AC. 4368 1. Mr Ohinad 503. 2. Library Pop 62 2. copy Metropolitan Borough of Poplar ANNUAL REPORT OF The Medical Officer of Health FOR THE YEAR 1956 Metropolitan Borough of Poplar ANNUAL REPORT OF The Medical Officer of Health FOR THE YEAR 1956 I N D E X Page Public Health Committee 4 Staff 5 Statistics 12 Causes of Death 13 Sanitary Circumstances of the Area 15 Housing 29 Inspection and Supervision of Food 34 Infectious Diseases 48 General Provision of Health Services for the Area 53 -3- METROPOLITAN BOROUGH OF POPLAR PUBLIC HEALTH & BATHS COMMITTEE, 1956 - 1957 Councillor A. L. ATKINS, J.P., Mayor (ex-efficio) CHAIRMAN: Alderman W. I. BRINSON, J.P. VICE-CHAIRMAN: Councillor H. MANNING Alderman E. J. Caudwell Councillor A. E. Allen " E. M. Brown " J. J. Docker " Mrs. M. Goodway " G. H. Mills " M. Pollins " Mrs. M. M. Saunders " P. Sparks "A. W. Timson "J. T. Tucker " W. T. Tuson " J. W. Vicat Council' s representatives on the London County Council (Division 5) Health Committee: Councillor Mrs. N. F. Cressall " Mrs. E. Sims -4- STAFF OF THE PUBLIC HEALTH DEPARTMENT MEDICAL OFFICER OF HEALTH: W. C. TURNER, M.D. , B. S. , D.P.H., D.I.H. SENIOR SANITARY INSPECTOR: C, A. Grabham (a) (d) SANITARY INSPECTORS: G. L. Belshaw (c) (d) F. S. Jolliffe (c) (d) N. L. Brown (c) (d) H. W. Luke (c) (d) G. W. East (c) (d) J. E. G. Steeden (c) I. M. G. Farries (c) C. S. Westbrook (a) (d) CHIEF CLERK: A. A. Hamilton (c) CLERKS: A. M. Cannon T. E. Oldfield (from 10.12. 56 ) W. J. Crone G. R. Williamson DISINFECTORS: R. DESMOND (Chief Disinfector) PUBLIC ANALYSTS (Part-time): Albert E. Parkes, F. I.C. , F. C. S. H. A. Parkes, B. Sc. , F. I.C. (a) Cert. S.I.E. Board, (b) Cert. R.S.I, (c) Cert. R.S.I. & S. I.E. J.B. (d) Cert. Meat & Food Inspector. -5- TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF POPLAR Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health and sanitary circumstances of the Borough during the year 1956. The general standard of health of the inhabitants of the Borough has remained satisfactory but some distress is still being caused by the continued housing shortage. Efforts have been made over the years to secure improvements in the home living conditions but in Poplar the age of so many of the houses with serious inherent defects makes it inevitable that such improvements depend largely on the provision of new and better houses. Another aspect of the housing shortage has been the uncontrolled trespass by dwellers in tents, vans and sheds on land cleared as a result of war and housing activities, still vacant owing to delays in developing the sites. This has created an unexpected problem and a serious source of nuisance. The Food and Drugs Act 1955 came into operation on the 1st January, 1956. It is a consolidating Act and brings together all the previous legislation on food and drugs without introducing any new law. The Food Hygiene Regulations, 1955, made under the new Act also came into operation on 1st January, 1956. They replace and extend the powers contained in -6- Section 13 of the Food and Drugs Act, 1938 which were principally used in the past. The principal extensions to the previous law are expressly designed to improve food handling hygiene in an endeavour to lessen the number of cases of food poisoning. The provisions are very necessary and important as, owing to changes in eating habits more meals are eaten away from home and over the past five years the number of cases of food poisoning has shown a marked progressive increase. The new law includes:- Specific requirements designed to prevent the contamination of food; provision of sinks and other facilities for washing food and equipment; the provision of a constant supply of hot water for sinks, wash-basins, etc., in the food premises and of a supply of hot water on stalls and vehicles; restrictions on the preparation and packing of food in or about domestic premises; the temperatures and conditions under which certain foods that provide a particularly favourable medium for food poisoning organisms are to be kept in food premises; a requirement to provide vehicles used for the transport of meat with duck-boards and separate receptacles for offal, and, where the vehicles are not enclosed, a covering supported by a frame or poles; .-7- the circumstances in which persons carrying meat are required to wear overalls and head covering; the cleanliness of persons engaged in the handling of food and of their clothing, and the action to be taken where they suffer from, or are carriers of, certain infections. The Clean Air Act, 1956, was enacted during the year and, except for certain sections, came into operation on the 31st December, 1956. The Act is one of considerable social importance, more especially in Poplar where there are many dwellings adjacent to areas of the Borough zoned for in- dustrial purposes. It is well known that many of the industries carried on in the area are smoke producers. Last year mention was made that it had been proved without doubt that smoking habits are in part responsible for the increase in the number of cases of cancer of the lung. Further work has confirmed this relationship and it is regretted that figures for deaths from cancer of the lung continue to rise. It is absolutely essential that young people should be prevented from acquiring the habit or dissuaded from smoking as there is a delay of up to twenty years before the effects of this habit manifest themselves. From a purely medical point of view there would appear to be every justification for discontinuing the importation and sale of tobacco in its present form. I desire to express my thanks to Dr. R. Duncan Dewar under whose control the -8- statistics were compiled until he relinquished his appointment in April, 1956. My thanks are due to the Chairman and Members of the Public Health and Baths Committee for their help and encouragement to the Chief Officers of the Council and their staffs for their co-operation, and finally to Mr. C. A. Grabham, the Senior Public Health Inspector, Mr. A. A. Hamilton, Chief Clerk and all the other members of the staff of the Public Health Department for their assistance and loyal support at all times. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W; C. TUPNER, Medical Officer of Health. ,-9- SECTION A VITAL STATISTICS During the year births registered exceeded deaths registered by 467 but through rehousing and other reasons some 2,100 residents moved from the Borough to other areas and the home population estimated by the Registrar General to number 68,620 at the middle of the year shows a decrease of 1,640 compared with the estimate for the previous year. The birth rate was 17.5 per 1,000 of the population as compared with 16.6 for 1855. To enable a fair comparison to be made with other areas and the country as a whole, area comparability factors which take into consideration the age and sex distribution of the population are provided by the Registrar General. Factors are supplied both for births and deaths. Using the comparability factor the adjusted birth rate would be 16.1 as compared with 15.7 for England and Wales. The death rate in 1956 was 10.7 per 1,000 of the population as compared with 10.9 for 1955. Again using the comparability factor the adjusted death rate woul d be 12.6 as compared with 11.7 for England and Wales. Comparative rates for the previous year were 12.4 and 11.7 respectively. The infant mortality rate, being the number of deaths of infants under one - 10- year of age per 1,000 births, was 24.9 as compared with 29.2 for the previous year. The figures for England and Wales are 23.8 and 24.9 respectively. The causes of death are shown in Table l in accordance with the classification used by the Registrar General. Deaths from neoplasms of the lung have for the last decade shown a steady but progressive increase and during this year show an increase of approximately 25 per cent. It is felt that this increase can only be related to environmental factors which include smoking habits and atmospheric pollution. Deaths from other diseases show no significant change from the numbers recorded in 1955. STATISTICS OF THE AREA Area (excluding water) 2,136 acres Area (including water) 2,331 acres Population, estimated mid-year 68,620 Number of inhabited houses (according to Rate books) 18,145 Rateable Value £1,069,527 General Rate (1955-1956) 15/0d. in £ Sum represented by a penny rate (1955-1956) £4,180 -11- 12 13 TABLE1 DEATHS [###CAUSES OF DEATH SEX ALL AGES AGES GROUPS 0 - 1- 5- 15- 25- 45- 65- 75 ALL CAUSES M 386 11 - 2 3 19 131 105 115 F 350 19 - 2 2 20 62 87 158 1. Tuberculosis, respiratory M 9 - - - - 1 6 1 1 F - - - - - - - - 1 2. Tuberculosis, other M - - - - - - - - - F - - - - - - - - - 3. Syphilitic disease M 4 - - - - - 2 1 1 F 1 - . - - - - 1 - 4, Diphtheria M - - - - - - - - - F - - - - - - - - - 5. Whooping Cough M - - - - - - - - - F - - - - - - - - - 6. Meningococcal infection M - - - - - - - - - F 2 1 - 1 - - - - - 7. Acute poliomyelitis M - - - - - - - - - F - - - - - - - - - 8. Measles M - - - - - - - - - F - - - - -_ - - - - 9. Other infective and parasitic diseases M - - - - - - - - - F 2 - - - - - - 1 1 10. Malignant neoplasm stomach . M 12 - - - - 1 7 2 2 F 7 - - - - 1 - 3 3 11. Malignant neoplasm, lung, bronchus M 40 - - - - - 18 17 5 F 5 - - - - - 3 1 1 12. Malignant neoplasm, breast M - - - - - - - - - F 14 - - - 1 2 7 3 1 13. Malignant neoplasm, uterus . F 2 - - - - 1 - 1 - 14. Other malignant and lymphatic neoplasms M 37 - - - - 2 7 13 15 F 39 - - 1 - 2 8 13 15 15. Leukæmia, Aleukæmia M 1 - - - - - 1 - - F 1 - - - - - 1 - - 16 Diabetes M - - - - - - - - - F 5 - - - - - - 2 3 17. Vascular lesions of nervous system M 27 - - - - - 9 9 9 F 35 - - - - 1 4 10 20 18. Coronary disease, angina M 62 - - - - 2 22 19 19 F 47 - - - - - 5 16 26 19. Hypertension with heart disease M 4 - - - - - 2 1 1 F 8 - - - - - 2 3 3 20. Other heart disease M 29 - - - - 3 10 3 13 F 38 - - - - 3 8 6 21 21. Other circulatory disease M 21 - - - - 2 5 4 10 F 20 - - - - - 3 5 12 22. Influenza M 1 - - - - - - 1 - F 1 - - - - - - - 1 23. Pneumonia M 18 2 - - 1 - 3 3 9 F 22 7 - - - - 2 2 11 24. Bronchitis M 53 - - - - - 18 22 13 F 36 - - - - 1 3 11 21 25. Other diseases of respiratory system M 5 - - . - 1 2 - 2 F 3 - - - - - 1 2 - 26 Ulcer of stomach and duodenum M 10 - - - -- - 5 3 2 F 5 - - - - - - 1 4 27. Gastritis, enteritis and diarrhæa M - - - - - - - - - F 7 - - - - - 1 1 5 28. Nephritis and nephrosis M 4 - - - - i 1 2 - F 4 - - - - 3 1 - -- 29. Hyperplasia of prostate M 3 - - - - - 1 - 2 30. Pregnancy, childbirth, abortion F 1 - - - - 1 - - - 31. Congenital malformations M 3 2 - 1 - - - - - F 3 2 - - - 1 - - - 32. Other defined and ill defined M 21 7 - 1 - - 3 2 8 F 36 9 - - - 4 9 4 10 M 8 - - - 1 3 3 1 - 33. Motor vehicle accidents F 4 - - - l - 3 1 2 34. All other accidents . M 8 - - - 1 1 - 1 - F 1 - - - - - 3 - 1 35. Suicide M 6 - - - - 2 1 - - F 1 - - - - - - - - 36. Homicide and operations of war M - - - - - - - - - F - - - - - - - - - EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Males Females TOTAL Live Births: Legitimate 570 564 1,134 Illegitimate 36 33 69 Birth Rate per 1,000 estimated resident population: 17.5 Stillbirths: Legitimate 14 7 21 Illegitimate 2 1 3 Rate per 1,000 total (live and still) births: 19.6 Deaths 386 350 736 Death rate per 1,000 estimated resident population: 10.7 Deaths of Infants under one year of age: Legitimate 9 15 24 Illegitimate 2 4 6 Death rate of Infants under one year of age: All infants per 1,000 live births: 24.9 Legitimate infants per 1,000 legitimate live births: 21.2 Illegitimate Infants per 1,000 illegitimate live births: 86.9 14 SECTION B SANITARY CIRCUMSTANCES OF THE AREA Water Supply. The domestic water supply for every dwelling in the Borough is taken from the Metropolitan Water Board. Samples of the water are subjected to regular routine chemical and bacteriological examination at the Board's laboratories and the results of these examinations are made available to the local authority. The results were uniformly satisfactory throughout the year. Water supply certificates were granted in accordance with Section 95 of the Public Health (London) Act, 1936 in 358 cases. There are 11 private wells in the Borough some of which are used for industrial purposes. In no case is the water used for drinking purposes but by arrangement with the owners of the wells, the Metropolitan Water Board takes samples periodically for examination so as to have some record of the probable suitability of the water for drinking should this become necessary in the unlikely event of a major breakdown in the normal supply or in case of war. Sanitary Inspection of the Area. The District Sanitary Inspectors are responsible for the investigation of all complaints in connection with premises within their areas whether these be used as dwellings or for commercial or industrial purposes. The greater portion of the work concerns dwellings as can be seen from the summary of work done which follows. -15- TABLE II INSPECTIONS, INSANITARY CONDITIONS THEN EXISTING AND RE-INSPECTIONS DURING THE YEAR 1956 Number of Complaints received 2,098 Number of Inspections Dwelling Houses House-to-House - On complaint 2,036 After Infectious Disease 60 Factories Where power is used 78 No power used 3 Others 4 Outworkers - Stables 4 Smoke observations 24 Miscellaneous visits and inspections (including visits to infectious disease contacts, school inspections, etc.) 1,750 Re-inspections 7, 101 Premises requiring amendment Dwelling Houses 1,698 Others .21 Service of Intimations, etc.. Intimations served 1,575 Intimations complied with 1,306 Notices served 673 Notices complied with 505 Final Notices served 87 Final Notices complied with 95 Summonses applied for 39 Work done (number of instances not included above): (a) After legal proceedings 22 (b) Voluntarily 197 Defects, etc., found in Dwelling Houses: Nuisances, etc., found Works completed Drainage: Drains defective 80 108 Drains obstructed 144 136 Waste pipes defective, etc 81 95 Rainwater pipes not disconnected 1 1 W. Cs. and flushing apparatus defective 245 219 (continued) -16- TABLE II (continued) Nuisances, etc.. found Work s completed Dampness: (Not due to defects shown elsewhere) 539 552 Water: supply cut off 41 28 Dust receptacles: Insufficient or defective 83 60 Miscellaneous: Rooms, etc., dirty and / or verminous 284 467 Cases of overcrowding 5 3 Yards, etc., not properly paved or drained 57 64 Roofs defective 631 711 Rainwater pipes and gutters defective 225 227 Public House urinals requiring cleansing - - Other nuisances or defects 2,391 2,645 Defects, etc., found in Factories: Sanitary defects - - W. C. accommodation insufficient or unsuitable - - Overcrowding - - Stables: Accumulations found 1 1 Manure receptacles defective 1 1 -17- Drainage and Sewerage. Hiring the year 55 plans of drainage work to new and existing buildings were submitted and approved. Common Lodging Houses. There was one licensed Common Lodging House, with accommodation for 295 males, in the Borough. 