lilmy (I BOROUGH OF HENDOM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 J.L. PATTON. M.B. Ch.B. D.P.H. Medical officer of Health BOROUGH OF HENDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 J. L. PATTON, M.B., Ch.B., D.P.H. Medical Officer of Health 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 5-6 Deaths, Death Rate 5 Maternal Mortality 5 Infantile Mortality 6-8 Summary of Vital Statistics for the year 1956 9 Table Showing Vital Statistics for the years 1932-1956 10 Table Showing Certain Vital Statistics for the County of Middlesex for 1956 11 Table Showing Causes of Death for the Year 1956 12-13 Notes on Vital Statistics 14-15 Deaths from Cancer of the Lung and Bronchus 15-16 Road Traffic Accidents 17-19 SECTION B: PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES: Notifications 20 Age and Ward Distribution of Infectious Diseases 21-22 Infective Hepatitis 23-25 Notes on Infectious Diseases 26-28 Diphtheria and Diphtheria Immunisation 28-30 Smallpox Vaccination 30 Chest Disease 31-32 Report of Chest Physician 33-35 Mass X-Ray 36 SECTION C: GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA: Establishments for Massage or 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 the Middlesex County Council 39 Medical Practitioner Service 39 Laboratory Facilities 39 Edgware Group Health Services Liaison Committee 40 Welfare of Old People 41-43 Hendon Old People's Housing Society 43 Medical Examinations 44 SECTION D: SANITARY CIRCUMSTANCES OF THE AREA: Water Supply 44-45 Housing - Report of Housing Officer 45-46 Summary of Inspections carried out by Public Health Inspectors 47 Notices Served 47 Inspection of Dwellinghouses 47 Legal Proceedings Under Public Health Act, 1936 48 Housing Act, 1936 - Action Under 48 Housing Repairs and Rents Act, 1954 48-49 Cinemas and Places of Entertainment and Licensed Houses 49 Smoke Abatement 49 Cesspools 49 Disinfestation and Disinfection 49 Swimming Baths 50 Rag Flock and Other Filling Materials Act, 1951 50 Pet Animals Act, 1951 50 Hairdressers and Barbers 50 Rodent Control 50-51 Administration of Factories Acts, 1937 and 1948 52-53 Clean Air Act, 1956 54 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Food Hygiene 54-55 Food and Drugs Act, 1955 - Legal Proceedings 55 Action taken in connection with Food Stores and Shops 55 Number and Type of Food Premises in the Area 55 Food and Drugs Act, 1955 - Section 16 55 Registration of Hawkers and Premises 56 Milk Supply 56 Unsound Food Food and Drugs Act, 1955 - Sampling 58 Merchandise Marks Acts, 1887-1926 Labelling of Food Order, 1953 60 Slaughterhouses 60 COUNCIL of the BOROUGH (31-12 56) Mayor: COUNCILLOR L. C. CHAINEY, J.P, Deputy Mayor: COUNCILLOR DUDLEY A. DAVIS Aldernen: W. R. CLEMENS, J.P., F.C.A. A. A. NAAR, M.B.E. J. J. COPESTAKE, J.P. C. H. SHEILL A. W. CURTON, F.R.S.A., M, Inst.B.E. S. E. SHARPE J. L. FREEDMAN, J.P. , M. A. , LL.B. S.R.C. SUMPTER, F.B.A.A. R. J. KNOWLES, M.M. , J.P., M.I.W.M. Councillors: S. E. ARRIDGE (MRS.) G. McCALL W. P. ASHMAN R. J. MOWATT W. G. BATOfES K. G. PAMPLIN H. D. E. CARTER A. PAUL, J.P. J. S. CHAMPION M. POUNDER J. K. CONNOLLY D. F. SIMONS (MISS) M. EATON J. W. SHOCX, M.A. , F.C.A. A. P. FLETCHER A. C. B. W. SPAWPORTH B. E. FLETCHER. B.Com. A. V. SULLY, M.C., J.P. , F.C.A. J. D. GORDON-LEE (MRS.) C. M. THUBRUN S. D. GRAVES, F.R.I. C. S., F.A.I. C. V. L. VEGRASS, A.R.I. C. S. , M.R.S.H. L. A. HILLS H. E. WILSON W. LLOYD-TAYLOR PUBLIC HEALTH COMMITTEE (31- 12 - 56) Chaiman: COUNCILLOR (MRS.) C. M. THUBRUN Vice Chairman: COUNCILLOR (MISS) M. EATON Aldermen: A. A. NAAR M.B.E. C. H. SHEILL S, R. C. SUMPTER, F.B. A. A. Councillors W. P. ASHMAN (MRS,) G. McCALL L. C. CHAINEY, J.P., (MAYOR) A. PAUL, J.P. Ex-officio A. V. SULLY, M.C., J.P., F.C.A. B. E. FLETCHER, B.Com. C. V, L. VEGRASS, A.R.I.C.S., M.R.S.H. W. LLOYD- TAYLOR 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956. To the Mayor, Aldermen and Councillors of the Borough of Hendon. Mr, Mayor, Ladies and Gentlemen, I have the honour to submit my Amual Report for the year 1956. The vital statistics for the year show a satisfactory state of affairs. There has been an estimated slight decrease in the total population The infant mortality rate, which has been accepted as a measure of the standard of public health is at the low figure of 18 per 1 000 live births. I am pleased to report too that no maternal death occurred for the first year since 1932 when Hendon received its Charter. Our environment will improve now that new legislation has been introduced with the Food Hygiene Regulations in January and the Clean Air Act in December, and the Council has taken prompt action on both these useful measures. During the year 13 cases of poliomyelitis were notified, a considerable decrease on the record total notified in 1955. I am glad to report that prophylactic inoculation against this disease was introduced. Carcinoma of the lung and bronchus is now an important cause of death in those under sixty years of age. In the report I have included the observations of the Chairman of the Borough of Hendon Old People's Welfare Committee and of the Honorary Secretary of the now separate Hendon Old People's Housing Society. 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. 4 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 QiiIds Hill 593 Area of the Borough 10,369 Population figure supplied by Registrar General 153,200 Density of population, i.e., number of persons per acre 14 75 Number of inhabited houses at 31st December, 1956 (according to Rate Book) 44,000 Rateable value at 31st December, 1956 £3,393,424 Sum represented by a Penny Rate £13,900 Births Live Births. Male. Female. Total. Legitimate 987 923 1,910 Illegitimate 43 45 88 Total 1,030 968 1,998 Live Birth Rate per 1,000 Home Population 13.00 Birth Rate corrected for comparison with other areas 12.35 Comparability factor supplied by Registrar-General 0.95 Corrected Birth Rate per 1,000 Home Population, County of Middlesex 13.20 Birth Rate per 1,000 Home Population, England & Wales 15.70 Corresponding Rate for the Borough of Hendon for the year 1955. 11.80 5 Stillbirths. Male. Female. Total. Legitimate 18 20 38 Illegitimate - - - 18 20 38 Stillbirth Rate per 1,000 Total Births 18.66 Stillbirth Rate per 1,000 Home Population 0.25 Stillbirth Rate per 1,000 Total Births, England & Wales 23.00 Stillbirth Rate per 1,000 Home Population, England & Wales 0.37 Deaths: Male. Female. Total. 773 785 1,558 Death Rate per 1,000 Home Population 10.16 Death Rate corrected for comparison with other areas 10.67 Comparability factor supplied by Registrar-General 1.05 Corrected Death Rate per 1,000 Home Population, County of Middlesex 10.80 Death Rate per 1,000 Home Population, England & Wales 11.70 Corresponding Rate for the Borough of Hendon for the year 1955 10.52 Maternal Mortality, Number of women dying in consequence of childbirth Nil Maternal Mortality Rate per 1,000 total births Nil Comparative figure for the County of Middlesex 0.58 Comparative figure for England and Wales 0.56 Infantile Mortality. Deaths of infants under 1 year of age:- Male. Female. Total. Legitimate 16 17 33 Illegitimate 1 2 3 17 19 36 Death Rate of infants under 1 year of age per 1,000 live births 18.10 Death Rate of infants under 1 year of age per 1,000 live births, County of Middlesex 19.10 Death Rate of infants under 1 year of age per 1.000 live births, England and Wales 23.80 6 Deaths of infants under the age of 4 weeks:- Male. Female Total, Legitimate 12 16 28 Illegitimate 1 2 3 13 18 31 Neo-natal Mortality Rate per 1,000 live births 15.5 Neo-natal Mortality Rate per 1,000 live births. County of Middlesex 14.6 Neo-natal Mortality Rate per 1,000 live births, England and Wales 16.9 An analysis of the causes of death and the age at time of death reveals the following figures:- Causes of death Age at the 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 5 2 - - 12 - - - - 12 Pneumonia - - 2 2 1 5 - 2 1 1 9 Atelectasis 1 5 - - - 6 - - - - 6 Asphyxia - 1 - - - 1 - 1 - - 2 Heart Disease - 2 - - - 2 - - - - 2 Cerebral Anoxia 1 - 1 - - 2 - - - - 2 Intra-Cranial Haemorrhage - 1 - - 1 - - - - 1 Hyaline Membrane Disease - 1 - - - 1 - - - - 1 Erythroblastosis 1 - - - - 1 - - - - 1 TOTAL 8 15 5 2 1 31 - 3 1 1 36 7 The infant deaths were distributed throughout the wards of the Borough as follows:- Burnt Oak 8 Childs Hill 8 Garden Suburb 6 Central 3 Edgware 3 Park 3 West Hendon 2 Mill Hill 2 Golders Green 1 36 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 births. 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 1956 18 8 SUMMARY OF VITAL STATISTICS FOR THE YEAR 1956. England and Wales Borough of Hendon, Rates per 1,000 Hone Population Births Live births 15.70 12.35 Still births 0.37 0.25 23.0(a) 18.66(a) Deaths All causes 11.70 10.67 Typhoid & Paratyphoid Fever 0.00 - Whooping Cough 0.00 - Diphtheria 0.00 - Tuberculosis 0.12 0.12 Smallpox - - Acute Poliomyelitis & Polioencephalitis 0.00 0.00 Pneumonia 0.53 0.51 Influenza 0.06 0.06 Rates per lc000 Live Births All causes under 1 year of age 23.8 18.1 NOTIFICATIONS (CORRECTED) Rates per 1,000 Hone Population Typhoid Fever 0.00 - Paratyphoid Fever 0.01 0.04 Meningococcal Infection 0.03 0.01 Scarlet Fever 0.74 0.89 Whooping Cough 2.07 0.88 Diphtheria 0.00 0.00 Erysipelas 0.10 0.07 Smallpox - - Measles 3.6 1.92 Pneumonia 0.57 0.51 Acute Poliomyelitis Paralytic 0.04 0.05 Non-Paralytic 0.03 0.03 Food Poisoning 0.25 0,15 Puerperal Pyrexia 16.31(a) 55.5(a) 20 6* (a) (a) Per 1,000 Total (Live & Still) Births *This is the rate when the figure relating to Hendon residents only is taken. 9 TABLE II VITAL STATISTICS FOR THE YEARS 1932-1956. 