1) Mr. Swinson 5B AC 4411 (1) 2) Library BARK 52 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR BARKING FOR THE YEAR 1958 CONTENTS Pages 1. Membership Committees 3-4 2. Staff 5-6 3. Preface 7 4. General Public Health 8-14 5. Personal Health Services 15-21 6. School Health Service 22-45 17. Report of Chief Public Health Inspector 46-82 PUBLIC HEALTH COMMITTEE as at December, 1958 Chairman—Alderman Mrs. JULIA h. ENGWELL Vice-Chairman—Mr. Councillor LESLIE C. JONES The Mayor—Mr. Councillor G. J. G. BEANE Mr. Alderman G. H. COLLINS Mr. Councillor A. T. FRENCH Alderman Mrs. A. M. MARTIN Councillor Mrs. D. M. GLENNY Mr. Alderman J. R. SWEETLAND, Councillor Mrs. D. M. JONES C.C. Councillor Mrs. E. G. LAW Councillor Mrs. M. BREDO, C.A. Councillor Mrs. M. PRESTON. C.C. Councillor Mrs. J. CALLAN Mr. Councillor W. H. ROYCRAFT Mr. Councillor S. C. SIVELL Mr. Councillor LEONARD WRIGHT BARKING COMMITTEE FOR EDUCATION as at 31st December, 1958 Chairman—Councillor Mrs. E. G. LAW Vice-Chairman—Mr. Alderman G. H. COLLINS Representative Members:— Mr. Alderman A. E. BALL, J.P. Alderman Mrs. M. BALL, C.A. Alderman Mrs. J. H. ENGWELL German Mrs. A. M. MARTIN Mr. Alderman J. R. SWEETLAND Mr. Ald. W. G. WERMERLING Mr. Councillor G. J. G. BEANE Councillor Mrs. M. BREDO, C.A. Councillor Mrs. D. M. GLENNY Mr. Councillor L. F. HENSTOCK Mr. Councillor H. J. HILLS Mr. Councillor LESLIE C. JONES Mr. Cllr. R. W. G. KALBRAIER Councillor Mrs. M. PRESTON, C.C. Mr. Councillor S. R. ROWE Mr. Councillor W. H. ROYCRAFT Mr. Councillor S. C. SIVELL Mr. Councillor LEONARD WRIGHT Co-opted Members:— The Rev. Canon W. F. P. CHADWICK The Very Rev. Canon J. A. DACEY The Rev. N. POVEY Mr. J. ANDREWS Mrs. L. F. M. DAVIS Mr. A. E. GREEN Mr. A. STONE Mr. J. WARD Nominated Members:— Mr. County Alderman K. E. B. GLENNY, J.P. Mr. County Councillor G. H. SHALDERS Page 3 BARKING HEALTH AREA SUB-COMMITTEE of the Essex County Health Committee as at December, 1958 Chairman—Alderman Mrs. JULIA H. ENGWELL Vice-Chairman—Mr. Councillor LESLIE C. JONES Barking Borough Council Representatives:— Mr. Alderman G. H. COLLINS Alderman Mrs. A. M. MARTIN Mr. Alderman J. R. SWEETLAND Councillor Mrs. M. BREDO, C.C. Councillor Mrs. J. CALLAN Mr. Councillor A. T. FRENCH Councillor Mrs. D. M. GLENNY Councillor Mrs. D. M. JONES Councillor Mrs. E. G. LAW Councillor Mrs. M. PRESTON, C.C Mr. Councillor W. H. ROYCRAFT Mr. Councillor S. C. SIVELL Mr. Councillor LEONARD WRIGHT Essex County Council Representatives:— County Alderman Mrs. M. BALL Mr. County Alderman K. E. B. GLENNY, J.P. Mr. County Councillor A. C. BERRY County Councillor Mrs. L. FALLAIZE County Councillor Mrs. C. S. M. GODFREY The Executive Council for Essex Representative:— Councillor Mrs. A. E. PRENDERGAST The Local Medical Committee Representative.— Dr. W. J. C. FENTON, J.P. The Hospital Management Committee Representative Mrs. D. L. BELCHAMBER Voluntary Organisations Representatives:- Miss W. DAWSON Mrs. G. M. GRAFFY Miss N. L. ODELL Mrs. P. WILSON Page 4 STAFF, 1958 Medical Officer of Health, Area Medical Officer, and Divisional School Medical Officer:— F. GROARKE, M B., L.M., D.C.H , D.P.H. Deputy Medical Officer of Health. School Medical Officer, Assistant County Medical Officer, and Medical Supervisor of Midwives:— MARGARET I. ADAMSON, M B., B Ch., D.P.H. School Medical Officers and Assistant County Medical Officers: — EILEEN E. V. MARTIN, M B , C.Ch. EUGENIA POPPER, M.D. ARTHUR E. SELIGMANN, M.D., D.T.M. & H. (Retired 6.6.58) VIOLET SPILLER, M.D., M.R.C.S., L.R.C.P., D.P.H. MARY H. WESTLAKE, M. B., B.Ch., D.P.H. Dental Officers:— J. BUNTIN, L.D.S. R.F.P.S.G. Chief Public Health Inspector:— N. BASTABLE, F.R.S.H., F.A.P.H.I. Senior Public Health Inspector: — Mr. E. G. TWEEDY Public Health Inspectors:— Mr. E. A. ELLIS Mr. T. W. GLEW Mr. A. G MERRIMAN (At present in H.M. Forces) Mr. R. ROPER Mr. M. R. WILLIAMS Mr. B. R. SAUNDERS (From 23.7.58) Indent Public Health Inspector:— Mr. B. R. SAUNDERS Superintendent Health Visitor:— Miss P. M. FAWCETT Health Visitors /School Nurses etc. Miss C. M. BROWNING Miss A. CATTLE Miss N. A. FLUCK (Terminted 31.12.58) Miss L. GOODACRE Mrs. A. M. SMALL—Part-time Mrs. M. J. P. WEBSTER (Terminated 1.3.58) Miss G. K. JEFFREYS Miss J. McGILVRAY Miss F. PARRY Mrs. R. ROBERTSON Miss E. M SCHROPFER (Tuberculosis Visitor) Page 5 STAFF, 1958 —cont. Denial Nurses, etc. Mrs. P. J. BURBIDGE (Dental Attendant) Mrs. V. HARDING (Dental Nurse) (Terminated 28.2.58) (Commenced 10.11.58) Mrs. MOULE (Dental Nurse) In addition 18 part-time Nurses are employed for the staffing of the various Clinic services. Chief Clerk .— Mr. G. H. RUFF Administrative Assistants: — Mr. B. S. WEAVER Administrative A ssistant: — Mrs. E. M. BARTHOLOMEW (School Health Service) Miss H. BEARTON (Handicapped Pupils and Special Children) Mr. S. DEEKS (Supplies and Maintenance) Mr. A. HOWLETT (Prevention of Illness; Care and After-Care) Non-Medical Supervisor of Midwives:— Miss D. A. RISELEY District Midwives:— Miss E. V. ASHTON Mrs. I. M. BRONNICK Miss A. CUNNINGHAM | (Retired 27.11.58) Matron of Day Nursery:— Miss F. B. NASON Domestic Help Organiser:— Mrs. L. EVERITT Chief Chiropodist:— Mr. H. LEAVESLEY Senior Dental Technician:Mr. J. CONSTABLE Speech Therapists:— Mrs. A. LING (Part-time) (Terminated 31.3.58) Mrs. M. WARD (Part time) Mrs. G. M. STUFFINS (Full-time) (Commenced 20.5.58) Oral Hygienist:— Miss J. THURSTON (Part-time) (Terminated 16.5.58) Occupational Therapist Miss D. M. COLDWELL (Terminated 31.3.58) Miss Z. MERCER (Commenced 6.10.58) REGIONAL HOSPITAL BOARD STAFF Superintendent Physiotherapist Mr. T. HYND Remedial Gymnast:— Mr. H. OGLE Orthopist:Miss M. LEWIS Page 6 TOWN HALL, BARKING, ESSEX December, 1959. To the Mayor Alderman and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, In present this report. I should like to thank my colleagues and members the Council for the help they gave me during the year under review. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. Page 7 GENERAL PUBLIC HEALTH SHORTAGE OF HOSPITAL ACCOMMODATION It is pleasing to report that during the year the Ministry of Health confirmed that the proposed developments in the Ilford and Barking Hospital Group were included in the Minister's programme of schemes to be centrally financed and it was proposed that if possible the planning of the scheme should be completed in 1959/60. It was further stated that although a particular sum had not beet allocated to the proposals because details were not yet sufficiently advanced for the cost to be assessed a figure of up to £400,000 would be considered if this was required. Arrangements are in hand for selected architects to prepares preliminary scheme. HEALTH EDUCATION In addition to the routine arrangements in being for health education, special campaigns were mounted for the following themes During February, March and April the B.B.C. Television service produced a series of 10 weekly half-hour programme entitled "Your Life in their Hands." In order to stimulate interest in this series specially prepared hand-outs were prepared in the Department and issued from clinics, etc. Public comment collated by health visitors showed that the content of this series was provocative and denial strated once again that of all the media open to propaganda televison is the most potent. In November support was given to the National campaign entitled "Guard that Fire." Through the generous help of the Such John's Ambulance Brigade leaflets were delivered to 15,000 homes in the Borough, 100 posters were displayed in clinics, doctors surgeries, etc., colour films were shown at the two local cinemas and over 700 shops were circularised with publicity material. Specially prepared medallions were prepared in the department for issue to shops selling heating appliances in order that they could be attached to fires, etc. Many shopkeepers co-operated and every help was given by the local Electricity and Gas Showrooms. Although a considerable number of man hours of staff was used in putting this campaign into operation it is probable that its impact on the town as a whole was considerably less than one small topical cameo enacted on the television screen. Page 8 It, however, behoves all those concerned with the prevention of disease to continue to create and maintain a pressure of interest in health education which in turn will induce the allocation of television time to health topics. Towards the end of the year when the poliomyelitis vaccination scheme was extended to include all young people up to the age of 26 years, special inaugural vaccination sessions were held at which young local celebrities were invited to attend. The press as always was most co-operative in advertising these efforts and as a next step special efforts were made to reach as many members of youth organisations as possible. NATIONAL ASSISTANCE ACT, 1948 Only once was it necessary to invoke Section 47 of this Act to secure the compulsory removal to hospital of a man of 84 years. Once in hospital, however, he remained as a voluntary patient. WELFARE OF THE PHYSICALLY HANDICAPPED With the approval of the National Trust the Borough Council leased to the Essex County Council the ground floor of Eastbury House for use as an Occupation Centre for physically handicapped people living in Barking, Ilford and Dagenham. Making the most of the generous proportions of the rooms in this graceful Tudor Manor House, the County Architect carried out alterations to meet the special requirements of physically handicapped people, e.g. provision of ramps, lavatory accommodation to take wheel chairs, etc. With the installation of the necessary furniture and equipment including that for a woodwork room, a first-class Centre was created, which also has the advantage of having spacious grounds and walled garden at its disposal. It was fortunate that a dedicated staff was appointed to run the Centre and from the day it was opened a happy and contented atmosphere has revailed. All the Barking people who attend the Centre are weh known to the Health Department and it is very heartening to hear the cumulative evidence of the benefits derived from the Centre by these handicapped people. A passenger carrying vehicle, fitted with an hydraulic hoist for Wheel-chair case has also been provided for the transportation of People to and from the centre. The commencement of the Occupation Centre is the fulfilment of one of the most cherished wishes of the Council. Page 9 MATTERS OF LIFE AND DEATH Population The estimated population of Barking at each mid-year for the past decade, as notified by the Registrar General, is given below: 1949 79,530 1950 79,260 1951 78,170 (Census) 1952 77,140 1953 76,800 1954 76,580 1955 75,990 1956 75,560 1957 75,070 1958 74,850 Births 917 live births and 23 still-births were registered during 1958 as under:— Live Births:— Males Females Total Legitimate 462 420 88 Illegitimate 18 17 35 Totals 480 437 91 Still-Births:— Legitimate 9 13 23 Illegitimate 1 - Totals 10 13 23 Total Live and Still-Births 490 450 94 Birth Rate per 1,000 of Estimated Population 12.25. Birth Rate adjusted by Comparability Factor of 0.94 11.5. Still-Birth Rate per 1,000 (Live and Still) Births 24.47. Proportion of Illegitimate Live Births 3.8%. Maternal Mortality Again one maternal death occurred during the year. The de ceased had adamantly refused to accept a hospital confinement but Page 10 as forecast an emergency developed during labour necessitating admission to hospital. Although it was impossible to save the life of the mother, her baby was successfully delivered and survives. Loss of Injatu Lije The infant death rate in 1958 was 18.54 as compared with 18.55 for 1957. The national figures for these years was 22.6 and 23.1 respectively. The following tables show the causes of infant deaths: — INFANTILE MORTALITY—1958 Cause of Death Age at Death 0-1 mth. 1-3 mths. 3-6 mths. 6-4 mths. 9-12 mths. Total under 1 year Atelectasis 1 - - - - 1 Congenital Malformations 7 — — - — 7 Pneumonia 2 3 - - - 5 Prematurity 4 - — - - 4 Totals 14 3 — — - 17 NEO-NATAL MORTALITY—1958 Cause of Death Age at Death Under 1 wk. 1-2 wks. 2-3 wks. 3-4 wks. Total Atelectasis 1 - - - 1 Congenital Malformations 3 3 - 1 7 Pneumonia 2 - - - 2 Prematurity 4 — — — 4 Totals 10 3 — 1 14 Of the total of 17 deaths no less than 10 occurred within the first week of life The Neo-Natal death rate was 15.27. Page 11 DEATHS Causes of Death in 1958 Total Tuberculosis and other Infectious Diseases 8 Cancer and other Malignant Diseases 182 Diseases of the Brain and Nervous System 74 Diseases of the Heart and Circulatory System 187 Pneumonia, Bronchitis and other Respiratory Diseases (excluding T.B.) 102 Diseases of the Stomach and Digestive System 17 Accidents, Poisonings and Violence Infant Deaths and Congenital Malformations 17 Pregnancy, Childbirth and Abortion Other causes 35 Total 643 Crude Death Rate per 1,000 Estimated Population 8.59. Adjusted Death Rate (Comparability Factor 1.42) = 12 19. INFECTIOUS DISEASES The following notifications were received during the year: — Notification: Pneumonia 57 Tuberculosis: Respiratory 34 Non-Respiratory 4 Scarlet Fever 70 Dysentery 6 Puerperal Pyrexia 36 Measles 267 Whooping Cough 73 Food Poisoning 28 Erysipelas 5 Scabies 10 Meningococcal Infection - Poliomyelitis 1 Diphtheria 11 Ophthalmia Neonatorum 11 Page 12 DIPHTHERIA The complacency of the town generally towards the ever-potential danger of diphtheria was shattered by the occurrence of a sharp outbreak of diphtheria which occurred in the autumn. An account of this outbreak as submitted previously to your Public Health Committee is set forth as an Appendix on pages 37 to 44. POLIOMYELITIS The sole case of poliomyelitis diagnosed during the year was not confirmed by virological examination and there was no paralysis. CARE OF THE AGED Throughout the year Health Visitors continued to visit the aged in their homes, and resulting therefrom action was taken in many instances to procure necessary treatment and help where needed. One of the most appreciated services which is given on the recommendation of the health visitor's visit is domiciliary chiropody. This is provided by the Barking Old People's Welfare Committee and at the end of the year 184 old people were receiving this service, an increase of 50 over the previous year. It is interesting to note that the average age of the people receiving this service was 77 years. During the year there has been constant and cordial contact with hospitals receiving the chronic sick and with the County Welfare Department. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT Licences were renewed during the year in respect of three establishments which are governed by the Borough's bye-laws. LAUNDRY SERVICE Once again the Borough Council's laundry service proved an invaluable adjunct to the services provided in the home to care for the chronic sick. During the year 44 cases were assisted. PATHOLOGICAL SERVICE Dr. T. Elias-Jones was appointed Consultant Bacteriologist to Barking Hospital during 1956. Alterations and improvements have since been carried out and new equipment installed which enables the laboratory to increase the scope of the services to patients. Page 13 including the provision of a routine pathological service for patients of local general medical practitioners, a service which is keenly appreciated and fully utilised, especially for haematological investigations. Your medical staff submit hundreds of specimens to this laboratory annually for diagnostic purposes and in the control and prevention of infectious disease. For instance, food handlers are examined carefully for infectious disease on appointment and prior to resuming duty after certain illnesses. Regular blood examinations are an essential part of ante-natal care and are carried out at this laboratory. Invaluable assistance was rendered me by the Staff of this laboratory at the time of our diphtheria outbreak. CHEST CLINIC The following statistics relate to 1958: — Male Female Total No. of primary notifications: Pulmonary 20 14 34 Non pulmonary 2 2 4 No. of cases transferred from elsewhere: Pulmonary 10 17 Non pulmonary — 1 1 Total 32 34 66 Cases remaining on the register=624 (583 households). It is pleasing to report that the incidence of tuberculosis disease continues to decline steadily. Nevertheless, many new cases of the disease occur each year and a great deal of careful work is done to trace and examine persons who have been in close contact with an infectious case. The Chest Physician, Dr. J. T. Paterson, holds his clinic at Barking Hospital where modern X-ray equipment is installed Modern medication is very effective and in the vast majority of cases rapidly arrests the disease. Pneumothorax or surgical method are rarely needed nowadays in the treatment of this disease, and the diagnosis need no longer strike terror to the heart of the sufferer Two members of your nursing staff are seconded to this clinic to assist at clinic sessions and home visiting. Page 14 PERSONAL HEALTH SERVICES This section deals with those services which come under the control of the Barking Health Area Sub-Committee of the Health Committee of the Essex County Council. CLINIC PREMISES Health Services Clinic—Thames View Estate In late December, 1958, the Ministry of Health agreed that this scheme could be commenced provided it was completed by the end of 1959. The housing estate as such was started in 1954 and the final phases of the scheme are now under way. By agreement with the family doctors running the group practice on the estate, district midwives' clinic was started on Wednesday afternoons as from 14th July. 1958, and an infant welfare session was commence on the 13th August, 1958. in the temporary surgery accommodation erected on behalf of the group by the Barking Borough Council. CARE OF MOTHERS AND YOUNG CHILDREN MATERNITY SERVICE Ante-Natal Care. This was given as follows:— Clinics 713 Hospitals (excluding Barking Hospital) 137 General Practitioners 77 927 Confinement During the year 930 mothers were confined, giving birth to 9 ) infants (including 10 sets of twins). These were born as follows:— Barking Hospital 566 Other Hospitals 141 At home 233 940 Page 15 In three instances, patients failed to seek ante-natal care and of these cases two of the children were illegitimate and in the third Che mother was unaware of her pregnancy until labour commenced. Post-Natal Care. 333 Barking mothers attended the Post-Natal Clinic making a total of 357 attendances. In addition 202 mothers were under the care of their family doctors and 137 were under the care of hospitals outside the district. INFANT WELFARE ATTENDANCES AT INFANT WELFARE CLINICS — 1957 & 1958 1957 1958 Number of children born in year who attended 771 743 Total number of children who attended 2,413 2,312 Total attendances 23,409 21,855 Distribution of Welfare Foods The following table shows the welfare foods distributed during 1957 and 1958:— 1957 1958 National Dried Milk 25,124 21,711 tins Cod Liver Oil 6,061 3,957 bottles Vitamin Tablets (A & D) 3,445 3,011 packets Orange Juice 62,398 35,506 bottles In addition, during 1958, nearly 16,000 packets of proprietary brands of milk foods, etc., were sold at clinics. In November, 1957, the issue of orange juice was limited to children under the age of 2 years and this restriction is reflected in the substantial drop in the take up of orange juice during 1958. With the commencement of infant welfare sessions in the temporary accommodation on the Thames View Estate, arrangements were made for the sale of welfare foods there during such sessions. Day nurseries The table below shows the attendances at Gale Street Page 16 Nursery during 1958:— No. on Register Average daily attendances January 51 36.4 February 51 42.2 March 49 40.7 April 47 39.3 May 46 40.0 June 46 35.1 July 48 35.8 August 44 33.4 September 46 38.3 October 50 38.1 November 45 36.8 December 42 33.4 Nursery and Child Minders' Regulation Act There arc no registered Child minders in the Borough. midwifery Five midwives continued to practice in the district, including two under the auspices of the Queen's Nurses, until November when Miss E. A. Ashton retired. Her district was absorbed by the remaining four midwives. District Midwives undertook the confinement of 231 patients which represented 25% of Che births occurring in the Borough. Supervision of Midwives Dr. M. I. damson continued as Medical Supervisor of Midwives and Miss D. Riseley, Matron of the Barking Hospital, continued to act as Non-medical Supervisor of Midwives. health VISITING The following statistics relate to the work of health visitors. HEALTH VISITING 1957 1958 No. of visits to Expectant Mothers 1,345 1,266 No. of visits to Children under five 10,184 9,251 No. of other visits 4,418 5,712 No. of Non-Access visits 2,487 2,270 Page 17 home nursing This service, together with approximately half of the domiciliary midwifery service, is still administered from the County Training Home at Leytonstone. vaccination and immunisation Smallpox Vaccination The number of primary vaccinations carried out in 1958 was 187 in infants under one year, 88 in those over one year. This means that just over 20% of infants are being vaccinated during the first year of life. Poliomyelitis Vaccination At Che end of 1957 we had received instructions to extend the scheme from 5-9 year-olds only to children up to and including those of 15 years of age and to expectant mothers. The school children were quickly tackled and with the valuable co-operation of schools some 12,500 consent forms were given out. By the end of February well over 6,000 completed forms had been returned and. remembering that parents had the choice of English made or Imported vaccine, family or clinic doctor, the task of collating records was considerable. The acceptance rate of expectant mothers was rather low, something like 25%, but was still higher than in many other towns. To try to raise the general acceptance rate still more, the schools helped us once again in the summer by distributing a further consent form and leaflet to each school child still unregistered. This offer produced some 2,000 new consents. During the first few months of the year vaccine was not plentiful and at the end of June when nearly 8,000 people had applied for vaccination there were more than 5,000 not fully protected. However, supplies improved as the year progressed and only some 600 had not been offered an appointment when it closed, and of inmost were cases where the parents insisted upon waiting for English type vaccine which was still in short supply. This meant that approximately 70% of the under 16's had been given two injections since the introduction of the scheme in 1956. The abstaining family doctors were again asked if they would like to join the scheme and many more did so. As can be seen from Page 18 The following table below approximately half the injections during the year were given by family doctors. Family Doctor Clinic Children Expectant mothers Children Expectant mothers Imported 4,102 118 4,541 106 British 788 106 586 62 TOTALS 4,890 224 5,127 168 Grand Totals: Children 10,017 Booster doses 2,206 Expectant mothers 392 10,409 This was not the end of the 1958 story because in October the Ministry of Health decided that a further age group should now be offered vaccination, viz. the 16-25's. Not only that but we were now to offer booster doses to all children who were given a 2nd injection 7 months or more previously. Special additional immunisation sessions to meet the needs of this age group were started viz, commencing 6th November regular weekly evening sessions were held at Central and Woodward Clinics together with regular Saturday morning sessions. The response from this new age group, however, was disappointingly low—only 118 were given two injections by the end of the year. DOMESTIC HELP SERVICE The following table shows the number of hours of service given during the past nine years, together with a detailed analysis of how the hours of service were deployed in 1958:— Year Number of Helps Employed Number of Cases Helped Total Hours Worked 1950 55 387 80,699 1951 49 327 70,611 1952 84 318 85,743 1953 89 384 105,121 1954 89 503 101,960 1955 90 556 105,104 1956 93 596 104,863 1957 93 581 97,536 1958 97 550 103,787 Page 19 The following table shows the help given to various categories during 1957 and 1958:— Category Cases Helped Hours of Service 1957 1958 1957 1958 Maternity 47 47 3,524 3,454 Acute Sick 25 12 1,833 823 Tuberculosis 22 21 4,009 4,552 Chronic Sick 106 106 20,769 24,351 Aged chronic sick 225 255 37,851 49,273 Aged 153 106 29,139 20,490 Others 3 3 411 844 581 550 97,536 103,787 Diphtheria and Whooping Cough Immunisation The number of children receiving primary courses of immunisation during the year was as follows:— DIPHTHERIA Family doctors Clinics Total Separate 308 651 1,159 Combined with whooping cough 239 - 239 Total diphtheria 547 651 1,198 WHOOPING COUGH Family doctors Clinics Total Separate 95 302 397 Combined with diphtheria 239 — 239 Total whooping cough 334 302 636 Page 20 PREVENTION OF ILLNESS, CARE AND AFTER-CARE Chiropody Service This remains a popular service and during the year 23,077 attendances were made. Sick Room Equipment This continues to be much in demand and helps greatly to assist the nursing of patients at home. At the end of the year 563 articles were out on loan. Page 21 SCHOOL HEALTH SERVICE, 1958 MEDICAL INSPECTION AND TREATMENT The Statistical Return at the end of this report shows the classification of defects found and the treatment thereof. Minor Ailment Clinics Attendances at these clinics were well maintained during the year. cases treated at minor ailment centres Eyes: (External and other—excluding errors of refraction and squint) 402 Ears, Nose and Throat Defects (other than operative) 613 Skin: Ringworm (body) 1 Scabies 3 Impetigo 59 Other 2,250 Other minor ailments (e.g. minor injuries, bruises, sores, chilblains, etc.) 2,153 Total attendances 24,176 Speech Therapy During the year the speech therapy sessions which had previously been held at Paget Ward were integrated with the Clinical sessions held at Central and Woodward Clinics. During the year 169 cases made 2,203 attendances to the speech clinics. Mrs. A. Ling, part-time Speech Therapist, left in May and was succeeded by Mrs. G. Stuffins who came as a full-time officer. Mrs. M. Ward continued to give 6 sessions per week. During term time the Speech Therapists continue to give 4 sessions per week at Faircross School. DENTAL SERVICES Statistics relating to the dental inspection and treatment of school children will be found in the statistical return at the end of this report. Page 22 During the year we unfortunately only had the services of one full-time dentist but throughout the year varying numbers of parttime dental officers were obtained, ft was, however, impossible to give proper continuity in treatment and inspection and orthodontic work fell to a minimum. In May the oral hygienist (employed in the Walthamstow area and seconded to us for two sessions per week) resigned and was not replaced. The Dental Laboratory continues to construct dentures and appliances not only for Barking but for many dental centres elsewhere in the County and during the year the following appliances and dentures were processed for school children:— DENTURES AND APPLIANCES CONSTRUCTED FOR SCHOOL CHILDREN AT THE DENTAL LABORATORY IN 1958 Description of Denture or Appliance Barking Other County Districts Partial Denture (5-9 teeth) 5 6 „ „ (1-4 teeth) 37 88 Repairs to Dentures 13 83 Fixed Splints — 21 Acrylic Crowns — 5 Oral Shields — 39 Space Retainers — 5 Simple Orthodontic Appliances 2 41 Complex Orthodontic Appliances 49 433 Andresson - 7 Study Models (Sets) 71 634 Special Trays (Acrylic) 4 16 Box Plate Trays - - Bands 4 12 Silver Splint — 1 Page 23 SPECIALIST SERVICES Eye Clinics Dr. R. F. Jamieson, M.B., Ch.B., D.O.M.S., continues to attend Central, Porters Avenue and Woodward Clinics. Cases dealt with were as follows: — External and other diseases excluding errors of refraction and squint 44 Errors of refraction (including squint) 1,306 Total 1,350 The number of pupils for whom spectacles were prescribed was 1,029. Miss Lewis, Orthoptist, treated 135 school children during 1958. Ear, Nose and Throat Clinics Miss M. Mason, F.R.C.S., continues as the Consultant Ear, Nose and Throat Specialist. Figures for treatment are:— Operative treatment (cases):— (a) For diseases of the ear 4 (b) For adenoids and chronic tonsillitis 96 (c) For other nose and throat conditions 10 Other forms of treatment (cases) 244 Miss M. Mason, F.R.C.S., undertakes operative treatment for Barking children at the Chadwell Heath Hospital where a delightful suite has been reserved for her cases. The waiting time for admission to hospital for operative treatment has been short, amounting in most cases to a few weeks. It has been noticed in other years, and this year has proved exception, that there are a fairly large number of cases of allergic rhinitis. It is difficult to ascertain the exact cause of this but Presumably it could be due to atmospheric pollution and/or the Prevalence of pollen from marsh grasses. 