STE 51 METROPOLITAN BOROUGH OF STEPNEY ANNUAL REPORT for the Year 1946 (Abridged) of the Medical Officcr of Health and Administrative Tuberculosis Officer F. R. O'SHIEL. L.R.C.P.I.,L.M.,D.P.H. Together with a SUMMARY of the REPORT of the PUBLIC ANALYST PUBLIC HEALTH DEPARTMENT, 43, White Horse Road, STEPNEY, E.1. To the Mayor, Aldermen and.Councillors of the Metropolitan Borough of Stepney, Your Worship, Ladies and Gentlemen, I have the honour to present my report for the year 1946. The report is again abridged in accordance with the directions of the Ministry of Health. Tho Registrar-General's estimate of the population of the Borough for the mid-year 1946 was 94,800. The population figures frcn the last pre-war year are as follows:1938- 200,500; 1939- 197,200; 1940- 136,030; 1941 - 75,010; 1942- 71,980; 1943- 72,920; 1944- 73,030; 1945 - 77,610. The birth rate increased from 18,5 in 1945 to 22.6 in 1946, and there was a very great increase in births, viz. 1495 to 2198. The death rate was lower than last year, 14.7 compared with 18.9. There were four maternal deaths, giving a maternal mortality of 1.8; and tho infantile mortality rate was 51.2 compared with 56.17 last year. There was one death this year from diphtheria and one from measles; none from scarlet fever or whooping cough. Diphtheria immunisation increased from 967 to 1516 and 667 children were immunised against whooping cough. The number of infectious diseases notified varied very little from last year, viz. 1222 in 1945, 1194 in 1946. There were 80 deaths from pneumonia, compared with 62 in 1945. Whooping cough decreased frcn 96 cases to 87. Diphtheria cases numbered 45 - one more than last year. Measles cases notified were 733 (725 in 1945). There were no cases of smallpox, two cases of typhoid with one death. 212 cases of tuberculosis were notified, 11 less than last year. Of these cases 187 were pulmonary and 25 nonpulmonary. There were 81 deaths, 19 less than last year. There is much difficulty in getting beds for the tuberculous sick. As this is due almost entirely to the present shortage of nursing staff, it is not easy to remedy. There was a further decline in Scabies in 1946, formal notifications being 758 compared with 807 last year. -1- The control of flies and other vermin has been much simplified by the new insecticides perfected during the war. "D.D.T.", both in powdered form and in spray, is extensively used by the disinfosting staff for treating homes and furniture. When parents become conscious of the effectiveness of good D.D.T. preparations and their extreme simplicity in use, children's heads infested with nits and lice will soon be a memory of the past. Suitable and pleasant hair creams are supplied at all the Council's infant welfare centres and day nurseries. Road traffic deaths were reduced, from 18 in 1945 to 11 in 1946 - no doubt partly attributable to the local Road Safety Campaign. I would like to express my thanks to the Chairmen and members of the Committees for their suppport and interest throughout the year, and to the staff for their very willing help and co-operation. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient servant, F. R. O'SHIEL. Medical Officer of Health. -2- STAFF OF THE PUBLIC HEALTH DEPARTMENT on the 31st December 1946. Medical Officer of health & Administrative Tuberculosis Officer; F.ROANTREE O'SHIEL, L.R.C.P.I.,L.M.,D.P.H. Deputy.& Assistant Medical Officer of Health: J.W.CRAWFORD, M.D.,M.B.,B.Ch.,D.P.H. Public Analyst: D.HENVILLE, F.I.C. Deputy Public Analyst: W.M.PAULLEY, B.A.,F.I.C. Assistant Administrative Officer: W.F.LELL0W(2) Sanitary Inspectors: District: W.E.ANSTEE (1,3) H.J.GREEN (1,2,4) R.MAHONEY(3) (Tempy.) J.H.BROWNLEE (1,3,4) C.F.GUY (2) J.G.McCARTHY (3) J.J.COVENEY (3) W.H.HAWORTH (3) R.ROPER (3, 4) W.CUE (1,3) J.J.KENIRY (3) W.F.SMITH (2,4) R.W.G.DAY (3) S.S.LOWTHER (3,4) E.P.WEBBER (3,4) G.D.FREELAND (1,3,4) J.G.LYONS(3) (Tempy.) (Tempy.) Food: H.ABSON (1,2,4) T.W.DEE (2,4) A.C.BROWN (2,4) S.VOGLER (3,4) Other: E.J.EDWARDS (2,4). Disinfestation.(Seconded to War Damage Department.) Miss H.A.WHITTY (3,4,5,6,8), Disinfestation and Female Common Lodging Houses. Clerical Staff: R.BACH S.EMBLETON W.P.HOWARD D.J.BERRY Miss M.FITZGERALD Miss M.W.HUNT(M&CW) MISS G.BOULTON (M&CW) (M&CW) J.McMULLON MISS G.A.CARTHY(M&CW) W.E.HART P.PAYNE W.J.DIXON Mrs.H.HILES (M&CW) M.PLISKIN B.REILLY S.F.ROBERTS Vaccination Officers: E .PRICE (3) E.J.ROBERTSON Madical Officers for Maternity & Child Welfare (Part Time): NORAH COTTER,M.B.,B.Ch. DOROTHY GIBSON, M.B.,B.S. SYBIL PRATT, M.R.C.S., DORIS PULLEN, M.B.,B.C. L.R.C.P. DAISY STEPNEY, L.S.A. Health Visitors: Miss M.BAILEY (5,6,7).Miss E.CLEMENTS(5,6). Miss A.M.STAGG(5) Miss A.CARTY (5,6,7), Miss V.RUBENS(5,6,7) .Miss M.F.E,STYLES (5,6,7). -3- Tuberculosis Officer: R.M.0RPWOOD, M.R.C .S.,L.R.C.P.,D.P.H. Tuberculosis Visitors: Miss E.LINDSLEY (7) Miss M.F.WEATHERILT(5,6,7) Nurse Dispensers: Miss M.COULMAN(5,6,7,9) . Miss A. O.JONES(7,8,9) Clerk & Secretary to Care Committee: Miss M.GRANT. Consulting Gynaecologist: R.CHRISTIE BROWN, M.B.,M.S.,F.R.C.S. Dental Surgeon (part time): F.L.PAYNE, L.D.S. Anaesthetist (part time): M.J.O'TOOLE, M.B.,B.Ch.,B.A.O. Diphtheria Immunisation: W.W. KING-BROWN, M.B.,B.S. (Lon.), Part time Medical Officer. GUY BOUSFIELD, M.D.,B.S. (Lon.),Hon. Advisory Expert. TEMPORARY STAFF. Assistant Medical Officer of Health: Dr.GLADYS MONTGOMERY, M.D., D.P.H. Assistant Tuberculosis Officer (part time): Dr.GABRIELLE HIGHFIELD JONES, M.B.,B.Ch. Health Visitors: Miss B.S.BEARDSON(5) Miss H.L.HIRSCH(5) Miss M.T.SMITHSON Miss L.E .GODTSCHAILK Miss D.LACEY (6,8) (5,6,7) (5) Miss M.PYSER (6) Mrs.S.J.YARNELL(5) Tuberculosis Visitors: Miss J.P.WILSON (5,6) Miss G.BURNS (6,7) Clerical Staff: S.S.HARRIS Miss R.LEVEY Miss D.P.NASH(Tub.) Miss T.HILES (M&CW) Miss E.M.LOVETT Miss S.SELLIN(M&CW) Day Nurseries: Matrons:- Miss M.M.CLULEY (7) Mrs.M. GAMBLE (7) Miss A.MURRAY (7) Deputy Matrons:- Miss W.D.BLOSS (8) Miss M.OLIVE (7) Miss F.TAYLOR (8) 1. Cert. Royal San. Inst. 5. Health Visitors Cert. 2. " San. Insp. Exam. Bd. 6. State Certificated Midwife. 5. " Royal San. Inst. & San. 7. State Registered Nurse. Insp. Exam. Joint Board. 8. Trained Nurse. 4. " Meat & Other Foods. 9. Cert. Soc. of Apothecaries. - 4 - SUMMARY OF STATISTICS, 1946. Area of Borough (in acres) 1902.766 Population (Registrar-General's estimate) 94,800 Number of inhabited houses (end of 1946) according to Rate Books 25,004 Rateable Value,1946 £1,229,808 sum represented by a penny rate £4,820 Total Male Female Birth rate (Legitimate 1972 1051 921 per 1000 of the estimated resident population 22.6. Live Births (Illegitimate 175 91 84 ( Total 2147 1142 1005 Still Births 51 28 23 Rate per 1000 total (live & still) births 23.7 2198 1170 1028 Deaths 1399 808 591 Death rate per 1000 of the estimated resident population 14.7 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List:- Deaths Rate per 1000 total (live and still) births No.29. Puerperal sepsis 1 0.4 No.30. Other puerperal causes 3 1.4 Total 4 1.8 Death rate of Infants under one year of age:- All infants per 1000 live births 51.2 Legitimate infants per 1000 legitimate live births 46.6 Illegitimate infants per 1000 illegitimate live births 102.8 Deaths from Cancer (all ages) 198 " " Measles (all ages) 1 " " Dierrhoea (under 2 years of age) 15 -5- I. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Public Assistance and Unemployment. The Chief Officer of Social Welfare and the Ministry of Labour have kindly supplied me With the following information:- (a) Stepney residents in receipt of out-door relief:- 1946. Men Women Children Total 5th January 210 404 240 854 28th December 220 402 248 870 (b) Number of unemployed persons aged 16 to 64 years resident in Stepney who were recorded as unemployed at Employment Exchanges as at 9th December:- Men Boys Women Girls Total 755 13 38 4 810 II. GENERAL PROVISION OF HEALTH SERVICES. Staff. I am pleased to record that all the Sanitary Inspectors with one exception who were seconded to the Council's War Damage Department resumed their normal duties in the Public Health Department. All the staff and employees who were serving in H.M.Forces have now been demobilised and have resumed duty. Mr.W.H.Howard, Sanitary Inspector, resigned on 27th April in order to take up another post. The following Health Visitors resigned and took up positions elsewhere: Miss A. Clifford on 2nd February, Miss W.K. Brazier on 9th March, and Miss A, Carty on 31st December. Nursing in the Home. The arrangement with the East London Nursing Society to undertake the nursing of children and persons suffering from certain illnesses was continued during the year. The number of visits was as follows:- No. of Cases. Revisits. To children under 5 years 70 735 To persons over 5 years 627 15,607 Insulin for persons suffering from Diabetes was provided free of cost to 17 patients of which 4 were new cases, under authority of Circular 2734 of the Ministry of Health. -6- TUBERCULOSIS Tuberculosis Dispensary. All sessions are held at the Main Dispensary, Steel's Lane, Devonport Street, and the present time-table is as follows:- MON. TUES. WED. THURS. FRI. SAT. Morning Men* Special Cases Men* School Children Afternoon Women & Children Women & Children Women & Children Evening Workers* *Double sessions. In addition new patients are seen daily at 10 a.m. except Thursday when they attend at 6 p.m. Patients are also seen at times other than the above by special appointment. Laboratory. The Laboratory is fully equipped for the examination of sputa, etc., both by direct microscopic method and by culturing. The service is available to all medical practitioners in the Borough as well as for the routine work of the Tuberculosis Dispensary, During the year 821 specimens of sputum were examined, 694 were negative and 127 positive. 71 specimens were cultured, 65 were negative and 6 were positive. X-Ray. The Council continue to use the facilities at the Radiological Department at Mile End Hospital made available by the London County Council. In addition to all X-ray films taken for the Dispensary, the Department's plant is used by the Tuberculosis Officer for examination by screening in connection with the special treatment clinic held by him at the Hospital. 1655 X-ray films were taken in 1946 and 523 screen examinations were made. Special Treatment. For some years the Council has had special arrangements with certain Chest Hospitals for the carrying out of refills for Artificial Pneumothorax, etc. These arrangements are still utilised, but an increasing proportion of this type of treatment is being undertaken by the Tuberculosis Officer at his clinic at Mile End Hospital. During 1946, 6 patients were treated -7- at Chest Hospitals, making 139 attendances for this purpose. 40 patients were treated at the Tuberculosis Officer's clinic, making 658 attendances. Details are given below:- No. of patients. No. of attendances. Pneumothorax refills at Brampton Hospital 2 72 " " " London Chest Hospital 3 39 " " " Grove Park Hospital 1 28 Finsen &. Sunray treatment at London Hospital 4 382 Tuberculosis Officer's Clinic at Mile End Hospital:- No. of patients under treatment (for pneumothorax) 40 „ „ Artificial Pneumothorax refills given 587 „ „ Pneumoperitoneum refills given 69 " " Air replacements performed 2 " " patients screened by X-ray in connection with the above 523 Total attendances at the Clinic 658 Tuberculosis Allowances. Treatment allowances are paid to certain patients undergoing treatment for Pulmonary Tuberculosis. Payments are made weekly either at the Dispensary or at the Hospital or Sanatorium where the patient is being treated. The payments are made by the Borough Treasurer and the expenditure is reimbursed by the Exchequer through the London County Council under Ministry of Health Memo. 266/T. No. of cases considered during 1946 769 No. of cases accepted " " 660 New cases considered " " 90 No. of patients in receipt of allowances on 31.12.46 80 Supply of Extra Nourishment. Grants to Tuberculous patients were made on the recommendation of the Tuberculosis Officers for periods of 28 days in the first instance, The grant consists of one and a half pints of Pasteurised milk per day and one pound of Ovaltine per month. During the year 628 grants were made to 235 persons, Boarded-out Contacts. 7 children who were contacts of infectious cases of pulmonary tuberculosis were boarded out during the year. -8- Care Committee. The Tuberculosis Care Committee considered 204 cases at their meetings during 1946. Of these, 148 were patients who were eligible for the tuberculosis maintenance allowances and did not need any further immediate assistance. The remaining 56 patients required help in the form of pocket money whilst in sanatorium, warm clothing, fares for relatives to visit, assistance with removal expenses, etc. The Committee was able to help in all these needy, cases, thanks to the continued success of the Christmas Seal Sale, which provides practically the whole of the Committee's voluntary fund for supplying the "extras" which will always be a necessity for our patients. The 1946 Seal Sale was the most successful yet held, and the Committee would like to record its appreciation of the generous response given by local people to their appeal. An expenditure up to £50 was sanctioned to be spent on Christmas donations to the poorest families. These gifts were very much appreciated and many letters of grateful thanks were received. Several patients had special dinners at the Invalid Kitchens in Stepney Way. The dinners were al3o delivered to some bed-ridden patients at their homes for a time, and were of great help to women who were ill and had no one to cook for them. It has not yet been possible to reopen the handicraft class at the Dispensary, but several patients are working at home on rugs, handbags, gloves, etc., when they can obtain the materials, which can Only be bought with a licence, and in very small quantities. During the year a total of over £212 has been spent as follows in making a little easier the lot of those who had the misfortune to develop this long and costly illness:- Pocket money for small extras in sanatorium £72 Fares for relatives to visit patients £26 Warm clothing £56 Extra comforts and Christmas gifts £58 Institutional Treatment. The number of patients recommended to the London County Council for Sanatorium treatment has varied very little during the past seven years in spite of the drop in the population of the Borough during that period. This has been due to a smaller decrease of numbers of the tuberculous compared with the - 9 - crease in the rest of the population, and to the fact that the number of fresh cases each year has been relatively constant. During 1946, 255 patients were recommended for treatment in Sanatorium (compared with 237 in 1939). The waiting time for the individual patient has increased considerably during the past two years. The average waiting period for new and early cases is approximately 3 months, the time being longer for patients with more advanced disease. Such a wait must be deplored, especially when this means that the patient must remain at home in a house or flat often overcrowded and almost always unsuitable. There is, unfortunately, no immediate remedy. The position has been brought about by shortage of staff, more particularly nursing and domestic, and the consequent closure of beds in the sanatoria. There seems no likelihood of any improvement until new methods of reoruitment and administration comc into being. The position is even worse with regard to