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 Maternal 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 1945 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 0.87 1951 155.700 2,082 13.36 1,635 10.50 47 22 2 0.94 1952 156,400 1,981 12.66 1,598 10.22 41 21 1 0.49 1953 155,500 2,008 12.91 1,479 9.51 32 16 1 0.49 1954 154,800 2,008 12.97 1,392 8.99 42 21 2* 0.98* 1955 154,000 1,934 12.55 1,559 10.12 40 21 1 0.51 1956 153,200 1,998 13.00 1,558 10.16 36 18 Nil Nil *The interval between the maternal condition and the date of death in one case exceeded 1 year. 10 11 COUNTY COUNCIL OF MIDDLESEX. CERTAIN VITAL STATISTICS FOR THE YEAR 1956. District Population mid-1956 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 (a) Crude Adjusted Crude Adjusted Pulmonary Tuberculosis (a) Cancer (a) Infant (a) Neo-natal (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 66,240 13,8 12.8 11.0 11.4 0.14 (9) 2.2 (149) 23.0 (21) 13.1 (12) - (-) Brentford & Chiswick 58,330 14.1 13.1 10.9 11.1 0.07 (4) 2.8 (150) 18.2 (15) 15.6 (12) - (-) Ealing 134,200 13.6 13.1 10.4 11.4 0.11 (21) 1.8 (329) 13.9 (35) 10.7 (27) - (-) Edmonton 98,110 12.9 12.6 9.8 11.2 0.13 (13) 2.2 (214) 22 9 (29) 15.8 (20) - (-) Enfield 109,000 12.4 12.4 11.0 9.4 0.09 (10) 2.1 (229) 24.3 (33) 17.7 (24) - (-) Feltham 49,230 16.7 16.2 6.6 10.6 0.06 (3) 1.3 (65) 21.9 (18) 18.2 (15) - (-) Finchley 69,800 13.0 12.4 11.9 10.9 0.11 (8) 2.2 (152) 13,2 (12) 8.8 (8) 1.08 (1) Friern Barnet 28,570 11.6 12.2 17.7 9.7 0.04 (1) 2.2 (62) 21.1 (7) 15.1 (5) - (-) Harrow 216.200 12.9 13.2 8.8 10.6 0.06 (13) 1.9 (409) 21.1 (59) 16.8 (47) 0.70 (2) Hayes & Harlmgton 66,460 15.2 14.3 7.5 12.2 0.08 (5) 1.6 (106) 14.8 (15) 11.8 (12) 0.97 (1) Hendon 153,200 13.0 12.4 10. 2 10.7 0.11 (17) 2.2 (332) 18.0 (36) 15.5 (31) (-) Heston & Isleworth 105,100 11,8 11.7 10.8 11.4 0.10 (11) 2.0 (215) 17.8 (22) 14 6 (18) - (-) Hornsey 97.220 15.0 14.0 11.5 10.4 0.12 (12) 2.2 (217) 23.3 (34) 15.8 (23) 1.34 (2) Potters Bar 18,910 15.7 14.8 9.2 11.7 - (-) 1.8 (34) 27 0 (8) 20.3 (6) - (-) Ruislip & Northwood 73,930 13.7 13.8 7.3 9.3 0.01 (1) 16 (119) 15.8 (16) 11.8 (12) 0.98 (1) Southall 53,220 13.4 13.4 12.3 10.5 0.17 (9) 2, 4 (127) 18.2 (13) 14.0 (10) 1.39 (1) Southgate 71,670 11.2 12.2 11.8 9.9 0.03 (2) 2.6 (184) 13.8 (11) 7.5 (6) - (-) Staines 44,200 17.2 16.2 8.8 10.7 0.07 (3) 1.9 (82) 23.7 (18) 22.4 (17) - (-) Sunbury 26,700 19.6 17.8 7.6 9.6 0.04 (1) 1.3 (36) 19.1 (10) 11.5 (6) - (-) Tottenham 120,700 12.9 12.5 10.4 11.3 0.15 (18) 2.3 (273) 24,4 (38) 21.8 (34) 1.25 (2) Twickenham 104,000 12.8 13.2 11.4 10.9 0.14 (15) 2.1 (223) 10.5 (14) 6.8 (9) 0.74 (1) Uxbridge 59,640 17.8 16.4 8.2 10.6 0.07 (4) 1.6 (94) 17 9 (19) 11.3 (12) - (-) Wembley 128,300 11.6 11.7 9.0 10.6 0.06 (8) 2.1 (265) 16.8 (25) 12.7 (19) 1.32 (2) Willesden 174,900 15.3 13.9 9.9 11.4 0.14 (25) 2.1 (372) 22.8 (61) 17.9 (48) 1.83 (5) Wood Green 50,100 11.5 11.5 10.7 10.5 0.02 (1) 2 5 (123) 17.3 (10) 15.6 (9) - (-) Yiewsley & W. Drayton 23,070 18.5 17.0 6.5 9.1 - (-) 1.1 (26) 16.4 (7) 14.1 (6) - (-) COUNTY 2,251,000 13.6 13.2 10.0 10.8 0.10 (214) 2.0( 4587) 19.1 (586) 14.6 (448) 0.58 (18) Note: (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison. 12 TABLE IV Deaths of Hendon residents during the year 1956-classified according to age groups and sexes. Causes of Death AGE GROUPS TOTALS Under 1 year 1 - 4 years 5 - 14 years 15 - 24 years 25 - 44 years 45- 64 years 65 - 74 years 75 years and over 1, Tuberculosis, respiratory M 3 6 3 12 F 2 1 1 1 5 2. Tuberculosis, other M 1 1 2 F 3. Syphilitic Disease M 1 1 2 F 4. Diphtheria M F 5. Whooping Cough M F 6. Meningococcal Infections M F 7. Acute Poliomyelitis M F 1 1 8 Measles M F 9. Other Infective & Parasitic Diseases M 1 1 1 3 F 1 4 1 6 10. Malignant Neoplasm, Stomach M 9 7 6 22 F 5 7 7 19 11. Malignant Neoplasm Lung, Bronchus M 2 28 19 9 58 F 10 2 12 12 Malignant Neoplasm, Breast M F 1 3 23 6 5 38 13 Malignant Neoplasm, Uterus M F 1 8 5 2 16 14. Other Malignant & Lymphatic Neoplasms M 4 36 34 22 96 F 4 24 21 22 71 15. Leukaemia, Aleukaemia M 1 1 1 3 F 2 1 3 16 Diabetes M 3 1 4 F 2 2 2 6 17. Vascular lesions of Nervous system M 1 20 24 36 81 F 12 34 81 127 18. Coronary Disease, Angina M 3 68 64 28 163 F 1 18 29 54 102 Deaths of Hendon Residents-Continued TABLE IV (Continued) 13 Deaths of Hendon Residents-Continued TABLE IV (Continued) Causes of Death AGE GROUPS TOTALS Under 1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years and over 19. Hypertension with Heart Disease M 5 5 5 15 F 1 4 13 18 20. Other Heart Disease M 2 13 18 41 74 F 1 3 14 23 85 126 21. Other Circulatory Disease M 5 6 22 33 F 5 7 32 44 22. Influenza M 2 1 6 9 F 1 1 23. Pneumonia M 1 4 5 22 32 F 3 1 1 1 4 8 29 47 24. Bronchitis M 16 15 14 45 F 1 4 5 22 32 25. Other Diseases of Respiratory System M 1 1 1 2 2 3 10 F 1 3 1 5 26, Ulcer of Stomach and Duodenum M 1 5 2 5 13 F 1 2 3 27. Gastritis, Enteritis & Diarrhoea M 1 1 F 1 2 3 6 28. Nephritis & Nephrosis M 1 1 1 3 F 1 1 2 4 29. Hyperplasia of Prostate M 1 2 3 5 F 30 Pregnancy, Childbirth Abortion M F 31. Congenital Malformations M 1 1 2 F 3 1 4 32 Other Defined & Ill-defined Diseases M 13 3 3 12 6 17 54 F 12 1 21 11 26 71 33. Motor Vehicle Accidents M 2 2 3 1 1 9 F 3 2 5 34, All Other Accidents M 1 1 1 1 2 2 8 F 1 2 6 9 35 Suicide M 2 3 6 2 1 14 F 3 1 4 36. Homocide & Operations of War M F M 17 1 5 8 30 243 224 245 773 F 19 2 3 3 18 167 172 401 785 All Causes TOTALS 36 3 8 11 48 410 396 646 1558 VITAL STATISTICS Population. According to the figure supplied by the Registrar-General the estimated mid-year population for 1956 was 153,200. This is 800 less than that for the year 1955 and 2,657 less than the Census figure for 1951. Births. The number of live births recorded during the year increased by 64, 1,998 occurring compared with 1,934 in 1955, giving an increased corrected birth rate of 12.35 per 1,000 Home Population compared with 11.80 last year. The rate, however, is less than that for the County of Middlesex which is 13.2 and less than that for England and Wales which is 15.7 per 1,000 Home Population. The number of stillbirths increased from 31 to 38 giving a stillbirth rate of 18.66 per 1,000 total births compared with 15.77 in 1955, The rate for the Borough of Hendon compares favourably with that for England and Wales which is 23.0 per 1000 total births. Deaths. Although there was one death fewer than last year, owing to the fact that there was a fall in population the corrected death rate of 10.67 per 1,000 Home Population is higher, but is less than the rate for England and Wales which is 11 7 per 1,000 Home Population and the County of Middlesex which has a corrected death rate of 10.8 per 1,000 Home Population. Heart and associated diseases again accounted for the largest number of deaths and second in the principal causes was cancer. Deaths from motor vehicle and other accidents decreased, 31 people dying from these causes compared with 43 in 1955. Eighteen people committed suidde, seven more than last year. Infantile Mortality, Thirty-six children died in the first year of life compared with 40 in 1955 giving an infantile mortality rate of 18 1 per 1,000 live births. With the exception of the years 1950 and 1953 when the infant mortality rate was 16, this is the lowest rate ever recorded in the Borough of Hendon. The rate for the Borough compares most favourably with that for England and Wales, which at 23.8 per 1,000 related live births is the lowest ever recorded in this Country, The rate for the County of Middlesex, 19 1 per 1,000 live births, is higher than that for Hendon. 14 Of the 36 children, 31 died before reaching the age of 1 month, giving a neonatal mortality rate of 15.5 per 1,000 live births compared with 16.9 for England and Wales. Maternal Mortality. For the first time since the district became a Borough in 1932, no mother died as a result of childbirth. Deaths from Cancer of the Lung and Bronchus. An increase in the number of deaths from cancer of the lung and bronchus and a 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 a similar trend is seen locally in Hendon. Our knowledge of the cause of lung cancer has been increased by the recent (1957) statement of the Medical Research Council which, discussing the subject, reported that:- "Evidence from many investigations in different countries indicates that a major part of the increase is associated with tobacco smoking, particularly in the form of cigarettes. In the opinion of the Council, the most reasonable interpretation of this evidence is that the relationship is one of direct cause and effect." During the year in Hendon 58 men and 12 women, many of whom were under sixty years of age, died from this cause. 15 BOROUGH OF HENDON DEATHS FROM CANCER OF LUNG AND BRONCHUS NUMBER OF DEATHS DETHS FROM RESPIRATORY TUBERCULOSIS. 1951-1956 16 ROAD TRAFFIC ACCIDENTS. The following tables show the road traffic accidents and casualties occurring within the Borough of Hendon during the year 1956 and the comparative figures for the years 1953, 1954, 1955 and 1956. 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 shown in the list of causes of death supplied by the Registrar-General. The Registrar-General's figures refer to Hendon residents only, and the death may have occurred within the Borough of Hendon or outside the district. TABLE V ROAD TRAFFIC ACCIDENTS FOR THE YEAR 1956. Month No. of Accidents Adults Ch ildren TOTAL Killed Seriously Injured Slightly Injured Killed Seriously Inj ured Slightly Injured January 72 4 15 59 1 1 3 83 February 45 4 11 34 - 1 3 53 March 68 3 14 64 - 2 4 87 April 73 - 16 63 - 2 15 96 May 82 1 12 73 - 2 13 101 June 68 - 15 56 - 4 8 83 July 83 2 18 67 - 4 12 103 August 80 - 18 82 - - 6 106 September 86 2 12 76 - 7 15 112 October 84 1 15 84 1 1 13 115 November 79 - 8 77 - 2 9 96 December 72 "" 17 78 - 3 8 106 TOTALS 892 17 171 813 2 29 109 1,141 17 TABLE VI CLASSES OF ROAD USER KILLED OR INJURED DURING 1956. PEDESTRIANS MOTOR DRIVERS MOTOR CYCLISTS PILLION PASSENGERS PEDAL CYCLISTS OTHER ROAD USERS Killed Serious Slight Killed Serious Slight Killed Serious Slight Killed Serious Slight Killed Serious slight Killed Serious Slight January 3 4 12 - 2 25 - 3 8 - - l 1 3 7 1 4 9 February 2 9 5 1 1 13 - 1 7 - 1 - - - 4 1 - 8 March 2 6 10 - 2 16 1 3 15 - - 2 - 3 6 - 2 19 April - 5 11 - 3 14 - 6 17 - - 2 - 1 13 - 3 21 May - 8 11 - 1 12 1 2 23 - 1 4 - 1 19 - 1 17 June - 3 11 - 1 15 - 7 13 - 1 1 - 4 11 - 3 13 July 1 8 7 - 4 18 - 5 18 - - 5 - 3 15 1 2 16 August - 6 6 - 2 22 - 7 18 - 1 3 - 1 13 - 1 26 September 2 9 11 - 3 13 - 3 26 - - 3 - 2 8 - 2 30 October 1 3 12 - 1 22 1 7 14 - 1 8 - - 14 - 4 27 November - 5 14 - 2 21 - 1 19 - - 4 - 1 10 - 1 18 December - 5 13 - 2 24 - 1 14 - - 1 - 3 8 - 9 26 To ta1s: 11 71 123 1 24 215 3 46 192 - 5 34 1 22 128 3 .32 230 TABLE VII COMPARATIVE FIGURES OF ACCIDENTS AND CASUALTIES FOR 1953, 1954, 1955 AND 1956. 