Cat one AC4366 BET 58 Metropolitan Borough of Bethnal Green ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1953 R. DUNCAN DEWAR, B.Sc., M.B., Ch. B„ D.P.H., Barrister-at-Law, Medical Officer of Health 23/9/54 Metropolitan Borough of Bethnal Green ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1953 R. DUNCAN DEWAR, B.Sc., M.B., Ch. B„ D.P.H., Barrister-at-Law, Medical Officer of Health -2- INDEX Page Public Health Committee 3 Staff 4 Statistics of the Area 7 Extracts from Vital Statistics 7 Causes of Death 11 Sanitary Circumstances of the Borough 13 Housing 26 Inspection and Supervision of Pood 30 Prevalence of, and Control over, Infectious Disease 38 General Provision of Health Services other than those provided by the Borough Council 44 3 METROPOLITAN BOROUGH OP BETHNAL GREEN PUBLIC HEALTH COMMITTEE Chairman: Councillor G.M. Browne Vice-Chairman: Councillor S. Duncombe Alderman A.E. McAuliffe Councillor W.J. Griffiths Councillor Mrs. M.S. Benenson " W.R. Johnson " Miss E.A. Carpenter " Mrs. A.M. Sivill " J. Docherty " L.J. Smith " Miss E. Gilbert " E. Winslow Ex-Offlclo Members: The Worshipful the Mayor (Councillor F.E. Sanders, J.P.), Alderman H.J. Stubbs, J.P. " Mrs. B.L. Tate, L.C.C. " H.P. Wilson, J.P. Councillor G.A. Hadley " A.W. Hastings " A.C. Jacob " Miss D.W. Morshead " A. Stocks Council's Representatives on the London County Council (Division 5) Health Committee: The Worshipful the Mayor (Councillor F.E. Sanders, J.P.) and Councillor G.M. Browne -4- STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: R. DUNCAN DEWAR, B.Sc., M.B., Ch.B., D.P.H,, Barrister-at-Law. Sanitary Inspectors: Senior Sanitary Inspector: F.C. Sharpe ø m Housing Inspector : G.S. Freeman ø Food Inspectors : G.E. Gould ø m : S.R. Slater ø m Factory Inspector : E.F. Swash ø District Inspectors : H.G. Avril ø : W. Johnson ø (Superannuated 30.4.53) : L. Foxley ø m (Resigned 28.1.53) : J.C. McManus ø : S.J. Cassidy ø m . : L.G. James ø m : L.A. Folley ø m Administrative and Clerical Staff: Chief Clerk : J.E. Pestell Senior Clerk : S.A. Wright Assistant Clerks : R.F. Marshall C.W. Foxton J.J. Parker Junior Clerks : F.S. Frid (H.M. Forces) Miss L. Driver Other Employees: Attendants 2 Disinfectors 4 Female Cleansing Attendant 1 Rodent Operatives 2 Drainage Staff 3 ø Certified Sanitary Inspector m Certified Meat, etc., Inspector -5- Public Health Department, Town Hall, BETHNAL GREEN, E.2., June, 1954. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report on the health and sanitary circumstances of the Borough for the year 1953. Fortunately during the year there were no major epidemics nor was there any recurrence of the disastrous "smog" which affected the Borough towards the end of the previous year. This Is reflected in the reduced death rate for 1953. The real improvement in the health of the public is less easy to measure. There has undoubtedly been some improvement and the degree of improvement bears some relationship to the standard of living of the population. Nearly two hundred new flats were provided by the Borough Council, a proportionate number of bad, insanitary and crowded houses were pulled down. It is very evident that the standard of housing demanded is now considerably higher than it was a few years ago and requisitioned property which rarely contains a bath or hot water supply, but which was previously accepted very readily, is now not infrequently declined if the applicant has even a remote chance of a new dwelling within a year or more. The standard of housekeeping has also risen and although there always was a large number of people who maintained a high standard it is obvious, when visiting a number of houses, that the decoration, furnishing and general care of houses is better than ever before. It appears that the improved economic circumstances of the people, the greater availability of goods in the shops and, perhaps, the "do-ityourself" campaign in the press have all assisted in bringing about this result, but whatever the reasons it is a most satisfactory trend. -6- There appears also to be some improvement in the attitude adopted towards the cleanliness and handling of food but this is counteracted to some extent by the sale of food from stalls in the streets. However well it is carried out the sale of food in the street can never be as satisfactory as sale in a shop and cleanliness is bound to suffer. It is true that with proper care contamination of food sold from a stall can be prevented. It is equally true that with proper precautions a woman can have a baby quite safely in a stable but nobody would suggest that a stable is as satisfactory for this purpose as a maternity home. The arguments against the abolition of the sale of food from stalls, appear to be first that this form of trading has been allowed for many years, secondly that its abolition would cause hardship to the stallholders and thirdly (although I doubt the truth of it) that it is cheaper for the housewife. I suggest that as against cleanliness of food which the public is entitled to, the arguments are without real substance. Similar arguments could be applied much more forcibly to housing but nobody would suggest that they would Justify the perpetuation.of slums. The disgusting state of the roads towards the end of a day's trading adds nothing to the amenities of the Borough and it would not be unreasonable to describe those parts of Bethnal Green where street trading is carried on as a food slum. The work of the Public Health Department Is summarised in the report which follows and the Divisional Medical Officer, Dr. G.O. Mitchell, has again kindly supplied me with some particulars of the personal health services which are, of course, the responsibility of the London County Council. I would like to thank the Chairman and Members of the Public Health Committee for their encouragement and support throughout the year. I would also like to thank the Chief Officers of the Council and their staffs for their ready assistance and advice at all times and my own staff in particular for their very loyal help on every occasion. I have the honour to be Your obedient Servant, R. DUNCAN DEWAR, Medical Officer of Health. -7- SECTION A STATISTICS OF THE AREA Area 760 acres Population, estimated mid-year 56,650 Number of inhabited houses (at 31st December, 1953) 15,948 Rateable Value £445,992 General Rate 23s. 8d. Sum represented by a penny rate £1,744 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Males Females Total Live Births: Legitimate 437 419 856 Illegitimate 25 21 46 Rate per 1,000 estimated population 15.9 Stillbirths: Legitimate 9 7 16 Illegitimate 2 - 2 Rate per 1,000 total (live and still) births 