Ac4366 BET 53 Metropolitan Borough of Bethnal Green Abridged Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1948 BY CHARLES PORTER, M.D., B.Sc., M.R.C.P.Ed. Barrister-at-law. LONDON: Printed by J. S. Forsaith & Son, Ltd., Bethnal Green Road, E.2 Metropolitan Borough of Bethnal Green Abridged Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1948 BY CHARLES PORTER, M.D., B.Sc., M.R.C.P.Ed. Barrister-at-law. Metropolitan Borough of Bethnal Green PUBLIC HEALTH COMMITTEE. (Which also acted as Maternity and Child Welfare Committee.) Councillor F.E. Sanders, Chairman. Councillor Mrs. M.E. Dyson, Vice-Chairman. Alderman M. Finlay. Councillor W.E. Hart. „ C. Sleigh. „ Mrs. M.E. Peaston. Councillor Mrs. N.R. Blackman. „ Mrs. A.M. Sivill. „ R.W. Charlton. „ Mrs. L.A. Stubbs. „ A.G. Clark. „ I. Sulkin. Ex-Officio Members: His Worship the Mayor (Councillor G. R. H. Hemsley, J.P.) Committee: Chairman: Baths Councillor A.E. McAuliffe. Electricity „ H.P. Wilson, J.P. Finance and Valuation „ H.J. Stubbs, J.P. Housing „ H. Hooke. Law and General Purposes „ H.E. Tate, J.P. Libraries and Street Trading „ Mrs. B.L. Tate. Staff and Establishment „ G.R.H. Hemsley, J.P. Works and Stores „ A.E. Turpin. Council Representatives on Joint (Tuberculosis) Dispensary Committee and Care Committee: (Until transfer of this service to the L.C.C.) Councillors Mrs. M.E. Dyson and Mrs. A.M. Sivill and the Medical Officer of Health. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Admin. Officer for Maternity and Child Welfare and Tuberculosis: Murdoch MacGregor, M.D., Ch.B., D.P.H., Barrister-at-Law. Temporary Medical Officer of Health: Charles Porter, M.D., B.Sc., M.R.C.P.Ed., Barrister-at-Law. Chief Administrative Assistant: J. Henry Lloyd, F.S.S. (Retired 31.7.48). Chief Clerk: R.W. Slyfield, A.R.San.I. (Appointed 19.7.48.) Clerical Staff: Senior Clerk: J.E. Pestell. Assistant Clerk: S.A. Wright. Senior Correspondence Clerk: R.F. Marshall. Correspondence and General Clerk: C.W. Foxton. Temporary Clerk: I. Laud. Senior Sanitary Inspector: *m.F.C. Sharpe. Sanitary Inspectorial Staff: Food Inspectors: *m.W.H. Heron. *m.G.E. Gould. Factories Inspector: *m.S. R.B. Slater. District Inspectors: *G.S. Freeman. *E.F. Swash. *H.G. Avril. *W.Johnson. *B.S. Harraway. *W. Baxendale. * Certified Sanitary Inspector. m. Certified Meat, etc., Inspector. Associated Part-time Officers: Public Analyst: A.E. Parkes, F.R.I.C., F.C.S. Vaccination Officers: R. Berriff, Miss M.E. Peters. (Offices redundant since 4th July, 1948.) Other Employees: General 2 Attendants. Mortuary 1 Attendant. (Temporarily held by a Shoreditch Borough Council employee.) Drainage 1 Leading Labourer. 4 Labourers. Disinfection 1 Leading Disinfector. 2 Disinfectors. 1 Motor Driver. Personal Cleansing Station 1 Woman Attendant (part-time). 5 STAFF TRANSFERRED TO THE LONDON COUNTY COUNCIL (5th July, 1948). Public Health Department Clerical Staff 4 Maternity and Child Welfare Supt. Health Visitor 1 Health Visitors 6 Clerk Dispenser 1 Clerk 1 Storekeeper 1 Cleaners 4 Home Helps 4 Day Nursery Staff Matrons 3 Deputy Matrons 3 Wardens 2 Nursery Nurses 5 Nursery Assistants 12 Nursery Assistants (part-time) 20 Nursery Students 3 Cooks 2 Laundresses 3 Cleaners 5 Tuberculosis Health Visitors 2 6 The Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Your Worship, Ladies and Gentlemen, Though I was privileged to act as Medical Officer of Health of Bethnal Green only during the last third of 1948 the honour of submitting the report on the state of the Public Health of the Borough during that year fell to me. Fortunately the task was greatly simplified since the records are very full and have been most carefully kept and I had the valuable assistance of Mr. Slyfield, Chief Clerk, and Mr. Sharpe, Senior Sanitary Inspector, and other members of the staff of the Department. In addition I had help from Dr. MacGregor whose place I took in the service of the Borough Council when the heavy duties and responsibilities he was called upon to undertake on his appointment as Senior Medical Officer to the London County Council made it impossible for him to continue to act as Medical Officer of Health of Bethnal Green as well. The report for 1948, like several of its predecessors, is in the nature of a summary and contains only brief comment upon the more important facts and figures set out. In a general way it is not out of place in this introductory note to say that as shown by Vital Statistics at any rate the health of the people of the Borough was satisfactory. In the matter of Infant mortality there was a notable improvement, the rate which had been 45 per 1,000 births in 1947 being brought down to 23.6. This figure, which may be taken as evidence of the excellence of the Maternity and Child Welfare scheme operated by the Borough Council, compares most favourably with the rate both of the country (34.0) and of London as a whole (31.0). The general death rate at 10.9 was lower than that for 1947 when it reached 13.8 per 1,000. In the case of Infectious Disease an increase is shown, from 1,003 to 1,475. The condition responsible for this was Measles, notifications of which went up from 235 to 857. The epidemic of Poliomyelitis which had caused