the urgent admission to General Hospitals of advanced or acutely ill cases of tuberculosis. The number of beds available in tuberculosis wards of the Hospitals in the County is wholly inadequate, and there are no wards of this type in Stepney. Advanced cases slowly going downhill often have to wait 6 months for a vacancy while harassed relatives do their best to cope with them. Only very occasionally an urgent case is found a bed at short notice, and then with great difficulty, and often in a non-T.B. ward of a general hospital. While this situation would be serious in any area, in Stepney, with its badly housed population and its considerable number of common lodging houses, the position is even more lamentable. Lodging houses and the small, ill-ventilated and usually overcrowded dwellings, which still form a part of the Borough, are quite unsuitable places for the care of acutely ill and infectious oases of tuberculosis. It is not possible to treat such patients adequately in such surroundings, and the danger of infecting other members of the household is ever present. The reason for the shortage of beds is, as with the Sanatoria, lack of staff. The remedy is presumably the same. It would appear possible, however , for a larger proportion of the present numbers of medical beds available to be allocated to the treatment and care of the tuberculous, and so to close a dangerous and ever-widening gap in the Tuberculosis Scheme. If no attempt is made to remedy this defect in treatment, it is not difficult to foresee an increase in this infectious disease in the future. -10- Return relating to the work of the Dispensary during 1946:- Diagnosis Pulmonarv. Non-Pulm. Total. Adults Children Adults Children Adults Children Grand Total (A) 1. No. of definite cases of Tuberculosis on Dispensary Register at beginning of year M 515 68 61 62 576 130 1115 F 273 53 50 33 323 86 2. Transfers from Authorities of areas outside that of Council during year M 37 9 3 4 40 13 87 F 28 2 4 - 32 2 3. Lost sight of cases returned during year M 2 - - - 2 - 3 F 1 - — - 1 — (B) No. of New Cases diagnosed as tuberculous during the year: 1. Class T.B. minus - M 42 9 - — 42 9 94 F 29 14 . - 29 14 2. Class T.B. plus - M 43 1 - - 43 1 64 F 18 2 — — 18 2 3. Non-pulmonary M . - 4 5 4 5 22 F - - 7 6 7 6 (C) No. of cases included in A and B written off Dispensary Register during year as:- 1. Recovered - M 19 2 4 1 23 3 43 F 11 2 2 2 13 4 2. Dead (all causes)- M 36 — - - 36 — 61 F 21 2 2 - 23 2 3. Removed to other) Areas) M 25 7 5 - 30 8 60 F 15 2 3 2 18 4 4. For other reasons- M 26 5 3 4 29 5 60 F 14 2 6 3 23 3 (D) No. of definite cases of Tuberculosis on Dispensary Register at end of year M 533 77 56 65 589 142 1161 F 284 64 49 33 333 97 -11- No. of attendances at Dispensary (including contacts) 5811 „ „ consultations with Medical Practitioners (a) Personal 315 (b) Other 643 " " visits by Tuberculosis Officers (including personal consultations). 469 " " visits by Tuberculosis Visitors for Dispensary purposes 4476 „ „ Contact examinations made 900 „ „ Contacts boarded out 7 " " Patients recommended for Sanatorium 235 " " Specimens of sputum examined: Negative 760 Positive 135 Total 895 " " X-Ray Examinations: Films 1655 Screening 523 Total 2178 " " New Cases examined during year 595 Special Treatment at Tuberculosis Officer's Clinic:- No. of patients under treatment 40 " " Artificial Pneumothorax refills given 587 " " Pneumoperitoneum refills given 69 " " Air replacements performed 2 Public Health (Prevention of Tuberculosis) Regulations 1925. These regulations provide that persons suffering from Tuberculosis of the Respiratory tract shall not be employed in the handling of milk or mi1k receptacles. Power is given to the Council to cause such persons to discontinue their employment. It was not found necessary to take action under the regulations during the year. DENTAL CLINIC. Summary of work carried out during the year at the council's clinic:- •Maternity Tuberculosis Ch. F. Total. M. F. Total. Attendances 49 790 839 19 37 56 Fillings - 18 18 - - - Scalings - 100 100 3 6 9 Extractions 24 127 151 3 9 12 Teeth extracted 69 599 668 18 47 65 Dentures: Upper - 58 58 1 4 5 Lower - 49 49 1 4 5 New patients 31 88 119 2 6 8 Sessions 51 26 -12- Form M.C.W.96. MATERNITY AND CHILD WELFARE (1) Arrangements made for maternity and child welfare by the Council and by Voluntary Associations providing maternity and child welfare services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and (2) giving particulars of the work done during the year 1946. 1, No, of births notified in the area, Live births 2158 as adjusted by any transferred Stillbirths 56 notifications:- Total: 2214 2, Health Visiting. No. of Health Visitors employed By the Council 12 at the end of the year:- Voluntary Assen 1 No, of visits paid by all the first Total Health Visitors: visits visits to expectant mothers 1153 2016 to children under 1 year 1946 7399 to children between ages 1 and 5 - 8399 3, Infant Welfare Centres. No. of Centres provided and maintained by tho Council 7 Do. Voluntary Associations 1 No, of children under 5 years who first attended the Centres during the year and who, on the date of their first attendance, were: Under 1 year of age 1719 Over 1 " " " 583 No, of children under 5 years who attended the Centres during the year and who, at the end of the year, wore: Under 1 year of age 1540 Over 1 " " " 2262 -13- 4. Ante-natal and Post-natal Clinics. Ante natal Post natal No, of Clinics provided and maintained by the Council open at 31ct Dec. 1946 2 2 Do. Voluntary Associations do. 2 1 No, of women who attended at the Clinics during the year 1379 187 5. Day Nurseries. No,of No,of children approved on register at No. places end of year 0-2 2-5 0-2 2-5 Nurseries maintained by the Council 3 76 94 51 76 Voluntary Assocn3. 2 - 41 - 46 8. Home Helps: 3 (part-tine) employed. 9. Institutions provided by The Council make a Voluntary Associations and grant of £200 per subsidised by the Council:- annum for one bed. No, of women admitted from the Council's area. 24. 10. Maternal Deaths. No, of wenen who died from sepsis 1 „ „ „ „ other causes 3 All died in institutions, 11. Illegitimate Children. The Health Visitors work in close co-operation with the local moral welfare workers. -14- 12. Care of Premature Infants. (Circular 20/44). No. of premature babies notified during 1946 whose mothcr is normally resident in the Council's area. 218 Recommendations implemented:- Para.2 (b) Equipment in stock if required. (c) Most prematures cared for in hospital whore breast milk is available. (d) No paediatrician employed but hospitals employ them. (e) Each Health Visitor looks after own cases. (f) Home Helps. Para.3. No special units or cote in hospitals but apecial attention given to prematures in local hospitals. Arrangements made between the hospitals and the Welfare Authority to insure the follow-up of the infants on discharge:- There is closs liaison between hospitals, Medical Officcr of Health and Health Visitors to follow up those infants on their discharge from hospital. Total No, of premature babies notified who were born at home 14 Do. do. in hospital 196 No. of those born at home who were nursed entirely at hone 14 Do. who died during the first 24 hours 1 Do, who survived at end of one month 15 No, of those born in hospital who died during the. first 24 hours 19 Do. who survived at end of one month 164 (13 died after 24 hours but before the end of one month). -15- 13. Infectious Diseases. No. of Cases Ophthalmia Neonatorum Puerperal Fever Puerperal Pyrexia Domiciliary Institutional Domiciliary Institutional Domiciliary Institutional Confinements Confinements Confinements Notified during the year. 1 3 3 1 3 5 Visited by officers of the Council. 