39 inspections were made during the year. Seamen's Lodging Houses. There were two licensed Seamen's Lodging Houses, providing accommodation for 187 and 26 males respectively, in the Borough. Inspections made during the year totalled 28. Personal Cleansing. Owing to the very small number of cases requiring personal cleansing an arrangement was made with the Stepney Borough Council to carry out cleansing where necessary at the Stepney Cleansing Station at Branch Poad. The Poplar Cleansing Station, which is in Yeo Street adjoining the Disinfecting Station, is maintained in proper order and can be re-opened at any time should this be necessary. The number of persons cleansed during 1956 was as follows:- Verminous Scabies Total Adults 30 16 46 Children 6 11 17 36 27 63 -18- Disinfection and Disinfestation The Council maintains a disinfecting station at Yeo Street and a summary of the work carried out is given below:- (a) Disinfection:- Premises Articles Disinfected Disinfected Infectious Disease 203 1,687 Tuberculosis 63 629 Verminous- - Miscellaneous 229 2,445 Disinfection for manufacturing firms - 42,708 TOTALS 495 47,469 In addition, 365 tons of waste paper were disinfected. (b) Disinfestation:Inspections:- Number of visits 1,103 Premises requiring treatment 766 Furniture requiring treatment 217 Re-inspections after disinfestation 64 Miscellaneous visits and revisits 95 Disinfestation carried out: - Rooms (in 763 premises) 1,729 Beds, bedding, etc.. articles 1,879 Furniture articles 2,116 -19- 20 Prevention of Damage by Pests Act, 1949. Rodent Control measures throughout the Borough have been carried out under the supervision of the Rodent Officer and a staff of six operatives. Work of the section may be divided into three main categories:- (a) Sewer Maintenance Treatment. (b) Business premises - routine inspection for rodent control. (c) Dwelling houses - complaints from occupiers. Sewer Maintenance. Treatments have been carried out at six-monthly intervals with the co-operation of the Borough Engineer & Surveyor,s Department under the direction of the Ministry of Agriculture and Fisheries to synchronise with treatments in the neighbouring Authorities' Areas. Business Premises. The Council's Contributory Scheme of Rodent Control in business premises has again continued to function well. The income derived from this Scheme is now £3,200 per annum and the charges made to individual contributors are calculated in units of £5 to £200 dependent on the size of the premises and the storage of rat and mice attractive materials. It must be appreciated that the Borough has extensive river and canal frontages and an immense volume of goods of all description is carried by ship and barge. The Rodent Control staff carry out considerable routine work of inspection and treatment of premises where goods are landed. It is extremely difficult entirely to eliminate the menace of rats, but 21 by constant supervision and treatment, rats and mice in these areas have been reduced and maintained at a minimum which emphasises the general benefits of the Council' s Contributory Rodent scheme. Dwelling Houses, During theyear under review 461 complaints have been received many of mice infestation Each complaint has been investigated and treatment or treatments are carried out as may be necessary Where rat infestation of dwelling houses has been discovered it has usually been found to be due to defects in the drain or sewer and suitable repairs have been effected. This service is carried out by the Council's Staff and no charges are made to occupiers of dwelling houses. TYPE OP PROPERTY Local Authority Dwel1ing Houses including Council houses All Other (including Business Premises ) TOTAL Number of properties in Borough 39 17,107 3, 042 20,188 Number of properties inspected as a result of- (a) Notification - 300 97 397 (b) survey under the Act , - 132 153 285 Total inspections carried out, including re-inspections 6 1, 495 6, 128 7, 629 Number of properties inspected which were found to be infested by:- (a) Rats M a j o r - 37 29 66 Minor 5 203 362 570 (b) Mice Major - 25 27 52 Minor - 221 214 435 No. of infested properties treated 12 459 499 970 Total treatments carried out 13 1,283 2,458 3,754 Number of Block contro] schemes carried OUT 7 - 220 227 22 FACTORIES ACT, 1937 (TABLES III, IV & V) TABLE III INSPECTIONS FOR THE PURPOSE OF PROVISIONS AS TO HEALTH Premises Number on Register Number of Inspections Written notices Occupiers prosecuted 1. Factories in which Sections 1. 2, 3, 4 and 6 are to be enforced by Local Authorities 64 3 - - 2. Factories not included in (1) in which Section 7 is enforced by the Local Authority 649 78 - - 3. Other premises in which Section 7 is enforced by the Local Authority 19 4 - - TOTAL 732 85 - - 23 TABLE IV CASES IN WHICH DEFECTS WERE FOUND Particulars No. of cases in which defects were No. of cases in which prosecutions were instituted Found Remedied Referred to H. M. Inspector by H.M. Inspector Want of cleanliness - 4 - 4 . Overcrowding - - - - - Unreasonable temperature - 1 - 1 - Inadequate ventilation - - - - - Ineffective drainage to floors Sanitary conveniences:- - - - -- - (a) Insufficient - 1 - 1 - (b) Unsuitable or defective - - - - - (c) Not separate for sexes - - . - Other offences against the Act (not including offences relating to Outwork) - 1 - 1 - TOTAL - 7 - 7 - 24 TABLE V OUTWORKERS NATURE OF WORK SECTION 110 SECTION 111 No. of outworkers in August list required by Sec.110 (1) (c) (3) No. of cases of default in sending lists to the Council No. of p rosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel Making, etc. 124 - - - - - Cleaning and washing - - - - - - Miscel1aneous 67 - - - - - TOTAL 19 1 - - - - - 25 Offensive Trades. One Dresser of Furskins is established in the Borough. Two inspections were carried out. Smoke Abatement. During the year 12 complaints of nuisance from smoke were received. 