11 (1) LER 52 BOROUGH OF LEYTON HEALTH REPORT FOR THE YEAR 1958 MELVILLE WATKINS M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health, Borough of Leyton Area Medical Officer, County of Essex Divisional School Medical Officer PUBLIC HEALTH COMMITTEE 1958-1959 The Worshipful the Mayor: Councillor W.J.Low. J.P. (ex-offlcio) Chairman: Councillor F.W.Marshall Vice-Chairman: Councillor W A Cross Aldermen G.S.Flack B. G, Rayner Councillors Mrs. A. M. M. Burrell Mrs. E. M. Dare H. E. Martin E. L. Sanders W. H. Sanders F.W.Wigg STAFF Medical Officer of Healths Melville Watkins, M R. C.S., L. R C P ,, DP.H. Deputy Medical Officer of Health; Mary Lyle Gilchrist, M D., MB., Ch.B., D.P.H. Chief Public Health Inspector: B. J. Ashcroft, M. A. P.H.I., M. Inst. B. E. Deputy Chief Public Health Inspector: R A Reeves, M. A. P. H. I. Chief Administrative Assistant: W D. Softley TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON Mr.Mayor, Ladies and Gentlemen, I have the honour to submit this my fourth Annual Report as required by the Ministry of Health. As will be noted this includes a statistical section on the personal health services (National Health Service Act, 1948 Part III) but does not include any report on the School Health Services as this is now published as a separate document. The Registrar General's estimate of the population in the Borough for 1958 is 98,760, a decrease of 910 persons compared with the previous year. The National decrease of population due to more deaths than births accounts for a loss of 86 of the population and it is obvious that the bulk of the decrease is due to the young couples moving out of the Borough to obtain housing in new towns. Thus every year the percentage of aged persons in the Borough increases and so do the problems, dealt with more fully in the body of the report, of the Care of the Aged and housing for this group of the community. The death rate of 13.44, the highest since 1944. is much above the national provisional rate of 11.7. However, with an ageing population such as appertains in the Borough the death rate is bound to be above the national average. The birth rate of 12,67 is much below the national provisional rate of 16.4 and it would appear that the decline in the population will continue for some years to come, and will probably eventually become fairly static at about 85,000. The causes of death, follow the same pattern as in most post war years. The incidence of infectious disease was very low. In fact the lowest ever recorded in the Borough. Notifications totalled 897 of which measles accounted for 433, pneumonia being the next highest (132) with scarlet fever (l06) and whooping cough (104). No notifications of poliomyelitis or diphtheria were received. There were 38 isolated cases of sonnei dysentery. I draw attention to the short reports on the laundry for the incontinent, care of the elderly and housing of the elderly. The problem of the aged lonely person will be with us for all time and I refer in the report to the amount of time that has to be expended on these cases. In the section of the report dealing with sanitary circumstances of the area I would draw attention to the stress that is placed on health education rather than punitive action. The public must be educated to comply with statutory requirements, it is not sufficient to issue orders and regulations that even the officials have difficulty in understanding. The role of the Public Health Inspectors must be more and more educative. The shop window of 280 High Road is a great asset to the Department and provided it is used with imagination and intelligence can serve a useful educative purpose. There have been many tributes to the dressing of these windows both from Members and the public. The subjects have to be chosen with care and with regard to the seasons. The display is contributed alternately by the Local Sanitary Authority and Local Health Authority Staff and a friendly rivalry exists within the department in producing the displays. During 1958 progress was made in respect of supplementing the provision of the Clean Air Act, 1956. It is hoped that in the Report for 1959 I may be in a position to report more fully on the action taken during the year. Reference is also made to the commencement of the detailed survey of the second of the Council's proposed slum clearance and redevelopment areas. This is a continuing process which will engage the department for a number of years. (2) Attention is drawn to the ready compliance of the majority of the food traders with the requirements of the Food Hygiene Regulations, . As Medical Officer of Health I am required to report on the personal health services within the Borough. However, as I am also Area Medical Officer this is made easier. Once again I re-iterate that, in my opinion, the carrying out of the environmental and personal health services under one roof is to my mind one of the most valuable integrations of local government. This is only possible with the mixed appointments which apply to my Deputy, Chief Administrative Assistant and myself. In some cases it is necessary to integrate the work of the Health Visitors Domestic Help. Public Health Inspectors and medical staff all dealing with one case at the same time and by this overall control it is possible to obviate duplication of visits and co ordinate the health service team. The personal health services section of the report is mainly statistical. I have however written a few introductory notes preceding the statistics. I take the opportunity of recording my appreciation of the support of the Council and in particular Councillor F.W.Marshall Chairman of the Public Health Committee, and Alderman Mrs.J Hammond. Chairman of the Leyton Health Area Sub Committee the co-operation of officers of other departments and the loyalty and industry of the staff of the Health Department. I have the honour to be, Mr.Mayor, Ladies and Gentlemen, Your obedient servant, MELVILLE WATKINS. Medical Officer of Health. Public Health Offices, Sidmouth Road, Leyton E. 10. LEYtonstone 3650. (3) VITAL STATISTICS Area in Acres 2,594 Population (Census 1951) 105,978 Population (Registrar General's Estimate,1958) 98,760 Assessable Value for General Rate Purposes £1,271,674 General Rate in the £ (1958/59) 20s.1d The Registrar-General's mid-year 1958 estimate of population (viz., 98,760) has been used for the calculation of the following statistics:- Live Births 1,252 Live Birth Rate per 1,000 population 12.67 Stillbirths 29 Stillbirth rate per l,000 total (live and stillbirths) 22.63 Total Live and Stillbirths 1,281 Infant Deaths 31 Infant Mortality rate per 1,000 live births 25.87 " " " per 1,000 legitimate births 25.04 " " " per 1,000 illegitimate births 18.51 Neo-natal Mortality Rate (first four week) per 1,000 related live births 19.16 Early Neo-natal Mortality Rate (first week) per 1,000 related live births 16.77 Peri natal Mortality Rate (stillbirths and deaths during the first week) per 1,000 total still and live births 39.03 Percentage of illegitimate live births 4.31% Maternal Deaths (including abortion) - Maternal Mortality Rate (including abortion) per 1,000 total live births - Total Deaths 1,338 Death Rate 13.54 Natural Decrease of Population 86 Comparability Factor To make approximate allowance for the way in which the sex and age distribution of the Borough population differs from that for England and Wales as a whole, the RegistrarGeneral has issued the following comparability factors for Leyton. Area comparability factor for births 0.98 Area comparability factor for deaths 0.87 These factors, when applied to the crude rates, produce the following adjusted rates Live Births 12.42 Deaths 11.77 (4) COMPARATIVE STATISTICS OF BIRTHS. MORTALITY ETC.LEYTON.1901.1958. Year Population Births Birth Rate Deaths Death Rate Deaths under 1 year Infantile Death Rate 1901 100.000 2.963 29.63 1.243 12.4 404 136 1902 100.000 3.152 31.52 1.183 11.8 336 106 1903 102.000 3.273 32.08 1.112 10.9 322 99 1904 104.000 3.198 30.07 1.370 13.1 444 138 1905 105.000 3.209 30.05 1..177 11.2 303 94 1906 108.000 3.344 30.9 1.327 12.2 382 114.5 1907 120.000 3.190 26.6 1.269 10.6 182 86.6 1908 121.200 3.071 25.3 1.185 9.8 242 78.8 1909 121.200 2.979 24.6 1.208 9.9 244 81.9 1910 123.300 3.011 24.4 1.112 9.0 191 63.4 1911 124.736 2.931 23.5 1.473 11.8 327 116.6 1912 126..700 2.797 22.1 1.343 10.6 223 79.7 1913 129.366 2.904 22.4 1.336 10.3 242 83.3 1914 130.847 2.800 21.4 1.363 10.4 219 78.2 1915 124.497 2.655 21.3 1.510 12.1 225 84.7 1916 B 132.107 * 2.560 19.4 1.471 12.1 197 76.9 D 121.420 * 1917 B 125.352 * 2.005 16.0 1.414 12.6 172 85.8 D 112.452 * 1918 B 125.352 * 1.791 14.3 1.723 15.3 161 89.9 D 112.452 * 1919 B 129.062 * 2.195 17.0 1.397 11.3 154 70.16 D 123.896 * 1920 128.832 3.168 24.6 1.330 10.3 207 63.54 1921 128.432 2.679 20.86 1.290 10.04 182 67.94 1922 131.600 2.416 18.36 1.420 10.79 155 64.16 1923 132.800 2.328 17.53 1.228 9.25 106 45.53 1924 133.500 2.101 15.74 1.325 9.92 110 52.36 1925 132..700 2.091 15.76 1.349 10.16 114 54.51 1926 130.000 2.022 15.55 1.261 9.7 131 64.79 1927 128.920 1.826 14.16 1.322 10.25 80 43.81 1928 130.300 1.853 14.22 1.290 9.90 91 49.10 1929 128.300 1.731 13.49 1.510 11.76 100 57.77 1930 128.300 1.757 13.69 1.222 9.52 81 46.09 1931 128.600 1.812 14.09 1.365 10.61 71 39.18 1932 127.140 1..666 13.10 1.341 10.54 89 53.43 1933 125.700 1.499 11.91 1.468 11.67 76 50.70 1934 123.430 1.454 11.78 1.317 10.67 64 44.02 1935 121.690 1.493 12.26 1.225 10.06 60 40.18 1936 119.900 1.421 11.85 1.272 10.61 74 52.07 1937 118.100 1.420 12.02 1.349 11.42 75 52.81 1938 117.200 1.509 12.87 1.148 9.79 70 46.38 1939 B 116.100 * 1.499 12.90 1.242 11.21 46 31.65 D 110.800 * 1940 96.500 1.353 14.02 1.563 16.2 50 39.03 1941 84.790 1.129 13.31 1.142 13.46 37 38.30 1942 86.960 1.452 16.69 1.123 12.91 73 50.27 1943 87.880 1.595 18.14 1.248 14.20 57 35.73 1944 85.440 1.613 18.87 1.285 15.04 68 42.15 1945 87.330 1.474 16.87 1.147 13.13 52 35.27 1946 101.910 2.223 21.81 1.181 11.58 64 28.78 1947 105.550 2.359 22.35 !..278 12.10 78 33.06 1948 106.100 1..810 17.06 1.118 10.53 38 20.99 1949 106.700 1.630 15.27 1.232 11.54 43 26.38 1950 106.600 1.447 13.57 1.134 10.64 29 20.04 1951 104.700 1.311 12.52 1.362 13.00 27 20.59 1952 104.200 1.355 13.00 1.220 11.70 37 27.30 1953 103.200 1.279 12.39 2.029 19.66 30 23.45 1954 103.100 1.232 11.95 1.133 10.99 18 14.61 1955 102.000 1.136 11.13 1.258 12.33 28 24.64 1956 100.900 1.185 11.74 1.296 12.84 27 22.78 1957 99.670 1.160 11.64 1.228 12.32 17 14.65 1958 98.760 1.252 12.67 1.338 13.54 31 25.87 *Population as estimated for purposes of B. Birth Rate; D. Death Rate. (5) Deaths The Registrar-General's classification of causes of death by sex totals are shown in Table I on this page. The total number of deaths in 1958 (1338) compares with 1228 in 1957 the respective death rates per 1 000 population being 13.547 and 12.32. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1958. Causes of Death AGE GROUPS - MALES AGE GROUPS - FEMALES TOTAL 0-1 1-5 5 -15 525 2545 45- 65 65- 75 7 5+ TOTAL MALES 0- 1 1-5 5-5 15- 25 25- 4 5 45- 65 65- 75 75+ TOTAL FEMALES 1. Tuberculosis respiratory 15 - - - - - 6 3 1 10 - - - - 1 3 1 - 5 2- Tuberculosis, other - - - - - - - - - - - - - - - - - - - 3. Syphilitic disease 2 - - - - - - 1 1 2 - - - - - - - - - 4 Diphtheria - - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - - 6. Meningococcal Infections - - - - - - - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases 4 - - 1 - 1 2 - - 3 - - - - 1 - - - 1 10. Malignant neoplasm stomach 27 - - - - 1 12 5 2 20 - - - - - 2 1 4 7 11. Malignant neoplasm lung bronchus 43 - - - - - 22 10 7 39 - - _ - - 4 - - 4 12. Malignant neoplasm breast 22 - - - - - - - - - - - - - 1 8 9 4 22 13. Malignant neoplasm uterus 11 - - - - - - - - - - - - 1 5 3 2 11 14. Other malignant and lymphatic neoplasms 109 - - - - - 10 24 24 58 - - _ 1 1 14 16 19 51 15. Leukaemia, aleukæmia 10 - - - - 1 - 3 3 7 - - - - - 2 1 - 3 16. Diabetes 3 - - - - - - 1 1 2 - - - - - - - 1 1 17. Vascular lesions of nervous systern 178 _ - - _ 5 6 20 30 61 - - _ _ 2 9 24 82 117 18. Coronary disease angina 200 - - - - 1 47 38 41 127 - - - - - 14 24 35 73 19. Hypertension with heart disease 28 - - - - - 4 3 5 12 - - - - - 2 2 12 16 20. Other heart disease 298 - - - - 2 14 15 85 116 - - - - 4 14 17 147 182 21. Other circulatory disease 59 - - - - - 6 11 8 25 - - - - 1 6 10 17 34 22. Influenza 4 = - - - - 2 - - 2 - - - - - - 1 1 2 23. Pneumonia 86 1 1 - - 1 9 11 25 48 2 1 - - 1 4 7 23 38 24. Bronchitis 83 2 - - - - 15 15 24 56 - - - - - 2 8 17 27 25. Other diseases of respiratory system 10 - 1 - - 1 3 1 1 7 - - - - - 2 1 3 26. Ulcer of stomach and duodenum 13 - - - - - 6 - 4 10 - - - - - 1 1 1 3 27. Gastritis enteritis and diarrhœa 2 - - - - - - - 1 1 - - - - - - - 1 1 28. Nephritis and nephrosis 3 - - 1 - - 2 - - 3 - - - - - - - | - - - 29. Hyperplasia of prostate 5 - - - - - - 2 3 5 - - - - - - - - - 30. Pregnancy. childbirth. abortion - - - - - - - - - - - - - - - - - - 31. Congenital malformations 8 4 2 - - - 1 - - 7 - - - - 1 - - - 1 32. Other defined and ill-defined diseases 77 10 - 1 - 2 10 9 6 38 10 - - - 3 4 3 19 39 33. Motor vehicle accidents 10 - - - - 1 2 3 1 7 - - - - - 1 - 2 3 34. All other accidents 13 1 - - - - 1 2 3 7 1 - - - 1 1 1 2 6 35. Suicide ... 