great anxiety during 1947 happily died down before the end of that year and showed no real tendency to recur in 1948. Other infections call for no special reference, though perhaps it might be 7 tioned that most of them were more or less distinctly less prevalent than in the previous year. Because it saw the coming into operation of the National Health Service Act, the year 1948 was a very notable one. So far as the Borough is concerned its effect was to deprive the Council of participation in a number of health activities in which their efforts in the past had been attended with conspicuous success. Prominent amongst the services in which the Council and its Public Health Department ceased to take active part at 5th July, the Appointed Day in 1948, were Maternity and Child Welfare and Tuberculosis. The former with all the staff of health visitors, the Clinics and the Day Nurseries went to the London County Council, which became the Local Health Authority under the Act. The main clinical duties of the Borough Council in relation to Tuberculosis went to the Regional Hospital Board. During the period prior to the handing over on 5th July the Department continued to carry on as previously. This may be gathered from the information given under the appropriate headings in the body of the report. Though I was not here on the appointed day it has been made clear to me that the transference took place not without regret on the part of the Council and its Public Health Committee and the staff of the department, those who left as well as those who remained. The smoothness shown in connection with the operation of handing over of the more personal health services was revealed also in regard to the concentration on the no less important duties associated with the giving of attention to and seeking to improve conditions in the environment of the people, though it may be noted that in this matter shortage of staff interfered with their efforts to some extent. Apart from the National Health Service Act, the year saw come into operation on the 5th July the National Assistance Act, 1948, section 50 of which placed upon the Council the responsibility for providing for the burial or cremation of the dead in certain circumstances. Between the appointed day and the end of the year the Public Health Department was called upon to deal with seven cases, most of the persons having died in hospital and being either without relatives or without any possessing the means to carry out the burial, 8 In concluding this rather long introductory note I should like to express my appreciation of the kindness and readiness to co-operate and help in every way possible shown by members of the staff of the Public Health Department. To chief officers and staff of other departments of the Council I owe a debt also and gladly express gratitude and appreciation for all the helpfulness and kindness shown. To the members of the Council generally and in particular to the Chairman (Mr. Councillor Sanders) and members of the Public Health Committee as to the Chairmen and members of other Committees with which the work of the Public Health Department is concerned I most sincerely offer thanks and express gratitude for co-operation given and for encouragement and courtesy shown throughout the period I have been privileged to hold office in the Borough. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient Servant, Charles Porter. 9 VITAL STATISTICS. The Vital Statistics for the year, calculated on the basis of the Registrar-General's estimate of the civilian population as 60,580, are as follow: Bethnal Green London England and Wales Bethnal Green 1947 Birth Rate 18.9 20.1 17.9 23.0 Death Rate 10.9 11.6 10.8 13.8 Infant Death Rate 23.6 31.0 34.0 45.0 Maternal Death Rate 1.7 — — 0.7 As was anticipated in the report for last year the high Birth Rate was not maintained. In addition to the 1,145 live births which compares with 1,378 for 1947 there were 24 stillbirths which formed 2% of the total births (live and dead). The Death Rate shows a definite decrease from the figure for last year. Two diseases in which a welcome fall was shown were Pulmonary Tuberculosis and conditions affecting the heart. The Infant Death Rate is also down and is below that both for London and the country. As will be seen the Maternal Mortality Rate is up and is nearer that for the year 1946. The following table shows the causes of death and the age and sex composition of the people who died in the year: 10 11 Causes of Death. Cause of Death. 0-1 year. 1-5 years. 5-15 years. 15-45 years. 45-65 years. 65 years. Total. 