1953 1954 1955 1956 Total number of Road Accidents involving personal injury 695 776 930 892 Accidents per mile of road 4.. 17 4 64 5.57 5.33 Adults Killed 13 17 17 17 Seriously Injured 117 148 196 171 Slightly Injured 584 706 830 813 Totals. 714 871 1,043 1,001 Children (0 - 15 years) Killed Nil 1 1 2 Seriously Injured 20 28 16 29 Slightly Injured 114 92 117 109 Totals: 134 121 134 140 Combined Adults and Children Totals. 848 992 1,177 1,141 Casualties per mile of road 5.23 5.09 7.05 6.82 18 CLASSES OF ROAD USERS KILLED OR INJURED. YEAR Pedestrians Motor Drivers Motor Cyclists Pillion Passengers Pedal Cyclists Other Road Users Killed Serious Slight Killed Serious Slight Killed Serious SLight Killed Serious Slight Killed Serious Slight Killed Serious Slight 1953 11 43 152 - 12 112 2 39 116 - 7 25 - 24 156 - 12 137 1954 8 59 167 1 11 135 8 45 149 - 9 30 1 25 139 - 27 178 1955 12 52 151 - 44 172 3 55 203 - 12 34 1 22 154 2 27 233 1956 11 71 123 1 24 215 3 46 192 - 5 34 1 22 128 3 32 230 Included in the above table are the Children s Accident figures which are as follows:- Y E A R Pedestrians Pedal Cyclists Other Road Users Killed Serious Slight Killed Serious Slight Killed Serious Slight 1953 - 10 52 - 8 38 - 2 24 1954 1 16 51 - 6 23 - 6 18 1955 - 12 40 - 3 36 1 1 41 1956 1 18 42 1 8 3.3 - 3 34 I am indebted to the Borough Engineer and Surveyor for supplying me with the 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 136 50 Whooping Cough 135 8 Measles 295 4 Acute Poliomyelitis Paralytic 8 7 Non-Paralytic 5 3 Diphtheria 1 1 Pneumonia 79 38 Dysentery 54 7 Paratyphoid Fever 6 6 Erysipelas 11 1 Meningococcal Infection 2 2 Food Poisoning 24 3 Puerperal Pyrexia 113 112 Ophthalmia Neonatorum 13 13 TOTAL 882 255 20 21 TABLE IX AGE DISTRIBUTION AGE GROUP DISEASE Scarlet Fever Whooping Cough Acute Poliomyelitis Measles Diphtheria Dysentery Meningococcal Infection TOTAL Paralytic Non-Paralytic M. F M, F. M. F. M. F. M. F. M. F. M. F. M. F. Under 1 year - - 10 2 - - - - 7 3 - - 1 2 - - 25 1-year - 3 4 11 - - - - 11 4 - - 2 - - - 35 2-years 3 2 9 8 1 1 - - 19 12 - - 4 - - - 59 3-years 9 3 8 10 - - - - 11 14 - - 2 4 - 1 62 4-years 11 12 8 10 - - - - 22 12 - - 1 4 - - 80 5-9years 28 36 22 32 2 1 1 2 95 60 - - 6 10 1 - 296 10-14 years 14 7 - - - - 2 - 4 9 - - 1 2 - - 39 15 -24 years 8 - - - - - - - 1 - - 1 1 6 - - 17 25 & over - - 1 - 1 2 - - 2 6 - - 2 6 - - 20 Age unknown - - - - - - - - 1 2 - - - - - - 3 TOTAL 73 63 62 73 4 4 3 2 173 122 - 1 20 34 1 1 636 AGE GROUP DISEASE Pneumonia Erysipelas Food Poisoning Puerperal Pyrexia Ophthalmia Neonatorum Paratyphoid Fever TOTAL M. F. M, F. M. F. M. F. M. F. M. F. Under 5 years 4 3 - - 2 3 - - 7 6 1 - 26 5-14 years 4 2 - - 6 3 - - - - 1 - 16 15-44 years 6 8 - - 4 3 - 113 - - 3 1 138 45 - 64 years 16 5 2 3 2 1 - - - - - - 29 65 & over 15 16 1 5 - - - - - - - - 37 Age unknown - - - - - - - - - - - - - TOTAL 45 34 3 8 14 10 - 113 7 6 5 1 246 22 TABLE X WARD DISTRIBUTION NUMBER OF CASES OF INFECTIOUS DISEASE NOTIFIED IN EACH WARD OF THE BOROUGH Disease Ward. TOTAL Mill Hill Burnt Oak West Hendon Central Park Golders Green Garden Suburb Childs Hill Edgware Scarlet Fever 40 15 14 2 15 9 10 8 23 136 Whooping Cough 9 33 10 14 15 19 2 21 12 135 Acute Poliomyelitis Paralytic - - 1 - 1 - 4 1 1 8 Non-Paralytic 1 - - 1 1 - 2 - - 5 Measles 42 4 27 13 9 49 102 38 11 295 Diphtheria - - - - - - - 1 - 1 Meningococcal Infection - - - - - 1 - 1 - 2 Pneumonia 12 13 7 6 6 6 1 22 6 79 Dysentery 22 10 - 3 3 3 2 1 10 54 Erysipelas 2 - 2 - 1 - 1 2 3 11 Food Poisoning 5 1 1 - 6 1 - 5 5 24 Puerperal Pyrexia 6 80 8 4 7 1 - 5 2 113 Ophthalmia Neonatorum 1 7 3 1 1 - - - - 13 Paratyphoid Fever 1 - 1 2 1 - 1 - - 6 TOTAL 141 163 74 46 66 89 125 105 73 882 INFECTIVE HEPATITIS. OUTBREAK IN A JUNIOR SCHOOL IN THE BOROUGH. A major outbreak of infective hepatitis occurred in a junior school in the Borough during the period November 1955 to February 1956. Twenty-seven cases, including one member of the staff, were reported in the school which is attended by 509 children. Jaundice had been occurring in the neighbourhood for some time and in a nearby infants school eleven cases had been reported at infrequent intervals during a period of fourteen months. In the junior school the epidemic was more virulent and cases were distributed evenly throughout the different age groups, classes and sexes, The children were absent from school as follows:- Onset. Date of Return to school Days Absent H..M. 7.11. 55. 5. 12. 55. 28 D.B. 13.11.55. 11. 12.55. 28 C.W. 14. 11.55. 5.12.55. 21 G. S. 16 12. 55. 10. 1.56 35 I. R. 29.11.55. 10. 12.55. *11 A.E. 2.12. 55. 10. 1.56. 39 B.W. 5.12 .55 12. 12.55 *7 P.H. 11.12.55. 10.1.56. 30 I.M. 21.12.55. 16.1.56. 26 J.W 22.12.55. 10.1.56. 19 L.S. 22.12.55, 10.1.56. 19 C.W. 26.12.55. 17.1.56. 22 M. R. 2. 1.56. 23. 1.56. 21 G.W. 9. 1.56. 23.1.56. 14 A.G. 9.1 56. 6.2.56 43 L.B. 25.12.55 30.1.56. 36 J.S. 13.1.56. 6.2.56. 24 S.B. 16.1.56. 13.2.56. 28 C.M. 16.1.56. 24.2.56. 39 D.H. 16.1.56. 24.2.56. 39 A.P. 17.1.56. 13.2.56. 27 L.G. 19.1.56. 13.2.56. 25 P.B. 20.1.56 30.1.56 10 J.P. 25.1.56 13.2.56 19 G. B. 30. 1. 56 16. 2.56. 17 R.K. 1. 2.56. 14. 2 . 56. 13 B.J. 3. 2.56 15. 2.56. 12 23 Following the outbreak, the Director of the Colindale Laboratory offered sufficient gamma globulin for the immunisation of 177 children attending the school. The offer was made to the parents of all the children except those in classes taking the Grammar School Entrance Examination and the parents of 344 children accepted. A random sample of 177 was selected and each child was immunised with 1½ c c. of gamma globulin on 3rd February, 1956 11 was explained that the immunity was not likely to last more than six weeks The progress of the epidemic was followed carefully and during the next three months only three further cases occurred in unimmunised children Date of onset J.S. 20. 2. 56. who was not offered immunisation as he was in a class taking the examination. D. A. 27. 2. 56. whose parents had not given consent for immunisation* S.C. 29.2.56. The investigation of this outbreak is informative in two respects. First, the onset of a large number of cases during the middle two weeks of January suggests that the two children marked * who were absent from school seven days and eleven days respectively may have been infectious when they returned to school in mid December. A second interesting aspect of the investigation is that only three cases occurred in the school after the immunisation;, although only one third of the total had been immunised, and therefore approximately 300 children were not immune It is postulated that by increasing the degree of herd immunity in a school so that one third are immune, the school ceases to be a favourable nidus for the continuation of the epidemic I am indebted to the Area Medical Officer of the Middlesex County Council for the assistance given to me in carrying out these inoculations and investigations, NOTIFICATION The disease is not notifiable As the incubation period is usually about twentyeight days the epidemics are spread over a long period and the effect on school absences is seldom serious at any one time Cases which show jaundice are easily diagnosed but diagnosis is more difficult when jaundice is absent Such cases are equally responsible for the spread of infection and for this reason it is probable that the disease has not been made notifiable. 24 Infective Hepatitis is usually mild but it can be followed by ill-health for as long a period as two months. (1) There is no proof that it is not responsible for chronic liver disease in later life and fatal cases have been reported (2) There would appear to be a need for more information about the epidemiology of infective hepatitis and I support the plea that it should be made notifiable. (1) I was surprised to find that no reference was made to the disease in the Joint Memorandum on "The Closure of Schools and Exclusion from Schools on account of Infectious Illness "published last year by the Ministry of Education and the Ministry of Health I suggest that it would be useful if the following recommendation was adopted for the guidance of Teachers and Medical Officers: - Disease, Period of Exclusion. Children suffering from disease Children in whose family or household living together as a family the disease has occurred. Infective Hepatitis Two weeks When Infective Hepatitis is endemic in a school, children who vomit should be excluded for one week. Reference:- (1) The Editor, The Lancet 1956.2.716. (2) The Editor, The Medical Officer 1956.96.17. 