24 smoke observations were carried out. Shops Act, 1950 Under the provisions of this Act 8 visits were made. No exemption certificates under the Act were issued during the year. Pharmacy & Poisons Act, 1933. A list of persons who sell poisons included in Part II of the Poisons List is maintained under the provisions of the Pharmacy & Poisons Act, 1933. The number of persons on the list at the end of 1956 was 92. Rap Flock and other Filling Materials Act, 1951* This Act requires the registration of premises upon which a business is carried on involving the use of filling materials. The number of premises registered is io. The Act also requires the licensing of premises for the storage of rag flock, and 2 licences have been issued. Pet Animals Act, 1951-' Licences have been issued in respect of eight premises within the Borough. 26 Hairdressers and Rarbers. During the year two persons and one premises were registered in accordance with the provisions of Section 18 of the London County Council (General Powers) Act, 1954, bringing the total on the register at the end of the year to 49 persons and 44 premises. National Assistance Act, 1948, Section 47. A number of cases of aged people came to the notice of the Public Health Department, but with the co-operation of the Home Help Service of the London County Council and with the assistance of the District Nurses, the Voluntary Services and friends and neighbours it was possible to provide proper care in their own homes but where necessary they were persuaded voluntarily to enter hospital or other suitable establishments. Care of the Aped. Help, advice and assistance forold people through the statutory authorities and voluntary organisations associated in welfare work continued throughout the year and the old people have benefited greatly from the services provided. National Assistance Act, 1948, Section 50. Burials carried out under the provisions of this Act totalled 6 (4 adults: 2 children). The total cost was £50 is. 6d., of which £31 15s. 2d. was recovered. 27 Mortuary and Coroner's Court. The poplar Mortuary is situated in poplar High Street adjoining the Coroner* s Court. Itis fitted with modern refrigerating plant which will hold fifteen bodies and it has a well equipped post-mortem room. In addition there is a viewing room, a waiting room and accommodation for the use of the pathologists and clerks. In consequence of the reconstitution of Coroners' districts by the London County Council arrangements for the joint use of Poplar Mortuary by the three boroughs of Bethnal Green, Poplar and Shoreditch, which had been in operation since August, 1954, ceased to have effect. The total number of bodies received during 1956 was 627. (Residents 250, non-residents 377). Post-mortem examinations were made in 518 cases and inquests were held in 109 cases. Swimming Baths and Wash-houses, The following bathing establishments are maintained by the Council under the supervision of the Chief Baths Superintendent:- Poplar Baths Vapour, Foam and Slipper baths, Swimming Pools Bow Baths Slipper Baths and Laundry Island Baths Slipper Baths and Laundry Wick Lane Baths Slipper Baths and Laundry Watts Grove Baths Slipper Baths and Laundry Sophia Street Baths Laundry only 28 Public Cleansing. The arrangements for collection, removal and disposal of refuse are under the control of the Borough Engineer and Surveyor, who has supplied the following information: - Refuse. During the year 23,485 tons of house, trade, street, gully, market and kitchen refuse were collected and disposed of at the controlled tip. In addition 15,131 tons of refuse from a neighbouring borough were also dealt with at the Council's Refuse Disposal Depot. Street Cleansing. Two mechanical sweeper-collector machines work in conjunction with the manual sweepers, and as required 3 watering machines are used for street watering. Gully Cleansing. Three gully emptying machines have carried out 5,841 cleansings of the gullies during the year. 29 SECTION C HOUSING Details of new housing accommodation completed in the Borough during 1956 are as follows:- Poplar Borough Council 262 dwellings London County Council Devons Estate 96 dwellings The number of families living in property owned or managed by the Borough Council at 31st December, 1956, was as follows:- Type of dwelling No. of Lettings Pre-war Council houses and flats 1,066 Post-war Council houses and flats 1,416 Temporary bungalows 517 Old properties in Compulsory Purchase Areas 22 Requisitioned Properties 814 Temporary hutments 3 TOTAL PROPEPTIES 3,838 30 Certificates of Disrepair Housing Repairs and Rents Act, 1954 No of applications for certificates Number granted Number refused No. of applications for revocation of certificates Number granted Number refused (a) Dwelling houses which have been the subject of a notice of repairs increase of rent under Part II of the 1954 Act 20 17 3 42 54 3 (b) Dwelling houses which have not been the subject of a notice of repairs increase of rent under the 1954 Act but in respect of which permitted increases of rent are recoverable under Section 2(l)(c) and (d) of the Increase of Rent and Mortgage Interest (Restrictions) Act. 1920 14 10 3 7 5 2 31 Overcrowding (Housing Act, 1936). Particulars of overcrowding and abatement of cases of overcrowding in the Borough during the year are as follows:- Number of cases reported during the year 5 Number of cases of overcrowding relieved during the year:- Rehoused by London County Council 1 Rehoused by Poplar Borough Council 18 Number of persons concerned in cases rehoused 97 Closing Orders (Public Health (London) Act, 1936). No Closing Orders were made under this Act during the year but two which had been made previously were revoked by the Magistrate. Closing Orders (Housing Act, 1936). Closing Orders in respect of 15 underground rooms were made under Section 12 of the Housing Act, 1936, during 1956. 32 i Housing Statistics. 1. Inspection of dwelling houses during the year:- (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,373 (b) Number of inspections made for the purpose 9,474 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 526 (b) Number of inspections made for the purpose 613 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 15 (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1,772 2. Remedy of defects during the year without service of formal notice:- Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 1,099 33 3. Action under Statutory Powers during the year:- (a) Proceedings under Public Health Acts: (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 673 (2) Number of dwelling houses in which defects were remedied after service of formal notice:- (a) By owners 600 (b) By Local Authority in default of owners (b) Proceedings under Sections 9. 