1 3 3 1 3 5 Removed to hospital - 4 - 4 - 8 In all cases of Ophthalmia Neonatorum the vision was unimpaired. 14. Child Life Protection. Individual Foster Mothers Receiving children under nine for reward apart from their parents at the end of the year. 9 No. of children under nine received during the year. 9 Do. at the end of the year 11 Two foster-mothers, included above, are guaranteed payment by the Council. No. of Child Protection Visitors at the end of the year: Health Visitors 13 Other 1 female. Proceedings taken during the year: No. of Cases Act and Section under which proceeding were taken. Result 1. Public Health (Ldn)Act, 1936. Sec.258,sub-Sec.6. Fined £2 - Obstruction of visit. Do. Sec.261,sub-Sec.l. Refused order for removal of child. -16- 15. Adoption of Children (Section 7 of the Adoption of Children (Regulation) Act, 1939). No. of persons who gave notice under Section 7(3) 6 Total number of children in respect of whom notice was given under Section 7(3) 6 No. of children notified under Section 7(3) under supervision at the end of the year 6 Child Life Protection. No. of persons who were receiving children for reward at the end of the year 9 No. of nurse children at end of the year 11 No. of Child Life Protection Visitors: Health Visitors 12 Others 1 Visits made by above to Homes of foster mothers 49 " " " " " " " " children 112 Other Visits 56 Proceedings taken during the year 1 Day Nurseries. There are 3 Municipal and 2 Voluntary Day Nurseries in the Borough. A summary of the accommodation and attendances thereat is given below. Accommodation:- Municipal Voluntary Queen Eliz. Hosp. Old Church Road Vall- ance Road. St. Paul's (Opened October) Beaumont Hall. 0-2 years 16(incl. 6 infants) 30(incl. 10 infants) 30(inc. 10infants) - - 2-5 " 34 30 30 25 20 Totals 50 60 60 25 20 Average attend- ances per day:- 0-2 years 17 16 21 - - 2-5 " 23 21 26 24 20 Totals 40 37 47 24 20 Highest attendances in any one day:- 0-2 years 20 18 25 - - 2-5 " 23 30 30 25 21 Totals 43 48 55 25 21 -17- VISITS BY HEALTH VISITORS. The following table shows the number of visits, etc. paid by the Municipal Health Visitors during the year. Visits:- Primary 1,946 Revisits:- To infants under 1 year 5,735 To children between 1-5 years 11,422 Ante-natal:- Primary 983 Subsequent 624 Ophthalmia Neonatorum 4 Puerperal Fever 4 „ Pyrexia 8 Measles 699 „ Revisits 178 Scabies 677 Miscellaneous 3,759 Attempted visits 3,075 Child Life Protection:- Visits to homes of foster mothers 2 Visits to foster children 59 Other visits 22 Tota1 29,177 Centres attended 1,702 Scabies Clinic attended 84 Total 1,786 INFANT WELFARE CENTRES AND ANTE-NATAL CLINICS. Details of the work at the Municipal Infant Welfare Centres and AnteNatal Clinics will be seen in the following table. No. of Infant Welfare Sessions (total) 682 " Attendances of InfantS 15,394 " " Children 1 to 5 9,268 " Infants on Registers at end of the year 1,436 " Children " " " " 2,023 " Ante-Natal Sessions 98 " " New Cases 251 " " Attendances 1,045 " Doctors Consultations 790 Toddlers Clinics: No. of sessions held 12 " first attendances 82 Total attendances 151 No. of toddlers found with defects 103 Total No. of defects found 103 -18- Owing to the large number of mothers attending the Lime house Infant Welfare Centre and Ante-Natal Clinic, an extension was opened on 9th December. The local midwives have a consulting room for their patients at the centre. A new Centre was also opened in Ashfield Street in November, to replace the centre at Newark Street which for many years was considered unsatisfactory. SUPPLY OF MILK AND VITAMINS. Under the National Scheme, Welfare foods have been distributed through the Infant Welfare Centres etc., as follows:- Commodity Day Nurseries Institutions Welfare Centres Food Office Total National Dried Milk Full Cream 48 1,581 16,021 14,422 32,072 National Dried Milk Half Cream 2 663 1,106 1,157 2,928 Cod Liver Oil 698 198 7,263 3,450 11,609 A.& D. Capsules - - 1,370 1,373 2,743 Orange Juice. 1,521 3,084 48,043 25,653 78,301 ILLEGITIMATE BIRTHS. The result of an investigation into 106 cases was as follows:- Died before reached age of one Month 4 " " " „ one Year 6 Looked after by own mother in own home during first year of life 59 Looked after by an individual foster mother during first year of life 1 Looked after in L.C.C. or other Local Authority Home or Institution 4 Mother of child normally lives outside Stepney 14 Birth transferred at once to Borough in which mother normally resides 64 -19- III. SANITARY CIRCUMSTANCES OF THE AREA. Pharmacy and Poisons Act. 1933. 67 persons are entered in the List of Persons entitled to sell Poisons included in Part II of the Poisons List, 168 inspections and visits were made by the sanitary inspectors during the year. Rent and Mortgage Interest Restrictions Acts. 155 certificates were issued to tenants as to houses not being in a reasonable state of repair, and 14 applications for such certificates were Refused. 15 certificates to landlords were issued as to houses being in a reasonable state of repair and 28 such applications were refused. Rats and Mice. During the year 588 complaints were received as to nuisances from rats or mice. As a consequence 479 drains were tested and in 103 instances were found to be defective, 406 complaints were forwarded to the Borough Engineer & Surveyor, so that the Council's ratcatchers could call and assist the tenants concerned. The Borough Engineer & Surveyor has kindly supplied information as to Rat Destruction carried out by the Council's Ratcatchers during the year No. of premises visited 1,260 No. of visits 18,119 No. of rats found dead 73 No. of rats caught in our traps 398* No. of premises cleared of rats as reported by the Occupiers 326 No. of complaints received 511 *264 of these were actually brought into the Depot and destroyed. The poisons used were as follows:- Barium carbonate 49,462 cubes. Extract of Squills 2,561 portions(2 oz) Rat Bane(Zinc Phosphide) 72,554 portions. “Maintenance Treatments” for destruction of Rats in Sewers: In accordance with Local Authority Circular N.S.No.6 (dated 29th August 1944) issued by the Ministry of Food (Infestation Division), 2 treatments for the destruction of rats in sewers were carried out during the year, viz. from 31st December 1945 to 6th February 1946 (inclusive) and from 17th June 1946 to 27th July 1946 inclusive). The system adopted was that recommended, viz. days pre-baiting and 1 day poison baiting. The pre-bait used was damped sausage rusk and the poison zinc phosphide (2½%). Over a thousand manholes were treated on each occasion, at selected points throughout the borough. -20- Sanitary inspection: The following is a summary of inspections carried out by the district sanitary inspectors during the year. Bakehouses 43 Complaints 9,633 Canteens 65 Drainage 4,177 House-to-House 252 Houses-let-in-Lodgings 771 Housing Act investigations 1,704 Infectious Diseases and Contacts 657 Lodging Houses: Common 87 Seamen's 129 Markets (week-end) 35 Offensive Trades 283 Pharmacy and Poisons Act 168 Rent Restrictions Acts 250 Restaurants and Eating Houses 195 Shops Act, 1934 494 Smoke nuisance observations 209 Essentiality Certificates and Building Licences-surveys 2,231 Factories: Mechanical 1,313 Non-mechanical 271 Outworkers 178 Workplaces 108 Miscellaneous 5,544 Revisits 11,126 Intimation Notices served 5,529 Statutory Notices served 1,332 Legal Proceedings taken 27 Drainage. A summary of the drainage work carried out under the supervision of the Sanitary Inspectors will be found on page 22. 