EAS 33 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health For the Years 1956 JOHN S. COLEMAN, M.B., B.S. (LOND.) M.R.C.S. L.R.C.P. D.P.H. (ENG.) Medical Officer of Health Principal School Medical Officer. COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health For the Years 1956 and 1957 JOHN S. COLEMAN, M.B., B.S. (LOND.) M.R.C.S. L.R.C.P. D.P.H. (ENG.) Medical Officer of Health & Principal School Medical Officer. 1. PRINCIPAL CONTENTS SECTIONS:- PAGES Constitution of Council 2 Public Health Staff 4 Introduction 5 Statistical and Social Conditions of Area 7 Infectious Diseases 22 General Provision of Health Services 31 National Health Service Act, 1040:- Sec. 22 Care of Mothers and Young Children 35 Sec. 23 Midwifery Services 42 Sec. 24 Health Visiting Services 46 Sec. 25 Home Nursing Services 47 Sec. 20 Vaccination and Immunisation 49 Sec. 27 Ambulance Services 52 Sec. 28 Prevention of Illness, Care and After-Care 53 Sec. 28 & 51 Mental Health Services 58 Sec. 29 Home Help Services 03 Sanitary Section and Housing 65 Inspection and Supervision of Food 68 2. EAST HAM CORPORATION COUNCIL (shewing Chairmen and Vice-chairmen of Health, M. & C.W., Mental Health and Education Committees). THE MAYOR: Mr. Councillor John Albert Kemp, J.P. (1956/7) Mr. Councillor Edwin John Davey, J.P. (1967/0) THE DEPUTY MAYOR: (1) Mr. Alderman Walter Edwin Hurford (1968/7) Mr. Alderman Frank. Herbert Howard (1967/8 ALDERMEN: Mr. William Henry Whlttock Beecham (Deceased 24.9.56) Mr. Leslie Alfred Victor Bennett. Mr. Charles William Bradlng, J. P., C. R. P. Mr. Charles William Dixon Mr. Sidney Arnold Elson (From 23.10.56) Mr. John Albert Hart, J. P. Mr. Herbert Percy Jackson, J. P. (5) Mrs. Winifred May Knight. Mr. Alfred Prior J. P. COUNCILLORS: (6) Mr. Charles Frederick Chapman Mr. Frederick George Pryer Clayton Mrs. Ruby Lilian Collett. (2) Mrs. Daisy May Davey. (4) Mrs. Elsie Mary Devenay Mr. William Doran. Mr. Frederick Robert William Easter. Mr. Charles Edward Ellett. Mr. Sidney Arnold Elson (Until 22.10.66) Mr. Roy Evans (1957/8) Mr. Henry John Fisher Mr. Frances William French Mr. Leonard Lewis Griffiths Mr. Stanley John Hobbs. Mr. Reginald Arthur James, (1966/7) Mr. Thomas. Alfred Jenklnson. Mr. Harold Francis Lugg Mr. Stanley Henry Mall Mr. Arthur George Murrell Oakes. Mr. John Henry Pagett. Mr. Reuben Frederick Ricketts. Mr. Albert Cyril Smith. Miss Florance Louisa Stevens, M.B.E. (3) Mrs. Lily Sutton. Mr. Joseph Charles Taylor. Mrs. Dorothea Minnie Wood. Mr. Thomas Henry Wood Mr. Albert William Wyman Co-opted members of the Health, M. & C.W., Mental Health and Education Committees:- Dr. O Thomas Mr. W.E. Revlll Health Mrs. A.A. Bradshaw Mrs. E. Bamford Mrs. L. Willis (1967/8) Mrs. Foord (1966/7) Maternity and Child Welfare Mr. S. C. Foreman Mrs. E. Gadd Mr. H. F. McNeil Mental Health 3. Mrs. M. E. Bennett. J. P. Rev. V. Hurley. Mr. R. Evans (1056/7) Mr. 0. Marshall (1956/7) Mr. H.J. Pitt Mr. L.S.J. Witter, B. Sc. Nr. R. A. Horsley (1957/8) Mrs. M.M. Lawes (1957/8) Mr. B. Holmes, B. Sc. Education (1) Chairman, Health Committee & Mental Health Sub-committee (1956/7 & 1957/8) (2.) Vice-Chairman, Health Committee (1956/7) (3) „ „ „ „ (1957/8) (4) Chairman, Maternity & Child Welfare Sub-Committee (5) Chairman, Education Committee (6) Vice-Chairman, Education Committee 4. STAFF Medical Officer of Health and Principal School Medical Officer J. S. COLEMAN, M.B., B. S., M. R. C. S.. L. R. C. P., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer J. DRUMMOND, M. B. , Ch. B., D. P. H. Assistant Medical Officers - 0. CROSBY, M. R. C. S., L. R. C. P. M. B. GALVIN, M. B., Ch. B., B. A. O. (Dublin) F. GASKELL, M. R. C. S. , L. R. C. P. J. T. REES, M.R.C.S., L.R, C.P. A. Wilkes, M. B. , B.S., D.P.H. Principal School Dental Officer - ALLAN ROSS, M. R. C. S., L. R. C. P., B. D. S. Chief Public Health Inspector and Food and Shops Act Inspector D. G. TONKIN, M.P.H.I. A. Superintendent Nursing Officer and Non-Medical Supervisor of MidwivesM. SHIRLAW, S. R.N., S.C.M., H.V's. Cert., Q.N. Superintendent Health Visitor:- B.L. MARYON, S.R.N., S.C.M., H.V'S. Cert. (R.S. I.). Senior Tuberculosis Visitor- F.M. ROGERS, S. R.N., T. A. Cert. Chief Administrative Assistant H.J. HORSNELL 5. COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, East Ham, E. 0. TO: THE WORSHIPFUL THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE COUNTY BOROUOH OF EAST HAM. Mr. Mayor, Ladles and Gentlemen, I have the honour to present my reports for the two years 1956 and 1957 and to remark the welcome recovery in the birth rate from the record low figure of 11.7 in 1956 to 12.5 in 1957. It is hoped the birth rate will continue to rise in view of the overall decline in population which stood at 120,873 in 1951, 114,400 in 1956, and has further declined to 112,700 in 1957. It is gratifying also to report the fall in infant mortality from 22.9 in 1956 to 15.2 per 1,000 live births in 1957. The corresponding figures for England and Wales stand at 23.8 and 23.1 so that our low infant mortality, a record for East Ham, may well reflect a long step forward in the maternity and paediatric services given to our people, or alternatively could be regarded as a barometlc Index of the social and cultural uplift of family life. Fewer children died under the age of 4 weeks (15 per annum in both years under review) and this sharp decline in neo-natal mortality is probably the most pleasing fact to note in the analysis of the vital statistics. However, of the 15 infants who in each year died at or within the four weeks of birth, 8 succumbed from prematurity in 1956, and 6 in 1957, and we are little likely to see further striking improvement in perinatal mortality figures until the problems of the causation of prematurity are elucidated. I have referred to this matter in my reports of 1953/1954 and followed up by urging strongly the discontinuance of work for financial gain by expectant mothers after the 30th week of pregnancy. It is some consolation to find that whereas in 1955 there were 25 perinatal deaths with 18 (72%) dying of prematurity, in 1957 there were 15 perinatal deaths in which 6 (40%) were attributable to this cause. In my 1955 report I referred to deaths in women from cancer of the lung, and the following table again brings to public notice the fact that each year a number of women die in this way, whose cancer was probably associated with cigarette smoking over a long period and whose deaths probably were preventable. 1957 1956 1955 1954 Cancer of breast. 19 28 23 21 Cancer of womb. 5 11 4 4 Cancer of stomach. 40 42 28 35 CANCER OF LUNGS. 83 52 66 47 In many spheres of social life, women play a leading role in ordering and developing the march of conduct in the young men in the community. The smoking mother and smoking young girl are a challenge to young boys which can be answered only in one way, to smoke even more assiduously to assert their manhood. The male leaders in the family and the community are falling miserably in their duty to lead the young away from the pernicious habit of smoking. The wonen who I believe set much of the standard of social conduct, need not fall If they will bend their efforts to achieve that in which their men folk have abjectly failed. In the body of the report will be found some preliminary observations on the value of B. C. G. vaccination given to children in the penultimate year of their school life. So encouraging are the results of the B.C.G. trials conducted by the Medical Research Council in East Ham and elsewhere, that it could be said a signal advance has been made in the preventive field in the fight against tuberculosis, and the protection which can be afforded this vulnerable group of the young adult population should spare many adolescents on the threshold of a business or professional career, the terror and torment of tuberculosis. 6. In the maternity sphere a.closer working unison with the hospitals has been achieved, so that at least for expectant mothers who need admission to hospital at any time during the gestation period, for toxaemia of pregnancy or other medical condition, a ted is readily available. In view of the continued need for maternity beds for East Ham mothers - over 70% of confinements take place in hospital - the administrative machine controlling admission will have to be re-geared. It should not be necessary for the Medical Officer of Health, at certain times of the year, literally to be hunting around for maternity beds to satisfy the requirements of mothers whose social or environmental circumstances demand hospital confinement. The Hospital Management Committees have been made aware of our predicament and the Group Secretary does everything possible to meet my requests for maternity beds in the area during periods of difficulty. The problems of old people still continue to crop up with disturbing frequency. Our services are extended fully to support the old folk, to achieve, in some semblance of decency and comfort, the Independence of their own homes. But physical illness or mental deterioration easily upsets the oft delicately poised balance between adequate comfort and squalor, and the greatest problem of all is to obtain temporary admission to hospital for such old people, to tide them over until independent existence can once more be resumed. In the body of the report will be found details of the medico social services which come under the aegis of the Health Department, and statistics and social conditions of the area. Close study of these matters surely will lead to the conclusion that East Ham offers to its residents personal health services of high quality as well as educational and cultural facilities of a progressive character. I would like to take this opportunity to thank the Chalrr.ian and all the members of the Health Committee who have evinced an abiding interest in the work, and the deepest concern for the well-being of every section of the community. And to thank also the medical and health visitor staff and the administrative and clerical staff without whose zealous services the wheels of progress would soon become clogged. I have the honour to be, Mr. Mayor, Ladles and Gentlemen, Your obedient Servant, J.S. COLEMAN Medical Officer of Health and Principal School Medical Officer. 7. STATISTICAL AND SOCIAL CONDITIONS OF THE AREA 1956 ] SOCIAL. Area (in statute acres) land and water .. 3,324 3,324 Population. Census - April 1961 120,873 120,873 Estimated civilian population - Mid. year 114,400 112,700 Number of inhabited houses (end of year according to rate books) (including tenements and shops but excluding factories, cinemas, government properties corporation properties (offices and works), utility undertakings and other miscellaneous herlditaments not actually occupied as dwellings) 31,937 31,966 Rateable value at 31st December £1,520,437 £1,424,851 Sum represented by a penny rate for the year £6,184 £6,447 EXTRACTS FROM VITAL STATISTICS 1950 1957 M F T M F T Live Births Legitimate 708 637 1.345 712 681 1,393 Illegitimate 19 29 48 36 18 64 Totals 727 666 1,393 748 699 1,447 Still Births Legitimate 10 13 31 22 17 39 Illegitimate - 2 2 2 1 3 Totals 18 15 33 24 18 42 Birth Rate per 1,000 population 12.1 12.8 Still Birth Rate per 1,000 population 0.28 0.37 Still Birth Rate per 1,000 Total (Live and Still) Births 23.1 28.2 Deaths Males 634 665 Females 546 581 Total 1,180 1,246 Death Rate per 1,000 population 10.3 11.0 Deaths from Cancer (all ages) 245 267 Deaths Rate per 1,000 total (Live and Still) Births Deaths from Puerperal Causes 1956 1957 1956 1957 Puerperal Sepsis _ - - - Other Maternal Causes - 1 - 0.67 Total NIL 1 0.07 Death Rates of infants under one year of ages- All infants per 1,000 live births 22.9 15.8 Legitimate infants per 1,000 legitimate live births 22.3 15.6 Illegitimate infants per 1,000 illegitimate live birts 41.6 0.00 8. POPULATION The Registrar General's estimates of the population at 30th June each year were:- 1956 - 114,400 1957 - 112,700 The corresponding figure for 1955 was 116,100. The various rates per 1,000 population quoted in this report are based on the above estimate PUBLIC HEALTH ACT 1936 - SECTION 203 The following tabulation shows the number of births notified each year, as adjusted by transferred notificatlons:- (a) Live Births: 1956 1957 (1) Domiciliary 298 284 (11) Institutional 1,090 1,436 (b) Still births: (1) Domiciliary 1 5 (11) Institutional 31 35 (c) Totals (1) Domiciliary 299 289 (11) Institutional 1,121 1,471 Grand Totals 1,420 1,760 Number of premature infants notified during the years (including transferred notifications) where the mothers normally reside in the area. 1956 ] (1) Born at home 15 9 (11) Born in hospital or nursing home 63 71 Totals 78 80 The number of births assigned to the area and birth rates for the years under review, with comparative figures for previous years are shown in the following tabulation: 1953 1954 1955 1956 ] Number of live births 1.606 1.526 1.441 1.393 1.447 Birth rate per 1,000 population 13.5 12.9 12.4 12.1 12.8 Area comparability factor 0.95 0.95 0.95 0.97 0.98 Corrected birth rate 12.8 12.2 11.8 11.7 12.5 Birth rate for England and Wales 15.5 15.2 15.0 15.6 16.1 STILL BIRTHS The numbers of still births registered and the rates per 1,000 total (live and still) births are shown in the following table, together with comparable figures for the preceding three years: 1953 1954 1955 1956 1957 No. of still births 30 28 41 33 42 Rate per 1,000 total births 18.3 18.0 27.6 23.1 28.2 The still birth mortality rates for England and Wales and East Ham are shewn in the following table:- TABLE I Still births per 1,000 population 1953 1954 1955 1956 1957 England and Wales 0.35 0.36 0.33 0.36 0.37 East Ham 0.25 0.23 0.35 0.28 0.37 9. DEATHS Details of deaths of residents In 1956 and 1967 with comparative figures are shown below:- 1964 1965 1956 1957 Number of deaths notified 1,143 1.168 1.180 1.246 Death rate per 1,000 population 9.7 9.9 10.3 11.0 Area comparability factor 1.06 1.06 1.12 1.11 Corrected death rate 10.2 10.4 11.6 12.2 Death rate Tor England and Wales 11.3 11.7 11.7 12.2 Number of deaths occurring in institutions.. 608 626 650 710 (63.2%) (54%) (56%) (66.9%) Number of deaths occurring outside the borough 624 648 683 626 Number of non-residents dying in the borough 69 88 73 91 The number of deaths In the various age groups was as follows:- 1966 1957 M F T M F T Under 1 year 23 9 32 16 6 22 1-4 years 2 1 3 3 1 4 6-14 years 1 1 2 2 1 3 15-24 years 2 2 4 6 4 10 25 - 34 years 4 2 6 11 12 23 35 - 44 years 16 9 24 15 15 30 45 - 54 years 64 40 104 67 38 105 65 - 64 years 124 66 190 127 76 203 66 - 74 years 170 133 303 215 149 364 75 - 84 years 178 206 384 175 200 375 85 - 94 years 51 63 114 26 75 101 95 years and over - 14 14 2 4 6 Totals 634 546 1,180 666 681 1,246 INFANTILE MORTALITY The following tabulation shows details of deaths of infants under one year, comparative figures for England and Wales and for the years 1964 and 1965 being quoted: 1954 1955 1966 1957 Number of deaths of infants under one year of age 30 35 32 22 Infant mortality rate (per 1,000 live births) 19.6 24.2 22.9 16.2 Rate for England and Wales 25.5 24.9 23.8 23.1 Number of deaths of illegitimate infants under one year of age 3 1 2 NIL Mortality rate (per 1,000 illegitimate live births) 71.4 24.6 41.6 - NEO-NATAL MORTALITY The number of deaths of children under the age of four weeks and the causes of such deaths were as follows:- 1964 1955 1956 1957 Number of children dying under the age of four weeks 27 26 15 15 Neo-Natal mortality rate (per 1,000 live births) 17.6 17.3 10.7 10.3 Cause of death Number of deaths 1956 1957 Atelectasis - - Pneumonia - - Premature Birth 8 6 Congenital Malformation, Birth Injury, etc. 4 1 Other causes 3 8 Total 15 15 10. Comment has already been made in the foreword to this report on the reduction in neo-natal mortality. The problem of prematurity remains, with foetal and infant deaths arising therefrom as the hard oore of the matter to be resolved before substantial further progress is made. Supervision of the ante-natal period by the Health Visitor and Midwife, guided and assisted by the Oeneral Practitioner Obstetrician and Local Authority medical staff, will continue, in a Joint effort to effect the maximum possible saving of infant life. MATERNAL MORTALITY There were no deaths from maternal causes in 1950 and one such death in 1957 giving a maternal mortality rate per 1,000 live and still births of 0.67. TABLE 2 - BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1956 Live Births per 1,000 Population Still Births per 1,000 Total (Live and Still Births) Annual Death Rates per 1,000 Population Deaths of infants under one year (Rate per 1,000 Live Births All Causes Malignant Neoplasm Lung and Bronchus Acute Pollonyelitis Pneumonia Whooping Cough Diphtheria Influenza Coronary Disease, Angina Pectoris Tuberculosis (All Forms) England and Males 15.6 22.9 11.7 0.41 0.00 0.52 0.00 0.00 0.00 1.67 0.12 23.8 Great Towns 15.6 23.0 11.6 0.47 0.00 0.57 0.00 0.00 0.04 1.68 0.14 24.0 Smaller Towns 15.6 22.7 11.6 0.39 0.00. 