AC 4367 STE 53 Metropolita Borough of Stepneg. ANNUAL REPORT (Abridged) for the Year 1948 of the Medical Officer of Health 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 Metropolitan Borough of Stepneg. ANNUAL REPORT (Abridged) for the Year 1948 of the Medical Officer of Health 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 COMMITTEE (at 31st Dec. 1948) Ex-Officio: His Worship The Mayor (Alderman T. Aylward, J.P.) Chairman: Councillor (Mrs.) H. Roberts, O.B.E. Vice-Chairman: Councillor (Mrs.) A. Barnes. Alderman (Mrs.) M. Sambrook Alderman I.M. Vogler Alderman D. J. Wallis Councillor A. Blatt Councillor (Mrs.) K. O'Connor " (Mrs.) A.P. Bunn " M.A.J» O'Leary, J.P. " A. Butler " (Miss) E. Ramsay, M.B.E. ,B.A. " (Mrs.) C. Edwards " (Mrs.) C. Roeder " J.L. Tine, O.B.E.,J.P. " J. Sambrook " (Mrs.) A.M. Jolly " (Mrs.) B. Sokoloff " (Mrs.) A. Kemp " (Mrs.) S. Spicer " M.S. Levitas " L. Tanaman " (Mrs.) H. Long " (Mrs.) Q. Weinberg " (Mrs.) R.E. Maffia MATERNITY AND CHILD WELFARE COMMITTEE (to 4th July, 1948) Ex-Officio: His Worship The Mayor (Alderman T. Aylward, J.P.) Chairman: Councillor (Miss) E. Ramsay, M.B.E.,B.A. Vice-Chairman: Councillor (Mrs.) C. Edwards. Together with The Members of the Public Health Committee. METROPOLITAN BOROUGH OF STEPNEY PUBLIC HEALTH DEPARTMENT 43, White Horse Road, Commercial Road, E.l. To The Mayor, Aldenrmon and Councillors of the Metropolitan Borough of Stepney. Your Worship, Ladies & Gentlemen, I have the honour to present my report for the year 1948. The report is again abridged in accordance with the direction of the Ministry of Health. The last estimate of the population of the Borough is 100,020. The total live births In 1948 show a slight decrease, 2129 compared with 2184 last year, giving a live birth rate of 21.2 for 1948 tornpared with 21.8 for. 1947. The infant mortality rate continues to drop - 51.2 in 1946, 37.5 in 1947 and 27.7 this year. The latter figure is the lowest recorded infant mortality rate in the history of the Borough and compares most favourably with rates in boroughs of better environment (see graph on page (x)). Perhaps it would not be unjustifiable to take this low rate as being in part at least due to the Borough Council's successful administration of the Maternity and Child Welfare services - a matter which I think it is only fair to comment upon in this year's report when these services are being handed over to the County Health Authority under the National Health Service Act of 1946. Whatever the justification may be for taking the Maternity and Child Welfare Services away from the local administration of the Metropolitan Borough Councils in London, it cannot be said that it was because of any failure of the local system. The infant mortality of 27.7 is undoubtedly low but the Borough Council had hoped to reduce still further these rates by opening a residential nursery for the care of premature infants at the new Mary Hughes Centre in Underwood Road, However the introduction of the new Act and the consequent transfers of functions intervened. No doubt, in due course suitable provision will be made in some part of the plan of the Regional Hospital Board. A small local unit for premature infants in Stepney in very close contact with the mothers of the infants concerned which was envisaged in the Underwood Road scheme would' perhaps be preferable. It is good to be able to record that the maternal mortality rate per 1000 live and still births has again reached zero as in 1944, The figures for the last few years were 1.8, 0.8 and now 0.0. One hopes that this can be attributed in a considerable degree to the mothers themselves - that they are better fed and educated and more (i) knowledgable in self-care during the pre-natal period, that they appreciate more the value.of vitamins and correct diet in pregnancy, that the excellent scheme of propaganda in pre-natal diet conducted by the Ministry of Food in the press and cinema has taken effect and that the latest generation of grandmothers are passing on sound and up-to-date advice. Deaths from the notifiable infectious diseases were extremely low this year, and apart from pneumonia and tuberculosis there was only one death i.e. from cerebrospinal-fever. There were no deaths from diphtheria of which there were 36 notified cases (53 last year). There were 774 cases of measles arid 203 of whooping-cough with no deaths. There were only two cases of poliomyelitis (infantile paralysis), with no permanent paralyses and no deaths, and one case of enteric (paratyphoid-B) which recovered. Eighteen cases of dysentery were notified (8 last year). The number of notified cases of tuberculosis decreased from 215 last year to 189, with 99 deaths last year and 71 in the year under review. Formal scabies notifications were reduced, from 415 in 1947 to 156 this year. There were no caSes of smallpox in the Borough. With the coming into operation of the National Health Service Act on 5th July this year the Maternity and Child Welfare. Services with the staff and Health Visitors passed from the Borough Council to the control of the London County Council as the Local Health Authority for the personal health services. Diphtheria immunisation, whooping-cough immunisation and routine vaccination against smallpox will now also be under the London County Council though the Borough Medical Officer of Health still rotain3 powers of vaccination under the Public Health (Smallpox) Regulations, 1917. Under the National Assistance Act 1948 the Borough Council has taken over from the London County Council the burial of those persons who die without any suitable alternative provision having been made for burial. Such of the above persons who die in hospital, however, will now bo buried by the Regional Hospital Board, and those who die in welfare homes (lately Public Assistance Institutions) will continue to be buried by the London County Council. Much of the Tuberculosis 'administration has passed to the Regional Hospital Board of the Ministry of Health. The tuberculosis notification registers, measures for the prevention of tuberculosis, supervision of the environment of tuberculous persons etc., remain with the Borough Medical Officer of Health but the Tuberculosis Dispensary service together With most of the staff including the Tuberculosis Officers have passed to the Regional Board. 'The Tuberculosis Health Visitors will now be under the control of the London County Council with the exception of their duties as clinic-nurses at the tuberculosis dispensary which work will be under the supervision of the Regional Board. The Tuberculosis Care Committee and the duties concerned therewith, pass to the London County Council, and a briof review of the growth of the Tuberculosis Dispensary. Service is appropriate at this time of. change and of transfer of responsibility. (ii) In 1907 tuberculosis was more prevalent in Stepney than in any other part of London and it was in this year that the Jewish Board of Guardians appointed 2 Tuberculosis Visitors to visit patients suffering from phthisis. In 1911 a Dispensary for the Prevention of Consumption was opened at 4, Arbour Square. In 1912 two further Dispensaries were opened at 208, High Street, Shadwell and at 18, Great Prescot Street. The Stepney Borough Council took over all 3 voluntary Tuberculosis Dispensaries together with their staffs in 1921 and in 1924 the Tuberculosis Officers were appointed to the Poor Law Hospitals for consultative purposes. Between 1927 and 1929 a handicraft class was begun at 208, High Street, Shadwell in connection with the Dispensary and an L.C.C. openair school was opened at the rear of 35 Stepney Green which premises at that time functioned also as a Tuberculosis Dispensary. It was in October 1935 that the present Tuberculosis Dispensary at Steel's Lane was opened. This is a modern building which was designed specially for the purpose of tuberculosis detection and supervision of patients and it has a well equipped laboratory in addition to consulting rooms and waiting rooms. It serves the whole of the Borough and it is this Dispensary together with the staff which have now passed into other hands. The success of the tuberculosis scheme is indicated by the decline in deaths from phthisis-from 624 in 1901 to 68 in 1948. With tho termination of the Borough Council's Statutory powers in the administration of the Maternity and Child Welfare services, it is also interesting to look back and to survey the development of Maternity and Child Welfare and the work of the Maternity and Child Welfare Committee since its inception on 26th March 1919. The Maternity and. Child Welfare Act of 1918 gave full powers to Local Authorities to establish and develop Maternity and Infant Welfare Centres, but long before that individual boroughs and voluntary bodies had given attention to the care of mothers and babies. From early times France had taken measures for the protection of infant life. The earliest efforts were made for the care of orphans and abandoned infants, and a hospital for sick children was opened in Paris in 1802. Creches were opened in France in 1844 to enable married women with young children to accept employment in factories. Dr.Pierre Budin opened the first Infant Welfare Centre at the Charite Hospital in Paris in 1892, a model for all future infant welfare centres. Mothers brought their babies for inspection and. weighing and advice was given on care and feeding. Soon many other centres were opened in Paris and the provinces. The need for pure milk centres became apparent and the first was opened in Fecamp. In London, the Foundling Hospital was established by Chapter in 1739 in Hatton Garden-in 1748 Dr.William Cadogan a visiting physician urging breast feeding and proper clothing for infants, etc. With the "Dispensary for the Relief of the Infant Poor" in Red Lion (iii) Square in 1769 these were the first Infant Welfare institutions in England. Dr.Brunnell of the new Dispensary in 1816 was already advocating the "home visiting of infants," In 1852 the Hospital for Sick Children.- Great Ormond Street, was founded. The first milk centres in England were opened in St..Helens, Lancashire, in 1899. Sterilised and suitably modified milk was Supplied. In 1901 Infant Welfare Centres were opened in. Liverpool by Dr. E. W. Hope, the Medical Officer of Health, to which Health Visitors were attached. In 1905, home visiting of infants by Corporation Visitors in Glasgow was commenced. In 1906, Huddersfield Corporation obtained parliamentary powers for the compulsory notification of births in the Borough, and this let to the Notification of Births Act, 1907, an adoptive act, made compulsory in 1915. In 1902 the Midwives Act was passed, leading to other acts, until the 1936 Midwives Act established a full-time domiciliary midwifery service. The Education Act of 1907 established the systematic medical inspection of school-children, and experience in working this Act soon showed that regular medical inspection of children prior to school age was necessary. Dr. D.L. Thomas, the Medical Officer of Health to the Limehouse District Board, and afterwards in 1901 to the Stepney Borough Council, was not behind in realising the necessity for infant care in Stepney. The infant mortality of Limehouse (though not of Stepney as a whole) was then the highest in London. In 1900 he urged the District Board to appoint 2 Health Visitors to visit and instruct mothers in the care and feeding of their infants. It was intended that these women would have the status of sanitary inspectors, so as to secure a grant from the Local Government Board towards the payment of their salaries. The Local Government Board refused to give a grant and the scheme fell through. Arrangements were then made to distribute leaflets of advice on infant care to the mothers in the Limehouse area. Had the Board appointed Health Visitors they would have been the first municipal health visitors in London. However, in Stepney much welfare work was being done by voluntary associations. One of the earliest was started by-Mrs. Alice Model, who founded the Jewish Sick Room Help Society in 1895, which was allied to the Jewish Maternity Hospital in Underwood Road and the Infant Welfare Centre subsequently attached thereto. Mrs. Model spent an active life devoted to Infant Welfare, until her death last year. The Jewish Maternity Hospital is now known as the Boarsted Memorial Hospital and has new premises in Lordship Road, Stoke Newington. In 1902 the Public Health Committee of the Stepney Borough Council considered a report from Dr. Thomas advising the appointment of two female Health Visitors, to be appointed in the first instance for 2 years, at a salary of £100 a year. Their suggested duties included: (iv) (1) To visit the homes of the-poor and give advice on matters of Home Hygiene including proper clothing and feeding of infants. (2) To visit houses in the district where diarrhoea, measles and whooping cough were prevalent, and instruct the relatives as to the necessity of isolation and proper care of the sick. The ladies to be appointed were to be trained nurses of tact and education who should wear uniforms, and one of whom should be able to speak Yiddish. The Public Health Committee recommended the appointments to the Council, but the Council rejected the scheme by 29 votes to 17. Following this failure, a "well-known nobleman" associated with an outside society offered to pay the salary of a Health Visitor for the Limehouse district for 2 