1. Typhoid and paratyphoid fevers M. — — — — — — F. — — — — — - - 2. Cerebro-spinal fever M. - - - - - - - F. - 2 — — — - 2 3. Scarlet Fever M. - - — - — — - F. - — — - — — — 4. Whooping Cough M. - — — - — - — F. 1 1 — - — — 2 5. Diphtheria M. - — - - — — — F. - - - - — — — 6. Tuberculosis of respiratory system M. - - — 8 17 4 29 F - - - 10 — 2 12 7. Other forms of tuberculosis M. - - — 1 1 — 2 F. - 1 — 1 — — 2 8. Syphilitic disease M. - - - — 2 2 4 F. - - — — 1 1 2 9. Influenza M. - — — — — - - F. - — — — - - - 10. Measles M. - 1 — — — - 1 F. - — — — — - - 11. Acute Poliomyelitis and polioencephalitis M. - - — — — — — F. - — — 1 — — 1 12. Acute infectious encephalitis M. - — — 1 — — 1 F. - — — - — — — 13. Cancer of mouth and oesophagus Cancer of uterus M. - — — — 1 3 4 F. - — — 2 2 1 5 14. Cancer of stomach and duodenum M. - - — — 1 3 4 F. - — — 1 2 2 5 15. Cancer of breast M. - — — — — — — F. - - — 2 8 4 14 16. Cancer of all other sites M. - 1 — 5 19 29 54 F. - — — 3 6 21 30 17. Diabetes M. - — — — — — — F. - — — — — — - 18. Intra-cranial vascular lesions M. - — — 1 5 13 19 f. - - - 1 5 27 33 19. Heart Disease M. - - - 5 16 75 96 F. - — — 6 19 72 97 20. Other diseases of circulatory system M. - — — — 4 11 15 F. - — — — 3 14 17 21. Bronchitis M. 2 — — — 8 14 24 F. — - - - 3 13 16 22. Pneumonia M. 2 — - - 3 10 15 F. 2 1 - - 2 7 12 23. Other respiratory diseases M. — — — 2 5 3 10 F. — - - - 1 2 3 24. Ulcer of stomach or duodenum M. — — — 2 - 6 8 F. - - - - - - - 25. Diarrhœa (under 2 years) M. 1 - - - - - 1 F. 1 - - - - - 1 26. Appendicitis M. — - - - 2 - 2 F. — 1 - 1 - - 2 27. Other digestive diseases M. - - — 2 2 - 4 F. - - - - 5 4 9 28. Nephritis M. — — - - - 3 3 F. — - - 1 3 3 7 29. Puerperal and post-abortive sepsis. F. — - - 1 - - 1 30. Other maternal causes F. - — - 1 — - 1 31. Premature birth M. 2 - - - - - 2 F. 1 - - - - - 1 32. Congenital malformation, etc. M. 9 1 - - - - 10 F. 2 - - - 2 - 4 33. Suicide M. — - - - - 3 3 F. — - - - 1 - 1 34. Road traffic accidents M. — - - 1 I 2 4 F. — - - - - - - 35. Other violent causes M. 3 1 1 3 3 3 14 F. 1 - 1 - - 7 9 36. All other causes M. — 2 2 1 5 15 25 F. — - — — 7 8 15 total 27 12 4 63 165 387 658 M. —354 F. —304 12 As in previous years, the figures for Cancer claim attention. The fact that there were fewer deaths from Heart Disease is interesting and noteworthy. In the following table the incidence of Cancer in 1948 is compared with that in 1947 and the pre-war years 1936-38: Death rate per 1,000 population Average 1948 1947 1936-38 Cancer of: Mouth and oesophagus M .07 .15 .10 Uterus F .08 .07 .08 Stomach and duodenum M .07 .18 .26 F .08 .30 .12 Breast M - - - F .23 .23 .16 Other sites M .89 .88 .61 F .49 .78 .42 Total M 1.02 1.22 .97 F .89 1.38 .78 In considering these rates, the effect of the postwar higher age composition of the population should be borne in mind. Statistics with regard to Tuberculosis mortality will be found in the section of this report devoted to Infectious Disease. 13 MATERNITY AND CHILD WELFARE. That the Council's activities in relation to Maternity and Child Welfare ceased at the coming into operation of the National Health Service Act 1946, on the Appointed Day, 5th July, 1948, has already been noted. In the following table originally introduced to illustrate the extent to which the Council's welfare facilities had been used in recent years the figures for 1948 relate only to the period preceding transference of the work to the London County Council. 14 Attendances at Welfare Centre. Babies (0-1) †Children (1-5) Mothers First Attendances Subsequent Attendances First Attendances Subsequent Attendances Ante-Natal Post-Natal First Subsequent First Subsequent Average* 1936-38 992 9339 178 6794 345 991 219 125 1942 682 4860 83 702 319 853 7 1 1943 639 5733 53 705 413 1321 12 4 1944 562 3556 34 565 338 1120 9 — 1945 694 5426 54 810 401 1428 11 — 1946 926 7780 84 1057 855 3159 14 — 1947 1131 10,441 79 1283 737 3151 21 — 1948 (1st half of year) 514 4909 58 1261 296 1557 4 - * During this period and part of 1939 three sessions a week were held at a Branch Centre, in addition to those at the Main Centre. † With regard to the children in this age group, it should be pointed out that since 1942 some 200 have been under daily close health supervision in the nurseries. Home Visits by Health Visitors. Average Babies under 1 year. Children 1-5 years. Mothers Stillbirths, Infant deaths, Maternal deaths. Puerperal fever and pyrexia, Ophthalmia neonatorum Other infectious diseases. AnteNatal. PostNatal. 1936-38 12577 13880 1340 367 101 94 2339 1942 4764 4826 317 49 49 38 1074 1943 7646 6730 830 98 63 12 1351 1944 6912 6428 802 36 45 25 833 1945 7389 7142 581 34 59 16 1275 1946 8245 7117 754 55 60 38 1457 1947 8843 5027 499 47 53 32 1386 1948(1st half of year) 4476 3660 243 17 17 28 1255 15 Notification of Births.—By Sec. 22 (3) of the National Health Service Act, 1946, which came into operation on the 5th July, 1948, the Local Health Authority (i.e. for this area the London County Council) became the designated authority to whom all births are now required to be notified. As from the appointed day the Medical Officer of Health ceased to receive the actual notifications from the father or other person responsible but has received from the County Council a weekly return which has enabled statistics of live and still births to be given for the complete calendar year. The following table shows that 1,146 live births and 26 stillbirths were notified during the year and allocated to Bethnal Green, these being corrected figures after adding the inward transferable births and deducting those which, although born in this Borough, belonged to parents ordinarily resident in other Boroughs. Male Female Total 1st half of year—Live births 326 317 643 Stillbirths 5 5 10 2nd half of year—Live births 258 245 503 Stillbirths 8 8 16 597 575 1172 In 61 cases the low birth weight brought the children within the definition of "Premature infants". Illegitimate Infants.