19-6 Deaths Death Rate per 1,000 estimated population 10.1. Deaths of Infants under one year of age- Legitimate 6 7 13 Illegitimate - - - Death Rate of Infants under one year of ageAll Infants per 1,000 live births Legitimate infants per 1,000 legitimate live births 15.2 Illegitimate infants per 1,000 illegitimate live births Nill During 1953, the population showed a natural increase of 331, that is that there were 331 more births than deaths, but in spite of this the Registrar General estimated that the number of persons resident in the Borough was 390 less than in the previous year, showing that upwards of seven hundred persons had been rehoused outside the Borough or left for other reasons. -8- The death rate at 10.1 per 1,000 persons is 15% below the rate for the previous year, which is very satisfactory although with fairly small numbers it is expected that there should be a moderate variation from year to year. The death rate is also affected by the composition of the population and it would be expected, for instance, that an area with a large number of elderly residents would have a higher death rate than a district where the proportion of old people was less. In order to make reasonable comparisons therefore, the Registrar General gives Area Comparability factors which take into account the variations in the population from the national average and factors are given both for deaths and for births. Using this comparability factor the adjusted death rate for Bethnal Green is 10,7 as compared with a rate of 12.5 for the Administrative County of London and 11.4 for England and Wales. The birth rate for 1953 was 15.9 as compared with 17.4 for the previous year. The adjusted rate for comparison with other areas is 13.8 as compared with 17.5 for London and 15.5 for England and Wales. The figures for 1952 were 16.5, 17.6 and 15.3 respectively. The infantile mortality rate, that is the number of deaths of children under one year of age for every 1,000 live births, was 14.4. This is approximately only half the figure for 1952 and whilst it is very satisfactory it is a rate which is based on a very small number of deaths and it varies considerably from year to year. The rate for London was 24.8 and it would be reasonable to say that although the rate should be interpreted with caution it does indicate that the standard of child care in Bethnal Green is at least as good as that for London as a whole. The causes of death are shown in Table 1, which follows. There was a general reduction in the number of deaths but there was no significant change in the proportion of deaths attributable to any particular cause. Notification of Births Arrangements continued in operation during the year whereby the London County Council furnished to the Borugh Council a weekly return of births (including stillbirths) notified to them as the Local Health Authority under the National Health Service Act, 1946. -9- During the year 921 live births (478 male and 443 female) were notified and in addition there were 16 stillbirths (10 male and 6 female). These figures represent corrected totals after the addition of inward transfers and the deletion of outward transfers and the difference between these figures and those set out previously is due to the fact that births must be registered only within 6 weeks and it is not uncommon for a child to be born and notified in one calendar year but not actually registered until after the New Year. -10- TABLE 1 CAUSES OF DEATH (See next page) -11- -12- TABLE 1 CAUSES OF DEATH Causes of Death Under 1 1 to 5 5 to 15 15 to 25 25 to 4.5 45 to 65 65 to 75 75 and upwards Totals M F M F M F M F M F M F M F M F M F All Causes 6 7 1 2 1 1 2 17 15 85 49 106 87 81 111 297 274 1 Tuberculosis, respiratory - - - - - - - - 2 - 1 - 5 1 - - 8 1 2 Tuberculosis, other - - - - _ - - - - - - - - - - - - - 3 Syphilitic disease _ _ _ . _ _ - - - - 1 - - - 1 - 2 4 Diphtheria - - - - - - - - - - - - - - - - - - 5 Whooping cough - - - _ - - _ . - - - - - - - - - — 6 Meningococcal infections - - - - - - - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - - - - - - - 8 Measles . - _ _ _ _ - - - - - - - - - - - 9 Other Infective and Parasitic diseases - - - - - - - - - - - - -1 - - 1 l 1 10 Malignant neoplasm, stomach - - - - - - - - 2 - 2 2 4 4 1 12 7 11 Malignant neoplasm, lung, bronchus - - - - - - - - 1 - 11 2 14 - 5 1 31 3 12 Malignant neoplasm, breast - - - - - - - _ _ 1 - 3 - 1 - 3 - 8 13 Malignant neoplasm, uterus - - - - - - - - - 1 - 3 - - - - - 4 14 Other malignant and lymphatic neoplasms - - - - - - - 1 1 - 10 9 11 5 12 5 34 20 15 Leukaemia, aleukaemia - - - - - - - - - - 1 1 - - - 1 1 2 16 Diabetes - - - - - - - - - - - - 1 1 - 1 1 2 17 Vascular lesions of nervous system - 1 - - - - - - - - - 6 7 8 10 16 21 31 18 Coronary disease, angina - - - - - - - - 3 - 16 2 9 1 0 11 5 39 17 19 Hypertension with heart disease - - - - - - - - - 1 1 - 3 1 3 4 7 6 20 Other heart disease - - 1 - - - 1 - 3 5 - 4 11 8 20 18 40 21 Other circulatory disease - - - - - - - - 2 - 3 4 3 14 2 6 10 24 22 Influenza - - - - - - - - - 1 1 - 1 - 2 2 4 3 23 Pneumonia 2 - - - - - - - - 2 2 2 5 4 8 8 17 16 24 Bronchitis - 1 - - - - - - - - 11 2 23 10 8 27 42 40 25 Other diseases of respiratory system - - - - - - - - 1 - 3 1 4 1 - - 8 2 26 Ulcer of stomach and duodenum - - - - - - - - - - 3 2 3 2 1 2 7 6 27 Gastritis, enteritis and diarrhoea - - - - - - - - - - l - - 1 - - 1 1 28 Nephritis and nephrosis - - - - - - - - 2 1 2 2 - 1 - - 4 4 29 Hyperplasia of prostate - - - - - - - - - - - - 1 - 2 - 3 - 30 Pregnancy, childbirth, abortion _ - - - - - - - - - - - - - - - - - 31 Congenital malformations 1 2 - 1 - - - - - 1 - - - - - - 1 4 32 Other defined and ill-defined diseases 2 2 - 1 - - - - 2 2 2 1 6 8 5 5 17 19 33 Motor vehicle accidents - - - - - 1 1 - - 1 - - - - - 1 1 3 34 All other accidents 1 2 - - - - _ - 1 - 1 1 - 3 - - 3 6 35 Suicide - - - - - - - - 3 - 3 1 - 1 6 2 36 Homicide and operations of war - - . - - - - - - - - - - - - - - - -13- SECTION B SANITARY CIRCUMSTANCES OF THE BOROUGH (1) Water Supply Water for domestic purposes in the Borough is obtained in all cases from the Metropolitan Water Board. Bacteriological and chemical examination of the water is carried out at frequent intervals by the Metropolitan Water Board. The results of examination are available to the local authority and they were uniformly satisfactory during 1953. There has been no evidence that the water has a plumbo-solvent action. Notices were sent to the Board in 41 cases where wastage of water due to defective pipes or fittings was observed. During the year 196 new premises were certified as having a proper and sufficient water supply in accordance