16 cases of suspected deafness were referred tor assessment of hearing by audiometry. 4 were found to have some degree of deaf- Page 24 ness, 2 of which were treated conservatively and 2 by operation. 4 cases of defective hearing, which had been confirmed by routine audiometry, were referred to this Clinic, 2 were treated conservatively and 2 by operation. Orthopaedic Clinic Professor Leon Gillis, M.B.E., F.R.C.S., continues as the Consultant Orthopaedic Surgeon and attends fortnightly at the Physiotherapy Department, Barking Hospital. The Department, which is under the control of the Ilford and Barking Joint Management Committee, occupies the east wing of Ross Ward and is well equipped with varied and up-to-date apparatus enabling patients to have most types of treatment requested by their doctors. Mr. Hynd, the Senior Physiotherapist, who has worked in Barking for 13 years now, continues in charge of the physiotherapy work. Classes are conducted each Wednesday morning for children with physical nd organic defects. The Department works on an "appointment system," whereby a patient is "in and out" in 30 minutes (excepting cases where treatment prescribed takes longer). No patient is kept waiting more than 5 minutes before receiving treatment. Patients requiring conveyance are given treatment on Tuesdays and Fridays when transport is placed at the disposal of the department for these essions by the ambulance service. In this way the appointment system is not interfered with. There is an evening session on Tuesdays, and a morning session on Saturdays for patients who have returned to work so that they do not lose time from their employment. The number of cases seen by Professor Gillis was 301, half of which were under 16 years of age. Of the total number seen by Professor Gillis, 40 required medical or surgical treatment as inpatients, but because no beds were available in Barking Hospital they had to be admitted to various hospitals outside the Barking and Ilford area. Efforts are still being made to earmark beds locally for orthopaedic cases. Skin Clinic. Dr. P. M. Deville, M.R.C.P., M.R.C.S., Consultant Dermatologist, attends the Skin Clinic at Upney Clinic twice a month, and Page 25 during the year 927 attendances were made to his clinic. Child Guidance The number of cases referred to the Child Guidance Clinic numbered 23. Participation in case conferences has continued to be of invaluable help and interest, and we are grateful to Dr. H. M. S. Davidson, Consultant Psychiatrist, and her team at the clinic for their enthusiastic support. It gives me pleasure to include the following report by Dr. Davidson on the work of her clinic:— " The work of the Clinic has continued with little change during 1958 but we have met with an increasing interest in our work and a wish to know more about it. Though we are called a Child Guidance Clinic we are essentially a Family Clinic, our patients are members of a family where personalities react on each other and where problems are closely interrelated. Children are sent to us through many sources:—School Teacher. Medical Officer, General Practitioner, Hospitals and Clinics, Children's Officer, Probation Officer, or the parents or guardians of the child themselves. They come because someone is worried, either the child who is anxious and fearful, or the parent or teacher who is faced with behaviour they do not like but are unable to modify. The gradual transition from the stage of early childhood where impulses and emotions are strong and egotistic and self control is weak, to that of the adult, socially responsible, good citizen is a difficult one. It requires a secure background with loving parents who can supply the child's needs for emotional as well as physical satisfaction and control him while his own self control is yet weak, and give him those standards and ideals through personal example which the child will eventually make his own. Since parents and children vary in their needs and capacities in carrying out this task, the sources of maladjustment are legion. Min,r difficulties abound, as all parents know. Most of them are temporary It is in overcoming them that parents and children gain in mutual understanding and capacity to deal with difficulties in life. But sometimes they do not clear up and may get worse; then the whole machinery of family relationships is in danger of being thrown out Page 26 of gear and the child's whole development may be endangered. The child reacts to the situation of stress in one of two ways: (1) He reacts actively, e.g. with persistent temper tantrums, aggressive and destructive, or other forms of antisocial behaviour; with a persistence of babyhood habits, thumb sucking, wetting, soiling, etc.; with nervous symptoms such as tics, nail-biting or other compulsive habits; with psychosomatic disturbances such as asthma attacks, etc., or (2) He react passively. He is timid and fearful of everything; he reverts to babyishness and immaturity, feels he can do nothing right so refuses to attempt anything; fails to learn at school though hr is of normal intelligence; fails to adjust socially and cannot make friends. Many children present quite severe problems in their homes, yet may function quite normally at school. Others may be outwardly conforming at school but release the pent-up feelings relating to school with increased intensity when they return home. Most teachers now recognise the over-good child as a disturbed child who is afraid to be natural. Diagnostic Survey. When children are brought to us, we need to know as much as possible about them and the family set-up and background. We make use of whatever records are available from the School Medical Officer, Family Doctor, Health Visitor, and the schools he has attended. The parents first come (fathers as well if they can) and are seen by the Psychiatric, c Social Worker who takes a full social history. This includes the problem for which they attend, its onset, duration, and also a full life history of the child's development, his personality and his interests, his relationships to his parents and brothers and sisters and their to him; the family background, housing and material conditions and the varied anxieties and stresses through which the family has passed. The parents' own history of their childhood is important. The way they handle their children will depend very largely on how they were treated themselves and what their relationships were their families. It is their own past sufferings and problems, rather than "the sins of the parents" which are visited Page 27 upon the children and much of the work with parents here is helping them to understand and sort this out. If the child is old enough and willing enough to separate from his parents he is seen by the Educational Psychologist while the mother is seeing the Psychiatric Social Worker, and is given a series of tests, not only to assess his intellectual capacity but to gauge his attitude to learning. Some children show particular types of learning difficulties, e.g. in reading, which may indicate a need for special help. The parents and child are then asked to attend for an interview with the Psychiatrist who already has the reports of the first interviews. The child is usually seen first in the playroom with toys where the Psychiatrist attempts to form a friendly relationship and observes the child's behaviour and reactions with play material and offer to help him with his problems. Most children, even three-year-olds. are quite willing to admit that they have worries and usually express their willingness to come again for further help. The Psychiatrist then sees the parent or parents and discusses the child's problems and possible ways of dealing with them, though final decision about this may need to be postponed till the case conference has taken place. A Case Conference between the Psychiatrist, Psychiatric Social Workers and Educational Psychologists, and attended by the Child Therapists, who may take the child on for treatment, is then held. In some of the cases the problem is largely a social marital one; in others an educational measure may be needed; in some the mother needs help and counselling in her handling of the child; but in a large proportion of cases, the child needs to attend for weekly treatment while the mother sees the Psychiatric Social Worker. These diagnostic interviews are very time consuming but are nevertheless essential. It was stated recently in a Medical Journal that under the National Health Service, the doctor talks and the patient listens, while in private practice the patient talks and the doctor listens. In this respect, all our patients are largely private patient It is what they say and how they say it that gives us the data on which we make our diagnosis. In a full diagnostic survey at least three people are involved. each spending an hour and a half on every case and there are often additional interviews as well as the Case Conference. Page 28 Treatment. Our decision about the type of treatment and its probable duration rests largely on whether the problem when referred to us is still an external one or whether it has become internalised within the child's own personality. in the small child of pre-school age most problems are external and present a conflict between him and his mother, or father, or brother or sister. Often help for the mother, with or without the child, may clear up the problem in a small number of interviews. Another type of external problem for which we can give considerable assistance is in helping the child to adjust psychologically to some traumatic but unavoidable happenings:—a severe physical handicap, an injury such as the loss of a leg, the death, or mental or physical illness, of a parent. We can also help to prepare a child for the birth of a brother or sister, for going to school or going to hospital in cases where the parents ecognise that the child will have considerable difficulty. In older children, too, problems are usually external at first, but are too often left untreated until they have become interna'ised and reappear as neurotic symptoms. They are then much less accessible to external help and to change attitudes in the family and need prolonged psychotherapy to cure them. To give an example, all children feel jealousy of younger brothers and sisters though they may not show it openly, and have some difficulty in coming to terms with it and developing a satisfactory fraternal relationship where a competitive spirit is mutually helpful. Some children fail in this task, especially if they are made to feel too guilty over their jealousy and may repress the whole struggle only to show it later in an internalised form when they fail in all competitive situations. If their conscience forbids them to have any feelings of rivalry they may fail at school and elsewhere whenever such feelings tend to be aroused. The neurotic symptoms which we see are these inhibitions of learning or making friends, fears of all types, anxiety states, chronic depressive symptoms with persistent crying and many others. In these children with largely internalised problems the Psychiatrist or Therapist takes them on for weekly treatment of ¾ hour for an average period of eighteen months, though difficult cases may take longer. Those with externalised problems need a shorter period of Page 29 treatment. The Therapist's aim in these interviews is to establish a relationship with the child which will enable the child to work out his own problems and thereby to cope more adequately with his other relationships so that as an adult he may become a socially responsible good citizen. The child's parent, mother or father, is also seen by the Psychiatric Social Worker for ¾ hour each