0.45 0.00 0.00 0.05 1.71 0.11 24.1 London - Administrative County 15.9 20.2 11.7 0.58 0.00 0.67 0.00 0.00 0.04 1.70 0.14 21.4 EAST HAM 11.7 23.1 11.5 0.45 0.55 - - 0.01 1.46 0.11 22.9 A dash (-) signifies there were no deaths 11. TABLE 3 - BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1957 Live Birth Rates per 1,000 Population Still Birth Rates per 1,000 Total (Live and Still Births Annual Death Rates per 1,000 Population Deaths of Infants under one year. (Rate per 1,000 Live Births) All Causes Malignant Neoplasm Lung and Bronchus Acute Poliomyelitis Pneumonia Whooping Cough Diphtheria Influenza Coronary Disease, Angina Pectoris Tuberculosis (All Forms) England and Wales 16.1 22.5 12.2 0.43 0.01 0.52 0.00 0.00 0ll5 1.70 0.11 23.1 Great Towns 16.1 22.5 11.5 0.50 0.00 0.58 0.00 0.00 0.15 1.72 0.12 23.5 Smaller Towns 16.0 23.2 11.4 0.40 0.00 C.47 0.00 - 0.15 1.72 0.10 23.5 London - Administrative County 16.2 20.0 11.4 0.61 0.00 0.65 0.00 0.00 0.12 1.70 0.13 21.9 EAST HAM 12.5 28.2 11.5 0.61 - 0.85 -- - 0.16 2.22 0.18 15.2 A dash (-) signifies there were no deaths 12. 13. Study of these tables of mortality Tor 1956 and 1957 show that in East Ham the deaths of infants under one year of age declined during these years to give the present figure (1957) of 15.?. per 1,000 live births, the lowest infant mortality rate in the country. This may reflect in some measure the advance in the field of child nurture in the community and the value of the Health Visiting and Paedlatrlc Services in our borough. The general practitioners also increasingly are sharing the responsibility for infant welfare with the Local Authority's staff. TABLE 4 - CAUSES OF DEATH IN AGE GROUPS 1956, AND TOTAL DEATHS FOR THE YEARS 1952 - 1956 Reference No. Cause of Death Deaths at different periods of life of residents (including non-civilians) whether occurring within or without the district Total deaths in Institutions Total deaths for the years All Ages Under 1 year L - 4 Years. 5- 14 Years 15-24 Years 25-44 Years 45-64 Years 65-74 Years 7b Years and above 1956 1955 1954 1953 1952 M F M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratiry 8 4 - - - - - - - - - 1 3 2 2 - 3 1 5 3 12 13 12 18 26 2. Tuberculosis, other forms - 1 - - - - - - - - - - - - - - - - - 1 1 1 - 3 2 3. Syphilitic Disease 3 1 - - - - - - - - — — — 1 2 — 1 — 2 1 4 7 — 4 8 4. Diphtheria - - — - — — - - — — — ~ — — — - - - - - — — — — 5. Whooping Cough - — - — — — - - — — — - - - - - - - - - - — — — 6. Meningococcal Infections 2 - 1 - 1 - - - - - - - - - - - - - 1 - 2 — 1 1 - 7. Acute Poliomyelitis - - - - - - - - - - - - — — - — — — - - — — — — 2 8. Measles - - - - - - - - - - - - - - - - - - - - - 1 — — - 9. Other Infective and Parasitic Diseases 1 - - - - - - - - - - - 1 - - - - - 1 - 1 3 1 2 2 10. Malignant Neoplasm, Stomach 23 19 - - - - - - - 1 - - 10 9 9 3 4 6 11 7 42 28 37 3b 49 11. Malignant Neoplasm, Lung, Bronchus 46 6 - - - - - - - - 1 - 21 2 19 2 5 2 30 6 52 66 56 47 54 12. Malignant Neoplasm, Breast 2 28 - - - - - - - - - 1 1 17 1 6 - 4 1 12 30 23 21 21 23 13. Malignant Neoplasm, Uterus - 11 - - - - - - - - - - 6 6 - 3 — 2 — 2 11 4 4 9 6 14. Other Malignant & Lymphatic Neoplasms 57 53 - - - - - - - - 2 2 22 17 14 13 19 21 30 29 110 119 102 100 117 15. Leutaemla, Aleukaemla 5 5 - - - - 1 - - - 2 - 1 2 1 3 - - 5 5 10 6 6 4 10 16. Diabetes 5 4 - - - - - - - - 1 1 — 1 - - 1 2 5 3 9 8 8 6 12 17. Vascular Lesions of the Nervous System 50 73 - - - - - - - - - 2 15 11 12 14 23 46 34 .38 123 119 136 113 161 18. Coronary Disease Angina 102 65 ~ - - - - - - - 5 - 41 10 30 26 26 29 43 24 167 176 196 171 177 19. Hypertension with Heart Disease 13 15 - - - - - - - - - - 2 1 5 5 5 9 3 8 28 33 26 22 35 20. Other Heart Disease 81 111 - - - - - - 1 - 3 1 9 7 15 18 53 85 43 48 192 152 l58 131 201 21. Other Circulatory Disease 24 27 - - - - - - - - 1 - 3 2 10 5 10 20 l5 17 51 52 60 50 54 22. Influenza 2 - - - - - - - - - - - 1 - - - 1 - 1 - 2 6 3 l5 3 23. Pneumonia 35 28 6 1 1 - - - - - - 1 9 2 8 10 11 14 25 22 63 62 49 65 77 24. Bronchitis 67 27 - - - - - - - - - - 18 4 21 3 28 20 26 9 94 84 77 98 109 25. Other Diseases of Respiratory System 11 3 - - - 1 - - - - - - 5 1 2 - 4 1 9 1 14 13 8 8 l5 26. Ulcer of Stomach and Duodenum 8 1 - - - - - - - - 1 - 2 - 3 1 2 - 7 1 9 13 19 l5 10 27. Gastritis, Enteritis and Diarrhoea 5 4 - - - - - - - - - - 2 1 1 1 2 2 4 3 9 5 5 10 5 28. Nephritis and Nephrosis 5 6 - - - - - - - - - 1 1 3 3 2 1 — 4 5 11 12 8 8 18 29. Hyperplasia of Prostate 11 - - - - - - - - - - - 1 - 1 - 9 - 9 - 11 10 12 5 7 30. Pregnancy, Childbirth, Abortion - - - - - - - - - - - - - - - — — — — — — 1 1 7 2 31. Congenital Malformations 9 4 8 4 - - - - - - - - - - - - 1 - 8 3 13 6 10 13 9 32. Other Defined and 111 Defined Diseases 44 41 8 4 - - - 1 1 - 1 - 10 5 10 l5 14 16 36 29 85 100 88 67 93 33. Motor Vehicle Accidents 4 2 - - - - - - - 1 1 - 3 — - 1 - - 4 2 6 13 10 l5 14 34. All Other Accidents 7 4 - - - - - - - - 1 1 1 - - 1 5 2 4 2 11 13 14 17 18 35. Suicide 4 3 - - - - - - - - - - 3 2 1 - ~ 1 2 1 7 9 l5 13 11 36. Homicide and Operations of War - - - - - - - - - - - - - - - - - - - - - - - 1 — Totals 634 546 23 9 2 1 1 1 2 2 19 11 188 106 170 133 229 283 368 282 1,180 1, l58 1,143 1,094 1,330 14. TABLE 5- CAUSES OF DEATH IN AGE GROUPS 1957, AND TOTAL DEATHS FOR THE YEARS 1953 - 1957 Reference No. cause of Death Number of deaths of residents (Including non-civilians) whether occurring within or without the district Total deaths In Institutions Total deaths for the years Reference No. All Ages Under 1 Tear 1-4 Years 5-14 Years 15-24 Years 25-44 Years 45-64 Years 65-74 Years 75 Years and over M F M F M F M F M F M F M F M F M F M F 1957 1956 1955 1954 1953 1. Tuberculosis, respiratory 16 4 - - - - - - - - 3 1 1 1 7 - 5 2 11 1 20 12 13 12 18 1 2. Tuberculosis, other forms - — - - - - - - - - - - - - - - - - - - — 1 1 — 3 2 3. Syphilitic Disease 1 - - - - - - - - - - - - - - - - - - - 1 4 7 4 3 4. Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - 4 5. Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - 5 6. Meningococcal Infections - - - - - - - - - - - - - - - - - - - - - 2 — 1 1 6 7. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - 7 8. Measles - - - - - - - - - - - - - - - - - - - - - - 1 - - 8 9. Other Infective and Parasitic Diseases - — - - - - - - - - - - - - - - - - - - - 1 3 1 2 9 10. Malignant Neoplasm, Stomach 23 17 - - - - - - - - - 1 6 2 11 4 6 10 16 12 40 42 28 37 35 10 11. Malignant Neoplasm, Lung, Bronchus 54 9 - - - - - - - - 1 1 26 6 19 - 8 2 30 6 63 52 66 56 47 11 12. Malignant Neoplasm, Breast - 19 - - - - - - - - - - - 8 - 5 - 6 - 10 19 30 23 21 21 12 13. Malignant Neoplasm, Uterus - 5 — - - - - - - - - - - 1 - 2 - 2 - 3 5 11 4 4 9 13 14. Other Malignant & Lympnatlc Neoplasms 71 59 - - 1 - - - 1 - 6 5 27 21 25 14 11 19 46 31 130 110 119 102 100 14 15. Leukaemia, Aleukaemia 3 3 - - 1 - - - - - - 1 1 1 1 - - 1 2 3 6 10 6 6 4 15 16. Diabetes 2 2 - - - - - - - - - - - - 1 - 1 2 1 1 4 9 8 8 6 16 17. Vascular Lesions of the Nervous System 51 85 - - - - - - - - 1 - 11 13 17 32 22 40 39 43 136 123 119 136 113 17 18. Coronary Disease, Angina 153 79 - - - - - - - - 4 1 50 16 65 32 34 30 66 28 232 167 176 196 171 18 19. Hypertension with Heart Disease 9 13 - - - - - - - - - - 1 1 1 5 7 7 5 3 22 28 33 26 22 19 20. Other Heart Disease 71 111 - - - - - - 1 - - 4 12 12 15 21 43 74 48 57 182 192 152 158 131 20 21. Other Circulatory Disease 18 26 - - - - - - - - - 2 5 1 5 8 8 15 11 16 44 51 52 60 50 21 22. Influenza 8 9 - - 1 - 1 - 1 - - - 2 1 1 2 2 6 3 1 17 2 6 3 15 22 23. Pneumonia 51 36 3 1 - - 1 - - - 1 - 10 4 14 9 22 22 39 22 87 63 62 49 65 23 24. Bronchitis 51 21 1 - - - - - - - - - 13 1 21 5 16 15 23 4 72 94 84 77 98 24 25. Other Diseases of Respiratory System 9 1 - - - - - - - - - - 6 - 2 - 1 1 6 - 10 14 13 8 8 25 26. Ulcer of Stomach and Duodenum 6 3 - - - - - - - - - - 1 2 2 1 3 - 4 1 9 9 13 19 15 25 27. Gastritis, Enteritis and Diarrhoea 3 6 - - - - - - - - - 1 1 2 1 1 1 2 3 6 9 9 5 5 10 27 28. Nephritis and Nephrosis 8 5 - - - - - - - 1 3 - 2 2 1 1 2 1 6 2 13 11 12 8 8 28 29. Hyperplasia of Prostate 4 - - - - - - - - - - - 1 - 1 - 2 - 2 - 4 11 10 12 5 29 30. Pregnancy, Childbirth, Abortion - 1 - - - - - - - - - 1 - - - - - - - 1 1 - 1 1 7 30 31. Continental Malformations 2 4 1 1 - - - - - - - 1 1 2 - - - - 2 3 6 13 6 10 13 31 32. Other Defined and 111 Defined Diseases 32 39 11 4 - - - - 1 - 2 6 7 8 4 4 7 17 32 29 71 85 100 88 67 32 33. Motor Vehicle Accidents 7 8 - - - 1 - - 2 2 2 1 3 2 - - - 2 6 8 15 6 13 10 15 33 34. All Other Accidents 9 10 - - - - - 1 - 1 3 1 4 2 1 2 1 3 7 7 19 11 13 14 17 34 35. Suicide 3 6 - - - - - - - — — - 2 5 - 1 1 - 1 3 9 7 9 15 13 35 36. Homicide and Operations of War - - - - - - - - - - - - - - - - - - - - - - - - 1 36 TOTALS 665 581 16 6 3 1 2 1 6 4 26 27 194 114 215 149 203 279 409 301 1246 1180 1158 1143 1084 15. 10. Study of these tables shows - (1) Coronary disease and angina continue to take an increasing toll, in a number of instances causing death in middle life. it is idle to speculate on this condition. it seem3 to strike active and sedentary persons alike, persons of a worrying disposition and those more phlegmatic, and it is extremely difficult to assess the place of alcohol in the causation. (?) Cancer of the lung continues to loom larger as a cause of death and as nothing is done in the community to stop smoking, which is considered by the concensus of medical opinion to be a causative factor, it will be interesting to observe the effects of reduction of atmospheric pollution which is also impugned as a carcinogenic agent. TABLE 6 - INFANT DEATHS UNDER ONE YEAR OF AGE, 1956 & 1957 Cause of Death Total deaths AGE AND SEX Total under 1 year Under 1 week. 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months M F M F M F M F M F M F M F M F M F Pneumonia 1956 7 - - - - - - - - 2 - 4 - - 1 - - 6 1 1957 4 - - - - - - - - 1 1 2 - - - - - 3 1 Premature Births 1956 9 5 3 - - - - - - 1 - - - - - - - 6 3 1957 6 5 1 - - - - - - - - - - - - - - 5 1 Congenital Malformations) Birth Injury, Infantile Diseases 1956 12 3 - - 1 - - 1 1 1 1 2 - 1 1 - - 8 4 1957 2 - 1 - - - - - - 1 - - - - - - - 1 1 Other Causes 1956 4 2 1 - - - - - - - - - - 1 - - - 3 1 1957 10 4 2 1 - - 1 1 - - - 1 - - - — — 7 3 TOTALS 1956 32 10 4 - 1 - - 1 1 4 1 6 - 2 2 - - 23 9 1957 22 9 4 1 - - 1 1 - 2 1 3 - - - - - 16 6 17. 18 CANCER. 1956 1057 Total deaths 245 257 Male deaths 128 148 Female deaths 117 109 TABLE 7 - CANCER DEATHS 1956 - LOCATION OF THE DISEASE Parts of Ages Body Affected Under 15 15-24 25-34 35-44 45-54 55-64 65-74 75 and upwards Total M F M F M F M F M F M F M F M F M F Buccal Cavity and Pharynx - - - - - - - - - - 1 - 1 - 2 2 4 2 Digestive Organs and Peritoneum - - - 1 - 1 1 - 3 6 14 9 14 7 7 15 39 39 Lungs, Bronchus - - - - - - 1 - 8 1 13 1 19 2 5 2 46 6 Other Respiratory Organs - - - - - - - - - - - - 2 - 1 - 3 - Uterus - - - - - - - - - 1 - 5 - 3 - 2 - 11 Other Female Genital Organs - - - - - - - - - - - - - - - - - - Breast - - - - - - - 1 - 6 1 11 1 6 - 4 2 28 Male Genital Organs - - - - - - - - - - - - - - - - - - Urinary Organs - - - - - - - - 2 - 2 - 3 3 8 - 15 4 Skin - - - - - - - - - - - - 1 - - - 1 - Brain and other parts of Nervous System - - - - - - - - 1 1 1 - - - - - 2 1 Other 6r Unspecified Organs - - - - - - 1 1 4 5 4 5 2 6 5 9 16 26 TOTALS - - - 1 - 1 3 2 18 20 36 31 43 27 28 35 128 117 19. TABLE 8 - CANCER DEATHS 1057 - LOCATION OF THE DISEASE Parts of Ages Body Affected Under 15 15-24 25-34 35-44 45-54 55-04 65-74 75 and upwards Total M F M F M. F M F M F M F M F M F M F Buccal Cavity and Pharynx - - - - - - - - - 2 1 1 3 1 - 1 4 5 Digestive Organs and Peritoneum - - - - 1 - 1 1 6 3 6 4 17 7 11 15 42 30 Lungs, Bronchus - - - - - - 1 1 7 2 19 4 19 - 8 2 54 9 Other Respiratory Organs - - - - - - - - - - - - - - - - - - Uterus - - - - - - - - - - - 1 - 2 - 2 - 5 Other Female Oenltal Organs - - - - - - - - - 1 - 3 - 1 - 1 - 6 Breast - - - - - - - - - 2 - 6 - 5 - 6 - 19 Male Oenltal Organs - - - - - - - - - - - - - - 1 - 1 - Urinary Organs - - 1 - - 1 - - 2 1 3 - 4 1 3 3 13 6 Skin - - - - - - - - - - - - - - - - - - -Brain and other parts of Nervous System 1 - - - 2 1 - - 1 - 1 1 1 1 - - 6 3 Other or Unspecified Organs - - - - 1 1 1 2 3 2 10 5 11 7 2 9 28 26 TOTALS 1 - 1 - 4 3 3 4 19 13 40 25 55 25 25 39 148 109 20. BIRTH AND DEATH RATES (PER 1,000 POPULATION) 1891 - 1957 BIRTH RATE DEATH RATE The high death rate in 1941 was due to deaths resulting from enemy action 21. INFANTILE MORTALITY RATES (PER 1,000 LIVE BIRTHS) 1941 - 1957 England and Wales East Ham - 22. INFECTIOUS DISEASES The quarterly returns to the Registrar-General were as follows:- Qtr. ending 31/3/56 Qtr. ending 30/6/57 Qtr. ending 30/9/56 Qtr. ending 31/12/56 Total Scarlet Fever 9 4 3 9 25 Whooping Cough 16 36 91 26 168 x Acute Poliomyelitis — — 3 1 4 Measles 6 117 176 18 316 Diphtheria - - - - - Pneumonia 23 14 1 16 54 Dysentery 6 34 6 1 45 Acute Encephalitis - - - - - Paratyphoid Fever - 4 - - 4 Erysipelas 1 6 2 6 14 Meningococcal Infection - 1 - - 1 Food Poisoning 4 8 7 22 41 Puerperal Pyrexia 3 2 - 1 6 Ophthalmia Neonatorum 2 1 - - 3 x Three cases of Poliomyelitis were Paralytic and one non-paralytic. The numbers of new cases of tuberculosis notified during the year 1956 were as follows:- Pulmonary - Males 69 Females 49 Non-Pulmonary - Males 4 Females 4 Totals 126 Details of these notifications are set out In Table 12. Qtr. ending 31/3/57 Qtr. ending 30/6/57 Qtr. ending 30/9/57 Qtr. ending 31/12/57 Total Scarlet Fever 47 37 29 32 145 Whooping Cough 71 29 11 6 116 x Acute Poliomyelitis 3 3 7 2 15 Measles 246 441 114 6 807 Diphtheria - - - - - Pneumonla 22 13 7 33 76 Dysentery 114 47 6 - 167 Typhoid Fever - - - - - Paratyphoid Fever - 1 - - 1 Erysipelas 9 1 - 3 13 Meningococcal Infection - 2 - 1 3 Food Poisoning 4 4 7 1 16 Puerperal Pyrexia 1 2 - 1 4 Ophthalmia Neonatorum - - - - — Tuberculosis - Respiratory 25 23 23 28 99 Tuberculosis - Meninges & C.N.S. - - 1 1 2 Tuberculosis - Other 6 1 1 - 8 x Of the 15 cases of Acute Poliomyelitis, 11 were paralytic and 4 non-paralytlc. Following the despatch of the quarterly returns to the Registrar General, the diagnosis was changed for two cases of Food Poisoning In the Quarter ending 31/3/57 and for one case In the quarter ending 30/6/57. The true total of Food Poisoning cases for the year therefore Is 13. There were no deaths from the seven principal Zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever.) Details of the Notifications of tuberculosis are set out In Table 13. 23. TABLE 9 - PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/56 DISEASE Cases notified In whole district Ward Distribution of Cases No. of Cases removed to Hospital Total Deaths At all ages - years Manor Park. Little Ilford Wood grange Plashet Xenslngtor Castle Central Wall End Greatfleld South At all ages Under I 1 to 4 5 to 9 10 to 14 15 to 24 25 to 34 35 to 44 45 to 64 65 and up Scarlet Fever 25 - 9 15 1 - - - - - - 9 - - 3 6 - 3 - 4 9 - Diphtheria - - - - - - - - - - - - - - - - - - - - - - Erysipelas 14 - - - - - - 4 9 1 2 1 1 2 3 1 2 - 1 1 4 - Puerperal Pyrexia 6 - - - - 2 3 1 - - - 1 - 3 1 - - 1 . - - 6 - Ophthalmia Neonatorum 3 3 - - - - - - - - 1 - - - - - - 1 - 1 3 - Paratyphoid Fever 4 - - 1 1 1 1 - - - 1 - - - - - - 3 - - 3 - Pneumonia 54 4 2 1 - 2 2 4 23 16 5 18 1 4 5 1 5 10 3 2 11 *63 Acute Poliomyelitis 4 - 1 1 1 1 - - - - 1 1 - - - - - 1 1 - 4 - Meningococcal Infection 1 - 1 - - - - - - - - - - - - - - 1 - - 1 2 Dysentery 45 1 10 12 7 3 3 4 2 3 5 9 - 18 3 - 1 4 1 4 27 - Food Poisoning 41 - 7 5 6 5 4 9 4 1 - 12 1 4 5 3 1 6 2 7 7 - Measles 316 16 144 154 1 1 - - - - 38 72 47 13 9 32 55 9 15 26 3 - Whooping Cough 168 11 60 88 6 1 - 1 1 - 16 67 13 9 9 10 6 19 4 15 6 - * Total deaths from all forms of pneumonia. 24. TABLE 10 - PPEVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Tear ended 31/12/57 DISEASE Cases notified In whole district Ward Distribution of Cases No. of Cases removed to Hospital Total deaths At all ages - years Manor Park Little Ilford WoodGrange Plashet Kensington Castle Central Wall End Greatfleld South At all ages Under 1 1 to 4 5 to 9 10 to 14 15 to 24 25 to 34 35 to 44 45 to 64 65 and up Scarlet Fever 15 1 35 80 22 3 2 1 1 - 27 53 8 16 2 11 2 7 5 14 34 - Diphtheria - - - - - - - - - - - - - - - - - - - - - - Erysipelas 13 - - 1 - 1 - 2 7 2 2 3 2 1 1 1 - 2 - 1 1 - Puerperal Pyrexia 4 - - - - 2 2 - - - 1 1 - 1 1 - - - - - - - Paratyphoid Fever 1 - - - - - - - - 1 - - - - 1 - - - - - 1 - Pneumonia 75 4 2 4 1 1 5 7 28 23 9 16 1 3 7 7 7 8 2 15 18 *87 Acute Poliomyelitis 15 - 4 4 4 1 2 - - - 1 4 4 - - - 3 3 - - 15 - Meningococcal Infection 3 1 - - - 2 - - - - - - - - - - 1 - 1 1 3 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - Dysentery 167 1 68 33 15 11 18 7 11 3 12 9 4 69 2 27 19 13 5 7 6 -j Food Poisoning 13 - 3 - - 1 3 2 3 1 4 1 1 - 1 1 - 4 1 - 3 - Measles 807 31 380 379 11 4 2 - - - 129 119 61 72 99 44 37 71 99 76 11 - Whooping Cough 116 15 55 38 6 2 - - - - 5 6 4 12 4 4 20 8 11 42 5 - * Total deaths from all forms of Pneumonia. 