMODATION, Bdgware General Hospital, Hendon Isolation Hospital (Tuberculosis Ward closed October 1955). Admissions are also arranged through the Regional Hospital Board to the Regional Chest Hospitals, particularly Colindale and Clare Hall. A Chest Clinic at Edgware serves primarily those living in the Borough of Hendon and the Stanmore, Queensbury and Kingsbury districts of Harrow and Wembley. 38 HEALTH SERVICES PROVIDED BY THE MIDDLESEX COUNTY COUNCIL, The following services are provided by the Middlesex County Council under Part III of the National Health Service Act, 1946 - * Care of mothers and young children (Section 22) * Midwives Service (Section 23) * Health visiting (Section 24) * Home Nursing (Section 25) * Vaccination and Immunisation (Section 26) * Domestic Help (Section 29) School Health Services and Dental Services. (Provided under Education Act, 1944, the Borough of Hendon being an Excepted District.) * These services are administered, on an area basis, Area 4 consisting of the Boroughs of Hendon and Finchley. The Area Health Committee acts as a Sub-Committee of the Public Health Committee of the County Council and consists of representatives of the two Boroughs, Middlesex County Council, certain professional bodies and other persons with special knowledge of these services. MEDICAL PRACTITIONER SERVICE. The Middlesex Executive Committee has classified the different wards of the Borough into three categories. (1) Designated area - Burnt Oak Ward. A Designated Area is one where the number of patients on the average general practitioners list is high and in such an area an initial practice allowance may be claimed by a doctor who establishes a new practice. 39 In Burnt Oak Ward most of the houses are included in the Watling Estate of the London County Council and many of the residents attend doctors practising in other wards. (2) Intermediate Area - Central, Childs Hill, Edgware, Mill Hill, Park and West Hendon Wards. In these areas the number of patients on the average general practitioner's list is reasonable. New practices may be established in such areas but the initial practice allowance is not likely to be paid. (3) Restricted Areas - Garden Suburb and Golders Green V/ards. These are areas in which the number of doctors is adequate. Normally application by doctors to start new practices is not granted. LABORATORY FACILITIES. These are provided at the Central Public Health Laboratory, Colindale. Specimens may be sent direct to the Laboratory by Medical Practitioners or by special collection from the Public Health Department provided they are received not later than 3.30 p.m. Monday to Friday and 11.0 a.m. Saturday. I would like to express my appreciation of the work carried out by the staff of the Laboratory who during the course of the year has given considerable advice and help to the Public Health Department. The number of samples taken in respect of milk, icecream, domestic water supplies and swimming pools are shown elsewhere in the report. MEDICAL EXAMINATIONS. During the year under review 173 employees of the Hendon Borough Council were medically examined for Superannuation purposes. welfare of old people. The following extracts are from the Report for the year 19 55 - 56 of the Borough of Hendon Old People's Welfare Committee. I am indebted to Mr. A. E. Harvey, the Honorary Secretary and Treasurer, for supplying me with the information. Visiting The need for this service continues to grow, and it is one which requires expanding; more visitors are urgently required. The majority of the old folk were most grateful, and are always anxious for further visits to be made to them. A very 40 large number of these pensioners are known to the Committee, through their visits to the office, or through requests for a visitor to call on them from hospitals, almoners, doctors, nurses etc. If only a few visits are possible during the year, the old people do feel that they are being cared for, and that someone is interested in them. CHIROPODY SERVICE. This Service has increased considerably. Clinical treatments are arranged by the British Red Cross Society on our behalf; this Committee arranges for the housebound to be treated in their own homes. We have been fortunate this year in obtaining a grant of £60 per annum for a three