with Section 95 of the Public Health (London) Act, 1936. In addition to the supply from the Metropolitan Water Board, there are five wells used for purposes other than drinking. These aret:- Attached to Council's Public Baths 1 Attached to a hospital 1 Supplementary supply for industrial purposes 3 (2) Sanitary Inspection of the Borough The Borough was divided into six sanitary inspectors' districts and Table 2, which follows, gives a summary of the work of the inspectors. The major portion of the work was concerned with insanitary conditions. Following the 2,745 complaints of insanitary conditions sanitary defects were found requiring the service of Intimation Notices in 2,104 cases. Of these statutory notices were required in 874 instances and legal proceedings were instituted in 80 cases. The main types of defects found are shown in Table 3. / -14- In connection with the supervision of drainage works, a total of 2,868 inspections were made during the year. Fourteen notices were served under Section 40 of the Public Health (London) Act, 1936, and in two instances the necessary work was carried out by the Council, the expenses incurred being recovered from the owners of the property It had been necessary on account of. staff. shortage, etc., to utilise the services of the factory inspector for district work and other duties and the work of inspecting the factories was in arrear. During 1953, it was decided that- the district inspectors should be responsible for the routine inspection of factories and It was possible by this means almost to double the number of primary inspections that were carried out in 1952. Amongst the sanitary defects in connection with which notices were served, the number of dirty and/or dilapidated rooms dropped from almost 4,000 in 1952 to just over 2,500 in 1953. This is in part due to decisions of the magistrates that lack of decoration is not a statutory nuisance and items requiring the redecoration of a room are consequently erased from orders made by the court for compliance with statutory notices. In a recent case a similar decision by a magistrate was upheld on appeal and consequently becomes binding on magistrates in the future. -15- TABLE 2 RECORD OF VISITS Notifiable Infectious Diseases 670 Non-notifiable diseases 44 Food Poisoning 4 Complaints as to insanitary conditions 2,745 Aged and Infirm persons 52 Factories 1,235 Milkshops 565 Other Food premises 2,973 Outworkers' houses 361 Tenement houses 57 Drainage work 2,868 Smoke observations Enquiries with regard to housing 879 Other inspections and special work 3.140 Re-inspections 11,207 Total 26,807 TABLE 3 SANITARY DEFECTS IN CONNECTION WITH WHICH NOTICES WERE SERVED Dirty and/or dilapidated rooms 2,553 Defective drains and choked W.C.'s 241 Defective and dirty W.C.'s 1,039 Defective water supply 65 Defective paving Defective gutters and rain water pipes 371 Defective roofs 866 Dampness ., 1,l8l Defective dustbins 171 Smoke Nuisances 8 Other defects 2,627 Total 9,182 -l6- (3) Supply of Dustbins It has been the practice for many years in Bethnal Green for the owner of the house to supply the dustbin and it is only during recent times when the price of bins has Increased and the ownership of property has become increasingly uneconomic that there have been objections to the continuance of this practice. In the great majority of cases an informal notice to the owner has been sufficient to obtain the supply of a new dustbin and this has probably been assisted by the fact that the Borough Council has been unable to supply a standard bin for £1 which is somewhat less than the price charged by private traders. In eighteen cases during the year it was necessary for the Council to consider the service of a notice under Section 105 of the Public Health (London) Act, 1936, and in consideration of all the circumstances notice was served on the owner in seventeen cases and on the occupier in the remaining one. In no case was an appeal lodged. CO Legal Proceedings It was found necessary on 80 occasions during the year to take legal proceedings to enforce compliance with the requirements of Notices served. In 24 of these cases Abatement Orders were made by the Magistrate with the infliction of costs amounting to £64. Is. Od. Brief details are set out below. Abatement Orders Premises Offence Result of Proceedings 128, Columbia Road Non-compliance with Nuisance Notice Abatement (28 days) Order made £3.3.0 costs ro CO Wennington Road do. do. do. 59, St. Peter's Avenue do. do. do. 63, St. Peter's Avenue do. do. do. 65, St. Peter's Avenue do. do. do. «7, St. Peter's Avenue do. do. do. 169, Cambridge Heath Road do. do. do. 74, Canrobert Street do. do. £2.12.6 cost 17, Felix Street do. do. do. 20, Clare Street do. do. do. -17- Abatement Orders (continued) Premises Offence Result of Proceedings 16, Longman Street Non-compliance with Nuisance Notice Abatement (28 days) Order made £2.12.6 costs 18, Longman Street do. do. do. 104, Cranbrook Street do. do. do. 55, Linden Buildings do. do. do. 34, Granby Street do. do. do. 28, Ducal Street do. do. do. 12, Chambord Street do. do. do. 54, Barnsley Street do. do. do. 34, Linden Buildings do. do. do. 73, Granby Street do. do. do. 16/19, Delamere Buildings do. do. do. 55, Mape Street do. do. do. 42, Linden Buildings do. do. do. 18, Austin Street do. Abatement (14 days) Order made 1 No costs A Closing Order was granted by the Magistrate in respect of 98, Gibraltar Walk for non-compliance with Nuisance Notice and £3.3s.0d. costs were awarded to the Council. In 55 cases summonses were withdrawn owing to the nuisances being abated prior to the date of hearing, the defendants paying expenses amounting to £78. 15s. 0d. (5) Rent and Mortgage Interest (Restrictions) Acts During the year the number of certificates of disrepair issued to tenants was 25, and certificates of fitness were granted on application of property owners in 15 cases. (6) Swimming Baths 24 samples of water were taken during the year from the Council's Public Swimming Baths and submitted for bacteriological examination and chemical analysis. The reports showed that the water consistently maintained a high degree of purity. -18- (7) Factories, Workshops and Workplaces Factories and Workplaces in this Borough carrying on a variety of trades number 1,455 and a total of 1,266 inspections and reinspections were made during the year. A number of visits were made in regard to drainage and applications under the Town and Country Planning Act, 1947. The following Tables give details of work carried out under the Factories Acts, 1937 and 1948, during the year:- -19- TABLE 4 INSPECTIONS FOR THE PURPOSE OF PROVISIONS AS TO HEALTH Premises Number on Register Number of Inspections Written notices Occupiers prosecuted \ 1. Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 616 503 55 - 2. Factories not included in (l) in which Section 7 is enforced by the Local Authority 835 759 116 - 3. Other premises in which Section 7 is enforced by the Local Authority 4 4 TOTALS 1,455 1,266 171 - -20- TABLE 5 CASES IN WHICH DEFECTS WERE FOUND Particulars No, of Cases in which Defects were Found No. of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 66 46 3 2 _ Overcrowding - - - - - Unreasonable temperature 2 - - - - Inadequate ventilation 4 2 - - - Ineffective drainage of floors 1 1 1 - - Sanitary conveniences:- (a) Insufficient 5 4 - 2 - (b) Unsuitable or defective 358 241 7 76 - (c) Not separate for sexes 3 - - 3 - Other offences against the Acts - (not including offences relating to outwork) 147 106 4 1 - TOTALS 586 400 15 84 - -21- OUTWORK i SECTION 110 No. of Outworkers in August list required by Section 110 (1) (c) Wearing apparel (Making, etc. Cleaning and washing) 172 Curtains and Furniture hangings 32 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 37 Chocolates and sweetmeats 40 Cosaques, Christmas crackers, Christmas stockings, etc. 34 Total 315 Section 110. There was no case of default in sending list to the Council. Section 111. There was no,£instance of work being carried on in unwholesome premises. (8) Shops Acts During the year the Sanitary Inspectors paid 345 visits to shops in relation to general sanitation, ventilation and temperature requirements. 43 notices were served in respect of unsatisfactory conditions found to exist. (9) Disinfection and Disinfestation The following is a summary of the routine work carried out by the disinfecting staff during the yean- No. of rooms disinfested 979 Articles of clothing, bedding, etc., submitted to steam disinfection 2,288 Articles disinfected by formalin 298,539 Hospital mattresses, pillows, etc., disinfected 5.359 Number of articles destroyed by request 584 In addition, all bombed sites, static water tanks and stables in the borough were sprayed with insecticide as preventive measures against flies and mosquitoes during the summer months. The furniture and bedding of 221 families removing to Borough Council flats were disinfested. -22- (10) Personal Cleansing Station During the year, 34 adults and 1 child had baths for verminous conditions at the Personal Cleansing Station, simultaneous disinfection of clothing being carried out. The majority of adults concerned were men from a Common Lodging House. In addition, 14 adults received treatment for Scabies at the Station. Sanitary Inspectors visit and advise in all cases of Scabies and In those cases where verminous conditions persistently recur. During the year, the Public Health Committee approved the purchase of mobile bathing equipment for the cleansing, by consent, of aged persons in their own homes where the persons concerned are so enfeebled as not to be able to attend at the Personal Cleansing Station. 13 such baths were given. (11) Prevention of Damage by Pests Act, 1949 During the year, 222 complaints of infestation by rats or mice were received and in most cases smoke tests of the drainage of the premises affected were carried out by the Drainage Staff under the supervision of the Sanitary Inspectors. Systematic baiting and poisoning was carried out by the Rodent Operatives on 478 premises with satisfactory results. In accordance with the suggestion of the Ministry of Agriculture and Fisheries, all sewers under the control of the Council were baited twice during the year, involving a total of 1,331 manholes. Positive results were obtained in 583 instances. (12) National Assistance Act, 1948 Under Section 47 of the National Assistance Act, 1948, as amended by the National Assistance (Amendment) Act, 1951, provision is made thereby a court of summary jurisdiction may make an order for the removal of ill, infirm or incapacitated persons who are not receiving Proper care and attention. -23- Whllst this provision Is very necessary in order to deal with unusual and very difficult cases it is one which should be resorted to only when all else has failed. A number of cases came to the notice of the Public Health Department where it was suggested that conditions would justify action under this section. Mostly they were old people living alone but there were some cases of elderly married couples. On investigation it was found that some of these people were unaware of the facilities provided by the London County Council under the Home Help Service and the provision of a Home Help solved most of the difficulties. In some cases it was possible to arrange voluntary admission to a hospital or other suitable place. In a few instances arrangements were made for adequate care to be provided by friends or relatives. In only one case was it necessary to resort to legal proceedings. A Magistrate's Order was obtained for the removal of an elderly woman to hospital, where she unfortunately died after a few days. (13) Burial of the Dead In accordance with Section 50 of the National Assistance Act, 1948,. the Council is responsible for the burial or cremation of the body of any person who had died or been found dead within the Borough, and where no private arrangements are being made for the disposal of the body. Authority is given to recover from the estate of the deceased person, or from any person who, under the Act, was liable to maintain the deceased immediately prior to his/her death, the expenses incurred in carrying out the duty, in so far as these expenses are not covered by any grant under the National Insurance Act, 1946. During the year, 12 burials were arranged by the Department at a cost of £102. 19s. Od. of which £36. 12s. Id. was recovered up to the end of the year, and a further £17. 