10 and 16 of the Housing Act 1936:- (1) Number of dwelling houses in respect of which notices were served requiring repairs (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) owners (b) By Local Authority in default of owners (c) Proceedings under Sections 11 and 13 of the Housing Act 1936:- (1) Number of dwelling houses in respect of which Demolition Orders were made 6 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5 (d) Proceedings under Section 12 of the Housing Act 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 15 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 (a) Proceedings under Section 25 of the Housing Act 1936:- (1) Number of dwelling houses included in Clearance Areas 39 (2) Number of dwelling houses demolished as a result of Clearance Area procedure 39 4. Miscellaneous visits and inspections (not included above) made by the Housing Inspector during the year 376 34 SECTION D INSPECTION AND SUPERVISION OF FOOD In June of this year a small outbreak of food poisoning involving sixteen persons was traced to the factory of a manufacturer of meat products within the Borough. Immediately on the receipt of the information nose, throat and stool specimens were taken from the staff engaged in the handling of the food, samples of the suspected product were taken from stock, the manufacture of the article was suspended and stocks withdrawn from retailers. In addition, information regarding the outbreak and the suspected staphylococcus organism was passed to the laboratory. The organism (Staphyloccus aureus coagulase positive) was isolated from the stool specimen of the cook at the factory and was also found in the samples of food taken from stock. It was found the commodity concerned, pressed brisket beef, received excessive handling after cooking: a study of the production methods at the factory enabled us to advise an entirely new and safer procedure. To those engaged in investigating outbreaks of food poisoning there may be little that is sensational in this story. In fact it may be fairly commonplace. But one important point does emerge and that is in connection with the time factor. Most of the patients concerned lived outside the Borough and information regarding them was received from five different local authorities and the Public Health Laboratory Service. In each case the information was telephoned pending official confirmation in writing. Had it not been for this prompt co-operation it is quite 35 likely that the number of persons affected would have been considerably larger since the manufacturers distribute their goods over a very wide area. The factory proprietors were as anxious as the authorities to bring the outbreak under control and acted promptly on our advice. This incident adequately illustrates the importance of prompt notification being passed to the authority concerned. If food poisoning is to be kept uncfer control it is essential that there should be the closest co-operation between local authorities, laboratory services, medical practitioners and the food trader. Delay creates problems which are often insurmountable. No specimens of food remain; dates, times and order of symptoms are confused if not forgotten by the patient end few people can remember precisely the food eaten say, six or seven days previously. Food Premises. The number of food premises in the area by type of business is as follows:Manufacturing premises 40 (Confectionery 6; Flour millers 3; Edible oils 1; ice cream 2; Wine blenders 2; Nut roasters 3; Grocery 3; Pickles 3; Spice grinders l; Milk pasteurising 1; Food Dehydration 1; Meat products 6; Mineral waters 1; Sugar refiners 2; Bakers 3; Essences 1; Sausage Pusk 1). This list does not include places where food is manufactured principally for retail sale on the premises. 36 Wharves 28. Cold stores l. Wholesale premises 25 (Grocers 16; Banana ripeners 4; Confectioners 5). Retail premises 988 (Grocers 179; Confectioners 111; Pestaurants 128; Industrial canteens 98; Non-industrial canteens 31; School meals centres 25; Public houses 171; Off-licences 25; Bakers 33; Fishmongers 35; Herbalists 1; Greengrocers 62; Butchers 60; Chemists 15; Miscellaneous 14). Street market stalls 130. Slaughterhouses 2. Registered premises. Food & Drugs Act, 1955. Section 16. (a) ice cream; Manufacture and sale 15 Sale and storage 166 Storage only 2 (Note - in addition to the premises referred to above ice cream is also sold from 37 premises exempt from registration, i.e., Restaurants, Cinemas, etc.). (b) Sausages and preserved, etc., foods 53 31 Milk & Dairies Regulations 1949. Dairies 2 Milk Distributors: Inside the Borough 137 Outside the Borough 29 Inspection of Food Premises. The following is a detailed summary showing the types of premises inspected during the year:- Number 01 Inspections Bakers 48 Dairies 73 Milk Distributors 134 Restaurants 260 Industrial catering establishments 94 Other catering establishments 44 Fish shops, fryers and curers 37 Stalls and itinerant vendors 35 Market inspections 60 Ice cream premises 188 Wharves 87 Butchers 126 Registered food manufacturers 94 Other food premises 557 TOTAL INSPECTIONS 1,837 I'nsuti s factory conditions, warranting formal act ion, wen- tminJ at 2 pn-mi scs. 38 39 TABLE VI Sample No. ARTICLE RESULT OF ANALYSIS ACTION 5* Flaky pastry Mot properly labelled. The ingredients were not stated on the label. Letter to Manufacturers. 30* Potted Meat Contained addec starch. Should consist entirely or meat. Formal sample to be purchased. 56* Margarine Contained 0.4 per cent. of water in excess of the legal limit. Formal sample taken, No. 68 68 Margarine Contained 0.2 per cent. of water in excess of the legal limit. Letter to Manufacturer. 221 Cream Buns The buns contained a filling which was not dairy cream. Letter to retailer. 239* Frozen Beef The article, which was pre-packed, did not show on the label either the name and address of the packer or a Registered Trade Mark. Letter to packers. Label 1 ater corrected. 262* Citroze Glucose Drink Contained 50 parts per million of benzoic acid preservative in excess of the amount permitted. See forma] sample No. 286 286 Citroze Glucose Drink Contained 60 parts per million of benzoic acid preservative in excess of the amount permitted. Letter to Manufacturer. 369* Beef Sausages Contained sulphur dioxide preservative the presence of which was not disclosed on the label. Notice displayed in shop, but too sma] ]. New notice displayed. 370* Lyons' Puff pastry Mix Contained a rancid fat. Letter to Manufacturer. 379* Birds' complete Cake Mix Contained a rancid fat. Letter to Manufacturer. 393* Orange Juice Fermenting and unfit for human consumption. Taken from 34 casks imported. 394* Orange juice Fermenting and unfit for human consumption. All surrendered and destroyed. 395* Orange Juice Fermenting and unfit for human consumption. ditto 398 Cake Mix Contained a rancid fat. Letter to Manufacturer. 448* Complete Cake Mix Contained a rancid fat. Formal sample taken No. 472. 468* Acetic Acid Bottle incorrectly labelled. As it contained Acetic Acid of 19.8 per cent. strength it should have been labelled "Concentrated Solution of Acetic Acid" and should have carried a warning Dangerous-not to be used unless diluted". Letter to retailer. 472 Complete Cake Mix Contained a rancid fat. Letter to Manufacturer. 499* Mulligatawny Soup Contained an excessive amount of tin, namely, 458 parts per million. Balance of stock destroyed. 