14 - - - 1 2 3 1 2 9 - - - - 1 3 1 - 5 36. Homicide and operations of war 1 - - - - - - - - - - - - - - 1 - 1 TOTALS 1 338 18 4 3 1 17 183 178 278 682 13 1 - 1 19 101 131 390 656 (6) LABORATORY FACILITIES (a) Pathological Departmentt Whipps Cross Hospital, E.11. For pathological speciments. (b) Central Public Health Laboratory, Colindale. For special bacteriological investigations supply of lymph for vaccination, supply of diphtheria toxin (F.T.) (c) Counties Public Health Laboratories, Queen Victoria Street, London. For bacterial and chemical examination of water milk and other foods. (d) Public Analysts Analytical Laboratory 20 Eastcheap, E. C.3. For analysis under provisions of Food and Drugs Act 1938. AMBULANCE FACILITIES In July, 1948, the County Council became responsible for the provision of ambulance facilities in the area. The service is now administered centrally from Chelmsford, the vehicles and staff being accommodated at the Ambulance Depot in Auckland Road. (Telephone LEYtonstone 6077/8). HOSPITALS The following hospitals, administered by the Leytonstone (No.10) Group Hospital Management Committee on behalf of London N.E. Regional Hospital Board, are situated within the Borough of Leyton. (a) Whipps Cross Hospital. (b) Langthorne Hospital. NURSING HOMES There are two nursing homes in the Borough registered under the provisions of the Public Health Act 1936 1 Queens Road Leytonstone, with accommodation for 69 patients, *Brooklands* 22 Fairlop Road Leytonstone, with accommodation for 25 patients. HEALTH SERVICES CLINICS (See page 38 ) LAUNDRY FOR THE INCONTINENT In January 1957 the premises at the rear of 280 High Road Leyton were converted and adapted for use as a laundry for the incontinent. There is no doubt of the value of the service to the relatives or friends of patients who have difficulty in the laundering of foul linen and pergonal clothing. During the first year of the operation of the service (1957) a total of 115 individual launderings took place involving 1417 articles. Also in 1957 an agreement was entered into with the County Borough of West Ham whereby launderings were carried out in respect of West Ham patients. In 1958 this extension of the service continued and during the year 421 launderings took place which involved 5,852 articles. Of these 62 launderings and 3,072 articles were in respect of West Ham patients, (7) The operation of laundering is carried out by handymen attached to the department. With an ever increasing ageing population I have no doubt that the service will be used to an even greater extent as time goes on, with a consequent increased pressure on equipment, especially drying facilities. DISINFECTION AND DISINFESTATION OF BEDDING Two years ago I reported to the Public Health Committee that the steam disinfector was no longer serviceable and recommended that we entered into an arrangement with the neighbouring Borough of Walthamstow whereby they carried out disinfection or disinfestation for this department. This recommendation was adopted and since that time the facilities have been available to us. During 1958 only on one occasion was it necessary to take advantage of the arrangement. This "silent revolution* indicates a vastly improved socio-economic state and a more enlightened attitude towards ordinary hygiene. There is no doubt that costly methods of disinfection or disinfestation are no longer necessary to be set up by small authorities and that the availability of one such unit between authorities is the most economical-method of dealing with the occasional demand that is likely to arise. SCABIES AND VERMINOUS CONDITIONS With the co operation of Hackney Borough Council facilities are made available at the Cleansing Centre, Millfields Road Clapton for the treatment of Leyton patients suffering from scabies or verminous conditions. During the year only two cases involving five treatments were necessary, NATIONAL ASSISTANCE ACT, 1948 SECTION 47 It was not necessary to make application to a Court of Summary Jurisdiction for any order under Section 47 of the National Assistance Act,, 1948, during the year. Visits were made to quite a number of cases where such an action had to be considered, however with the co-operation of the personal health services of the Local Health Authority, the County Welfare Department and Duly Authorised Officer, arrangements were satisfactorily made for the patients welfare and no court action was necessary. These cases are extremely time consuming and in one case in particular, I estimate that before a satisfactory solution of the problem was effected, my staff, the Duly Authorised Officer and myself expended 100 hours of time. However, in my opinion, this expenditure of man hours is worthwhile compared with having a patient admitted to accommodation against their will. Eccentricity of age combined with illness can be an extreme barrier to common sense and reason and it must be expected that constant visits are necessary to gain the confidence of persons of this nature. SECTION 50 During the year it was necessary to carry out 23 burials under this section of the Act. This compared with a figure of 21 for 1957 shows a small increase. It is unpredictable as to how many such cases will qualify for burial by the Local Sanitary Authority during any one year. (8) MORTUARY FACILITIES The arrangements entered into between the Borough Council and the local Hospital Management Committee for the provision of mortuary facilities at Whipps Cross Hospital have continued during the year. CARE OF THE AGED Each day's post brings its problems in connection with the aged. Either young couples who have bought a house with an aged person as sitting tenant sharing the inconveniences of meagre domestic facilities with older people, etc., older people or relatives who no longer feel they can face up to the responsibilities of looking after aged parents,and request assistance for someone else to take over the responsibility of caring for them. My colleagues and I have great sympathy with both sides in this too familiar problem and a great deal of health visitors', administrative officers" and medical officers' time is spent endeavouring to assist in cases of this nature. There is no easy solution and the facts of each case have to be sifted with great care and diplomacy. It is time consuming and in many cases so little positive action can be taken to alleviate what has grown into big problems as far as those who are concerned view it. Many of these old people do not qualify for either Welfare, Hostel or Part III accommodation. There are two types of lonely people those who are cut off from their contemporararies through circumstances over which they have little or no control and those who are lonely by temperament. In the first case the basic problem is housing accommodation, accommodation where they can have a certain amount of companionship and yet retain the independence which is so dear to them. Even in the worst of cases personal health services can do an enormous amount to enable the elderly to live in comparative ease during their declining years. In the second case that is those who are lonely by temperament, the greatest difficulty arises., and the most time consuming cases are those elderly people who through their eccentricities either refuse help or obstruct when it is granted. The personal health services with health visiting domestic help allied to the Borough of Leyton Welfare Services Committee meals on wheels and domiciliary chiropody, deal adequately with the problem of looking after people in their own homes, even when environmental conditions are unsatisfactory. HOMES FOR THE ELDERLY In my previous Annual Report I wrote at length regarding the problems of aged persons who required a little supervision and assistance. The Council have purchased four properties, three of which have been adapted for elderly people. The accommodation provides a separate bedsitting room for each tenant, with communal kitchens on each floor where two persons share a gas cooker. Prom my observations it is apparent that, in the main, the tenants are settling down well and enjoying the companionship of their fellow tenants. There is a pressing need for infinitely greater numbers of small simple but convenient and easily run homes for the elderly in the Borough. (9) PREVALENCE AND CONTROL OF INFECTIOUS AND CONTAGIOUS DISEASES During the year 1958 the notifications of infectious diseases were the lowest ever recorded in the Borough. The total notifications received were 897, and 433 of these were in respect of cases of measles. Set out hereunder is a table of the notifications received. The figures in brackets denote the number of notifications received in 1957. Disease Notifications Received Smallpox (-) Diphtheria - (-) Erysipelas 13 (17) Scarlet Fever 106 (60) Pemphigus Neonatorum - (-) Tuberculosis, Pulmonary 41 (51) Tuberculosis Other forms 3 (9) Pneumonia 132 (223) Ophthalmia Neonatorum 2 (3) Typhoid Fever - (1) Paratyphoid Fever - (1) Puerperal Pyrexia 1 (13) Meningococcal Infection - (1) Poliomyelitis, Paralytic - (11) Poliomyelitis, Non-paralytic - (8) Acute Encephalitis, Infective 1 (1) Acute Encephalitis, Post infectious - (-) Measles 433 (1033) Whooping Cough 104 (159) Dysentery 38 (6) Food Poisoning 23 (29) TOTAL 897 (1626) DIPHTHERIA No case of diphtheria has been notified since 1951. However, the threat of outbreaks remains, and I should feel more complacent if the percentage of the immunisation of the child population were much higher than it is at present. The medical and nursing staff are unremitting in their propaganda efforts but, as so few of the present day mothers have seen a case of diphtheria they appear to be unaware of the severity of the disease. DYSENTERY The number of notifications received increased from 6 in 1957 to 38 in 1958. There were eight family outbreaks involving 24 of the cases notified. In only 12 of the cases was the diagnosis bacteriologically confirmed. Nine of the persons notified were admitted to infectious disease hospitals, POOD POISONING Twenty-three persons were notified to be suffering from food poisoning - a decrease of 6 compared to the previous year. There were 3 "outbreaks" involving 6 cases and 17 single cases. In only 6 of the (10) notified cases was the agent identified, 4 being salmonella typhimuriunu 1 salmonella shigella and 1 Clostridium welchii. MEASLES Notifications in respect of measles were 600 fewer than in the previous year. It is well known that the cycle of measles does not coincide with the calendar year. No deaths were recorded as due to measles. Hospitalisation was necessary in the case of 13 patients either due to bad housing, or an imminent confinement in the house, rather than on medical grounds. PNEUMONIA 132 notifications of persons suffering with pneumonia were received during 1958, a decrease of 91 compared to the previous year. Seventeen of the cases were either admitted to, or notified from, hospitals. POLIOMYELITIS No cases were notified during the year 1958 - the first year in which there have been no cases since 1951. The vaccination of persons in the eligible age-groups has continued during the year and particulars of this will be noted on page 47 of this Report. SCARLET FEVER As will be seen from the table of cases notified, there has been a considerable increase in the notifications of scarlet fever (106, compared to 60 in the previous year). The majority of the notifications occurred in the 5-9 age group. Only in four cases was it necessary for the patient to be admitted to hospital, and this action was due to bad housing conditions rather than medical emergencies. WHOOPING COUGH The number of cases notified decreased from 159 in 1957 to 104 in 1958- No deaths were attributable to the disease and in only three cases was it necessary for the patient to be admitted to hospital. The gradual decrease in notifications during the past few years coincides with the introduction and acceptance of immunisation against whooping cough, particulars of which may be found on page 47 of this Report. TUBERCULOSIS The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1958. (11) TUBERCULOSIS PULMONARY NON-PULMONARY TOTAL M F Total M F Total Number on register at commencement of year 535 418 953 38 62 100 1053 Number first notified during year 34 7 41 1 2 3 44 Number entered in register otherwise than by notification 14 15 29 - 2 2 31 Number removed during year 42 26 68 3 3 6 74 Number remaining at end of year 541 414 955 36 63 99 1054 Died 22 7 29 - - - 29 Removed from district 16 15 31 1 1 2 33 De-notified - - - - - - - Cured 4 4 8 2 2 4 12 Of the cases first notified during the year the age group distribution was as follows; Age Periods PULMONARY NON PULMONARY M F M F* Under 5 years - - - - 5-14 years - 1 - 15-24 " 5 2 - 1 25-44 " 10 1 1 - 45-64 " 16 3 - - 65 and over 3 - - 1 TOTAL 34 7 1 2 (12) SANITARY CIRCUMSTANCES OF THE AREA PART 1 - COMMENT The authorized establishment comprises the Chief Public Health Inspector Deputy Chief Public Health Inspector and 7 District Public Health Inspectors. This allows for one Inspector for every 11,000 inhabitants, whereas the officially recorded average for the country as a whole is one Inspector for every 9,000 inhabitants. Although this establishment may be considered to be adequate to deal with routine day to day