13s. 6d. in respect of burials carried out before the period under review. (14) Mortuary The Council's Mortuary at St. Matthew's Row continued In use during 1953 and during the year 314 bodies were received and 302 post-mortem examinations were carried out. The mortuary serves the Boroughs of Bethnal Green and Shoreditch but it is an old building which is not readily capable of being modernised and it has no provision for refrigeration. -24- During the latter part of 1953 the whole matter of mortuary accommodation for the Boroughs of Bethnal Green, Poplar, Shoredltch and Stepney was reviewed with the object of making a combined arrangement and during the last months of the year bodies from the above four Boroughs were all sent to the Poplar Mortuary. Owing to a number of difficulties caused by the differing needs of the Boroughs, a final arrangement had not been settled at the end of the year but It was anticipated that the Borough of Stepney would npt join In the arrangement and that the other three Boroughs would combine to use the Poplar Mortuary as the main mortuary and that the one In Bethnal Green should be kept In readiness as a reserve mortuary so that It could be brought Into use In the event of say a serious local disaster or If for any reason the Poplar mortuary had to be temporarily closed. It was understood that an arrangement on these lines would be acceptable both to the Coroner and to the London County Council. (15) Offensive Trades There are four premises In the Borough registered for the purpose of carrying on offensive trades. One being the business of a fur skin dresser and three poultry slaughterhouses. During the year, 50 visits of Inspection were made to these premises. One premises previously licensed for the slaughter of cattle or horses has not been In use since 1939• (16) Pharmacy and Poisons Act, 1933 The provisions of the Act and the Poisons Rules relating to the sale of poisons specified In Part II of the Poisons List were administered during the year. During 1953, the names of 51 persons (46 retentions and 5 new applications) were entered on the Council's list of Persons entitled to sell Part II Poisons. All applications are investigated to ensure compliance with the and Poisons Rules. -25- (17) Rag Flock and Other Filling Materials Act, 1951 This Act provides for the licensing by the local authority of all premises used for the manufacture and/or storage of filling materials to which the Act applies, and for the registration of certain premises where such materials are used In upholstering, stuffing or lining of bedding, toys, baby carriages, etc. There are no premises In the Borough where rag flock or other filling materials are manufactured but 41 premises are registered for the use of such materials In the trades conducted therein. (18) Pet Animals Act, 1951 The operation of this Act Is probably of more Importance In Bethnal Green than In any other London borough on account of the Sunday morning dog market which has been held In Bethnal Green for many years and which serves both vendors and purchasers throughout the whole of the County of London and even beyond. The conditions under which all pet animals are sold have Improved very much indeed since the Act was Introduced. During the year 24 licences were granted In respect of shops and 54 licences in respect of stalls. Legal proceedings were instituted in one case for selling, when not licensed, a dog but the oase was dismissed It being held by the Magistrate that the sale of a single animal did not constitute the carrying on of a business. Also during the year seventeen warning letters were sent In connection with various infringements of the Act. ? f' "j ■ , «- • • ' j. -26- SECTION C HOUSING Clearance Areas (Section 25 Housing Act, 1936) During the year there was no official representation in respect of clearance areas but a survey of one area was made prior to representation. Demolition of Insanitary Houses (Section 11, Housing Act, 1936) Following official representations two Demolition Orders were made during the year. Fifteen premises were demolished as a result of Demolition Orders made previous to the year under review. An undertaking was accepted from an Owner not to use two premises for human habitation. Having regard to the effect of demolition upon adjoining property, Closing Orders were made upon three premises in accordance with Section 10 of the Local Government (Miscellaneous Provisions) Act, 1953, in lieu of making Demolition Orders under Section 11 of the Housing Act, 1936. Closing; of Unfit parts of Buildings (Section 12, Housing Act, 1936) Following official representations two Closing Orders were made during the year prohibiting the use for human habitation of four underground rooms. Repair of Unfit Houses (Section 9» Housing Act, 1936) Following the service, prior to the period covered by this report, of 197 notices requiring the owner of a block of flats to execute specified works in order to render such premises fit for human habitation, the carrying out by the Council of the necessary work (under contract with a local builder) continued during the year and Is now nearing completion. -27- Overcrowdlng (Housing Act, 1936) Details of overcrowding in the Borough, and of cases where overcrowding was abated, are given below:- No. of cases On register at end of 1952 668 New cases reported during 1953 39 Total 707 Overcrowding abated during 1953 56 On register at end of 1953 651 Families Equiv. Adults Rehoused by London County Council 27 145 Rehoused by Bethnal Green Borough Council Removed from register:- 17 89½ No longer overcrowded by reason of altered circumstances - - Removed, mostly without trace 12 67 Total 56 301½ New Housing During the year new housing accommodation was provided as shown below:- Name of Premises Provided by:- No. of flats Beatrice Webb House Borough Council 15 Reynolds House do. 60 Stafford Cripps House do. 51 Clarion House do. 6 James Middleton House do. 45 Ellen Wilkinson House do. 4 Peabody Estate (Reconstruction of one block) Peabody Trust 15 Total 196 -28- Housing Statistics General details with regards to Inspection of dwelling houses are submitted In the following tabular form:- Total number of houses In the Borough 15,948 1. Inspection of Dwellinghouses during the year:- (1) (a) Total number of dwellinghouses Inspected for housing defects (under Public Health and Housing Acts) 3,928 (b) Number of Inspections made for the purpose 15,135 (2)(a) Number of dwellinghouses (Included under subhead (1) above) which were Inspected and recorded under the Housing Consolidated Regulations, 1925 123 (b) Number of Inspections made for the purpose 3,302 (3) Number of dwellinghouses found to be In a state so dangerous or Injurious to health as to be unfit for human habitation 5 (4-) Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be In all respects reasonably fit for human habitation 2,750 2. Remedy of defects during the year without service of Formal Notices:- Number of dwellinghouses rendered fit In consequence of Informal action by the Local Authority or their Officers 603 3. Action under Statutory Powers during the Jear:- (a) Proceedings under Public Health Acts:- (1) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 2,133 (2) Number of dwellinghouses In which defects were remedied after service of formal notice:- (i) By Owners 2,372 (11) By Local Authority in default of Owners 7 (b) Proceedings under Sections 9. 