year period from the National Corporation for the Care of Old People, towards this Service. We are most grateful for this grant. NIGHT ATTENDANT SERVICE, This is still available for those wishing to take advantage of it. ANNUAL HOLIDAY. Last year a large party went to Cliftonville and spent a most enjoyable week. Financial reasons prevented many going who would have liked to go, and unfortunately we are limited to the amount we can assist. Many Borough Councils are making this possible, and now give a grant for this purpose. CLUBS. There is still considerable interest shown, and the following clubs continue to operate, within the Borough. The British Red Cross Society's "Evergreen" Clubs meet at Colindale, Childs Hill, Edgware, Golders Green, Hampstead Garden Suburb and West Hendon, The W.V.S. "Derby & Joan" Clubs at Burnt Oak and Mill Hill, whilst the Watling Community Association Veteran's Club meets at the Watling Centre. Special facilities exist for Jewish people of pensionable age, there being three Friendship Clubs attached to the Synagogues at Edgware, Golders Green and Hendon. The Old People s Welfare Committee is responsible for the "Over Sixties" Club which has made rapid progress during the past six months. Work has now commenced on the new Club and Office premises in Station Road, Hendon, N.W.4, and we hope to occupy these in October, 1956. MEALS ON WHEELS. During the year the W.V.S. have served 9,047 meals to old age pensioners, and these are very much appreciated by the recipients. HOUSING. This question is a great National problem, and causes us great concern. Many requests are received for accommodation, one of the main complaints of the old people is the many stairs they have so often to climb, and up which coal, and often water, has to be carried. 41 Last year a residential Home was opened in Childs Hill by the Hendon Old People's Housing Society, which accommodates 42 old people, 90% of whom are Hendonians. It is a great pleasure to see how happy and contented the old folk are in this Home. We note with satisfaction that further one-room flatlets are being built by the Hendon Borough Council in Station Road, N.W.4, for the old people. CHRISTMAS DINNERS. 112 Christmas dinners were taken to House-bound old people, and we are indebted to the W.V.S. in assisting us to distribute these. VISITS etc., FROM 1ST APRIL, 1955, TO 31ST MARCH, 1956. Old people who called at the office for advice 725 Visits made from the office to ill or house-bound people 387 Visits made by other Lady Visitors 636 17748 Old people helped to find accommodation 45 Old people helped to find part employment 36 Help given in arranging for holidays and convalescence 30 Cases under care from 31st March, 1955 93 New cases 1st April, 1955, to 31st March, 1956 116 Cases sent in by:- Welfare Officer 10 Hospitals 32 Local Authorities 30 Brought to our notice (other than above) 44 Districts:- Edgware 222 Mill Hill 171 Burnt Oak 298 West Hendon and Colindale 275 Hendon Central 277 Childs Hill 273 Garden Suburb 70 Golders Green 162 1,748 Chiropody:- Total cases:- House-bound 66: Treatments 148 Total cases:- At Clinic 87: Treatments 344 The office of the Committee is situated in the Methodist Church Hall (Room 3), The Burroughs, Hendon, N.W.4, Telephone HENdon 0404, and is open Mondays, Tuesdays, Wednesdays and Fridays, to deal with any enquiry relating to old people and for interviews. 42 SECTION D. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply, The Borough has a dual source of supply. The northern part is supplied by the Gblne Valley Water Company and the central and southern portion by the Metropolitan Water Board. The Colne Valley water is derived from deep wells sunk into the chalk and before distribution to the consumers the water is under constant supervision of a chemical and bacteriological staff which carries out examinations in modern laboratories situated at the works. The water supplied by the Metropolitan Water Board is selected Thames water which has been subjected to purification by storage in which time it is freed of the bulk of organisms. It is filtered through rapid and then slow filters, attaining a degree of purity which compares favourably with the general supplies in Great Britain, but as a further safeguard terminal chlorination is