968 drains were tested, of which 192 were found to be defective. Aged and Infirm Persons. Many requests were made during the year asking be to take action to secure the compulsory removal of diseased or infirm persons to hospitals or institutions. Suoh persons are usually persuaded to enter an institution, but in 3 cases it became necessary for me to apply to a Magistrate for an Order to have then removed under Section 224 of the Public Health (London) Act, 1936. -21- The following is a summary of the work completed under the supervision of the sanitary inspectors during the year. Animals kept so as to constitute a nuisance, removed 27 Bakehouses: No. of cleansings of 84 Cisterns cleansed, covered and repaired 36 Dampness in premises remedied 1,716 Drains - Cleansed or repaired 704 Constructed or reconstructed 729 Dust receptacles provided 557 Number of dwelling rooms cleansed 5,252 Houses ventilated beneath the lower floor 6 Improved light and ventilation provided to rooms. 26 Manure receptacles provided or reconstructed 4 Offensive accumulations removed 245 No. of gutters and rain-water pipes fixed or repaired 906 No. of repairs to roofs 1,785 Sink, bath and lavatory pipes fixed or repaired 766 Smoke nuisances abated 13 Urinals fixed or repaired 25 Verminous rooms cleansed 155 Water-closets- Cleansed or repaired 660 Light and ventilation provided 38 Pans and traps fixed 744 Provision or repair of flushing apparatus 592 Water supply to houses reinstated or repaired 355 Yards, areas and forecourts cleansed, paved, or paving repaired 213 Floors, windows, staircases, fireplaces and coppers repaired 2,340 Miscellaneous 509 Legal Proceedings. The number of cases taken and the fines and costs imposed are as follows:- No. of Cases Finess Costs £. s. d. £. s. d. Public Health (London) Act, 1956. 51 22. 0. 0 65. 19. ,0 Food & Drugs (Adulteration) Act, 1928. 51 71. 10. 0 24. 11. ,0 Milk & Dairies Order, 1926 2 8. 0. 0 5. 5. 0 64 £101. 10. 0 £95. 15. 0 -22- FACTORIES The following tables contain a summary of the inspections and the defects found and remedied during the year 1946. Inspections:- Nunber of premises. No. of Inspections. No. of Written Notices Premises. Factories with mechanical power 1488 1313 192 Factories without mechanical power 632 271 55 Other Premises under the Act (including works of building and engineering construction but not including outworkers premises) 34 108 2 2154 1692 249 Defects Found:- Particulars No. of Dofoctc. Found Remedied Want of cleanliness 84 84 Overcrowding - - Unreasonable temperature 1 1 Inadequate ventilation 7 7 Ineffective drainage of floors 24 24 Sanitary Conveniences - Insufficient 30 30 Unsuitable or defective 108 108 Not separate for sexes 31 31 Other nuisances 54 54 Other offences (Not including offences relating to Homework) - - 339 339 Outworkers. The net number of outworkers on the Register is 421 and they are engaged in the trades as follows:- Making, cleaning, etc., of wearing apparel 399 Umbrellas 4 Boots and Shoes 2 Handbags 2 Stationery and Bookbinding 14 Total 421 The number of inspections made to outworkers premises was 178. Notifiable diseases occurred in 3 premises. -23- IV. HOUSING STATISTICS. Inspection of dwelling houses during the year:- (1) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 12,361 (b) Inspections made for the purpose 15,925 (2)(a) Dwelling houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 127 (3) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably- fit for human habitation 5,457 Remedy of defects during the Year without service of formal Notice:- Defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 4,426 Action under Statutory Powers during the Year:- (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936: (1) Dwelling houses in respect of which notices were served requiring repairs Nil (b) Proceedings under Public Health Acts:- (1) Dwelling houses in respect of which notices wore served requiring defects to be remedied 1,298 (2) Dwelling houses in which defects were remedied after service of formal notices: By owners 1,192 By Local Authority in default of owners Nil Water Supply. It is not lawful for a house to be occupied as a dwelling house unless it is certified by the Sanitary Authority to have a proper and sufficient supply of water. During the year such certificates were granted in respect of 61 flats and 177, bungalows. As far as can be ascertained there are 16 wells in the Borough; 3 are used for domestic purposes, 5 for business purposes, and 8 are not in use, 24 Essentiality Certificates and Building Licences. Applications for Building Licences and Essentiality Certificates prior to the issue of a building licence for the repair of property are submitted to me for observations and recommendations, After the necessary visiting, recommendations are forwarded to the Licencing Sub-Committee. 25 No. Received Recommended Recommended with modifications Not Recommended 1880 1144 532 204 Preferential Homing on Grounds of Health. No. of cases investigated 68 " " referred to London County Council 37 " " " " Stepney Borough Council 9 Defence Regulation 68 C.A. 85 Investigations of premises have been made for possible contravention relating to "Change of User," Overcrowding - Housing Act. 1956. No, of cases investigated 1114 " " referred to London County Council 621 " " " " Stepney Borough Council 11 Prefabricated Houses Erected. No, of prefabs, erected since close of hostilities: London County Council - Uni-Seco type 238 Stepney Borough Council - Nissen type 300 Uni-Seco type 200 Total: 738 Permanent Flats erected 31 (West India House opened 30th November 1946) V. INSPECTION AND SUPERVISION OF FOOD Particular attention is still paid to milk sampling, and samples taken at schools and hospitals in the Borough were all satisfactory. In no instance was it found necessary to institute legal proceedings in respect of adulterated milk and the efforts of the Sampling Officers in concentrating in the early years of the formation of the "Food Section, on particular sources of adulterated milk supply, have been amply justified. One summons was issued during the year against a vendor for selling adulterated artificial vinegar. The artificial vinegar was manufactured by the defendant himself, and a fine and costs were imposed. Thirty summonses were issued under the Food and Drugs Act (Sec.13), for unsatisfactory conditions existing at grocery shops, restaurants and ice cream premises, and fines and costs were imposed. Two summonses were taken out under the Milk and Dairies Order, 1926, against an itinerant milk vendor for the unsatisfactory condition of milk utensils. In addition to the imposition of fines and costs, the vendor's name was ordered to be removed from the Register of Dairymen by the Magistrate. In numerous instances, the technical skill and knowledge of the Food Inspectors was readily placed at the disposal of the Ministry of Food during the period under review. During the year, the Ministry of Food established a Food Salvage Depot in the Borough, and approximately 160 tons of canned milk, jam, meat, etc., were condemned. ( * Food Section commenced 1935 ) 26 The following is a summary of the inspections, etc., by the four special Inspectors engaged in the supervision and inspection of food:- H.Abson A.C.Brown T.W.Dee S.Voglor TOTALS Bakehouses - 16 — 4 20 Butcher & Bacon Shops 249 - 8 257 " " " Stalls. 134 - - - 134 Butter & mergarine Premises — 54 — 13 67 Complaints 14 12 12 33 71 Cowsheds - 65 - 30 95 Fish Shops & Stalls - 304 - 529 833 Grocery & Provision Shops — 167 1 116 284 Greengrocers & Fruiterers shops & stalls - - 63 -- 63 Ice Cream premises — 339 - 251 590 London Fruit Exchange - - 180 - 180 Markets (Daily) 378 536 71 507 1492 Markets (Week-end) 2 3 2 5 10 Milkshops - 472 - 383 855 Poultry Shops 536 - - - 536 Poultry Stalls 459 - - - 459 Prepared Food premises 169 174 - 110 453 Railway Depots 15 1 200 - 216 Restaurants & Cafes 4 167 - 204 375 Spitalfields Market 8 - 161 - 169 Wharves 363 11 690 - 1064 Wholesale Grocers — 144 - 210 354 Miscellaneous Visits Samples taken - 49 123 55 193 425 Food & Drugs - 775 - 770 1545 Other 2 54 8 66 130 Revisits 121 209 29 655 1014 No. of Summonses taken out. - 10 - 23 33 Includes 6 special night or early morning inspections a Bishopsgate Goods Station. X Includes 50 special night or early morning inspections at Bishopsgate Goods Station. 