years, and the Committee were thus enabled to appoint a Miss Forrester, who worked in Limehouse for two or three years and then was transferred to another district in Stepney for two years. She commenced her duties on 1st October 1903. Dr. Thomas records that her efforts were apparently successful and that the infant mortality rate of Limahouse was lowered during hor period of office. In October 1906 the Women's Industrial Council approached the Council to appoint a health visitor, and in 1907 a deputation from the Stepney Visitors Association came before the Council urging the appointment of a visitor who should be a woman Sanitary Inspector. A subcommittee approved the proposal for a woman "Sanitary Inspector and Health Visitor" for a period of-twelve months, but the full Health Committee could not see its way to agree. In March 1908 a deputation from the Stepney Council of Public Welfare, including the Bishop of Stepney, addressed the. Council and made a similar request, which was however not passed by the Council. Dr.Thomas, in his report of 1908, commenting upon this matter, observed that most districts with a population of over 100,000 had already appointed a woman sanitary inspector; that 22 Metropolitan Boroughs had appointed between them 39 female sanitary inspectors, and only six remained to do so. These women sanitary inspectors did some of the work now done by Health Visitors. However, the Council may have considered that much work was already being done by voluntary associations in Stepney. The Notification of Births Act, 1907, gave power to Local Authorities to appoint Health Visitors, and the London County Council (General Powers) Act, 1908, strengthened these powers in London, enabling the Borough Council to pay for the Health Visitor's salary. The Borough Council on 28th July 1909 adopted the Notification of Births Act, 1907, and the Act came into force in the Borough on 8th September 1909. The Borough Council then appointed its first Municipal Health Visitor, who commenced duties on 1st February 1910. This lady wa3 the late Miss Virtue who remained in the service of the Council until her death in November 1931. Meantime much voluntary effort was being made for maternity and child welfare in the Borough. In 1908 the Stepney Infant Welfare Centre and School for Mothers (v) commenced at 587, Commercial Road.E. It was the second infant welfare centre to be opened in London. This Infant Welfare, and School for Mothers continued to operate until taken over by the Borough Council in 1946. In 1911, the Centre held a clinic every Tuesday with two medical men in attendance, and there were also classes in sewing, cooking, and home nursing. During the 1914-18 war the Centre assisted in evacuating mothers and babies to the country and in 1917 the Board of Education nado a grant which was continued in the post-war years by the Ministry of Health for the expansion of the service. There was considerable co-operation between the Health Committee and the voluntary Infant Welfare Centres and the Council's Health Visitor worked in association with the voluntary Health Visitor of the Stepney School for Mothers and between them they thus covered Limehouse, Ratcliffe and Shadwell. Attached to the centre there was a small residential nursery for backward infants, which closed at the beginning of the war and has been greatly missed. In 1909 there were the following voluntary Creches (Day Nurseries) in Stepney: Dr.Barnardo's (Marie Hilton) Creche, 50 children; Jewish Nursery at New Road, 35-50 children; George Yard Centre, 18-20 children, and 154, St. George's St root, 10-18 children. The St. Paul's Day Nursery, Wellclose Square, the only one of these Day Nurseries which is still operating in the Borough, was then taking 18-20 children. Sister Dorothy Reilly, the present devoted matron, has been in charge for 22 years. About 1912 the body known as the St.George's and Wapping Infant Care Committee had infant consultation centres at nine different addresses, with Doctors in attendance at each. In 1911, Dr.Thomas was pressing for the appointment of a second Borough Health Visitor. In Great Britain there were many unpaid. persons helping with infant welfare, but in 1913 there were only 470 salaried Health Visitors in England and Wales. The Council adopted the 1909 Notification of Births (Extension) Act in-1912. The Notification of Births (Extension) Act of 1915 enabled half the cost of infant welfare schemes to be paid from Government grants, and in 1916 a second Municipal Health Visitor was appointed by the Borough Council. The Maternity and Child Welfare Act, 1918, enablod any local authority within the meaning of the Notification of Births Act, 1907, to make such arrangements as might be sanctioned by the Local Government Board for attending to the health of expectant and nursing mothers and of. children who had not attained the age of 5 years and were not being educated in schools recognised by the Board of Education. The provisions of the Act of. 1918 were adoptive and the Council, on 26th March, 1919, upon a report by the Public Health Committee decided to adopt the provisions of the Act for the Borough of Stepney. As the result of this decision there was set up for the first time the Maternity and Child Welfare Committee which held its first meeting on the 26th March, 1919. (The final meeting was on the 22nd Juno, 1948). (vi) At the time when the provisions of the Act of 1918 were brought into operation in Stepney, there were 20 Infant Welfare Centres, 4 Ante-Natal Clinics, 10 Creches and a Dental.Clinic, all of which were operating in the Borough on a voluntary basis. In this year the Council appointed four Health Visitors. The Infant mortality rate was then 115 deaths per 1,000 live births, compared with 178 during the five years from 1890 to 1894. Within two years, 14 Municipal Health Visitors had been appointed, 5 Municipal Infant Welfare Centres had been established in the Borough, and the milk scheme was further developed, the cost of this scheme having, within one year ended December 1919, mounted from £10 to £500. In this year 94 cases were supplied. During the following year the estimate for the milk scheme was increased to £3,000, and 1,381 persons benefited from the scheme. About this time the Infant Mortality rate showed a noticeable improvement, the number of deaths for the year 1922 being 79 per 1,000 live births as compared with 115 for the year 1918. Developing the maternity and child welfare services on progressive lines the Council increased the number of Health Visitors and established further welfare centres. The milk scheme was further extended and by 1924, 10,000 persons were supplied during the year at a cost of £4,000. By 1926, there were 6 Municipal Welfare Centres and in addition seven Convalescent Homes were being used by.the Borough Council. During the following five years 7 Municipal Welfare Centres were in operation in addition to the 9 Voluntary Infant Welfare Centres. Prior to the commencement of the war in 1939 the Council employed 10 Health Visitors, there being in addition 14 Voluntary Health Visitors. There were 7 Borough Infant Welfare Centres and 9 Voluntary Infant Welfare Centres, and 5 Voluntary Day Nurseries. On the outbreak of the war the 5 Voluntary Day Nurseries were evacuated to safe districts and the Borough remained without day nurseries until 1942, when the War-time Day Nurseries were opened, one at the. Queen Elizabeth Hospital for Children, Glamis Road accommodating 50 children, the second at Old Church Road with 60 children and the third at Robt Montefiore School, Vallance Road with 60 children. Only one of the 5 Voluntary Day Nurseries (St.Paul's, Wellclose Square) returned to Stepney after the war and is still functioning. Only one Voluntary Infant Welfare Centre, The Dame Colet at 29. Duckett Street, continues in the Borough, the remaining 8 which were operating in the Borough in 1938 having been taken over by the Borough Council on the following dates:- Shadwell Memorial Hall, 291 The Highway in 1940; Women's League of Service, 12 Clare Street , the Minories-December 1940; St.John's Mission Hall, 61 carr Street - December 1941; East Stepney Jewish Centre, Beaumont Street - August 1942; Jewish Infant Welfare Centre, Berner Street-1943; "Jewish Mothers Welcome," Berner Street-1943; Jewish Infant Welfare Centre (of the "Jewish Sick Room Help Society") 36 Underwood Road in 1945; Stepney Infant Welfare Centre and School for Mothers, then at No.2 Salmon Lane in 1946. (vii) Side by side with the foregoing activities the Council have developed a Home Help Scheme, but from 1939 to 1943, owing to the war, this scheme was held in abeyance. In 1943 the scheme was revised for Domestic and Home Helps, the Domestic Helps being provided to assist in the homes where necessary owing to ill-health or old age, and Home Helps for expectant mothers. In 1947, a Nursery Creche with morning and afternoon sessions for 30 children was opened at 57, White Horse Road. In Novamber of the same year the Council opened the Mary Hughes Centre and Nursery at Underwood Road having acquired the property which was formerly occupied by the Jewish Maternity Hospital and carried out extensive works of conversion and adaptation. The Council's Day Nursery at Robt.Montefiore School, Vallance Road and the Infant Welfare Centre at Hughes tensions, Vallance Road were then both transferred to these premises. At the time of the transfer of the Council's maternity and child welfare powers to the London County Council there are functioning within the Borough 3 Municipal and 2 Voluntary Day Nurseries; 1 Municipal Creche; 7 Municipal and 1 Voluntary Infant Welfare Centres and 2 Municipal Ante-Natal Clinics, while the Domestic and Home Helps service employs 65 Home Helps caring' for approximately 150 cases. In addition, a prefabricated Nursery Hut erected by the Borough Engineer and Surveyor (see p.15) in the Christian Street area is nearing completion and will provide Nursery accommodation for 55 children. Some indication of the measure of success achieved by the Borough Council's Maternity and Child Welfare Scheme is to be found in the decrease in infant mortality from 165 per 1,000 live births in 1901 to 27.7 per 1,000 live births in the year ended 1948; in other words the infant mortality rate has decreased to one-sixth of the rate recorded 48 years ago. Furthermore the maternal mortality rate which in 1914 was 3.1 deaths per 1,000 live and still births, having fluctuated very considerably during the intervening years, has reached zero this present year. At its meeting on the 22nd June this year the Borough Council expressed to all officers and employees of the Council engaged in the Maternity and Child. Welfare services, and to those about to be transferred to the London County Council and the Regional Hospital Board, its appreciation of the loyal and devoted service they had rendered and the Council's best wishes for their future. success. I too would like to add my tribute to those officers and employees of the Maternity and Child Welfare, Tuberculosis and other transferred services and I hope and feel that under the auspices of the London County Council and the Regional Hospital Board the personal Health Services will go forward to still greater successes for the benefit of the citizens of Stepney. It remains for me to express my thanks to the Chairman and members of the Committees for their continued support and interest (viii) and to thank the Staff for their assistance and co-operation during the year. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient Servant, F. R. O'SHIEL, Medical Officer of Health. (ix) (x) STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December, 1948 Medical Officer of Healths F.ROANTREE O'SHIEL, L.R.C.P.I.,L.M.,D.P.H. Deputy Medical Officer of Health: J.KERR BROWN, B.Sc.,M.B.,Ch.B.,D.P.H. Public Analyst: D.HENVILLE, F.R.I.C. Deputy Public Analyst: W.M.PAULLEY, B.A. ,F .R.I.C. Assistant Administrative Officer: W.F.LELLOW (2) Sanitary Inspectors: District: R.W.G.M(3) W.H.HAW0RTH(3) W.E.ANSTEE(1.3) S.FIRSHT (3) J.J.kENIRY(3) E.G.CARTER(3) G.D.FREELAND(1.3.4) S.S.L0WTHER(3.4) W.CUE(1.3) E.C.HAWKER(3) E.P.WEBBER (3.4) Food: A.C.BROWN(2.4) H.J.GREEN(l.2.4) W.F.SMETH(2.4.7) S.V0GLER(3.4) Disinfestation: E.J.EDWARDS (2.4). Disinfestation and Female Common Lodging Houses: MISS H.A.WHITTY (3.4.5.6.8) Housing: C.F.GUY(2) Rodent Control J,G-.McCcCARTHY(3) Clerical Staff: T.AYLWARD W.J.DIXON W.P.HOWARD MISS R.LEVEY D.J.BERRY S.EMBLETON S.S.HARRI J.McMULLON S.J.CARR MRS.C.GARDNER W.E.HART P.PAYNE M.PLISKIN B.REILLY Caretakers: Foreman Disinfector: A.N.COOK, Public Health Offices W.SEXTON W.CLARK, Mortuary TEMPORARY STAFF Clerical: MRS .M.E.MEREDITH MRS.M.MUNDAY E.F.E.ROOME Rodent Investigators: S.SMITH T.T.WAIKER S.C.LUDLOW 1.Cert.Royal San.Inst. 5.Health Visitor's Cert. 2.Cert.San.Insp.Exam.Board. 6.State Cert.Midwife. 3 .Cert.Royal San.Inst. & San. 7.Diploma. Social Science. Insp. Exam.Jt.Board. 8.Trained Nurse. 