25 NOTIFICATIONS OTHER THAN TUBERCULOSIS Poliomyelitis There was a considerable reduction in the number of cases of poliomyelitis notified during the year, 13 cases occurring compared with 55 in 1955 when the disease assumed epidemic proportions and was in fact the worst outbreak in Hendon since the disease became notifiable. Of the 13 cases, 8 were paralytic and 5 non-paralytic. Two of the cases were fatal One of these cases, although notified in 1956 died in February 1957 and this death will be counted therefore in the Registrar-General s return for 1957 The cases, with the exception of 2, occurred in the second half of the year and the monthly distribution was as follows:- January 1 February 1 July 3 August 1 September 1 October 2 November 1 December 3 Ten of the cases occurred in children up to the age of 14 years, the remaining three being adults aged 29, 31 and 52 years respectively. The cases were spread throughout the Borough and the ward distribution was as fol lows:- Garden Suburb 6 Wes t Hendon 2 Mill Hill 1 Park 1 Central I Childs Hill 1 Edgware 1 Daring the year prophylactic inoculations against the disease were introduced and I am indebted to the Area Medical Officer for the following figures;- Number of Children in the Borough of Hendon who completed poliomyelitis vaccination during 1956. Year of Birth No. of cases vaccinated 1947 95 1948 72 1949 62 1950 67 1951 90 1952 59 1953 53 1954 29 527 26 Puerperal Pyrexia There was an increase in the number of cases of puerperal pyrexia, 113 cases occurring compared with 109 in 1955 Of the 113 cases, 42 only were Hendon residents, the remainder being women from other areas who entered the maternity hospital in the Borough for their confinements. Notifications in respect of these cases 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 rate for Hendon is high. That for the year 1956 is 55.5 per 1,000 total (live and still) births. If the figure for the Hendon residents only is taken the rate is 20 6 per 1,000 total (live and still) births. The rate for England and Wales is 16.31. Ophthalmia Neonatorum There was a reduced incidence of ophthalmia neonatorum 13 cases being notified compared with 18 in 1955, All of the cases were admitted to hospital. Scarlet Fever. There was an increase of 28 in the number of cases of scarlet fever notified during the year, 136 cases occurring compared with 108 in 1955. Fifty of these cases were removed to hospital. Measles. As was to be expected, after the epidemic in 1955. there was a considerable drop in the number of cases of measles notified, 295 compared with 1952 last year Measles tends to occur in epidemic form every two years An epidemic may be expected, therefore, in the spring of 1957 Whooping Cough This disease showed a decrease on the 1955 figure, 135 cases being notified compared with 196 last year. Dysentery. Fifty-four cases of dysentery were notified compared with 28 in 1955. During the year an outbreak of sonne dysentery occurred in a County Council Hostel where homeless families are housed temporarily and the figures are included in the 54 notifications, 27 Eight cases occurred, 1 adult and 7 children, whose ages ranged from 4 months to 14 years The cases were spread amongst seven families Recent research into the spread of this type of dysentery shows that the disease is most easily spread when the temperature is low, humidity high and there is a lack of sunligt Food Poisoning Twenty-four notifications of food poisoning were received during 1956, six less than in 1955. The cases were distributed throughout the year as follows,- First Quarter. Second Quarter Third Quarter, Fourth Quarter. TOTAL. 3 3 11 7 24 In fourteen cases the organism was identified as salmonella typhi murium and in the remaining ten the cause of the infection was unknown The cases occurred in different families scattered throughout the Borough. Paratyphoid Fever. Six cases of paratyphoid fever were notified during the year compared with 1 in 1955 These cases were isolated ones and were spread throughout the Borough with no common source of infection Oie of the patients had returned to this country from Egypt, just prior to notification, another had been on holiday at the seaside, one was a doctor on the medical staff of a hospital and another a school teacher The remaining two cases were children Diphtheria One case of diphtheria occurred during the year. This was a mild case in a young adult who was removed to Isolation Hospital on 14th December, 1956. The patient had not been immunised Prior to this, the last case to be notified in Hendon was in 1953 The following table shows the number of cases and the deaths from diphtheria since the inception of the immunisation scheme in 1935:- 28 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 - - 1956 1 - 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 1956 29 TABLE XII NUMBER OF CHILDREN RESIDENT IN THE BOROUGH OF HENDON WHO RECEIVED IMMUNISING INJECTIONS DURING 1956 Age at time of injection Primary Inoculations Reinforcing Injections Diphtheria only Combined Diphtheria/ Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria/ Whooping Cough Under 1 year of age 75 950 1 - - 1 year of age 27 300 3 3 - 2-4 years of age 24 65 8 150 20 5-9 years of age 83 28 1 1,917 84 10 - 14 years of age - - - - - 15 years & over 1 - - 2 - TOTAL 210 1,343 13 2,072 104 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 1956., TABLE XIII Age at 31st December 1956. Under 1 year 1 year 2-4 years 5 - 9 years 10 - 14 years 15 years and over TOTAL Number vaccinated 1,079 63 29 39 - 107 1,317 Number re-vaccinated - 1 14 67 - 437 519 30 CHEST DISEASE Notification of Tuberculosis The following table shows the number of cases of tuberculosis notified for the first time during the year 1956 and transfers into the district. TABLE XIV Age Group in years. Respiratory Non-Respiratory TOTAL Males Females Males Females New Cases Transfers into District New Cases Transfers into District New Cases Transfers into District New Cases Transfers into District Under 5 years 2 - 1 - - - - 3 5 - 14 4 3 5 1 1 - - 1 15 15 - 24 10 8 15 4 1 1 2 1 42 25-44 16 23 10 30 1 1 6 2 89 45 64 22 5 3 4 - - 2 - 36 65 & over 6 - 4 - 1 - 2 - 13 Age unknown - - - - - - - - - TOTAL 60 39 38 39 4 2 12 4 198 The ward distribution of tuberculosis for the year 1956 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 Central Park Golders Green Garden Suburb Childs Hill Edgware Respiratory 9 10 8 12 9 14 11 17 8 98 Non- Respiratory 2 1 1 2 4 - - 3 3 16 TOTAL 11 11 9 14 13 14 l1 20 11 114 31 The following table shows the primary notification of tuberculosis, excluding inward transfers, for the ten-year period 1947-1956. TABLE XVI Year Respiratory Non-Respiratory TOTAL M, F, M F. 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 1956 60 38 4 12 114 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 Tuberculosis All forms of Tuberculosis. Male, Female. Total. Male. Female. Total Male. Female, Total 12 5 17 2 - 2 14 5 19 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. 773 618 89 96 862 714 1,391 185 1,576 32 THE CHEST CLINIC 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:- "As mentioned in reports in former years Edgware Chest Clinic serves as a centre from which a socio-medical team serves an area including the Borough of Hendon and parts of the Boroughs of Harrow and Wembley, Besides medical clinical work, preventive and welfare responsibilities are also undertaken by the physicians and by the staff appointed to assist them for these purposes by the Middlesex County Council Close liaison is maintained with the Area Medical Officer of the County Council and with the Medical Officers of Health of the three Boroughs A number of tuberculin surveys have been carried out at schools in the area. These have shown on the whole a low level of tuberculinization of the pupils which it is gratifying to record The schemes recently started under the auspices of the County Council Health Department for B.C.G vaccination of school children have opened another field for co-operation between the clinic and the conventional preventive services Full advantage is being taken of the consequent tuberculin testing as an additional case finding method by X-ray of positive reactors and their domiciliary contacts The main consultative functions of the chest clinic have continued as in earlier years, and the volume of work has been maintained, although there is less time now devoted to refill treatments of outpatients as their numbers continue to decline Patients are referred for opinion mainly from the general medical practitioners of the area; and a considerable proportion come initially for chest X-ray by the Odelca camera unit which has now been in use for six years. A proportion of cases are referred from the various departments of Edgware General Hospital, and in particular a chest X-ray service is provided for ante-natal and diabetic patients and for members of the hospital and group-staff. An appointments system for out- patients is still in force and is fairly successful. One of the difficulties with which it has to contend is a present day tendency of patients to fail to keepor to attend at times other than that of their appointment. In the early part of the year during the cold weather, the temperature in the clinic was such as to be a severe hardship on patients undressing for examination by the doctors An additional pump was installed in the autumn to improve the heat supply to the radiators. This may prove successful but has not yet had an opportunity to be tested by a bout of severe cold weather. 33 Tuberculosis Register. The number of cases of tuberculosis on the clinic register has ceased to increase and may well decline in the future. The number of new cases has not declined further since 1955. There has been a considerable increase in the number of cases removed because of death - in many of these the cause of death is known to be a condition other than tuberculosis. About one third of the deaths occurred in the first quarter of 1956 during the very cold spell With continued use of domiciliary treatment and the shortened time of in-patient treatment, the waiting list for admission has remained of small proportions, even though it is very seldom that one of the beds in the wards used by the Clinic at either Edgware General Hospital or Colindale Hospital is empty. An analysis of the age and sex distribution of those tuberculosis cases at present on the chest clinic register shows that the disease is still largely one of young adults. Carcinoma Register The number of cases diagnosed as having carcinoma of the lung continue steadily In their treatment a close liaison is maintained with the thoracic surgical units at Clare Hall and St. Charles Hospitals and the radiotherapeutic department of the Middlesex Hospital. A large proportion of the follow up work and attention to the social aspects is undertaken at the chest clinic. Chronic Bronchitis. This, and other chronic respiratory disorders, cause much suffering. It has been possible to take a special interest in the clinical, social and preventive aspects of this problem, although for many cases the treatments available are not more than palliative. Close touch with the general practitioners and with the physical medicine department of Edgware General Hospital is maintained Advantage has been taken of the special facilities available at Clare Hall Hospital to send out of the built up area of London during the foggy weather (mid December to February) some patients with chronic bronchitis particularly affected by adverse weather conditions. Staff. Dr. W. E. Snell, Physician Superintendent of Colindale Hospital, has joined the clinic staff during the year and conducts a short consultative period weekly on Fridays. As in previous years, a number of overseas scholars have been attached to the clinic for various periods during 1956. 