35 inspections were also made by the District Sanitary Inspectors. 43 inspections were also made by the District Sanitary Inspectors. 27 Milk supply No. on Register No.of Inspections No. Notices Served Dairy Premises 78 855 12 Purveyors' bottled milk 181 - 22 Itinerant vendors 44 - — Cowsheds 9 95 2 28 17 samples of milk were taken in course of delivery to various schools in the borough. 9 of the samples were submitted for chemical analysis and 8 for bacteriological examination. All the samples proved to be satisfactory. 7 samples of milk were taken in course of delivery to various hospitals and institutions in the borough. 6 were submitted for chemical analysis and 1 for bacteriological examination. All the samples were satisfactory. The following samples were submitted for bacteriological examination:- Nature of Sample No. of samples Number unsatisfactory and action taken. Milk (Pasteurised) 13 - - Milk (Beat Treated) 26 7 All taken from the same vendor. The Area Milk Officer, Ministry of Food, was notified. Milk (Sterilized) 15 - — Milk (T.T. Pasteurised) 1 — — Chopped Ox Liver 1 - - Chopped Meat 1 - - Kosher Salt Beef 1 1 Necessary action taken to ensure that persons handling the food observed proper precautions. Winkles 1 - - Clean Milk Bottle 1 1 Vendor instructed to wash bottles more efficiently. Household Salmon 1 - — Ice Cream & Ingredients 73 (See special report on Ice Cream) . Ice Cream. There are 180 premises on the register, of which 63 are registered for the manufacture of ice cream, 590 inspections were made and 12 notices served. Manufacture of ice cream at a number of registered premises has been temporarily discontinued. Particular attention was paid to ice cream premises and samples were taken for bacteriological examination or chemical analysis. The following is a list of samples of ice cream and ingredients taken for bacteriological examination:- Number Number classified as:- examined. Good Fair Unsatisfactory Ice cream 61 14 24 23 Ingredients 12 7 4 1 Of the unsatisfactory samples, 7 were manufactured by firms outside the borough and the Medical Officers of Health of the boroughs concerned were notified. Investigation of those premises where unsatisfactory samples were procured revealed that the poor bacteriological results were mainly due to bad handling of the product and lack of proper sterilization of the vessels and equipment used in the manufacture, sale or storage. Visits were made to these premises and attention specifically drawn to these aspects, and a circular letter sent to all ice cream manufacturers and vendors in the borough emphasising the importance of thorough cleanliness at all stages of manufacture, storage and sale. In several instances, the Food Inspectors spent some hours on the premises supervising the actual manufacture, pointing out where improvements in the process were necessary. As a result, subsequent samples gave improved bacteriological results. In two instances, manufacturers who had previously used a cold mix were persuaded to change over to a boiled mix. There are several itinerant vendors who sell ice cream from barrows in the borough. Periodic inspections are made for cleanliness of utensils, etc. 29 35 licences were issued under the Milk (Special Designations) Regulations, 1936-1946, as follows:- Dealers Licences Supplementary Licences "Pasteurised" 13 10 "Tuberculin Tested" 7 4 "Accredited" 1 The Minister of Health has issued Draft Ice Cream (Heat Treatment) Regulations, 1946, dealing with the manufacture, storage and sale of ice cream. Due consideration was given to these draft regulations and representations were made by the Council to the appropriate Ministries that bacteriological and chemical standards be formulated for ice cream, and that itinerant vendors should be registered. With regard to the formulation of a bacteriological standard, the Ministry of health experts point out that, up to the present, there is difficulty in instituting a satisfactory bacteriological test for ice cream, but that such tests, however, may usefully be employed as an indication of faulty methods of manufacture, and assist Local Authorities in discovering manufacturers and vendors who fail to comply with the requirements of the Regulations or of Section 13 of the Act. As regards the quality of ice cream, it would not be difficult to lay dam some standard for fat and solids-notfat, and for sugar, etc., but the Ministry of Food prefer to postpone this until the necessary ingredients are more readily available. Butchers' Chops and Stalls. 391 inspections were made during the year, and 6 Notices were served. Cowhouses. There are 9 licensed Cowhouses in the Borough. 95 inspections were made, and 2 Notices were served. 30 41 samples of icc cream were submitted for chemical analysis and showed variations of fat, millk solids-not-fat, sugar and starch, as follows:- No. examined Fat. Milk solidsnot fat Sugar and Starch Ice cream 40 0 21-12.01% 2 64-11.04% 3.81-22.79% Choc. Ice Cream 1 19.75% 5.04% 21.84% 31 Butter & Margarine Factories. No. on Register Notices served. No. of Inspections. Butter and Margarine Factories 4 - 67 Wholesale Dealers in Margarine 41 2 Prepared Food Premises. Preserved Fish premises 70 38 453 Preserved Meat " 153 6 Restaurants & Eating Houses. 354 inspections were made and 56 notices served. Greengrocers & Fruiterers Shops & Stalls. 63 inspections were made and 7 notices served. Wholesale Grocers, etc. 354 inspections were made and 4 notices served, 42 notices were served in respect of miscellaneous food premises. Certification of Food Products for Export. 2 certificates were issued respecting the export of consignments of food products prepared within the Borough, 1 to Belgium and 1 to Buenos Aires. 676 carcases of imported mutton were examined for caseous Lymphadenitis by the cutting of the lymphatic glands. Of these, I was found to be diseased. No diseased carcases were found during 1945. Unsound Food. 1064 inspections were made at the various wharves in the Borough. The following is a list and quantity of unsound foodstuffs from the wharves disposed of during the year under the Public Health (Imported Food) Regulations, 1957:- Meat and Poultry tons cwts. qrs. lbs. Lamb 8 Assorted canned meat and poultry. 2 3 0 Fruit and Vegetables Assorted canned fruit & vegetables 2 11 1 22 Dates 9 2 25 Gooseberry Pulp 1 Grapes 16 3 6 Prunes 25 Raisins 1 2 0 Sultanas 3 21 The following unsound foodstuffs were disposed of during the year under the Public Health (London) Act, 1936. tons. cwts. qrs. lbs. (a) Spitalfields Market & London Fruit Exch. Apples 1 0 0 Assorted dried fruit 1 14 2 23 Capsicums 1 1 0 18 Chestnuts 1 1 20 Currants 4 2 26 Dates 6 1 0 Lettuce 2 0 0 Melons 4 3 1 26 Oranges 3 8 0 0 Potatoes 39 19 0 0 Persimmons 1 6 0 18 Pineapples 7 1 22 Pears 3 13 0 13 Peaches 7 9 1 2 Prunes 3 4 2 20 Raisins 13 2 21 Savoys 5 0 0 0 Sprouts & Tops 1 8 0 0 Sultanas 2 0 0 15 Tomatoes 2 6 2 14 78 10 3 14 (b) Ministry of Food Salvage Depot, 141-5 Mile End Road. tons cwts. 3. qrs. lbs. Assorted canned goods 159 18 1 17 (c) Other Premises. tons. cwts. qrs. lbs. Fruit and Vegetables. Assorted canned fruit & vegetables 1 3 10 Assorted dried fruits 1 8 1 5 Apricot pulp 2 2 1 14 Butter beans 1 1 4 32 Sundries tons cwts. qrs. lbs. Almond Kernels 1 2 19 Assorted canned goods 5 11 0 16 Cocoa. 