4.Cert.Meat and other Foods, Temporary officer made "permanent" 16 June 1948. Seconded to the War Damage Department. Returned to the Public Health Department 13 Sept .1948. -1- Under the National Health Service Act 1946 the following servioes of the Borough Council were transferred to the London County Council on 5th July 1948 with the exception of the Tuberculosis Dispensary which went to the Regional Hospital Board: Infant Welfare Centres, Ante-Natal Clinics and Day Nurseries Care of mothers and young children Health Visiting Home Nursing ' Cere and after care Domestic and Home Helps Dental Clinic Tuberculosis Dispensary Service Vaccination and the undermentioned staff and. employees were transferred in consequence thereof:- (a) to the Local Health Authority (London County Council) Health. Visitors: Tuberculosis Visitors: Mrs.G.C.Buchanan Miss A.M.O.Jones Miss M.Bailey " M.Coulman " B.S.Beardson " E.Lindsley " E.Clements " M.F.Weatherilt " L.E.Godtschailk " J.P.Wilson " D.I.Griffin " H.L.Hirst Tuberculosis Care " M.Pyser Committee Secretary: " V.Rubens Miss' M.Grant " M.T.Smithson " M.F.S.Styles Home Helps Organiser: " H.Woodfine Miss M.M.Hugh Mrs.S.J.Yarnell Vaccination Officer: Clerks: Mr.R.Bach, B.A. Miss G.Boulton " G.A.Carthy Caretakers: " M. Fitzgerald Mrs.L.M.Treadway " M.W. Hunt Mr.J.P.Mulshaw " H. Dzvonkus " I.Segal Mrs.H.F.Hiles Mr.F.S.Roberts temporary officer made "permanent" by the Borough Council 16th June 1948. -2- Nursery Metrons: Nursery Students: Miss M.Olive Miss M.Bowen " M.M.Cluley " M.Dixon " D.Woodman " E.Edgett " A.Murray " R.Folkard J.Hambleton Nursery Deputy Metrons: " A.Jacobs Mrs. D.N.Yates " B.Rice Miss L.E.Berkery " J.M.King " W.D.Bloss " B.Rice " R.Thomson Nursery Warden: " M.E.Miller Miss P.Mellors " J.B.Clark " R.Foulger Nursery Nurses: " J.Hatt Miss N.J.Nowing " I.Nash " J.L.Turner " C.Howard " J.Clements " S.Srsith " I. Baugh " R.M.Everett " W.M.Baxter " E.Harvey " A.L.Robinson " M.Anderson " E. J.Spicer " E.M.Simms Mrs. D.Andrews " J.Larmas " J.M.Mottram " J.Do'Ath " M.Stanbridge " D.Stead " L.Novill Nursery Assistants: Miss A.L.Robinson Miss D.A.Wright Mrs. A.Humpleman Mrs. M.Dotnon " S.Martin " E.M.Poek In addition to the above, all cooks and cleaners at the Nursery Creche, Day Nurseries, Infant Welfare Centres and at, 35, Stepney Green were transferred, as well as a parttime cleaner. (b) to the Regional Hospital Board of the Ministry of Health. Tuberculosis Officer: Asst.Tuberculosis Officer: Dr.R.M.Orpwood Dr.G.Highfield-Jones Clerk: Laboratory Attendant Cr-retaker: Miss D.P.Nosh & Messenger: Mr.A.G.Harcus Mr.W.Swan Temporary officer made "pormanent" by the Borough Council on 16th June 1940. -3- SUMMARY OF STATISTICS, 1948 Area of Borough (in acres) 1902.766 Population (Registrar-General's last estimate) 100,020 Number of inhabited houses (end of 1948) according to Rate Books 25,130 Rateable Value, 1 April 1948 £1,215,511 Sum represented by a penny rate, gross £5,065 LIVE BIRTHS. TOTAL M. F. Live birth rate per 1000 Legitimate 1942 - - estimated resident popu- Illegitimate 187 - lation - 21.2. Total Live Births: 2129 1095 1034 STILL BIRTHS. 42 19 23 Stillbirth rate per. 1000 total (live and still) Total Births: 2171 1114 1057 births - 21.7. DEATHS. 1202 680 522 Death rate per 1000 estimated resident population - 12.0. DEATHS FROM PUERPERAL CAUSES. (Headings 29 and 30 of the Registrar-General's short list): Deaths Rate per 1000 total (live & still) births No.29 Puerperal sepsis Nil Nil No.30 Other puerperal causes " " DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE. All infants per 1000 live births 27.7 Legitimate infants per 1000 legitimate live births 28.3 Illegitimate " " " illegitimate " " 21.3 DEATHS FROM:- Cancer (all ages) 236 Measles " " Diarrhoea (under 2 years of age) 8 Tuberculosis of respiratory system 68 Do. Other forms 3 Note:- Subject to correction after publication of Registrar-General's figures for 1948. -4- I. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Population. The last estimate from the RegistrarGeneral was 100,020. Births. The total number of live births of StepneyResidents during the year was 2129 - 1095 males and 1034 females or 55 less than in the previous year. The birthrate was 21.2 per 1000 of the population. Marriages. The total number of marriages which took place during the year was 1271. Deaths. The total number of deaths, after deducting deaths of non-residents who died in the Borough and adding those residents who died in outlying institutions was 1202 - 680 males and 522 females or 217 loss than in the previous year. The death rate for the whole Borough was 12.0 per 1000 of the population (14.1 in 1947). Public Assistance and Unemployment. The Ministry of Labour and the Chief Officer of Social Welfare have kindly supplied me with the following information: (a) Estimated number of persons residing in the Borough registered as unemployed at 31 December 1948: Men Boys Women Girls 1520 25 142 9 - Total 1696 (b) Residents of Stepney in receipt of outdoor relief at 27 December 1947: Men Women Children 207 384 251 - Total 842 In view of the passing of the National Assistance Act on 5th July 1948 no persons now receive Poor Law relief. Alternative assistance is now administered by the Assistance Board of the Ministry of Pensions. -5- Stepney Borough Council Information Service. An Information Centre, under the direction of the Borough Librarian, Mr.G.Newland, and his staff, was opened at 671a, Commercial Road, E.14 (Stepney Green 2218) on the 6th December 1948 to supply Stepney citizens with information and advice on all everyday problems e.g. National Health and Insurance, Family Welfare, social and dories tic problems, local activities, education, form filling, etc. With the growth of the new Social Services it is essential that every member of the public should be aware of the benefits to be obtained from these services and the Stepney Information Centre will advise accordingly. At the date of publication of this report, close on 2,000 residents in the borough have consulted the Information Service on their various problems, not the least of which is "how they are affected by the Health Services." Welfare of Aged Persons (see also p.26). The plight of aged persons in the Borough has given concern to the Borough Council, and on the 4th February a resolution was passed, as a result of which a large conference, representing all the interests in the Borough, was called on 22nd March. Arising out of this, the Women's Voluntary Services have provided a "Meals on Wheels" Scheme, assisted by a grant from the Borough Council under Section 31 of the National Assistance Act 1948. The service started on 26th April, and at the time of publication of this report 1,000 meals a month are being delivered to aged persons in the Borough. A "Darby and Joan Club" has been organised by the W.V.S., with a present membership of 80, where 150 meals per week are served (see also the Home Help Service on p.9). One of the most serious problems at the present time is that of the care of aged and infirm persons. Owing to the shortage of nursing staff it is difficult to oxpand the accommodation in the Hospitals and Welfare Homes. It is not easy to get chronic aged persons admitted. -In consequence many old persons, sometimes in poor health, remain in their own dwellings (often in single rooms). Families to-day are small and. many sons and daughters, married or -6- otherwise, seem to find it impossible to care for their aged parents. The Home Help services are necessarily limited in scope, and it is not easy to expand this service. Voluntary visiting of aged persons is practically non existent, or at best very irregular. The expansion of institutional accommodation, Home Help services, "Meals on Wheels" etc. are somewhat long term solutions, but the problem is, an urgent one. Application of Section 47 of the National, Assistance Act 1948 is limited to special cases. Meantime the aged person not only requires lay attendance in his own home, but frequently the services of a doctor. The system in operation before July 1948 by which the Relieving Officer could call out a District Medical Officer no longer operates. It has been replaced by the General Practitioner Service of the National Health Service Act. I am afraid, at the present time, this Service is not working out too well for the decrepit aged. Some of them are too old and helpless to get themselves registered with a general practitioner. It involves attendance at a postoffice, collecting a panel card, completing it, and lastly, finding a doctor who is willing to take them on his panel. Temporarily, therefore, many old folk have not got a doctor. Everyone interested in old persons should try to help them with the procedure of getting a doctor. It would be helpful if, at least temporarily, some provision wore made to replace the district medical officer; i.e. the initiative in finding a doctor should not be loft with the aged as at present. The Assistance Board is most helpful as far as money is concerned. The aged usually have not only a pension, but supplementary pensions to meet any special expense. But again, some are so aged and helpless that they cannot spend their money. They require daily assistance with shopping, cooking and washing. I think this problem of the aged is more acute in the industrialised East End than in other parts of the country. -7- II. GENERAL PROVISIONS OF HEALTH SERVICES. Staff. Various changes in the staff of the Department took place during the year: (a) ceased duty K.C.Clark Sanitary. Inspector 12 June J.J.Coveney do 31 March Miss I.Love Health Visitor 28-February G.L.Nicklin Sanitary Inspector 11 December (b) commenced duty T.Aylward Correspondence Clerk 1 April Mrs.G.C.Buchanan Health Visitor 5 April S.J.Carr Principal Assistant 9 August K.C.Clark Sanitary Inspector 9 February Mrs.C.Gardner Clerk 16 August E.C.Hawker Senitary Inspector 13 December E.G.Carter do 11 November G.L.Nicklin do 7 June J.P.Mulshaw Caretaker, Mary Hughes Centre & Nursery 1 April Laboratory Facilities. There were 938 investigations carried out at the Mile End Hospital on behalf of the Public Health Department. These consisted of: 758 swabs for diphtheria bacilli (15 of which were positive). 2 animal inoculations. 72 bloods for rhesus factors and grouping. 79 Wasserman reactions. 13 swabs for micro-organisms. 5 urines for typhoid. 5 faeces for typhoid. 4 Widals for typhoid. Insulin. Under the authority of the Ministry of Health Circular 2734, insulin was supplied free during the period 1st January to 30th June to 13 persons suffering from diabetes, of which 3 were new cases. Nursing in the Homes. 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 until taken over by the London County Council on the 5th July 1948. The number of visits to that date was as follows No.of Cases Revisits To children under 5 years 16 194 To persons over 5 years 374 8,993 -8- Domestic and Hone Helps. No. of part-time Helps on the panel 57 " Cases attended: Free 810 Paying 383 " attendances made to them 8296 " visits by the Organiser 210 1 of these related to a confinement. HEALTH PROPAGANDA continued to receive the attention of the Public Health Department. Diphtheria. In compliance with the Ministry of Health Circular 97/48 a diphtheria immunisation campaign was carried out in the Borough. Cinema slides were shown at six local cinemas for various periods between August and September. Press advertisements in local newspapers appeared during August, September and October. In addition an advertisement appeared in a local Parish magazine during the whole year. Immunisation birthday cards were sent to every child in the Borough on its first birthday. Literature and Posters. Over 15,500 leaflets and 750 posters were distributed to factories, clubs, schools, doctors' surgeries, and throughout all Borough Council establishments. Health Danger of Bathing in Thames. 300 posters on this subject were displayed along the riverside and canal banks. Vaccination. 250 leaflets giving particulars of facilities for vaccination against smallpox were distributed. In addition, various leaflets and posters on the importance of washing hands before preparing food, advice on diarrhoea, food poisoning, infantile paralysis, flies, measles, whooping cough, home and everyday accidents, etc. were distributed throughout the Borough. at 30th June 1948. -9- TUBERCULOSIS (to 4th July) No. of attendances at Dispensary (incl. contacts) 2886 "consultations with Medical Practitioners:- (a) personal 287 (b) other 405 " visits by Tuberculosis Officers (including personal consultations) 317 " " " Tuberculosis Visitors for dispensary purposes 1490 " contact examinations made 484 " contacts boarded out 7 " patients recommended for sanatorium 118 " specimens of sputum examined: Negative 371 Positive 83 Total 454 " X-ray examinations made: Films 1208 Screening 642 Total 1850 " new cases examined during the period 210 Special Treatment. (a) Tuberculosis Officer's Clinic at Mile End Hospital: No.of patients under treatment 52 " artificial pneumothorax refills given 520 " pneumo-peritoneum refills given 122 Total attendances at the Clinic 642 (b) at other Hospitals: No.of No.of patients attendances Pneumothorax refills at Brompton Hospital 4 74 " " " London Chest " 4 45 " " " Grove Park "1 19 " " " Royal Chest "1 8 Finsen and Sunray treatment at London " 3 31 Supply of Extra Nourishment. 328 grants of extra nourishment were supplied to 101 patients. Tuberculosis Financial Allowances. 68 patients were in receipt of these allowances at the end of June. -10- Memo.37/T (Revised) Ministry of Health Form T.145. Return showing the work of the Dispensary during the period 1 January to 4 July 1948:- Diagnosis. Respiratory: Non-Resp. : Total. Grand Total Sex | Adults ren: Adults Child -ren Adults Child -ren 1.