week and, through the establishment of an accepting relationship, helped to understand and modify her or his attitudes towards herself or himself and the child. In addition to regular treatment sessions, our Staff are frequently called upon, both personally and by telephone, for discussions or advice on many different problems. Many families still need some support and the opportunity to come and talk over new problems, as they arise after we have finished treatment. The parents of those children in boarding schools for Maladjusted Children continue to need help and are seen regularly by the Staff. Our Psychiatric Social Workers are very hard pressed and could do more of this valuable advising work if they had more time. We need a third Psychiatric Social Worker to cope even with the existing work." Paediatric Clinic. A Consultant Paediatrician of the Regional Hospital Board holds a session each fortnight at the Upney Clinic and during 1958 school children were seen as follows:— New cases 39 Re-examination 210 Total Attendances 249 Dr. T. Savage, who had underaken locum duties following Dr. Dimson's resignation in June, 1957, was appointed Consultant Paediatrician to this clinic early in 1958. B.C.G. VACCINATION B.C.G. Vaccination is offered to all 13-year-old children. and is normally carried out in the term preceding their fourteenth birthday Number to whom offered 1,109 Page 30 Below are given some statistics relating to this service:— Number tuberculin tested after parents' consent had been received 723 Heaf Mantoux Positive result 75 73 Negative result 648 650 Number who received B.C.G 648 HANDICAPPED PUPILS A summary is given below of the ascertainment and placement of handicapped pupils during the year: — Category No. of pupils ascertained during 1958 No. of pupils admitted to Total No. of pupils in Special during Day School year Residential Special as at Day Schools 1.12.58 Residential Deaf 1 1 — 4 2 Partially deaf — — — 5 — Blind 1 — 2 — 4 Partially sighted — — — 2 1 Epileptic — — — — — Delicate 5 3 2 11 7 Physically Handicapped 4 2 - 15 2 Educationally Sub-Normal 10 7 - 40 - Maladjusted 1 - 1 - 6 Speech - - - - - Totals 22 13 5 77 22 Faircross School. At the end of the year there were 201 pupils at Faircross Special School distributed as follows:— Barking Other Districts E.S.N. Section 40 80 Open Air Section 26 55 E.S.N. Section. During the year 6 children left the E.S.N. Section on ceasing to be of compulsory school age (1 Barking and 5 out-of-district)—all were recommended for supervision by the Local Health Authority under Section 57(5) of the Education Act, 1944. Five children (1 Barking and 4 out-of-district) were found to be ineducable and recommended for action under Section 57(3) of the Education Act, 1944. Page 31 Four children (all out-of-district) were transferred to Residential Special Schools for E.S.N, pupils. Open-Air Section. During the year 23 delicate and 5 physically handicapped children were admitted from Barking and the surrounding districts. The following table shows the number of children in attendance on the 31st December, 1958, together with the medical condition for which they were admitted. Medical Condition Burking East Ham Romford Dagenham Asthma 3 2 6 6 Asthma and eczema — 1 - 1 Bronchitis 1 1 1 4 Asthma and bronchitis — — 1 — Bronchiectasis 1 3 1 — Atelectasis — — - 1 Debility General — 3 1 1 Nervous — 1 — — Underweight — — - 2 Migraine — — 1 1 Debility following T.B. hip & T.B. Cervical Adenitis - 1 — T.B. Lungs 2 — - 1 Ulcerative Collitis 1 — - — Nephritis 1 — - — Fibrocystic Disease of Pancreas - 1 - — Ehler Donlos Syndrome — — - 1 Poor physical condition, poor speech & backward 1 1 1 — Recurrent T.B. knee — 1 - - Perthe's Disease 1 - - - Anaphalactoid purpura — — — 1 Page 32 Medical Condition Barking East Ham Romford Dagenham Paralysis Spastic 5 — 2 — Poliomyelitis 6 — — — T.B. Meningitis — — 1 — Injury 2 — — — Hydrocephalus — 1 — — Congenital deformities 1 — — 1 Scoliosis — — 1 — Congenital Heart — 1 — — Epilepsy and bronchitis 1 — — — Fragilitus ossium — 1 — — Christmas Dsease — 1 — — Motor Disabity — — 1 — Rheumatoid Arthritis — — — 1 It will be appreciated that pupils handicapped by such variety of diseases require most careful medical supervision. This responsibility is well undertaken by Dr. Violet Spiller in close association with the teaching staff. Regular physiotherapy, remedial exercises, postural drainage and other remedial treatment is available at the school, and speech therapy sessions are held four times weekly during term time. During the year 11 children (3 Barking and 8 out-of-district) were no longer considered to require special educational treatment—9 returned to ordinary schools and 2, aged 15, were allowed to leave school. In addition, one child transferred to the Educationally Subnormal Section and three children were admitted to Residential Schools. Page 33 Other Special Schools. During the year thirty-five Barking children attended other special schools or received home tuition as follows: — Home Category Day Residential Tuition Blind — 4 - Partially Sighted 2 1 - Deaf 4 2 - Partially Deaf 5 - - Physically Handicapped — 2 1 Delicate — 5 1 Diabetic — 2 - Epileptic - - - Educationally Sub-Normal - - Maladjusted — 6 - Convalescence. Seventy-five children were sent away for periods of convalescence of up to 6 weeks. Page 34 Page 35 SCHOOL HEALTH STATISTICS FOR THE YEAR 1958 Total (All Schools) 1. MEDICAL INSPECTION OF PUPILS (a) PERIODIC Number of children examined at school: — (i) Entrants 958 (ii) Second age group 1,530 (iii) Third age group 1,006 (iv) Others 608 Total 4,102 Number of defects found requiring treatment 518 Number of defects found requiring observation 523 Number of individual pupils found to require treatment 479 Nutritional classification of pupils examined:— Entrants 2nd Age Group 3rd Age Group Others Satisfactory 956 1,529 1,006 607 4,098 Unsatisfctory 2 1 — 1 4 (b) SPECIAL Numbe of children specially examined (including medical examinations for School Camps, Boxing and Part-t ine Employment) 8,633 Number of defects found requiring treatment 6,117 Number of defects found requiring observation 118 (c) RE-INSF CTION Number of children re-inspected 9,136 2. TREATMI MT OF CHILDREN (a) Total attendances at Specialists' Clinics: — (i) Ear, Nose and Throat 620 (ii) Ophthalmic 2,425 (iii) Orthopaedic 66 (iv) Paediatric 249 (v) Skin 927 (b) Total attendances at Treatment Clinics:— (i) Minor Ailment 24,176 (ii) Chiropody 824 (iii) Orthopaedic 4,474 (iv) Orthoptic 1,387 (v) Speech Therapy 2,203 (vi) Skin 2,079 (c) Number of children who received operative treatment for tonsils and adenoids 96 3. HOME VISITING Total number of visits made by School Nurses 3,081 SCHOOL HEALTH STATISTICS FOR THE YEAR 1958-com Total (All Schools) 4. HYGIENE INSPECTIONS (i) Number of examinations of pupils in school 12,925 (ii) Number of pupils found unclean 179 5. DENTAL INSPECTION AND TREATMENT (i) Number of pupils inspected in school 1,566 (ii) Number of pupils inspected at Clinics 2,183 Total 3,749 (iii) Number found to require treatment 2,983 (iv) Attendances for treatment 8,385 (v) Number of fillings: Permanent teeth 2,452 Temporary teeth 243 (vi) Number of teeth filled: Permanent teeth 2,117 Temporary teeth 214 (vii) Number of teeth extracted: Pennanent teeth 1,232 Temporary teeth 3,519 (viii) Number of general anaesthetics administered for extractions 1,958 (ix) Other operations: Permanent teeth 2,659 Temporary teeth 1,289 (x) Number of treatments (included in (ix) above) carried out by Oral Hygienist Page 36 APPENDIX A DIPHTHERIA OUTBREAK Not so long ago diphtheria was a prevalent killer disease but nowadays it tends to produce local epidemic outbursts only. Such outbreaks can be troublesome to control because of the presence of human chronic carriers, themselves immune to the disease, who act as reservoirs of infection to the susceptible young members of the community. The local epidemic now described occurred in Barking, Essex, during September and October, 1958. On the morning of 30th September, 1958, the Health Department was notified by a local isolation hospital that a diagnosis of diphtheria had been arrived at in the case of two Barking infant school children. The following details were obtained. Case I. boy of 7 years, fifth in a family of eight children was taken ill on: urn from school on 19th September. He was treated at home as a case of tonsillitis for four days and received antibiotic therapy, but failed to make a good response and on 24th September he was admitted to an Isolation Hospital. Routine nose and throat swabs on admission failed to reveal the presence of C. diphtheriae. He appeared to be making satisfactory progress during the next few days, when on 29th September he became pale, lethargic and collapsed with an irregular pulse and marked electrocardiographic abnormalities. The diagnosis of diphtheria was now made on clinical grounds in the absence of laboratory confirmation. This boy died on September 30th. Case II. A girl of six years, a close friend and classmate of Case I, and fourth in a family of seven children, was taken ill with we throat on 25th September, and was seen and treated for tonsillitis with antibotics on 27th September. She was admitted to hospital on 29th September where she was found to be very ill, with " bull neck," pharyngeal exudate, and cardiac involvement. An E.C.G. showed Bundle Branch Block. Diphtheria was diagnosed immediately and anti-toxin administered, together with cortisone therapy. This child was extremely ill for some days but eventually recovered. No Page 37 bacteriological confirmation of the diagnosis could be obtained in this case either. The school class in which the two cases occurred was one of four in a modern single storey infants school with 127 pupils aged between five and seven years in attendance. The children for the most part kept to their own classes but mixed together during playtime, assembly and for certain instruction, e.g. singing lessons. Adjoining this school, separated by a wooden fence, are boys' and girls' secondary schools whose 1,000 pupils are drawn from the same catchment area. The infants share the senior school dining room. Cases I and II both stayed to school dinners. Immn sation state: The class concerned in the infant school contained 35 pupils born between 1952 and 1953, and of these 17 were known to have been immunised by the immunisation record cards held in the Health Department, 11 were said never to have been immunised, while no record cards were held for the remaining seven pupils whose parents could not remember whether or not diphtheria immunisation had been carried out. Taking the school as a whole 60 of the 127 pupils were immunised, 48 had never been immunised, and the position regarding the remaining 24 pupils was in doubt. No immunisation record card could be found for either of the two cases. On the day of notification teams of doctors and health visitors inspected the throats and took swabs from about 100 contacts of the children including the rest of the class and the patients' families and close contacts. No further suspected cases were revealed by this examination, and apart from one doubtful positive swab from an older brother of a boy in the class, all the swabs were negative for C. diphtheriae. While awaiting the swab results, Schick testing wis carried out on 31 pupils in the affected class because some 5 years or so had elapsed in some cases since primary immunisation and in other cases the immunisation state was unknown. Case III. On 4th October an unimmunised girl from the same class developed a sore throat. She had been under observation as a contact and was admitted to hospital on the same day without home treatment. Antitoxin was given at once and she was never seriouly. ill. Virulent gravis organisms were grown from her throat Page 38 after admission. The swabs taken before she became ill had been negative. Case IV. The next day another six-year-old girl from the class was found on a routine visit to be suffering from sore throat with slight exudate on both tonsils. She was admitted to hospital where she was given antitoxin. The diagnosis was subsequently confirmed bacteriologically. She suffered a mild attack only. This patient had received a single dose of a combined diphtheria and whooping cough vaccine over five years before. As a result of this development, it was decided to close temporarily the affected class and to administer prophylactic serum to its nine remaining Schick positive members. It was also decided to re-swab the affected class and home contacts and to Schick test and swab the pupils in the remaining three classes of this school. The school staff was included in the investigations. Case V. On 7th October diphtheria was diagnosed in a girl of 12 years whose brother was a classmate of the four known cases. This boy had already been swabbed twice and proved negative, yet a repeat swab taken on 7th October was positive, but although he was never immumised according to available records, he did not develop the disease, perhaps because he had been given prophylactic serum two days before when his Schick test was found to be positive. His sister had never been immunised either and had a severe attack, from which she eventually made a good recovery. She had not been to school since 29th September, but fortunately no cases or carriers were revealed amongst her classmates on routine inspection and tabbing. More carriers were now being detected including the original doubtful positive swabbed on the first day, and three more members of his family, including his mother, whose swabs were