34 STATISTICS. General. 1952 1953 1954 1955 1956 New patients referred to Clinic 7,133 8,295 8,459 9,439 10,909 Total attendances. 30,183 30,644 30,841 32,454 31,744 Total attendances for refills. 11,443 10,114 9,523 8,652 7,454 Number of persons X-rayed 18 388 16,537 17,096 16,544 17,173 Number of home visits by Physicians 300 383 415 286 411 Sessions held - 861 861 1,192 1.198 TUBERCULOSIS REGISTER New respiratory tuberculosis cases 184 171 180 147 149 New non-respiratory tuberculosis cases. 28 16 26 24 27 Total new tuberculosis cases. 212 187 206 171 176 Tuberculosis cases on register on 31st December. 1,761 1,764 1,767 1,788 1,733 Removed from register because of death. 47 44 32 24 44 Removed from register as recovered 72 54 89 57 68 Number of tuberculous patients awaiting hospital admission 31st December 95 48 16 1 1 TUBERCULOSIS CASES ON THE REGISTER AT 31/12/56, Age Groups Respiratory Non-Respiratory Male Female Male Female 0-4 5 1 - 3 5-14 35 27 17 7 15-24 103 107 14 11 25-34 179 236 18 20 35-44 206 189 10 14 45-54 181 76 6 10 55-64 118 47 5 3 65 and over 46 14 1 4 TOTAL 893 697 71 72 LUNG CARCiMOMA REGISTER 1952 1953 1954 1955 1956 New cases diagnosed 40 38 33 41 50 Cases known to have died (all causes) 31 23 19 36 36 I am indebted to Dr. Trenchard for submitting this report. 35 MASS X RAY I am indebted to Dr. J. R. Mikhail, Medical Director of Mass X-ray Unit 5B for the following Statistics relating to Surveys carried out in the Hendon Area by the Unit during 1956 at Open Public Sessions and in organised Factory Groups. MALES Years since last X-ray. AGE GROUP 14-19 20-24 25-34 35-44 45-54 55-64 65 plus TOTAL No previous X-ray. 177 150 264 259 171 106 60 1,187 Under1 year 14 28 20 16 7 5 0 90 l 29 82 112 48 41 10 6 328 2 108 185 600 612 550 244 49 2,348 3 17 69 89 71 97 53 21 417 4 3 24 49 30 33 6 2 147 5 0 21 24 23 14 7 2 91 6 3 8 23 22 12 11 0 79 7 1 3 7 3 10 2 1 27 8 0 3 28 25 15 10 5 86 Total 352 573 1,216 1,109 950 454 146 4,800 FEMALES No previous X-ray. 124 136 246 270 196 115 45 1,132 Under 1 yr. 4 12 14 12 9 3 0 54 1 10 32 43 24 12 4 1 126 2 16 57 84 62 68 21 1 309 3 7 14 29 19 20 10 0 99 4 3 20 25 16 13 2 1 80 5 2 0 14 11 6 1 0 34 6 3 8 10 10 4 4 0 39 7 0 4 3 2 4 2 0 15 8 2 0 13 17 8 7 3 50 Total 171 283 481 443 340 169 51 1,938 TOTAL No previous X-ray 301 286 510 529 367 221 105 2,319 Under 1 yr. 18 40 34 28 16 8 0 144 l 39 114 155 72 53 14 7 454 2 124 242 684 674 618 265 50 2,657 3 24 83 118 90 117 63 21 516 4 6 44 74 46 46 8 3 227 5 2 21 38 34 20 8 2 125 6 6 16 33 32 16 15 0 118 7 1 7 10 5 14 4 1 42 8 2 3 41 42 23 17 8 136 Total 523 856 1,697 1,552 1,290 623 197 6,738 Out of the total number X-rayed, 6 acute cases, 4 males and 2 females were discovered, and 6 cases, 5 males and 1 female, were referred for occasional supervision 36 SECTION C. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Establishments for Massage or 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 and granted the following applications:- New Licences 4 Renewals of Licences 29 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. Apart from one case, mentioned in my Annual Report for last year, where action was started in 1955 and completed in January 1956, it was not found necessary to take formal action in any case Thirty-nine 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 person was considered individually and advised how best they could be helped by the existing voluntary and statutory services. 37 In those cases where removal was essential, the old people concerned agreed to go into hospital or other accommodation voluntarily. There are a number of old people who are unable to look after themselves in their own homes and yet are not likely to benefit by hospital treatment. For this group there is a shortage of accommodation and this shortage may be due either to an increase in the numbers involved or to an insidious decrease in the number of privately owned old peoples homes In dealing with the problem the co-operation of Mr. R. R. Holland, the Area Welfare Officer, has been greatly appreciated. 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 one case. 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. Edgware General Hospital Admissions are also arranged through the Regional Hospital Board to the Regional Chest Hospitals, particularly Clare Hall and Colindale 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 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 two categories (1) Intermediate Area - Burnt Oak, Central, Childs Hill, Edgware, Mill Hill, Park and West Hendon In these areas the number of patients on the average general practitioners list is reasonable New practices may be established in such areas but the initial practice allowance is not likely to be paid (2) Restricted Areas - Garden Suburb and Golders Green Wards 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. 39 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, ice cream, domestic water supplies and swimming pools are shown elsewhere in the report, The Edgware Group Health Service Liaison Committee. On the 1st February, 1956, an informal meeting, arranged by the Deputy County Medical Officer on the suggestion of members of the Middlesex Local Medical Committee, was held at Edgware General Hospital to consider the need for a Medical Liaison Committee in the area covered by the Hendon Hospital Group. This was attended by representatives of the Group Medical Advisory Committee, the Middlesex Local Medical Committee and the Medical Officers of the Local Authorities. As a result the Edgware Group Health Services Liaison Committee was formed, its function being to promote the smooth working of the health services in the area of Hendon, Harrow and Wembley. The Committee, which has been recognised by the various statutory bodies, is composed of General Practitioner representatives nominated by the Middlesex Local Medical Committee, Hospital Specialists nominated by the group Medical Advisory Committee and Medical Officers of the Public Health Service in the same area. During the year, apart from the inaugural meeting, the Committee met on four occasions. At the first meeting, from a paper given by the Geriatrician, a need for more hospital beds for elderly people was evident. The various statutory authorities were approached and a request was submitted to the North-West Metropolitan Regional Hospital Board Subsequently the number of geriatric beds in the area was increased by twenty At the second meeting a comprehensive survey of the existing maternity services was given by the Consultant Obstetrician of Edgware General Hospital. The Chairman of the Hospital Management Committee invited the Liaison Committee to consider, in conjunction with the Consultant Obstetricians at the Edgware General Hospital, a Memorandum issued by the Minister of Health on Ante-Natal Care Related to Toxaemia and to report back to the Group Medical Advisory Committee and also the Middlesex Local Medical Committee The last two meetings were devoted to health visiting and the problem of nursing staff. The discussion on health visiting was preceded by a paper on the scope and possibilities on the work of a Health Visitor given by the Superintendent Health 40 Visitor, Area 4. Middlesex County Council, The need for better liaison between the General Practitioner and the Health Visitor was emphasised and it was decided, with the agreement of the Area Medical Officers, that the Health Visitor should be asked to take action in the first instance by asking for an interview with the General Practitioners of the patients with whom she was dealing Consideration was given to liaison between hospitals and health visitors and it was decided that better usage could be made of the existing system without making any administrative changes. That on the shortage of nursing or staff was opened by the Matron of Edgware General Hospital, the Divisional Superintendent of the British Red Cross Society in Hendon and the Superintendent of District Nurses in Area 4 of Middlesex County Council. The Committee made several proposals including one that recruiting posters might be displayed in the waiting rooms of General Practitioners In addition to these major problems, the Committee considered the need for and the design of a personal immunisation record card It was agreed, in view of the large number and complex nature of modern prophylatic injections, that a personal record card was essential for every child and the views of the Committee on the design of such a record card were forwarded to the County Medical Officer At the last meeting the Committee drew attention to the fact that the services of a Paediatric Consultant are available for domiciliary consultation, I am indebted to Dr, G Barwell, Chairman of the Edgware Group Health Services Liaison Committee for this report WELFARE OF OLD PEOPLE I am indebted to Alderman J, L. Freedman, J,P., M.A., LL.B Chairman of the Hendon Old People's Welfare Committee for the Report for the year 1956-1957 from which I have extracted