(1) No. of definite cases of Tuberculosis on Dispensary Register on 1/1/48 M 530 83 53 60 583 143 F 289 65 53 35 342 100) 1168 (2) Transfers from Authorities of areas outside that of the M 14 2 - - 14 2 F 8 3 - 1 8 4 28 (3) Lost sight of cases returned - - - - - - - - II.No.of cases diagnosed as Tuberculosis during half year:- M 25 5 2 - 27 5 (1) Class A (T.B.minus) F 7 10 2 - 9 10 51 (2) Class B (T.B.plus ) M 28 - - - 28 - F ,15 — — 15 - 43 II.No.of cases included in I and II written off the Dispensary Register during half year as:- M 6 2 - 1 6 3 (1) Recovered F 8 1 2 1 10 2 21 (2) Dead (all causes). M 22 — 1 1 23 1 F 9 — 1 - 10 - 34 (3) Removed to other M 15 - - 2 15 2 F 11 3 2 1 13 4 34 Ml 9 1 1 1 10 2 F - - — 2 - 2 14 IV.No.of definite cases of Tuberculosis on the Dispensary Register on M 545 87 53 55 598 142 4/7/48 F 291 74 50 32 341 106 1187 Tuberculosis Care Committee. During the six months ended June 1948, the Tuberoulosis Care Committee considered 107 cases. Fifty five of these were patients or their families needing extra help, and with the aid of their voluntary fund the Committee were able to arrange for all the assistance required. Removal expenses to better accommodation were paid, warm clothing provided, pocket money allowed to destitute patients in sanatorium, and those without any sickness benefit. Help was also given towards the cost of holidays, speqtacles provided, and fares paid for relatives to visit patients at sanatorium for long periods. The Tuberculosis Allowances Scheme will be superseded by increased insurable benefits, and supplementary help from the National Assistance Board, but there will still be the need for the Care Committee to provide certain necessary assistance that cannot be covered by State grants. 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 milk 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 done at the Dental Clinic to 30th June 1948. Maternity Tuberculosis Ch. F. Total M. F. Ch. Total No. of attendeances 37 323 360 14 17 31 No. of Fillings: Simple - - - - - — - Root - 17 17 — — — - No. of Scalings - 58 58 - 2 — 2 Extraction Cases: Without anaesthetic — — - — - — — Local administration - 2 2 - 1 - 1 Gas administration 16 68 84 3 5 - 8 No. of teeth extracted 34 297 331 23 14 - 37 Dentures: Uper - 23 23 1 — - 1 Lower - 18 18 1 - - 1 Re-models — - - - — - - Repairs - 12 12 1 - - 1 No. of dressings - 59 59 - 1 - 1 Number for advice 20 45 65 4 10 - 14 Denture visits - 162 162 7 1 - 8 No. of New Patients 20 41 61 3 9 - 12 Session: Gas 12 7 Ordinary 12 7 -12- MATERNITY AND CHILD WELFARE Arrangements made for maternity and child welfare by the Council and by voluntary associations, giving particulars of the work done during the period 1st January to 4th July 1948. 1. No. of births notified in the area during the half year ended 4th July, as adjusted by any transferred notifications:- Live births 1080 Stillbirths 26 - Total: 1106 2 Health Visiting. No. of Health Visitors employed as at the 4th July:- By the Council 13 By voluntary associations 1 (and 1 part-time) No. of visits paid by all the Health Visitors:- First Total visits To expectant mothers 553 978 " children under 1 year 1022 6178 " " between ages 1 and 5 - 9367 3. Infant Welfare Centres. No. of Centres provided and maintained: By the Council 7 By voluntary associations 1 No. of children under 5 years of age who first attended the Centres during the period, and who on the date of their first attendance were:- Under 1 year of age 988 Oyer 1 year of age 161 No. of children under 5 years of age who attended the Centres during the period, a rd who at the end of June were:- Under 1 year of age 1343 Over 1 year of age 1671 4. Ante-Nntal and Post Natal Clinics. No. of Clinics provided and maintained : Ante-Natal Post Natal By the Council 2 — By voluntary associations 2 1 No. of women who attended at the Clinics 638 118 to 4th July 1948. -13- 5. Day Nurseries. No. No. of approved places No. of childern on register Nurseries maintained: 0-2 2-5 0-2 2-5 By the Council 3 76 94 77 99 " Voluntary Associations 2 - 45 1 61 " Municipal Nursery Creche 1 15 15 (approx. 200) 8. Home Helps and Domestic Helps. Employed 57 (part-time). No. of cases where helps were provided was 1193 including one Home Help in a confinement case. 9. Institutions provided by Voluntary Associations and -subsidised by the Council. The Council made a grant of £200 per annum for one bed. No. of women admitted from the Council's area 24 (2a month) 10. Maternal Deaths. No. of women who died from sepsis Nil " " " " " " other causes Nil 11. Illegitimate Children. The Health Visitors work in close co-operation with the local Moral Welfare Worker. 12. Care of Premature Infants. (Circular 20/44). No. of premature babies notified whose mother is normally resident in the Council's area 84 Total number of premature babies notified who were born at home 3 In hospital or nursing home 81 No. of those born at home who were nursed entirely at home 3 Died during the first 24 hours - Survived at end of one month 3 No. of those born in hospital or nursing home who died during the first 24 hours 5 (6 died after 24 hours but before end of 1 month) Survived at end of one month 70 to 4th July 1949. -14- . 13. Infectious Disease. No. of Cases: Ophthalmia Neonatorum. Puerperal Pyrexia. Notified during the year 2 3 Visited by Officers of the Council 2 3 Removed to hospital 2 3 In both cases of Ophthalmia Neonatorum the vision was unimpaired. 14. Child Life Protection. Individual foster mothers receiving children under 9 years of age for reward apart from their parents at the end of June 9 (One was guaranteed payment by the Council). No. of children under 9 years of age received during the period 1 No. of children under 9 years of age at the end of June 11 No. of Child Protection Visitors: Health Visitors 14 Other (female Sanitary Inspector) 1 Christian Street Day Nursery. By agreement with the Ministry of Health, the Borough Council have erected a day nursery planned by Mr.B.W.Stuttle, Borough Engineer and Surveyor, to the detailed requirements of the Medical Officer of Health, and constructed from the component parts of standard huts supplied by the Ministry of Works. The nursery will provide accommodation for between 50 and 60 children from 0 to 5 years of age. It has many unique features, including under-floor heating, and is of a simplified and convenient design, whereby the Toddlers, Tweenies and Infants Nurseries are arranged on the southern side of a wide corridor, whilst the Matron's office, the kitchen and the staff rooms are on the northern side of the corridor. The toilets for each group are conveniently placed on the north side immediately opposite the entrance to each nursery. Quarters are provided for a resident caretaker. The nursery was not completed by the Borough Council until after the 5th July, and was handed over to the London County Council on the 25th October. I understand it is the intention of the County Council to open this nursery some time in April 1949, to 4th July 1948. -15- Day Nurseries (to 4th July) Particulars as to the attendances at the Council's three Nurseries and the two Voluntary Nurseries are given below: Old Church Road Mary Hughes Queen Elizabeth Beaumont Hall (Vol.) St. Paul's (Vol.) Accommodation: 0-2 yrs. 30 30 16 - - 2-5 “ 30 30 34 20 25 No. of children on Register at 30 June: 0-2 yrs. 26 28 23 - 1 2-5 " 33 38 28 29 32 No. of mothers whose children were on the Register at 30 June: (i) In employment: (a) whole-time 55 58 43 24 28 (b) part-time 4 2 8 3 - (ii) Not in employment — 1 — 2 2 Average attendance per day: 0-2 yrs. 20 22 16 - 1 2-5 " 28 33 28 22 29 Highest attendance in any one day: 0-2 yrs. 26 22 25 - - 2-5 “ 30 28 37 28 33 Nursery Creche. The total number of children attending the Creche was 4706, i.e.: January 1003 April 750 February 801 May 561 March 844 June 747 Nursery Hostel. The Hostel for the accommodation of Nursery Students was opened at the Mary Hughes Nursery on the 14th June, and the hostel staff and equipment at 35, Stepney. Green were transferred en that date. to 4th July 1948. -16- Births Notification Act. Live births Stillbirths Total No. of births notified: By Doctors 892 19 911 By Midwives 188 7 195 1080 26 1106 Feeding of Infants. No. breast fed 915 “ artificially fed 105 " dead before visit by Health Visitor 6 " removed before visit by Health Visitor 27 " untraced 1 Infant Welfare Centres and Clinics. Details of the work are given on page 22. On the 12th January the Centre at 2, Salmon Lane was transferred to 673, Commercial Road and the Ante-Natal Clinics held there were transferred to 2, Salmon Lane. Dinners were supplied through the Londoner's Meals Service on the grounds of health to expectant and nursing mothers and to children under five years of age who were in necessitous circumstances. The number of dinners supplied was 362 to adults and 480 to children at a cost to the Borough Council of 38.4s.2d. Sunlight Treatment was given at the Mile End Hospital to 11 children who attended the infant welfare centres, the number of treatments being 78. Child Life Protection. 52 visits were made:- To Foster mothers 7 " " children 26 " Other 19 The number of foster mothers receiving children for reward at the end of June was seven with one child and two with two children. • • • • • . One foster mother was guaranteed payment by the Borough Council. to 4th July 1948. -17- HEALTH VISITORS. - The following table shows the number of visits, etc., paid up to the 4th July, 1948. Miss BAILEY. Miss BEARDSON. Miss CLEMENTS. Mrs. DICKSON (Vol.) Miss GODTSCHAILK. Miss GRIFFIN. Miss HIRST. Miss LOVE (to 28 February) Miss PYSER. Miss RUBENS. Miss SMITHS0N. Miss STYLES. Miss WOODFINE. Mrs. YARNELL. Mrs. BUCHANAN. (from 5th April) TOTALS. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Visits: - Primary 48 92 65 78 73 61 78 30 71 112 68 67 84 75 20 1022 Revisits: - To infants under 1 year 303 457 254 454 410 328 472 126 396 306 207 372 527 398 197 5156 To children between 1-5 years 564 501 540 1014 663 784 438 105 920 764 511 504 793 895 371 9367 Ante-natal:- Primary 15 59 17 69 49 38 45 15 58 59 26 25 17 35 26 553 Subsequent 11 22 10 78 21 33 15 6 20 26 48 1 25 90 19 425 Ophthalmia Neonatorum - 1 - - - - - - - 1 - - - - - 2 Puerperal Fever — — — — — - - - - - - - - - - - Puerperal Pyrexia - - 6 - - 1 - - - - 1 1 - - - 9 (Continued) 18  (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Measles 21 18 33 63 66 46 53 - 25 27 33 57 28 58 11 538 Measles revisits 3 8 11 - 5 15 3 7 2 2 15 1 1 14 11 98 Scabies - 7 7 2 4 — — - 2 12 4 1 — 13 2 54 Miscellaneous 74 274 118 171 249 219 202 111 104 219 79 13 138 321 103 2395 Attempted visits 106 87 201 126 70 181 83 91 8 148 145 108 147 226 112 1909 Child Life Protection: Visits to homes of foster mothers - - - - - - - - - - - 2 - - 1 3 Visits to foster children. 1 - - - 1 - - - - 1 3 8 - 9 1 24 Other visits - - — - — 4 - - - 13 2 - - - - 19 TOTALS 1145 1526 1262 2055 1611 1710 1389 491 1676 1690 1141 1110 1760 2134 874 21574 Infant Welfare Centres attended 67 51 88 50 61 62 88 24 40 63 68 78 78 48 31 897 Scabies Clinic — - 1 - - - - - - - - - - - - 1 TOTALS 67 51 89 50 61 62 88 24 40 63 68 78 78 48 31 898 19 Supply of Milk and Vitamins (1 January to 30 June). Under the National Scheme, welfare foods have been distributed through the Infant Welfare Centres etc. on behalf of the Ministry of Food as follows:- Institu tions Day Nurseries Food Office Welfare Contres W.V.S. London Hospital TOTAL Full Cream(Pkts) 774 60 17,800 10,492 1,069 - 30,215 Half Cream( " ) 321 36 784 570 50 - 1,761 Cod Liver Oil (Bots) 90 496 5,386 5,311 678 6 11,967 A & D. Tablets (Pkts) - - 2,031 876 210 - 3,117 Orange Juice (Bots) 1704 1,392 21,856 18,808 3,386 27 47,173 VACCINATION. By virtue of the National Health Service Act 1946 compulsory vaccination is abolished as from the 5th July, 1948, but free vaccination can be obtained for anyone who desires it. The following is a report of the Vaccination Officer to 30th June: NO. of cases in birth lists 1948 No. of certificates of vaccination received 816 No. of certificates of postponement owing to:- Health of child 18 Condition of house - Prevention of infectious disease - No. of statutory declarations under Sec.l of the Vaccination Act 499 No. of certificates of insusceptibility or having had smallpox 5 No. of cases of parents removed 569 No. of cases otherwise not-found 20 No. of entries. in lists sent to Public Vaccinators 481 -20- INFANT WELFARE CENTRES.— Details of the work at the Centres from 1 January to 4 July 1948 are given in the following table. Limehouse St.Georges Spitalfields Ashfield St. Mile End Wapping Salmon Lane Dame Colet (Vol.) TOTAL No. of Infant Welfare Sessions 101 77 51 52 50 26 - 50 407 " Attendances of Infants 3026 1855 1771 1061 1632 803 - 1159 11307 " " Children 1-5 1280 844 728 793 894 620 - 525 5704 " Infants on Registers at 4th July 413 246 237 107 203 94 - 111 1411 " Children on Registers at 4th July 436 170 284 225 174 160 - 170 1619 " Ante-Natal Sessions - - 25 — _ — 25 — 50 " " New Cases - - 29 — - — 78 — 107 " " Subsequent Attendances - - 51 - - - 239 - 290 " Doctors' Consultations 101 83 76 52 50 26 25 50 463 Toddlers Clinics: No. of Sessions held - 6 — — — — — — 6 " first attendances - 45 - - - — — — 45 Total attendances — 68 — — — — — — 68 No. of toddlers found with defects - 49 - - - - — — 49 Total No. of defects found - 50 - - - — — — 50 21 III. SANITARY CIRCUMSTANCES OF THE AREA Shops Act, 1934. 295 inspections were carried out during the year. It was found necessary to serve 2 Notices with respect to insufficient water-closet accommodation. No applications were received for exemption under section 10(2) of the Act. Pharmacy & Poisons Act, 1933. 