applied which ensures a first class water in every respect. Samples of water are examined bacteriologically, chemically and for taste and other special purposes on every working day. The supply to all areas was satisfactory in quality and quantity. Number of dwellinghouses supplied from public water mains:- (a) direct to houses 43,200 (b) by means of standpipes Nil. Number of the population supplied from public water mains:- (a) direct to houses 154,000 (b) by means of standpipes Nil. Natural Fluoride content of water supplies:- Colne Valley Water Company: Fluoride Content - Nil. Metropolitan Water Board: Fluoride Content - 0.15 to 0.25 parts per million. HOUSING, I am indebted to the Housing Officer for the following observations and statistics relevant, to the housing situation in the Borough. During the year under review the progress made in providing accommodation for inadequately housed persons has been maintained, and a further 129 families were rehoused into permanent Council houses. The number of permanent Council dwellings at 43 31st December, 1955, amounted to 3,435 of which 2,073 have been erected in post-war years. Despite this progress, however, the number of housing applicants registered as in need of alternative accommodation continues to increase and, at the close of the year, the waiting list totalled 5,701. The need to put to the best use the diminishing amount of land left available in Hendon for building purposes is reflected in the increased flats development undertaken by the Council, and the majority of schemes in progress, or proposed, are planned on this basis. The assistance afforded in the past by the New and Expanded Towns has continued, and during the past twelve months many families have been nominated by Hendon for rehousing in these areas. Without this help these families who are now happily settled in decent living conditions would have been obliged for many years to come to exist in unsatisfactory housing accommodation. The clearance of outdated dwellings has progressed, and the Cricklewood Lane Redevelopment, providing 140 flats, is now completed. Hendon Park Row redevelopment scheme, providing 36 flats, is now nearing completion, and a commencement has been made on the clearing away of the 73 temporary bungalows in Claremont Road and Miitefield Avenue, so that this site may be redeveloped to provide for 184 dwellings. Approval has also been obtained in principle to redevelopment in the following areas:- New Brent Street (North and South) Belle Vue Terrace and Hermitage Lane. Proposals have been submitted for similar redevelopment at West Hendon and Granville Road. During the year the Council has commenced a modernisation scheme affecting 50 houses in the Childs Hill area, to provide for a separate hot water system, a bathroom, and improvements in sanitary and food storage accommodation, in each house. The welfare of elderly persons has not been overlooked, despite the pressing problems presented by overcrowding. Apart from the conversion of premises purchased and converted by the Council to bed-sitting room accommodation, all new estates provide for a proportion of dwellings specially designed for rehousing the older members of the community. The demand from families evicted or threatened with eviction shows slight signs of improvement but emergency accommodation in Half-Way houses is not always available and although 21 families were helped during 1955, in a number of other instances it proved impossible to assist. 44 The passing of the Requisitioned Houses and Housing (Amendment) Act, 1955, has accelerated the pace of release of requisitioned properties, and consequently less vacancies arising in requisitioned property have been available for the rehousing of families inadequately housed. In some cases the Council has negotiated the purchase of requisitioned premises in order to increase the amount of permanent accommodation at its disposal, The policy of transferring to smaller accommodation Council tenants living in accommodation in excess of their requirements has been continued. By so doing it has been possible to make the larger types of houses available for re-letting to bigger families and so relieve many cases of overcrowding. Advantage has also been taken of opportunities to co-operate with