previously negative. The econd sweep through the affected class revealed three carners amongst the pupils, two of whom had received prophylactic serum a few days earlier as a result of the Schick test. Hospital treatment was arranged for the treatment of carriers, but as the demand for beds for cases, suspected cases and carriers grew. accommodation became scarce, and it was decided to isolate and treat healthy carriers at home where conditions permitted, and with the co-operation of the family doctors. Page 39 Despite the fairly close contact with the pupils in the affected class swabbing of the pupils in the three unaffected classes did not bring to light any further carriers. The Schick testing revealed that 28 pupils in the remaining classes were susceptible and it was decided to protect these children by the simultaneous administration of antitoxin and antigen, a procedure suggested by Downie et al (1948 Journal of Hygiene, 46, 34). A.P.T. was chosen despite the slight risk of provoking poliomyelitis (Lancet, 1956, 11, 1223), becauseat the time the district was free of this disease, and it was considered that a potent antigen such as A.P.T. is more likely to lead to a satisfactory level of immunity in the presence of small amounts of antitoxin. The outbreak stimulated a marked increase in demand for diphtheria immunisation, and approximately 1,800 children were immunised or received a booster dose of antigen within the few weeks of the epidemic. T.A.F. or F.T. was used in all cases except for the close contacts, who received prophylactic serum and A.P.T Cases VI and VII. On 10th October two older siblings of one of the carriers in the class were found also to have positive throat swabs. Both had slight sore throats with scanty exudate when seen at home. They were admitted to hospital and later notified as cases of diphtheria although the clinical diagnosis was considered by the Physician-in-Charge to be rather doubtful. Both had been immunised in the past (one of them not for 8 years) and they had mild attacks. Case VIII. Also on 10th October a sister of case V, aged 8 years, developed a sore throat and was sent to hospital as a suspected case of diphtheria. Bacteriological confirmation was later obtained She was under observation and was detected at an early stage. She had not been immunised, but was not severely affected. Case IX. The only patient not of school age was now detected A boy of two years was admitted to hospital on 9th October with inflamed tonsils sparsely covered with exudate. The diagnosis was confirmed bateriologically later. He was bright and active all along and was never very ill. His sister attended the affected school. but was in a different class. He lived in the area from which most of the cases and carriers were found. This boy's father, a labourer, and the sister referred to above, were subsequently found to be carriers, and treated at home. Page 40 Case X. This patient was sent to hospital for treatment as a carrier and presented a diagnostic problem to the clinicians who notified him eventually as a mild faucial diphtheria. He was a member of the affected class who had never been immunised and was found on 3rd October to be Schick positive. Two days later he was given prophylactic serum. A repeat routine swab taken on 7th October was found to be positive and he was admitted to hospital. His condition was satisfactory throughout. His uncle, who worked as a bus conductor, and lived in the same house was found to be a carrier and was successfully treated at home before resuming his employment Case XI The source of infection introduced to this class before 19th September was never discovered, and things were settling bac to normal when an interesting development occurred. A boy of six years from the affected class where he sat next but one to Case No. I was last at school on September 12th, the term commencing on 8th September after the summer holidays. Symptoms of sore throat and difficulty in swallowing developed soon after return from school, and his neck gradually became swollen. A locum doctor who saw the boy on the 15th was said to state that the boy was suffering from mumps and "coccal" throat. Notes made on the boy's medical record card on 24th September read " very severe streptococcal throat infection with oedema. Made very satisfactory recovery with penicillin, M. & B., Actinomycin (not all at once)." This boy was medically examined, including an E.C.G. and swabbed several times subsequently without producing evidence of diphtheria, when on 22nd October, about six weeks after his illness from which he had apparently made a full recovery, the boy returned to his doctor with paralysis of the palate on both sides. He was admitted to hospital and notified as diphtheria (faucial—missed case). He made a very satisfactory recovery in a few weeks. Further investigation did not reveal the source of this boy's infection. In all, in addition to the 11 cases described, 15 carriers were detected. All but three of these 26 patients either were in the class, had a sibling in the class or were very closely associated with a known case or carrier. Three adult carriers were detected, and only one of the patients was under school age. The 22 school children involved attended six schools in all. Routine swabbing was carried out on all pupils at the infants school and on the 1,000 pupils Page 41 of the adjoining senior schools. Pupils attending five classes in four other schools who might have been contacts of cases or carriers were also swabbed. Bacteriological investigation of the mass swabbings was carried out by the London County Hall, Public Health Laboratory, and of approximately 3,000 swabs submitted only two carriers were discovered who could not be considered to be closely associated with any of the known cases or carriers. This small number found in what might be regarded as the general community of school children supports the supposition that it is rare nowadays to find carriers except amongst persons closely associated with an outbreak. The bacteriology associated with the close school and community contacts was carried out by the Laboratory attached to the local isolation hospital where, with the exception of case 1 and II, who had been treated at home with antibiotics for several days prior to admission to hospital, and case XI, who also received antibiotic therapy and was only considered to be a case when the complication of palatal paralysis was discovered several weeks later, all the cases and carriers detected were found to be infected with a virulent gravis strain C. diphtheriae. In all some 4,000 swabs from 1,800 persons were submitted for examination, and a vast amount of work was carried out by the medical, nursing and administrative staffs in following up contacts and keeping them under observation. Previous Immunisation History. One of the patients, aged 13 years (Case VI) had had a full course of immunisation in 1946, with a booster dose in 1950, and his brother aged 10 years (Case VII) completed immunisation in 1950 and had a booster injection in 1954. In both cases the illness was so slight that there was some doubt regarding the diagnosis. Two other children had begun a course of primary immunisation 5 and 7 years previously and had not completed it. No immunisation record cards could be found for the remaining seven cases including the original two cases. Nine of the carriers including 2 sisters of cases VI and VII had been immunised at some time. Three others, carriers who had never been immunised, had been protected by prophylactic serim. Three adult carriers were detected. Page 42 Protection Methods. When the fourth case arose in the alfected class, nine pupils in the same class, as a result of the Schick test were given 8,000 units antitoxin in order to prevent further spread amongst the exposed unprotected children. 0.5 c.c. A.P.T. was given two weeks later to this group and repeated in a further six weeks. Three month*; later a post Schick test was performed on five of these children, when all were now found to be Schick negative In the remaining classes at the alfected school, 28 pupils received simultaneously 500 units antitoxin in one arm and 0.5 c.c. A.P.T. in the other. Six weeks later the group received a repeat dose of A.P.T. Three months later 22 members of this group were Schick tested and all were found to have converted to Schick negative. Anaphylactic Reactions. Antitoxin treatment was followed in two cases by fleeting urticarial eruptions. There were no other sequelae. Treatment of Carriers. Eight carriers were treated at home and the remainder received hospital treatment. Sensitivity tests were carried out in each case before treatment commenced. In all cases the organisms were found sensitive to sulphanilamide, penicillin, erythromycin, tetracyline and other antibiotics. Four patients were given orally tablets combining 120 mgm penicillin, and 0.88 G sulphanilamide four hourly for four days. On re-swabbing three days after completion of this course, two of the four were found to remain positive. Two children received oral penicillin alone, 125 mgm 6 hourly for 4 days; one did not respond. Erythromycin in doses of 200 mgm 6 hourly for 4 days, was given as the initial treatment in one case, a brawny labourer, with success, and in three cases where the primary course with other Medicaments had failed. In two cases this sufficed to effect a cure, but one case failed completely to respond to penicillin initially, then Erythromycin and finally 2500 mgm Terramycin 6 hourly for 4 days. He was eventually seen by a Consultant Ear, Nose and Throat Surgeon, who enucleated his tonsils and adenoids. This operation efectively cured the carrier condition. We are indebted to the various members of staff whose vigilance over several weeks made possible the early ascertainment and Page 43 ful treatment of several cases of gravis diphtheria, and whose efforts undoubtedly led to the control of the outburst. We should like also to thank family doctors and hospital staffs, and in particular Laboratory personnel, for their ready help and full co-operation throughout the epidemic. DR. F. GROARKE, Medical Officer of Health, Borough of Barking. DR. M. I. ADAMSON. Deputy Medical Officer of Health, Borough of Barking, Page 44 Page 45 STATISTICS ANNUAL REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR FOR THE YEAR 1958 Section A—GENERAL ADMINISTRATION Section B—HOUSING Section C—FOOD SUPPLIES Section D—FACTORIES AND WORKPLACES Section E—GENERAL SANITATION AND ATMOSPHERIC POLLUTION Section F—PEST INFESTATION CONTROL Section G—MISCELLANEOUS Section A—GENERAL ADMINISTRATION Table No. 1 Summary Total Inspections 13,861 Complaints received and investigated 1,614 Preliminary notices served 395 Statutory notices served 199 Notices outstanding at December 31st 163 Table No. 2. Analysis of Inspection Work performed by the District Public Inspectors Housing 59,15 After infectious disease 159 Premises at which food is prepared, stored and sold 3,162 Factories and Workplaces 641 Outworkers premises 689 Shops 847 General Sanitation 161 Smoke observations 457 Rent Act, 1957 346 Pest Infestation Control 51 Hairdressers 249 Street traders Page 46 Table No. 3 Premises at which improvements were effected. Dwelling houses (rendered habitable) 374 Premises used for preparation and sale of food 34 Shops—other 17 Drainage (reconstruction, repair, etc.) 103 Factories and Workplaces 18 Portable dustbins provided 564 Table No. 4 Defects found and dealt with under the Public Health Act, 1936, and The Housing Act, 1957. No. of defects 2,133 Roofs and Flashings 178 Gutters 134 Rainwater pipes 69 Sinks 16 Bath and sink waste pipes 25 Choked drains 207 Defective drains 15 Inspection covers 7 Ventilation and soil pipes 4 Gully dishing 30 Gully traps 8 Flushing arrangements 77 W.C. structures 8 W.C. seats 11 W.C. pans 15 Yard paving 11 Chimney pots and stacks 32 Damp walls 72 External walls 44 Underfloor ventilation 23 Window sills 65 Window and door reveals 24 Window frames 66 Sashcords 67 Stair treads 1 Doors and door frames 37 Door sills 18 Floors 44 Page 47 Stoves 19 Walls and ceilings 80 Water supplies 25 Dustbins and dust chutes 584 Verminous rooms 51 Accumulation of rubbish 44 Animals and birds 14 NEW LEGISLATION AND STATUTORY INSTRUMENTS January Diseases of Animals (Waste Foods) Order, 1957. Function under Act transferred from Essex County Council from 1st January, 1958. Regulation 7. Food Hygiene (Amendment) Regulations. 1957, with effect from 1st June, 1958. March Clean Air Act, 1956 (second approved day) Order, 1958. 1st June, 1958 (operation). April Petroleum (Consolidation) Act, 1928. Petroleum (Carbon Disulphide) Order, 1958. 1st April, 1958. The Carbon Disulphide (Conveyance by Road) Regulations, 1958. 1st April, 1958. June Labelling of Food (Amendment) Regulations, 1958. 3rd May, 1958 (operation). Clean Air Act, 1956. Dark Smoke (Periods) Regulations, 1958. 1st June, 1958 (operation). Alkali, etc. Works Order, 1958. 