129 applications were received for retention or entry in the Council's list of persons entitled to sell poisons included in Part II of the Poisons List. Of these 26 were new entries. Twohundred and fiftythree inspections or visits were made by the Sanitary Inspectors. Complaints. 2168 written complaints were made to me during the year, which were duly investigated. Of these 15 were from H.M. Inspector of Factories relating to nuisances in factories, 12 from the London County Council regarding verminous premises, and 2141 relating to the condition of houses etc. In addition numerous complaints were made to the Sanitary Inspectors. Drainage. 2579 drains were tested and of these 289 were found to be defective and necessary action taken. Offensive Businesses. There are 16 authorised offensive businesses Tn the Borough, i.e.:- Tripe Boilers 5, Whitechapel High Street 94, Wentworth Street Dresser of Furskins 48,50,50a,54,56, Old Church Road 34/8, Brodlove Lane 29, Spelman Street. Slaughterers of Poultry 21/2, Hessel Street Lower Market 21, Fordham Street 14, Hessel Street 39, Woodseer Street 49, Globe Road 16/18, Cobb Street 13, Leyden Street 15, Loyden Street 82, Stepney Way 8, Gun Street 9, Gun Street. -22- Rent & Mortgage Interest Restrictions Acts. 188 applications were received for certificates or reports as to houses being in a reasonable state of repair. Of these 149 certificates were issued to tenants and 9 were refused, and 22 reports were issued and, 8 refused. Water Supply. Certificates under the provisions of the Public Health (London) Act, 1936, as to new dwellinghouses having a proper and sufficient supply of water, were granted in respect of 280 flats and 61 terraced houses. In 167 instances water was supplied to tenement houses. Wells. There are 13 premises in the Borough containing a total of 16 wells. The following 8 wells are out of use: (1) Truman, Hanbury & Buxton's Brewery 91 Brick Lane, E.l. (2) Old Baths 86 Brick Lane, E.l. (3) Thomas Hubbuck & Son Ltd. 368 The Highway,E.l. (4) The Tower of London - (5) The Royal Mint - (6) Potter & Clarke Ltd. Fairclough Street, E.l. (7) John Braydon Ltd. 6/8 The Highway, E.l. (Destroyed during the war). (8) Commercial Gas Co. Harford Street, E.l. (Scaled off and pump dismantled). The following 8 wells are in use: (9) Free Trade Wnarf The Highway, E.l.) (10) Co-operative Wholesale Scty. Loman Street, E.l.) (2 wells) (Used only for drinking purposes and are frequently sampled by the Metropolitan Water Board.) (11) Taylor Walker's Brewery Narrow Street, E.14.) (3 wells) (12) Charrington's Brewery Mile End Road, E.l.) (Used for brewing and are tested frequently) (13). Mann, Grossman & Paulin's Brewery Raven Row, E.l. (Used only for beer bottle washing). -23- Lodging Houses. (a) Common Lodging Houses: There has been a notable reduction in the number of common lodging houses in the Borough: whereas in 1901 there were 04 and in 1933 18, to-day there are only 4, i.e.:- Accommodation Wilson Carlile House, 20/2 Johnson Street 258 men Salvation Army Hostel, 177 Whitechapel Rd. 535 " Salvation Army Hostel, Hopetown Street 250 women 15/16 Crlvin Street 10/15 couples This was closed in September 1941 and reopened in November 1948. Seventyfive inspections were made during the year and 3 sanitary notices served. (b) Seamen's Lodging Houses: There are now only 4 licenced seamen's lodging houses in the Borough, compared with 18 in 1931, i.e.:- Accommodation Sailors Home & Rest, Ensign Club, Dock St. 235 men 5 North East Passage 11 " Empire Memorial Hostel, 747 Commercial Road 315 " 220 Cable Street 30 " Sixtytwo inspections were made during the year. Public Cleansing. I am indebted to the Public Cleansing Officer for the following information relating to the arrangements in the Borough for the collection and disposal of refuse. No material changes have taken place in the Public Cleansing Services during the year: Salvage collected and disposed of: Waste paper 211 tons Kitchen waste 881 tons House, Trade, Street and Market Refuse disposed by controlled tipping under Ministry of Health Regulations. 42,359 tons The Council's policy of replacing a portion of the motor fleet has been continued and during the year under review 7 Scammel Sssloo vehicles were acquired. A notable feature of this type of vehicle is mechanical rear loading, the adoption of which relieves the dustman of an appreciable part of his arduous duties. -24- Rodent Control. The staff consists of an Assistant Rodent Officer, 1 clerk 3 rodent investigators, and 7 operatives. The work done by the Rodent Section of the Public Health Department under the Ministry of Agriculture & Fisheries (Infestation Division) Schemes, N.S.12 and N.S.19, for the first three months of the year was under N.S.12, and the remaining nine months under N.S.19. As 15 out of the 16 districts were completed in the 12 months ended 31st March, 1947, the remaining district was investigated and treated under N.S.19. Since 1st April, 1948, 12 districts have been investigated and treated, and the remaining 4 districts will be completed by the 31st March, 1949. A "Block Control" scheme was successfully carried out at the Spitalfields Market. In addition, the riverside wharves were investigated and 10 wharves received treatment. Open sites and derelict premises continue to be a source of nuisance due to inability to treat them because of the danger to the public and animals. At the request of the Ministry's Technical Branch, live and dead rats have been supplied to them for experimental purposes, and included in one batch were three albino ship rats, a rarity much appreciated by the experts, who state that there have been only two other known albino specimens among ship-rats in England. The specimens were skinned, treated and mounted, and one was returned for instructional purposes. Business premises Dwellings No. of visits made by Rodent Investigators 6,696 17,952 No. of infestations found 815 1,916 No. of treatments undertaken 522 1,722 No. of visits made by Rodent Operatives 5,426 11,857 No. of prebaits laid 134,264 No. of poisoned baits laid 44,420 Estimated kill of rodents 9,700 No.of bodies recovered 989 No.of complaints received 1,101 -25- "Maintenance Treatments" for destruction of rats in sewers. The Borough Engineer has kindly supplied me with the following information. In accordance with Local Authority Circular N.S.6 (dated 29th August 1944) issued by the Ministry of Food (Infestation Division) two treatments for the destruction of rat3 in sewers were carried out during the year, viz. from 8th December 1947 to 24th January 1948 (inclusive) and from 31st May 1948 to 29th July 1948 (inclusive). The system adopted was that recommended, viz. 2 days pre-baiting and 1 day poison baiting. The pre-bait used was damped sausage rusk and the poison zinc-phosphide [2½%). 1,256 sewer manholes were treated during the first period and 1,307 during the second period. Post War Training of Sanitary Inspectors. Six students were given practical training with the Council's Sanitary Inspectors under the special scheme prepared by the Ministry of Health for ex-Service students. Local Proceedings - Summary of No.of Summonses Fines Costs £ s. d £ s. d Public Health (London) Act, 1936. 50 32. 0. 0 126. .15. 0 Food and Drugs Act, 1938 26 109. 0. 0 55. .19. 0 Ice Cream (Heat Treatment) Regulations, 1947 2 4. 0. 0 . 4. . 4. 0 Defence (Sale of Food) Regulations 1943 & 1945 4 15. 0. 0 17 .17. 0 L.C.C. Byelaws relating to dung receptacles 1 10. 0 2. . 4. 0 83 £160. 10. 0 £206 19. 0 Aged and infirm persons. Section 224 of the Public Health (London) Act, 1936, relating to the compulsory removal to suitable premises of persons in need of care and attention, has been repealed and replaced by Section 47 of the National Assistance Act, 1948, which came into operation on 5th July. During the year it became necessary for me to apply to a court of summary jurisdiction for the removal of five persons under Section 224 of the Public Health (London) Act, 1936 (see also page 6). -26- Mortuary. The Borough Council under Section 234 of the Public Health (London) Act, 1936, provide a Mortuary at Branch Road for the reception of dead bodies. During the year sixteen bodies were deposited therein M. F. Adults 13 2 Children l - Burial of Dead Bodies. Under Section 50 of the National Insurance Act, 1946, it is the duty of the Borough Council to arrange for the burial or cremation of any person who has died or has been found dead in the area and where no other suitable arrangements for burial have been made or are being made. Sixtyfive bodies have been buried under the above powers since the appointed day, 5th July, i.e.:- St. Patrick's Leytonstone (R.C) East London Plaistow (C.E) OUTSIDE AREA TOTAL Tottenham (C.E) Che1msford C.E) Adults and children over 10. M 3 32 1 1 37 F 3 3 - - 6 Children 5-10 years. M — - - — — F - - - — - Children under 5 years. M - - - • - F - 1 — — 1 Children of and under 1 month. M 2 2 - - 4 F 2 2 - - 4 Stillborn. M 1 4 — — 5 F 1 7 — - 8 Totals. 12 51 1 1 65 -27- Debris Clearance - War Dimaged Sites. The debris from the many war-damaged premises in the Borough was largely removed during and since the war partly by the War Damage Scheme of the London County Council and partly by the Borough Council in conjunction with the Ministry of Health and the War Damage Commission. Most sites were left in a clean condition and bombed premises boarded up. I regret to have to report that in Stepney as in other parts of London unscrupulous members of the public have developed the habit of dumping household and trade refuse on the sites and many hoardings and protective fences have been torn down. The gradual accumulation of refuse has caused a major annoyance to law-abiding citizens in the areas concerned. The removal of such refuse cannot be undertaken by local authorities' Public Cleansing Departments who are limited by existing legislation to clearing roads and pavements. Section 93 of the Public Health (London) Act, 1936., gives limited powers to the Public Health Department; but this peace-time legislation is inadequate to deal with a problem arising out of the war. Although the Council is enforcing Section 93 as far as practicable a number of sites recently cleared are again being used as dumping grounds. Sites Rubbish cub.yds Hardcore cub.yds Under Section 93 the Public Health Department have cleared 21 1156 249 In addition the War Debris Clearance Scheme operated by the Borough Council War Damage Department cleared:- Sites: 26 1757 2397 Under Section 33 of the London County Council (General Powers) Act, 1925, efforts are being made by the Works Department of the Borough Council to fence in cleared sites as far as possible. Unfortunately most of the legislation in connection with the preblem of refuse accumulations is clumsy and difficult of application. -28- CONFERENCES, &c. During the year, the undermentioned conferences, lectures and refresher courses were attended Date and Place, Conference or Lecture. Attended by 8,15,22,29 Jan. 5,12,19,26 Fob. COLINDALE. Course of lectures on Food and Drink Infections held by the Central Council for Health Education. Food Inspectors: Mr. H.J.Green Mr.W.F.Smith. 17 March. LONDON. Conference on the Training of Nursery Nurses held by the Royal College of Nursing. Nursery Matrons: Miss M.M. Cluley Miss D. Woodman Miss A. Murray. 6,13,20,27 May COLINDALE. Course of lectures on Food and Drink Infections held by the Central Council for Health Education. Food Inspector: Mr. A.C. Brown. 18-29 May LONDON. Post Certificate Refresher Course for Health Visitors held by the Royal College of Nursing. Health Visitors: Miss M. Bailey Miss M.F.E. Styles. 24-28 May HARROGATE. Annual Congress of the Royal Sanitary Institute. Cr.(Mrs) H.Roberts, O.B.E. & Medical Officer of Health. 7-11 June BLACKPOOL. Conference of the Sanitary Inspectors Association. Cr. (Mrs) A.P.Bunn & Miss H.A. whitty, Sanitary Inspector. 23-25 June FRIENDS HOUSE, EUSTON ROAD. Annual Conference of Maternity and Child Welfare. Cr. (Miss) E.Ramsay, M.B.E., B.A. & Deputy Medical Officer of Health. 29 Sept. to 1 October CHELTENHAM. Fifteenth Annual Conference of the National Smoke Abatement Society. Cr. J. Sambrook & Mr. G.D. Freeland, Sanitary Inspector. -29- SUMMARY OF INSPECTIONS, ETC., CARRIED OUT BY THE DISTRICT SANITARY INSPECTORS DURING THE YEAR 1948 W.E. ANSTEE. E.G. CARTER. (from 11 Nov. ) K.C. CLARK. (9 Feb to 12 Jun) J.J. COVENEY• (to 31 Mar) W. CUE. R.W.G. DAY. S. FIRSHT. G.D. FREELAND. E.C. HAWKER. (from 13 Dec.) W.H. HAWORTH. J.J. KENIIRY. S.S. LOWTHER. G.L. NICKLIN. (7 Jun to 11 Dec) E.P. WEBBER. TOTALS. (1) ( 2) (3) (4) ( 5) (6) (7) (8) (9) (10) (11) (12)(13) (14) (15) Bakehouses - - - - - - - 1 - - 6 - - - 7 Complaints 976 76 398 285 906 834 1469 1106 25 808 1501 1136 518 1035 11083 Canteens 3 — — - 4 2 - — - 12 1 14 - 1 37 Drainage 365 1 50 162 310 180 507 226 16 802 487 329 99 555 4089 House-to-House 2 — 11 — 6 32 - — - - - - — - 51 Houses-let-inLodgings 180 - - 2 5 161 3 203 - 49 269 37 - 30 939 Housing investigations 52 - 5 - 4 - 109 11 - - - - 70 - 251 Infectious disease and contacts 33 4 17 21 62 36 24 61 1 21 30 58 12 39 419 Lodging Houses: Common 58 - - - - 1 9 6 - 1 - - - - 75 Seamen's - - — - 15 — - - — 1 46 — - - 62 Markets end 2 - 1 1 1 2 1 2 - 3 2 2 - 3 20 Offensive Trades 50 — 3 5 - — 19 36 — — — - 4 — 117 (Continued) -30-  (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (l5) Pharmacy and Poisons Act, 1933 26 - 17 13 36 18 26 25 - 6 12 34 1 39 253 Rent Restrictions Acts. 3 - 10 2 49 16 7 16 - - 4 50 16 17 190 Restaurants & Eating Houses. - - - - - - 2 2 - 2 16 5 - - 27 Shops Act, 1934 54 - - 2 40 32 37 11 1 24 17 48 1 28 295 Observations re. smoke nuisance - - 4 15 33 - 1 - - 1 11 56 - 29 142 Surveys re. Essentiality Certificates & Licences 109 1 83 56 113 65 175 68 - 94 39 164 40 109 1116 Defence Reg. 68 CA 14 - - - 6 1 10 12 - 9 1 7 - 3 63 Factories: Mechanical 183 - 37 51 82 97 195 56 6 214 91 101 25 50 1188 Non-mechanical 7 - - 11 23 21 6 18 — 90 32 17 - 5 230 Outworkers 61 — 20 2 1 2 110 — — 6 — 28 — 20 250 Workplaces - - - 6 22 3 1 - - - 1 25 - 6 64 (Continued.) 