5 1 0 Coffee 2 0 Lemon juice 4 0 0 Orange juice 4 2 3 Tomato puree 4 0 20 Tea Sweepings 3 20 12 0 2 17 33 Fruit & Vegetables (continued) tons cwts. qrs. lbs. Cabbage 13 14 1 8 Carrots 5 16 0 7 Cauliflowers 1 4 0 0 Cucumbers 1 3 4 Gooseberry pulp 12 0 0 Grapefruit pulp 2 0 0 Lemons 2 4 Lettuce 4 10 2 8 Melons 5 13 0 0 Onions 3 0 0 Oranges 9 2 2 Parsnips 2 5 2 0 Peaches 1 7 2 10 Pears 22 15 0 18 Peas 7 5 2 18 Plums 3 4 1 5 Runner beans 1 1 4 Strawberry pulp 1 0 0 0 Sprouts 8 1 1 0 Tomatoes 19 Tomato puree 1 2 15 Tangerines 2 7 2 0 Turnips 4 0 0 0 Fish. Assorted canned fish 2 5 Assorted fresh fish 3 3 1 16 Herrings in brine 1 3 0 Kippers 2 8 Meat and Poultry. Beef 3 2 17 Assorted canned meat 10 0 24 Bacon 1 4 1 22 Duck 5 FowIs 13 1 2 Geese 1 3 8 Lamb 20 Lamb Heads 1 10 Ox Heads 2 1 3 26 Pork 5 1 25 Rabbits 2 4 Salami 1 3 Sausages 1 0 11 Tripe 20 (c) Other premises (continued). Sundries. tons cwts. qrs. lbs Assorted canned goods 15 3 0 21 Assorted foodstuffs 29 2 0 3 Biscuits 1 5 1 2 Butter 1 24 Cheese 1 2 2 Cocoa 3 13 Coffee beans 2 3 26 Confectionery 12 1 27 Eggs 1 1 1 Egg Powder 2 0 0 0 Flour 2 2 22 Honey 1 0 1 12 Margarine 2 14 Orange & Lemon Squash 4 10 0 0 Rice 2 0 0 Rolled Oats 1 3 21 Sugar 1 3 0 26 Tea 7 152 11 1 14 50 Detention Notices and 53 Release Notices were issued during the year in respect of the undermentioned foodstuffs:- Detention Notices. Release Notices. Article Quantity No. Notices Height. t.c.q.lbs. Quantity 1 No. Notices Weight. t.c.q.lbs. Mutton 12,351 carcase. 30 - 12,350 & 1 part carcse. 30 - Raw Coca and Sweepings. 1,100 bags. 12 67.7.1. 5 976 bags. 9 59.6.0. 2 Sugar & sweepings. 103 bags. 7 9.8.0.19 110 bags. 8 10.2.3.19 Pineapple . 15 tins 1 2.24 - - - Sultanas - - - 494 pekgs 3 12.9.1.12 Prunes - - - 51 pekgs 2 13.0.0 Apricots - - - 6 bags. 1 5.2. 0 34 Zeebrugge-Harwich Train ferry. This Ferry closed down during the war and resumed operating on monday, 19th August, 1946, 36 special night and early morning visits were made by the Food Inspectors, In addition, 13 inspections were made by day. 956 trucks containing 6869 tons 11 cwts. of fresh fruit arriving from the Continent were examined. This consisted of:- Italian fruit 855 trucks containing capsicums, chestnuts, grapes, mandarines, melons, peaches, pears, persimmons, pomegranates and walnuts. Swiss fruit 48 trucks containing pears, Czecho-Slovakian fruit 32 trucks containing pears. Belgian fruit 21 trucks containing hot-house grapes. 36 trucks of Hungarian turkeys weighing 373 tons, and small consignments of Belgian fish, were also examined. The following foodstuffs were found to be unsound and were destroyed:- 2768 packages of pears, 20 packages of melons, 3891 packages of peaches, 5 boxes of capsicums and 1 box of persimmons, all Italian fruit, weighing 56 tons 1 cwt. The ferry traffic was temporarily suspended from 25th December 1946 to 4th February 1947, due to the withdrawal of the ferry boat for essential repairs. 35 VI. PREVALENCE OF AND CONTROL OYER. INFECTIOUS AND OTHER DISEASES. Notifications. 1194 notifications (other than of tuberculosis) were received, or 28 less than in the previous year. Wrong Diagnosis. 59 cases of infectious diseases removed to hospital were found not to be suffering from the disease stated on the certificate. Of these, 8 were cases of scarlet Fever, 31 of Diphtheria,.6 of Dysentery, 8 of Measles, 5 of Whooping Cough and 1 of Cerebro-Spinal Fever. Diphtheria Immunisation. In addition to the 52 sessions held at 35 Stepney Green every Friday afternoon, children are also immunised at most of the Infant Welfare Centres. S.B.C. L.C.C. Total Und.5, Over- 5 Und.5 Over 5 Post Schick Tests 538 64. - - 602 Immunisation Certificates given 462 83 - - 545 Attendances of Children for Schick or Immunisation. 2599 255 - - 2854 Children who completed the full course of Immunisation 918 35 79 484 1516 Secondary injections 23 - - - 23 Whooping Cough Immunisation. In addition to the Whooping Cough Immunisation. Clinic should in conjunction with the Diphtheria Immunisation Clinic every Friday afternoon at 35 Stepney Green, facilities are provided at most of the Infant Welfare Centres, 35 Stepney Green. Infant Welfare Centres Total Attendances of children 878 1147 2025 Completed Immunisations 300 367 667 No. of Sessions held 17 - 17 Verminous Persons Branch Road Cleansing Centre M. F. Ch. Total No. of persons bathed & clothing disinfected 266 47 3 316 " " baths and treatments given 275 62 3 340 36 Bug Eradication. The following is a summary of the work carried out by the special inspector No. of inspections 1012 Revisits 464 No. found verminous. 262 Miscellaneous Visits 892 No. of Council Premises sprayed 179 " " " Rooms " 416 " " Private Premises " 416 " " " Rooms " 775 103 of the families which were re-housed in Stepney Borough Council flats had their furniture and other household effects treated with H.C.N. 3 loads of furniture etc. which had been loaned to bombed-out families were treated with H.C.N. prior to return of these articles to the re-housing store. I load of very verminous furniture was treated with H.C.N. from a private premise whilst the owner, an aged woman, was in hospital. All bedding was separately treated with steam. Cleansing and Disinfection. 512 rooms were disinfected because of infectious disease and 21 because of pulmonary tuberculosis. 148,705 articles of clothing and bedding were steam disinfected. Scabies (Scabies Order 1941). No. of cases notified: Formally - 758. Informally - 570. Diagnostic Clinic M. F. Ch. Total No. of sessions - - - 108 No. of persons who attended 434 623 519 1576 " " " found positive 132 191 183 506 Total number of attendances 512 709 584 1805 Branch Road Treatment Centre Persons bathed co clothing disinfected 159 200 106 465 No. of baths & treatments given. 287 348 166 801 London Hospital Treatment Centre Persons bathed and clothing disinfected 315 298 283 896 Statutory Action Inspection of promises notices serve 216 Medical Examination notices served 307 37 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING TEE YEAR, 1946. DISEASE. Under l yr. Tota1 Cases notified In Groups. 65 and over Total cases admitted to Hospital Total Deaths. 1- 2- 3- 4- - 5- 10- 15- 20- 35- 45- Smallpox. - - - - - - - - - - - - - - - Scarlet Fever. 3 7 17 14 20 50 18 8 4 1 - - 142 66 - Diphtheria. 1 4 4 2 5 15 5 2 7 - - - 45 45 1 Membranous Croup. - - - - 1 1 - - - - - - 2 2 - Enteric Fever. - - - - - - 1 - - 1 - - 2 2 1 Measles. 48 120 105 122 113 197 17 4 5 1 1 - 733 117 1 Whooping Cough 17 16 14 10 11 18 1 - - - - - 87 23 - Puerperal Fever. - - - - - - - - 4 - - - 4 4 4 Do Pyrexia - - - - - - - - 7 1 - - 8 8 - Encephalitis Lethargica. - - - - - - - - - - - - - - - Erysipelas. - - - - - 3 2 - 3 6 11 5 30 16 - Cerebrospinal Fever. 2 1 - - 1 1 1 - - - 1 - 7 7 2 Ophthalmia Neonatorum 4 - - - - - - - - - - - 4 3 - Poliomyelitis - - - - - - - - - - - - - - - Polio-Encephalitis. - - - - - - - - - - - - - - - Dysentry. 1 5 2 3 2 3 1 - 3 6 - 1 27 22 - Malaria. - - - - - - - - 10 4 - - 14 7 - Pneumonia. 9 2 1 4 2 14 5 3 10 9 16 6 81 30 80 Food Poisoning - 1 - - - - - - 3 2 2 - 8 1 - Totals 85 156 143 155 155 302 51 17 56 31 31 12 1194 353 89 Malaria. All cases contracted abroad, except one, which was induced. 38 VII. STATISTICS FOR THE YEAR 1946. (Prepared by Registrar-General) Estimated Civilian Population 94,800 LIVE BIRTHS STILL BIRTHS M F M F Total (Legitimate and Illegitimate) 1142 1005 38 23 Illegitimate 91 84 5 3 DEATHS UNDER 1 YEAR M F Legitimate 54 38 Illegitimate 10 8 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case-rates for certain Infectious Diseases in the Year 1946. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 C.B.S and Great Towns including London. 148 Smaller Towns Resident Pop. 25,000-50,000 1931 Census. London Adm. County. 1. 2. 3. 4. x Rates per 1,000 Civilian Population. Births Live 19.1 22.2 21.3 21.5 Still 0.53 0.67 0.59 0.54 Deaths All causes 11.5 12.7 11.7 12.7 Typhoid and Paratyphoid. 