25. The hospitals to which the patients suffering from Infectious diseases were admitted are named below:- Name of Hospital No. of cases admitted 1956 1957 Plalstow Hospital, Samson street, E. 13 32 55 Ilford Isolation Hospital, Chadwell Heath 19 23 Eastern Fever Hospital, Homerton, E.9 - 6 St. Mary's Hospital for Woman and Children, E.13 2 1 Queen Mary's Hospital, E. 15 2 - Rush Green Hospital, Romford - 1 Honey Lane Hospital, Waltham Abbey - 1 Poplar Hospital, E. 14 1 - Queen Elizabeth Hospital, E.1 - 2 The Hospital for Sick Children, W.C.1. - 1 St. Bartholomews Hospital, E.C.1 - 1 East Ham Memorial Hospital, E.7 27 - Whipps cross Hospital, E.11 1 - St. Andrew's Hospital, Devons Road, Bow, E.3 - 3 St. Ann's General Hospital, St. Ann's Road, N. 15 - 3 64 97 No difficulty Is ever experienced In obtaining admission to hospital for a case of Infectious disease. We are grateful to the hospital staffs for their ready co-operation In this matter, and for the excellent reports sent to this department concerning the progress and condition on discharge of each patient. 26 TABLE 11 - TOTAL CASES OF NOTIFIABLE DISEASES, 1933 - 1957 DISEASE 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Small Pox 1 1 - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 222 289 270 203 343 245 172 32 27 145 Diphtheria 180 379 254 134 149 141 91 47 45 49 59 33 31 19 46 14 2 1 - 1 - 1 1 - - Enteric or Typhoid Fever 5 - 2 2 13 15 8 10 3 - 4 - - - - 1 - 3 - 1 - - - - - Paratyphoid Fever - - - - - - - - - - - - - - - - - 1 1 1 1 - - 4 1 Erysipelas 69 74 55 59 53 71 41 33 23 37 28 18 14 25 23 21 24 21 19 16 15 14 11 14 13 Puerperal Fever 4 7 12 7 5X ł ł ł ł ł ł ł ł ł ł ł ł ł ł ł ł ł ł ł ł Puerperal Pyrexia 10 11 14 7 7 18 16 8 6 15 8 8 2 8 5 4 2 3 2 7 10 3 9 6 4 Meningococcal Infection 1 3 3 - 2 3 3 11 5 12 4 3 1 8 1 5 6 1 1 4 1 3 2 1 3 Encephalitis Letharglca 1 1 1 - 1 1 - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 9 5 5 6 7 9 7 3 4 1 1 4 2 1 2 - 4 2 1 1 - - 1 3 - A.ute Poliomyelitis 2 5 13 2 4 - 2 1 - - - - 1 - 7 8 13 10 7 10 7 3 24 4 15 Acute Polio Encephalitis 2 1 - - - - - - - - - - - - 1 - - - - - 1 - - - - Dysentery - 1 - - 3 18 - - - - 6 5 7 5 2 - 1 10 321 3 285 41 11 45 167 Malaria 1X2 - - - - - - - - - - - lX2 3a - - - - - - lb - - - - Measles NOT NOTIFIABLE 3 36 460 1091 971 258 1498 815 964 1559 1098 988 2198 1883 960 30 2240 316 807 Whooping Cough NOT NOTIFIABLE - 19 262 227 241 293 67 258 430 578 498 1027 625 361 554 117 208 168 116 Food Poisoning NOT NOTIFIABLE 4 5 23 8 7 8 7 41 13 148 100 88 101 111 85 59 42 33 37 72 50 55 97 143 111 88 41 58 61 70 45 60 54 75 Tuberculosis - Pulmonary 164 174 184 186 188 149 157 130 139 164 200 156 205 194 211 211 148 142 117 101 126 127 110 118 99 Non-Pulmonary 35 33 37 31 39 20 24 30 22 22 23 15 16 9 26 20 11 14 16 14 12 12 5 8 10 Totals 1333 1774 1079 894 969 817 607 447 1070 1865 1834 975 2053 1635 2040 2754 2188 2538 3592 2815 2295 J 575 2721 8091 1468 X Notifiable as Puerperal Pyrexia as from 1/10/37. a 1 Induced for therapeutic purposes, 2 Contracted abroad, X2 l Induced In an Institution ł Notifiable as Puerperal Pyrexia b Contracted abroad 27. TABLE 12 - PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1ST JANUARY, 1956 TO THE 31ST DECEMBER, 1956 Formal Notifications Age Periods Number of Primary Notifications of new cases of tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males 1 - - 2 2 2 5 10 14 12 10 10 1 69 Respiratory, Females - 2 1 4 - 5 4 12 8 5 4 3 1 49 Non-Respiratory, Males - 1 - - 1 - - - 1 - 1 - - 4 Non-Respiratory, Females - - - - - - - 1 - 1 1 1 — 4 NEW CASES OF TUBERCULOSIS COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER OF HEALTH DURING THE YEAR, OTHERWISE THAN BY FORMAL NOTIFICATION Source of Information Number of cases In age Groups 0- 1- 2- 5- 10- 15- 20- 25r 35- 45- 55- 65- 75r- Total Death Returns from Local Registrars Resplratcry M - - - - - - - - - - 1 - - 1 (A) F - - - - - - - - - - - - 1 1 (B) Non-Respiratory M - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - (B) Non-Res plratory M - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - (D) Totals (A) 1 (B) 1 (C) — (D) - 28. TABLE 13-PUBLIC HEALTH (TUBERCUL OBIS) PECULATIONS, 1952 SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1ST JANUARY, 1967 TO THE 31ST DECEMBER, 1967 Formal Notifications Age Periods Number of Primary Notifications of new cases of tuberculosis 0- 1- 2- 5- 10- 15- 20- 26- 35- 45- 55- 65- 76- Total (all ages) Respiratory, Males - - - 1 1 4 5 9 11 11 10 6 4 62 Respiratory, Females — — — — 2 2 7 8 11 4 1 1 1 37 Non-Respiratory, Males — - — - 2 2 - - - 1 - - - 5 Nori-Respiratory, Females — - - - - - 1 - 2 2 - - - 5 NEW CASES OF TUBERCULOSIS COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER OF HEALTH DURING THE YEAR, OTHERWISE THAN BY FORMAL NOTIFICATION Source Of Information Number of cases In age Groups 0- 1- 2- 5- 10- 16- 20- 25- 36r- 45- 56- 65- 75- Total Death Returns from Local Registrars Respiratory M - - - — - - - — - - 1 - - 1(A) F - - - - - - - 1 - - 1 - 1 3(B) Non-Respirators M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - (D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M - - - - - - - 3 - - - - 1 4(A) F - - - - - - - - - 1 - - - 1(B) Non-Resplratorj M - - - - - - - - - - - - - -C) F - - - - - - - - - - - - - -(D) Posthumous Notifications Respiratory M - - - - - — - - - - - - - -(A) F - - - - - - - - - - - - - -(B) Non-Resplratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - (D) Totals [A) 5 (B) 4 (C) - (D) - 1950 and 1957 could be regarded as 'measles years' with ?16 and 007 cases respectively. Whilst 1957 saw a marked Increase In the notifications of scarlet fever, few cases of any severity bolng recorded, whooping cough notifications declined In 1967 rrom 168 (In 1956) to 116. Tuberculosis shows a reduction in the number of new cases notified which is very welcome. 1956 - 126. 1967 - 109. Nevertheless the reduction is not of the magnitude to warrant complacency. The death rate has fallen, the prospect of cure with modern therapy has brightened very considerably, and the process of cure has been greatly accelerated. But the attack rate of tuberculosis remains high and Is reflected in the number of notifications of 'new cases' each of which probably contracted the disease from an infective person in the community. To root out these sources of infection is one of our chief problems at the present time. POOD P0IS0NIN0. In accordance with Ministry of Health Circular 46/49, the following Information was supplled:- (1) Food Poisoning Notifications (Corrected) Return to Registrar—Qeneral :- 1956 1957 1st Quarter 4 4 2st Quarter 8 4 3st Quarter 7 7 4st Quarter 22 1 Total 41 16 (2) There were no outbreaks due to identified agents. (3) There were no outbreaks of undiscovered cause during these two years. (4) Single cases: The various organisms identified in each case as the cause of illness were:- 1956 1957 Salmonella Typhlmurlum 28 12 Salmonella Enterltldls 3 - Salmonella Stanley 1 - Salmonella Newport - 1 Welchll Presumptive Type A 3 - B. Proteus 4 - B. Morgan 11 2 - 41 13 There were changes in diagnosis In those cases in 1957 subsequent to their notification to the Registrar General and the true total of cases for that year, as shown in paragraph 4, is 13. The figure 13 represents a marked reduction in the number of cases of 'notified' food poisoning on the figure of 41 for 1956- Nevertheless it is probable both figures do not give a true picture of the incidence of this condition In our borough. Kitchen techniques and personal hygiene are two of the most difficult subjects to deal with In any community. 30. Kitchen Techniques are vested mostly in women notoriously resistant to change, and young persons dismiss the idea of personal hygiene as something too remote to matter, especially in view of th6 lack or hand washing In, the toilets of many of our schools. VENEREAL DISEASES 1J)e following statistics have been abstracted from copies of form V. D. (R), which have been received from the Hospitals named and total figures for 1964 and 1966 are also shown:- Patients Dealt With for the First Time During the Year 1956 1967 Syphilis Gonorrhoea Other Conditions Total Syphilis Gonorrhoea Other Conditions Total Whltechapel Clinic, London Hospital 3 16 122 140 3 21 103 127 St. Thomas' Hospital - - 1 1 - 1 4 6 Akbert Dock Hospital - 8 36 44 - 4 30 34 Queen Mary's Hospital, E.15 1 3 32 36 1 2 26 29 Totals 4 26 191 221 4 28 163 196 Totals for 1954 7 19 183 Totals for 1956 6 26 194 CHILDREN'S ACT - NURSERY AND SCATTERED HOMES. The statistics for the two years are appended:- 1956 1967 1. Average number in homes throughout the year 106 91 2. No. chargeable to East Ham on let January 96 97 3. No. chargeable to East Ham on 31st December 92 80. 4. Average weekly admissions 3 1.4 5. Average weekly discharges 2 1.6 During the year 1956 the withdrawal from our Children's Homes of children from other Local Authorities was completed, the last remaining Essex child being dlshcarged on 4.8.68 and the last children from West Ham on 3.11.56. PUBLIC MORTUARY Following the demolition of the old war damaged buildings, a new mortuary was erected on the site in the High Street South and was opened for the reception of bodies on 17th October, 1956. The building was designed and erected by the Borough Engineer and consists of chapel, with adjacent waiting and viewing room, refrigerator chamber, post mortem room and offices for pathologist and mortuary attendant. Refrigerator accommodation is provided for a maximum of nine bodies. In addition to the reception of the bodies of people dying in East Ham, arrangements have been made for bodies to be received from the adjoining boroughs of Barking, Dagenham and Ilford, payment being made by these authorities on a per capita basis. 31. The bodies received and autopsies carried out during the years under review are detailed In !.he following table:- TABUS 14. PUBLIC MORTUARY - STATISTICS AUTHORITY PERIOD 17.10.66-31.12.66 YEAR 1957 No. of Bodies Received No. of Autopsies Performed No. of Bodies Received No. of Autopsies Performed EAST HAM 28 27 141 141 BARKING 9 9 66 56 DAGENHAM 6 6 63 61 ILFORD 4 3 27 28 BFXLEY HEATH - - 1 1 HORNCHURCH - - 1 1 WEST HAM - - 1 1 TOTALS 47 45 290 289 NATIONAL ASSISTANCE ACT, 1948 - SECTION 47. The above section of the National Assistance Act, 1948, deals with the removal to suitable premises of persons In need of care and attention. It has not been found necessary for action to be taken under this section during the years 1956 and 1957. WATER SUPPLY. (1) The water supply of the Borough In Its several parts has been satisfactory both In quality and quantity. (11) All houses In the area have water services laid on from the Metropolitan Water Board's mains. No bacteriological or chemical analyses were made by this Authority on the raw water going Into supply. (Ill) The water supply of this district from the Metropolitan Water Board does not give rise to plumbo-solvent action. (lv) There were no contamination areas. REGISTRATION OF NURSING HOMES Under Sections 187 to 194 of the Public Health Act, 1936, there were no homes registered during the years 1956 and 1957, and there were no homes on the register at the end of either year. 32 FACTORIES ACTS, 1937 and 1948 In accordance with the Factories Act, 1937, and at the request of the Minister of Labour and National Service, the following Information Is included in this report. (See Tables 15 and 16.) TABLE 15 FACTORIES ACTS, 1937 AND 1948. YEAR 1956 PART I OF TOE ACT 1. - INSPECTIONS for purposes of provisions as to health (Including inspections made by Public Health Inspectors) Number on Register Number of Inspections Written notices Occupiers prosecuted (1) Factories in which sections l, 2, 3, 4 and 6 are to be enforced by Local Authorities 42 27 1 - (11) Factories not included In (1) in which Section 7 is enforced by the Local Authority 291 287 5 - (11) Other Premises in which Section 7 Is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 333 314 6 - 2. - CASES IN WHICH DEFECTS WERE POUND (If defects are discovered at the premises on two, three or more separate occasions they are considered as two, three or more "cases") PARTICULARS Number of cases In which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. I) 28 5 - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) 1 - 1 - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) insufficient - - - - - (b) unsuitable or defective 13 2 - - - (c) not separate for sexes - - - - - Other offences against the Act (not Including, offences relating to Outwork) 3 - - - - Total 45 7 1 - - 33. PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Nature of Work. Section 110 Section 111 No. of out-workers In August list required by Sect. 110(1) (c) No. of cases of default In sending lists to the Counc11 No. of prosecutions for failure to supply lists No. of Instances of work in unwholesome premises Notices served Prosecutions Wearing Apparel (Making etc*) 173 - - - - - Umbrellas, etc. 1 - - - - - Making Cardboard Boxes or Containers 9 - - - - - Christmas crackers, cosaques, Christmas stockings, etc. 37 - - - - - Total 220 - - - - - TABLE 16 FACTORIES ACTS, 1937 AND 1948 YEAR 1957 PART I OF THE ACT 1. - INSPECTIONS for the purposes of provisions as to health (Including inspections made by Public Health Inspectors). 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 44 38 - - (11) Factories are Included in (1) in which Section 7 Is enforced by the Local Authorlty 295 244 2 - (ill) Other Premises in which Section 7 Is enforced by the Local Authority (excluding out-workerS premises) 1 1 - - Totals 340 283 2 - 34. 2. -CASES IN WHICH DEFECTS WERE FOUND (If defects are discovered at the premises on two, three or more separate occasions they are considered as two, three or more "cases") Particulars Number of cases in which defects were found Number of cases In which prosecutions were Instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) 26 0 - - - Overcrowding (S.2) - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S.4) 1 - - - - Ineffective drainage of floors (S. 0) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 1 - - - - (b) unsuitable or defective 18 4 - - - (c) not separate for sexes - - - - - Other offences against the Act (not Including Including offences relating to Outwork) 5 1 - - - Totals 51 11 - - - PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Nature of Work 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 Wearing Apparel (Making etc.) 153 - - - - Umbrellas, etc. 1 - - - - Textile Weaving 1 — - - - Totals 155 - - - - 35. NATIONAL HEALTH SERVICE ACT, 1946 SECTIONS 22, 23, 24 , 25. 20, 27, 28, 29, and 61. Full details of the Council's Proposals approved by the Minister of Health, as Indicated In my report for 1948, have been published In booklet form and are available for reference. SECTION 22 - CARE OF MOTHERS AND YOUNG CHIIDREN DENTAL CARE. Dr. Allan Ross, the Senior Dental Officer, submits the following reports on the dental treatment provided for expectant and nursing mothers and pre-school children in 1958 and 1957:— 1956 "At the end of 1956, there were three dental officers and this continued to be the position throughout 1950. It was found quite Impossible to fill the establishment of four In spite of numerous advertisements. The statistical pattern of 1950 was very similar to that of 1955 except that many more teeth were conserved for children. This sort of work Is often difficult, but It Is well worth while as the chances or future orthodontic treatment proving necessary are considerably reduced. Generally speaking, most children are fundamentally good patients, but some parents almost go out of their way to make their children nervous and apprehensive with regard to dental treatment. There Is much talk of "nerves" and being dreadful patients themselves. With this as a background, the dentist Is unlikely to establish an Ideal relationship with his young patient." 