requirements it is not sufficient to compensate for vacancies which occur from time to time and to cope adequately with the added commitments imposed on the Inspectorate by new legislation such as the Rent Act Clean Air Act, etc., introduced over the past few years, many local authorities have in fact increased their establishments for this reason. For many years there has been an average of 3 to 4 vacancies on the establishment of Public Health Inspectors and because of this it has been difficult if not impossible to operate a comprehensive sanitary service. For years the depleted staff (down to half of what is officially recorded as adequate) were primarily employed in dealing with complaints, applications for Certificates of Disrepair, the training of Student Public Health Inspectors, of which the Department has 3, and other matters requiring urgent day to day attention, leaving little time for less urgent work and special duties. However, I am pleased to report that in September of this year all vacancies on the establishment were filled. Although it will be sometime before the arrears of work created by the shortage of technical staff is completely overtaken, the immediate effect of a full establishment was to enable the Chief Public Health Inspector to undertake a preliminary survey of the Borough under the Clean Air Act in connection with proposed smoke control areas and to commence a detailed survey under the Slum Clearance Provisions of the Housing Act of properties included in the second of the Council's Proposed Redevelopment Areas. HEALTH EDUCATION Environmental sanitation may be defined broadly as the control of all those factors in man's physical environment which exercise a deleterious effect on his physical development health and survival. This definition sums up the responsibilities of the local sanitary authority; the conditions in which people live, work and play, the purity of their food and drink and of the air they breathe have considerable influence on their health and well being, and the aim of the environmental health services is to control or eliminate those factors which are, or may be. harmful. To achieve this objective the local sanitary authority is armed with a large and ever increasing number of complicated Acts, Statutory Orders and Regulations, yet it has been increasingly realised that legislation alone does not secure betterment of environ -mental conditions and more and more emphasis is being placed on the importance of health education - laws as necessary and excellent as they may be, are so much waste paper if they are not appreciated and understood by the people who are supposed to abide by them. Reliance on persuasive measures rather than punitive powers in the field of environmental sanitation was referred to in the report of the Working Party on the Recruitment, Training and Qualification of Public Health Inspectors:- "Broadly, the function of a Public Health Inspector is a regulatory one, that is, he is concerned to secure compliance on the part of the public with certain branches of the law designed to protect the health of the community. We say to "secure compliance" rather than to "enforce", because whilst enforcement by process of law (13) is the ultimate remedy, compliance is in fact increasingly secured by advice persuasion and education.® It is a mistake to consider health education separately and something apart from the Public Health Inspectors routine day to day work on the district. In the cause of clean air, clean and safe food and the betterment of environmental conditions in houses, shops, factories, workshops places of public entertainment, etc., and in the promotion of congenial communal relationship he is continually practising health education in a personal and practical way by giving advice and instruction on the spot. It is only as a last resort that he uses his statutory powers by way of legal enforcement. This type of activity is not always recognised as health education, yet by virtue of personal contact it may possibly be more effective than the more elaborate and spectacular activities, such as the organisation of exhibitions giving of public health lectures and talks to specialised groups etc. It is an accepted fact that people learn more rapidly and thoroughly by demonstration and participation than by theoretical instruction. Public Health Inspectors meet people at their places of work, for instance food handlers and operators of industrial plant capable of causing air pollution, visit people in their homes, and indeed are in contact with everyone in the community whose activities have a public health significance. The Inspector has, therefore, unrivalled opportunities for effective health education by demonstrating on the spot how the principles and practices of environmental sanitation should be observed, and pointing out faulty habits and practices as they occur. In the words of Sir George Newman (Memorandum on Public Education in Health, 1924):- "The first and best form of public education is the effective administration of the public health services. Sanitation itself is a fine educator of the community, the sound practice of the science and art of medicine is the supreme instruction of the patient. No elaborate series of health lectures and no impressive articles in the local Press can take the place of an effective discharge of sanitary law and administration. For such an executive fulfilment is itself educational in the highest degree. Consider the physical, mental and even moral effect of a wholesome and abundant water supply upon the people of a district. And what is the effect of satisfactory housing accommodation? or efficient scavenging and clean streets and curtilages? or sanitary factories and work-shops? or of a wisely administered and comprehensive public medical service? Their educational health value is beyond measure." The shop windows at 280 High Road Leyton E. 10 are now being used for health education purposes. At the time of preparing this report the environmental health services of the local sanitary authority were represented on two occasions covering a period of approximately 9 weeks,. one in connection with a clean air display, and the other with clean food and food hygiene generally. This is a novel way of presenting a small health exhibition and, judging from the number of enquiries received and requests for technical literature, and health propaganda leaflets, it would appear that it is proving quite successful in stimulating civic interest in the work of the depart ment. In addition to the above mentioned activities the Medical Officer of Health and Chief Public Health Inspector gave a number of health education talks to various organisations throughout the year. AIR POLLUTION Shortly after the provisions of the Clean Air Act 1956 relating to the establishment of smoke control areas came into force the Public Health Committee advised the Council to convene a joint conference of local authorities for the purpose of discussing matters of common interest in regard to air pollution and to give preliminary (14) consideration to the possibility of joint action in regard to any proposals for the creation of smoke control areas which might involve more than one authority. The Committee also had in mind a suggestion made by the Minister of Housing and Local Government in a memorandum on smoke control areas, in which he stated that it was highly desirable that local authorities should keep one another informed about their smoke control programmes and co ordinate as much as possible. The first joint conference of local authorities was held at Leyton Town Hall in October 1957 under the chairmanship of the then Mayor (Councillor Mrs. A. M. M. Burrell, J. P.). It was attended by representatives of the Ministry of Housing and Local Government, the London and Home Counties Clean Air Advisory Council, and the following local authorities Barking. Dagenham, East Ham Hackney, Ilford Poplar Walthamstow Wanstead & Woodford. West Ham and Woolwich. Leyton is to be congratulated on initiating this joint Conference of Local Authorities; since its inception meetings have been held at Barking, Wanstead & Woodford, and Walthamstow. It has now become established as a forum for the exchange of information between local authorities, each meeting provides an admirable opportunity for delegates to discuss progress on smoke control schemes, procedural and economic difficulties, availability of smokeless fuels, in fact all matters connected with the all important question of clean air. Getting to know what one's neighbour is doing in this field is an experience which is bound to have a salutory and beneficial effect; it promotes healthy competition between neighbouring Councils who are apt to vie with each other as to progress made, it stimulates discussion and keeps alive interest, and may provide a source of encouragement to those who in spite of economic difficulties and other obstacles are determined to pursue a bold realistic policy towards the betterment of atmospheric conditions. What perhaps is more important still, such experience may possibly awaken the conscience of others who are not so minded and whose opinions on the subject lead one to believe that they regard clean air not as ordinary air but as something which one should expect to breathe only when on holiday. In December of this year the Public Health Committee recommended the Council to approve in principle the establishment of'a smoke control area. The Council accepted the Committee's recommendations and the provisional plan and relevant documents were subsequently submitted to the Minister of Housing and Local Government for his comments. The proposed area covers approximately some 296 acres and some 1,500 dwellings (1,756 householders), and 90 industrial/commercial premises will be affected. At the time of preparing this report the Minister's approval of the Council's proposals had been received and the Chief Public Health Inspector was authorized to proceed with the detailed survey of the proposed area preparatory to the Council making a Smoke Control Order. It is anticipated that two Public Health Inspectors will be employed full time on this detailed survey for a period of 10 to 12 months, and as this is the beginning of what is hoped to be a longterm programme which will ultimately bring the whole Borough under smoke control it is reasonable to assume that two Public Health Inspectors will be employed full time on this type of work for an indefinite period, possibly 20 years or more. Before a Smoke Control Order can become operative it will be necessary for stoolbottom grates and other solid fuel appliances in premises where smokeless fuel cannot be burned satisfactorily to be altered or replaced. In private dwellings the cost of adaptations and incidental work will be borne by the national exchequer the local authority and the owner/occupier in the following proportions (a) the Exchequer contribution is 40% in all cases. (b) the Borough Council's minimum contribution in the case of private properties is 30% leaving the owner or occupier to bear 30%, they (15) MAY, if they think fit, repay to the owner or occupier the whole or any part of the 30% for which he is responsible. (c) In the case of dwellings owned by the Borough Council the local authority"s contribution is 60%. The local authority also have power to make grants at their discretion towards the cost of necessary adaptations in churches, chapels and charitable institutions, but there is no corresponding Exchequer contribution for this purpose. Grants are not available from either the local authority or the Exchequer in respect of other types of property. The works of adaptation which are eligible for grant, and whose execution the local authority may require by statutory notice include: (a) adapting or converting a fireplace. (b) replacing a fireplace by another fireplace or by some other means of cooking or heating. (c) altering a flue or chimney which serves a fireplace. (d) carrying out any operations incidental to those mentioned in (a), (b) and (c) above, i.e., gas ignition, electric points, etc. The cost of adapting or converting existing appliances will vary considerably according to the type of fireplace and appliance to be replaced, and the amount of work involved. A number of examples of the type of conversion, etc., which will be required, are given below:- (a) replacement of stool-bottom fire with an approved inset open fire. (b) replacement of stool-bottom fire and back boiler with approved open fire with boiler flue set. (c) replacement of old cast-iron fireplace with tiled surround, standard fireback and approved open fire. (d) replacement of old-type open fire and cast-iron surround with an independent appliance, i.e., free-standing openable/closed stove, etc. (e) replacement of coal burning range cooker with or without boiler with an approved solid fuel cooker, or, as an alternative, a free-standing open fire or openable stove, and gas or electric cooker. ( f) gas ignition to existing appliances or integral with new appliance. The following action is required to bring a Smoke Control Order into operation: (1) Decision by local authority in principle on the location, size of area and types of property to be included, and notification