31  (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) Miscellaneous 488 39 34 119 375 348 835 549 10 1256 161 142 46 580 4982 Revisits 1268 257 232 269 737 780 2374 916 37 952 635 1070 536 1269 11332 premises recommended for requisitioning for rehousing 3 - - 1 - - - 2 - - 1 - - - 7 Intimation Notices Served: To L.C.C. and Council ing Dept 9 27 49 10 37 68 143 65 2 16 20 67 60 102 675 To Owners 335 78 266 131 289 338 1020 641 11 478 286 379 286 508 5046 Statutory Notices served 76 25 55 22 27 66 368 38 - 156 69 122 36 175 1235 Legal Proceedings 3 - - 4 2 - 13 2 - 5 4 - - 18 51 -32- FACTORIES ACT, 1937. The following tables contain a summary of the inspections and defects found and remedied during the year 1948. 1. INSPECTIONS for purposes of provision as to health. Premises. No. on Register. Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sec. 1,2,3,4 8c 6, are to be enforced by Local Authorities 514 230 7 - (ii) Factories not included in (i) in which Sec. 7 is enforced by the Local Authority 1681 1108 59 - (iii) Other premises in which Sec. 7 is enforced by the Local Authority (excluding out-workers premises) 64 64 4 - TOTALS. 2259 1482 70 - 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars. Number of cases in which defects were found. No. of cases in which prosecutions were instituted. Found Remedied. Referred To H.M, tor. By H.M. tor. Want of cleanliness 47 47 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation. 3 3 1 - - Ineffective drainage of floors 12 12 - - - Sanitary Conveniences: (a) Insufficient 18 18 - - - (b) Unsuitable or defective 27 27 - - - (c) Not separate for sexes 12 12 - - - Other offences against the Act (not including offences relating to Outwork) 26 26 - - - TOTALS. 145 145 1 - - -33- SUMMARY OF WORKS CARRIED OUT UNDER THE SUPERVISION OF THE DISTRICT SANITARY INSPECTORS DURING THE YEAR 1948 W.E. ANSTEE. E.G. CARTER. (from 11 Nov.) K.C. CLARK (9 Feb to 12 Jun) J.J. COVENEY. (to 31 Mar) W. CUE. R.W.G. DAY. S. FIRSHT. G.D. FREELAND. E.C. HAWKER. (from 13 Dec.) W.H. HAWORTH. J.J. KENIRY. S.S. LOWTHER. G.L. NICKLIN. (7 Jun to 11 Dec) . E.P. WEBBER. T O T A L S. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (12) (14) (15) Animals kept so as to constitute a nuisance removed - - - - 1 - - - - 2 4 - - 2 9 Bakehouse no. of cleansings of - - - - - - - - - - - - - - - Cisterns cleansed, covered & repaired. - - - - - - - - - 14 6 - - 20 Dampness in premises remedied. 492 57 95 122 209 451 955 115 4 84 58 238 171 217 3268 Drains cleansed or repaired 183 9 26 15 51 202 227 65 2 37 16 49 52 108 1042 Drains - Constructed or reconstructed 43 12 9 2 88 37 35 136 3 136 124 94 17 109 845 Dust receptacles provided 41 4 19 3 47 32 21 43 - 29 11 116 21 91 478 (Continued) -34-  (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (l5) No. of dwelling rooms cleansed 611 90 286 169 743 575 982 292 5 365 130 611 267 559 5685 Houses ventilated beneath lower floor - - - - - - - - - 6 7 - - - 13 Improved light and ventilation provided to rooms - 1 - - - - - - - 2 - - - - 3 Manure receptacles provided or reconstructed - - - - 1 - - - - - - - - 2 3 Offensive accumulations removed 76 - - - 13 40 88 23 - 51 9 7 32 22 361 No. of guttors and rainwater pipes fixed or repaired 97 4 28 17 191 102 91 59 1 65 38 177 47 140 1057 No. of repairs to roofs 323 41 121 71 308 377 534 226 2 122 103 359 92 384 3063 Sink, bath and lavatory pipes fixed or repaired 45 6 56 7 160 62 93 43 1 37 22 212 53 194 991 Smoke nuisance abated 64 - - 9 6 23 72 - - - 8 2 20 2 206 Urinals fixed or repaired - - - - 4 2 - - - 7 11 20 - 14 58 Verminous rooms cleansed 115 - - 28 13 97 189 132 - 23 56 31 21 32 737 (Continued) 35  (1) (2) (3) (4) (5) (6) (7) (8) (9) (l0) (11) (12) (13) (14) (l5) Waterclosots- Cleansed or repaired 93 6 27 19 109 150 247 59 - 44 29 128 60 211 1182 Waterclosets tight and ventilation provided 28 - - 2 4 5 - 1 - 1 7 - - 14 62 Waterclosets - Pans and traps fixed 57 5 31 7 187 50 97 57 - 27 52 83 58 131 842 Waterclosets Provision or repair of flushing 51 6 25 11 98 129 233 44 - 36 32 129 45 119 839 Water supply to houses reinstated or repaired 46 10 11 16 21 53 96 63 1 44 60 37 42 34 534 Yards, areas and forecourts cleansed, paved or paving repaired 37 7 29 23 31 31 24 90 1 68 16 91 28 92 568 Floors, windows, staircases, fireplaces and coppers repaired 388 70 186 97 376 322 437 275 3 221 191 478 280 459 3783 Miscellaneous 90 22 69 23 250 57 31 422 4 180 153 279 24 386 1610 -56- OUTWORKERS. The net number of outworkers on the Register is 610, the nature of the work being as follows:- Making, cleaning, etc. of wearing apparel 588 Boots and shoes 4 Buckles and button makers 1 Umbrellas 2 Artificial flowers 3 Handbags 1 Feather workers 1 Christmas crackers 1 Paper bags and cardboard boxes 5 Waterproof makers 4 The number of inspections made to Outworkers' premises was 250. Notifiable diseases occurred in 7 premises. Number of Firms in the Borough employing Outworkers 44 Of these Outworkers, resided in the Borough 123 resided outside the Borough 127 Number of Outworkers residing in the Borough employed by firms outside the Borough 487 HOUSES LET IN LODGINGS. There are 1813 houses let in lodgings in the Borough. 939 inspections were made to them and it became necessary to institute legal proceedings in one instance. -37- IV. HOUSING Statistics. I. Inspection of dwelling houses during the year:- (1)(a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 10,524 (b) Inspections made for the above purpose 19,814 (2)(a) Dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 122 (b) No. of inspections made for the purpose 131 (5) No. of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Dwelling houses found not to be in all respects reasonably fit for human habitation 5,585 II. Remedy of defects during the year without service of formal Notices Defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 4,350 III. Action under Statutory Powers during the year:- (a) proceedings under Sections 9, 10, 11, 13 and 16 of the Housing Act, 1936:(1) Dwelling houses in respect of which notices were served requiring repairs - (b) Proceedings under Public Health Acts (1) Dwelling houses in respect of which notices were served requiring defects to be remedied 1,235 (2) Dwelling houses in which defects were remedied after service of formal notices:- By owners 1,235 By Local Authority in default of owners (d) Proceedings under Section 12 of the Housing Act, 1936:No. of separate tenements or underground rooms in respect of which Closing Orders were made 7 -38- Overcrowding (Housing Act, 1936, Part IV). During the year 957 cases of overcrowding were investigated, and of these - 412 were.referred to the London County Council for rehousing, and 2 were referred to the Rehousing Department of the Stepney Borough Council. A total of 485 overcrowded families were rehoused during the year, 359 by the London County Council and 126 by the Borough Council. Preferential Housing on the Grounds of Health. 177 cases were investigated. 57 cases were referred to the London County Council for rehousing and 9 to the Stepney Borough Council Rehousing Department. Underground Rooms. There are now approximately 4,000 underground rooms which do not comply with the Housing Act and the Regulations made thereunder. During the year 557 underground rooms were inspected and in 7 of these Closing Orders were made. Number of Flats Erected. By Stepney Borough Council 165 By London County Council 178 Building Licenses and Essentiality Certificates. Applications received 1288 Recommended 1255 Recommended with modifications 90 Not recommended 49 Returned with no observations 14 No. of inspections under Defence Regulation 68CA 65 Slum Clearance. No representations were made for slum clearance during the year, but much old property was cleared away under the Redevelopment Areas in operation at present, viz. Bancroft Road Area, Limehouse Fields Extension Area and Tarling Street Area, and on the 6th October a Public Enquiry was held by the Minister of Health with regard to the Sidney Street Redevelopment Area. -39- Inspections and Visits made by the Housing Inspector. 1. House-to-house inspections to compile evidence for use in:- "Sidney street Redevelopment Area" 21 "Cornwall street Area" 12 2. Inspection of dwellings to ascertain if rehousing justified on grounds of health 177 3. Inspection of underground rooms with a view to closure 112 4. Inspection of other underground rooms 5 5. Inspections for Overcrowding 1089 6. Inspection of dwellings with a view to requisitioning 7 7. Inspections to ascertain Permitted Number under the Housing Act, 1936 5 8. Inspections under Sections 9 and 10 of the Housing Act, 1936 - 9. Inspections under Section 11 of the Housing Act, 1936 95 10. Visits with regard to issue of building licences and essentiality certificates 296 11. Miscellaneous visits 272 V. INSPECTION AND SUPERVISION OF FOOD During the year special attention has been paid to restaurants, canteens and eating houses and there was an increase of 405 in the number of inspections made to these premises as compared with the previous year. With a view to encouraging this type of trade, the Council formulated on the 18th March a Code of standards, full compliance with which entitles them to a Certificate of Hygiene issued by the Borough Council. Over 269 tons of unsound food were condemned necessitating the issue of approx. 2,000 condemnation certificates. Work on food salvage increased towards the end of the year when the Salvage Division of the Ministry of Food was disbanded and, in substitution, certain wholesale grocers and food manufacturers were registered by the Ministry to act as agents dealing with this class of goods. One such firm in the Borough is very actively engaged, dealing with large consignments of salvaged foodstuffs of all kinds. Legal proceedings were taken in 32 instances, 26 under the Food and Drugs Act, 1938, 4 under the Defence (sale of Food) Regulations and 2 under the Ice Cream (Heat Treatment ) Regulations, 1947. Fines amounting to £128 and costs of £78 were imposed. Seventeen of the summonses were in respect of unsatisfactory conditions at various food premises, 10 were in respect of unsatisfactory samples and 5 were for selling articles of food which were unfit for human consumption. -40- Summary of inspections, etc. by the special inspectors engaged in the supervision and inspection of food. A.C.BROWN H.J.GREEN W.F.SMITH S.V0GLER TOTAL Bakehouses - 185 146 - 329 Butcher and bacon shops 255 - - 159 414 Butcher and bacon stalls 91 - - - 91 Butter & margarine premises - 28 33 - 61 Complaints 14 22 24 17 77 Cowsheds - 12 17 - 29 Fish shops and stalls 369 - 28 249 646 Grocery and provision shops 1 127 193 - 321 Greengrocers and fruiterers shops and stalls 422 - - 455 875 Ice Cream Premises - 286 250 - 536 London Fruit Exchange 69 — - 148 211 Markets (daily) 403 98 85 202 786 Markets (week-end) 3 4 3 2 12 Milkshops - 260 146 - 406 Poultry shops 340 - - 392 732 Poultry stalls 368 - - 665 1033 Prepared Food premises 256 - 4 122 382 Railway Depots ø199 - - X 112 311 Restaurants,Cafes & Cunteens 51 412 365 51 879 Spitalfields Market 117 - - 108 225 Wharves 589 - - 198 787 Wholesale Grocers - 110 229 - 339 Miscellaneous visits 61 231 265 96 653 Samples: Food and Drugs 60 570 568 13 1211 Others 11 68 129 20 228 Revisits 195 86 226 622 1129 No. of summonses taken out 5 12 13 2 32 ø Includes 128 special night or early morning, and 1 Sunday inspections at Bishopsgate Goods Station. X Includes 92 special night or early morning inspections at Bishopsgate Goods Station. 