other local authorities and private property owners to secure exchanges of tenancies which have proved mutually beneficial. The following table sets out the number of housing applicants assisted during the year ending 31st December, 1955:- 1. Number of families rehoused in permanent accommodation. (a) Pre-war Houses etc. 39 (b) Post-war Houses etc. 85 (c) Temporary bungalows 5 129 2. Transfers arranged to deal with overcrowding, under-occupation etc. on Council Estates 184 3. Number of families given emergency accommodation in Half-way Houses 21 SANITARY INSPECTION. The following summary of the inspection work, together with a report on the various duties performed by the Sanitary Inspectors, has been submitted to me by Mr. A. H. Smith, Chief Sanitary Inspector. During the year under review inspections were carried out as set out below:- Inspections made 6,859 Re-inspections after order or notice 12,975 Complaints received and investigated 1,481 Bakehouses 71 Butchers shops 332 Caravans 205 Dairies 17 45 Drain tests 320 Factories 187 Hawkers and Food delivery vans) 57 Hawkers storage premises and stalls) Ice cream samples 36 Ice cream premises 37 Infectious disease 316 Licensed Premises 133 Milk samples 103 Other food shops 962 Overcrowding 23 Outworkers 59 Piggeries 27 Public entertainment in connection with licensing 136 Restaurants, cafes etc. 270 Smoke observations 198 Stables 11 Swimming baths 40 Pet Animals Act, 1951 12 Hairdressers and Barbers premises 19 Notices served. Informal or cautionary 797 Complied with 680 Statutory Notices. Applied for 193 Served under Public Health Acts 99 Outstanding from 1954 18 Complied with during 1955 101 Outstanding at end of 1955 16 Inspection of Dwelling Houses During 1955. Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 1,653 Number of inspections made for the purpose 5,054 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 516 Legal Proceedings under Public Health Act 1936 During the year it was found necessary to institute legal proceedings in one case. In this instance the Magistrates made an Order for the necessary work to be carried out within 28 days. HOUSING ACT, 1936. No Clearance Areas were made by the Council during the year. The return as required by Section (1) of the Housing Repairs and Rents Act, 1954, 46 was sent to the Ministry of Housing and Local Government. In this return the Council did not propose to deal with any area as a Clearance Area but 173 houses in the Borough were considered to be unfit and it was proposed that these should be dealt with in the period of the following 5 years. Of the 173 houses the Council has already made 24 Demolition Orders and 19 Closing Orders and accepted undertakings from the owners to make the houses habitable in three cases. Eleven families have been rehoused, one house was unoccupied and one family found their own accommodation. The remainder of the houses dealt with are still occupied, difficulty being experienced by the Council in providing alternative accommodation for the occupiers. HOUSING REPAIRS AND RENTS ACT, 1954. The year under review was the first full year in which this Act was in operation. The following figures show the number of applications for Certificates of Disrepair and Revocation and the action taken during the year. Certificates of Disrepair. Number of applications received 70 Number of certificates issued 47 Number of applications refused 13 Number of cases in which the applicant was not entitled to a certificate or the application waswithdrawn 10 Number of applications remaining to be dealt with at the end of 1955 Nil. Revocations. Number of applications received 27 Number of certificates of revocation issued 22 Number of applications refused 1 Number of applications remaining to be dealt with at the end of 1955 4 The number of applications for Certificates of Disrepair is surprisingly low and it can only be assumed that landlords are not availing themselves of the opportunity to increase the standard rent, presumably in many cases on account of the heavy expenditure which would be involved in putting the houses in a state of good repair. 