to the Minister of provisional plan. The following information should be submitted at the first stage:- (a) a map showing the proposed area; (b) particulars of the classes of buildings (domestic, commercial, (16) industrial, etc.) to which the Order would apply and the approximate number in each class (c) the best guidance possible on the cost of any adaptations in private dwellings which would qualify for grant: (d) an approximate estimate of the amount of bituminous coal or other smoky fuel to be replaced and however roughly, the best estimate of the additional supplies of the various smokeless fuels that will be required stating the basis of calculations, (e) the date on which it is proposed to bring the Order into operation. (2) After receipt of the Minister's comments on the provisional plan, the detailed survey of the Area, which will involve an inspection of every house and building, and preparation of specification and estimates of the work required for adaptation or conversion. (3) The making of the Order the carrying out of the statutory procedure, and the submission of the Order for confirmation. (4) After confirmation action to bring the Order into operation, service of notices on owners/occupiers, approval of cost of work of adaptation, and supervision and approval of finished works, payment of local authority grants and claiming of Exchequer contributions. The Minister of Housing and Local Government and the Central Office of Information have published a leaflet entitled "Smoke is Your Enemy'' for circulation to house-holders likely to be affected by a proposed smoke control area. This leaflet contains much useful information about air pollution and smoke control areas in a readily understandable form and is reproduced here in full " SMOKE IS YOUR ENEMY WHAT HARM DOES SMOKE DO? Smoke affects health creates dirt and drudgery and wastes fuel. It blackens and it corrodes. And it is costly. People who live where the air is smoky and sulphurous suffer more from bronchitis and chest diseases than country dwellers. Their resistance to disease is lowered by lack of sunlight and they take longer to recover from illness. This goes on all the time but when fog comes the danger to health is much greater. The white fog of the countryside is a nuisance, not a menace. But it can become a killer if mixed with smoke and other impurities. It killed 4 000 Londoners in December 1952. The national bill each year for air pollution, including all the washing, cleaning painting and repairs it necessitates has been estimated at £250 million. WHERE DOES THE SMOKE COME PROM? Half the smoke comes from house chimneys and mainly during the winter when fogs are most likely. The other half is from industry commercial buildings and railways. (17) If you burn coal on an open fire you cannot avoid making smoke. It happens when you light the fire and whenever you put on another shovelful of coal. Industrial furnaces work at much higher temperatures and if properly designed and operated they need make very little smoke indeed. But not all of them do this yet. "WHAT CAN BE DONE ABOUT SMOKE? The Clean Air Act, 1956. does two main things: 1. It bans "dark smoke" from chimneys everywhere, except when it is really unavoidable. Although houses are subject to the ban. they seldom produce "dark smoke"; so the ban will apply chiefly to factories and commercial buildings. 2. It empowers local authorities to ban all smoke from the chimney of any building, including houses, in districts known as "Smoke Control Areas" SMOKE CONTROL AREAS To create a smoke control area your local council must first make an order setting out the extent of the area. The order will be advertised in the local Press, and notices will be put up. The notice will explain where a map of the area can be seen, and what people should do if they wish to object to the order. The Council's order will need to be confirmed by the Minister of Housing and Local Government. If any person affected lodges an objection the Minister will hold a public inquiry before deciding. No order operates until six months after confirmation. But once it is operating the order means that you must stop making smoke. If you already burn smokeless fuels, or use gas or electricity, you need do nothing more, but if you burn coal or wood you will have to burn smokeless fuel instead. You can still have an open fire with smokeless fuel if you have the right kind of grate. There are many of these fuels - coke, anthracite, dry steam coal, "Coalite", "Rexco", Phurnacite", "Cleanglow", "Phimax", and, of course, gas and electricity. Oil-burning appliances can also be used on certain conditions. GRANTS AVAILABLE TO YOU You may need to alter or replace your present grates to burn smokeless fuel. Don't do anything now. The Council's inspectors will shortly be visiting you to ask what work needs to be done to the coal-burning fires you use regularly. If the Council agree that the work is necessary they will pay you, or the landlord if he does the work, a grant at least equal to 14/- in every pound of the cost (unless your house was built or converted after the date of the Act 5th July, 1956). If you want a more expensive fireplace or cooker you can have it. The Council will pay you their grant towards the cost of work which they would be prepared to approve, leaving you to meet the extra cost yourself. Grants may be paid towards the cost of:- (18) 1. Altering an existing fireplace including fitting gas ignition. 2. Replacing a fireplace where necessary by another fireplace or some other means of cooking or heating, 3. Any necessary incidental work. If you want to change from coal to gas or electricity you will be able to do so with the help of grants. The Council's inspectors will be able to help you with the choice of appliances and smokeless fuels and to tell you where you can get advice about the various types available. WILL IT BE WORTH IT? All this may mean some changes and it may cost you something. But it is going to be worth it. Your home will be cleaner and stay clean longer. There will be less need for laundering painting and decorating. Your neighbourhood will be a lot less smoky and you will find that new grates save money because they give out more heat from less fuel. You will be helping the Clean Air Campaign. The plan is that smoke control areas will spread and that smoke and grime from chimneys everywhere will be steadily reduced until our cities and towns are cleaner, brighter and healthier places to live in than ever before." The Chairman of the Public Health Committee Councillor F. W. Marshall, and the Chief Public Health Inspector are the Council's representatives on the London and Home Counties Clean Air Advisory Council and the Standing Conference of Co operating Bodies set up by the Department of Scientific and Industrial Research with which Leyton is co-operating in the investigation of atmospheric pollution. Daily observations continued throughout the year. The recording apparatus operated by the Public Health Inspectors is situated in the offices in Sidmouth Road a summary of these observations is reported to the Public Health Committee quarterly. The tables which follow in the statistical section show the results recorded during the 12 months ended March 1959, divided into summer and winter periods. The average results for the 7 year period ended March 1958, are also shown for comparison. Concentration of smoke is expressed in milligrams per 100 cubic metres and sulphur dioxide in parts per 100 million. The average concentration of smoke for the year ended 31st March. 1959, was 23.5 milligrams per 100 cubic metres compared with 21 5 milligrams for the previous eight years an increase of 9 3% whilst the concentration of sulphur dioxide for the same period was 8.7 parts per 100 million compared with 6 9 parts for the previous eight years an increase of 26.1%. The practical measures taken by Public Health Inspectors to mitigate pollution of the atmosphere by smoke and grit include the taking of smoke observations of factory chimneys: inspection of boiler installations, advice to boiler operatives on proper use of fuel and methods of stoking and discussions with managerial staff; 100 such investigations were carried out during the year. It was necessary for the Chief Public Health Inspector to carry out special investigations into numerous complaints received from various sources concerning nuisances arising from excessive emissions of grit and dust from the Gas Works in Lea Bridge Road, and comprehensive reports on this matter were submitted to the Public Health Committee. Consequent upon these reports the Council made several representations to the North Thames Gas Board and in October the situation was considered so grave as to warrant a special (19) meeting being called to discuss the problem. The meeting was held under the chairmanship of Councillor P.W.Marshall (Chairman of the Public Health Committee) in the Council Chamber, and was attended by members of the Public Health Committee, representatives of the Ministry of Housing and Local Government, the Alkali Inspectorate, North Thames Gas Board Medical Officer of Health and Chief Public Health Inspector. There was also present Mr.E.W.Sorensen, the local M.P. The Council's case was presented by the Town Clerk the Board's Officers were informed of the Council's grave concern at the continuance of the serious nuisances emanating from their Works at Lea Bridge and of the Council's determination that these nuisances should cease. They emphasized that although the Council recognized that the Board had a statutory duty to provide an adequate gas supply the Corporation's duty as a Public Health Authority was paramount. If the Board in the fulfilment of their duty interfered to an unreasonable degree, and there was ample evidence that they were in fact interfering, with the normal life of the inhabitants of the area, then the Council would not hesitate to invoke the aid of the Courts. The Officers of the Board acknowledged that consequent upon the introduction of a new form of coke manufactured at Lea Bridge Works in October 1956 there had been cause for complaint. They were aware that those complaints continued and conceded that to a degree they had been justified, but they claimed that they were doing everything possible to solve the problem. Works costing over £111,000 had been carried out since October 1956, as part of a planned programme of measures to reduce the amount of dust emitted, including the installation of new coke handling plant in August 1958, which the Board claimed had already effected a considerable improvement. Further works costing about £50,000 were to be carried out during the next twelve months, and the Board felt that by the end of this time the major sources of any dust emission would have been dealt with. A full report of the proceedings of this joint meeting was circulated to all members of the Council and the local Press, and the Chief Public Health Inspector was requested to keep the matter under close observation and to participate with the Board's Technical Officers in carrying out further tests to ascertain the amount and source of dust deposited in the vicinity of the Works. Accordingly Technical Officers of the Board were invited to attend a meeting held at the Public Health Offices on 10th December, 1958. There were also present representatives of the Alkali Inspectorate and the Department of Scientific and Industrial Research. The Board's Group Engineer was reminded of the Board's agreement to co-operate with the Council's Officers in carrying out a special survey to measure the amount of dust and grit deposited in Lea Bridge Area; such survey to be consistent with a scientific interpretation of the results. In reply the Board's representative said that he could speak with full authority of the Board and gave an assurance that they were anxious to co- operate fully in this and every respect. The general problem of grit and dust emission from the Works was discussed in all its aspects and reference was made to a previous discussion the Council's Technical Officers had had with the Department of Scientific and Industrial Research in relation to scientific means of measurement of grit and dust generally and in particular to the siting of British standard deposit gauges and the analysis of the material collected therefrom. On the question of analytic examination the representative of the Board said he was prepared to accept the Public Analyst's Certificate as to the amount of soluble and insoluble matter but he thought it desirable that in addition the deposits should be examined microscopically so that an estimate of the proportion of collected grit and dust which could be attributed to various sources of pollution in the area, apart from the Gas Works, could be determined. After a full discussion on this and other matters it was finally agreed that:- (i) The North Thames Gas Board would be prepared to erect a temporary staging of tubular scaffolding to support two British standard deposit gauges some 10ft. above the ground in the garden at the rear of one of the houses in Clementina Road. The staging would be suitably protected to prevent the possibility of the gauges being (20) interfered with. The site was chosen as being the most suitable and fairly