10 and 16 of the Housing Act, 1936:- (1) Number of dwellinghouses In respect of which notices were served requiring repairs - (2) Number of dwellinghouses which were rendered fit after service of formal notices:- (i) By Owners (ii) By Local Authority in default of Owners 73 -29- (o) Proceedings under Sectiore 11 and 13 of the Housing Act, 1936:- (1) Number of dwellinghouses In respect of which Demolition Orders were made 2 (2) Number of dwellinghouses demolished In pursuance of Demolition Orders 15 (3) Number of Rouses closed (Local Government (Miscellaneous Provisions) Act, 1953) 3 (d) Proceedings under Section 12 of the Housing Act, 1936:- (1) Number of rooms In separate tenements or underground rooms In respect of which Closing Orders were made 4 (2) Number of separate tenements or underground rooms In respect of which Closing Orders were determined, the tenement or room having been rendered fit (e) Proceedings under Section 25 of the Housing Act, 1936:- (1) Number of dwellinghouses included in Clearance Areas - (2) Number of dwellinghouses demolished as a result of Clearance Area procedure 50 Re-Housing Programme The following statement shows the number of families and persons accommodated by the Housing Committee to the 31st December, 1953:- Premises Families Persons Council flats 232 232 844 Requisitioned properties 63 63 197 Total 295 295 1,041 At the end of the year there were approximately 2,876 applications for re-housing outstanding. -30- SECTION D INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply (1) Inspection of Premises A total of 433 visits were made in 1953. to dairies and other premises In the Borough used in connection with the distribution of milk and in 23 instances appropriate action was taken to deal with unsatisfactory conditions which were found to exist. (2) Registration and Licensing Details of premises on the register at the end of 1953 and the number of licences issued during the year under the Milk (Special Designation) Regulations, 1949, are set out below:- Number of Premises on Register at end of year Dairies 16 Distributors:- (a) Inside the Borough 112 (b) Outside the Borough 23 Number of Licences issued under Milk (Special Designation)(Pasteurised and Sterilised Milk) Regulations, 1949, and Milk (Special Designation) (Raw Milk) Regulations, 1949 Sterilised Pasteurised Tuberculin Tested Accredited Dealers' Licences 127 80 34 18 Dealers' entary Licences 23 18 18 3 Totals 150 98 52 21 One Dealer's (Pasteuriser's) Licence was Issued during the year. -31- (3) Milk Sampling During 1953. 90 Informal samples of milk were submitted to the Public Analyst for examination, all of which were reported as genuine. In addition, 90 samples of heat treated milk were submitted to tests, the results of which are set out in Table 6. TABLE 6 Class of Milk No. tested Phosphatase test Meth.Blue test Turbidity test Passed Failed Passed Failed Passed Failed Pasteurised 79 78 1 78 1 - - Sterilised 9 - - - - 9 - Tuberculin Tested (Pasteurised) 2 2 - 2 - - - Total 90 80 1 80 1 9 - 58 samples of milk were submitted to test for presence of chlorates as an indication of the efficiency of bottle washing. All were found to be free from same. (b) Meat and Other Foods Arising out of the 2,623 visits paid to shops, stalls and other premises where food is sold, prepared for sale or stored, a total of 117 notices were served in relation to unsatisfactory conditions found to exist in such premises within the Borough. Further details are given in the following table:- -32- TABLE 7 INSPECTION OF FOOD PREMISES Type Number in Borough Number Registered Inspections Notices Served Ice Cream 166 166 4l8 7 Mllkshops and Dairies 128 128 ^33 23 Butchers 51 39 312 5 Fried Fish Shops 17 16 47 - Fish Curers 9 8 34 1 Eel and Pie Shops 9 8 38 6 Miscellaneous 24 7 72 3 Offal Dealers 5 5 21 1 Other Fish Premises 5 2 15 - Restaurants 97 - 298 20 Licensed Premises 139 - 247 33 Greengrocers 60 - 117 3 Grocers 42 - 111 6 Bakehouses 28 - 109 4 Confectioners 27 - 39 - Factory Canteens 23 - 26 2 Bakers' Shops 9 - 29 2 Poultry Slaughterhouses 3 - 50 - Street Stalls 210 - 207 1 Totals 1,052 379 2,623 117 During the year, Certificates of Suitability were issued in respect of eight Underground Bakehouses in the Borough. (c) Unsound Food During the year under review Food Inspectors examined and took appropriate action in relation to-unsound food on 211 occasions. Details of the food together with-quantities are set out below:- Tons Quantity Cwts. lbs . Contlnental Sausages 8 13 49 " Ham 4 16 5½ Heat - Tinned 1 10 30 " - Carcase 1 6 52½ Fish 3 84 Rice 2 - Dried Fruit 1 76 Milk Curd 1 42 Rabbits 90 Chocolates 60 Cheese 51½ Various 78 16 17 58½ -33- Other Foodstuffs Eggs 277 Fruit l,64l tins Milk 227 tins Vegetables 167 tins Various (75 tins, 59 Jars, (26 boxes, 1 bottle Condemned Food Is collected by Council and destroyed or, where suitable, used for animal food. (d) Food and Drugs Act Mr, A.E. Parkes, F.R.I.C., F.C.S., of l6l, Bow Road., E.3., Is Public Analyst for the Borough and Mr. H.A. Parkes, B.Sc., F.R.I.C., is Deputy Public Analyst. Out of a total of 391 samples (15 formal and 376 Informal) examined by the Public Analyst during 1953, 4 of the Informal samples were found to be adulterated. -34- TABLE 8 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 Ale and Beer - - - 16 16 - 16 Confectionery - - - 19 18 1 19 Culinary Powders 1 1 - 60 58 2 6l Drugs - - - 43 43 - 43 Fish Paste - - - 15 15 - 15 Ice Cream - - - 24 24 - 24 Milk - - - 90 90 - 90 Table Jelly - - - 10 10 - 10 Whisky 12 12 - - - - 12 Various 2 2 - 99 98 1 101 TOTAL 15 15 - 376 372 4 391 -35- TABLE 9 Action taken In regard to samples reported by the Public Analyst to be not genuine. Sample No. Article Result of Analysis Action 21 Shredded Suet 2.1 per cent deficient In fat Formal Sample Genuine 48 Baking Powder 15 per cent deficient In available carbon dioxide Formal Sample Genuine 146 Butterscotch Lumps 2.2 per cent deficient in butter-fat Letter of caution 148 Baking Powder 11.2 per cent deficient in available carbon dioxide Letter of caution In addition, 4 samples were reported by the Public Analyst to be unsatisfactory, as follows:- Sample No. Article Report of Analyst Action 144 Diluted Acetic Acid Incorrectly labelled Letter of caution 301 Acetic Acid Incorrectly labelled Letter of caution 317 Milk Contained portion of horse-chestnut None. Placed In bottle by schoolchlld 364 Solution of Acetic Acid Acid attacked tin coating of metal cap Letter of caution (e) Preservatives in Food The routine practice under which all samples of milk, butter, margarine and cheese submitted to the Public Analyst, are examined for the presence of a preservative was continued throughout the year and in no Instance was a preservative found to be present. -36- (f) Ice-Cream During the year, 26 applications for registration for the sale of Ice-cream were approved. One application was refused on the grounds that other articles were being sold or handled In the shop which would Increase the danger of contamination of the Ice-cream and It was not possible or not practicable to place partitions In the shop or to use other means of avoiding this danger. At the end of the year there were 166 premises In the Borough registered for the sale of Ice-cream and 4l8 Inspections of these premises were made during the year. In 7 Instances notices were served concerning Insanitary conditions. 