—77 of the live births, and 2 of the stillbirths which occurred during the year were illegitimate, the percentage being 6.7 which although higher than the pre-war rate, shows a reduction on 1946. The Council has hitherto made a grant through the Metropolitan Boroughs' Standing Joint Committee to certain voluntary associations who provide the services of experienced social workers for the welfare of the illegitimate child and unmarried mother. On the 16 5th July the responsibility for making such grants passed to the London County Council. Child Life Protection.—Responsibility for the administration of Part XIII of the Public Health (London) Act, 1936, in regard to Child Life Protection, which was hitherto that of the Borough Council, was taken over by the London County Council on the transfer to them of the health services. Physio-therapy.—The Physio-therapy Clinic established at the Infant Welfare Centre continued to operate under the control of the Council during the first half of the year. During this period there were 80 attendances by new patients and 1,127 subsequent attendances for light treatment, while 9 children attended for massage for the first time. These and other children made 151 subsequent attendances for such treatment. Nursing Assistance.—The Shoreditch and Bethnal Green District Nursing Association continued to provide, at the Council's expense, nursing assistance in a variety of circumstances, mostly to expectant and nursing mothers and children under 5. During the first half of the year 54 new cases were dealt with and a total of 465 visits were paid. NURSERIES. The three Day Nurseries continued to be administered during the first half of the year under review notwithstanding staff difficulties. The following table shows the average attendance of children in the four quarters prior to the transfer of the Nurseries to the London County Council. 1947 1948 Sept. qr. Dec. qr. Mar. qr. June qr. Columbia Market 53.4 56.0 58.6 49.9 Pritchards Road 38.6 45.1 49.7 45.1 University House 38.0 45.9 40.9 42.5 17 PREVENTION AND CONTROL OF DISEASE. The accompanying table shows the number of cases of various diseases notified during the year, also the number removed to hospital. There was a general reduction in cases of Diphtheria, Scarlet Fever, Tuberculosis and Whooping Cough. Measles, however, increased greatly in prevalence, the number of notifications being nearly quadrupled. By the end of the previous year the epidemic of Poliomyelitis had spent itself and during 1948 only 1 case, which proved fatal, was notified. 18 Infectious Disease. Disease. 0-1 year. 1-2 years. 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65years. Total Removed to Hospital. Deaths. Smallpox - - - - - - - - - - - Enteric Fever — — — 1 — 1 1 — 3 3 — Diphtheria (inc. Memb. Croup) 2 4 10 15 3 1 - 1 36 36 — Scarlet Fever 1 6 34 68 5 5 — — 116 53 — Puerperal Fever — — — — — 1 — — 1 1 1 Puerperal Pyrexia - — — — 1 4 — — 5 3 Ophthal. Neonatorum 22 — — — — — — - 22 1 - Erysipelas — — — 1 — 7 5 — 13 4 — Cerebro-spinal Fever — — 2 2 1 — — - 5 4 2 Acute poliomyelitis — — — — — 1 — - 1 1 1 Acute Encephalitis Lethargica - - - - — — — - - — — Acute Polioencephalitis - - - 1 - - - - 1 1 - Acute Pneumonia 1 4 3 6 5 7 9 6 41 3 27 Dysentery 1 5 9 6 3 1 3 2 30 13 — Malaria — - — — - - — - — — — Continued Fever — - — — - - — - — — — Typhus Fever, Cholera, Plague, Relapsing Fever - - - - - - - - - - - Anthrax, Hydrophobia, Glanders - - - - - - - - - - - Measles 63 136 371 282 4 1 — - 857 91 — Whooping Cough 38 38 84 34 — 1 — - 195 30 2 Scabies 2 — 4 3 9 7 4 3 32 — — Pulmonary Tuberculosis 1 2 3 8 25 37 25 5 106 - 41 Other forms of Tuberculosis — - — — 5 4 1 1 11 — 4 Total 131 195 520 424 61 78 48 18 1,475 244 78 19 Measles, Whooping Cough, &c.—In addition to the formal notifications from doctors included in the foregoing table, there were reported from other sources, 117 cases of Measles, 42 of Whooping Cough, 96 of Chicken pox, 180 of Mumps, 20 of German measles, 59 of Scabies, and 66 of Gastro-enteritis. Diphtheria.—There was a considerable reduction in the number of cases of Diphtheria notified—from 50 to 36. There were no deaths. IMMUNISATION. Immunisation against Diphtheria continued to be carried out during the year at the Clinic which was established by the Borough Council at the Infant Welfare Centre, Cornwall Avenue, in March 1946, and also at the three Day Nurseries in the Borough. Similarly there was a continuance by the School organisation of their activities in this direction. Responsibility for this phase of our public health work passed to the London County Council on the transfer to them of the health services, notwithstanding the close association of this work with other activities in connection with the prevention and control of infectious disease which still remain with the Borough Council. During the early part of the year it was found possible to introduce at the Welfare Centre the use of a combined Diphtheria and Whooping Cough immunising agent giving immunity against both diseases by a single course