representative of the properties most seriously affected by the nuisance. The monthly deposits from one of these gauges would be analysed by the Public Analyst on behalf of the local authority and the deposited material from the other would be analysed by Chemists of the Board. (ii) The British standard deposit gauge now situated within the curtilage of the Gas Works (near the entrance between Nos. 16 and 18 Clementina Road) would be under the control of the Council's Public Health Inspectors and its contents analysed by the Public Analyst. (iii) The Board would be prepared to co operate with the Council's Inspectors in carrying out an informal investigation to ascertain the amount of grit, dust, etc., deposited inside houses. For the purpose of comparison two houses would be used, one on the Clementina Estate and the other remote from the Gas Works. The deposited material would be collected by means of petrie dishes sited in the rooms in question and left for specified periods which would vary according to climatic conditions, appropriate measures would be taken to ensure that the rooms would not be used during the period of investigation. The petrie dishes would be deposited and collected in the presence of the Board's Officers and the contents would be weighed and microscopically examined. The arrangements as set out above have now been satisfactorily implemented and the survey for the scientific measurement of grit and dust deposited in the area is now in progress; a third British standard deposit gauge has also been sited in the Lea Bridge Road area for comparative purposes. The British standard deposit gauge is the instrument recommended by the Department of Scientific and Industrial Research for the measurement of solid atmospheric pollutants and is in use by local authorities and other organisations throughout the country. The results of such tests are expressed in tons per square mile per month and in grammes per 100 sq. metres per month, and these are published monthly in the Atmospheric Pollution Bulletin of the Department of Scientific and Industrial Research. In the course of time it will, therefore, be possible to consider the amount of dust and grit deposited in the vicinity of the Gas Works in relation to deposits officially recorded in other parts of the Borough and in comparable areas in London and elsewhere. The Board's programme of the further improvements they propose to carry out at the Works to mitigate grit an dust emission appears to be progressing satisfactorily but it is too early to draw any definite conclusions from this or from the results of the tests so far recorded. HOUSING AND NUISANCE ABATEMENT Of the statutory duties and responsibilities confronting the local sanitary authority none is more important, or indeed more onerous than that which concerns obsolescent housing. The duties of the Public Health Inspectorate in relation to existing housing accommodation is concerned generally with the repair, demolition and closure of unfit houses, slum clearance, and other matters arising from the issue of Certificates of Disrepair under the Rent Act. Dwelling houses are inspected as a general routine or on complaint and statutory action taken as appropriate to secure the remedying of defects and abatement of nuisances. Over the past 12 months some 17,347 inspections and re-inspections were made under Public (21) Health Acts, Housing and Rent Acts and other legislation, 2,653 complaints regarding unsatisfactory conditions were investigated and 726 notices specifying works to remedy defects such as dampness, general disrepair, defective drainage, leaking roofs, etc., were served. In addition, pursuant to the requirements of Section 3 of the Housing Act, 1957 and the Housing Consolidated Regulations. 1925/32, some 723 houses were surveyed to ascertain their fitness for human habitation having regard to the standard prescribed by the Act and the possibility or otherwise of their being included in a slum clearance scheme or dealt with by demolition or closing order procedure. Legal proceedings arising from the failure of owners to comply with the requirements of notices served under the nuisance abatement procedure of the Public Health Acts were instituted in 8 cases. Such proceedings are not, however, always successful in enforcing essential repairs, in a number of instances the Public Health Committee were obliged to consider the deferred demolition procedure as provided by Section 17 of the Housing Act, 1957, which enables the Council to purchase such houses at site value with a view to maintaining them in a tolerably habitable condition until such time as alternative accommodation is found for the occupants. The somewhat confusing procedure under the Rent Act, 1957, relating to the issue of certificates of disrepair and with regard to the rights and duties of the tenant and the responsibilities of the local sanitary authority made it necessary for the Council to set up a special enquiry bureau to assist members of the public. During the year under review, 264 applications for certificates of disrepair and 139 applications for certificates as to the remedying of defects etc., were received and dealt with by the Public Health Inspectorate; 254 notices (Form J) of the Council's proposal to issue such certificates were served on landlords arising out of which 189 undertakings (FormK) to remedy defects specified thereon within a period of 6 months were submitted by the owners and accepted by the Council and 100 certificates of disrepair were issued. Administration of the new Rent Act has added considerably to the work of this Section of the Department, the steady flow of applications from tenants and owners for various certificates under the Act continues and at the time of preparing this report over 700 had been received and dealt with. Owing to the staff shortages referred to earlier, it was not until September that it was possible for the Public Health Inspectorate to start a detailed survey of the properties included in the second of the Council's proposed slum clearance and redevelopment areas. However, substantial progress has now been made preparatory to the submission to the Public Health Committee of an official representation pursuant to Sections 42 and 157 (1) of the Housing Act. 1957. The section of the report entitled "Sanitary circumstances of the area, Part 2 Statistics* contains full details of inspections and notices served under the Housing and Public Health Acts and relevant legislation; the number of houses classified as a result of inspections under the Housing Consolidated Regulations, 1925/32; details of improvements affected to dwelling houses as a result of informal and statutory action, and further information regarding the institution of legal proceedings and the administration of the Rent Act, 1957. RODENT AND INSECT PEST CONTROL Under the prevention of Damage by Pests Act, 1949, the Statutory duty of the Council in regard to rodent control is threefold; to inspect the district in order to ascertain the degree of infestation by rats and mice; to destroy rodents on land of which they are the occupiers and to ensure if necessary by legal proceedings that owners and occupiers of land are taking all practicable steps for the destruction of rats and mice. It should be noted that land for this purpose includes buildings or parts of buildings. In order to meet its obligations under the Act the Local Authority must maintain an organisation adequate to requirements for effective rodent control according to the condition of (22) infestation of its area and in particular pay special attention to efficient rodent control in its sewers, refuse dumps refuse destructors and its other public service properties, In this connection the Council's sewers were disinfested in April and October, each treatment being of four to five weeks duration and involving some 1,000 odd manholes. As a result of investigation of surface infestations by the Public Health Inspectorate it was necessary to liaise with the Borough Engineer and Surveyor in regard to the repair of drainage systems at 592 houses which had proved a source of infestation. Some 443 complaints were received during the year concerning rodent infestation involving treatment by rodent operatives of 366 private houses and 77 business premises. The total number of visits in connection with these investigations and subsequent disinfestation amounted to 4.987. In December the Chief Public Health Inspector reported to the Public Health Committee concerning the carrying out of extensive block reatments against rodent infestation on the banks of the River Lea near the Council's Pleasure Ground the Oliver Road Allotments, the Council's Destructor Works and Marsh Lane Tip and the Dagenham Brook and surrounding land. He made some general observations on the problem of rodent infestation in the area concerned and reported upon his consultation with the Divisional Rodent Officer of the Ministry of Agriculture Fisheries and Pood in regard to difficulties connected therewith, when it had been suggested that the use of hydrogen cyanide gas be adopted in dealing with this problem. He stated that it was proposed subject to the approval of the Committee, to arrange an extensive gassing treatment of the three mile length of the Dagenham Brook (with the exception of the banks adjoining domestic and industrial property) and land adjoining to be carried out during the winter period, and also reported upon his discussions with the British Transport Commission-s Estate and Rating Surveyor about rodent control on the Commission's land and railway sidings adjoining Dagenham Brook as a result of which tentative arrangements had been made for the Disinfestation Section of the Commission to carry out a block treatment of their land simultaneously with the proposed gassing treatment so as to ensure the maximum amount of rodent destruction in the area as a whole. The Public Health Committee authorized the use of hydrogen cyanide gas and the area referred to was subsequently treated by gas as arranged. The Chairman of the Public Health Committee Councillor F.W.Marshall and the Chief Public Health Inspector continued to be the Council's representatives on the Workable Area Committee set up by the Ministry of Agriculture Fisheries and Food for rodent controlsThe Committee, comprising some 11 neighbouring authorities meets about three times per year and apart from discussing general methods of rodent control and forms of treatment investigate the results of the simultaneous treatment of interconnected sewers carried out bi annually by adjacent authorities. FOOD HYGIENE The detailed survey of the 1,500 odd premises in the Borough comprising shops, clubs factories schools catering establishments staff and factory canteens, stalls, etc., where food is prepared stored handled transported or sold, necessitated by the introduction of the Food Hygiene Regulations which contain new provisions for securing the observance of sanitary and hygienic practices in the food trades continued throughout the year. It should be realised however that the success of a survey of this kind, measured in the terms of improvements effected as a result of compliance with notices served must depend largely upon the ability of the staff to carry out re-inspections on a systematic basis. Such follow up procedure has been seriously curtailed because the depleted Public Health Inspectorate were for the greater part of the year primarily engaged on dealing with complaints applications for Certificates of Disrepair and other matters which brook no delay. However inspite of staff difficulties some 1,438 visits to food premises were made and some 80 odd notices in relation to such contraventions of the Regulations as the provision of separate facilities for hand washing and for washing of food and equipment provision of hot and cold water first aid kit locker accommodation, (23) faulty construction and maintenance, etc., were served. The practical application of the new standards to the wide variety of food premises has presented some difficulty, especially where business and domestic activities are combined. The occupier of a small shop may apply to the local authority for a certificate exempting his premises from certain requirements because of restricted accommodation or other special circumstances. No such applications were received during the year. Taken by and large, food traders in the Borough have responded well in complying with the statutory requirements, but it should be realised that the Food Hygiene Regulations are not who'ly concerned with premises, apparatus and equipment, they also lay down requirements in respect of the cleanliness of persons engaged in the handling of food and of their clothing and habits; a most important and unpredictable factor in the campaign for cleaner food is the worker. Carefully designed and elaborately equipped food premises are not proof against the careless food handler who fails to observe the elementary principles of persona] hygiene. It is often said that "one man's meat is another man's poison." In relation to food handling it could be said that ONE MAN'S POISON MAY BE ANOTHER MAN'S MEAT. This is the crux of the problem. One employee in a food establishment may by ignorance, apathy or mere