32 samples of Ice-cream were submitted to the Methylene Blue test and graded as follows:- Grade 1 21 Grade 2 7 Grade 3 1 Grade 4 3 (g) Food Poisoning There were no outbreaks of food poisoning during the year. Five (corrected) notifications were received, the Illnesses alleged to be due to the consumption of either a meat pie, sausages or tinned salmon. In no case was any portion of the suspected food available for submission for bacteriological examination. In one case Salmonella typhl-murium was identified and In four cases the cause was unknown. There were no deaths. (h) Clean Food Campaign The efforts of the Department for an Improved standard of hygiene In all matters relating to the manufacture, handling, storage and distribution of food have continued throughout the year. All food Premises in the Borough were visited and although it was necessary on seven occasions to send notices under Section 13 of the Food and Drugs Act, 1938, it was possible through the co-operative relationship between the occupiers and the Department to secure many desirable improvements without recourse to official action. -37- (i) Milk in Schools The arrangements for sampling milk at London County Council Schools continued without variation. A total of 40 samples were submitted for examination, all of which satisfied the prescribed tests with the exception of one sample which failed to pass the Phosphatase test for heat treated milk. (j) Milk at Nurseries Three samples of milk submitted for examination passed the necessary tests. (k) Milk at London County Council Restaurant One sample of milk submitted for examination passed the necessary tests. -38- SECTION E PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE The total number of notifications of Infectious disease during 1953 was 1,229 as compared with 1,080 In 1952. The Increase was mainly due to the larger number of cases of measles and whooping cough and these two diseases accounted for more than 75% of all notifications. There were no cases of Diphtheria during the year and this happy result Is undoubtedly due to the very successful immunisation programme which has been carried on during the past 12 years. There is a danger that the absence of cases of diphtheria not only in the Borough but throughout the County may make the need for Immunisation against diphtheria less apparent in the public eye but the risk still remains and the Council has maintained its propaganda. This is done In conjunction with the London County Council, the greater proportion of actual Immunisation being done by officers of the County Council In welfare centres and schools. Details of immunisation carried out are given in Section F of this report. Three cases of suspected poliomyelitis were notified during the year but fortunately only in one Case was the diagnosis confirmed. No cases of smallpox were notified during the year. In any outbreak of smallpox the staff of the Public Health Department Is more likely to be exposed to the infection than any other group of persons and during the year as a preventive measure all the sanitary inspectors and the staff of the disinfecting station were vaccinated or vaccinated. There was an Increase in the number of cases of dysentery notified during the year. In all cases which were confirmed bacteriologically, the disease was Sonne Dysentery which is generally only a serious disease in very young children. A number of cases did occur both in schools and in day nurseries. None of the cases were of a serious nature but a number of persons, both children and adults, were found who were excreting the causal organism although they were apparently <?ulte well and a certain amount of difficulty was experienced in ensuring the exclusion of these persons until they were shown bacteriologically to be free from infection. In the majority of cases children are admitted to the day nurseries because it is necessary for the mother to go out to work and It Is perhaps asking a good deal these mothers to expect them willingly to stay off work to look after children who are apparently in good health. The active coderation of the officers of the County Council assisted materially in controlling these outbreaks of sonne dysentery. -39- The number of oases of other diseases notified is shown in Table 10, which follows, and requires no special comment. The arrangement whereby any variation in the original diagnosis is notified by the Hospital Authorities continued in operation during the year, and Table 10, which gives details of cases notified, has again been prepared with a column showing the corrected figures for each disease after taking into consideration the latest information supplied by hospitals. -40- TABLE l0 INFECTIOUS DISEASE DISEASE NOTIFICATIONS Total Notified Corrected figures Removed to Hospital 0-1 year 1-2 years 3-4 years 5 - 14 years 15-24 years 25-44 years 45-64 years 65 - years Diphtheria - - - 2 2 1 - - 5 - 5 Scarlet Fever - 10 19 43 1 - - - 73 70 32 Puerperal Pyrexia - - - - 2 1 - - 3 3 - Ophthalmia Neonatorum 3 - - - - - - - 3 3 - Erysipelas - - - - 2 2 7 4 15 14 5 Meningococcal Infection 1 2 - 1 1 - - - 5 5 5 Acute Poliomyelitis - 1 1 - 1 - - - 3 1 3 Acute Pneumonia - 1 1 2 2 1 2 2 11 11 5 Dysentery 3 27 19 37 3 5 3 5 102 99 11 Measles 33 172 196 230 3 2 - - 636 636 46 Whooping Cough 32 82 86 90 1 1 - - 292 289 21 Scabies - - 2 2 3 3 1 2 13 13 - Pulmonary Tuberculosis - 1 4 1 15 21 17 5 64 64 Other forms of Tuberculosis - - - 2 1 1 - - 4 4 TOTALS 72 296 328 410 37 38 30 18 1,229 1,212 133 -41- Tuberculosis During the year formal notifications under the Public Health (Tuberculosis) Regulations, 1952, were received in respect of 64 cases of respiratory tuberculosis and 4 non-respiratory cases as compared with 71 and 8 cases respectively for the previous year. The following table gives details of the age and sex incidence of these cases:- TABLE 11 Primary Notifications Age periods 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Respiratory males - - 2 1 - 3 2 7 3 4 12 4 - 38 Respiratory females - - 3 - - 6 4 10 l 1 - 1 - 26 Non-respiratory, males - - - - - - - - - - - - - - Nonrespiratory, females - - - 2 - 1 - - 1 - - - - 4 In addition to the above, information was received of 25 other cases from the following sources:- Local Death Returns 1 Registrar General's Death Returns (transferable deaths) 1 Posthumous notifications Transfers from other areas 23 There were 9 deaths during the year certified as being due to Tuberculosis. -42- TABLE 12 The following table shows the number of cases on the Tuberculosis Register at the end of 1952, variations which have taken place during the year, and the number of cases remaining on the Register on the 31st December, 1953. Pulmonary Non-pulmonary Total Males Females Males Females No. of cases on register 31. 