1st June, 1958 (operation). September Factories Act, 1937—Section 1(c). Factories (Cleanliness of Wall and Ceilings) Order, 1958. l5th June, 1958 (operation). Petroleum Spirit (Conveyance by Road) Regulations, 1958, with effect from 1 st July, 1958. Housing (Financial Provisions) Act, 1958, with effect from October, 1958. Landlord and Tenant (Temporary Provisions) Act, 1958. with effect from 1st August, 1958. Page 48 Section B—HOUSING Provision of Housing Accommodation, Year 1958. New Council Accommodation Dwellings Provided Thames View Estate 447 Bradfield Drive (Houses and Flats) (completion) 98 Mayesbrook Meadow (Part) 30 Total for year 575 New Dwellings completed since end of 1939-1945 War Barking Council 2,801 Private Owners 80 London County Council 97 2,978 War dertroyed—(Rebuilt) Barking Council 63 Private Owners (including London County Council) 331 394 Temporary Bungalows Barking Council 200 London County Council 297 497 Registered Applicants January, 1958—Waiting List 3,121 December 1958—Waiting List 3,251 Borough of Barking (a) Linton Road and (b) Church Road Compulsory Purchase Order, 1957. In December the public inquiry relating to the above compulsory Purchase orders took place. Page 49 At this date we had reached the following position in respect of the 236 properties in the two areas. Linton Road Church Road Purchased by the Council 93 properties 61 properties Remaining 59 „ 23 Total 152 Total 84 There were residing in the area 267 families comprising 728 persons. Plans are already completed for the redevelopment of the site. Photographs of typical properties are:— Page 50 Page 51 Pat>e 52 Unfit Properties During the year under review the Council declared as unfit the following dwellings:— Housing Act, 1957 Dwellings Families Gascoigne Road Nos. 2-8 4 3 St. Paul's Road No. 4 Compulsory Purchase Order. St. Paul's Road Nos. 79-99 11 15 Gas Yard No. 2 1 1 Eldred Road Nos. 1-7 4 4 Total 20 23 Old People's Dwellings The Council continued discussions with the Essex County Council with the object of providing additional dwellings in accordance with the government recommendations of March, 1957. The Council was most anxious that the welfare needs of the old people should be met and following collaboration with the County Council is proceeding with the construction of 22 dwellings at the rear of Lovelace House, comprising:— 12 Double Bed/Sit flats 4 Single Bed/Sit flats 6 2 person bungalows including one for the warden A community room is included in the proposals. This is the first joint scheme to be commenced in the Borough. The Essex County Council has not provided, or received any approval to provide, an old people's hostel in the Borough. The Borough Council is also expecting to build a second block of small flats at Westbury Road and Ripple Road corner, when the site is cleared, similar to the popular Mayflower House accommodation. Information re Local Land Charges, etc. Information as to statutory orders made in respect of dwelling houses and as to notices not complied with requiring works of repair was supplied in respect of 490 properties upon request for official search of the Land Charges Register. Page 53 In addition particulars as to properties were supplied in five cases in which mortgages were being arranged under the Housing Act, 1949 in respect of the purchase of small dwellings. This reduction from 233 in the previous year was due to the credit squeeze. Improvement Grants—Housing Acts, 1949/1957 Enquiries as to improvement grants were received principally from owner-occupiers of dwelling houses. Grants for the improvement of housing accommodation were approved in respect of 8 applications, the cost of the work amounting in the aggregate to £2,391 3s. Od. Improvement grants amounting to £1,195 11s. 6d. were granted. RENT ACT, 1957 The following gives details of action during the year:— Number of enquiries (G Forms issued) 183 Applications for Certificate of Disrepair 46 Undertakings received after a "Notice of Intention to Serve Certificate of Disrepair" 36 Certificates of Disrepair issued 14 Cancellation of Certificate of Disrepair (after work completed to satisfaction of tenant) Certificate of Disrepair issued after owner had failed to comply with undertaking given to occupier 5 A visit by a Public Health Inspector was made to the houses of 183 occupiers asking for "G" forms to offer advice on their completion. Revisits are made after application for cancellation has been received from the owner. Default Action In 21 instances it was necessary to report to the Council where owners of properties had not carried out the requirements of notices served within the time specified. The works were carried out by the owners, in each case later before legal proceedings were instituted. Repairs were carried out by the Corporation at 31 prermses in Page 54 accordance with the provisions of Section 39 and 45 of the Public Health Act, 1936, and the cost charged to the owners of the properties. FOOD SUPPLIES In order that the bacteriological and chemical condition of foodstuffs may be assessed, sampling is a continuous process. It is also necessary to ensure that the food supplied to the purchaser is of the nature, or substance, or quality demanded. For chemical examination samples are submitted to Dr. J. Hamence of Peek House, Eastcheap. The Public Health Services Laboratory at County Hall, Westminster, examines our samples bacteriologically whilst the Counties Public Health Laboratory assists with examination of samples included in the Essex County Council joint scheme, viz. water and special groups of cooked meat products. New methods of food preservation are providing new public health problems and future methods using irradiation for sterilisation and preservation will call for close attention. FOOD AMPLES REPORTED NOT TO BE GENUINE Sample No. Food Adulteration or Labelling Offence Action Taken 4268 Pork Sausage Contained Sulphur Dioxide 700 parts per million. Warning letter to manufacturer. 4269 Beef Sausage Contained Sulphur Dioxide 600 parts per million. Warning letter to manufacturer. 4271 Hamburger Contained Sulphur Dioxide 630 parts per million. Warning letter to manufacturer. 4289/96 Apples Three out of eight samples contained excessive arsenic and lead contamination. Ministry of Food advised of these unsatisfactory conditions. 4331 Blackcurrant Syrup The sample was poor in its content of Fruit Juice. Check sample satisfactory. 4363 Pork Sausage 56% meat content. In the Analyst's opinion pork sausage should contain 65% meat content. Manufacturer advised. Check sample satisfactory. Page 55 Food Hygiene The Food Hygiene Regulations, 1955, were introduced to establish a higher and uniform standard in food manufacture, preparation, storage and sales. In the four years that have passed since their introduction much progress has been made in the structural condition of buildings and cleanliness of equipment, correct types of preparation surfaces and suitable storage facilities. These improvements are not enough without a higher standard of personal hygiene for the food handler. We find it necessary to continue to impress this need upon the employer and personnel, whilst persisting with our talks to groups of people and school children. Onion Peeling Food Hygiene (Amendment) Regulations, 1957 These regulations came into operation on 31st December, 1957. The new regulation 7 is to apply to shrimps, prawns and onions and permits the giving out of such after June 1st, 1958, for peeling on domestic premises if the premises are registered for the preparation of foods. The Council considered the applications received from persons wishing to peel onions at their home, but as they decided the necessary hygienic requirements could not be met, were unable to register an) applicants. FOOD PROSECUTIONS AND COMPLAINTS Complaints were received regarding the sale of food alleged to be unsound or not of the nature, substance or quality demanded by the purchaser. The complaints were investigated and action taken as set out in Page 56 the table below:— Nature of Complaint Action Taken 1. Mouldy loaf of bread Legal proceedings against retailer. Fined £2 plus £1 2s. costs. 2. Mouldy Cornish pasty Legal proceedings against retailer. Fined £5 plus £2 2s. costs. 3. Mouldy pork pie Warning letter sent to retailer. 4. Metal screw in walnut gateau Legal proceedings against retailer. Case dismissed, insufficient evidence cake was purchased from them. 5. Metal in bread Legal proceedings against manufacturer. Fined £10 plus £7 15s. costs. 6. Weevil larvae in nougat Remainder of stock surrendered and destroyed. 7. "Jubbly" orange drink Legal proceedings against manufacturer dismissed on a technical point. 8. Mouldy sausage roll Legal proceedings against retailer. Fined £2. 9. Bristles in bread Warning letter to manufacturer 10. Flies in medicine Warning letter to manufacturer. MANUFACTURE OF SAUSAGES At the present time there are 32 premises registered for the manufacture of sausages. One of these establishments is a central factory for several butchers shops under the same control. Another factory produces sausages and other cooked meat foods for the wholesale trade and distributes over a wide area of London and the County of Essex. The remaning 30 premises are butchers shops where the sausages are made and sold in conjunction with their trade. Routine regular sampling for chemical analysis has been maintained and it noteworthy to record that although there still remains an absence of official standard for meat content in sausages, on no occasion has there been a sample reported below 50% for Beef Sausages and only one below 65% for Pork Sausages. BEEF SAUSAGES MEAT CONTENT No. of Samples 50%—54% 55%—59% 60% plus 16 3 5 8 Page 57 PORK SAUSAGES MEAT CONTENT No. of Samples 56% 65%—69% 70%—74% 75% plus 16 1 8 5 2 Cooked Meats and Special Type Sausages There is a food factory in the Borough producing continental types of sausages for the London and Home Counties area. Arising from the sample results the public analyst has called attention to the meat content which in his opinion is insufficient. A standard percentage has not so far been fixed so the manufacturers wishing to market a better product finds he is unable to do so because of the price war between himself and his competitors. There is confusion among public analysts, some of whom demand 80% meat whilst others will accept 65% for hamburge: frankfurters and Viennese steaks. There is urgent need for a decision by the Food Standards Committee in respect of this type of sausage. Another difficulty experienced in a standard meat percentage is the problem of satisfying the varied tastes of the purchasing public who complain that an increase in the meat content makes the hamburger unpalatable. Bacteriological Examination of Meat Products An investigation was carried out with the folio ng results: — Page 58 Page 59 Sample No. Material Cultural 2 days Agar at 37°C Examination 1 2 days A. gar 1 at 20°C Coliform Reaction Bact. Coli. Staphy. Pyogenes. Salmonella Remarks 1 Raw Beef Sausages 600,000 75,000,000 Pos. 0.1 Pres. in 1.0 Pres. in 0.1 - Unsatisfactory 2 Raw Pork Sausages 500,000 1,200,000 „ 0.01 „ „ 0.01 „ „ 0.1 - „ 3 Raw Pork Sausages 400,000 1,400,000 „ 0.1 „ 1.o „ „ - - Satisfactory 4 Raw Beef Sausages 100,000 900,000 „ 0.1 — — - „ 5 Pressed Pork 4,400 600,000 „ 0.1 „ „ 1.0 — - ,, 6 Saveloy 300,000 2,400,000 „ 0.l — — - „ 7 Pressed Beef 240,000 560,000 „ 0.1 — — - „ 8 Brawn 22,000 64,000 — — — - „ 9 Jellied Veal 24,000 2,100,000 — — — - Excellent 10 Black Pudding 70,000 300,000 — — — - „ 11 Meat Pie 300 Less than 1,000 — — — - „ 12 Jellied Eels Less than 100 5,000 — — — - Satisfactory 13 Minced Meat 90,000 540,000 „ 0.l — — - „ 14 Corned Beef 6,300 8,000 „ 1.0 — — - Unsatisfactory 15 Pork Sausages 800,000 36,000,000 „ 0,00001 „ „ 0.00001 — - Satisfactory 16 Beef Sausages 480,000 1,200,000 „ 0.0001 „ „ 0.001 — - „ 17 Beef Sausages 2,000,000 30,000,000 „ 0.00001 „ „ 0.001 — - „ 18 Pork Sausages 320,000 8,00,000 „ 0.001 „ „ 0.001 — - „ 19 Beef Sausages 220,000 700,000 „ 0.1 — — - „ 20 Pork Sausages 710,000 1,800,000 „ 0.0001 „ „ 0.0001 — - „ 21 Luncheon Meat 26,000 60,000 „ 0.l „ „ 1.0 — - „ 22 Saveloy 700 4,000 — — — - „ 23 Frankfurter 8,000 18,000 — — — - „ 24 Luncheon Sausage 2,800 19,000 — — — - „ 25 Liver Sausage 900 2,000 — — — - „ 26 Saveloys 900 6,000 - — — — „ Technique of Examination Fifty grams of the sample was mixed with sterile water and the volume adjusted to 500 mls. After a very thorough shaking the mixture was allowed to stand to settle and the supernatant fluid was used for examination. FOOD PREMISES The following is a list of the various premises in the Borough used for the sale of food:— Bakehouses 6 Bread and Cake Shops 21 Butchers Shops 42 Confectionery Shops 81 Factory Canteens 58 Fishmongers and Fish Fryers 22 Fruiterers and Greengrocers 43 Grocery Shops 113 Ice Cream Manufacturers 2 Ice Cream Vendors 139 Milk Shops 44 Public Houses and Off-Licensed Premises 27 Public House Restaurants 8 Restaurants 50 Shops in Markets School Meal Centres and Kitchens 45 Street Traders Food Hygiene Regulations, 1955 Bones, 47, Creekmouth. This prosecution related to a small general shop situated in a clearance area. The occupier had been warned repeatedly but action was delayed because of his promise to close down the premises. The defendant was fined £5 for having a dirty shop and £5 for having dirty equipment. The bench dismissed summonses in respect of his hands and clothing. Page 60 SAMPLES SUBMITTED TO PUBLIC ANALYST JANUARY 1st to DECEMB9R 31st, 1958 Almonds 1 Apples 8 Aspirin 1 Baked Beans 1 Beef Dripping 1 Beef Suet 1 Blackcurrant Syrup 1 Blancmange 1 Bread Roll 1 Butter 6 Cheese 1 Cheese Spread 1 Chicken Paste 1 Chocolate 1 Cinnamon 1 Citroze 1 Cooking Fat 2 Crab Paste 1 Cream 2 Cream Cheese 1 Currants 2 Custard Powder 1 Flour 1 Fruit Pudding 1 Fruit Salad 1 Gherkins 1 Gin 2 Hamburger 2 Herrings 1 Ice Cream 32 Jam 2 Jellies 2 Lard 4 Lemon Barley 1 Lemon Juice 1 Lollies 18 Lucozade 18 Margarine 4 Page 61 Marmalade 1 Milk 10 Milk—Condensed 1 Mincemeat 2 Nutmeg 1 Ointment 1 Onions—Pickled 1 Orange Drink Peel—Mixed 1 Pickles Pork Pie 1 Raisins 3 Raisin Drink 1 Rice—Creamed 2 Rice—Flaked 1 Ricory 1 Rum 2 Salad Cream 1 Salmon Spread 1 Sauce 3 Sausages—Beef 17 Sausages—Liver 2 Sausages—Luncheon 6 Sausages—Pork l6 Saveloy 1 Soup 2 Steak and Kidney Pie 2 Sugar 1 Sultanas 2 Tea 1 Tomato Ketchup 3 Vinegar 3 Whisky 2 Total 208 Page 62 MILK SUPPLIES It is gratifying to record that the milk supplies are of a satisfactory bacteriological standard. There have been 96 samples obtained from retailers during delivery and all have been found satisfactory. The whole of the milk supply retailed in the Borough, including that delivered to schools, is Heat Treated and made safe for public consumption. BACTERIOLOGICAL EXAMINATION OF MILK Designation of Milk Total Samples Submitted Methylenr Blue Test Phosphatase Test Turbidity Test Passed Failed Passed Failed Passed Failed Pasteurised 57 57 57 - — — Tuberculin Tested (Pasteurised) 39 39 - 39 - — — LICENCES Milk (Special Designation) (Specified Areas) Order, 1951. Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949/1953. Dealers Licences 44 Supplementary Licences 12 Milk (Special Designation) (Raw Milk) Regulations, 1949/1954. Dealers Licences 3 Supplementary Licences Nil INSPECTION OF FOOD PREMISES During the year the following inspections were made and notices served: — Number of visits made to these premises 2,700 Nummber of defective or dirty walls, ceilings and floors 32 Number of notices to repair or provide hot water fittings Nil Number of notices to repair counters and tables and cup- boards Nil Number of notices to repair drains and yard paving 8 Page 63 Number of notices to provide sinks and wash-hand basins Number of notices to repair or renew defective sanitary fitments 27 Number of notices to prevent contamination of food Nil Number of notices to provide soap, nail brushes and towels Nil Number of notices to provide suitable and sufficient lighting Nil Number of notices to stop and prevent smoking 1 Number of notices to provide first aid equipment Nil On occasions the inspecting officers gave verbal notices to remedy minor defects where it was not considered necessary to serve written notices. ICE CREAM AND LOLLIES There are two manufacturers and 143 retailers of Ice Cream registered in the Borough, including 48 itinerant vendors. During the year 21 samples of Ice Cream have been submitted to the Methylene Blue examination. All the samples were reported to be Grade 1 quality. Ice Cream Production The trade name Dicky Bird was well known in the London and Essex areas. At the beginning of the year the Company became part of the larger group known as Neilsons who describ themselves as manufacturers of Canadian and English style ice cream. At the time of the change the Dicky Bird Company acknowledged the beneficial assistance and co-operation afforded them by the Council and its officers. Later in the year the erection of a new factory stated to be the largest lollie factory in the country was commenced Thirty-two samples of Ice Cream were obtained for chemical analysis and all have been reported satisfactory. Examination of the Ice Cream samples showed a fat content much in excess of the present standards for fat content. Nineteen samples of lollies were analysed and found to be satisfactory. Page 64 ICE CREAM METHYLENE BLUE PROVISIONAL GRADINGS Total No. of Samples Grade 1 Grade 2 Grade 3 Grade 4 21 21 — — — CHEMICAL ANALYSIS FAT CONTENT Total No. of Samples 0%—5% 5%—10% 10%—15% 32 - 4 28 ICE LOLLIES LEAD CONTENT Total No. of Samples Satisfactory Unsatisfactory 19 19 — Page 65 Table 6 UNSOUND FOOD CONDEMNED AND DESTROYED - 1958 Baby Foods 3 tins Beans 33 tins Beetroot 3 tins Corned Beef 202 lbs. Cream 6 tins Creamed Rice 1 tin Custard Powder 3 lbs. Fish 2 stone Fish (Tinned) 53 tins Fruit Juice 1 tin Fruit (Tinned) 325 tins Ham 1,076 lbs. Jam 15 jars Macaroni 1½ lbs. Marmalade 5 jars Meat (Fresh) 579 lbs. Meat (Tinned) 77 tins Milk 25 tins Peas 74 tins Pease Pudding 3 tins Rice 8 lbs. Soup 19 tins Spaghetti 3 tins Steak Pie 1 Steak Pudding 1 tin Sweets—Nougat 15 bars Syrup 3 tins Tomatoes 34 tins Vegetables 5 tins Page 66 REGISTRATION OF PREMISES USED FOR THE MANUFACTURE OF SAUSAGES, PRESERVATION OF FOOD, MANUFACTURE AND SALE OF ICE CREAM AND DEALERS IN MARGARINE Trade Number of applications received during 1958 Number of applications refused during 1958 Total number of premises on register 1938 Manufacturers of Ice Cream - - 2 Retailers of Ice Cream 7 — 143 Manufacturers of Sausages — — 32 Fish Frying and Preserving - - 21 Ham Boilers - - 11 Margarine Dealers - - 1 FOOD DISTRIBUTION DEPOTS Ice Cream 2 General Foods 3 Confectionery (Sweets, etc.) 2 Mineral Waters 1 Butchers Shops—Meat Supplies There are 46 butchers shops in the Borough. Each is provided with modern refrigerators, adequate sinks and wash-hand basins with constant hot and cold water supplies. Of these shops 12 are also fitted with modern refrigerated window stalls and display cabinets. Each of these butchers shops has a properly constructed glazed front thus preventing contamination of the meat deposited for sale to the public from dust and dirt from the streets and surroundings. There are no slaughterhouses in the Borough. Meat supplies generally are obtained from Smithfield Market, and are of high standard. Two meat retailers in the district have animals slaughtered at their own slaughterhouses outside the area. Page 67 SWIMMING BATHS AND SWIMMING POOL I am indebted to the Borough Engineer who has supplied me with the following figures: — East Street Baths 1956 1957 1958 Total bathers 80,781 77,566 86,567 Park Swimming Pool Total bathers 51,635 99,117 73.008 Slipper Baths Total bathers 41,185 39,713 36,623 Sampling Samples of swimming bath water were taken during the year, as follows:— East Street Bath 5 Park Swimming Pool 4 South East Essex Technical College 10 All the samples submitted to the Borough Analyst were reported to be of a high standard of bacterial purity. WATER SUPPLY (a) Domestic Water Each month samples from the main supplies were obtained for bacteriological examination and twice during the year for chemical analysis. All were reported to be satisfactory. (b) Industrial Water There have been 12 samples of water obtained from the wells in use at factories, submitted to bacteriological examination. Samples of water from both main and deep wells supply were found to be of a high standard of bacteriological purity. Section D—FACTORIES AND WORKPLACES Routine inspections of factories within the Borough were regularly carried out. The visits made and the results are set out in Tables 7 and 8. which have been prepared in accordance with the Factories Act., 1937, and the Public Health Act, 1936. Page 68 TABLE 7 1.—Inspections for purposes of provisions as to health Premises. Sections enforced by Local Authority Number on Register Number of Occupiers prosecuted Inspections Notices 1. Factories: Sees. 1-6 Factories Act, 1937 24 33 7 1 Factories (not included in 1) Section 7 Factories Act 263 457 8 - 3. Other premises Section 7 Factories Act 11 13 - - 4. Offices and Workplaces Public Health Act, 1936 58 154 3 - Total 356 657 18 — TABLE 8 Improvements effected at Factories 2.—Cases in hich defects were found Particulars Number of cases in which defects were found Found Remedied Referred to H.M. Inspector by H.M. Inspector Want of cleaningness (S.l) - - - - Overcrowding S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) - - - - Drainage of floors (S.6) - - - - Sanitary conveniences (S.7) - - - - (a) Insufficient - 1 - - (b) Unsuitable & defective 7 7 - - (c) Not for separate sexes - 1 - - Other offences against the Act (not outwork) — - — - Total 7 9 — — Page 69 OUTWORK Table 9 sets out the type of outwork being carried out in the Borough and the inspections made in respect thereof . Page 70 TABLE 9 —OUTWORK Factories Act, 1937 Section 110: Number of outworkers in list required by Section 110(c) 161 Nature of work carried out:— Making of wearing apparel 117 Umbrellas 1 Artificial flowers 1 Boxes, etc. 11 Brushes 1 Toys 2 Cosaques, Christmas crackers and stockings, etc. 27 Sacks 1 Section 111: Number of visits to outworkers 344 Number of unwholesome premises — Number of notices served — Number of prosecutions — CLEAN AIR ACT, 1956 On the 7th February, 1958, The provisions of the Clean Air Act relating to industrial smoke came into operation. Section 1 of the Act prohibits the emission of dark smoke from the chimney of any building for more than the periods specified by the Minister of Housing and Local Government. These periods were specified in Regulations which came into force on 1st June, 1958. Under these Regulations dark smoke may not be emitted from a chimney for more than 10 minutes in the aggregate in any period of 8 hours with extensions of the period for soot blowing or for chimneys serving more than one furnace. The emission of dark smoke for more than four minutes continuously or of black smoke for more than 2 minutes in the aggregate in any period of 30 minutes is prohibited. A special circular was sent to all factory occupiers concerned, which was later followed by a visit to offer advice. It is unlikely that any chimney will be kept under observation for 8 hours and therefore activities will mainly be confined to controlling continuous emissions of dark smoke and emissions of black smoke. Under Section 4 of the Act the Minister may, by Regulation, require the provision of smoke indicating and recording instruments. No regulation have yet been made but it is to be hoped that now smoke instruments are readily available, the Minister will use the power available to him and thus enable checks of smoke emitted throughout the whole of each day and night, to be made by reference to the records. Some boiler users have installed smoke indicating and recording instruments in order to give an indication to the operator of excessive smoke emitted. These have proved useful in preventing contraventions of the Clean Air Act. Section 16 deals with smoke other than that for dwelling houses or dark smoke from other chimneys. If it is a nuisance to the inhabitants of the neighbourhood it may be dealt with as a statutory nuisance under the Public Health Act. This would cover such things as bonfires, but there may be difficulty in establishing that a particular occurrence is a nuisance to the Habitants of the neighbourhood. Page 71 At the time the industrial provisions of the Clean Air Act came into operation a Circular was sent to the managements of all factories in the Borough drawing attention to the limits of smoke emission and inviting co-operation in reducing atmospheric pollution. Application for Exemption An application was made to the Corporation under Section 2 of the Clean Air Act for exemption from the provisions of Section 1 of the Act regarding emission of smoke. The application was made on the grounds that it had not been practicable to alter the installation in use to ensure compliance with the Act. In this particular case an oil fired furnace was being erected and special doors were being obtained for the existing furnace. Exemption was granted for a period of six months. In another case an application for exemption was not approved because it was felt that alternative arrangements could be made which would avoid the emission of dark smoke until new equipment was installed. Observations The number of observations of factory chimneys in the Borough carried out during the year were 161. All these observations were of thirty minutes duration and the smoke emissions were compared with a shade chart known as a Ringelmann Chart. All Public Health Inspectors have had practice in assessing shades of smoke using the chart but it is rather cumbersome for everyday use so a smaller version known as a Microringelmann is in general use as a guide. Any excessive emission is immediately drawn to the attention of the management of the factory concerned and advice s given on the best methods to be used to avoid such emissions. The has frequently resulted in the installation of new equipment. Domestic Smoke A conference of Local Authorities to discuss the implementation of the Clean Air Act as it affected domestic smoke was held at Barking Town Hall in November. Delegations from twelve local authorities were present together with representatives of fuel distributors. Each delegation gave information concerning the action being taken by their respective authorities to introduce smoke control orders and a general discussion took place on the difficulties involved. Page 72 Such conferences make a useful contribution to the work of securing clean air. Smoke does not stop at the boundary of the town in which it is produced and if the greatest benefit from smoke control areas is to be achieved it seems important to tackle the task on a regional basis. Each authority gains something from a conference by hearing the experience of other authorities, by joining in an approach to the Minister of Housing and Local Government concerning common problems and above all by being encouraged to go ahead with its own plans. London County Council Estate A meeting of representatives of Barking, Dagenham and Ilford Councils was held in October to discuss the question of making the whole of the London County Council Becontree Estate a smoke control area. It was thought desirable that the work of adapting grates in houses on the Estate should be co-ordinated to proceed at a similar rate in each of the three Boroughs. This work would liave to be phased according to the speed with which adaptations could be mad by the London County Council and would have to be spread over a number of years. The number of dwellings involved is:— Barking 8,221 Dagenham 15,986 Ilford 2,530 The delegates were agreed on the desirability of making an order to cover the whole of the estate