1957 "There was little change In the statistical pattern of the work done compared with the previous year. However, fewer mothers and children were treated due to various reasons. In the formei case a gradually Increasing number of mothers prefer to continue to receive treatment from their private practitioners. This group had usually well cared for mouths. The dental officers were left with those mothers who seldom, If ever, received dental treatment, had neglected mouths, were reluctant to receive conservative treatment, urgently required scaling etc. by the Dental Hyglenlst, and often required numerous extractions and large partial or full dentures. Another group of mothers seen were those who were normally treated by private dentists but could not afford the fee required for the provision of dentures. They were reluctant to obtain help from the National Assistance Board and presented themselves at the Clinics sometimes already under treatment by their private dentist. The dental officers employed by this Authority then found themselves In the embarasslng position of treating other dentists' patients, a position which would not arise but for an apparent anomoly In the Regulations. Briefly, expectant and nursing mothers can obtain free dentures at the Authority's Clinics but not from dentists in the General Dental Service. The number of children under five in this Borough Is gradually decreasing due to a falling birth rate, emigration and' re-housing and this fact Is reflected In the statistics. The recent huge Increases In the fees paid to private dentists for the conservation of deciduous teeth may well result in an increasing number of these small children being treated outside the Clinics. Numerous advertisements during the year for a fourth dental officer met with no response. About two and a half years have now elapsed since an advertisement was answered, and at the end of the year the prospect of filling the vacancy appeared remote." TABLE 17 NUMBERS PROVIDED WITH DENTAL CARE Examined Needing treatment Treated Made dentally fit Expectant & Nursing Mothers 1956 258 252 241 160 1957 218 211 211 139 Children under five 1956 455 428 370 313 1957 337 324 312 259 36- TABLE 18 FORMS OF DENTAL TREATMENT PROVIDED Extrac tions General Anaesthetics Fillings Scallngs or scaling and gum treatment Silver Nltra te treatment Radiographs Dentures provided Complete Partial Expectant & Nursing Mothers. 1950 501 84 128 20 4 18 35 32 1957 390 54 117 27 0 30 21 27 Children under five 1956 590 275 204 3 72 1 - - 1957 444 218 140 2 66 3 - - Number of premature Infants notified during the years (Including transferred notifications) where the mothers normally reside In the area. 1956 1957 (1) Born at home 15 9 (11) Born In hospital or nursing home 63 71 TOTALS 78 80 37• TABLE 19 Weight at Birth PREMATURE LIVE BIRTHS PREMATURE STILL-BIRTHS Born in Hospital* Born at home and nursed entirely at home Born at home and transferred to hospital on or before 28th day Born In nursing home and nursed entirely there Born in nursing home and transferred to hospital on or before 28th day Born In hospital Born at home Born In nursing home Total Died within 24 hrs.of birth Survived 28 days Total Died within 24 hrs.ol blrtt Survived 28 days Total Died within 24 hrs.of birth Survived 28 days Total Died within 24 hrs.of birth Survived 28 days Total Died within 24 hrs.of birth Survived 28 days (1) (2) (3) (4) (5) (3) (7) (3) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (a) 3 lb. 4 oz. or less (1,500 gns. or less) 1956 5 2 2 - - - 2 - 2 - - - - - - 4 - - 1957 0 2 3 - - - - - - - - - - - - a - - (b) Over 3 lb. 4 oz. up to and Including 4 lb. 6 oz. (1,500 - 2,000 sns.) 1950 13 1 9 1 - 1 1 - 1 - - - - - - 7 1 - 1957 11 1 10 - - - 3 1 2 - - - - - - 4 - - (c) Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. (2,000 - 2,250 gas.) 1950 16 2 14 1 - 1 - - - - - - - - - 1 - - 1957 13 1 12 1 - 1 - - - - - - - - - 2 - - (d) Over 4 lb. 15 oz. up to and including 5 lb. 8 oz. (2,250 - 2,500 gns.) 1956 29 - 28 10 - 10 - - - - - - - - - 3 - - 1957 41 2 38 4 - 4 1 1 - - - - - - - 2 - - Totals 1956 63 5 53 12 - 12 3 - 3 - - - - - - 15 1 - 1957 71 6 63 5 - 5 4 2 2 - - - - - - 14 - - * The group under this heading will include cases which may be born in one hospital and transferred to another. 38. MATERNITY AND CHILD WELFARE CLINICS The figures of attendance Illustrate the continuing need for these clinics. The cardinal points which are constantly borne In mind In carrying out these services are:- (1) As far as possible to establish clinics In large centres of population, to avoid long Journeys for mother and child. (2) To ensure private consultation with health visitor or doctor when necessary. (3) To effect full liaison with midwife, hospital and general practitioner whenever necessary. (4) To ensure ancillary treatments and services are fully utilized In individual Instances. (5) To ensure comprehensive dental care for mother and child. (9) To foster health education in the family and the comn.unlty from the earliest days. (7) The diligent search for backward children (both mentally and physically retarded) with a view to helping the child and family, and making complete assessment of Individual potential by the time the child reaches school age (five years). (8) Keeping observation on the toddler up to school entry. (9) Ensuring a good Immunisation programme for mother and child, as comprehensive as possible. 39. TABLE 20 ANTE-NATAL AND POST-NATAL CLINICS No. of clinics provided at end of year (whether held at Child Welfare Centres or other premises) No. of Sessions held per month at clinics Included In col. (2) No. of women in attendance Total No. of attendances made by women Included In col. (4) during the year No. of women who attended during the year No. of new cases included In col. (4) I.e. for A.N. clinics women vtio had not previously attended any clinic during current pregnancy & for P.N. clinics women who had not previously attended any P.N. clinic after last conflnemant (1) (2) (3) (4) (5) (6) Local Health Authority Clinics 195S 1957 1956 1957 1956 1957 1957 1957 1956 1957 Ante-natal clinics 4 4 44 36 1158 1125 899 845 4816 4505 Post-natal clinics ł - - - - 134 154 133 152 134 162 Clinic belonging to other L.H. A.* Ante-natal clinics 1 1 4 4 15 20 13 14 52 112 Post-natal clinics ł — — - - 5 5 5 5 5 5 * By arrangements with L.C.C. at Fernhlll Street Baths,North Woolwich, E. 16 ł Post-natal patients seen at ante-natal clinics and these numbers are not Included In the ante-natal figures No clinics were discontinued or new premises open during the year No ante-natal or post-natal examinations were carried out by General Practitioners at the mother's home or the practitioner's surgery under arrangements made with the Local Health Authority Whilst mothers booked for domiciliary confinement are examined at ante-natal clinics by the midwife with whom they are booked, a medical officer who Is examining mothers booked for hospital, also Is at the clinic and Is readily available for consultation should the midwife consider this necessary. There are at present 8 such sessions by mldwlves each month. 40. TABLE 21 CHILD WELFARE CENTRES, 1956 Number of centres provided at end of year Number of Child Welfare Sessions now held per month at centres Number of children who first attended a centre during the year, and who at their first attendance were under 1 year of age Number of children who attended during the year and who were born In : Total Number of children who attended during the year Number of attendances during the year made by children who at the date of attendance were: Total attendances during the year 1956 1955 1954-51 Under 1 year 1 but mder 2 2 but under 5 Local Health Authority Centres 4 48 1,091 968 780 383 2,131 12,504 1,771 1,319 15,592 Centre belonging to other L.H.A. ł 1 4 31 29 16 16 61 300 37 38 375 i By arrangement with L.C.C. at Fernhlll Street Baths, North Woolwich, E. 16. Note:- No clinics were discontinued or new premises opened during the year. 41. TABLE 22 CHILD WELFARE CENTRES, 1957 Number Pf centres provided at end of year Number of Child Welfare sessions held per month at centres Number of children who first attended a centre of this Local Health Authority during the year, and who at their first attendance were under 1 year of age Number of children who attended during the year and who were born In Total Number of children who attended during the year Number of attendances during the year made by children who at the date of attendance were Total Attendances during the year 1957 1956 1955-52 Under 1 year 1 but under 2 2 but under 5 Local Health Authority Centres 4 32 1,177 1,012 804 350 2,166 12,261 1,975 1,501 15,737 Centre belonging to other L. H. A. ł 1 4 31 24 24 16 64 351 25 23 399 f By arrangement with L.C. C. at Fernhlll Street Baths, North Woolwich, E. 16 No clinics were discontinued or new premises opened during the year. 42. DAY NURSERY TABLE 23 Year Number at 31st December No. of approved places No. of children on the register at the end of the year Average dally attendance during the year 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years 1956 1 35 54 21 48 14.8 38.8 1957 1 27 47 17 48 14.3 36.7 There are no Nurseries In the borough provided by Voluntary Organisations, the one nursery being operated by the authority. The need persists lor some 60 - 70 places In the day nursery, adequately to cope with the problems of child nurture and care, thrown up In the community from day to day. There Is little doubt much Individual suffering would be borne by a number of young children In addition to the certainty of disruption of certain homes, but for the timely assistance of the day nursery service. Constant vigilance Is called for to prevent abuse of this truly philanthropic service, both In dealing with requests for admission and In assessment of charges which can properly be made. Transport Is still provided to take the children to and from the day nursery. NURSERY AND CHILD-MINDERS REGULATION ACT, 1948. There were no dally minders provided by the Council during the years and there were no premises or dally minders registered under the above Act at 31st December In each year. The Authority do not pay any fees to dally minders under section 22 of the National Health Service Act, 1946. CARE OF UNMARRIED MOTHERS The Authority does not provide a Mother.and Baby Home, but, where necessary patients are admitted to homes maintained by voluntary Moral Welfare Associations or by other Local Health Authorities. It was not found necessary In 1956 to accept responsibility for the maintenance of any unmarried mother In such a home. In 1957, however, the Council accepted responsibility for seven mothers In recognised mother and baby homes, the periods of care varying from one week to eight weeks. ILLEGITIMATE CHILDREN (Circular 2866) The Council do not employ a social worker for the purposes of the above Circular. These duties are undertaken by the Superintendent Health Visitor, and close co-operation Is maintained with the Children's Officer and the Chief Education Officer. SECTION 23 - MIDWIFERY SERVICE This service has functioned very well throughout the two years under review. in 1956, in 291 domiciliary confinements the doctor was present at the delivery on 24 occasions only, whilst In 1957 In 276 such confinements a doctor was present for 17 deliveries. The role of the midwife cannot be overstressed when It is apparent the vast majority of deliveries at home are in fact carried out by the four Council mldwlves assisted by the pupil mldwlves from the Plalstow Maternity Hospital. 43. Two of our midwives are approved by the Central Midwives Board as Midwife Teachers (in possession or the required diploma) and the pupils carry out the whole or their Part II training on the district In East Ham, covering a period or six months. In both years gas and air analgesia was administered on 195 occasions and pethidine in about hair the cases. The work or our mldwlves is especially noteworthy as cars are not provided by the Council, but some assistance Is arrorded In the transport or the analgesic apparatus when this can be arranged. To date no dirricultles or delays have been experienced at the 'bridges" In the south or the borough. The mldwlves and pupils also attend at special ante-natal clinic sessions to give the necessary care to their expectant mothers. TABLE 24 MIDWIVES ACTS, 1902 - 1951 Number or mldwlves practising In the area at 31st December Domiciliary Mldwlves Mldwlves In Institutions Total 1956 1957 1956 1957 1956 1957 Mldwlves employed by the Council 4 4 - - 4 4 Mldwlves employed by Voluntary Organisations - (a) Under arrangements made with the L.H.A. In pursuance or Section 23 or the N. H. S. Act - - - - - - (b) Otherwise (Including hospitals not transTerred to the Minister under the N. H. S. Act) - - - - - - Mldwlves employed by Hospital Management Committees or Boards or Governors under the N. H. S. Act - - 7 7 7 7 Mldwlves In private practice 1 1 - - 1 1 Totals 5 5 7 7 12 12 44. TABLE 25 NUMBER OF DELIVERIES ATTENDED BY MIDWIVES IN THE AREA DURING THE YEAR Domiciliary Cases Cases in Institutions Doctor not booked Doctor booked Totals Doctor present at time of delivery of child Doctor not present at time of delivery of child Doctor present at time of delivery of child (either the booked Doctor or another) Doctor not presant at time of delivery of child 1956 1957 1956 1957 1956 1957 1956 1957 1956 1957 1956 1957 1. Mldwlves employed by the Authority 8 4 207 165 16 13 60 94 291 276 - - 2. Mldwlves employed by Voluntary Organisations (a) Under arrangements with the Local Health Authority In pursuance of Section 23 of the National Health Service Act, 1946 - - - - - - - - - - - - (b) Otherwise (Including Hospitals not transferred to the Minister under the National Health Service Act) - - - - - - - - - - - - 3. Mldwlves employed by Hospital Management Committees or Boards of Governors under the National Health Service Act - - - - - - - - - - 422 414 4. Mldwlves In Private Practice (Including Mldwlves employed In Nursing Homes) - - - 1 - - 1 - 1 1 - - Totals 8 4 207 166 16 13 61 94 292 277 422 414 45. TABLE 26 DOMICILIARY MIDWIVES - ANALGESIA AND ADMINISTRATION OF PETHIDINE Number of domiciliary mldwlves practising In the area at end of year who were qualified to administer Inhalatlonal analgesics In accordance with the requirements of the Central Mldwlves Board Number of sets of apparatus for the administration of Inhalatlonal analgesics In use at end of year Number of cases In which Inhalatlonal analgesics were administered by mldwlves In domiciliary practice during the year:- Number of cases In which pethidine was administered by mldwlves In domiciliary practice during the year:- When doctor was present at time of delivery of child When doctor was not present at time delivery of child When doct cr was present at time of delivery of child When doctor was not present at time of delivery of child Gas and air "Trllene" Gas and air "Trllene" Gas and air "Trllene" 1. Domiciliary Mldwlves employed directly by the Local Health Authority 1956 4 8 - 12 - 183 - 13 107 1957 4 5 - 16 - 179 - 12 130 2. Domiciliary Mldwlves employed under Section 23 by voluntary organisations as agents of Local Health Authority 1956 — - - - - - - - - 1957 - - - - - - - — - 3. Domiciliary Mldwlves employed under Section 23 by hospital authorities as agents of Local Health Authority 1956 — - - - - - - - - 1957 - - - - - - - - - 4. Domiciliary Mldwlves In private practice or employed by organisations not acting as agents of Local Health Authority 1956 - - - - - - - - - 1957 - - - - - - - - - Totals 1956 4 8 - 12 - 183 - 13 107 1957 4 5 - 16 - 179 - 12 130 46. INSTITUTIONAL MIDWIVES The numbers of mldwlves employed by East Ham Memorial Hospital, and qualified at 31st December to administer gas and air analgesia were as follows :- 1956 - Six 1957 - Six. Number of cases in which medical aid was summoned by a midwife under section 14(1 of the Mldwlves Act, 1951 1956 1957 (a) for domiciliary cases - (1) where the medical practitioner had arranged to provide the patient with maternity medical services under the N.H.S. Act 3 45 (11) others 53 33 Total 56 78 (b) for cases In East Ham Memorial Hospital 162 177 Number of cases delivered In institutions but attended by domiciliary mldwlves on discharge from Institutions and before the fourteenth day 32 38 Breast Feeding Number of domiciliary cases In which the Infant was viiolly breast fed at the fourteenth day 204 203 SECTION 24 - HEALTH VISITING SERVICE All Health Visiting Services are provided by the Authority. There are no agency arrangements with voluntary organisations. The total visits made in 1956 and 1957 were 30,975 and 25,328 respectively. In each year one visit In five proved abortive through 'no access', and means must be found to circumvent this wastage of valuable health visitor time. Increasingly the system of selective visiting is being adopted, and when one considers that cars are not provided by the Council for this branch of the service, the health visitors are accomplishing a huge task either on foot using public transport when possible, or on bicycle, both being very tiring and time-consuming. The ore c tic ally there are 23 areas In the borough each covered by a health visitor, but In practice there is considerable overlap due to shortage of staff, sickness, holidays and the pressure of other work. The health visitor Is taking a greater part than ever before in mental health work, the care of old people, and specialist work In relation to problem families and research surveys, e.g. B.C. G. vaccination of selected groups, and audlometrlc work with groups and individuals. The variety of duties she Is called upon to carry out has multiplied, so that soon it will become Imperative to exercise greater selection in allocating her dally task. 47. The problem of the Superintendent Health Visitor in this connection is a most unenviable one, for the Council for the time being is committed to the practice of a unified health visitorschool health service. TABLE 27 HEALTH VISITORS - STATISTICS Year Number of children under 5 years of age visited during year Expectant Mothers Children under 1 year of age Children age 1 and under 2 years Children age 2 but under 5 years Other cases Total number of families or households visited by Health Visitors Number of attendances by Health Visitors at Clinic Sessions First visits Total visits First visits Total visits Total visits Total visits Total visits Effective Visits 1956 6,532 1,310 1, 691 1,412 6,904 4,397 6,072 4,681 13,220 2,923 1957 5,491 1,146 1,521 1,512 7,068 3, 890 4,890 2,143 16, 641 2,531 No Access Visits 1956 485 2,181 1,457 1,687 1,420 1957 479 1,923 1,102 1,486 826 A "No Access" or Ineffective visit is one in which the Health Visitor did not make contact with the individual to be visited or a responsible representative of that Individual. SECTION 25 - HOME NURSING This service continues under the committee of the East Ham District Nursing Association (a voluntary organisation) on which sit members of the East Ham Council and the Medical Officer of Health. His finances of the Association, as far as expenditure incurred in this work is concerned, are linked to the Borough Treasurer's estimates, so that a complete working arrangement results. The headquarters of the Association are sited at 'Charnwood' in Shrewsbury Road, and an adjacent house 'Ascot Lodge' is also available for resident nursing staff. His services given to sick persons in the borough in their own homes by whole-time and part-time, resident and non-resident nurses, is asked for by the 'family doctor' or the hospitals. No night service is normally available. The nursing administration is under the control of the Superintendent Nursing Officer, whilst the day-to-day running of the service and the Nurses' Homes devolves upon the Resident Assistant Superintendent. The District Nursing Service is visited annually by an inspector of the Queen's institute of District Nurses, whose advices and reports are much valued. By continuance of the arrangement entered into in 1955, the part of our borough south of the 'swing bridges' is covered by the nurses of the Woolwich & Plumstead District Nursing Association from their headquarters across the river. 