the following information:- The year under review has been one of consolidation and, to some extent, reorganisation One feature has been the opening, through the generosity of the Hendon Borough Council who have placed the ground floor at No 158 Station Road, Hendon, NW 4 at our disposal at a purely nominal rent, of our office in premises used exclusively by ourselves, This has added greatly to the comfort of our Organising Secretary and of those old folk who have had need to seek advice or assistance from the Committee, Regular meetings of the Committee have been held, and the Executive Committee now meets once a month. Close touch has been kept with our 41 Constituent Organisations, bearing in mind that one of our primary objects is to co-ordinate and not to usurp the magnificent work which they do on behalf of Old People, and where it has been felt that such work could usefully be operated on a wider basis, the Committee has itself accepted the responsibility. VISITING This is probably one of the most important of the Committee's functions. Loneliness is one of the major problems affecting the welfare of the aged and when an aged person is sick or housebound every effort must be made to see that he or she obtains the benefit of cheerful company from time to time It is the feeling of the Executive Committee that the Organising Secretary, upon whom falls the brunt of the day to day administration of the work of the Committee should not, in ordinary circumstances, have to occupy herself with visits as well, and steps are being taken to endeavour to find a Constituent Organisation in each part of the Borough to whom the Organising Secretary can refer when the need for a visit arises and upon whom she can rely to carry out the visit, and continue visiting as long as may be required CHIROPODY SERVICE. With the assistance of continued financial support from the National Corporation for the Care of Old People, the Chiropody Service has been maintained and plans are well in hand to extend it Clinical Sessions have again been held throughout the year by the British Red Cross Society on our behalf at their Local Headquarters, and we ourselves have arranged such sessions for the inmates at the Residential Home at Childs Hill conducted by the Hendon Old People s Housing Society The Committee has also continued to arrange for the homebound to be treated in their own homes It has been felt that possibly more old people would be able to attend a clinic or surgery if it were nearer their homes, and it is hoped that arrangements will shortly be concluded with the Chiropodists practising in the Borough whereby they will treat old folk in their own surgeries on special terms, the agreed fees being paid by the Committee, who willl recover from the patients such proportion as they can afford to pay. CLUBS. The outstanding event of the year has been the establishment of our own Club at 158 Station Road, Hendon which is open every week-day afternoon except Saturdays We were grateful for substantial donations towards the cost of the furniture and equipment from the Hendon Borough Council and the King George VI Foundation, and other specific gifts were received, and the Club was formally opened by His Worship the Mayor of Hendon, our President, on December 8th, 1956 Here the old people can come as often as they wish, to spend an afternoon in comfort, to talk, read, play games or listen to the radio We already have well over 100 members of whom a 42 gratifying proportion come in every afternoon. Our best thanks are due to those of our Constituent Organisations who have undertaken to supply a Duty Officer to be in charge at the Club on a given day every week, and whose Representatives have been appointed as the Advisory Committee With the opening of this Club, it appeared that there was no longer any need for the weekly Over Sixties Club which we had previously organised. On the other hand, there were some old people who enjoyed the rather different form which that Club took and we were able to persuade Mrs Canneil, who had previously managed the Over Sixties Club for us, to continue it as a personal endeavour, and it still meets weekly at the Methodist Church Hall at The Burroughs on a self supporting basis, with the good wishes of but without any financial support from the Committee. Our Constituent Organisations, also, have continued to operate their weekly Club a fternoons. ANNUAL HOLIDAY. In the early Summer of 1956 we again organised a weeks holiday for the old people at Cliftonville and gave financial assistance to those few who could not afford to pay the whole of the cost involved, We are happy to observe that more and more Holiday Resorts are now offering special terms for parties of old folk and in the future it may be possible to change the destination of our party each year and thus introduce some variety CHRISTMAS DINNERS. Once again Christmas Dinners were supplied without charge to housebound old people, many individual members of the Committee co-operating with the W. V. S. in the distribution OFFICE. The office of the Committee is situated at 158, Station Road, Hendon, N.W.4, Telephone HENdon 9150, and is open every week-day except Saturday Prompt attention is given to all requests made by old people for help or guidance, and to cases referred to the Committee, whether by Doctors, Almoners of Hospitals, Nurses or private individuals. HENDON OLD PEOPLE' S HOUSING SOCIETY. The Honorary Secretary of the Housing Society is Mr A E Harvey, 36, Grampian Gardens, Hendon Way, N.W. 2. to whom I am indebted for the following remarks The Official Opening of the Home-Church Walk House - took place on the 25th May, 1956, the ceremony being performed by Her Highness the late Princess Marie Louise, and was attended by over 100 guests. 43 Church Walk House accommodates 43 old people, who are accepted under the National Assistance Act, there being 24 single rooms, 8 double rooms and one room taking three people. The resident staff consists of the Matron, Assistant Matron, Cook and Maid; in addition there is a deputy Assistant Matron, a full-time handyman and a number of part-time domestics. Staffing difficulties are experienced, but this appears to be universal The Committee would like to place on record their appreciation of the help and co-operation of the staff during the year. MEDICAL EXAMINATIONS During the year under review 109 new entrants or employees of the Hendon Borough Council were medically examined for superannuation purposes. Of this number, 100 employees were passed as fit, 3 were unfit and in six cases the decision was deferred pending further medical examination The number of examinations in respect of each department of the Council was as follows:- Town Clerk's 6 Borough Treasurer's 11 Borough Engineer's 42 Public Health 1 Library 32 Housing 17 109 SECTION D SANITARY CIRCUMSTANCES OF THE AREA Water Supply. The Borough has a dual source of supply. The northern part is supplied by the Colne 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 44 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 44,000 (b) by means of standpipes Nil Number of population supplied from public water mains- fa) direct to houses 153,200 (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 parts per million. The water supplied to Hendon is deficient in fluoride when compared with supplies in certain other places such as Slough, South Shields and Burnham-on-Crouch, where fluoride is present naturally in the water or in Watford where it is now being added artificially. The incidence of dental decay is reduced by more than half when the drinking water contains adequate fluoride. In the future I have no doubt that fluoride will be added to all supplies which are deficient in order to promote better dental health. HOUSING I am indebted to the Housing Officer for the following observations and statistics relevant to the housing situation. During the year under review the progress made in providing accommodation for inadequately housed persons has been maintained and a further 102 families were rehoused into permanent accommodation in Council houses and flats, The number of Council dwellings at 31st December, 1956, was 3,441 of which 2,140 have been erected in post-war years. A review of the housing waiting list in the early part of the year resulted in a reduction of 1,800 applications at that time, but a steady submission of new claims was maintained throughout the year and the total number of applications was 3,938 on the 31st December. The need to put to the best use the diminishing amount of land left in Hendon for building purposes is reflected in the almost exclusive flat development undertaken by the Council and schemes in progress and proposed are planned on this basis. 