carelessness, jeopardise the health of hundreds of people. The education of the food handler, especially by advice and demonstration at his or her place of work, is possibly the greatest single step that can be taken in producing cleaner food, and in this field the Public Health Inspector has admirable opportunities for exercising his role as health educator. Routine visits to the Council's Pleasure Ground, Lea Bridge Road, were made by Public Health Inspectors during Easter, Whitsun and August Pairs. Pood hawkers' stalls, mobile canteens, etc., were inspected and registrations checked. It is pleasing to report continued general improvement in the standard of hygiene practised by food vendors. It appears that inspections of the Pleasure Ground during Bank Holiday Pairs over the past years have had the desired effect, both in regard to ensuring that all food vendors are registered with the Council, and that trading is conducted in a hygienic manner. Attention is drawn to the statistical section of the report, which gives details in tabular form of premises and businesses registered and/or licensed under the Food and Drugs Act, 1955, and associated legislation. Full details are also given of inspections., notices, legal proceedings, and improvements effected to business premises as a result of action taken by the Department. DISEASES OF ANIMALS ACTS AND ORDERS The administration of the law relating to diseases of animals is carried out partly by officers of the Ministry of Agriculture Fisheries and Food and partly by officers of County Councils and local sanitary authorities, in Leyton, Public Health Inspectors are the authorised officers under the various Acts and Orders. The Diseases of Animals Acts and Orders deal generally with the prevention and control of outbreaks of scheduled diseases and protection of animals against unnecessary suffering and in this connection 63 inspections were carried out during the year. BUSINESS PREMISES In the Borough there are some 2,406 business premises, made up of factories, industrial undertakings, food premises - catering establishments, shops, etc., - involving some 3,120 activities including registration and licensing. All these premises are subject to routine inspection by the Public Health Inspectors to ensure compliance with the provisions of the Acts, Orders and Regulations controlling them, and for the welfare of those who (24) work in them. Because of staff shortages it was not possible to maintain throughout the year a regular and systematic inspection of all business premises. Nevertheless, 2,298 inspections were carried out 130 notices were served and 288 new registrations and/or licences were dealt with. Attention is drawn to the statistical section (Part II) which gives detailed information as to the Acts Orders and Regulations involved and the action taken in relation thereto. FOOD AND DRUGS, AND SHOPS ACTS ADMINISTRATION The Council is the Food and Drugs Authority for the district and the Public Health Inspectors are authorized under the Food and Drugs Act 1955 to procure samples of food and drugs for chemical analysis or for bacteriological or other examinations. 216 samples of a variety of food and drugs were submitted to the Public Analyst for chemical analysis. 14 adverse reports were received and reported to the Public Health Committee, these related to 2 informal samples and 12 formal samples. Of the 2 unsatisfactory reports received in respect of informal samples one was followed by a formal sample while the other concerned a consignment of Lebanese apples contaminated with arsenic and lead on the skins. In this case the retailer concerned was requested to treat the whole of the consignment to ensure that all trace of the chemicals was removed; this was done to the satisfaction of the Department. In respect of the reports received concerning 12 formal samples, in 2 cases the Committee considered no further action was justified. In one case concerning oranges contaminated with thiourea a further sample proved satisfactory and in 8 cases warning letters were sent to the proprietors concerned. Of these 3 were in connection with the sale and distribution of cream horns, meringues and cornets in contravention of Section 47 (1) of the Food and Drugs Act,1955. Under these provisions it is an offence for any person to sell or offer and/or expose for sale, any substance which resembles cream in appearance but is not cream, under a description or designation which includes the word cream. The Committee authorized legal proceedings in one instance in connection with a sample of minced meat containing preservative contrary to the Public Health (Preservatives in Food) Regulations, 1925/53. As a result of these proceedings the Council were awarded 5 guineas costs. The statistics in Part II give information as to food-stuffs in respect of which condemnation certificates were issued as a result of routine inspections. In addition, 6 complaints regarding unsound and/or adulterated food were investigated by the Public Health Inspectors. Of these the Committee resolved to send warning letters to the retailers and/or manufacturers concerned in 4 instances and the remaining 2 cases were noted with a resolve for no further action. SANITARY CIRCUMSTANCES OF THE AREA PART II - STATISTICS Reference has been made in the preceding paragraphs to the following tables and charts giving details in tabular form of the action taken and visits made by the Public Health Inspectorate pursuant to their statutory duties and responsibilities. (25) 1. INSPECTIONS; RE-INSPECTIONS, ACTION (a) GENERAL STATUTORY PROVISIONS COMPLAINTS RECEIVED INSPECTIONS AND RE-INSPECTIONS INFORMAL NOTICES SERVED FORMAL NOTICES SERVED NOTICES COMPLIED WITH BY OWNER NOTICES COMPLIED WITH BY LOCAL AUTHORITY HOUSES CLASSIFIED Clean Air Act, 1956 61 349 - - - - Housing Acts, 1936/57 152 1,695 - 23 16 - 723 Public Health Acts, 1936 1,997 10,781 724 368 608 - - Prevention of Damage by Pests Act, 1949 443 1, 512 2 - - - - Pood and Drags Act, 1955 60 1,407 - 81 33 - - Shops Act 1950 25 290 3 - 1 - - Essex County Council Act, 1952 3 73 - - - - - Leyton Corporation Act, 1950 4 47 1 - 1 - - Factories Act, 1937/48 28 407 - 48 5 - - Pet Animals Act, 1951 1 30 - 1 - - - Rag, Flock and Other Filling Materials Act, 1951 - 8 - - - - - Rent Act, 1957 - 685 - - - - - Diseases of Animals Acts - 63 - - - - - (26) (b) DETAILED (i) Housing Act 1957 (Sections 17/18) Housing Repairs and Rents Act, 1954 (Section 3) 1 house was dealt with under the deferred demolition procedure of the Housing Act, 1957. (ii) Rent Act, 1957. (a) Paragraph 4 of the First Schedule. Rent Act, 1957. Applications for certificates received 264* Decisions not to issue certificates 12 Decisions to issue certificates 254 Undertakings given by landlords under paragraph 5 of the First Schedule 189 Undertakings refused by local authority under proviso to paragraph 5 of the First Schedule 3 Certificates issued 100 Applications by landlords for cancellation 84 Objections by tenants to cancellation 34 Decisions by local authority to cancel in spite of objection 7 Certificates cancelled by local authority 64 Applications for certificates {Form P) 55 *5 of these applications were not dealt with owing to their being withdrawn or invalid. (iii) Pood and Drugs Act, 1955 - (Inspection and Supervision of Food Premises. The following inspections were carried out at the undermentioned food premises in accordance with the requirements of the Public Health Act, 1936, Food and Drugs Act, 1955, and Pood Hygiene Regulations. 1955, Ice Cream (Heat Treatment Reg.) 1947/52, Shops Act, 1950, Factories Act, 1937 Leyton Corporation Act, 1950, Essex County Council Act, 1952 and relevant legislation. (27) Type of Premises Insp. Det. Surv. Insp. Routine Total Number of Inspections Bakehouses - 38 38 Bakers - 39 39 Butchers 2 104 106 Catering Establishments 2 189 191 Confectioners 8 106 114 Corn Chandler - 3 3 Dairies and Distributors of Milk - 29 29 Factories 1 17 18 Factory Canteens 2 27 29 Fish Friers - 17 17 Fishmongers - 50 50 Game Dealers - 2 2 Greengrocers 5 106 111 Horse-flesh Dealers - - - Ice-Cream Places 3 40 43 Itinerant Food Dealers Stalls and Vehicles 7 73 80 Food Storage Accommodation Local Authority Canteen - 7 7 Meat Depots - 6 6 Miscellaneous - 111 111 Multiple Stores - 6 6 Off Licences 3 29 32 Provision Shops 6 308 314 Public Houses - 32 32 School Canteens - 25 25 Shell-fish Vendors - 12 12 Slaughterhouses (Poultry) - 21 21 Street Markets - 2 2 TOTAL INSPECTIONS 39 1399 1438 (iv) Inspection of Business Premises Other than Food Premises Inspections were carried out at the undermentioned business premises having regard to the requirements of the Public Health Act, 1936, the Shops Act, 1950; the Factories Act, 1937; the Pet Animals Act, 1951; the Rag, Flock and Other Filling Materials Act, 1951, the Diseases of Animals Acts and Orders, the Leyton Corporation Act, 1950; and the relevant legislation. (28) Type of Premises Insp. Det. Surv. Insp. Routine Total Inspection Clubs - 20 20 Factories with Mechanical Power 1 364 365 Factories without Mechanical Power 5 43 48 Fairgrounds - 4 4 Hairdressers and Barbers 5 35 40 Local Authority Properties - 2 2 Miscellaneous Shops etc. - 20 20 Outworkers - 137 137 Pet Animals Shops 3 27 30 Public Conveniences - 1 1 Rag Flock 1 7 8 Retail Shops 13 138 151 Schools - 3 3 Stables - 30 30 Workplaces - 1 1 TOTAL INSPECTIONS 28 832 860 (v) Factories Acts, 1937/48 The following is an extract from a Statutory Return made annually to the Ministry of Health under the provisions of Part I of the above Acts. Premises Number on Register NUMBER OF Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1 2 3 4 and 6 are to be enforced by Local Authorities 59 48 5 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 391 365 44 - (iii) Other premise in which Section 7 is enforced by the Local Authority (excluding outworkers premises) - - - - TOTAL 450 413 49 - (29) (vi) Prevention of Damage by Pests Act, 1949 - Rodent Control/Disinfection Rats Mice Total Complaints received 342 101 443 Enquiries and visits made:- By Rodent Operatives 2875 600 3475 By Public Health Inspectors 1409 103 1512 Premises treated individually:- Dwelling Houses 297 69 366 Business/Industrial Premises 45 32 77 Premises re-treated - Dwelling Houses 21 1 22 Business/industrial Premises 7 1 8 Number of rooms treated - - 253 Number of sites/tips treated - - 34 2. NUISANCES ABATED, DEFECTS REMEDIED, IMPROVEMENTS EFFECTED (i) PUBLIC HEALTH ACTS Nature of work carried out to dwelling houses and other premises:- Cement Work to sink waste gullies repaired 27 Chocked drains cleared 11 Dampness remedied 448 *Drains relaid or partly relaid 48 + 592 = 640 Floors repaired 127 Guttering repaired or renewed 99 Miscellaneous defects remedied 312 New W.C. pans and traps provided 19 Plaster repaired 281 Rainwater pipes repaired or renewed 30 Roofs repaired or renewed 253 Rooms redecorated 11 Sashcords renewed 138 Sinks provided 10 Sink waste pipes repaired or renewed 31 Stoves repaired or renewed 30 Vent pipes repaired or renewed 31 W. C. Cisterns repaired or renewed 58 Window sills, etc. repaired 90 Yards paved 13 * In 592 cases the public sewer was involved, the work carried out on behalf of the owners by the Council under the supervision of the Borough Engineer and Surveyor, the expenses incurred thereby being recovered from the owners. (30) (ii) FOOD AND DRUGS ACTS/FOOD HYGIENE REGULATIONS/SHOPS ACT Nature of contraventions remedied and improvements effected to food establishments, business/industrial premises as a result of statutory and informal action. Walls/Doors/Windows not kept clean or repaired 40 Ceiling not kept clean or repaired 36 Floor not kept clean or repaired 18 Inadequate ventilation 4 Inadequate lighting 1 Inadequate receptacles for refuse 5 Accumulation of refuse in room 9 Personal cleanliness 2 Cleanliness of apparatus and fittings 16 Facilities for personal cleansing and/or washing food and equipment inadequate, i. e.: Wash-basins 14 Hot water 25 Soap/towels/nail-brush 19 Sinks 3 Food not protected from contamination 16 First aid equipment 17 Wash-hand notice 28 Artificial light in W. C. 8 Inadequate W. C. accommodation 2 Inadequate locker (clothing) accommodation 3 Yard paving defective 2 Name and address not displayed 5 Roof defective 2 General defects 5 Miscellaneous 14 (iii) FACTORIES ACTS The under mentioned details were submitted to the Ministry of Health in accordance with the provisions of Part I of the above Act. Nature of Contravention Number of factories in which defects were found Found Remedied Want of Cleanliness 19 8 Sanitary Conveniences (S. 7) (a) Insufficient 6 - (b) Unsuitable or defective 1 - Other offences against the Act (not including offences relating to Outwork) 37 16 TOTAL 63 24 (31) 3, REGISTRATION AND/OR LICENSING OF BUSINESS PREMISES (i) APPROXIMATE NUMBERS OP BUSINESS PREMISES IN THE BOROUGH AND FUNCTIONS INVOLVED. NATURE OF TRADE/BUSINESS CARRIED ON No. of Premises ADDITIONAL LICENCES, REGISTRATIONS AND OTHER FUNCTIONS INVOLVED 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Ice-cream Milk Preserved Food Shell Fish Power Factory Non-Power Factory Catering Off-Licence Bakehouse Confectionery Fish Frier Grocer Barber With Storage Poultry Slaughterhouse Hairdressing A. Baker 42 - - - - 28 - 