47 Cinemas and Places of Entertainment and Licensed Houses. During the year these premises have been inspected by the Sanitary Inspectors and detailed reports submitted to the respective licensing authority. Smoke Abatement. Number of observations made during the year 198 In this connection advice was given where necessary. Cesspools. A number of houses in the more rural portions of the Borough are drained into cesspools. These were emptied by the Council on 222. occasions during the year. Disinfestation of Verminous Houses. 10 houses were successfully treated Privately owned 6 Council Houses 4 An arrangement exists whereby the Housing Officer notifies the Public Health Department of the transfer of tenants in Council Houses. Inspections are made of furniture, bedding and accommodation before transfer and disinfestation performed where necessary. The method employed is the application of a D.D.T. solution in spray form and in the case of heavy infestation the work is carried out by specialist firms. Disinfection. Disinfection of rooms by formalin spray is carried out after cases of certain notifiable infectious diseases and in the case of tuberculosis on request or by arrangement with the Chest Physician. An arrange-ment exists with the Regional Hospital Board for the steam disinfection of bedding and clothing, a charge being made to the Local Authority for this service. In cases other than notifiable infectious disease the service is carried out on request, an appropriate charge being made. During the year 401 library books and 3 gramophone records were disinfected. The number of rooms disinfected during the year was 235. Swimming Baths. There are two swimming baths within the district owned by the Local Authority, one at West Hendon and one at Mill Hill. 48 Frequent visits are paid by the Sanitary Inspectors and samples taken of the water. Twenty-seven samples taken from the Municipal Swimming Baths were all satisfactory. Rag Flock and Other Filling Materials Act, 1951. Number of Registered Premises 3 Pet Animals Act, 1951 Number of Licences Granted 9 Hairdressers and Barbers. Nineteen inspections were made in connection with the Bye-laws made under Section 282 of the Middlesex County Council Act, 1944. Prevention of Damage by Pests Act, 1949 - Rodent Control. Rodent destruction in dwelling houses and business premises is carried out by a foreman, three full-time and one part-time operatives working under the supervision of the Sanitary Inspectors and in accordance with recommendations of the Ministry of Agriculture, Fisheries and Food. Treatment of sewers is carried out by the Borough Engineer and Surveyor's Department. In the case of dwe1ling houses, treatment is undertaken by the Local Authority free of charge, while in the case of business premises, a charge, based upon time, cost of materials and overhead expenses, is made. In a small number of cases occupiers of business premises and agricultural holdings engage a servicing firm to carry out periodical treatment. It was not found necessary to take statutory action during the period under review. A report on the work carried put for the year ended 31st December, 1955, is given in the following table which is based on the return sent to the Ministry of Agriculture, Fisheries and Food. 49 TABLE XVII Type of Property Non-Agricu1tura1 (5) (1) (2) (3) (4) Local Authority Dwelling Houses (inc. Council Houses) All other (inc. Business Premises) Totals of Cols. (1) (2) and (3). Agricultural 1. Total number of properties in Local Authority's District 17 43,314 4,728 48,059 10 2. Number of properties inspected as a result of (a) Notification 3 785 86 874 1 (b) Survey under the Act - 647 57 704 - (c) Otherwise - 237 56 293 - 3. Total inspections carried out— including re-inspections 58 11,040 830 11,928 6 4. Number of properties inspected (under Section 2) which were found to be infested by (a) Rats (Major 1 - - 1 - (Minor 1 1,203 109 1,313 1 (b) Mice (Major - - - - - (Minor 1 162 34 197 - 5. Number of infested properties (under Section 4) treated by the Local Authority 3 1,360 130 1,493 1 6. Total treatments carried outincluding re-treatments 10 1,786 135 1,931 1 7. Number of notices served under Section 4 (a) Treatment - - - - - (b) Structural work (i.e., Proofing) - - - - - 8. Number of cases in which default action was taken following the issue of a notice under Section 4 of the Act - - - - - 9. Legal Proceedings - - - - - 10. Number of 'Block' control schemes