0.00 0.00 0.00 0.00 Scarlet Fever. 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.02 Diphtheria 0.01 0.01 0.01 0.01 Influenza 0.15 0.13 0.14 0.12 Smallpox 0.00 0.00 0.00 - Measles 0.00 0.01 0.01 0.01 39 1. 2. 3. 4. Deaths under 1 Year of age. Rates per 1.000 Live Births. 43 46 37 41 Deaths from Diarrhoea and Enteritis under 2 years of age. 4.4 6.1 2.8 4.2 x A dash (-) signifies that there wore no deaths Per 1.000 related births Rates per 1.000 population Notifications:- Rates per 1,000 Civilian Population Typhoid Fever 0.01 0.01 0. 01 0.01 Paratyphoid Fever 0.02 0.02 0.01 0.01 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 Scarlet Fever 1.38 1.51 1.33 1.42 Whooping Cough 2.28 2.48 2.05 2.22 Diphtheria 0.28 0.32 0.31 0.24 Erysipelas 0.2 0.25 0.22 0.27 Smallpox 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 Pneumonia 0.89 1.02 0.74 0.75 Rates per 1,000 Total Births (Live and Still) (a) Notifications:- Puerperal Fever 8.50 10.35 7.63 1.62 Puerperal Pyrexia 9.68 (b) Maternal Mortality in England and Wales:- code code' code No. 140 No. 141 No. 147 Nos. 142.6 Abortion Abortion Puerperal 148-150 with Sepsis without Sepsis Infections Other 0.13 0.06 0.18 1.06 Abortion:- Mortality per million women aged 15-45 in England and Wales:- No. 140 with sepsis No.141 without Sepsis 11 5 Including Puerperal fever 40 TOTAL DEATHS BY CAUSE AMD AGE IN THE METROPOLITAN BOROUGH OF STEPNEY, 1946. CAUSES OF DEATH. Sex All ages. 0- 1- 5- 15- 45- 65 & over 1. Typhoid and paratyphoid fever. M 1 _ - - 1 - - F - - - - - - - 2. Corebro-spinal fever. M 2 2 - - - - - F - - - - - - - 3. Scarlet Fever. M - - - - - - - F - - - - - - - 4. Whooping Cough. M - - - - - - - F - - - - - - - 5. Diphtheria. M 1 - 1 — — - - F •• - - — - - - 6. Tuberculosis of respiratory system. M 50 - - - 19 13 18 F 21 1 1 - 15 2 2 7. Other forms of Tubercu¬losis . M 7 - 1 2 1 3 - F 3 - — — 3 - - 8. Syphilitic disease. M 15 - - — 1 6 8 F 8 - - - — 6 2 9. Influenza. M 5 — — — 1 2 2 F 3 - - - 2 - 1 10. Measles. M 1 - 1 — - - — F - - - - - - - 11. Acute Poliomyelitis and Polioencephelitis. M - - - - - - - F - - - - — — - 12. Acute infectious Encephe litis. M 2 - — - 1 1 — F 1 - - - 1 - - 13m Cancer of buccal cavity and oesophagus. M 18 1 - - — 7 10 13f Cancer of Uterus. 9 - - — 1 5 3 14. Cancer of stomach and duodenum. M 25 - - - 1 12 12 F 10 — - — — 3 7 15. Cancer of breast. M — - - - '- - - F 7 — - - 1 4 2 16. Cancer of all other sites. M 75 - - 1 3 37 34 F 54 - 1 — 1 17 35 17. Diabetes. M 1 — - — — - 1 F 7 - — - • 5 2 18. Intra-cranial vascular lesions. M 49 — - — 1 6 42 F 53 — - — - 11 42 19. Heart disease. M 199 - - - 10 42 147 F 183 - - - 13 30 140 41 TOTAL DEATHS BY CAUSE AND AGE IN THE METROPOLITAN BOROUGH OF STEPNEY, 1946 - (continued). CAUSES OF HEATH. Sex All ages 0- 1- 5- 15- 45- 65 & over 20. Other diseases of the circulatory system. M 40 - - - 3 11 26 F 28 - - - - 5 25 21. Bronchitis. M 65 5 - - 1 28 55 F 52 - - - - 4 28 22. Pneumonia. M 56 9 2 - 4 14 27 F 24 9 1 - - 6 8 23. Other respiratory diseases. M 7 - - - 3 2 2 F 4 - - - 1 2 1 24. Ulceration of stomach or duodenum. M 23 - - - 5 12 6 F 2 - - - - 2 - 25. Diarrhoea. M 7 7 - - - - - F 8 8 - - - - - 26. Appendicitis. M - - - - - - - F 1 - - - - 1 — 27. Other digestive diseases. M 17 1 - - 4 5 7 F 18 - - 1 2 7 8 28. Nephritis. M 13 - - - 2 6 5 F 21 - 1 — 6 6 8 29. Puerperal and postabortive sepsis. F 1 - - - 1 - — 30. Other maternal Causes. F 3 - - - 3 - — 31. Premature birth. M 12 12 - - - - - F 11 11 - — — - 32. Congenital malformations, birth injury, infantile d isease . M 25 25 - — 1 1 - F 12 10 — — 2 — — 33. Suicide . M 6 - - — 2 5 1 F 2 - - - 1 1 - 34. Road Traffic Accidents M 9 - 2 1 3 1 2 F 2 — - - - 1 1 35. Other violent causes. M 35 5 5 2 5 10 10 F 18 2 1 1 2 1 11 36. All other causes. M 42 1 2 1 3 15 20 F 45 5 2 2 8 9 19 ALL CAUSES. M 808 64 12 7 75 257 415 F 591 46 7 4 63 128 545 Total 1,399 110 19 11 138 365 756 42 r 23rd Annual Report. SUMMARY OF BOROUGH ANALYST'S QUARTERLY REPORTS for the Year 1946. During the year, 1,568 samples were submitted for analysis. Of these 1,523 samples were taken under the Food and Drugs Act, The remaining 45 samples were received from Borough Departments, the Food Executive Officer and private purchasers. Samples taken under the Food and Drugs Act:603 samples were taken formally. 920 samples were taken informally. Total Samples. Foods (taken under the Act) 1,193 Foods (private samples) 31 Drugs (taken under the Act) 330 Other private samples 14 1,568 Out of 1,224 samples of food including private samples 17 or 1,4 per cent were adulterated and out of 330 samples of drug3 5 or 1.5 per cent wore adulterated making a total of 1,554 foods and drugs out of which 22 or 1.4 per cent were adulterated, MIIK. 575 samples were examined. The average composition including 1 adulterated sample was:- Fat, 3.53 per cent and Solids-not-fat, 8.70 per cent. The percentage of adulteration of all samples (1.4 per cent) is the lowest during the 23 years of these reports; the highest figure was obtained in 1942 when the percentage of adulteration was 9.1 per cent. 43 Poor quality samples. 33 samples (including 13 samples of Milk) were reported as being of inferior grade or doubtful quality. Legal proceedings. For the adulterated sample of milk the fine was £3 with £3-3-0d costs. The summons in the case of the sample of tinned soup was withdrawn as it was found that the firm was specially licensed by the Ministry of Food to market this product. Douglas Henville, F.R.I.C. Public Analyst. 44 ADULTERATED SAMPLES ( including other offences) Nature. Adulterated etc. Prosecu tions Cautions No action Informal Formal Private Foods. Whisky 1 - - - - - Ground Cinnamon 1 1 - - - 1 Coffee c: Chicory Essence 1 - - - - - Lemonade - 2 - - 1 1 Mustard 1 - - - - - Tinned Soup 3 1 - 1 - - Milk - 1 - 1 - - Pork Sausages 1 - - - - - Private Foods. Butter Beans - — 1 - - - Coffee Beans - - 2 - - — Egg Substitute Powder - - 1 - - - Drugs. Nursery Powder 1 1 - - 1 - Calamine Lotion 1 1 - - 1 - Ammoniated Tincture of Quinine 1 - - - - - INDEX Page I. Statistics and social Conditions of the Area 6 II. General Provision of Health Services 6 III. Sanitary Circumstances of the Area 20 IV. Housing 24 V. Inspection and Supervision of Food 26 VI. Prevalence of, and Control over, Infectious ad other Diseases 36 VII. Statistics provided by the Registrar-General 39 Aged and Infirm Persons 21 Analyst's Report 43 Ante-Natal and Post-Natal Clinics 14 Area of Borough. 5 Births Births Act, Notification of 13 Bug Eradication 37 Care Committee Child Life Protection 16-17 Cleansing of persons 37 Day Nurseries 17 Deaths 5, 41 Dental Clinic 12 Diphtheria Immunisation 36 Disinfection 37 Drainage 21 Extra Nourishment, Supply of 8 Factories 23 Fines and Costs Food Inspection 27 " Sampling 28 " Unsound 31 " Zocbrugge-Harwich Ferry 35 Foster Mothers 16 Health Visitors, work of 13, 18 Housing:- Statistics 24 Essentiality Certificates 25 Houses erected 25 Ice Cream 29 Illegitimate Births 19 Infant Welfare Centres, Work at 13,18 Infantile Mortality 5 Infectious Disease 36,38,40 45 Page Inhabited Houses 5 Insulin 6 Legal Proceedings 22 Maternal Mortality 40 Maternity and Child Welfare 13 Milk shop supply 29 Milk and Vitamins, supply of 19 Nursing in the Hone 6 Outworkers 23 Overcrowding 25 Pharmacy & Poisons Act 20 Population. 5 Premature Infants 15 Public Assistance 6 Puerperal Fever and Pyrexia 40 Rateable Value 5 Rats and Mice Destruction 20 Rent and Mortgage Interest Restrictions Act 20 Sanitary Inspectors:- Inspections 21 Return of Sanitary Work 22 Scabies 37 Social Conditions 6 staff 6 Statistics, Summary of 5 Stiliblrths 5 Tuberculosis:- Dispensaries, Report on 7 Notifications 1 Unemployment 6 Unsound Food 31 Verminous persons and premises 37 Vitamins, supply of 19 Water Supply 24 Whooping Cough Immunisation. 36 46