41 Milk Supply. No. on Register No. of Inspections No. of Notices Served Dairy premises 69) 406 6 Purveyors' Bottled milk 176) 15 Itinerant Vendors 44 — — Cowsheds 1 29 — Only one of the nine licences issued for cowhouses in the Borough was renewed at the end of the year. In this instance, although the cowshed is licensed for 36 cows, only 12 are kept. Prior to the last war, over 400 cows were maintained in cowhouses in the Borough. A sample of bulk milk was taken from the cowshed and submitted for examination for tuberculosis by guinea pig inoculation. The sample proved to be negative to tuberculosis. Thirtythree samples of milk were taken in course of delivery to schools, hospitals and institutions etc. in the Borough. Twentysix of the samples were taken in course of delivery to hospitals and institutions, 4 to schools, 2 to L.C.C. Meals Centres and 1 to a Day Nursery. All the samples were submitted for chemical analyses and were found to be genuine. Thirtynine licences were issued under the Milk (Special Designations) Regulations, 1936-1946, as follows:- Dealer's licences Supplementary licences. "Pasteurised" 15 9 "Tuberculin Tested" 9 6 The following samples were submitted for bacteriological examination: Nature of sample. No. of samples Number unsatisfactory and action taken. Heat Treated milk 26 2. Area Milk Officer,- Ministry of Food informed. Pasteurised milk 2 - Tuberculin Tested milk 2 - Undesignated milk 1 - Silver Beet (canned) 1 - Dutch Mussels (canned) 1 — Winkles 2 - Semolina 1 — Semolina Pudding 1 - Ice Cream 162 See special report on Ice Cream. -42- Ice Cream. The provisions of the Ice Cream (Heat Treatment) Regulations, 1947, have not yet become fully applicable owing to the issue of the Ice Cream (Heat Treatment) Amendment Regulations, 1948, which postpone the enforcement of that part of the original Regulations dealing with cooling apparatus. Difficulty is also still experienced by the trade because of the shortage of certain types of essential machinery. In consequence it has not been possible to achieve, in all cases, the most desirable method of production. The total number of premises registered in the Borough is .176, of which 40 are registered for manufacture. These premises were all systematically inspected by the Food Inspectors during the year, 536 inspections being made for this purpose. In 40 instances, it was necessary to write to the proprietors for improvement or cleansing, and in two cases legai proceedings were instituted for dirty utensils. There has been a marked improvement in the standard of purity due in no small measure to the regular supervision of premises and advice given, particularly to manufacturers. This is borne out by the following table giving.results of the 162 samples which were taken and submitted for bacteriological examination. It will be seen that 39 per cent of the samples reached the satisfactory bacteriological standard approved by the Ministry of Health. In fact, 21 per cent of the samples were Grade I whereas none attained this standard in the previous year. 1947. 1948. Grade 1 - 34 (21.0%) Grade 2 9 (21.5%) 29 (18.0%) Grade 3 5 (11.9%) 44 (27.0%) Grade 4 28 (66.6%) 55 (34.0%) As a matter of interest, the 14 samples submitted for chemical analysis showed fat content varying from 0.34 to 9.53 per cent, with an average per sample of 2.96 per cent. Butchers1 Shops & Stalls. 505 inspections were made during the year and 29 notices served. Bakehouses, Baker Shops. 329 inspections were made and 51 notices served. There were 72 bakehouses in the Borough, of which 21 are certified Basement Bakehouses. One of the latter ceased during the year and has been removed from the register of basement bakehouses. Catering Establishments. 879 inspections were made and 156 notices served. Greengrocers & Fruiterers Shops & stalls. 87.5 inspections were made and 80 notice's served. -43- Wholesale Grocers. 359 inspections were made and 3 notices served. Fish Shops & Stalls. 646 inspections were made and 8 notices served. Retail Grocery & Provision Shops, etc. 321 inspections were made and 12 notices served. Thirtyeight notices were served in respect of miscellaneous food premises. Butter & Margarine Factories. No. on Register No.of Inspections No. of Notices Served. Butter & Margarine Factories 4) 61 - Wholesale Dealers in Margarine 40) Preserved Food Premises 188 382 56 Meat Inspection. Cysticercus Bovis (Measly Beef). In November, the Ministry of Food circularised Local Authorities drawing attention to evidence of cysticercus bovis in cattle in different parts of the country, including Scotland. The most commonly affected sites are the muscles of mastication, the heart, the head, the tongue and the pillars of the diaphragm. Inspection of the carcases in the slaughterhouse guards materially against infested meat finding its way to the public, but as an added safeguard, visits were made by the Council's Meat Inspectors to all butchers, offal dealers and prepared meat dealers in the borough. The fullest information was given to them on the method of inspection for the detection of the disease and they were advised to communicate immediately with the Public Health Department if they came across any suspected cases. In addition to these visits, a circular letter was sent to all dealers concerned. Caseous Lymphadenitis in imported mutton. Under the Public Health.(Imported Food) Regulations, 1937, the importation of meat from which a lymphatic gland had been taken out was prohibited except in the case of a gland necessarily removed in preparing the meat. As a result of the Public Health (Imported Food) Amendment Regulations, 1948, which came into operation on 1st May, 1948, such prohibition does not now apply to imported mutton and lamb. The method of inspection and judgment of carcases has also been amended by Memo.62B Foods, issued by the Ministry -44- of Food in April, 1949. Caseous lymphadenitis is more common in imported South American mutton and sheep than in Australian and New Zealand mutton. From time to time, quantities of imported mutton are delivered to Middletons Cold Store, Wapping. A detention notice is served under the Public Health (Imported Food) Regulations, 1937, and a 5 per cent. examination is carried out and the prescapular, superficial-inguinal, supra-mammary and precrural lymphatic glands of sheep are incised and examined as routine. No carcases have been condemned as a result of this examination during the year. Since 1st May, 1948, it has been found that a more thorough examination of the associated lymphatic glands in South American mutton has teen made by the exporting countries. Several carcases have had either one of the prescapular or one of the precrural lymphatic glands removed, but on a detailed examination, in accordance with Memo 62 and Memo 62B Foods, no evidence of disease has been found in these carcases or the other lymphatic glands, and the meat has been released for human consumption. A total of 619 carcases were examined during the year but none were condemned as unfit for human consumption. Food Salvage. The methods of food salvage in operation since the early days of the war were changed by the disbanding of the Ministry of Food Salvage Division on 30th September, 1948. As a result, the Food Salvage Order came into force on 1st October, whereby such goods are handled through certain wholesale grocers and food manufacturers who have registered with the Ministry of Food as salvage dealers. Some 14 firms of this kind in Stepney are so registered. One firm in particular has engaged in salvaged food extensively, handling most of the returned ships' food stores from the ports of London and Southampton, food coming into the possession of the Metropolitan Commissioner of Police and also goods from the Railway Executive. This has necessitated the inspection of considerable quantities of food of various kinds and a good deal of time has been devoted to this work. It may be interesting to mention the classification applied when inspecting salvage goods, which is:- (a) Fit for human consumption. (b) Fit for human consumption after treatment or processing. (c) Suitable for manufacturing purposes for human food, or for catering trade. (d) Unfit for human consumption and suitable for animal food or manufacturing purposes other than for human food. (e) Fit for destruction only. -45- Inspection of Food on Wharves. The amount of imported food condemned at the various wharves in the borough during the year was approx. 90 tons. The major portion of this was disposed of by the Public Cleansing Department but where possible, unsound food is diverted for animal feeding purposes. A considerable amount of damaged foodstuffs was examined on behalf of the Ministry of Food to ascertain if such foodstuffs were suitable for manufacturing purposes for human consumption and this has resulted in the saving of foodstuffs which, although unsuitable for retail trade, could be used for manufacturing purposes. Liaison between the Council's Wharf Inspectors and the Commodity Officers of the Ministry of Food continues to work satisfactorily and no difficulty has arisen as the result of the implementation of the Salvage Goods Order. Unsound Food. In addition to that dealt with at Bishopsgate Goods Station (see 'Zoebrugge-Harwich Train Ferry'), the following is a list of quantity of unsound foodstuffs disposed of during the year under the Public Health (Imported Food) Regulations, 1937, and the Food and Drugs Act, 1938. Wharves. Tons cwts. qrs. lbs. Assorted canned goods 60 16 1 21 Apricots 11 1 0 Clemantines 2 14 3 0 Cinchona Bark 3 2 8 Coffee 4 12 2 12 Currants 8 3 0 Dates 2 1 19 Egg Powder 1 0 Figs 3 16 Fruit pulp 2 0 0 Lemons 2 18 0 0 Mussels (canned) 10 17 2 0 Oatmeal 8 3 0 Pearl Barley 11 1 0 Potatoes 10 0 0 Raisins 1 2 Sago 3 1 9 Sultanas 12 2 6 Tomato Ketchup 5 2 20 Tomatoes 5 0 2 0 90 14 3 1 -46- London Fruit Exchange & Spitalfields Market. Tons cwts. qrs. lbs. Apples 2 2 0 Apricots 11 1 26 Aubergines 3 0 0 Broccoli 5 7 0 0 Brussels Sprouts 2 2 Cherries 3 12 Currants 3 6 1 21 Celery 2 5 0 0 Dates 1 5 2 0 Grapes 1 1 2 Melons 45 2 1 14 Onions 19 0 0 Pears 11 17 1 15 Peaches 1 9 3 13 Prunes 3 16 Radishes 6 1 20 Raisins 13 Savoys 4 1 4 Sultanas 11 2 22 Tomatoes 4 2 0 4 Walnuts 3 12 77 18 2 0 Railway Depots. Assorted cereals 11 2 17 Cauliflowers 1 0 0 Offal 3 26 Savoys 2 10 1 12 3 3 3 27 Other Premises. Assorted canned goods 54 16 0 9 Assorted foodstuffs 1 4 1 14 Bacon 12 1 18 Bakery cream 13 3 17 Beef 5 0 10 Biscuits 1 12 Butter 1 1 11 Cake 1 0 4 Cake etc. mixtures 2 1 26 Cheese 1 0 19 Cherries 8 2 20 Citric Acid powder 2 0 Confectionery 1 0 22 Cornflour 1 1 0 Custard powder 24 (Contd.) -47- Other premises (contd.) Tons cwts. qrs. lbs. Cereals (assorted) 6 16 3 19 Dough 2 2 20 Dried fruits (assorted) 1 7 2 3 Flavouring 7 0 0 Flour 2 7 2 4 Fish (assorted) 5 5 1 16 Ice Cream powder 8 0 0 Jelly crystals 2 21 Lamb 3 Lime Juice 1 Mutton 2 2 0 Olives 2 3 2 Oranges 2 24 Peas (dried) 2 3 3 Peel (candied) 7 Pepper (black) 9 Pickles 12 Potatoes 2 0 0 Poultry 12 1 14 Pork 2 Rabbits 2 10 Salt 9 Sausages 17 Shell eggs 2 4 Suet 1 19 Sugar 3 14 Tea 6 3 0 Tripe 1 16 Vermicelli 7 76 19 0 14 -48- 76 Detention Notices and 64 Release Notices were issued during the year in respect of the undermentioned foodstuffs:- Article Detention Notices. Release Notices Quantity No. of Notices Weight Quantity No. of Notices Weight T. c. q. lb T. c. q. lb Mutton. 12,894 carcases. 29 - 12,894 carcases. 29 - Cocoa and Sweepings. 726 bags. 19 44. 15. 2. 26 745 bags. 20 20. 6. l. 7 Sugar Sweepings. 168 bags. 12 12. 0. 3. 1 7 bags. 1 10. 2. 25 Tomato Concentrate (tinned). 2730 cases. 6 50. 19. 3. 0 2730 cases 6 50. 19. 3. 0 Oatmeal. 7 bags. 2 8. 3. 0 - - — Coffee. 105 bags. 1 4. 12. 2. 12 — - — Tomato Ketchup 54 barrels 1 5. 8. 0. 0 — — — "Empilian" Emulsion base 49 tins. 1 16. 0. 21 49 tins. 1 16. 0. 21 Mussels ( tinned) 12894 cases & 30 tins. 1 20. 17. 2. 0 1169 cases & 18 tins. 3 10. 0. 0. 0 Dutch Cockles (tinned) - - - 50 cartons. 1 1. 3. l. 21 Dessicated Cocoanut. 3 cases. 1 5. 2. 0 3 cases. 1 5. 2. 0 Pearl Barley. 9 bags. 1 11. 1. 0 — — — Sultanas. 17½ cases. 1 11. 0. 22 17½ cases. 1 11. 0. 22 Currants. 8 bags. 1 8. 0. 10 8 bags. 1 8. 0. 10 -49- Zeebrugge-Harwich Train Ferry. 220 night and early morning, 1 Sunday and 24 other visits to Bishopsgate Goods Station, were made by the Food Inspectors, for the purpose of examining 3592 trucks containing foodstuffs arriving from the Continent. These consisted of:- Italian foodstuffs 2,707 trucks containing almonds, apricots, aubergines, beans, carrots, cherries, cauliflowers, cheese, chestnuts, filberts, grapes, lemons, lettuce, mandarines, melons, onions, peaches, pears, peas, pimentos, plums, potatoes and walnuts. Hungarian foodstuffs 706 trucks containing ducks, fowls, geese, hares, turkeys, bacon, eggs, liver paste, apricots, melons and canned vegetables. Belgian foodstuffs 173 trucks containing cherries, endives, fish, grapes, pears, canned and frozen vegetables. Spanish foodstuffs 4 trucks containing chestnuts. The total weight of the foodstuffs examined was 27,221 tons 19 cwts. The following were found to be unsound and were stopped and destroyed: 1450 packages Belgian cherries, 400 packages Italian apricots, 200 packages Italian grapes, 499 packages Italian peaches, 13 cases Hungarian turkeys and 75 cases of Hungarian chickens. The total weight of this was 20 tons lOcwts. 3qrs. 0lbs. -50- VI. PREVALENCE OF, AND CONTROL OVER INFECTIOUS OTHER DISEASES Notifications. 1350 notifications (other than of tuberculosis) were received, or 45 more than in the previous year (see table, page 55). Corrected Diagnosis. 