carried out - 5 - 5 - 50 Factories Acts, 1937 and 1948. The following is a report on the work carried out by the Sanitary Inspectors during the year:- Part I of the Act. 1. - Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises. Number on Register Number of Inspections Number of written Notices (i) Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 39 16 2 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 382 171 8 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 8 5 2 TOTAL 429 192 12 2. - CASES IN WHICH DEFECTS WERE FOUND. Particulars Number of cases in which defects were found Found Remedied Referred by H.M. Inspector Want of cleanliness (S.1) 12 12 - Overcrowding (S.2) - - - Unreasonable temperature (S.3) - - - Inadequate ventilation (S.4) - - - Ineffective drainage of floors (S.6) - - - Sanitary Conveniences (S.7):- (a) Insufficient - - - (b) Unsuitable or defective 4 4 - (c) Not separate for sexes - - - Other offences against the Act (not including offences relating to Outwork) 20 20 - TOTAL 36 36 - 51 Part VIII of the Act. OUTWORK. (Sections 110 and 111) Nature of Work. No. of outworkers in August list required by Sect. 110(1)(c). Surgical Appliances 1 Wearing apparel — making, etc. 82 Household Linen 3 Curtains and furniture hangings 2 Brass and brass articles 19 Artificial flowers 1 Nets, other than wire nets 1 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 2 Feather sorting 1 Stuffed toys 5 Cosaques, Christmas crackers, Christmas stockings etc. 5 Lampshades 3 Sacks 1 Brush making 1 TOTAL 127 52 SECTION E. INSPECTION AND SUPERVISION OF FOOD. FOOD AND FOOD PREMISES. 1,893 inspections were made of premises where food intended for sale for human consumption is prepared, stored or sold. During the year particular attention has been paid to the implementation of the Clean Food Bye-laws in respect of the proper screening of foodstuffs to prevent contamination. The Food and Drugs Act 1955, is due to come into operation on 1st January, 1956, at which time partof the Food Hygiene Regulations, 1955, will also become operative. These Regulations will increase considerably the powers of Local Authorities to improve hygiene in food premises and further prevent the risk of the contamination of foodstuffs. It was necessary to institute legal proceedings under Section 3 of the Food and Drugs Act, 1938, in 6 cases. In five of these convictions were obtained, the defendants fined and costs awarded to the Council. In the sixth case the Magistrates considered that, although the Council were justified in taking the proceedings, the offence was not due to unsatisfactory conditions in the bakery and they granted the company an absolute discharge on payment of £2. 6. 0. costs. ACTION TAKEN IN CONNECTION WITH FOOD STORES AND FOOD SHOPS. Ninety-nine notices were served on occupiers of shops and stores for infringements of the Food and Drugs Act, 1938, and Clean Food Bye-Laws. At the end of the year 97 notices had been complied with. The principal matters dealt with were:Sanitary accommodation: Defective Sanitary conveniences 5 Defects in drainage system 9 Choked drains 2 Compartments cleansed 20 Provision of washing facilities: Provision of hot water supply 12 Refrigerators: Interiors cleansed 5 General. Insufficient accommodation for storage of refuse 7 Want of cleanliness 34 Other defects 119 53 NUMBER AND TYPE OF FOOD PREMISES IN THE AREA. Grocers and provision merchants 210 Butchers 91 Bakers and Confectioners 65 Greengrocers 93 Fishmongers 39 Confectionery Shops 128 Restaurants and Cafes 147 Butter Blending Factory 1 Works Canteens 43 Food Warehouses 2 FOOD AND DRUGS ACT, 1938-SECTION 14. Registered Premises. Inspections. Ice Cream Premises 197 37 Preservation of food 67 40 Thirty-six samples of ice cream were taken during the year and submitted for bacteriological examination to the Central Public Health Laboratory, Colindale. The results of the ice cream samples were as follows:- Grade. Number of samples. Grade I 27 Grade II 6 Grade III 1 Grade IV 2 MIDDLESEX COUNTY COUNCIL ACT, 1950-SECTION 11. Registration of Hawkers and Premises. Number of Inspections. Number Registered. Hawkers 63 57 Premises 24 MILK SUPPLY. Number of registered dairymen and distributors 47 Number of registered dairies not being dairy farms 11 Number of