12. 52 388 289 72 68 817 No. of cases notified during 1953 38 26 - 4 68 Other cases added to register during 1953 9 14 - - 23 Cases transferred from Nonpulmonary to Pulmonary - - - - - 435 329 72 72 908 No. of cases removed from register during 1953 30 27 1 4 62 Cases transferred to Pulmonary from Non-pulmonary - - - - - Remaining on register 31. 12. 53 405 302 71 68 846 The following Information concerning the Tuberculosis Dispensary at the London Chest Hospital, E.2., has been furnished by the Tuberculosis Officer, Dr. M. Caplln:- Times of Clinics Monday 10.00 - 12.00 Wednesday 10.00 - 12.00 5.00 - 6.30 " 2.00 3.30 (Refills) Thursday 10.00 - 12.00 " 2.00 - 3.30 (Refills) Friday 10.00 - 12.00 " 1.30 - 2.30 (B.C.G.) Saturday 10.00 - 12.00 -43patients requiring Institutional treatment can be admitted to any of the sanatoria, or hospitals dealing with tuberculosis, under the North East Metropolitan Regional Hospital Board. In addition, patients with certain types of the disease can be admitted to the London Chest Hospital or to the Country Branch at Arlesey near Letchworth. During 1953, the Public Health Committee authorised the Issue of a suitable disinfectant to tuberculous persons for use in sputum flasks and for the soaking of handkerchiefs. During the year 32 ½ pint tins of disinfectant were issued upon the authority of the tuberculosis visitors. -44- SECTION F GENERAL PROVISION OF HEALTH SERVICES OTHER THAN THOSE PROVIDED BY THE BOROUGH COUNCIL 1. (a) Laboratory Facilities The bacteriological work of the Borough was carried out as part of the National scheme by the Public Health Laboratory Service (directed by the Medical Research Council for the Ministry of Health). During the year the laboratory at 134, Denmark Hill, S.E.5 was closed and arrangements made for the examination of specimens at the new laboratory, Room 617, County Hall, S.E.1. (b) Ambulance Facilities The London County Council which undertook responsibility for the provision of ambulance transport within the administrative County of London on the coming Into force of the National Health Service Act, 1946, continued to provide this service during 1953. 2. Hospitals The following Hospitals In the Borough continued to be administered by the North East Metropolitan Regional Hospital Board:- Total bed complement ø Bethnal Green Hospital 313 Mlldmay Mission Hospital 56 Queen Elizabeth Hospital for Children (with branches at Shadwell and Banstead) 317 ø These figures do not necessarily represent beds staffed and In use. The London Chest Hospital designated a Teaching Hospital and under the control of a Board of Governors, Is also situated within the Borough and the Tuberculosis Dispensary established at this Hospital, which serves Bethnal Green and part of the Borough of Hackney, continued to function during the year. The Little Folks Home at Bexhill, which Is associated with the Queen Elizabeth Hospital for Children, has a complement of 40 beds. -45- 3. Personal Health Services The following information regarding the operation of the personal health services in the Borough during 1953 has been furnished by Dr. G.O. Mitchell, Divisional Medical Officer (Division 5) London County Council. (a) Services Available Day Nurseries:- Columbia Market, Columbia Road, E.2. Prltchards Road, E.2. University House, Sugar Loaf Walk, E.2. Maternity and Child Welfare Centre, Cornwall Avenue, E.2:- Monday 2-4 p.m. - Ante-natal Clinic Monday afternoon - Physiotherapy Clinic Tuesday 10 a.m. - 12 noon - Ante-natal Clinic Tuesday 2-4 p.m. - Infant Welfare Clinic Wednesday 2 - 4 p.m. - Infant Welfare Clinic Wednesday 2 - 4 p.m. - Vaccination and Immunisation Thursday 10 a.m. - 12 noon - Ante-natal Clinic Friday 2 - 4 p.m. - Infant Welfare Clinic Friday (second and fourth weeks in month) 2-4 p.m. - Toddlers Clinic Friday morning - Physiotherapy Clinic. School Treatment Centres:- Bethnal Green School Treatment Centre, Lyte Street, E.2. Rochelle Street Treatment Centre, Rochelle Street School, E.2. Foot Clinic:- Bethnal Green School Treatment Centre, Lyte Street, E.2. Monday and Tuesday afternoons - 2 - 5 p.m. -46- (b) Statistics (1) Infant Welfare Centres Total No. of children who first attended during the year and who on the date of their first attendance were:Under 1 year of age 663 1-5 years of age 56 Total No. of children who attended and who at the end of the year were:Under 1 year of age 606 1-5 years of age 875 Total attendances by children:- Under 1 year of age 6,395 1-5 years of age 1,658 (2) Ante-natal and Post-natal clinics Ante-natal consultations:- No. of women who attended for the first time 409 No. of women who attended 513 Total attendances 2,331 Post-natal consultations:- No. of women who attended 26 (3) Health Visitors No. of infants under one year of age visited for the first time 873 Total visits to infants under 1 year of age 5,882 Total visits to children 1 to 5 years of age 9,l8l No. of expectant mothers visited 425 Total visits to expectant mothers 701 (4) Infant Life Protection No. on register, 1st. January, 1953 Poster mothers 2 Foster children 1 No. on register, 31st December, 1953 Foster mothers 1 Foster children 1 -47- (5) Child Minders (Daily Guardians) No. of Dally Guardians - Statutory - Voluntary 19 No. of children minded - Statutory - Voluntary 10 (6) Care of Premature Infants No. of premature births during the year 48 No. of deaths under 1 month 13 (7) Diphtheria Immunisation No. of children who completed a full course of primary Immunisation:- Under 5 years of age 571 5 to 14 years of age 51 No. of children wfyo were given a secondary or reinforcing Injection 440 (8) Vaccination No. of children successfully vaccinated or re-vaccinated 309 (9) Domestic Help Service Domestic help was provided as follows:- Maternity T.B. Aged and Other cases cases Infirm cases cases Northern District Office - covering Bethnal Green and parts of Stepney and Cit$- of London 31 22 719 58