507* Mixed Pickles in Mustard. Sold in an unlabel led container. Letter to retailer. 508 White Cake Mix Contained a rancid fat. Letter to Manufacturer. Informal sample. 40 Food Sampling A total of 754 samples of food were procured during the year by the Council's Food Inspector. Of these, 550 were submitted to the Public Analyst for chemical examination, the remaining 204 being sent to the Public Health Laboratory Service for biochemical or bacteriological report. Samples examined by the Public Analyst included a comprehensive variety of food. 62 samples were acquired formally and 488 informally. A total of 21 samples (3.8 per cent) were found to be adulterated. Details of the unsatisfactory samples and the action taken are shown in Table VI, on pages 38 and 39. During the year twenty-one samples of sausages were purchased mostly from different manufacturers, including local butchers. The meat content of pork sausages varied from 54.4 to 70.6 per cent., with an average of 63.4 per cent. Prices varied from 2/4d. to 2/10d. per lb. with an average of 2/7d. per lb. In the case of beef sausages the meat content varied from 44.5 to 79.9 per cent, with an average of 57.5 per cent. Prices were from l/4d. to 2/4d. per lb. with an average of l/10d. per lb. -41- Unsound food. The Council's Pood Inspector is called upon to pass judgment of fitness on great quantities of food. Frequently large and valuable stocks are involved. Among special lots of food examined during the year were the following:- Miscellaneous Foods4 cwts. Condemned and destroyed. (Damaged by a fire). Dutch Potatoes 200 tins Condemned and destroyed. (Stock at Wharf) Sugar 37 cwts. Condemned and destroyed. (Stock at Wharf) Dutch Potatoes 90 tins Condemned and destroyed. (Stock at Wharf) Canned Pineapple 500 cases 25 cases condemned and (P.H.(Imported Food) Regs.) detained destroyed. Concentrated Orange Juice 34 casks Condemned and destroyed. (P.H.(Imported Food) Regs.) 136 cwts. Italian Peeled Tomatoes 1,000 cases inspected. 1,262 tins condemned and (P.H.(Imported Food) Regs.) 662 cases destroyed. each 24 tins detained. Italian Peeled Tomatoes 1,000 cases inspected, 1,450 tins condemned and (P.H.(Imported Pood) Regs.) each 48 tins destroyed. 42 The following is a summary of foods condemned as being unfit for human consumption:- Fresh foods Canned foods Meat and offal 1,259 lbs. 426 lbs. Meat products 90 lbs. 523 lbs. Hdm 8 lbs. 1,231 lbs. Poultry 250 lbs. - Cheese 606 lbs. 7 lbs. Pish 43 lbs. 134 lbs. Milk - 448 lbs. Fruit juice 15,232 lbs. 4,733 lbs. Fruit (Dried) 110 lbs. - Sugar . 4, 144 lbs. - Vegetables 649,608 lbs. 856 lbs. Fruit - 18,717 lbs. Other foods 105 lbs. 123 lbs. This summary differentiates only between canned food and others; foods preserved by salt, sugar, dehydration, etc. , being included under the heading "Fresh Poods". Disposal of Unsound Food. The bulk of the food condemned as being unfit for human consumption is removed from the premises concerned by the Borough Engineer's refuse disposal service as trade refuse and the cost of removal is charged to the owners in accordance with the Council's fixed scale of charges. In special cases, where large quantities of food are condemned, arrangements maybemade under suitable guarantees from the owners, for the foods to be utilised for animal feeding or non-edible industrial purposes such as soap, starch, or manure making. 43 Milk Supply. All domestic supplies of milk are sold in sealed bottles or cartons bearing a designation. Except for very smail auantities of raw Tuberculin Tested milk from Attested herds, all milk is heat treated. Although a large number of shop keepers are registered to sell milk, the greater proportion of milk supplied to domestic consumers is delivered to the door through twenty of the registered distributors. The London fresh milk depot of one of the leading wholesale milk concerns is situated within the Borough. Here, over 9,000,000 gallons of milk are pasteurised annually and distributed over some thirty to forty districts in the Greater London area. The Council is responsible for licensing and supervising the pasteurising process. Samples of milk have been taken from dairies, shops and deliverymen for the purpose of checking duality, purity and bacteriological cleanliness. Samples were also taken on delivery from supplies to schools. During the year 207 inspections were made of dairies and other premises from which milk is distributed. Conditions on the whole were found to be satisfactory. Registration and Licensing. For details of registration of dairies and distributors see page 37, Licenses issued under the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, and Milk (Special Designation) (Raw Milk) Regulations, 1949:- Sterilised Pasteurised Tuberculin tested Dealers 145 67 22 Supplementary 28 24 23 Pasteurisers - 1 - 44 Milk sampling. A total of 46 samples of milk (43 formal, 3 informal) were submitted to the Public Analyst for chemical examination. All samples were satisfactory. For average solids in all samples, excluding Channel islands milk, the figures were: Fat 3.44; Non-fatty solids 8.64. The Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956, introduced on 13th June, fixed a minimum standard of 4 per cent fat in connection with milk sold under the Description Channel islands, Jersey, Guernsey and South Devon. 9 samples of Channel Islands milk were taken and reports showed fat figures from 4.3 to 4.7 with an average of 4.45. Average figure for non-fatty solids was 9.04. Of the 68 samples of designated milk (52 pasteurised; 11 tuberculin tested pasteurised; 2 tuberculin tested; and 3 sterilised) submitted to the Phosphatase, Methylene Blue and Turbidity tests as appropriate, 1 sample of tuberculin tested pasteurised milk failed the Phosphatase test. Since themilk was produced outside the Borough, the appropriate Licensing Authority was informed. All other samples were satisfactory. Milk delivered to Schools and other London County Council Establishments. Of the 20 samples of milk taken on delivery at London County Council Establishments, 10 were submitted for chemical and 10 for bacteriological examination. All samples were reported to be satisfactory. 