of injections. It is understood that this combined form of prophylactic treatment has been continued by the London County Council. The following table gives details of the number of children immunised during the year but it is not possible to 20 distinguish between those who received the combined form of treatment and others. Number of children who completed a full course of primary immunisation. Total number of children who were given a secondary or reinforcing injection. Under 5 5—14 years Total 1st half of year 571 249 820 85 *2nd half of year 523 50 573 61 *Figures supplied by London County Council Divisional Medical Officer. TUBERCULOSIS. During the year, 117 new cases of Tuberculosis were notified, 106 of these associated with the respiratory tract, 11 being in the non-respiratory group. The names of 755 patients were recorded as remaining on the register at the 31st December. The Tuberculosis Visitors paid 2,404 visits to patients during the period ending on the 4th July, 1948, when their services were transferred to the London County Council. The following table gives details of the age and sex incidence of the new cases: PRIMARY NOTIFICATIONS. Age Periods 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Respiratory, Males - - 2 3 2 6 5 14 9 12 9 4 - 66 Respiratory, Females 1 2 1 1 2 6 8 10 4 1 3 1 - 40 Non-Respiratory, Males — — - - - - 2 1 - - - 1 - 4 Non-Respiratory, Females - - - - - 2 1 2 1 - 1 - - 7 Grants of extra nourishment in the form of milk, ovaltine or invalid meals continued to be made during 21 the first half of the year when 141 grants were made to 47 necessitous patients. TUBERCULOSIS DISPENSARY. The Tuberculosis Dispensary at the London Chest Hospital which has been progressively operating since 1917 has ceased to be the responsibility of the Borough Council and has been handed over for dual control by the Regional Hospital Board and the London County Council. During the first half of the year there had been a steady increase in the volume of the work as is shown in the following table : New patients examined 449 Number found to be suffering from tuberculosis 68 Attendances of old patients 1537 Contacts examined 165 Home visits by Clinical Tuberculosis Officer 32 Cases referred to Hospital Departments: Out-patients 20 X-ray 988 Throat 2 Surgeons 9 Artificial Pneumothorax Clinic (attendances) 518 Sputum examinations: Positive 54 Negative 303 Disinfection.—Although reduced in volume compared with pre-war experience, a substantial amount of disinfection was carried out : 890 rooms and 10,828 articles being dealt with, while 173 articles were destroyed by request. 22 Scabies and Verminous Conditions.—The Personal Cleansing Station provided facilities for the treatment of Scabies for 23 men, 29 women and 18 children, who made 178 attendances. In addition 24 men, 37 women and 8 children received treatment for vermin making 76 attendances. The persons' clothing was disinfected in every case. Bacteriological Examinations. — The arrangements with the Clinical Research Association for bacteriological examinations in connection with suspected infectious disease were continued. The following table shows work done. Disease Found Suspected Examined Positive Throat and nasal swabs Diphtheria 359 9 Sputum Tuberculosis 22 1 Faeces Typhoid, Dysentery, etc. 17 8 SUPERVISION OF FOOD SUPPLY. The following table shows the number and nature of the samples of food taken and analysed during the Summary of Analyst's Reports. Article. Samples taken formally Samples taken informally Total number of samples taken. No. taken Genuine Adulterated No. taken Genuine Adulterated Milk 103 103 — 21 21 — 124 Sterilized Milk 3 3 - 1 1 — 4 Butter 1 1 — — — — 1 Cheese — — — 1 1 — 1 Vinegar 55 49 6 30 29 1 85 Acetic Acid 1 1 — 2 2 — 3 Pepper — — — 6 6 — 6 Salad Oil 3 1 2 — — — 3 Salad Cream — — — 2 2 — 2 Sauce — — — 4 4 — 4 Curry Powder — — — 1 1 — 1 Herbs — — — 2 2 — 2 Sage and Onion Stuffing — — — 1 1 — 1 Gravy Powder — — — 1 1 — 1 Barley Flour — — — 1 1 — 1 Batter Flour — — — 1 1 — 1 Baking Powder — — — 1 1 — 1 Custard Powder — — — 4 4 — 4 Custard Sauce — — - 1 1 — 1 Dessert Powder — — — 1 1 — 1 Sponge Mixture — — — 1 1 — 1 Lemon Flavouring — — — 1 1 — 1 Lemonade Powder — — — 1 1 — 1 Lemonade Tablets — — — 2 2 — 2 Tapioca — — — 1 1 — 1 Tea - — — 1 1 — 1 Tea time Tablets — — — 1 1 — 1 Jam — — — 1 1 — 1 Sweets — — — 1 1 — 1 Fruit Juice — — — 2 2 — 2 Ice Cream Powder — — — 1 1 — 1 Cordials 14 14 - 8 8 — 22 Ginger Wine Essence - - — 1 1 — 1 Drinking Chocolate — — — 1 1 — 1 Chocolate Spread — — — 4 4 — 4 Ginger Spread — — — 1 1 — 1 Verox Spread — — — 1 1 — 1 Yeastril — — — 1 1 — 1 Sausages 9 9 — 2 2 — 11 Sausage Meat 2 2 — 1 1 — 3 Sausage Rolls — — — 1 1 — 1 Savouries 2 2 — — — — 2 Whale Sausages 1 1 — — — — 1 Meat Pies - — — 2 2 — 2 Meat Paste - - — 2 2 — 2 Cooking Fat, unrationed — — — 1 — 1 1 Frying Oil 4 4 — — — — 4 Teaseed Oil - - — 1 1 — 1 Gelatine — — — 3 3 — 3 Gin 2 2 - - — — 2 Rum 1 1 - - - - 1 Whiskey 7 6 1 - - - 7 Drugs 3 2 1 22 22 — 25 TOTALS 211 201 10 146 144 2 357 24 The Public Analyst reports on the work done during the year as follows. ANNUAL REPORT OF THE PUBLIC ANALYST FOR 1948. During the year 1948, 357 samples were examined under the Food and Drugs Act, 211 formal and 146 informal. All samples were submitted by the Inspector. No samples were submitted by the public under the Act. Twelve samples were found to be adulterated, 10 formal and 2 informal. The adulteration was at the rate of 3.4%. The rate of adulteration in the Borough for the past ten years was as follows : Year. Number of Samples Examined. % of Adulteration. 