and arranged to meet again after reporting to their respective Councils. Supply of Smokeless Fuels A great deal has been said recently about the shortage of smokefuel and some local authorities have postponed taking any action deal with domestic smoke because of an alleged shortage. Undoubtedly there has been difficulty in the supply of what are Known as premium smokeless fuels such as Clean-glo, Coalite and Rexco. These are specially manufactured fuels which are more expensive than coke and the demand for them has recently been greatly increased. Page 73 Unfortunately the rate of production has not kept pace with the increased demand, mainly because of the large capital expenditure involved in setting up the necessary plant. More plant is being set up, however, so the situation should improve. Whatever may be the supply position regarding premium smokeless fuel when the Clean Air Act was passed the Government expected the demand for smokeless fuel to be satisfied by open fire cake and enquiries into the supply situation encouraged the belief that this was possible. The Gas Board have repeatedly given assurance that there is an ample supply of open fire coke to satisfy the demands of any smoke control areas which are created. The approved grates installed in such areas are equipped with facilities for gas ignition and are specially designed to burn coke. There is a technique for burning coke on an approved appliance and arrangements can be made for demonstrations to show householders how to obtain the best results Properly used 16-cwts. of coke will give as much heat as one ton of coal. There has been a move recently to set a standard specification for open fire coke so that householders will be sure of obtaining a fuel of uniform quality. Before any smoke control area is created the Minister of Housing and Local Government enquires into the available fuel supply and will not approve the area unless he is satisfied that it is adequate. Measurement of Atmospheric Pollution Measurements of solid deposit and sulphur dioxide in the atmosphere continued to be made in four places in the Borough, the readings from which for the last six years are set out on page 78. These measurements form part of an investigation in which systematic measurements of air pollution are made in many parts of the country. Results are obtained from 2,441 instruments. The average deposit of solid matter for all sites throughout the country for the year ended 31st March, 1957, was 18 tons per square mile per month. The average of the six sites at which the greatest deposits took place was 102 tons per square mile per month. The average of the six sites at which the lowest deposits occurred was Page 74 5 tons per square mile. These figures may be compared with an average deposit in Barking of 21 tons per square mile per month. The measurement of air pollution has been going on in Barking for 10 years and below is given a chart showing the average solid deposit in tons per square mile per month for each of the last ten years. It is gratifying to be able to record a reduction over that period despite an increase in industrial activity and an increase in the number of dwellings in the Borough. Page 75 Record of Chimney Observations carried out during 1958 Observations. The number of observations on Factory Chimneys in the Borough during 1958 total 155. Contraventions number 16. Black Smoke minutes Moderate Smoke minutes Little or No Smoke minutes Amount of smoke recorded during the year 147.5 290.25 4206.25 Average amount of smoke recorded per observation .951 1.872 27.137 6 2½ 21½ 6 14½ 9 2½ 4½ 25½ 4 1 25 5 2½ 22½ 2 2 26 Particulars of contraventions of the Byelaws (over 2 minutes Black Smoke in ½ hour) 25 5 — 20 5 5 5 4 21 3 4½ 22½ 3 - 27 2 2 26 11 12 7 30 — — 14 7 9 2½ 4½ 23 Page 76 ATMOSPHERIC POLLUTION MONTHLY DEPOSITS IN TONS PER SQUARE MILE MONTH 1953 1954 1955 1956 1957 1958 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 JANUARY 30.48 28.61 22.32 21.40 32.20 18.16 42.09 42.33 - 22.74 35.78 42.74 34.90 24.38 30.98 30.87 24.90 14.34 30.01 33.36 19.64 19.08 FEBRUARY 30.52 23.24 24.97 46.03 39.35 27.54 31.85 29.05 14.89 17.28 14.94 21.66 12.52 11.81 34.82 32.41 21.46 15.44 39.35 31.96 23.90 20.98 MARCH 20.48 22.38 14.30 30.98 30.35 26.75 24.27 32.75 15.41 14.44 26.08 30.93 19.26 19.35 38.32 37.51 24.00 13.61 29.41 23.82 9.05 15.94 APRIL 22.41 19.88 21.94 13.34 16.32 12.31 31.08 30.11 21.43 24.51 20.04 24.40 17.13 15.01 19.94 15.64 13.17 14.40 25.18 17.89 8.97 11.51 MAY - 21.52 17.47 30.48 38.60 18.02 27.48 37.85 27.30 - 22.91 31.35 16.85 18.31 28.88 39.18 21.08 15.68 31.15 27.71 14.41 17.27 JUNE 25.58 26.52 12.28 34.28 35.93 22.08 23.04 27.07 20.94 27.51 29.11 37.58 13.44 17.57 22.14 17.92 16.57 10.43 30.98 29.70 16.30 17.51 JULY 26.94 24.04 24.79 26.42 32.61 21.43 17.61 24.23 12.69 32.22 27.11 - 23.11 20.21 39.28 27.38 — 15.37 4.46 — 24.14 13.31 AUGUST 25.74 22.89 21.49 27.01 32.92 20.15 21.88 28.95 30.30 17.07 26.18 45.51 27.17 16.68 31.08 24.19 17.68 19.24 30.91 25.46 22.38 — SEPTEMBER 30.71 27.75 21.18 28.15 38.46 25.31 31.15 31.55 26.14 20.44 37.55 33.74 23.25 14.51 32.08 23.88 18.98 16.81 29.51 23.98 14.55 14.11 OCTOBER 45.89 28.92 21.56 34.52 36.82 20.85 22.80 28.91 19.87 16.75 26.71 31.07 16.68 17.07 28.41 26.48 23.08 12.77 20.51 19.33 17.61 12.52 NOVEMBER 33.55 31.79 21.94 40.19 38.77 30.67 25.18 30.08 22.59 22.21 21.38 24.44 16.51 11.61 22.07 14.51 23.38 10.70 14.01 23.34 17.43 13.36 DECEMBER 41.59 44.04 31.74 29.25 35.83 26.65 25.55 40.66 27.75 17.01 36.45 39.35 29.61 21.11 32.48 41.34 17.64 21.31 20.15 22.21 19.98 14.15 Averages 30.25 25.18 21.33 30.17 34.01 22.50 28.32 31.96 21.75 21.10 25.35 32.98 20.87 17.3 30.04 27.61 19.27 15.01 28.20 25.34 17.36 15.34 STATIONS. D.56—Barking Park; Alfreds Way from May, 1952 ; Barking Cemetery from May 1955 ; Roy craft Avenue from August, 1956. D.57—Greatfields Park. D.58—Par sloe s Park. D.1571—Barking Park from January. 1955. Page 77 ATMOSPHERIC POLLUTION—SULPHUR DIOXIDE READINGS MEASURED AS MILLIGRAMS OF S03 PER DAY COLLECTED BY 100 sq. C.M. LEAD PEROXIDE MONTH 1953 1954 1955 1956 1957 1958 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 JANUARY 3.50 4.06 3.09 4.43 3.81 3.71 4.19 3.47 3.20 2.23 3.83 4.69 3.59 2.72 3.73 3.97 3.86 2.51 4.04 5.04 4.48 3.56 FEBRUARY 2.68 2.98 2.01 4.24 3.35 3.69 4.39 3.68 3.27 2.39 2.71 3.57 3.45 2.28 3.74 4.57 3.84 3.06 3.07 3.65 3.10 2.33 MARCH 2.89 2.57 2.77 3.17 3.64 3.14 3.46 2.24 0.59 1.29 1.91 2.74 2.12 2.41 2.08 2.50 2.35 1.65 6.10 2.19 3.20 1.72 APRIL 2.16 2.48 2.03 2.23 1.74 2.38 2.88 2.31 1.92 1.31 2.00 2.49 2.32 1.52 1.17 1.48 1.84 0.88 1.79 1.72 1.83 1.13 MAY 1.53 1.17 1.50 2.20 1.80 1.95 1.50 2.11 1.55 1.03 1.32 2.25 1.52 1.17 0.97 1.49 1.24 0.92 1.90 2.10 1.87 1.08 JUNE 1.27 1.35 0.97 2.00 1.94 1.22 1.14 1.71 1.13 0.82 0.82 1.55 1.07 0.89 1.06 1.51 0.98 0.90 1.11 1.52 1.27 0.96 JULY 2.19 2.23 1.82 2.63 2.42 1.64 0.34 0.66 0.42 0.32 1.00 2.00 1.49 0.91 1.07 1.67 1.41 0.91 1.34 1.55 1.28 0.82 AUGUST 2.43 2.05 1.57 1.93 1.80 1.19 0.70 1.27 0.91 0.64 1.04 2.21 1.67 0.97 1.20 1.84 1.11 1.14 1.49 1.50 1.38 0.95 SEPTEMBER 2.18 1.75 1.75 3.32 3.03 2.29 1.40 2.87 1.70 1.11 1.01 1.75 1.59 1.01 1.52 2.34 1.82 1.40 1.31 1.47 1.44 0.88 OCTOBER 2.53 1.84 1.78 4.16 3.63 2.89 2.18 3.24 2.38 1.85 1.86 3.06 2.35 1.80 2.47 3.00 2.81 1.91 2.30 2.49 2.40 1.52 NOVEMBER 4.15 3.91 3.51 4.36 4.05 3.22 2.66 3.53 2.69 1.91 2.96 3.97 3.20 2.67 2.63 3.08 2.94 2.08 2.34 1.90 2.56 2.51 DECEMBER 3.38 3.08 3.15 5.00 4.80 3.48 2.60 3.53 2.56 1.83 3.79 4.45 4.45 2.73 5.27 4.69 4.27 2.98 2.71 3.54 1.01 2.63 Averages 2.57 2.46 2.16 3.33 2.95 2.57 2.29 2.55 1.86 1.39 2.2 2.9 2.40 1.75 2.22 2.68 2.37 1.69 2.12 2.72 2.31 1.67 STATIONS. D..56—Barking Pa.rk ; Alfreds Way from May, 1952 ; Barking Cemetery from May, 1955. D.57—Greatfields Park. D.58—Parsloes Park. D.1571—Barking P.irk from January. 1955. Page 78 Section F—PEST INFESTATION CONTROL The systematic treatment of the sewers in accordance with the recommendations of the Ministry of Agriculture, Fisheries and Food (Infestation Control Division) was carried out twice during the year. The results of the treatment are set out as follows :— May November Number of manholes baited 421 421 Number showing pre-bait take 231 110 Number showing complete pre-bait take 159 116 Surface Infestation The following extract from the Annual Report submitted to the Ministry o Agriculture, Fisheries and Food for the year 1958 indicates the incidence of Rodent Infestation in the Borough, dealt with by your officers. A charge of 7/0d. per hour is made for treatment of business premises of all description, whilst dwelling houses are serviced without charg. PREVALENCE OF RATS AND MICE Type of Property (1) Properties in Area No. of properties in area in which infestation was found Analysis of Col. 4. Number infested by RATS MICE (2) Notified by Occupier (3) Survey under the Act (4) Total Major Minor Local Authority's property 5,340 27 - 27 - 13 14 Dwelling houses 22,236 140 - 140 - 79 61 Business premises 2,160 18 242 260 — 209 51 Totals 29,736 185 242 427 — 301 126 Page 79 Disinfestation oj Verminous Premises During the year we received complaints from 45 premises of vermin infestation—bed bugs. This was a startling increase not only in respect of the increase in numbers but also because under the present standard of living and new forms of bedding, totally unexpected. Most of the infestations were minor and were resolved by simple treatment. The total premises comprised:— Barking Council Houses 25 London County Council Houses 14 Privately owned 6 45 The Council provide a free disinfestation service PESTS Flies and Cockroaches We have continued to operate a mobile spraying unit using dispersable gammexane chiefly for dealing with breeding sites at offensive trade premises, stables, open land, tips, piggeries and stagnant water courses. We are satisfied that this practice is successful as a preventive measure. There were 120 premises treated. Hoarding oj Rubbish The Council removed from one house no less than nine cubic yards of rubbish which had been accumulated in a number of rooms in the occupation of a family of three adult persons. The dwelling was subsequently cleansed. Section G—MISCELLANEOUS Supply of Dustbins The number of premises where dustbins are supplied and maintained by the Corporation in accordance with Section 75 (3) of the Public Health Act, 1936, was at the end of the year 5,206. Page 80 The number of dustbins supplied by the Corporation under this arrangement during the year was 480. In accordance with a hire scheme complementary to the above mentioned 125 properties were supplied with dustbins. In each of these cases the dustbin will be paid for by eight annual payments of five shillings each. The total number of properties in the instalment scheme for the provision of dustbins is 716. Therefore, the total number of privately owned premises in the Borough now supplied with standard type of dustbin has reached 5,922. Public Cleansing Refuse Disposal The Borough Engineer and Surveyor has supplied me with the following information :— The quantity of refuse collected and disposed of throughout the year was 75,223 cubic yards, the average weight 5.48 cwts. per cubicyard, and the total weight 20,754.72 tons. In addition 51,098.75 tons of refuse were received from other Boroughs. OFFENSIVE TRADES The Diseases of Animals (Waste Foods) Order, 1957 The Council, at the request of the Essex County Council, agreed to take over their functions with respect to this Order as from 1st January, 1958. Your public health inspectors, who already visit the three large P'ggeries in the Borough, have carried out the duties of inspection and control. Throughout the year there have been 24 visits to the eight "tensive trade premises in the Borough. Type of Trade Number Oil Boilers 6 Gut Scraper 18 Off Boilers There are three groups of products where oil boiling is part of the Page 81 process of manufacture :— 1. Paint; 2. Printers' Ink ; 3. Stand oil and lithographic varnish. Over a number of years your public health inspectors have maintained a close contact with the manufacturers to avoid the emission of offensive fumes from these processes. We still receive a few complaints but the manufacturers have so improved their processes that the escape of fumes into the atmos phere is now generally avoidable. Accidents and mechanical breakdowns occur, however, which give rise to nuisance occassionally. Fat Melting and Gut Cleaning One factory remains in use. It is well conducted and sofarasi practicable mechanically operated. Owing to redevelopment in the area it is now badly sited it relation to new industry and during the warm weather complaint continue to be received of its operation. REFUSE TIP—RIPPLESIDE Essex County Council Act, 1933—Paragraph 2 (J) and 2 (d) of Part 1 of the Third Schedule Legal proceedings were instituted against the owner of the refuse tip for not complying with the conditions of the above Act. A fine of £50 in respect of the first charge plus £10 on the seconi charge, together with £3 3s. Od. costs was imposed. Pet Animals Act, 1951 During the year 15 inspections were made of the eight licensed premises in the Borough. All the premises are satisfactorily complying with the above Act which requires provision for fire prevention ; proper sanitary conditions thoughout the premises and suitable housing and feeding facilities for the pet animals kept for sale. RAINFALL Rain fell during the year on 156 days and measured 26.44 inches compared with 18.80 inches for the previous year. Daily records show that 0.01 inches or more rain fell on 38 days and 0.04 inches or more rain was recorded on 118 days. Page 82