45 The assistance afforded in the past by the New and Expanded Towns has continued and many families have been nominated by the Council for rehousing in those areas Some indirect benefit is also derived by reason of the fact that 'key' workers in industries established in the New Towns are provided with accommodation by development corporations and as many of these persons may have been occupying adequate houses and flats their removal has released a certain amount of private accommodation in the Hendon area. The modernisation scheme affecting 50 Council houses in the Childs Hill area so as to provide for a separate hot-water system, a bathroom and other improvements has materially progressed and at the end of the year the scheme was almost completed. The welfare of single elderly persons received considerable help when, towards the close of 1956 bed/sitting-room accommodation with communal cooking and other facilities was provided for a further 30 persons by the conversion of additional properties purchased by the Council These converted properties now house a total of 51 single persons. In addition all new estates have a proportion of conveniently designed homes for accommodating elderly couples. In accordance with the provisions of the Requisitioned Houses and Housing (Amendment) Act 1955, the release of requisitioned properties has continued and the Council have also negotiated the purchase of several such properties in order to increase the amount of permanent dwellings at its disposal. The policy of transferring Council tenants living in accommodation in excess of their requirements to smaller dwellings, has enabled the larger type of houses and flats to be re-let to bigger families and has relieved many cases of overcrowding Every opportunity has been taken 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, 1956 1. Number of families rehoused in permanent accommodation (a) Pre-war houses, etc. 15 (b) Post-war houses 86 (c) Temporary Bungalows 1 102 2° Transfers arranged to deal with overcrowding, under- occupation etc. on Council Estates 210 3. Families given emergency accommodation in Half Way Houses 8 46 SANITARY INSPECTION. The following summary of the inspection work, together with a report on the various duties performed by the Public Health Inspectors, has been submitted to me by Mr. A. H. Smith, Chief Public Health Inspector. Djring the year under review inspections were carried out as set out below:- Inspections made 6,462 Re-inspections after order or notice 12,900 Complaints received and investigated 1,667 Bakehouses 82 Butchers Shops 425 Caravans 137 Dairies 25 Drains tests 325 Factories 139 Hawkers and food delivery vans ) Hawkers storage premises and stalls) Ice Cream samples 13 Ice Cream premises 12 Infectious Disease 314 Licensed Premises 108 Milk Samples 128 Other food shops 986 Overcrowding 18 Outworkers 94 Piggeries 18 Public entertainment in connection with licensing 109 Restaurants, cafes, etc. 315 Smoke observations 188 Stables 18 Swimming baths 14 Pet Animals Act, 1951 18 Hairdressers and Barbers premises 28 Notices served. Informal or cautionary 788 Complied with 708 Statutory Notices Applied for 195 Served under Public Health Acts 91 Outstanding from 1955 16 Complied with during 1956 84 Outstanding at end of 1956 25 Inspection of Dwelling Houses During 1956. Total number of dwellinghouses inspected for housing defects (under Public Health and Housing Acts) 1,626 Number of inspections made for the purpose 4,766 Number of dwellinghouses found not to be in all respects reasonably fit for human habitation 534 47 Legal Proceedings under Public Health Act, 1936. Daring the year it was found necessary to institute legal proceedings in three cases. In one instance the Magistrates made an order requiring the nuisance to be abated within 56 days and awarded the Council 8/6d costs In the other two cases, against the same owner, the Magistrates made orders requiring the nuisances to be abated within 28 days, imposed fines totalling £7 and awarded £4.12.8. costs to the Council. In addition, it was necessary to apply to the Magistrates for a warrant under Section 287(2) of the Public Health Act, 1936, authorising the Public Health Inspector to enter premises for the purpose of inspection in a case where admission had been refused by the occupier. HOUSING ACT, 1936. During the year under review 28 houses were dealt with by the Council involving the making of 10 Demolition Orders and 17 Closing Orders. In the remaining case the Council accepted an undertaking from the owner to carry out the works necessary to render the house fit Of the 28 houses, 2 were actually closed during the year and 2 parts of houses were closed. Over the same period 23 families involving 56 persons were displaced from unfit houses. In addition, 2 houses, in respect of which Demolition Orders were made prior to 1956, were demolished, HOUSING REPAIRS AND RENTS ACT. 1954. 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 40 Number of certificates issued 26 Number of applications refused 4 Number of cases in which the applicant was not entitled to a certificate or the application was withdrawn 3 Number of applications remaining to be dealt with at the end of 1956 7 48 Revocations. Number of applications outstanding 1955 4 Number of applications received 10 Number of certificates of revocation issued 10 Number of applications refused 2 Number of applications remaining to be dealt with at the end of 1956 2 Cinemas and Places of Entertainment and Licensed Houses During the year 217 inspections were made by the Public Health Inspectors and detailed reports submitted to the respective licensing authority. Smoke Abatement. Number of observations made during the year 188 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 147 occasions during the year. Disinfestation of Verminous Houses. 4 houses were successfully treated Privately owned 2 Council Houses 2 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 arrangement 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. 49 In cases other than notifiable infectious disease the service is carried out on request, an appropriate charge being made. EXiring the year 308 library books and 7 gramophone records were disinfected. The number of rooms disinfected during the year was 218 Swimming Baths. There are two swimming baths within the district owned by the Local Authority, one at West Hendon and one at Mill Hill Visits are paid by the Public Health Inspectors and samples taken of the water particularly during hot weather when the baths are most frequently used. Fourteen 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. Twenty-eight 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 dwellinghouses and business premises is carried out by a foreman, three full-time and one part-time operatuves working under the supervision of the Public Health 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 dwellinghouses, 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. During the year under review it was found necessary to serve notices under Section 4 of the Act in 4 cases. A report on the work carried out for the year ended 3ist December, 1956, is given in the following table which is based on the return sent to the Ministry of Agriculture, Fisheries and Food 50 TABLE XVII Type of Property Non-Agricultura1 (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 43,750 5,689 49,456 10 2. Number of properties inspected as a result of (a) Notification 1 688 90 779 2 (b) Survey under the Act - 600 61 661 - (c) Otherwise - 258 68 326 - 3. Total inspections carried out including re-inspections 72 11,188 1,062 12,322 7 4. Number of properties inspected (under Section 2) which were found to be infested by (a) Rats (Maj or 1 - 3 4 - (Minor - 1,234 111 1,345 1 (b) Mice (Maj or - - - - - (Minor - 160 35 195 - 5. Number of infested properties (under Section 4) treated by the Local Authority) 1 1,392 131 1,524 1 6. Total treatments carried out including re-treatments 20 1,841 160 2,021 1 7. Number of notices served under Section 4 (a) Treatment - - - - - (b) Structural work (i.e., Proofing) - 3 1 4 - 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 - 11 - 11 - 51 Factories Acts, 1937 and 1948 The following is a report on the work carried out by the Public Health Inspectors during the year:- Part I of the Act. A. - Inspections for purposes of provisions as to health (including inspections made by the Public Health 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 35 4 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 375 135 7 (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises). 8 4 2 TOTAL 418 143 10 2.- CASES IN WHICH DEFECTS WERE FOUND, Particulars dumber of cases in which defects were found Found Remedied Referred by H.M. Inspector Want of cleanliness (S,l) 5 5 2 Overcrowding (S,2) - - - Unreasonable temperature (S3) - - - Inadequate ventilation (S,4) - - - Ineffective drainage of floors (S.6) - - - Sanitary Conveniences (S.7):- (a) Insufficient -. - 1 (b) Unsuitable or defective 2 2 - (c) Not separate for sexes - - - Other offences against the Act (not including offences relating to Outwork) 10 10 - TOTAL 17 17 3 52 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). Wearing apparel - Making, etc 74 Household linen 2 Curtains and furniture 2 Furniture and upholstery 1 Brass and brass articles 17 Ivory Goods 2 Artificial flowers 3 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 Jewel cases 1 Carding, etc. of buttons etc 7 Stuffed toys 3 Cosaques, Christmas crackers, Christmas stockings, etc. 5 Lampshades 2 TOTAL 123 53 CLEAN AIR ACT, 1956 The Clean Air Act, 1956 was passed by the Government during the year, the various provisions to be brought into operation by Orders laid before Parliament. The first of these Orders was made in December, 1956 making 31st December,, 1956 the appointed day for certain provisions of the Act, including the making of smoke control areas. With the passing of the Act the Council considered a joint report of the Medical Officer of Health and Borough Treasurer and gave instructions to proceed with the preliminary work with a view to the Council making a smoke control area in the northwestern part of the Borough, The proposed area is approximately one square mile in extent and would comprise of some 628 properties, of which 471 would be municipal dwellings being erected in the area The Council also gave instructions for consideration to be given to the establishment of smoke measuring stations in the Borough to determine the extent of air pollution. If approved these stations would be located in the northern, central and southern parts of the Borough respectively and would be established in consultation with the Fuel Research Station. Department of Scientific and Industrial Research. SECTION E. INSPECTION AND SUPERVISION OF FOOD Food Hygiene. Daring the year under review an important advance in Food Hygiene was made with the coming into force of the Food Hygiene Regulations, 1955 Part of the regulations operated from 1st January, 1956, the remainder of the provisions operating from 1st July, 1956. These Regulations have resulted in many improvements being carried out which could not be