1948 357 3.4 1947 316 5.4 1946 571 4.5 1945 572 3.3 1944 500 6.4 1943 520 3.1 1942 569 3.9 1941 557 6.5 1940 557 3.2 1939 717 3.9 Average 524 4.4 25 One hundred and twenty-four samples of fresh milk were examined, 103 formal and 21 informal. There was no adulteration. The milk adulteration in the Borough for the past ten years was as follows : Year. Number of Samples Examined. % of Adulteration. 1948 124 — 1947 107 1.0 1946 171 2.3 1945 171 1.2 1944 164 2.4 1943 147 — 1942 149 0.7 1941 213 3.3 1940 210 3.8 1939 257 2.7 Average 171 1.7 STERILIZED MILKS. Four samples of sterilized milk were examined, 3 formal and 1 informal. There was no adulteration. DRUGS. Twenty-five samples of drugs were examined, 3 formal and 22 informal. One formal sample was adulterated. PRESERVATIVES. There was no contravention of the Preservatives Regulations. 26 Other samples examined for the Public Health Department were : Twenty samples of Heat Treated Milk, 11 sterilized and 9 Pasteurised. These were all satisfactory. SPECIAL EXAMINATIONS OF FOOD, &c. During the year, 8 bacteriological or special chemical examinations were made as follows : Ice Cream 6 Dinner 1 Water from deep well 1 UNSOUND FOOD. The number of occasions on which unsound food was condemned by the Food Inspectors was 276. INSPECTION OF FOOD PREMISES. The following premises in which food is prepared or deposited for sale were supervised and inspected by the staff of the department. Inspections Notices served Milkshops 298 31 Poultry slaughterhouses 132 2 Butchers 296 19 Fish shops 95 7 Restaurants 315 26 Bakehouses 148 17 Ice Cream Vendors 261 13 Total 1,545 115 27 FOOD POISONING. During the year 10 cases of food poisoning were notified. Three cases were alleged to be due to pie or stew which had been eaten by the children at a school dinner, but were exonerated as it was found that many other children had partaken of the same food without ill effect. The actual source of the infection remained unidentified. The children soon recovered. In 2 cases fried fish was found to be responsible, in 1 case sausage, 1 case chopped liver, 1 case corned beef, and 2 cases were later found to be associated with a case of paratyphoid. The following report which was prepared and submitted to the Public Health Committee towards the end of the year and which has been amplified by the addition of statistics for 1948, gives a general idea of the incidence of food poisoning in the Borough during recent years. 28 The Chairman and Members of the Public Health Committee. Mr. Chairman, Ladies and Gentlemen, FOOD POISONING. In view of the references which have recently appeared in the Press regarding an increase in the incidence of food poisoning outbreaks in this country. I have thought it proper to report to the Committee on the position in this Borough. Notwithstanding one or two very mild outbreaks, particulars of which I give later in this report, I am happy to say that so far Bethnal Green has been exceptionally free from any very serious outbreak. Food poisoning, it will be remembered, first became notifiable under the London County Council (General Powers) Act, 1932, and later the provisions in this Act were re-enacted in the Food and Drugs Act, 1938, when food poisoning and suspected cases of food poisoning became notifiable throughout the country. Since notification became compulsory 17 years ago only 261 cases have been reported. The yearly incidence is shown in the following table : 1932 — 41 1941 — 4 1933 - 34 1942 — 4 1934 — 25 1943 — 4 1935 — 27 1944 — 5 1936 — 16 1945 — 7 1937 — 29 1946 — 3 1938 — 28 1947 — Nil. 1939 — 13 1948 — 10 1940 — 11 The figures for 1932 include 14 cases which occurred following a wedding party where the guests had all partaken of a dish containing chopped liver. The remaining cases occurred singly and were due to the consumption of a variety of articles. In some 29 cases the food poisoning was merely suspected by the notifying practitioner. In 1946, in addition to the 3 notified cases, a report was received from a local restaurant that several of the diners there had been suffering from what was suspected to be a mild form of food poisoning. An investigation was carried out, as a result of which sliced cooked pork was suspected to be the cause. A sample of the pork was submitted to the Council's bacteriologist but no organisms of the Food Poisoning groups were found. The presence of B.Coli, however, seemed to indicate that contamination had taken place after the meat had been cooked. A further mild outbreak occurred in 1947 at a school in the Borough. Eleven of the teaching staff and some 20 to 30 children were affected six hours after the meal. Two of the teachers complained of double vision, but in most of the cases abdominal pain and diarrhoea were the chief symptoms. These symptoms passed off rapidly and