45 Oxidlsing Agents. The Milk and Dairies Regulations, 1949, provide for the use of certain cleansing agents for milk containers and plant. All these products are reauired to contain a small percentage of sodium chlorate to act as a detector of the efficiency of subsequent rinsing. Three samples were tested for the presence of chlorates and were found to be free. Ice Cream. Close supervision is exercised in connection with the manufacture, sale and storage of ice cream. Premises, plant and refrigerators were kept under constant observation. Pull and free consultation has taken place between manufacturers and the Council's Pood Inspector on problems of production. Inspections are madeofthe vehicles used by itinerant vendors; vehicles have been stopped, stocks inspected, temperature of containers checked and samples taken. A total of 101 samples were taken during the year. Of these 79 were submitted to the Public Health Laboratory for examination by the Methylene Blue test. The samples were graded as follows:- Grade 1 Grade 2 Grade 3 Grade 4 28 21 17 13 Most of the samples falling into the lower grades were taken from local manufacturers. Premises and plant are generally satisfactory and there appears to be no reason why, with reasonable care, a high standard of hygiene should not be reached. In most cases where disappointing results are investigated it is found 46 that the issue reauiring the greatest emphasis is the fundamental difference between cleaning plant and equipment and subjecting it to thorough and efficient sterilisation. The remaining 22 samples were examined by the Public Analyst under the Pood Standards (Ice Cream) Order, 1951. All samples were reported to be satisfactory, the quality in general being much higher than the standards prescribed in the regulations. Imported Food. The Council is a specially appointed Authority under the Public Health (Imported Pood) Regulations, 1937. Inspections are made of direct landings of imported foodstuffs at the Sufferance Wharves in the Borough. No prohibited meat may be imported into the country for sale for human consumption and no meat or meat products may be imported without an official certificate of inspection issued by the Country of Origin, and approved by the British Government. Detention notices were served under the Public Health (Imported Pood) Regulations on 3 occasions, two in respect of food found to be unfit for human consumption and one in connection with a meat product without official certificates. Foods for Export. In order to satisfy the Authorities of importing countries overseas it is necessary for the exporter to obtain a certificate of purity signed by the Medical Officer of Health for the district from which the food is shipped. During the 47 period covered by this report 38 inspections were made of foods exported from the district; 62 certificates of purity were issued. Food Poisoning. Twenty-four cases of food poisoning were notified during the year. Six of these cases occurred in connection with an outbreak associated with the consumption of pressed beef in which coagulase positive staphylococci, phage type 6/47/53, had been isolated, the cooked meat being prepared and sold by a firm in the borough. Investigations failed to establish a specific cause in the remaining eighteen cases. 48 SECTION E INFECTIOUS DISEASES The total number of corrected notifications of infectious disease during 1956 was 882 which was considerably less than the figure for the previous year and mainly due to the decrease in the number of cases of measles which were notified. Dipltheria, It is gratifying to report that no cases of diphtheria were notified during the yearbutit must be emphasised that this has been achieved by a vigorous policy of immunisation and if diphtheria is not to re-appear as a killing disease constant vigilance is required and there must be no apathy on the part of the public in availing themselves of immunisation facilities as this degree of freedom from this serious disease will only be maintained if at least 80 percent of the susceptible population are immunised and an alarming feature is that owing to the virtual disappearance of this disease there is a tendency to disregard its seriousness and the percentage of immunisation is barely being maintained at a satisfactory level in spite of vigorous propaganda campaigns. Poliomyelitis, During the year 12 cases of poliomyelitis (7 paralytic: 5 non-paralytic) were notified but diagnosis was confirmed in only 11 cases (7 paralytic: 4 nonparalytic). There were no deaths from this disease. 49 Measles. Ifce number of cases of measles notified during the year was 392 as compared with 1,559 in 1955 end 40 in 1954. This shows a slight deviation from the pattern of measles epidemics which nrior to the war showed a fairly clearly marked twoyear cycle in which a high peak was reached in alternate years, the intervening years being marked by relative freedom from the disease. Whooping Cough. There were 174 cases of whooping cough notified during the year as compared with 192 the previous year. 58% occurred in children below 5 years of age and 13% in children below l year. This disease shows little variation over the years and in view of the age group attacked, predominantly in children below 5 years, it must still be regarded as one of the most serious diseases of childhood because of the possibility of sequelae. Tuberculosis. Notifications show little change from last year but when it is realised that every case arises from a previous case which is in an active phase of the disease it is aDparent that in spite of modern therapeutic aids and imnroved diagnostic facilities this disease is only being held in check and is a long way from eradication. 50 The following table shows the age and sex incidence of the cases notified. TABLE VII TUBERCULOSIS - PRIMARY NOTIFICATIONS 0yrs. 1yrs. 2yrs. 5yrs. 10yrs. 15yrs. 20yrs. 25yrs. 35yrs. 45yrs. 55yrs. 65yrs. 75yrs. TOTAL Respiratory males _ _ _ 1 _ 4 1 5 8 8 6 5 12 40 Respiratory females - 2 _ 1 _ 3 2 7 2 1 _ _ _ 18 Non-respiratory males - - - - - - - - - - - - - - Non-respiratory females - - - 1 1 1 - 2 1 - - - - 6 In addition, 36 other cases were added to the register as a result of information received from the following sources:- Local death returns 1 Transfers from other areas 35 During the year 9 deaths were certified as being due to tuberculosis, as compared with 16 the previous year. The number of cases remaining on the register at 31st December, 1956, after adjustment in respect of deaths and transfers, was as follows:- Pulmonary Non-pulmonary TOTAL Mal es 417 63 480 Females 277 62 339 TOTAL 694 125 819 51 Mass Radiography. During the year a Mass Radiography Survey was carried out in the borough by the Mass Radiography Unit 6B of the North East Metropolitan Regional Hospital Board. The Unit was established at Poplar Baths from 5th to 26th March and St. Clement's Hospital from 27th March to 16th April. Information relating to the Survey, a summary of which is given below, has been furnished by Dr. A. J.Lawless, 0. B.E., Medical Director of the Unit. A total of 7,516 persons (4,113 males and 3,403 females), was examined and the results were as follows:- Poplar Baths St. Clement's Hospital Males Females TOTAL Males Females TOTAL No. of attendances for Miniature X-ray 2,010 1,360 3,370 2,103 2,043 4,146 No. recalled for Large Film examination 126 96 222 92 60 152 Tuberculous lesions Active tuberculosis 9 5 14 10 2 12 Rate per 1,000 examined 4.48 3.68 4.15 4.75 2.0 2.89 Inactive tuberculosis - - 61 - - 81 Rate per 1,000 examined - - 18.1 - - 19.54 Other abnormalities revealed Cancer of lung - - 3 - - 5 Miscellaneous - - 130 - - 119 52 TABLE VIII INFECTIOUS DISEASE DISEASE Corrected Notifications Removed to Hospital 0yrs. 1yrs. 3yrs. 5yrs. 15yrs. 25yrs. 45yrs. 65yrs. TOTAL Dysentery 6 23 17 24 8 14 3 - 95 26 Erysipe]as - - - - 1 - 2 1 4 1 Measles 19 80 116 177 - - - - 392 7 Meningococcal Infection 2 - 2 - - 1 - - 5 5 Opthalmia Neonatorum 1 - - - - - - - 1 1 Paratyphoid 'B' - 1 - - 2 - - - 3 3 Pneumonia - 1 2 8 2 10 14 10 47 6 Poliomyelitis, Ac.:Paralytic - 2 2 2 - 1 - - 7 7 Poliomyelitis, Ac.: NonParalytic _ _ 1 3 _ . . . 