48 TABLE 28 HOME NURSING - STATISTICS Year TYPE OF CASE Number Patients who were 65 or over at the time of the first visit during the year Number of Children who were under 5 at the time of the first visit during the year Number of Patients who had more than 24 visits during the year Medical Surgical Infectious Diseases Tuberculosis Maternal Complications Others Totals Number of cases attended by Home Nurses during the year 1956 2,121 114 4 77 20 172 2,508 1,139 50 570 1957 1,711 105 7 69 18 400 2,310 857 33 465 Number of visits paid by Home Nurses during the year 1956 54,220 2,739 49 3,975 136 356 31,475 37,529 226 45,991 1957 47,792 2,812 29 3,157 171 5,225 59,186 34,987 144 39,077 All home nursing services are provided by voluntary organisations acting as agents of the Council in accordance with arrangements made under Section 25 of the Act. The Council do not directly employ home nurses for this service. 49. SECTION 26 - VACCINATION AND IMMUNISATION DIPHTHERIA IMMUNISATION TABLE 29 Immunisation carried out by Age at date of final injection or of reinforcing injection as appropriate Total under l year 1-4 years 6-14 years Number of children who completed a full course of primary immunisation during the year General Practitioners 1956 1957 1956 1957 1956 1967 1956 1957 - 378 - 199 - 22 - 699 Local Health Authority - 391 - 97 - 35 - 523 Totals 808 769 420 296 278 67 1506 1122 Number of children who received a secondary or reinforcing injection during the year General Practitioners - 1 - 47 - 86 - 134 Local Health Authority - - - 463 - 87 - 550 Totals - 1 - 510 - 173 2494 684 TABLE 30 Number of children who at the end of the year had completed a course of immunisation at any time in the preceding 15 years. Age at 31st December of year under review Under 1 year 1-4 years 5-9 years 10 - 14 years Total under 15 years A Number of children who completed a course of immunisation (primary or booster) in the last five years. 1956 258 4,069 4,013 1,267 9,607 1957 192 4,137 4,130 1,600 11,059 B Number of children who completed a course of immunisation (primary or booster) in the ten years preceding A above 1956 - - 4,341 5,685 10,020 1957 - - 3,342 6,478 9,820 C Estimated mid-year child population 1956 1,380 5,920 16,800 24,100 1957 1,410 5,590 16,400 23,400 D Immunity index i.e. percentage of children immunised in the past five years A/c x100/1 1956 18.6 68.7 31.8 39.8 1957 13.6 74.0 34.9 47.3 It is pleasing to observe that the percentage of the child population immunised against diphtheria, has risen from 68.7 per cent to 74 per cent (but the child population in the age group 1 year to 4 years has fallen from 6,160 to 5,690). 60. TABLE 31 SMALLPOX VACCINATION No. of persons vaccinated or re-vaccinated Age at date of vaccination Totals Under 1 year 1 year 2-4 years 5-14 years Over 14 years Number vaccinated 1956 374 33 40 31 58 536 1957 454 88 72 152 202 968 Number re-vaccinated 1956 1 2 4 7 92 106 1957 2 2 7 40 202 253 All vaccinations were carried out by general practitioners. There were no cases specially reported during the period under review of:- (a) Generalised vaccinia. (b) Post-vaccinal encephalomyelitis. (c) Death from complications of vaccinations other than (a) and (b) One must applaud the efforts of the general practitioners to raise up the vaccinal state of the community. Almost twice the number of persons were vaccinated or re-vaccinated as compared to 1950, in fact, there has been a steady improvement since 1954. Year Number protected by vaccination during the year 1954 585 1955 713 1956 842 1957 1,221 Poliomyelitis Vaccination The initial scheme for inoculation of children against poliomyelitis, using a vaccine produced in Great Britain, limited the offer of protection to children born in the years 1947 to 1954 inclusive and asked that the offer be made known to the parents of all eligible children. A special letter incorporating a reply paid consent form was sent to such parents, a total of 0,755 letters being despatched In respect of 12,430 children. By the closing date of the offer, 31st March 1956, replies had been received as follows:- Parents consenting to vaccination of their children 3,094 " refusing " " " " 1,119 Queries, e.g. removals, etc. 68 Totals 4,281 Thus 48.9 per cent of the letters were returned and the consents received related to 4,340 children 1,996 girls and 2,344 boys - 34.9 per cent of those eligible for vaccination. 51 At this stage no arrangements were made for general practitioners to participate in the scheme, and as and when vaccine was received from the Ministry of Health, all Immunisations were conducted in the Local Authority's clinics. Immunisation took place In May, June and December only in 1056, and in this time a total of 510 children in prescribed groups were given a full course of immunisation. In August 1957, the scheme was extended to cover children born in 1955 and 1956 and in December 1957, to those born in 1943-1946 Inclusive, to children born in 1957 if they were over six months old, to expectant mothers, and certain other groups at special risk. The offer of vaccination was made to the parents of the 1955-56 group by letter as set out above, and to the other groups by general publicity, i.e. posters, leaflets, press advertisements and personal contact by Health Department staff. Discussions took place with the Local Medical Committee on arrangements for General Practitioners also to participate in the scheme of vaccination, and this extension to the scheme in fact started in 1958. The following table shows the numbers registered and vaccinated as at 31st December, 1957: TABLE 32 1947-54 age groups 1955-56 age group. Totals Number of children registered 4,319 1,135 5,454 " " " given two injections. 3,798 1 3,799 " " " given one injection only 80 - 80 " " " awaiting vaccination 441 1,134 1,575 62. SECTION 27 - AMBULANCE SERVICE TABLE 33 Statistics for years ending 31.3.57 and 31.3.58 AMBULANCE SERVICE Transport by rail Grand Total Ambulances Dual Purpose (1 stretcher) vehicles Sitting case vehicles Total - All Vehicles No. of Operational vehicles on 31st March 1966/7 6 4 1 11 - 11 1957/8 6 4 1 11 - 11 No. of such vehicles fitted with wireless 1956/7 - - - - - - 1957/8 - - - - - - TOTAL 1956/7 70,373 91,452 161,826 - 161,825 MILEAGE 1957/8 77,544 90,100 167,644 167,644 No. of Patients carried: Stretcher Patients Sitting Patients Total (a) Accident or Emergency 1956/7 1,073 59 1,332 - 1,132 1957/8 991 71 1,062 - 1,062 (b) Others 1956/7 17,001 23,387 40,388 29 40,417 1957/8 16,775 22,251 39,026 20 39,046 TOTALS (a) & (b) 1956/7 18,074 23,446 41,520 29 41,549 1957/8 17,766 22,322 40,088 20 40,108 No. of Operational 1956/7 30 30 Staff on 31st March 1957/8 30 30 TABLE 34 COST OF SERVICE Period Ambulance Service £ Cars from Transport Pool etc. £ Transport By Rail £ Total £ Year ending 31st March 1951 19,057 463 3 19,523 Year ending 31st March 1952 19,522 677 7 20,206 Year ending 31st March 1953 22,094 219 3 22,316 Year ending 31st March 1954 24,279 144 3 24,426 Year ending 31st March 1955 27,482 185 9 27,676 Year ending 31st March 1956 29,987 198 15 30,200 Year ending 31st March 1957 32,192 95 17 32,304 Year ending 31st March 1958 35,253 69 7 35,329 63. TABLE 36 UNIT COSTS - AMBULANCE SERVICE Ambulance Service only Tear ending 31.3.57 Tear ending 31.3.58 Cost per Vehicle mile 4/- 4/3 Cost per Patient 16/6 17/7 Cost per 1,000 Population £282,0.0. £313.0.0. No. of Patients carried per 1,000 Population 363 366 Average mileage per patient 4.0 4.2 SECTION 28 - PREVENTION OF ILLNESS, CARE AND AFTER CARE Loan Clipboards. The scheme for the loan of articles to aid in the domiciliary nursing of the sick remains as detailed in my previous reports, except that cupboards are now maintained only at the Town Hall Annexe and at Church Road Clinic. Details of the items loaned during the year are shown in the following table - TABLE 36 Article No. of occasions item loaned Cupboard at Total Town Hall Annexe Church Road Clinic 1956 1957 1956 1957 1956 1957 Air bed rings 222 262 19 15 241 277 Bed Blocks 9 6 - - 9 6 Bed Boards - 1 - - - 1 Bed cradles 21 31 4 5 25 36 Bed pans 261 330 18 20 279 350 Bed rests 207 259 13 7 220 266 Blankets - 1 - - - 1 Commodes 7 12 - - 7 12 Crutches 12 12 - - 12 12 Douche cans 1 1 - - 1 1 Dunlopillo Rings 2 7 - - 2 7 Feeding Cups 12 8 1 2 13 10 Hot Water Bottles 1 1 - - 1 1 Hospital Bedsteads - 1 - - - 1 Mattresses 4 5 - - 4 5 Pillows 3 1 - - 3 1 Pillow Cases 1 1 - - 1 1 Rubber Sheets 191 239 13 11 204 250 Sand Bags 2 2 - - 2 2 Sheets - 1 - - - 1 Sputum mugs 12 12 - - 12 12 p Steam Kettles - 1 - 1 Urinals 121 146 12 10 133 156 Walking Sticks 3 6 - - 1 0 1 Water beds 1 1 - - 1 X Wheel Chairs 53 69 - - 53 by Totals 1,146 1,415 80 71 1,226 1,486 54. NOTE:- with the exception of garden shelters stored in sections on other Council promises, all large articles (owing to storage space) are kept at the Town Hall Annexe. In addition, from the premature baby outfit cupboard the following articles were issued:- No. of occasions 1966 1967 Premature baby outfits 4 3 Scales and weights 47 27 TUBERCULOSIS 1956 1967 No. of attendances at East Ham Chest Clinic 31,096 28,240 No. of visits to homes of patients by Tuberculosis Visitors 4,684 4,204 No. of attendances per month by Tuberculosis Visitors at Clinic Session 1,322 1,213 There is no change in the procedure outlined on page 53 of my report for 1949 in respect of the provision of free extra nourishment (milk and food) and free convalescent treatment to tuberculous patients. Number of occasions on which free extra nourishment was provided:- 1956 1957 Milk 696 644 101 114 Total 797 758 The following statistics relate to the work of the part-time occupational therapist:- 1956 1957 (a) Number of sessions at the therapy centre .. 98 89 (b) Number of attendances at Classes by patients 1,663 1,260 (c) Number of sessions worked in visiting patients and giving instruction in their homes 104 93 (d) Number of visits by therapist to patients' homes 697 512 B.C.G. VACCINATION The scheme for the protection with B.C.G. vaccine of contacts of active cases of tuberculosis continues and in addition, and on the recommendation of the Ministers of Health and Education, this protection was offered to all schoolchildren in their fourteenth year. Consent of the parents was sought in every case and it is to be noted that in 1956 consent was refused in 37% of the total number eligible, whilst in 1957 refusals totalled only 33%. All pupils giving a positive reaction to the initial skin test were referred to the Chest Clinic for further investigation including, if necessary, examination of familial contacts. Full details of the numbers tested and vaccinated are given in my reports as Principal School Medical Officer. The statistics submitted to the Ministry of Health for the years in question are summarised in the following table 65. TABLE 37 B.C.G. VACCINATION - STATISTICS Number Skin Tested Number found negative Number Vaccinated or re-vaccinated 1966 1957 1956 1967 1966 1957 A Contacts of active cases of Tuberculosis 366 264 250 209 252 101 B Schoolchildren (1) Initial examination 623 1,000 499 750 407 711 (11) Re-examination of children vaccinated 407 640 - 3 - - TUBERCULOSIS VACCINES CLINICAL TRIAL The following report on this trial of tuberculosis vaccine has been contributed by Dr. T.M. Pollock: of the Medical Research Council's Tuberculosis Research Unit. "Report for East Ham" During the last few years the Medical Research Council, in conjunction with East Ham and other North London boroughs, Birmingham, Manchester, and towns in the Midlands and North of England, have been engaged in an investigation to assess the value of two tuberculosis vaccines. The vaccines concerned are B.C. G. vaccine, which was first developed in France over thirty years ago and is now in general use in many countries, and vole bacillus vaccine, a British vaccine developed in recent years and so far not used so extensively as B. C. G. Although B.C.G. vaccine has been in use for a long period there have been world-wide differences of opinion about its value when used on a wide scale. In some countries, e.g. Denmark, B.C.G. has been offered as a routine public health measure to almost all children, while in others, such as the U.S.A., it has been used very little. In Britain it has been given to contacts of the disease and more recently to school children in some areas. It is difficult to assess the value of B.C.G. from the results of its use in other countries, because during the years since the introduction of the vaccine deaths from tuberculosis have been declining in all Western European communities. Many factors, including improved living standards and the recent striking advances in treatment and prevention, must have assisted in this decline but it is not possible to estimate accurately the part played by each. In fact the reduction in the death rates from tuberculosis achieved by some communities where the vaccine has not been used are as good as in some others where it has been extensively given. It was thus desirable that, before considering tuberculosis vaccination on a large scale in this country, an investigation into the contribution likely to be made by this measure to the prevention of tuberculosis in England should be known. Description of Investigation The effort to establish the value of the vaccines scientifically has required a large and detailed investigation. Between September 1950 and December 1952, 56,000 young people aged 14 volunteered to Join the scheme. Six hundred and fifty of these volunteers came from East Ham. Each volunteer had a chest x-ray and skin test, and a proportion of selected susceptible children were given one or other of the tuberculosis vaccines. Since then it has been essential for those conducting the investigation to be kept informed about the development of any cases of tuberculosis among the participants. This has been done by an annual postal enquiry, annual x-ray and annual home visit. The investigation has required a high degree of co-operation between the Medical Research Council and the areas taking part. In particular the home visiting of the participants by the health visitors has been largely responsible for its success. As a result of the intensive follow-up it has been possible to obtain evidence of the value of the vaccines comparatively soon after the beginning of the scheme. A progress report published in February of this year showed that vaccination of adolescents against tuberculosis is dence of the disease occurring between the ages of 14 and 17 by about one half, and thus make a valuable contribution to the prevention of tuberculosis. Now that the early results of the investigation are known, vaccination schemes can be introduced with the certain knowledge that the expense and effort 60. required will be justified by the results obtained, and the next step is the extension of such