the patients soon recovered. The meal consisted of mutton and vegetables including tinned beetroot. A sample meal was submitted for bacteriological examination. The mutton was found to have an unpleasant odour and putrefaction had commenced when the sample was received at the Laboratory. The organisms discovered were of the intestinal type and suggested contamination by excreta. It was not possible to indicate which item of the food was responsible for the outbreak as they had been in contact with each other and cross contamination had evidently occurred. No formal notifications were received and it was therefore assumed that the patients recovered without having to seek medical advice. This very satisfactory position, in my opinion, is due to the cumulative effect of the activities of the Public Health Department in such matters as the destruction of rats and the war on flies, together with the continuous supervision exercised over food premises. 30 In addition, for some years past it has been the practice to accept the surrender of food from individual tradesmen who, realising the danger of exposing for sale a doubtful commodity, prefer this course to the taking of risks to themselves and probably also their customers. This spirit of co-operation, together with the greater trust and friendly relationship which now exist between tradesmen and the Food Inspectors, may be to some extent the reason why the people of this Borough have for so many years enjoyed freedom from any serious outbreak of food poisoning. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, Charles Porter. 29th October, 1948. Medical Officer of Health. 31 SANITARY CONDITIONS. The main items in the work of the Sanitary Inspectors, apart from food, which is separately reported, during the year were: Visits to houses arising from: Notifiable infectious diseases 679 Non-notifiable diseases 36 Complaints as to sanitary conditions 4,267 Food poisoning 7 Inspections of: Factories 1,802 Milkshops 233 Other food premises 985 Outworkers' houses 201 Tenement houses 45 Common Lodging houses 3 Drainage work 3,316 Smoke observations 1 Enquiries with regard to Housing 1,432 Other inspections and special work 4,096 Re-inspections 12,944 Total 30,047 Nuisances were abated at 2,856 premises, as compared with 1,906 in 1947. The clerical staff prepared 3,755 Preliminary notices and 1,553 Nuisance notices. In addition 2,466 letters were sent out by the Department in connection with insanitary conditions and 1,008 in connection with housing applications. 32 The sanitary defects which gave rise to the foregoing action covered the following matters : Dirty rooms 7,820 Defective drains and choked w.c's 701 Defective and dirty w.c's 1,732 Defective water supply 368 Defective paving 232 Defective gutters and rain water pipes 905 Defective roofs 1,779 Dampness 1,534 Defective dustbins 211 Other defects 6,166 Total 21,448 As will be seen from the appended list of legal proceedings, it was necessary to take such measures to enforce compliance with some notices. Drainage.— Plans submitted and approved : 29. Water Supply.—As the great bulk of the water used in the borough comes from the mains of the Metropolitan Water Board and is frequently tested it does not call for special comment. It is, however, interesting to report that there are 7 wells in the borough. Two of them have not been used for some years, 2 are used as a supplementary supply for industrial purposes, 2 are attached to the Council's Public Baths, and the other 1 is attached to a local hospital and is used for all purposes. Seventeen certificates were issued in respect of the satisfactory supply of water to 370 new premises. 33 Notice was sent to the Metropolitan Water Board of observed waste of water in 321 cases. Rent Restriction Acts.— As a result of applications by tenants and following inspection of their houses, 32 certificates of disrepair were issued under the above Acts. In 8 cases the owner subsequently made application for a certificate to the effect that the repairs had been satisfactorily carried out and these were granted. Rats and Mice.—Investigations were made into 190 complaints of rat infestation received during the year and in most cases tests of the drainage of the premises affected were carried out by the drainage staff under the supervision of the sanitary inspectors. The two rodent operatives were fully employed during the year and baiting and poisoning were carried out on 372 premises with highly satisfactory results. Baiting of the sewers was undertaken during April and again in December. In all 1,291 sewer manholes were baited with positive results in 618 cases and it is estimated that at least 2,000 rats were killed. 