4 4 Puerperal Pyrexia - - - - 1 4 _ _ 5 5 Scabies - - 2 5 1 3 2 2 15 - Scarlet Fever - 2 9 19 3 - - - 33 2 Whooping Cough 23 38 40 72 1 - - - 174 13 Zymotic Enteritis 13 12 8 - - - - - 33 4 Tuberculosis, pulmonary - 2 - 2 10 22 15 7 58 - Tuberculosis, Meninges & C. N. S. _ _ - _ - _ - - . _ Tuberculosis, other forms - - - 2 1 3 - - 6 - TOTALS 64 161 199 314 30 58 36 20 882 84 -53- SECTION F GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA Laboratory facilities. During the year all bacteriological examinations for the Public Health Department were carried out by the Public Health Laboratory Service at the Laboratories at the County Hall, S.E.I. The service is also utilised by the general practitioners in the borough. Hospi tals. There are three hospitals in the Borough- St. Andrew's, St. Clement's and Poplar Hospital. These hospitals, together with the Poplar Chest Clinic, Wellington Way, E. 3, which continued to operate during the year, are under the control of the North East Metropolitan Regional Hospital Board. Ambulance Facilities. The provision of ambulance transport within the administrative County of London is the responsibility of the London County Council and is available, free of charge, in the following circumstances:- 54 (a) Accidents (wherever occurring) and sudden illness (in the streets, public places or places of emp1oyment) Dial "999" and ask for Ambulance' or follow instructions given on telephone instrument. (b) Very urgent illness at home For the conveyance of sick persons from their homes to hospital, provided a doctor certifies that the case is one of life or death and that arrangements have been made with a hospital for the patient's admission. Telephone WATerloo 6000 NEW Cross 2645 RELiance 3622 CENtral 6301 REGent 4000 (c) Maternity cases Normally, if the expectant mother has booked a bed at a hospital or nursing home, she is in possession of a white card (Form L.A.S.23) confirming the booking arrangements and giving full instructions for summoning the ambulance. Telephone HOP 7181 Where no previous arrangements have been made, however, the London Ambulance Service cannot accept direct applications for removal to hospital except in the case of emergencies occurring in the street or other public place, when the procedure as in (a) above should be made by a doctor or midwife to the Emergency Bed Service. (d) Other illness For the removal to and from hospitals, etc., of sick persons, provided the ambulance is ordered by the hospital authority, by the Emergency Bed Service or, in certain circumstances by a private doctor, application should be made in writing or by telephoning. Telephone WAT 3311 Further particulars may be had on application to theOfficer-in-Charge, London Ambulance Service, County Hall, S.E.I. Telephone enquiries relating to the ordering of ambulances to WATerloo 3311; general enquiries to WATerloo 5000, Ext. 6950. 55 Legislation, The undermentioned new legislation affecting the Public Health Department came into operation during the year: - Acts and Statutory Instruments. Poultry Premises and Vehicles (Disinfection) Order, 1956. Prevention of Damage by Pests (Application to Shipping) (Amendment) Order, 1956. Pent Restriction Regulations, 1956. Food Hygiene (Amendment) (No. 1) Regulations, 1956. Milk and Dairies (Channel Islands & South Devon Milk) Regulations, 1956. Food Standards (Curry Powder) (Amendment) Regulations, 1956. Food Standards (Tomato Ketchup) (Amendment) Regulations, 1956. London County Council (General Powers) Act, 1956. Sanitary Inspectors (Change of Designation) Act, 1956. Housing (Form of Orders and Notices) (Amendment) Regulations, 1956. Flour (Composition) Regulations, 1956. Clean Air Act (Appointed Day) Order, 1956. atioke Control Areas (Authorised Fuels) Regulations, 1956. Food Hygiene (Amendment) (No. 2) Regulations, 1956. Circulars. Ministry of Health. Annual Reports of Medical Officers of Health, Diphtheria Immunisation Publicity Campaign, Poliomyelitis Vaccination. Ministry of Food. Official Certificates under the Public Health (Imported Food) Regulations in respect of Falkland Islands, Iceland and New Zealand; - ApprovedOxydising and Preservative Agents; Model Byelaws for Slaughterhouses. 56 Personal Health Services. The following information and statistics relating to the operation of the Personal Health Services in this Borough during the year have been kindly furnished by the Divisional Medical Officer (Dr. G. 0. Mitchell), Division 5, London County Council, 273, Bancroft Road, E. 1. Treatment centres and Clinics. Ruston Street, E.3. 54, West Perry Road, E.14. Wellington Way, E. 3. 69, East India Dock Road, E.14. Will Crook's Centre, 1-3, Wigram House, Poplar High Street, E. 14. Newmill House, Coventry Cross, E.3. Statistics. Infant Welfare Centres. Total number of children who first attended during the year and who on the date of their first attendance were:- Under 1 year of age 1,061 1-5 years of age 179 Total number of children who attended during the year and who were born in: 1956 1,001 1955 991 1954-51 1,635 Total attendances by children:- Under 1 year of age 15,476 1-5 years of age 9,964 57 Ante Natal and Post Natal Clinics. Ante Natal consultations: Number of women who attended during the year 495 Number of new cases included above 441 Total attendances 3,212 Post Natal consultations: Number of women who attended 155 Bealth Visitors. Number of children visited during the year 6,313 Number of infants under 1 year of age visited for first time 1,242 Total visits to infants under 1 year of age 7,781 Total visits to children aged 1 year but under 2 years 5,212 Total visits to children aged 2 years but under 5 years 14,106 Number of expectant mothers visited 553 Total visits to expectant mothers 1,637 Infant Life Protection. Number on register at 1st January, 1956: Poster mothers 17 Poster children 9 Number on register at 31st December, 1956: Poster mothers 15 Poster children 8 Child Minders (Daily Guardians). Number of Daily Guardians: statutory Voluntary 73 Number of children minded: Statutory Voluntary 46 Care of preaature infants. Number of premature live births during the year 89 Number of deaths under 1 month 14 58 Diphtheria minimisation. Number of children who completed a full course of primary immunisation, and who at the date of the final injection were: Under 5 years of age 1,609 5-14 years of age 210 Number of children who were given a secondary or re-inforcing injection 1,824 Vaccination. Number of children successfully vaccinated or revaccinated 493 Donestic Help Service. Domestic Help was provided as follows: Maternity cases 24 T. B. cases 18 Aged and chronic sick cases 896 Other 21