schemes for older school children. Meanwhile the investigation is being continued and it is hoped that it will provide further Information about protection against tuberculosis. During 1950 and 1957 further progress was made in the Tuberculosis Vaccines Clinical Trial. East Ham and other areas co-operating with The Medical Reasearch Council in this extensive investigation to determine the contribution which vaccination against tuberculosis can make to the reduction of this disease. Beginning in September, fourteen year old children were invited to Join the investigation during their last terms at school. By December 1952, more than 60,000 or these young people had volunteered to participate. All were given a chest x-ray on entry and also a skin test to determine whether they were eligible for vaccination. Those who were eligible were given B.C.G. vaccine, the best known tuberculosis vaccine, or vole vaccine, a British vaccine which has been developed more recently than B.C.G.; others were not vaccinated. Since the trial began it has been the task of those co-operating in the work to keep the participants under observatlon and detect any cases of tuberculosis which arise. Contact has been maintained with the participants by sending each a postal form once a year, by an annual home visit by a health visitor, and by annual chest x-rays. All these methods have been successful and only a very small proportion of the young people have been lost sight of. However, the most important contact has been the visit to the home, and the health visitors deserve great credit for the persistence with which this work has been performed. In many of the houses visited, for example, it has been necessary to make repeated calls before anyone is found at home. At these visits details of the participants health and of any known contact with tuberculosis have been obtained, as well as other essential Information such as changes of address. The home visits have also provided an opportunity to remind the participants of the object of the investigation and have done much to assist their continued co-operation. The chest x-rays have also been an essential feature of the investigation. These examinations are a valuable health safeguard and ensure that any cases of tuberculosis or other chest disease which develop can be promptly and adequately treated at an early stage. Besides these principal methods of follow-up information has been made available from the chest clinics ln the areas concerned, and also from the Armed Forces. As a result of the intensive nature of the follow-up it has been possible to obtain Information about the protective effect of the vaccines quickly and ln 1956 the first results were published. The findings clearly showed that B.C.G. and vole vaccines both confer substantial protection against tuberculosis. Local authorities ln England and Wales have therefore been encouraged to begin or increase the vaccination of thirteen year old children who are now offered the vaccine ln all areas ln the united Kingdom. It is to be expected that this widespread vaccination will produce a considerable reduction ln the incidence of tuberculosis ln young people ln the future. This step forward ln preventive medicine has been made possible by the co-operation of the local authorities who have done so much to support this investigation of the vaccines. The evidence of the protective effect of the vaccines is available so far only for a few years after the vaccines have been given. There is still no certain knowledge how long protection lasts, and it is desirable to know whether its protective effect will fall off within a few years or remain for a long time. Accordingly it is hoped to continue the investigation for some further years. Apart from knowledge about the vaccines other Information of considerable value to the understanding and prevention of tuberculosis is likely to be obtained. As time goes on the difficulties of keeping ln touch with the participants have tended to increase especially when young people move from an original address. However, with the co-operation of the local health authorities arrangements have been made to have the participants visited and x-rayed ln any part of the United Kingdom to which they may move; similar facilities are available in many countries overseas. A large proportion of the young people, over 90 per cent, continue to have a regular home visit and response to the annual chest x-rays is still very satisfactory. In East Ham In 1967, for example, 65 per cent of the participants invited kept their x-ray appointment. When it is recalled that the Trial has been going on now for over eight years, and that the participants are now over twenty, the response is a tribute to the co-operation of the participants and to the able and conscientious work of the health visitors." MASS RADIOGRAPHY The Mass Radiography Unit (6B) visited East Ham and conducted a public survey from 7th October to llth November 1957 The Unit was accommodated ln the Town Hall Annexe and a total of 8,717 persons 4,218 males and 4?499 females - attended for examination. These can be classified Into the following group: General Public 5,244 Referred by General Practitioners 486 Groups from schools 147 Organised groups from factories, offices, etc. 2,840 8,717 57. TABLE 38 CONVALESCENT HOME TREATMENT - PERIOD OF' TREATMENT Age Groups Year Sex Up to 1 week 1-2 weeks 2-3 weeks 3-4 weeks 4-5 weeks 5-6 weeks over 6 weeks Total Under Five Years 1956 M - - 2 1 2 - 2 7 F - 1 2 2 1 - 2 8 M 1 1 - 1 - - 1 4 1957 F - - - 3 - - - 3 School Children 1956 M - 2 16 10 12 - 1 41 F 2 1 11 10 8 1 - 33 M - 4 7 10 7 1 - 29 1957 F - - 7 12 5 - - 24 Adults M - - 21 40 1 - - 62 1956 F 1 - 39 84 6 - - 130 1957 M - 36 21 - - - 57 F 1 4 81 36 3 - 3 128 Totals 1956 3 4 91 147 30 1 5 281 1957 2 9 131 83 15 1 4 245 TABLE 39 The recommendations for this treatment were submitted by:- Referred by Children 0-5 School children Adults Total 1956 1957 1956 1957 1956 1957 1956 1957 General Practitioners 5 3 30 21 154 150 189 174 Hospitals - - - - 9 15 9 15 East Ham Chest Clinic 1 2 9 3 25 20 35 25 School Health Service - - 29 22 - - 29 22 M. & C.W. Section 8 2 - - 3 - 11 2 Child Guidance Centre 1 - 6 7 1 - 8 7 Totals 15 7 74 53 192 185 281 245 For comparison the numbers of children and adults receiving this form of treatment In previous years are appended:- 1953 1954 1955 1956 1957 Children 0-5 years 12 27 14 15 7 Schoolchildren 80 90 80 74 53 Adults 117 158 175 192 185 It can be observed from the statistics for the years 1953 to 1957 that the trend Is towards a con valescent service mainly for adults. Great care is exercised ln the selection of adult cases to ensure the need is a recuperative period after a debilitating illness or accident, and not merely a desired holiday away from home and the environment of East Ham. The exercise of selection often taxes one's discrimination and humanity to the full, but by taking into consideration all the available evidence, including observations by the family doctor, our own officers and the hospital staffs, equitable assessment is arrived at in most instances. 68. PARK VIEW THERAPEUTIC CLUB The Club continues to function with an average of 26 - 30 members. There is little question that the constant attendance bears witness to the need of some place where persons still unsure of themselves as social entitles can meet and enjoy social intercourse. We would greatly value the support of the medical staff of Runwell Hospital and the referral to the Club of new cases for rehabilitation. We have close cooperation with the medical staff (which we value greatly) in many matters concerning the welfare of mental sufferers, yet liaison ln this connection escapes us. Can it be that the psychiatrists have ceased to attach any great importance to rehabilitation through social clubs ln individual cases? Is it the press of clinical duties within the hospital and the psychiatric out-patient clinics which militates against their support and occasional attendance at the Club? Or is it Just laissez-faire? The Petitions Officer, Mr. Steadman, and the Duly Authorised Officers, should be thanked warmly and sincerely for their continued support to the Park View Therapeutic Club. SECTIONS 28 AND 61. - MENTAL HEALTH SERVICE. The plans for the provision of a second centre for mental defectives remain as detailed on page 64 for the report for 1949. Despite the defects in the premises and lack, of facilities and equipment for social and simple industrial training, the Occupation Centre continues to fulfil a dally need ln the life of a hard pressed section of the community. For the presence of a defective within a household has inherent problems for parents, siblings and neighbours. But defectives can be taught social conduct and even social gracex. Anyone who has seen the Nativity Play staged annually at Christmas will admit this. But without the apparatus, equipment and Instructors, it is almost impossible to raise the level of attainment in individuals and groups, acceptable ln Industry ln the outside world. The staff of the Occupation Centre merit every praise for the fine humanitarian and altruistic task they accomplish daily. The Health Committee are well aware of their hopes and aspirations and only financial stringency puts the brake on expanding endeavour. 59. TABLE 40 PARTICULARS OF MENTAL DEFECTIVES REPORTED 1956 1957 Males Females Total Males Females Total Particulars of cases reported during the year:- (1) Ascertainment - (a) Cases reported by Local Education Authorities (Section 67, Education Act, 1944) - (1) Under Section 57(3) 7 3 10 1 1 2 (11) Under Section 57(5):- On leaving special schools 3 2 5 3 4 7 On leaving ordinary schools - - - - - - (b) Other ascertained defectives reported and found to be "Subject to be dealt with" - - - 1 - 1 Total ascertained defectives found to be "Subject to be dealt with" during the year 10 6 15 5 5 10 (c) Other reported cases ascertained who are not at present "Subject to be dealt with" 1 1 2 - - - (d) Cases reported but not confirmed as defectives by 31st December and thus excluded from (a), (b) or (c) 1 1 2 2 1 3 Total no. of cases reported during the year 12 7 19 7 6 13 (2) Disposal of cases reported during the year:- (a) Ascertained defectives found to be "Subject to be dealt with" (1) Admitted to Hospital etc. 2 - 2 2 1 3 (11) Placed under guardianship - - - - - - (111) Taken to "places of safety" - - - - - - (1v) Placed under statutory supervision 8 5 13 5 4 7 Total ascertained defectives found to be "Subject to be 10 6 16 6 5 10 (b) Cases not at present "Subject to be dealt with" - (1) placed under voluntary supervision 1 1 2 - - - (11) Action unnecessary - - - - - - Total cases not at present "Subject to be dealt with" 1 1 2 - - - 60. TABLE 41 MENTAL DEFICIENCY ACTS, 1913 - 1938 PARTICULARS OF MENTAL DEFECTIVES AS ON 31st, DECEMBER EACH YEAR 1956 1957 Males Females Total Males Females Total 1. No. of ascertained mental defectives found "Subject to be dealt with":- (a) In hospitals, etc. (including cases on licence therefrom) Under 16 years of age 20 6 26 21 6 27 Aged 16 years and over 87 90 177 85 89 174 (b) xUnder guardianship (including cases on licence therefrom) Under 16 years of age - - - - - - Aged 16 years and over 1 5 6 1 5 6 (c) In "places of safety" - - - - - - (d) under statutory supervision (excluding cases on licence) under 16 years of age 15 18 33 14 18 32 Aged 16 years and over 79 64 143 82 68 150 Total ascertained cases found to be "subject to be dealt with" 202 183 385 203 186 389 No. of cases included in (b) to (d) above awaiting removal to an institution 2 1 3 1 - 1 2. No. of mental defectives not at present "subject to be dealt with" but over whom some form of voluntary supervision is maintalned:- Under 16 years of age Age 16 years and over 26 25 51 27 26 53 Total number of mental defectives (1) plus (2) 228 208 436 230 212 442 3. No. of mental defectives receiving tralnlng:- (a) In day training centres Under 16 years of age 12 13 25 11 12 23 Aged 16 years and over 18 12 30 19 14 33 (b) At home - Total 30 25 55 30 26 56 x No defectives under guardianship were dealt with during the two years under the provisions of section 8 or 9. 61. GUARDIANSHIP CASES 1956 1957 No. on register on 1st january 8 6 No. admitted to institutions - - No. of Orders discharged by the Board of Control 2 - No. on register on 31st December 6 6 No. resident outside East Ham and visited by members of the Mental Health Sub-Committee 2 2 No. resident in East Ham and visited by the Medical Officer of Health 4 4 OCCUPATION CENTRE The numbers of defectives on the register of the Occupation Centre on 31st December of each year was as follows:- 1956 1957 Males 27 28 Females 26 25 Total 53 53 TABLE 42 OCCUPATION CENTRE - SESSIONS AND ATTENDANCES Morning Afternoon Total. Number on Register: 1956 - Males 27 26 53 Females 26 26 1957- Males 28 27 63 Females 25 25 Number of Sessions held during the year 1956 220 220 440 1957 216 216 432 Total Attendances:- 1958- Males 5,135 4,950 10,085 Females 4,752 4,752 9,504 Total 9,887 9,702 19,589 1957- Males 4,934 4,786 9,720 Females 4,202 4, 202 8,404 Total 9,136 8,988 18,124 Average attendance per session: 1956- Males 23.3 22.5 44.6 Females 21.6 21.6 1957- Males 22.8 22.2 41.9 Females 19.5 19.5 62. TABLE 43 MENTAL PATIENTS - LUNACY AND MENTAL TREATMENT ACTS Type of patient Number on register on 1st January Admissions to Hospitals during the year Discharges from Hospitals during the year Deaths ln hospitals during the year Number on register on 31st December 1960 1967 1968 1967 1958 1957 1950 1957 1950 1957 Certified Males 140 138 14 26 10 13 0 12 138 138 Females 171 184 43 32 24 25 0 12 184 179 Total 311 322 67 67 34 38 12 24 322 310 Temporary Males - - 2 3 2 - - 3 - - Females 4 6 3 1 - 1 1 6 4 Total 4 6 6 3 3 - 1 4 6 4 Voluntary Males 92 96 73 61 06 52 4 8 95 88 Females 106 91 86 78 85 84 15 6 91 80 Total 198 188 168 129 161 138 19 13 180 166 Grand Totals 613 613 220 189 188 174 32 41 513 487 Number of patients released on trial 1956 1957 Males 11 12 Females 20 28 Total 31 40 Number of patients returned from trial 1956 1957 Males 3 3 Females 10 11 Total 13 14 Disposition of Mental Patients 1956 1967 Runwell Hospital Other Hosp ltals Runwell Hospital Other Hospitals In patients on 1st January 504 9 503 10 Admissions during the year 215 5 185 4 Discharges during the year 188 - 172 2 Deaths during the year 31 1 41 In patients on 31st December 500 13 475 12 63. TABLE 44 DULY AUTHORISED OFFICERS DETAILS OF VISITS, ETC. No. of visits and/or attendances 1950 1957 Mental Deficiency Acts 1913 - 38 Guardianship 33 28 Statutory Supervision 1,370 1,399 Friendly Care 119 148 Home reports for patients detained in Institutions 118 168 Occupation Centre 100 112 Total visits or attendances 1,740 1,855 Lunacy and Mental Treatment Acts Patients reported to be in need of treatment 1,409 1,413 After-Care 728 833 Park View Therapeutic Social Club 86 87 Total visits or attendances 2,283 2,333 Grand Totals 4,023 4,188' SECTION 29 - HOME HELP SERVICE In my last report I commented on the fine work of the Home Help Organizer, Miss Knight, and her staff. Their work throughout the past two years has indelibly endorsed all that was written ln 1955. Hardly a dissentient note has been raised to lessen the volume of praise which has been voiced from every quarter of the borough. I should add the administrative work required to ensure first the imperative need of the service in individual households and secondly the equitable distribution of available working hours between the recipients, is a difficult and taxing task which demands all the skill, patience and understanding of the organiser and certain members of the office staff who specialize ln this work. 64. TABLE 45 HOME HELP SERVICE TABULATION OF CASES. Illness or other cause for which help provided Period of Service Provided Total under 1 week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Maternity 1956 2 36 1 - - - - - 39 1957 5 18 16 - - - - - 39 Tuberculosis 1956 2 - 2 1 11 4 8 30 58 1957 3 - 1 2 9 6 5 33 59 Cancer 1956 - 1 - 1 11 11 6 22 51 1967 2 1 1 2 18 3 8 24 69 Old Age 1966 6 8 13 11 •72 70 48 626 854 1967 10 9 6 26 114 78 81 669 892 Other Sickness 1956 8 8 16 16 31 28 11 64 171 1957 7 3 7 8 31 21 11 76 164 TOTALS 1956 18 53 32 28 125 113 72 732 1,173 1957 27 31 31 37 172 108 105 702 1,213 The approved establishment is 80 full time helps or their equivalent ln part time help and on 31st December of each year the staff employed comprised:— 1956 1957 Full Time Permanent Helps 1 1 Registered Casual Helps 120 132 Casual Helps on probation prior to Registration 17 19 Total 138 152 Provision was made for an average use of 2875 hours per week ln the financial year 1958/7 and 3,250 hours per week in 1957/8. The total hours of service given and the average hours worked per week were as follows:- Year Total hours worked Average per week 1958 142,730 2,744 1957 153,839 2,958 The salient feature in reporting on this most valuable of the social services is the steady expansion of the service exemp1ified in the following figures of average hours worked per week. 1953 - 2,331 hours per week 1954 - 2,441 " " " 1955 - 2,697 " " " 1956 - 2,744 " " " 1957 - 2,958 " " " 65. During the years under review, the Organiser and her Assistant made the following numbers of visits to the homes of applicants for the servlce:- 1956 1957 Primary visits to new applicants for the service 660 664 Visits to applicants already in receipt of the service 1,916 2,605 Totals 2,475 3,169 SANITARY SECTION 1956/1967 This section of the report relating to the sanitary circumstances, housing, food inspection and general routine work, of the Section has been completed by the Chief Public Health Inspector, Mr. D.G. Tonkin, M.P.H.I.A. The staff position during 1956-57 fortunately remained unchanged, as a large amount of extra work was placed on the section, particularly in regard to the implementation of the Food Hygiene Regulations, and the Rent Act 1957. The Council's decision that the Inspectors should assist tenants by giving them information with regard to the completion of Form G. (Notice to Landlord of repairs necessary) resulted ln inspectors spending much extra time on applications received. The service was much appreciated and landlords too, often seek Information of the department with regard to repairs necessary. During the period the department was busy with slum clearance inspections, and ln 1957 four areas ln North Woolwich and Bonnydowns were represented. A total of 414 houses was involved and the Minister after Public Enquiries confirmed the Orders made. The Housing Act, 1957 became operative during that year and the East Ham Corporation Act, 1957 also became law. This latter Act contains many clauses which are of assistance to the department. In 1956 the designation of Inspectors was changed by Act of Parliament from Sanitary inspector to Public Health inspector. ANNUAL REPORT, 1956 (A) Inspections 27, 538 (1) Housing Public Health Act 6,014 Re-inspections 10,342 Housing Act, 1936 2,393 (11) Sanitary Circumstances Yards, passages and stables 245 Drainage and sanitary accommodation 1,894 Drainage tests 153 Caravans 152 Offensive fumes 31 Miscellaneous 775 Factories 422 Workplaces and ouworkers 489 Places of public entertainment 349 (111) Food Supply Slaughterhouses 272 Milk and Dairy premies 169 Ice cream premises 347 Food premises, general and unsound food 1,672 Bakehouses 80 Cafes and restaurants 261 Itinerant food vendors and stalls 372 Sampling visits 550 (Contd.) 