visits made to dairies during the year 17 MILK (SPECIAL DESIGNATION) REGULATIONS. The following table shows the number of licences issued under these Regulations during 1955:- Dealers Licences:- Tuberculin Tested 34 Pasteurised 34 Sterilised 34 Dealers Supplementary:- Tubercul in Tested 19 Pasteurised 19 Sterilised 18 54 MILK SAMPLING The number of samples taken during the year is as follows:- Pasteurised 13 Tuberculin Tested Pasteurised 11 Raw bulk milk (Tuberculin Tested) 7 Sterilised 1 In addition, 60 samples of bottle rinses were taken during the year. CONDEMNATION OF FOOD. The amount of foodstuffs condemned during the year shows little change from 1954. A large proportion of the food condemned in the Hendon area is accounted for by the fact that a multiple firm has a central distributing depot within the Borough serving many branches throughout London. Condemned foodstuffs are disposed of by incineration at the Council's Refuse Disposal Works. LIST OF FOODSTUFFS CONDEMNED DURING 1955 MEAT 1,885 lb. 4 oz. (including:- Beef, Lamb, Offal, Salt Beef, Sausages) 272 lb. Cooked Meat and 3 Chickens. FISH 32 st. 3 1b. 4 oz. (including:- Catfish, Cod, Halibut, Kippers Lugs, Roe, Skate, Whiting) TINNED FOOD Meat 376 Milk 224 Fruit 932 Vegetables 875 Soup 183 Fish 252 Jam 97 Fruit Juice 73 Tomato Juice 9 Ham 37 (454 1b. 5 oz.) FRESH FRUIT. DRIED FRUIT AND VEGETABLES Dates 7 1b. Dried Fruit 46 1b. Dried Peas 2 1b. Ground Almonds ¾ lb. Nuts 4 1b. and 12 boxes Prunes 194 1b. 9 oz. Currants 7 1b. MISCELLANEOUS GOODS Baby Food 98 tins Biscuits 43¼ 1b. Blancmange Powder 3 pkts. Bread Rolls 1 pkt. 55 Cakes 4 Cake Flour 3 pkts. Cereal 343 pkts. Cheese 1426½ 1b. & 34 pkts. Chocolate eggs 12 Cherries, Glace' 9 pkts. Coffee 14 tins Confectionery 121 1b. 10½ oz. Cornflour 5 1b. & 2 pkts. Cream 3 jars & 4 tins. Custard Powder 5 1b.4 oz, & 15 pkts. Eggs 340 Egg Albumen 10½ 1b. Fruit 9 jars. Fish 1 jar Flour 125 lb. Gravy Powder 2 pkts. Icing Sugar 3 1b. Jam 24 jars Jellies 6 pkts. Junket Powder 14 pkts. Macaroni 15 1b. Lard 3½ 1b. Milk Foods/Beverages 18 tins. Mint 1 jar Pudding 5 tins & 5 pkts. Paste 8 j ars Pepper 5 cartons Pickles 8 jars Potato Crisps 5 pkts. Salad Cream etc. 21 jars. Sauce 1 bottle Semolina 2½ 1b. Soup 12 pkts. Spaghetti 3 pkts. Squash 2 bottles Suet 4½ 1b. Sugar 58 1b. Tea 4½ 1b. Vermicelli 1 pkt. FOOD AND DRUGS ACT, 1938 (SAMPLING) The Middlesex County Council is the Food and Drugs Authority for the Borough of Hendon and I am indebted to the Chief Officer of the Public Control Department for the following report of his Department during the year:- 56 SAMPLES PROCURED IN THE BOROUGH OF HENDON DURING THE YEAR 1955. Article Total Samples Procured Unsatisfactory Milk, various 189 3 Baking powder 2 - Butter 26 - Cakes 29 - Cheese 4 3 Coffee 1 - Cooked meats 15 - Cream 33 1 Curry powder 1 - Drugs 42 - Fish 5 - Fish cake 4 - Fish paste 5 - Flour 3 - Fruit drink 1 1 Ice cream 24 - Jelly 1 - Liver 10 2 Margarine 7 1 Meat 1 - Meat Paste 7 - Meat Pie 5 - Minced Meat 42 - Mincemeat 1 - Mustard 1 - Non-brewed condiment 1 - Oranges 1 1 Pastry 1 - Pickles 1 - Preserves 4 - Sausages 28 3 Smatana 2 - Soups 4 1 Sugar 1 - Sweets 9 - Tomato ketchup 1 - Vinegar 37 8 Wines and spirits 19 - 568 24 Regarding the samples noted as unsatisfactory, I add the following comments Milk. These three unsatisfactory samples were all of hot milk, procured at cafes, which contained added water. In two cases proceedings were instituted, the fines and costs in one instance being £2.2.0d. and £1.15.0d. respectively, and in the other case £2.0.0d. and £l.l.0d, In the third case the follow-up sample was genuine and therefore no further action was taken. 