enforced under previous legislation, involving 81 premises and 1,964 visits to food premises A large number of these improvements have been achieved by informal action and co-operation between the Food Traders and the Public Health Inspectors. The main items dealt with have been the provision of sinks for washing food and equipment or the provision of personal washing facilities for the staff with hot and cold water supplies in both cases; the protection of food from risk of contamination by the provision of suitable screening or covers etc.; the provision of storage accommodation for workers outdoor clothing; the provision of first aid equipment and the general improvement of the older type of food premises, This has meant that a considerable amount of time has been devoted by the Public Health Inspectors to this part of the work of the Department but it is gratifying to have achieved these improvements mainly by co-operation In no case 54 has it been necessary to take legal action during the year and in only one instance has it been necessary to serve formal notice of breach of the Regulations. No certificates of exemption have been issued by the Local Authority. Prior to the coming into force of the Regulations, one fitment with hot and cold water was accepted for the washing of food and equipment and hand washing, although in many cases both were provided In a few instances difficulty has been experienced in convincing traders of the necessity of providing separate sinks and wash-hand basins in order to comply fully with the Regulations. Although much has been achieved during the year, there still remains a large volume of work to be carried out in the field of Food Hygiene. POOD AND DRUGS ACT. 1955, Legal Proceedings It was necessary to institute legal proceedings under the Food and Drugs Act, 1955. in seven cases. In all instances convictions were obtained and the defendants were fined a total of £50,0.0. and costs amounting to £16.16.0, were awarded to the Council ACTION TAKEN IN CONNECTION WITH FOOD STORES AND FOOD SHOPS. 119 notices were served on occupiers of shops and stores for infringements of the Food and Drugs Act, 1955, and Food Hygiene Regulations, 1955. At the end of the year 75 notices had been complied with. NUMBER AND TYPE OF FOOD PREMISES IN THE AREA. Grocers and provision merchants 205 Butchers 88 Bakers and Confectioners 60 Greengrocers 95 Fishmongers 38 Confectionery shops 134 Restaurants and Cafes 172 Butter Blending Factory 1 Works Canteens 45 Food Warehouses 2 FOOD AND DRUGS ACT, 1955 SECTION 16 Registered Premises Inspections. Ice Cream Premises 197 25 Preservation of Food 67 30 Eleven 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 2 II 3 III - IV 6 55 MIDDLESEX COUNTY COUNCIL ACT, 1950 - SECTION 11. Registration of Hawkers and Premises. Number Registered. Number of Inspections. Hawkers 63 48 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 25 MILK (SPECIAL DESIGNATIONS) REGULATIONS The following table shows the number of licences issued under these Regulations during 1956. Dealers Licences: Tuberculin Tested 34 Pasteurised 34 Sterilised 40 Dealers Supplementary Licences. Tuberculin Tested 21 Pasteurised 21 Sterilised 20 MILK SAMPLING. The number of samples taken during the year is as follows:- Pasteurised 5 Tuberculin Tested Pasteurised 5 Raw Bulk Milk (Tuberculin Tested) 11 Sterilised 1 Milk in cartons 2 In addition 80 samples of bottle rinses were taken during the year. CONDEMNATION OF POOD. The amount of foodstuffs condemned during the year shows little change from 1955. 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. 56 LIST OF FOODSTUFFS CONDEMNED DURING 1956. MEAT 1,198 lb. 6 oz. (including;- Bacon, Beef, Chicken, Lamb, Offal, Tongue, Turkey, Veal.) FISH 10 st (including:- Cod and Skate). TINNED FOOD Meat 183 Milk 255 Fruit 1,032 Vegetables 787 Soup 99 Fish 8,642 Jam 43 Fruit Juice 226 Tomato Juice 8 Ham 25 (309 lb. 8½ oz.) FRESH FRUIT, DRIED FRUIT AND VEGETABLES Butter Beans ½ lb. Currants 34 lb 8 oz. Dried Peas 9 lb. Figs ½ lb. Nuts ½ lb. Nutmegs ¼ lb. Pears 50 lb. Prunes 64 lb. Raisins 2 lb. MISCELLANEOUS GOODS Biscuits 40¾ lb Blancmange Powder 2 pkts Bread Rolls 2 pkts. Butter 12 lb. Cakes 1,231 Cake Decorations 72 Cake Mixture 26 pkts. Cereal 336 pkts. Cherries, Glace ½ lb Cheese 293 lb. & 24 pkts. Chocolate Spread 1 carton Coffee 507 tins Confectionery 32 lb. 10 oz. Cornflour 10 pkts. Cream 19 tins Eggs 168 Fish 1 pkt. & 45 plastic containers Gravy Powder 1 pkt. Jam 9 Jars Jelly 3 pkts Junket 22 pkts. Lentils 5 pkts. Macaroni 6 lb. 57 Meat Extract 1 jar Milk Foods/Beverages 37 tins Mustard 3 tins Paste 2 tins Pepper 15 tins Pickles 6 j ars Potato Crisps 25 pkts. Pudding 11 tins Pudding Mixture 10 pkts. Rice 3 tins & 21 lb. Salad Cream etc. 42 jars Sauce 1 bottle Semolina 4 pkts. (3 lb.) Spaghetti 4 cartons Spice 3 cartons Suet 4 lb, 14 oz. Sugar, Icing 8 lb. Tapioca 1 lb. Tea 103¾ lb. FOOD AND DRUGS ACT, 1955. 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 on the work of his Department during the year. LIST OF SAMPLES PROCURED IN THE BOROUGH OF HENDON DURING THE YEAR 1956. Article Total Samples Procured Unsatisfactory Milk, various 217 - Milk, new 6 - Butter 44 - Cakes 28 2 Cheese 3 2 Cooked meats 10 - Cream 54 - Drugs 39 - Fish 6 - Fish Products 12 - Fruit, fresh 2 2 Fruit, dried 4 - Fruit, canned 2 - Fruit squash 12 - Horseradish 2 2 Ice Cream 23 - Jelly 5 - Margarine 35 - Meat 39 - Meat Products 18 - Miscellaneous 12 1 Preserves 5 - Rice-in-Cream 2 - Sausages, etc. 13 - Sweets 9 1 Vinegar 32 - Wines and Spirits 9 - 643 10 58 "Regarding the samples noted as unsatisfactory, I add the following comments;- Cakes. A confection described as 'Rum Baba' contained rum-flavoured syrup. Proceedings were authorised but the magistrates dismissed the case, no costs being granted. Cakes described and sold as 'Cream Horns' were found to contain imitation cream. Proceedings have been instituted in this case and are still pending. Cheese. A cheese described by label as 'Double Creamy cheese' contained insufficient fat to be so described An official caution was issued. Cheese described as 'Full Cream Cheese" should have been described as Whole Milk cheese'. The wholesalers agreed to amend the description Fruit, fresh. A greengrocer labelled and sold as "Victorias", Giant Prune Plums. Proceedings were instituted and he was fined £10.0.0d, and ordered to pay £2.2.0d. costs. Another greengrocer was found to be displaying Giant Prune Plums falsely labelled as 'Victoria Plums', An official caution was issued Horseradish. Two samples of horseradish, from the same firm of multiple grocers, contained preservative. An official caution was issued Sweets Sweets described 'Clotted Creams' did not contain clotted cream The manufacturers agreed to amend their label Miscellaneous. A condiment, from abroad, contained preservative. A letter of caution was sent to the importers The Food and Drugs Act, 1955, in section 47, contains new provisions concerning the descriptions which can be applied to certain substances which resemble cream in appearance but are not cream This has necessitated the making of many inspection visits and the giving of advice to all traders likely to be concerned to ensure that they were fully aware of these new requirements. Merchandise Marks Acts, 1887-1926. 343 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. 1,104 separate displays of meat, apples, tomatoes, poultry, butter and dried fruit were examined, Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. A firm of butchers sold and exposed for sale Argentine beef not marked with the country of origin They were fined £2 0 0d. and ordered to pay £3.3.0d. costs. Another butcher exposed for sale Argentine beef falsely described by label as "English", He was fined £6.0.0d, and ordered to pay £3.3.0d. costs A firm of grocers exposed for sale 'Standard* eggs to which the false trade description (of weight) "Large was applied. They were fined £3.0.0d and ordered to pay 10/6d. costs Two fruiterers were summoned in respect of infringements of the Acts and Orders, one in respect of imported apples and tomatoes and the other in respect of imported tomatoes not marked with a prescribed indication of origin, Convictions were recorded in respect of each offence and the fines and costs imposed totalled £15.10.0d. 59 THE LABELLING OF FOOD ORDER. 1953. This Order prescribes that, subject to certain exceptions, pre-packed foods shall be marked with legible and conspicuous statements of the designation of the food, of the ingredients of which compounded foods are composed, and of the name and address (or registered trademark) of the packer or labeller. It also prescribed special labelling requirements in respect of certain specified food and in respect of foods concerning which there is a claim as to their vitamin or mineral content., At 112 premises 363 articles of pre-packed food were examined. No proceedings were taken in respect of any of the infringements detected and manufacturers took immediate steps to correct unsatisfactory labels as soon as their attention was drawn to them. FALSE OR MISLEADING DESCRIPTIONS. A considerable amount of work is carried out each year in scrutinising advertisements and the labelling of pre-packed food and taking such action as is possible to secure satisfactory amendments in those eases where a label or advertisement contains a false or misleading description of the food to which it relates. This work is of benefit to all districts of Middlesex, irrespective of where the offending advertisement or label is discovered, and during the year under review corrective action has been taken in respect of cherry wine, biscuits, chocolate Easter eggs, flour and sugar confectionery, imitation caviare, blackcurrant punch, fruit juice drinks and creme de menthe SPECIAL DESIGNATED MILK. During the year in question one new 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. 50 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. 60