66. (IV) Infectious Diseases Visits 138 (V) Food Poisoning Visits 31 (V1) Diseases of Animals Act Visits 00 (Vll) Pet Animals Act Visits 42 (V111) Smoke nuisances and observations 279 (B) NOTICES During the year 1,700 preliminary notices were served, 940 such notices were compiled. Seven hundred and eighty statutory notices were served after report to committee, and of these 659 were compiled. (C) RODENT CONTROL The number of complaints received in respect of rat and mice infestation totalled 208. The rodent operative made 1,465 visits. The estimated number of rats killed was 487. (D) DISINFECTION AND DISINFESTATION Four hundred and forty-five visits were made by the Disinfector ln respect of infectious disease, bugs and dirty premises. The steam disinfector was ln operation on 95 days for disinfection of clothing and bedding; 760 library books were disinfected before return to the libraries from householders where infectious disease etc., had occured. All articles returned to the Health Department "loan cupboard" by ailing or disabled persons were sterilised or disinfected. (E) DRAINAGE The number of complaints of choked or defective drains received during the year totalled 594. This figure shows a slight reduction of 56 (629). As a result of drainage tests by the Inspectors, a considerable amount of repairs were carried out by the Corporation on behalf of owners. (F) FERTILISERS & FEEDING STUFFS ACT, 1926 Eight samples were taken during the year as follows:- Dried Blood Sulphate of Ammonia Superphosphate Potash Bone Meal (2) Expeller Palm Kernal Cake Expeller Coconut Cake One sample was unsatisfactory as follows:- Bone meal - below vendor's statutory statement - sample wrongly described as bone meal. The matter was brought to the attention of the Agricultural Analyst for determination and the manufacturer was cautioned. (G) RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Nine samples were taken during the year as follows:- Coir Fibre Cotton Flock Rag Flock (4) Cotton Felt Algerian Fibres (2) All the samples were found to be satisfactory upon analysis. (H) MOSQUITO CONTROL The usual spraying of ditches and stagnant water was carried out. (I) PET ANIMALS ACT 1951 There were 10 premises on the register at the end of the year licensed to be kept as Pet Shops. inspections of the premises were carried out to ensure that the conditions of the licence issued by the Council were observed. All compiled with the conditions of licence, and no complaints were received. 67. (J) SMOKE ABATEMENT The Clean Air Act received the Royal Assent during the year and represented the culmination of years of effort by local authorities and their staffs to secure legislation affording a more stringent check on air pollution. The Act followed the Report of the 'Beaver Committee' which made an exhaustive enquiry into the problem. Most of the Act was not operative until later years, but industrial undertakings were given seven years from the passing of the Act to "put their house in order" after which such defences as obsolete machinery would not be acceptable at law. Particular attention was paid to the few persistent offenders in the district, and in one case we were able to persuade the management of a large laundry establishment to rebuild and rebuild the chimney serving the boiler furnace. (K) FACTORIES, WORKPLACES AND OUTWORKERS The number of factories on the register at the end of the year was 333 including 42 power factories and 291 non-power factories. Arising out of 314 inspections carried out it was necessary to call the attention of the occupiers of the factories in 45 cases to defects existing on the premises, consisting for the most part of a want of cleanliness and unsuitable or defective sanitary accommodation. There are also 220 outworkers ln the district, primarily engaged ln the business of making wearing apparel or assembling Christmas crackers. The premises were visited to ensure that work was carried out under suitable conditions. (L) PLACES OF PUBLIC ENTERTAINMENT Frequent visits were paid to these establishments, including ordinary Dance Halls. The management or proprietors of these premises do afford the local authority's officers all co-operation ln maintaining satisfactory public health standards and ln carrying out the terms of the Corporation's Regulations with regard to the management of the premises. (M) SAMPLING The following table shows the number of samples of all types taken for analysis or examination. Chemical Food & Drugs Act 339 Bacteriological - Food 142 Water - drinking and bath 10 Fertilisers 6 Feeding Stuffs 2 Rag Flock & Filling Materials 9 Total 508 (N) DISEASES OF ANIMALS ACT Various Orders were made by the Ministry of Agriculture, Fisheries and Food and appropriate action was taken where Orders affected local animal or poultry dealers. HOUSING STATISTICS 1. Inspection of dwelllnghouses during the year 1. (A) Total number of dwelllnghouses inspected for defects (under Public Health Act or Housing Act) 8,545 (B) 18,887 2. (A) Number of dwelling houses included under Subhead (1) above which were inspected and recorded under the Housing Consolidation Regulations, 1925 - (B) Number of inspections made for the purpose - 3. Number of premises found to be ln a state so dangerous or injurious to health as to be unfit for human habitation - 4. Number of dwelling houses (exclusive of those referred to under preceding sub-heading) found not to be ln all respects 2,158 68. II. Remedy of defects during the year without service of formal notices. Number of dwelling houses rendered fit in consequence of informal action by local authority or their officers. 964 III. Action under Statutory Powers during the year:- (A) Proceedings under Sections 9. 10, and 16 of the Housing Act, 1936: 1. Number of dwelling houses in respect of which notices were served requiring repairs 2. Number of dwelling houses which were rendered fit after service of. formal notice (1) By owners _ (11) By local authority in default of owners - (B) Proceedings under Public Health Act:- (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 760 (2) Number of dwelling houses in which defects were remedied after service of formal notice (1) owners 659 (11) by local authority in default of owners '(C) Proceedings under Sections 11 and 13 of the Housing Act 1936:- 1. Number of dwelling houses in respect of which Demolition Orders were made - 2. Number of dwelling houses demolished in pursuance of Demolition Orders - (D) Proceedings under Section 12 of the Housing Act 1936:- 1. Number of separate tenements or underground rooms in respect of which Closing Orders were made. - 2. Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit. IV. Visits in connection with housing circumstances of applicants for rehousing 2,393 LEGAL PROCEEDINGS It was necessary to prosecute landlords in 20 instances for failure to comply with statutory abatement notices. In 14 cases the work was carried out and the summonses withdrawn on payment of costs. In 6 cases Orders were made for 21 days, and ln one of these a fine of £2. was imposed. HOUSING REPAIRS AND RENTS ACT, 1954 Particulars of applications made and Certificates Issued under the above-mentioned Act:- Applications by tenants for Certificates of Disrepair 28 Certificates of Disrepair granted 28 Applications by landlords for Certificates of Revocation 26 Certificates of Revocation granted 34 Applications pending (Certificates later granted) 1 Certificates of Disrepair cancelled 1 INSPECTION AND SUPERVISION OF FOOD SUPPLIES AND PREMISES (a) Milk Supply The number of Milk Distributors registered at the close of the year was 182, and the two large dairies London Co-operative Society Limited and Mortlocks Modern Dairies Limited continued to function satisfactorily. The following licences were issued to use special designations prescribed ln the Milk (Special Designation) Regulations 1949-54: Pasteurised Milk: Dealer's (Pasteuriser's) Licence 2 Dealer's Licences 109 Supplementary licences 11 Dealer's licence Pasteurised - tuberculin tested milk 3 69. Sterilised Milk: Dealer's Sterlliser's licence 1 Dealer's licences 100 Supplementary licences 11 Tuberculin Tested Milk: Dealer's licences 24 Supplementary licences 10 Ninety samples of milk were submitted for chemical analysis, i.e. fat content etc., all of which were satisfactory. Ninety-two samples of milk were submitted for bacteriological sampling. (b) Meat Inspection The three licensed slaughterhouses in the borough continued to operate, and the following table shows the number of animals killed and examined: - TABLE 40 Cattle Calves Sheep Pigs Total 270 51 1,303 1,591 3,275 There were 86 butchers' shops in the town (Including 3 Continental and 4 Kosher butchers) and these remises were inspected with regard to general hygienic conditions and stock carried. (c) Two hundred and eighty-nine premises remained on the register for the sale of ice-cream, of these 12 were new registrations. Twenty-two premises remained on the register for the manufacture of ice cream. Adequate inspection of places of manufacture were carried out and 44 samples of ice cream were submitted for bacteriological and biochemical examination; two samples of water ices proved to be unsatisfactory and remedial action was taken at the place of manufacture. The samples were submitted for bacteriological examination with, the following results: Grade I Grade II Grade III Grade IV 33 5 4 2 Three samples of ice-cream manufactured at large manufacturers outside the district were unsatisfactory, and the attention of the local authorities concerned was drawn to the results of the examinations. (d) Other Foods There were 121 premises on the register at the end of the year for the preparation or manufacture of preserved food. These premises include such premises as sausage manufacturers and fish fryers. Of these 3 were new registrations during the year. Arising out of the examination of a large variety of foodstuffs the following items were certified as unfit for human consumption:- Tinned fruit 600 tins " milk 111 " " meat 341 " " fish 23 " " and packeted other goods 927 " or packets Totals 2,002 70. Food other than tinned or packeted: Fish 539 lbs. Meat 881 " Cheese 148 " Turkeys (9) 148 " Chickens (3) 10½ " Butter ½ " Total 1,687 " 4 boxes herring roes. SAMPLING - FOOD AND DRUGS ACT Food and Drugs Sampling During the year 341 samples were submitted to the Public Analyst. Details as follows:- TABLE 47 Examined Number of Samples Found adulterated or below standard Butter 8 - Margarine 1 - Lard and cooking fat 4 - Cheese 4 - Confectionery 25 2 Jam 5 - Milk 90 - Sausage 63 2 Vinegar 6 - Wines & Spirits 24 - Drugs 5 - Other articles 106 3 Total 341 7 Included in "other articles" are two samples submitted to this department by members of the public as follows: 8312 - Suspected rat excreta in bread. 8201 - Beetle in bread. 71. Details of unsatisfactory samples: TABLE 48 Sample NO. Informal or Formal Article Adulteration or deficiency 7984 Informal Pork Sausage Deficient ln meat to extent of 3% 8084 Informal Pork Sausage Deficient ln meat to extent of 12% 8168 Informal Steak mince Sulphur Dioxide 70 parts per million. No provision made for preservatives ln minced steak under Public Health Regulations. 8201 Informal 2 slices of bread containing foreign matter Slice contained decapitated beetle and wing case. 8219 Informal Loose ice cream 0.6% less fat than prescribed minimum of 5%. 8223 Informal Ice cream 2.4% less fat than prescribed minimum. 8268 Informal Milk Shake Base Sample contained sulphur dioxide - not ln accordance with Food &. Drugs Regulations. In all cases cautions were issued, and follow-up samples were satisfactory. SHOPS ACT etc., ADMINISTRATION (Mr. D.G. Tonkin* Chief Inspector, Mr. T. Gilbert* Mr. L. Plnguey, Inspectors *Member Institute of Shops Act Administration SHOPS ACTS, 1950 During the years 1956-1957 there was much parliamentary activity concerning the law as applied to the conduct of shops, and a new Shops Bill was promoted ln the House of Lcrds. The Bill did not go so far as most people concerned with the administration of the Shops Act would have wished, but it did contain new clauses which would have obviated many of the anomalies ln the existing legislation. The Bill was actually passed by the House of Lords ln May 1957, but to the dismay of the local authority administration it was rejected by the House of Commons. Nevertheless within the framework of the existing legislation much useful work is carried out to ensure that adequate arrangements are made for the health and comfort of shop workers, hours of employment of young persons and ln the control of the closing hours for shops. Statistics for 1956 Number of shops in borough subject to Act 1,925 Number of shops in borough closed 117 Total 2,042 Other premises, laundries and dyers/cleaners 54 Number of shops visited 1,145 There were 520 visits to premises in connection with the health and comfort provisions of the Act, and in 62 premises the provisions were insufficient or unsatisfactory. Visits regarding records required to be kept were 566 and ln 120 cases the records were found to be not properly kept. 72. One thousand one hundred and three shops were visited after closing hours, and 497 visits were made during holiday closing time. Though the great majority of shop-keepers are co-operative In the matter of closing hours, It was necessary to Issue verbal cautions In 92 cases and to write warning letters In 21 Instances. Legal proceedings Three summonses were Issued during the year: 1. Contravention of Section 47 (open on Sunday for sale of unauthorised goods) Fine 10/- 2. Contravention of Section 50 (necessary notices not displayed) Fine £3. 