34 HOUSING ACT, 1936— ABATEMENT OF OVERCROWDING At the end of 1947, 2,113 cases of overcrowding were recorded in the Department. During the year, 361 new cases were discovered making a total of 2,474. By the end of 1948 (mostly by reason of a general review of old outstanding cases) this total had decreased to 997, 1,477 cases having been removed from the records for the following reasons: Families. Equiv. Adults. Rehoused by L.C.C. 359 1,757 Rehoused by Borough Council 26 137 Removed—mostly without trace 1,036 4,496 No longer overcrowded by reason of altered circumstances 56 312 1,477 6,702 The 997 overcrowded cases remaining at the end of 1948 comprised 5,310 equivalent adults. Applicants for London County Council accommodation who live in overcrowded conditions or have sufficiently serious medical reasons continue to be recommended for preferential consideration. During the year 361 cases of overcrowding and 46 cases on medical grounds were so recommended. The system of notifiyng the owner or other responsible person of the provisions of the Act relating to overcrowding has been continued in all known cases where overcrowding of premises had been abated. Approximately 270 letters have been written in this connection. 35 Factories.—Inspections and re-inspections of factory premises numbered 2,701 and led to 458 notices being served for sanitary defects. Mortuary.—The Council's Mortuary is now occupied and staffed by the Shoreditch Borough Council and serves both boroughs. During the year 290 bodies were received there and 263 post mortem examinations were made. Aged and Infirm Persons.—A number of enquiries were made by the sanitary inspectors into the conditions under which aged and infirm persons were living, but in no case was it necessary to take legal action to enforce removal to hospital. It was, however, possible to arrange for removal voluntarily in several cases. LEGAL PROCEEDINGS. During the year, it was found necessary to take out 33 summonses to enforce compliance with nuisance notices, with the following results : Withdrawn, upon payment of costs : £1 10s. 6d 1 £1 l1s. 6d 17 £2 2s. 0d 7 Nuisance orders made (with fines and costs amounting to £11 4s. 0d.) 6 Non-compliance with Nuisance order: Fine of £2 1 Withdrawn 1 36 In other cases the results were as follows : Fines Costs £ s. d. £ s. d. 4 Offences in connection with the sale of vinegar 3 0 0 26 5 0 4 Offences in connection with the sale of bread 5 0 0 12 5 0 2 Offences in connection with the slaughtering of goats 10 0 0 3 3 0 4 Summonses in connection with the sale of Olive Oil Dismissed 37 FACTORIES ACTS, 1937 and 1948. Annual Report of the Medical Officer of Health in Respect of the Year 1948 for the Metropolitan Borough of Bethnal Green in the County of London. Prescribed particulars on the administration of the Factories Act, 1937. PART I OF THE ACT. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises M/c line No. Number on Register Inspections Number of M/c line No. Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (6) (7) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 1 763 1,189 183 - 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 744 1,512 275 - 2 (iii) Other Premises in which Section 7 is enforced by the Local Authority † (excluding out-workers' premises) 3 - - - - 3 TOTAL 1,507 2,701 458 - † i.e. Electrical Stations [Section 103(1)], Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 38 2.—CASES IN WHICH DEFECTS WERE FOUND. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases".) Particulars M/c line No. Number of cases in which defects were found Number of cases in which prosecutions were instituted M/c line No. Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) (7) (8) Want of cleanliness (S.1) 4 228 176 1 38 - 4 Overcrowding (S.2) 5 2 2 1 — — 5 Unreasonable temperature (S.3) 6 2 1 - 2 — 6 Inadequate ventilation (S.4) 7 6 5 1 — — 7 Ineffective drainage of floors (S.6) 8 3 1 — 1 — 8 Sanitary Conveniences (S.7) (a) insufficient 9 20 17 2 10 — 9 (b) Unsuitable or defective 10 824 678 1 254 — 10 (c) Not separate for sexes 11 16 15 — 7 — 11 Other offences against the Act (not including offences relating to Outwork) 12 447 391 2 44 — 12 TOTAL 1,548 1,286 8 356 - 39 OUTWORK. PART VII OF THE (Sections 110 and 111) Nature of Work M/c line No. Section 110 Section 111 M/c line No. No. of out-workers in August list required by Sect. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) (8) (9) Wearing apparel Making, etc. 13 321 — — 4 3 — 13 Cleaning & washing 14 — — — — — — 14 Household linen 15 — — — — — — 15 Lace, lace curtains and nets 16 - — — — — — 16 Curtains & furniture hangings 17 76 — — — — — 17 Furniture and upholstery 18 — — — — — — 18 Electro-plate 19 — - — — — — 19 File making 20 - - — — — — 20 Brass and brass articles 21 — — — — — — 21 Fur pulling 22 — — — — — — 22 Iron & steel cables & chains 23 — — — — — — 23 Iron & steel anchors & grapnels 24 — — — — — — 24 Cart gear 25 — — — — — — 25 Locks, latches, and keys 26 — — — — — — 26 Umbrellas, etc. 27 1 — — — — — 27 Artificial flowers 28 1 - — — — — 28 Nets, other than wire nets 29 — — — — — — 29 Tents 30 — — — — — — 30 Sacks 31 - — — — — — 31 Racquet and tennis balls 32 — — — — — — 32 Paper bags 33 2 — — — — - 33 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 64 - - 4 5 - 34 Brush making 35 38 — — — — — 35 Pea picking 36 — — — — — — 36 Feather sorting 37 1 — — — — — 37 Carding, etc. of buttons, etc. 38 5 — — — — — 38 Stuffed toys 39 20 — — 1 1 — 39 Basket making 40 — — — — — — 40 Chocolates and sweetmeats 41 — — — — — — 41 Cosaques, Christmas crackers, Christmas stockings, etc. 42 3 - - 1 1 - 42 Textile weaving 43 — — — — — — 43 Lampshades 44 - — — — — — 44 TOTAL 532 — — 10 10 —