57 Cheese. Two samples sold as 'Cream Cheese' were found to be 'Whole Milk Cheese'. In one case an official caution was given the retailers, and in the other case proceedings were authorised under the Defence (Sale of Food) Regulations, 1943. The retailer was given a conditional discharge and ordered to pay £5.19.0d. costs A third sample, sold as 'Double Cream Cheese', was deficient in milk fat An official caution was given. Cream. A sample of sterilised cream (tinned) was found to be deficient in fat. A follow-up sample was genuine and no further action was taken. Fruit Drink. A bottle of orange juice bore a misleading statement of dilution, A caution was sent the manufacturers. Liver, Two samples of "lamb's liver" were found to be pig's liver. Proceedings were authorised and in one case the butchers were fined £1.0.0d. and ordered to pay 10/6d. costs and the manager was also ordered to pay similar sums in respect of aiding and abetting. In the second case the firm were fined £2.0.0d. and ordered to pay £2.2.0d. costs. Margarine. A sample of "Margarine with 10% butter" was found upon analysis not to contain butter. Investigations have not, as yet, been completed in this case. Oranges. Cyprus oranges were sold as Jaffa oranges'. Proceedings were instituted under the Merchandise Marks Acts and a fine of £5.0.0d with £2.2.0d. costs imposed. Sausages. Three samples of sausages contained undeclared preservatives. In two cases official cautions were issued, and in the third case the presence of preservative was declared at the taking of the follow-up sample and therefore no further action was taken. Soup "Cream of Mushroom Soup" was deficient in fat. Proceedings were authorised under the Defence (Sale of Food) Regulations, 1943 and the firm of retailers were ordered to pay £25 and £5.$.0d. costs. Vinegar. Six samples of vinegar, two from each of three suppliers, were found to be deficient in acetic acid. Official cautions were issued in two cases, and in the third proceedings were authorised and a fine of £2.0. 0d. plus £1.15.0d. costs imposed. The other two samples, purchased from the same retailer as "vinegar" were found to be non-brewed condiment. Proceedings were instituted and a fine of £l0,0.0d. plus £5.5.0d. costs imposed. 58 MERCHANDISE MARKS ACTS, 1887-1926. "276 inspections of shops were undertaken to ensure that the Marking Orders relating to certain imported foodstuffs made under the Merchandise Marks Act, 1926, were complied with. 1,128 separate displays of meat, apples, tomatoes, poultry, dried fruit, butter and honey were examined. Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. In two more serious cases proceedings were instituted, as follows. A greengrocer displayed for sale Australian Packham pears falsely described as "William Pears", Channel Island tomatoes falsely described as "English" and also had on display South African and Australian apples not marked with the country of origin. He was fined 10/- on each of three summonses and ordered to pay one guinea costs. A firm of butchers had on display for sale Argentine meat not marked with indication of origin They were fined £1.0.0d. on each of two summonses and ordered to pay £3.3.0d. costs. THE LABELLING OF FOOD ORDER, 1953. "This Order requires that in general pre-packed foods shall bear on the label a clear statement of the designation of the food and, in the case of compound foods, the ingredients. It also requires that the name and addressofthe packer or labeller appears. At 124 premises 439 articles of pre-packed food were examined. No proceedings were taken, but in respect of infringements found see paragraph " False or Misleading Descriptions" below. FALSE OR MISLEADING DESCRIPTIONS. "In addition to the foregoing activities which arise specifically from inspections in your area a considerable amount of work has been done for the benefit of all districts of Middlesex equally in scrutinising advertisements and the labels of pre-packed foods and correcting false or misleading descriptions or errors in statement of composition found therein. Corrective action during the year in question included biscuits, confectionery, spirits, sausages in brine, cereals, fruit squashes, margarine, ginger wine, imitation cream, liver puree, iced lollies, cheese spreads, tinned fruit and vegetables. SPECIAL DESIGNATED MILK. Hiring the year in question one licence was issued by my Council in respect of the use of the special designation 'pasteurised' for milk processed within your Borough. The premises were inspected regularly and compliance with the requirements of the Act or Regulations was maintained. 56 samples were taken, all of which were correct. SAFE MILK. In addition to the foregoing, six samples of raw milk were procured within the Borough and submitted to test for the presence of tubercle bacilli. None was found contaminated. SLAUGHTERHOUSES There are no slaughterhouses licensed in the district. 59