3. Contravention of Section 47 (open on Sunday for sale of unauthorised goods)Fine £3. The following table gives the number of shop assistants employed In the borough: Male 1,265 Female 1,910 Young persons - Male 84 Female 141 Total 3,390 This shows a decrease of 124 persons employed In shops during the year. During the year In 81 Instances there was a change of occupier, In 41 cases the occupier and the trade changed and In 3 Instances the occupier changed the trade. There were 7 shops registered In respect of Sunday Trading by Members of the Jewish faith and there were 4 Kosher butchers operating. Pharmacy & Poisons Act, 1933 Number of persons listed to retail Part II poisons 155 (renewals 151, new applications 8). There were 159 visits made primarily In connection with storage of poisons. Explosives Act 1875 Number of premises registered 166. (Renewals 144, new applications 23, cancellations 26). The Inspector carried out 109 observations In the vicinity of registered premises at the time of sale of fireworks, as this Is the type of explosive with which the department Is generally concerned, and In addition 170 visits of Inspection to premises were made with regard to storage of fireworks. Heating Appliances (Fireguards) Act 1952 During the year 2,637 observations and visits were carried out under the Act. It was necessary to prosecute one dealer for obstruction of the Inspector In the execution of his duties. The dealer was conditionally discharged. Domestic Servants Registry There Is one person In the borough carrying on the business of a Domestic Servants Registry. Inspection of the records at the Registry was made to ensure that the placing of persons was carried out In an orthodox manner. Minor Excise Licences There were 66 premises of persons carrying on the businesses of pawnbrokers, refreshment houses, money lenders and hawkers, and check visits were paid to all of these premises. 73. ANNUAL REPORT 1957 Inspections The number of Inspections of all classes 25,676 (1) Housing:- Public Health Ac 5,087 Re-Inspections 7,831 Housing Act, 1957 2,587 Clean Air Act 45 Rent Act, 1967 1,334 (11) Sanitary Circumstances Yards and Passages 90 Drainage and sanitary accommodation 2,073 Drainage tests 84 Caravans 251 Offensive smells 7 Miscellaneous 901 Factories (excluding bakehouses) 379 Workplaces and Outworkers 377 Places of Public Entertainment 218 (111) Food Supply Milk and Dairy premises 97 Ice cream premises 358 Food premises, general and unsound food 1,489 Cafes and Restaurants 298 Bakehouses 85 Itinerant food vendors and stalls 396 Sampling 545 Slaughterhouses 291 (lv) Diseases of Animals Acts Visits 33 (v) Pet Animals Acts Visits 38 (vl) Infectious Diseases Visits 476 (vll) Food Poisoning Visits 13 B. NOTICES The number of Notices served during the year totalled 1,994 of which 650 were Statutory Notices. The number of Notices compiled with in the same period was 1,352 Including 521 Statutory Notices. Complaints made to the Department with regard to sanitary circumstances, disrepair, Infestations, obstructed drains etc., totalled 2,230 C. RODENT CONTROL The number of complaints received in respect of rat and mice Infestation totalled 292 and 343 premises were Inspected in detail. The rodent operative made 1,595 visits. D. DISINFECTION AND DISINFESTATION 431 premises were treated as appropriate in respect of Infectious disease, bugs and dirty premises, and where circumstances warranted, help was given by the department for beetle Infestation. Hie steam disinfector was In operation on 81 days for dlslnfestatlon of clothing and bedding. Library books were disinfected before return to the libraries from households where infectious disease etc. had occurred. Similarly all articles returned to the Health Department loan cupboard by ailing or disabled persons were sterilised or disinfected. 74. E. DRAINAgE The number of complaints of choked or defective drains received during the year totalled 607. F. , FERTILISERS A FEEDING STUFF'S ACT 1926 3 samples were taken during the year as follows: Bone Meal (2) Meat Bone meal, (l) One unsatisfactory Did not comply with Vendor's statement Deficient In Phosphoric (Manufacturer cautioned). Acid 1.6556 Limit Is 1% 0. RAO FLOCK AND OTHER FILLING MATERIALS ACT, 1951 6 samples were taken during the year as follows: Cotton Felt Flag Flock (4) Orey-black fibre All samples were found to be satisfactory. There were 7 premises on the register at the end of the year. H. MOSQUITO CONTROL The dl3lnfector continued to give service to householders by spraying of ditches, stagnant water areas and sometimes rotting vegetation. In view of the amount of building that has taken place on vacant sites, in the last few years, complaints are not so numerous as heretofore. I. PET ANIMALS ACT 1051 There were 16 premises on the register at the end of the year licensed to be kept as Pet Shops. Inspections of the premises were carried out to ensure that the conditions of the licences Issued by the Council were observed. J. SMOKE ABATEMENT The Clean Air Act became partly operative during the year, and although no areas were designated •smoke control areas' a survey of all Industrial fuel burning plants was carried out. Our attention Is still necessary to stoke holes particularly where hand firing Is carried out. Factory managements are generally co-operative and In many cases new machinery Is being ordered. K. FACTORIES OUTWORKERS AND WORKPLACES The number of power and non-power factories on the register was 340. This Is a slight Increase on the previous year and Includes 295 non-power factories. A total of 283 Inspections was carried out, and In 51 premises It was necessary to call the attention of the management to orfences against the Factories Act, as previously, usually relating to want of cleanliness and Inadequate or unsuitable sanitary accommodation. Liaison Is maintained with Her Majesty's Inspector of Factories with regard to the establishment of new factories In the district. L. PLACES OF PUBLIC ENTERTAINMENT Routine visits of Inspection were carried out at places licensed for the provision of public entertainment. M. SAMPLING The following table shows the number of samples of all types taken for analysis or examination: Food and Drugs Act 339 Bacteriological - Food 127 Water - Baths 4 Fertilisers 3 Feeding Stuffs - Rag Flock and Filling Materials 6 Total .. 479 N. DISICASES OF ANIMALS ACT Various Orders were made by the Ministry of Agriculture during the year and necessary action was taken where this affected local traders. It has been necessary to visit the Docks on a number of occasions when animals were being exported or Imported. 75- The Diseases of Animals (Waste Food) Order 1957 placed the responsibility for Inspection of premises licensed for the boiling of swill for animals on to the local authority. There is one premises In the district licensed for this purpose, and although on initial Inspection the sterilisation of the food was not round to be adequate, the defective plant was subsequently put In order and later tests showed that the material was being adequately sterilised as required. 0. RENT ACT, 1957 Applications for Certificates of Disrepair 472 Decisions not to issue Certificates NIL Decisions to Issue Certificates 436 (a) In respect of some but not all defects NIL (b) In respect of all defects: 436 Undertakings given by landlords under paragraph 5 of the First Schedule 254 Undertakings refused by local authority under proviso to paragraph 5 of First Schedule NIL Certificates of Disrepair Issued 75 Applications by landlords to local authority for cancellation of certificates 6 Objection by tenant to cancellation of Certificate .. 1 Decisions by local authority to cancel In spite of tenant's objection NIL Certificates cancelled by Local Authority 1 HOUSING STATISTICS 1. Inspection of dwelling houses during the year 1. (A) Total number of dwelling houses Inspected for defects (Under Public Health Act or Housing Act) 8,150 (B) Number of Inspections made for the purpose 15,981 2. (A) Number of dwelling houses Included under Sub-head (1) above which were Inspected and recorded under the Housing Consolidation Regulations 1925 - (B) Number of Inspections made for the purpose 3. Number of premises found to be in a state so dangerous or Injurious to health as to be unfit for human habitation .. 414 4. Number of dwelling houses (exclusive of those referred to under preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,422 II. Remedy of defects during the year without service of formal notices Number of dwelling houses rendered fit In consequence of informal action by local authority or their officers 831 III. Action under Statutory Powers during the year:- (A) Proceedings under Sections 9, 10 & 16 of the Housing Act, 1936 (1) Number of dwelling houses In respect of which notices were served requiring repairs - (2) Number of dwelling houses which were rendered fit after service of formal notice (1) By owners - (11) By local authority In default of owners. (B) Proceedings under Public Health Act:- (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 550 (2) Number of dwelling houses In which defects were remedied after service of formal notice (1) By owners 521 (11) By local authority In default of owners - 76. (C) Proceedings under Sections 11 & 13 of the Housing Act 1936:- (1) Number of dwelling houses In respect of which Demolition Orders were made (2) Number of dwelling houses demolished pursuance of demolition order (D) Proceedings under Section 12 of the Housing Act 1936: (1) Number of separate tenements or underground rooms In respect of which Closing Orders were made – (2) Number of separate tenements or underground rooms In respect of which Closing Orders were determined, the tenement or room having been rendered fit – IV. Visits In connection with Housing circumstances of applicants for rehousing .. 2,237 LEGAL PROCEEDINGS It was necessary to prosecute landlords In 20 Instances for failure to comply with statutory abatement notices. In 15 cases the work was carried out and the summons withdrawn on payment of costs. In 4 cases Orders were made for 28 days. In one case a fine of £3. was imposed and In another a fine of £2. In 1 case an Order was made for 66 days, and costs. One street trader was prosecuted for dellverlng toys to children under 14 years, whilst engaged In collecting rags. A fine of £3. was Imposed. INSPECTION AND SUPERVISION OF POOD SUPPLIES AND PREMISES (A) Hie number of Milk Distributors registered at the close of the year was 167, and the two large dairies, London Co-operative Society Limited and Mortlocks Modern Dairies Limited, continued to function satisfactorily. The following licences were Issued to use special designations prescribed In the Milk (Special Designation) Regulations 1949-64: Pasteurised Milk: Dealer's licences 90 Supplementary licences 11 Dealer's (Pasteuriser's) licences 2 Dealer's licence - Pasteurised tuberculin tested milk 2 Sterilised Milk: Dealer's licences 133 Supplementary licences 12 Dealer's (Sterlllser's)llcence 1 Tuberculin Tested Milk: Dealer's licences 16 Supplementary licences 10 (B) Meat Inspections the three licensed slaughterhouses in the Borough continued to operate and the following table shows the number of animals killed and examined: Cattle Calves Sheep & Pigs Total Lambs 454 1 1,901 1,168 3,524 There were 85 butchers shops in the town (Including 3 continental and 3 kosher butchers) and these premises were Inspected with regard to general hygienic conditions and stock carried. Meat condemned as unfit for human consumption. Tins 1. Retail butchers 283 (1434 lbs.) & 1,694 lbs. 3,128 lbs. 2. Slaughterhouses, offal and carcase meat 2,20g½ lbs. 77. Unsound food examined: Tinned or Packeted Foog other than tinned or packeted Fruit 931 Fruit 60 lbs. (currants) Milk 223 Fish 714 " Fish 68 Chickens 67 " Other goods 807 Meat 1,694 " Meat 283 Total 2,312 Total 2,542 lbs. C. FOOD AND DRUGS SAMPLINQ During the year 339 samples were submitted to the Public Analyst. Details as follows: Examined Adulterated or below standard Butter 5 – Margarine 2 – Lard and cooking fat 1 – Confectionery 21 – Jam 5 – Milk 119 – Sausage 44 2 Vinegar 10 – Wines & Spirits 19 – Drugs 18 1 Other Articles 95 11 Total .. 339 14 Included in "other articles" are 5 samples submitted to this Department by members of the public as follows:- Sample No • Result 8863 Cream Slice (? rat exreta) Dirty dough. 8847 Meringues (suspected mice foullngs) Not due to rodent contact. Crumbs In separate wrappings contained rodent excreta. 8516 Orange drink (cement In bottle) Cement 8528 Hostess Cake (Ijrons) Unfit for human consumption. 8556 ± Pint milk (foreign matter) contained pieces of mould. Details of samples not satisfactory: Sample No. Informal or Formal Article Adulteration or Deficiency 8323 Informal Cold & Influenza mixture Mixture contained only half the stated amount of ethyl nitrite, an unstable compound. Contained 300 parts per million. Sulphur Dioxide. No declaration made as to preservative. Sample deficient In creta praeparata to extent of 85 made as per 100 grms of flour. Also slightly deficient In Vlt. B. Contained imitation cream: Mlsdescrlbed as cream bun. Mlsdescrlbed as cream bun. Fruit content 7%. Only. £ minimum fruit content. Fruit content low. No provision In Regulations for use of Benzoic acid preservative. Contained sulphur dioxide but no declaration. 8337 Informal Pork Sausage 8373 Informal Flour 8413 Informal Cream Bun 8427 Informal Cream Bun 8495 Informal Orange drink 8516 Formal Orange drink 8566 Informal Milk Flavouring 8639 Informal Sausage. Meat The attention of manufacturers was called to the unsatisfactory samples and In some cases cautions were Issued that legal proceedings would be taken In the event of further complaints being made. 78. BACTERIOLOGICAL SAMPLINO 1967 Milk 85 samples of milk, were submitted for bacteriological and chemical examination during the year. One sample (A.2800) was unsatisfactory. Ice Cream 42 samples of Ice cream were submitted for bacteriological examination with results as follows: Grade I Grade II Grade III Grade IV 28 6 6 3 Unsatisfactory samples: A. 2734 Loose Ice cream A. 2750 " " " A. 2759 " " » A. 2763 " " " A. 2773 " " " In addition 9 samples required reduction of conform organisms. 323 premises are registered for the sale of Ice cream, of these 18 were new registrations. 22 premises remained on the register for the manufacture of Ice cream. Adequate Inspection of places of manufacture was carried out. Bath Water 4 samples - all saltable for bathing. Rag Flock 6 samples - all satisfactory. Fertilisers & Feeding Stuffs 3 samples - 2 unsatisfactory. F. F. S. 185 Bone Meal - deficient In phosporlc acid 1.65%. F. F. S. 186 Meat Bone Meal - did not comply with Vendor's statement. SHOPS ACT etc., ADMINISTRATION (Mr. D. G. Tonkin, Chief Inspector* Mr. T. Gilbert* Mr. L. Plnguey Inspectors. * Member Institute of Shops Act Administration. Statistics 1957 Shops Act 1950 Number of shops In borough subject to the Act 1,915 Number of shops In borough closed Ill Total .. 2,026 Dyers/Cleaners .... 32 Laundries 28 Number of shops visited 997 There were 490 visits to premises in connection with the health and comfort provisions of the Act, and :0 premises were found to be unsatisfactory. Visits regarding records required to be kept were 573 and In 135 cases the records were found to be not properly kept. One thousand two hundred and seventy-one shops were visited after closing hours and 483 visits were made during holiday closing time. Though the great majority of shop-keepers are co-operative In the matter of closing hours, It was necessary to Issue verbal cautions In 42 cases and to write warning letters In 11 Instances. 79. Legal proceedings: Three summonses were Issued during the year: 1. Contravention of Section 50 (necessary notices not displayed) Adjourned sine die. 2. Contravention of Section 47 (open on Sunday for sale of unauthorised goods) n 3. Contravention of Section 47 (open on Sunday for sale of unauthorised goods) « The following table gives the number of shop assistants employed In the borough: Male 1,152 Female 1,782 Young persons Male 85 Female 123 Total 3,142 This shows a decrease of 248 persons employed In shops during the year. It was noted during the year that In 83 cases there was a change of occupier; In 56 cases the occupier and the trade changed and In 4 Instances the occupier changed the trade. There were 7 shops registered In respect of Sunday trading by members of the Jewish faith and there were 4 Kosher butchers operating. Pharmacy & Poisons Act, 1933 Number of persons listed to retail Part II poisons 146: (Renewals - 139: new applications 9: licences cancelled 16). Five of the new applications were due to change of occupier. Explosives Act 1875 Number of premises registered 162: (Renewal of licence 145: New applications 17: Including 7 due to change of occupier). The Ins psctor carried out 159 observations In the vicinity of registered premises at the time of the sale of fireworks, as this Is the type of explosive with which the department is generally concerned, and In addition 151 visits of inspection to premises were made with regard to the storage of fireworks. Heating Appliances (Fireguards) Act 1952 During the year 1,758 observations and visits were carried out. Domestic Servants Registry There Is one person in the borough carrying on the business of a Domestic Servants Registry. Inspection of the records at the Registry was made to ensure that the placing of persons was carried out in an orthodox manner. Minor Excise Licences Visits of Inspection were paid to all the premises concerned to establish that business was still carried on, and as a result of late night Inspections a number of eating houses were required to obtain Refreshment House Licences for the sale of refreshments after 9.30 P.m.