1 - 28 2 - - - - - - B. Butcher 76 - - 47 - 5 - - - - - - 4 - - 1 - C. Catering 103 54 1 - - - - - - - - - - - - - - D. Confectionery 147 55 - - - - - - - - - - - - - - - E. Fish 47 - - - 16 - - 10 - - - 29 - - - - - F. Greengrocer 80 1 - - - - - - - - - - 3 - - - - G. Grocer 205 51 89 1 - 2 - - - - - - - - - - - H. Multiple Store 5 3 - - - - - 2 - - - - 3 - - - 1 I. Milk 20 1 - - - - - - - - - - 2 - - - - J. Ice-Cream 131 - - - - - - - - - - - - - - - - K. Rag Flock 9 - - - - 7 2 - - - - - - - - - - L. Pet Animals 14 - - - - - - - - - - - 1 - - - - M. Hairdresser 97 - - - - - - - - - - - - 44 - - - N. Hawker 122 - - - - - - - - - - - - - 58 - - 0. Public House 35 - - - - - - 10 32 - - - - - - - - P. Off Licence 45 4 3 - - - - - - - - - 2 - - - - Q. Factory 450 - - - - - 57 36 - - - - - - - - - R. School 18 1 - - - - - 17 - - - - - - - - - S. Council Property 4 2 - - - - - 2 - - - - - - - - - T. Hospital 2 - - - - - - 2 - - - - - - - - - U. Miscellaneous Shops 754 - - - - - - - - - - - - - - - - TOTAL PREMISES 2,406 TOTALS: ADDITIONAL FUNCTIONS: 714 172 93 48 16 42 59 80 32 28 2 29 15 44 58 1 1 (32) (ii) DETAILS OF REGISTRATIONS/LICENCES ACT OR REGULATION On Register 31 12.1957 Removed during 1958 Registered during 1958 On Register 31 12.1958 Food and Drugs Act 1955 - S-16 Ice-Cream Premises 285 ~ 18 303 S. 16 Butchers Premises 47 - 1 48 Milk and Dairies Regs., 1949 - Distributors 105 11 19 113 Milk (Special Designations) Regs. (Annual Licences) - Sterilised 104 - 112 112 Sterilised supplementary 8 - 8 8 Pasteurised 51 - 63 63 Pasteurised - supplementary 6 - 6 6 Tuberculin tested 22 - 24 24 Tuberculin tested - supplementary 6 - 6 6 Essex County Council Act 1952 - Hawkers of Food 113 1 10 122 Hawkers Premises 54 - 4 58 Leyton Corporation Act 1950 - S 63 Vendors of Shell Fish 16 = - 16 S. 48 Hairdressers and Barbers 95 1 3 97 Pet Animals Act 1951 (Annual Licences) - Pet Shops 16 2 14 14 Rag Flock and Other Filling Materials Act, 1951 - Registration of Premises 9 - - 9 TOTAL 937 15 288 999 4. LEGAL PROCEEDINGS (i) PUBLIC HEALTH ACT (33) Resulting from the 368 statutory notices served on owners under the nuisance abatement procedure of the Public Health Act, 1936, in eight instances it was necessary to institute legal proceedings to secure compliance therewith. The results of such action are given hereunder: Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 5. 2.1958 Statutory nuisance - 11 Avenue Road, E. 11. Failure to comply with Abatement Order. Fined £2. 5. 2,1958 Statutory nuisance - 17 Avenue Road, E. 11. Failure to comply with Abatement Order. Fined £2. 26 2.1958 Statutory nuisance - 59 Cathall Road, E. 11. Abatement Order. 28 days, £1. Costs. 12. 3.1958 Statutory nuisance - 89 Fairlop Road, E. 11. Abatement Order. 28 days. £1 Costs. 6. 8.1958 Statutory nuisance - 34 Acacia Road, E, 11. Abatement Order 28 days £2. Costs. 8.10.1958 Statutory nuisance - 187 Dawlish Road, E. 10. Abatement Order. 28 days. £1. 1s. Costs. 22.10.1958 Statutory nuisance - 183 Essex Road, E. 11. Abatement Order. 28 days. £1. 1s. Costs. 31.12.1958 Statutory nuisance - 122 High Road. E. 15. Abatement Order. 28 days. £2. 2s. Costs. 5. MEAT AND FOOD CONDEMNED Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. The food condemned was destroyed by fire at the Council's Destructor Works. Commodity Cwts. Qrs Lbs. Commodity Units Bacon 1 - 16 Chickens 25 Cheese - 2 - Turkeys 1 Fish 11 3 8 Steak Pies 14 Ham - - 16 Loaves 33 Meat 4 1 4 Rolls 30 Sausages - - 16 Cheese 19 Pkts. Shortbreads - - 5 Herrings 6 Barrels Gherkins 189 Jars Fish 21 Tins Fruit 372 " Ham 21 " Luncheon Meat 173 " Milk 165 " Salmon 1 " Soup 12 " Vegetables 107 " (34) 6. SAMPLING (a) FOOD AND DRUGS ACT 1955. (i) Chemical Analysis Commodity Taken Satisfactory Unsatisfactory Milk 23 23 - Ice-Cream 8 6 2 Ice Lollies 1 1 - Miscellaneous 184 172 12 TOTAL 216 202 14 (ii) Bacteriological Examination Commodity Taken Grade I II III IV Ice-Cream 7 3 2 - 2 Ice Lollies 1 - - - - Water 10 - - - - Miscellaneous 2 - - - - TOTAL 20 3 2 - 2 7. ATMOSPHERIC POLLUTION (i) SMOKE ABATEMENT 24 observations were made as to quantities of smoke emitted from chimneys of industrial and commercial premises. Written intimations were sent to the managements of a number of business undertakings regarding excessive smoke and grit emission. (ii) DAILY RECORDS The average concentration of smoke for the year ended 31st March, 1959 was 23.5 milligrams per 100 cubic metres, compared with 21.5 milligrams for the previous eight years an increase of 93%, whilst the concentration of sulphur dioxide for the same period was 8.7 parts per 100 million, compared with 6.9 parts for the previous eight years an increase of 26.1%. The following tables show the results recorded during the twelve months ended March, 1959. divided into Summer and Winter periods. The average results for the 8-year period ended March, 1958, are also shown for comparison. (35) CONCENTRATION OF SMOKE EXPRESSED IN MILLIGRAMS PER 100 CUBIC METRES MONTH MONTHLY AVERAGE HIGHEST DAILY AVERAGE LOWEST DAILY AVERAGE 1950/58 1958/59 1950/58 1958/59 1950/58 1958/59 April 17.8 17.6 41.9 34.0 7.5 9.5 May 8.2 7.3 21.1 16.1 2.6 3.5 June 4.8 4.9 9.8 9.4 1.2 1.6 July 4.0 4.8 8.7 8.8 1.2 1.9 August 5.4 6.9 10.1 13.1 2.4 4.0 September 7.9 6.1 18.1 14.7 3.0 1.2 SUMMER AVERAGE 8.0 7.9 18.3 16.0 3.0 3.6 October 24.9 20.4 75.6 80.8 6.9 7.7 November 37.5 49.5 98.6 115.7 12.3 19.2 December 44.7 48.0 135.0 95.4 12.1 20.8 January 38.8 46.9 108.0 120.5 13.8 9.2 February 34.8 42.9 74.4 130.5 15.4 21.3 March 28.8 27.0 80.6 60.5 11.8 12.6 WINTER AVERAGE 34.9 39.1 95.4 100.6 12.0 15.1 CONCENTRATION OF SULPHUR DIOXIDE EXPRESSED AS PARTS 100 PER MILLION MONTH MONTHLY AVERAGE HIGHEST DAILY AVERAGE LOWEST DAILY AVERAGE 1950/58 1958/59 1950/58 1958/59 1950/58 1958/59 April 5.7 6.1 14.2 11.0 2.0 3.3 May 3.2 4.4 6.6 7.8 1.2 1.7 June 2.6 4.0 5.0 9.2 1.0 1.8 July 2.3 3.5 4.6 6.2 0.8 1.8 August 2.9 4.3 5.1 7.4 1.1 2.6 September 3.8 3.7 7.6 6.6 1.7 0.8 SUMMER AVERAGE 3.4 4.3 7.2 8.0 1.3 2.0 October 7.9 8.5 17.6 31.3 3.3 4.0 November 11.2 13.0 25.2 24.9 4.9 5.3 December 13.4 15.7 37.8 31.1 4.3 7.4 January 11.6 15.7 37.8 31.1 4.3 7.4 February 10.2 16.5 22.8 68.2 5.1 5.5 March 8.3 9.4 18.3 17.3 3.5 4.2 WINTER AVERAGE 10.4 13.1 25.6 36.3 4.4 5.1 8. RECORDS In connection with the undermentioned enquiries received during 1957 involving some 2561 properties a search is made of office records to ascertain whether any sanitary notices (statutory or informal) have been served in respect of the premises concerned and to what extent (if any) the notices have been complied with. In respect of enquiries under the provisions of Sections 4 and 20 of the Housing Acts, 1949/54, an inspection is made by the Public Health Inspector and the property classified. (i) Local Land Charge Enquiries 1763 (ii) Housing Act, 1949, Section 4 - Enquiries 414 (iii) Town and Country Planning Act, 1954, Section 33 - Enquiries 351 (iv) Housing Act, 1949/54, Section 20 Improvement Grants 33 (36) NATIONAL HEALTH SERVICE ACT, (PART III) SERVICES The Local Health Authority (Essex County Council) have delegated most of the administration of the Part III services to the Leyton Health Area Sub Committee. The Committee under the Chairmanship of Alderman Mrs,J.Hammond O.B.E.J.P., has shown great interest in the service. There are three Health Services Clinics in the area and plans are in hand to modernise both Park House Clinic and Leyton Green Clinic by the erection of central reception desks whereat the public will be properly directed to the appropriate clinic session. With the disposition of the Chiropody services to the clinics the use of these premises has increased and the thousands who attend the clinics for vaccination and immunisation also increases the need for proper direction and control. The Ante natal and child welfare clinic sessions have continued to be well attended. The Ante natal relaxation classes which are incorporated with lectures to mothers-to be are well appreciated by those who take advantage of this service. The Mothers Club and Keep Pit class held on Wednesday evenings at Leyton Green Clinic continues to be a live organisation. I had hoped that similar clubs would be inaugurated at the other Clinics however so far this wish has not been fulfilled. The "take up® of welfare foods continues to decline both locally and nationally. The reason for the fall in the issues of milk orange juice and cod liver oil is, in part, due to the much wider range of protective foods available to everybody at reasonable cost. The two day nurseries have been fully occupied during the year. In both nurseries there is an increase of young babies who need much individual attention, especially with feeding etc., at one time there were fifteen bottle fed babies in one of the nurseries. More and more medico social cases are being admitted and the day nurseries are playing a positive role in preventive medicine. The midwifery service continues to cope with the small percentage of home confinements (less than 20% of the whole) and I pay tribute to the excellent co operation that exists with the Lady Rayleigh Training Home both in the midwifery work and their excellent Home Nursing Service. The Domestic Helps attached to the department and the Home Nurses often meet in patients homes and it is pleasing to record both the co operation and common purpose of assisting the patients. The increases in the vaccination against poliomyelitis has imposed an enormous amount of work on the medical nursing and clerical staffs. This together with the third or "booster" dose has meant evening sessions and extra sessions at other times. Although the peak has now passed it is regretable that our efforts to persuade more of those in the eligible age groups to register failed whereas the emotionalism due to the sudden death of a professional footballer succeeded. The attendances at the three foot clinics continues to be maintained. The waiting time between treatments averages between 11 13 weeks. With a shortage of full time chiropodists and the increase of foot conditions in an ageing population there is little hope for a decrease in the waiting time. Each year I have to report an increase in the loan of sickroom equipment. Unfortunately, after ten years of the Act much of the equipment requires renewal so the financial provision for equipment will increase during the next few years. Requests for invalidchairs is the main demand and it would appear that a great deal of these demands are for (37) a permanent provision. Wherever possible patients are requested to make application to the Ministry of Health for the provision of a chair on permanent loan. The Domestic Help service continues to increase both in demand and service. At the time of writing the Sub-Committee have approved the appointment of an additional Organiser and it is hoped that with the increased supervision a stricter surveillance of Helps and the allocation of hours will be possible. There is no doubt of the value of this service to the community and with it I pay tribute to the Borough of Leyton Welfare Services Committee's "Meals on Wheels" and domiciliary chiropody service which are so much ancillaries to the Domestic Help Service. It is fitting that reference is made to the excellent work carried out through the Borough of Leyton Welfare Services Committee under the Chairmanship of Alderman Mrs.J. Hammond. The services they provide - social centres for aged persons - there are five of these, the meals-on-wheels service which provides up to one hundred meals per day on three days a week, reduced prices at launderettes for aged persons and financial provision for domiciliary chiropody, are all perfect ancillaries to the personal health services. At the present time the Committee are considering increasing the meals on wheels service to four days a week. The meals are cooked in the school canteens and distributed by voluntary workers who give up a considerable amount of time in this most worth-while service. It is not generally appreciated that the provision of meals on wheels eases the domestic help service which is already working at full demand. COUNTY HEALTH SERVICES - STATISTICS SECTION 21 HEALTH CLINICS: Leyton Green Road, Leyton, E. 10. (Opened in 1933) Granleigh Road, Leytonstone, E.11. ( " " 1935) Dawlish Road Leyton, E. 10. ( " " 1951) SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN Births registered during Year Male Female Legitimate 620 578 Illegitimate 32 22 Stillbirths 16 13 Births notified - 1281 CLINICS: Ante Natal First attendances 785 Subsequent attendances 4176 Post-Natal First attendances 182 Total attendances 393 (38) Birth Control First attendance 12 Total attendance 43 Child Welfare Leyton Green Park House Dawlish Road Emmanuel Hall UNDER 1 YEAR - First attendances 570 748 456 104 Subsequent attendances 6850 6708 3495 1270 Total attendances 7420 7456 3951 1374 1-5 YEARS - First attendances 293 276 249 54 Subsequent attendances 2155 2044 1297 289 Total attendances 2448 2280 1546 343 Total attendances (both age groups 9868 9736 5497 1717 Number examined by Clinic Doctor ... 2305 3155 1870 - Number weighed 7240 8881 5274 1676 DENTAL CLINICS Patients inspected and treated during the year Expectant Mothers Nursing Mothers Children under school age (1) Patients examined 112 75 436 (2) Patients found to require treatment 83 52 325 (3) Patients who have commenced treatment 83 52 325 (4) Patients who have completed treatment 57 38 245 (5) Patients awaiting treatment - - - (6) Attendance for treatment 318 257 971 (39) Types of Treatment Given Expectant Mothers Nursing Mothers Children under school age Extractions - (a) Permanent teeth 97 114 - (b) Temporary teeth - 1 323 Fillings - (a) Permanent teeth 97 76 27 (b) Temporary teeth • - 578 Inlays provided 3 1 - Crowns provided 1 - - Anaesthetics administered - (a) Local 39 43 34 (b) General (i) by Medical Offrs. on County Staff - - - (ii) by Others 33 24 176 (a) Scaling 28 18 6 (b) Prolonged scaling and gum treatment 66 26 - Silver nitrate treatment - - 384 Dressings 93 108 308 X-ray examinations 6 6 2 Dentures provided (a) Full 1 6 - (b) Partial 12 10 - Dentures repaired - 2 - Dentures remade - (a) Pull - - - (b) Partial - - - Orthodontic appliances - (a) Fixed - - - (b) Movable - - - Prophylactic treatment and other operations Gum treatment 12 4 3 Number of treatments (scaling and prophylactic carried out by Oral Hygienists) 96 44 2 (40) Orthopaedic Clinic New Cases 55 Re-inspections 131 Minor alterations to footwear 96 Surgical appliances supplied 4 Ophthalmic Clinic Children referred 8 Attendances 16 WELFARE FOODS The "take up" of welfare foods again shows a steady decline, even though there was an increase in clinic attendances. The large reduction in the issue of Orange Juice is accounted for by the Ministry of Health's policy of supplying Orange Juice only in respect of children up to the age of 2 years. Issues - The total issues during 1958 were:- National Dried Milk (Tins) 20,628 Cod Liver Oil (Bottles) 4,346 Vitamin A & D Tablets (Pkts) 3,626 Orange Juice (Bottles) 39,067 CARE OF PREMATURE INFANTS (weighing 5lbs. 8ozs. or under) Bora at Home 16 Born in Hospital or Nursing Home 56 CONVALESCENT HOME TREATMENT Numbers sent to Convalescent Home Children 4 Mother and children , 3 mothers with 4 children (41) DAY NURSERIES There are two Day Nurseries in the area, each having accommodation for 60 children. (1) Ellingham Road Day Nursery, Ellingham Road, Leyton, E.15. (Telephone MARyland 3683) (2) Knotts Green Day Nursery, Leyton Green Road, E.10. ( Telephone LEYtonstone 4100) KNOTTS GREEN ELLINGHAM ROAD TOTAL 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. Number of approved places at end of year 15 35 15 35 30 70 Number of children on register at end of year 20 36 18 42 38 78 Total attendances during year 3325 7347 2805 7439 6130 14,786 Number of days open 255 255 - INFANT, NEO NATAL AND FOETAL MORTALITY Live Births 1252 Deaths under 1 year 31 Deaths under 4 weeks 24 MORTALITY RATES Infantile 25.87 Neo natal 19.16 (Rate per 1,000 live births) STILLBIRTHS Number 29 Rate per 1,000 22.63 (42) (43) HEALTH CLINICS - CLINIC SESSIONS HEALTH CLINIC MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Leyton Green Ley ton Green Rd. E. 10. (LEYtonstone 3650 Extn. 267) A M Dental Minor Ailment Foot Clinic Dental Orthoptic Minor Ailment Foot Clinic Dental Minor Ailment Orthoptic Ophthalmic Ftoot Clinic Dental Minor Ailment Ante natal Foot Clinic Dental Minor Ailment Ophthalmic Orthoptic Foot Clinic Minor Ailment Dental (Alt.) Foot Clinic (Alt.) P.M. Infant Welfare Foot Clinic Dental Infant Welfare Foot Clinic Dental Orthoptic Infant Welfare Foot Clinic Dental P.N. (2nd) A. N. Exercises Orthoptic Foot Clinic Dental Orthoptic Special Medicals Foot Clinic A. N, Exercises (Alt. Fridays) Immunisation Evening Foot Clinic Dental Clinic Foot Clinic Park House Granleigh Road E. 11. (LEYtonstone 3650 Extn. 268) A M Dental (1) Minor Ailment Ante-natal (2nd and 4th) Foot Clinic Dental (1) Oral Hygiene Minor Ailment Foot Clinic Dental (1) Minor Ailment ° Aural Clinic Foot Clinic Dental (1) Minor Ailment Foot Clinic Dental (1) Minor Ailment Foot Clinic Dental (1) (Alt.) Minor Ailment Foot Clinic (Alt.) P. M Dental (1) Ante natal Exercises Foot Clinic Dental (1) Oral Hygiene Infant Welfare Foot Clinic Dental (1) &(2) Infant Welfare Foot Clinic Dental (1) Infant Welfare Foot Clinic Dental (1) Immunisation Ante-natal Exercises Foot Clinic Evening Foot Clinic Dental Clinic Foot Clinic Dawlish Road, Dawlish Road E, 10. (LEYtonstone 3650 Extn. 287) A.M Minor Ailment Dental (l) Foot Clinic Oral Hygiene Speech Clinic Dental (1) Minor Ailment Foot Clinic Speech Clinic Dental (1) Minor Ailment Ante-natal Toddlers Foot Clinic Speech Clinic Dental (1)&(2) Minor Ailment Speech Clinic Dental (1) Minor Ailment Foot Clinic Speech Clinic Minor Ailment Dental (1) (Alt) Foot Clinic (Alt.) P.M. Dental (1) Infant Welfare Foot Clinic Speech Clinic Dental (1) Immunisation Foot Clinic Ante-natal Exercises (Alt.) Speech Clinic Dental (1) Foot Clinic Speech Clinic Infant Welfare Foot Clinic Dental (1)&(2) Speech Clinic Dental (1) Foot Clinic Speech Clinic Bnmanuel Hall Hitchamn Road E. 10 Evening Foot & Dental Foot & Dental Foot & Dental P M. Weighing Session * By arrangement SECTION 23 MIDWIFERY Cases attended by Council Midwives Midwives Total Essex County Council Attached to the Lady Rayleigh Training Home Beechcroft Road Cases attended:- (a) As Midwives 89 158 247 (b) As Maternity Nurses 6 26 32 Ante-natal Visits 392 1757 2149 Ante-natal Examinations 691 2575 3266 Post-natal Visits 1542 6336 7878 Administrations of Gas and Air Analgesia 90 76 166 Administration of Pethidine 58 89 147 Administration of Trilene - 84 84 Gas and Air Analgesia Percentage of administrations 59.28 Medical Aid Where the Medical Practitioner had arranged to attend the patient 9 Others 106 Fees paid to Doctors Number of accounts received 49 Total amount paid to Medical practitioners £133.4.6. Maternity Outfits Number of outfits issued to Expectant Mothers 277 (44) SECTION 24 HEALTH VISITING Health Visitors During the year the Health Visitors made 19,687 visits to homes. (a) To expectant mothers - First visits 231 Subsequent visits 189 (b) To children under 1 year of age:- Pirst visits 1254 Subsequent visits 4789 (C) To children between the ages of 1 and 5 years:- First visits 208 Subsequent visits 6414 (d) Other visits:- Whooping cough - Measles - Ophthalmia neonatorum - Discharging eyes - Diarrhoea - Puerperal Pyrexia 15 Children's Act 8 After deaths 85 After stillbirths 20 Miscellaneous 1412 Ineffective 2765 Old people 2267 Hospital follow-up 30 Pemphigus neonatorum - SECTION 25 HOME NURSING Number of new cases 1305 Number of visits paid to above 49817 SECTION 26 VACCINATION AND IMMUNISATION Vaccination against Smallpox NUMBER OF PERSONS VACCINATED (OR RE-VACCINATED):- Age at date of Vaccination Under 6 months 6-12 months 1 year 2-4 years 5-14 years 15 years and over Total Number vaccinated 674 117 18 48 91 108 1056 Number re-vaccinated - - - 3 37 185 225 (45) Diphtheria Immunisation Age (in years) at final injection Children* who completed a full course of primary immunisation during the year Children* who were given a reinforcing injection during the year By General Practitioners By County Staff By General Practitioners By County Staff Under 1 300 270 - - 1 90 214 - - 2 9 20 3 - 3 8 15 4 3 4 12 10 40 45 5-9 29 68 284 261 10-14 4 2 22 7 Total 452 599 353 316 * Including temporary residents Percentage of School Children Immunised (1958) 5-year age group - Number examined 890 Number immunised 726 Percentage immunised 81.6 10-12 age group - Number examined 944 Number immunised 785 Percentage immunised 83.2 14-year age group - Number examined 1213 Number immunised 964 Percentage immunised 79.5 (46) Protection against Whooping Cough Age at time of final injection Children who completed a full course under the County Scheme Records of combined diphtheria-pertussis immunisations received By General Practi ti oners By County Staff Under 6 months 33 21 19 6-12 months 127 472 86 1 year 26 95 34 2- 4 years 12 23 9 5 years and over 13 8 14 Total (primary courses) 211 619 162 Reinforcing injections 16 - 30 Poliomyelitis Vaccination 1958 The following persons in the various age groups received a complete immunising course in 1958. Year of Birth Male Female Boosters Male Female 1943 249 222 - - 1944 320 287 - - 1945 317 302 - 1 1946 419 380 1 - 1947 160 145 144 148 1948 129 126 86 104 1949 125 126 78 84 1950 116 110 64 48 1951 142 151 31 21 1952 154 144 34 25 1953 143 148 17 11 1954 179 176 14 17 1955 270 249 31 32 1956 255 276 19 25 1957 245 230 1 - 1958 7 5 - - Hospital Staff 14 39 - 1 Total immunised during year 1958 3244 3116 520 517 Total immunised during year 1957 1359 1303 - - Total to 3ist December, 1958 4603 4419 520 517 Total Registrations to end of 1958 10,443 (Expectant Mothers immunised - 315 Boosters • 2) (47) SECTION 27 AMBULANCE SERVICE Total patients conveyed 41,119 Emergency cases 3,919 Hospital admissions 1,570 Hospital discharges 2,062 Hospital transfers 448 Stretcher cases 4,592 Sitting and walking cases 36,527 Conveyance to and from Clinic 33,104 Others 16 Total Mileage 144,345 miles SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER CARE Foot Clinic Female Chi 1dren Male New cases 242 865 415 Total attendances 3830 17662 2602 Tuberculosis (a) Open Air Shelters - Number in use at end of year 2 Total number of visits to shelters by health visitors or tuberculosis visitors 6 (b) Extra Nourishment - Number of new cases supplied with free milk 29 Total number being supplied with free milk at end of year ... ... 30 Loan of Sick Room Equipment Air Beds 1 Air Rings 86 Bed Back Rests 81 Bed Cradles 22 Bed Pans 147 Crutches 1 Diabetic Scales 1 Invalid Chairs 31 Rubber Sheets 124 Urinal Bottles 38 Feeding Cups 7 Commodes 32 Total 571 (48) Convalescence for Adults Number of applications during year 74 Length of stay - One week - Two weeks 43 Three weeks 29 Pour weeks 2 SECTION 29 DOMESTIC HELP Number of helps and hours worked - Number of domestic helps enrolled at end of year Whole-time helps 4 Regular part time helps 138 Number of domestic helps actually employed at end of year 136 Number of hours worked during year 165,382 Work of Domestic Help Organiser - (1) First Visits 537 (2) Re-visits to beneficiaries - (a) Domestic help present 223 (b) Domestic help not present 486 (3) Other visits 339 Help Provided Maternity Acute Sick Tuberculosis Chronic Sick Aged not Sick Others Total Aged Others Requests for help from new cases during the year 54 36 9 402 66 8 5 580 New cases helped during the year. 52 37 - 374 61 9 4 537 Total cases completed during the year (a) 53 27 5 326 41 12 4 468 Cases being helped at end of year who have received help for - Under 3 months - 8 - 83 15 3 - 109 3 -6 months - 3 - 51 9 - - 63 6-12 months - 1 1 99 13 1 - 115 Over 12 months - 5 317 32 14 - 368 Total (b) - 12 6 550 69 18 - 655 Total cases helped during the year (a) plus (b)) 53 39 11 876 110 30 4 1123 Hours of help provided during the year 3,081 1,864 2,944 134,958 16,731 5,425 379 165,382 (49) MEDICAL EXAMINATION OF STAFF County Council employees - Number of medical examinations:- (a) Entrants to County Councils service 81 (b) Retirement on Superannuation Nil No. of medical examinations Leyton Borough Council 57 Others 2 Entrants to teaching profession and training colleges 33 (50) INDEX Page(s) Acreage 4 Aged Care of 9 Air Pollution 14, 35 Ambulance Service 7, 48 Ante-natal Clinics 38 Bacteriological Examinations 35 Birth Control Clinic 39 Birth Notifications 38 Birth Rate 4 Birth Registrations 38 Births, Illegitimate 4 Burial of the Dead 8 Business Premises 24, 32 Care of the Aged 9 Chemical Analysis 35 Child Welfare Clinics 39 Clinic Sessions 43 Convalescent Home Treatment 41, 49 Comparability Factor 4 Day Nurseries 37, 42 Death, Causes of 6 Death Rate 4 Dental Treatment 39 Diphtheria Immunisation 10, 46 Diseases of Animals Acts and Orders24 Disinfestations Domestic Help Service 49 Domiciliary Midwives 37, 44 Dysentery 10 Extra Nourishment 48 Factories Acts 1937/48 29, 31 Food, Condemned 34 Food Hygiene 23, 25, 27, 31 Food Poisoning 10 Foot Clinic 48 Gas and Air Analgesia 44 Health Clinics 38 Health Education 13 Health Visiting 45 Home Nursing 45 Homes for the Elderly 9 Hospitals 1 Housing and Nuisance Abatement 21 Housing Repairs & Rents Act, 1954 27 Ice-Cream 35 Immunisation 45 Infant Mortality 4, 42 Infectious Diseases 10 Laboratory Facilities 7 Laundry for the Incontinent 7 Legal Proceedings 33 Maternal Mortality 4 Maternity Outfits 44 Meals on Wheels Service 38 Page(s) Measles 11 Medical Aid 44 Medical Examination of Staff 50 Midwifery 37, 44 Mortuary 9 Mothers Club 37 National Assistance Act, 1948 - (Sections 47 and 50) 8 National Health Service Act, 1946 - (Part III) 37 Neo-Natal Mortality 42 Notices, Sanitary 26 Nuisances, Abated 30 Nursing Homes 7 Ophthalmic Clinic 41 Orthopaedic Clinic 41 Pet Animals Act, 1951 33 Pneumonia 11 Poliomyelitis 11 Poliomyelitis Vaccination 47 Population 4 Post-Natal Clinic 38 Premature Infants 41 Redevelopment Areas 13, 21, 22 Rent Act, 1957 27 Rodent & Insect Control 22, 30 Sampling (Food & Drugs Act, 1955) 35 Sanitary Circumstances 13, 25 Scabies Clinic 8 Scarlet Fever 11 Shops Act, 1950 25 Sick Room Equipment 48 Slum Clearance 13, 21, 22 SDioke Abatement 14, 35 Statistics, Comparative - (Births, Deaths, etc.) 5 Statistics, Sanitary 25 Statistics, Vital 4 Tuberculosis 11, 12 Tuberculosis, Open Air Shelters 48 Vaccination 45 Vital Statistics 4 Welfare Foods, Distribution of 37, 41 Whooping Cough, Immunisation 47 Whooping Cough 11 (51)