45 cases of infeotious diseases removed to hospital were found not to be suffering from the disease stated on the certificate. Of these 10 were cases of Scarlet Fever, 22 of Diphtheria, 5 of Measles, 3 of Whooping Cough, 2 of Cerebro-Spinal Fever, 1 of Erysipelas and 2 of Dysentery. Diphtheria Immunisation. In addition to the sessions held at 35, Stepney Green every Friday afternoon, children were also immunised at most of the Infant Welfare Centres (to 30 June 1948): 35 Stepney Green Infant Welfare Centres Total Und. 5: Over 5 No. of sessions 26 - 26 Post Schick tests 133 41 295 469 Immunisation cates given 109 31 275 415 Attendance of children for Schick or sation 706 97 1570 2373 Children who completed the full course of immunisation 110 7 423 540 Secondary injections 8 2 - 10 Diphtheria Immunisation in relation to child population. (N.B. The figures below are approximate only, owing to the changes in population during the war, and do not include many children immunised by private doctors and during evacuation, etc. The true percentage is probably higher). No. of children who had completed a full course of immunisations at any time up to 31 December 1948.: Under 5 years 4,812 5 to 15 years 5,789 Total 10,601 Estimated child population up to age 15 21,000 Percentage immunised 50.48 -51- Whooping Cough Immunisation (to 30 June). The Council's facilities were continued at 35, Stepney Green and the Infant Welfare Centres: 35 Stepney Green Infant Welfare Centres Total Attendance of children 436 1024 1460 Completed immunisations 117 293 410 Infectious Disease Contacts. Where persons are precluded from continuing at work by reason of being a carrier, or having been in contact with infectious disease, benefits under the National Health Insurance Act, 1946, are only paid on production of a certificate from the Medical Officer of Health. It was not found necessary to issue any such certificates during the year. Authentication of Certificates of Vaccination and Inoculation. Circular 60/48 of the Ministry of Health relates to the difficulties in some countries by travellers from the United Kingdom who are required to prove that the certificates of vaccination or inoculation carried by them are genuine. In several parts of the world certificates are not accepted unless endorsed by a medical officer in the government or municipal service in which they are issued. The purpose of this is to provide proof that the signature of the person issuing the certificate is that of a registered medical practitioner. Arrangements were made to have the signatures authenticated by endorsement of the certificates, and during the year 41 such signatures were authenticated by me. Verminous Persons. Branch Road Cleansing Station. M. F. Ch. Total No. of persons bathed and clothing disinfected 164 38 14 216 No. of baths and treatments given 166 42 15 223 -52- Bug Eradication. The following is a summary of the work carried out by the special inspectors: Miss Whitty Mr. Edwards (from 13 Sept.) General inspections for vermin 902 156 No. of premises found verminous 488 58 Revisits 407 123 Miscellaneous visits 299 306 No. of premises sprayed with Council. Private insecticide:- Premises 476 770 Rooms 1339 1426 Twohundred and thirtyfive families were rehoused in Council houses and flats and their furniture and effects treated with H.C.N. prior to removal. All the bedding was disinfected by steam. Cleansing and Disinfection. 430 rooms were disinfected because of infectious disease and 18 because of pulmonary tuberculosis. 73,572 articles of clothing and bedding were steam disinfected. Of these, 58,389 related to articles of clothing for export. Scabies (Scabies Order 1941). This Order relating to power of entry and compulsory examination and treatment ceased to be operative on the 31st December. The County of London (Scabies) Regulations, 1943, which makes scabies notifiable is still in force. No. of cases notified: formally - 156; informally - 81. Diagnostic Clinic. The Council's diagnostic clinic ceased to function on the 30th June owing to the fall in attendance of contacts of scabies for diagnosis. The treatment of scabies continues at the Council's Treatment Centre and at the London Hospital. M. F. Ch. Total No. of sessions 23 No. of persons who attended 15 29 33 77 No. of persons found positive 2 6 2 10 Total number of attendances 16 30 33 79 to the 30th June 1948. -53- Branch Road Treatment Centre M. F. Ch. Total Persons bathed and clothing disinfected 47 42 22 111 No. of baths and treatments given 68 66 25 159 London Hospital Treatment Centre Persons bathed and clothing disinfected on behalf of Council 79 35 52 166 London County Council Pre-school Children (a) Scabies: No. of baths and treatments given - - 9 9 No. of children who attended - - 1 1 (b) Vermin: No. of children treated - - 13 13 Smallpox. No cases of smallpox were notified during the year and it was not necessary for me to take action under the Public Health (Smallpox) Regulations, 1917. -54- NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1948 DISEASE Under 1 year Total Cases Notified. In Age Groups. Cases admitted to Hospital Total. Deaths 1- 2- 3- 4- 5- 10- 15- 20- 35- 45- 65 and over Total Smallpox — — — — - — — — — — — — - - — Scarlet Fever 1 12 21 19 24 91 21 5 4 - - — 198 64 — Diphtheria 1 3 4 - 4 12 7 1 3 1 - - 36 36 - Membranous Group - - - - - - - - - - - - - - - Enteric Fever — - — — - - — — — - 1 — 1 — — Measles 58 137 113 113 87 250 8 2 4 1 — 1 774 65 - Whooping Cough 41 32 24 32 29 43 1 - — - 1 — 203 26 - Puerperal Fever - - - - - - - - - 1 - - 1 1 - Puerperal Pyrexia - - - - - - - 2 5 1 - - 8 7 - Encephalitis Lethargica - - - - - - - - - - - - - - - Erysipelas - - - - — - 1 - 2 9 10 5 27 10 - Cerebrospinal Fever 1 4 - — 1 1 - - - — - - 7 7 1 Ophthalmia Neonatorum im 2 - - — - - — - - - — - 2 2 - Poliomyelitis — — - - - 1 - - 1 - - — 2 1 - . Polio-encephalitis - — - - - — - - - - - - - - - Dysentery 2 3 4 2 3 1 - - 2 1 — - 18 13 - Malaria - — — - — — - — 1 - — - 1 - - Pneumonia 3 2 5 2 1 4 2 6 12 6 15 8 66 19 82 Food Poisoning 1 1 - - - - - - - 2 2 - 6 5 - Totals: 110 194 171 168 149 403 40 16 34 22 29 14 1350 256 83 Ceased to become notifiable as from July 1948. -55- Ministry of Health Form T.137/1948. PublIc heALTH (tUbercUloSis reGULAtions), 1930. Part 1.- Summary of notifications of Tuberculosis during the period from the 1st January, 1948, to the 31st December, 1948, in the Metropolitan Borough of Stepney. Formal Notifications No. of Primary Notifications of new cases of tuberculosis. Age periods. 0- 1- 2 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory: Males 2 3 4 5 3 4 12 17 17 17 10 8 — 102 Females 1 3 5 3 2 10 18 15 5 4 3 2 — 71 Non-Respiratory: Males - - 1 2 1 1 4 1 - 1 - - - 11 Females - - 1 1 1 - 1 - 1 - - - - 5 Part II. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the abovementioned period, otherwise than by formal notification. Death Returns from Local Registrars. 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55— 65- 75 Total Respiratory: : i i •' i Males - - - - - - - 1 1 - 2 2 - 6 (A) Females — — — - - - 1 - - — 1 - — 2 (B) Non-Respiratory: Males - - - - - - - - - - - - - - (C) Females - - - - - - - - - - - - — - (D) Death Returns from Registrar-General (Transferable deaths) Respiratory: Males - — — - — — — - — 1 - 1 — 2 (A) Females - - - - - 1 - - - - 2 2 1 6 (B) Non-Respiratory: Males - - - - - - - - - - - - - - (C) Females - - - - - - - - - - - - - - (D) -56- Posthumous Notifications. 0 1- 2- -5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Respiratory: Males - - - - - - - - 1 1 1 - - 3 (A) Females - - - - - - - - - - - - - - (B) Non-Respiratory: Males - - - - - - - - - - - - - - (C) Females - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory: Males - - - 3 - - 3 13 5 5 1 1 - 31 (A) Females - - 1 3 - - 9 5 2 1 - - - 21 (B) Non-Respiratory: Males - - - - - - - - - - - - - - (C) Females - - - 1 - - - - - - - - - 1 (D) Other Sources. Respiratory: Males - - - — - — — - 1 - - - - 1 (A) Females - - - - - - - - - - - - - - (B) Non-Respiratory: Males - - - - - - - - - - - - - - (C) Females - - - - - 1 - - - - - - - 1 (D) Totals (A) 43 (B) 29 (C) - (D) 2 -57- TOTAL DEATHS BY CAUSE AND AGE IN THE METROPOLITAN BOROUGH OF STEPNEY - 1948 CAUSES OF DEATH Sex All Ages 0- 1- 5- 15- 45- 65 & over 1. Typhoid and paratyphoid fevers. M - - - - - - - F - - - - - - - 2. Cerebro-spinal Fever. M 1 - 1 - - - — F - - - - - - - 3. Scarlet Fever. M - - - - - - — F - - - - - - - 4. Whooping Cough. M - - - - - - - F - - - - - - - 5. Diphtheria. M - - - - - - - F - - - — - - - 6. Tuberculosis of respiratory system. M 51 - - - 20 24 7 F 17 - - - 11 5 1 7. Other forms of Tuberculosis. M 2 — 1 1 - - - F 1 - - 1 - - - 8. Syphilitc disease. M 4 - - - 1 3 - F 2 - - - - 2 - 9. Influenza. M - - - - - - - F - - - - - - - 10. Measles. M - - - - - - - F - - - - - - - 11. Acute poliomyelitis and polioencephalitis. M - - - - - - - F - - - - - - - 12. Acute infectious encephalitis. M - - - - - - - F 1 - - - - - 1 13m Cancer of buccal cavity and oesophagus. 10 - - - 2 8 13f Cancer of uterus. 12 - - - 2 5 5 14. Cancer of stomach and duodenum. M 22 - - - 1 10 11 F 12 - - - 1 1 10 15. Cancer of breast. M - — - - - - - F 14 — — - 1 5 8 16. Cancer of all other sites. M 106 - - — 6 45 55 F 60 — - - 8 15 37 17. Diabetes. M 6 - - - - 1 5 F 6 - — - - 3 3 18. Intra-cranial vascular lesions. M 49 — — — 2 8 39 F 60 - - — 1 14 45 19. Heart disease. M 197 — — - 9 43 145 F 188 - - 1 10 39 138 (Contd.) -58- TOTAL DEATHS BY CAUSE AND AGE IN THE METROPOLITAN BOROUGH OF STEPNEY - 1948 (Contd.) CAUSES OF DEATH. Sex All Ages 0- 1- 5- 15- 45- 65 & over 20. Other diseases of the circulatory system. M 30 - - - - 8 22 F 20 - - - — 4 16 21. Bronchitis. M 25 2 1 - 1 5 16 F 9 2 — - 2 2 3 22. Pneumonia. M 47 5 2 1 1 11 27 F 35 5 1 - 1 5 23 23. Other respiratory diseases M 9 - - — - 8 1 F 3 - - - - - 3 24. Ulceration of the stomach or duodenum. M 22 - — - 2 15 5 F 2 - — - - - 2 25. Diarrhoea. M 5 4 1 - - - - F 3 3 — — - - - 26. Appendicitis. M 1 -— 1 - - - - F - - - - - - - 27. Other digestive diseases. M 2 - - - - 2 - F 7 - - - - 1 6 28. Nephritis. M 14 - - - 4 3 7 F 8 - — - — 4 4 29. Puerperal and postabortive sepsis. F - - - - - - - 30. Other maternal causes. F - - - - - - - 31. Premature birth. M 11 11 - - — — — F 8 8 — - — - - 32. Congenital malformations birth injury, infantile disease. M 8 8 - - - - - F 6 6 - - — - — 33. Suicide M 3 - - - — 2 1 F 3 — - - 2 — 1 34. Road Traffic accidents. M 1 - - 1 — - — F 2 - 1 - — - 1 35. Other violent causes. M 13 - 1 2 4 1 5 F 8 1 — — 1 - 6 35. All other causes M 41 2 1 3 8 12 15 F 35 2 - 1 1 9 22 ALL CAUSES. M 680 32 9 8 59 203 369 F 522 27 2 3 41 114 335 Total 1,202 59 11 11 100 317 704 -59- 25th Annual Report SUMMARY OF BOROUGH ANALYST'S QUARTERLY REPORTS for the Year 1948. During the year, 1,237 samples were submitted for analysis. Of these 1,152 samples were taken under the Food and Drugs Act, the remaining 85 samples were received from the Borough Departments, the Food Executive Officer and private purchasers. Samples taken under the Food and Drugs Act:470 samples were taken formally 682 samples were taken informally. Total Samples: Foods (taken under the Act) 909 Foods (private samples) 72 Drugs (taken under the Act) 243 Other private samples 13 1,237 Out of 981 samples of food including private samples 50 or 5.1 per cent were adulterated, and out of 243 samples of drugs 10 or 4.1 per cent were adulterated, making a total of 1,224 foods and drugs out of which 60 or 4.9 per cent were adulterated. Milk. 389 samples were examined. The average composition for the year including 2 adulterated samples and the average composition for each month are given below. Number examined Fat per cent Solids-notfat p/cent Total Solids per cent January 44 3.44 8.68 12.12 February 32 3.40 8.66 12.06 March 38 3.28 8.61 11.89 April 30 3.26 8.62 11.88 May 34 3.21 8.75 11.96 June 50 3.35 8.76 12.11 July - - - - August 24 3.52 8.72 12.24 September 21 3.60 8.74 12.34 October 39 3.63 8.75 12.38 November 41 3.74 8.77 12.51 December 36 3.71 8.72 12.43 Whole year 389 3.47 8.71 12.18 Legal Minimum - 3.0 8.50 - The best quality milk sold in the Borough was obtained in the November month. The poorest quality is usually obtained in the months April, May or June and the richest in November. -60- Adulterated and Unsatisfactory Samples Foods Fish Paste. A3. (Informal). l9.l per cent deficient in fish. Fish Paste. A552. (informal). 14.9 per cent deficient in fish. Dessert Mould. A44. (informal). No ingredients stated. Ground Ginger. D70. (Informal). 45.9 per cent deficient in water-soluble ash and 30 per cent deficient in water-soluble extractive. Ground Ginger. D71. (informal). 43.5 per cent deficient in water soluble ash and 10 per cent deficient in water-soluble extractive. Malt Vinegar. A.135.(Formal). Consisted of artificial vinegar. Vondor fined £2 with £5-5-0 costs. Calces. D124. (informal). Mouldy condition. Tomato Sauce. D129. (informal). Contained 600 parts sulphur dioxide per million. Tomato Sauce. D162. (Formal). Contained 96 parts sulphur dioxide per million. Vendor cautioned. Tomato Sauce. A308. (informal). Contained 370 parts sulphur dioxide per million. Tomato Flavoured Sauce. D268. (Formal). Contained 302 parts sulphur dioxide per million. Vendor cautioned. Tomato Sauce. A574. (Informal). Contained 130 parts sulphur dioxide per million. Tomato Sauce. A590. (Formal). Contained 140 parts sulphur dioxide per million. No action. The Preservatives, etc. in Food Regulations, 1925-1940, state that sauces may contain 250 parts per million of benzoic acid as preservative. (and apparently may contain sulphur dioxide if an article in which sulphur dioxide is permitted is used in the manufacture.) but S.R.& O. 1947, No.876 states that tomato ketchup must contain no fruit or vegetable other than tomatoes (except onions, garlic and added spices) and future legislation recommended by the Food Standards Committee 1948 requires tomato sauce, etc. to have the same composition. Such a product would not contain sulphur dioxide. The presence of sulphur dioxide in a few of the samples examined is presumably due to an earlier Ministry notice, PS/175, 3rd June 1943 allowing manufacturers to use apple pulp containing not more than 350 parts sulphur dioxide per million. Crab Paste. A176. (Informal). 19.4 per cent deficient in fish. -61- Crab Paste. A202. (Formal). 16.4 per cent. deficient in fish. No action. Imported food. The Ministry of Food proposes, in granting import licences, to impose a condition that all imported fish paste shall conform to the 70 per cent minimum fish content prescribed in the Meat Products Order. Pork Sausage Meat. B282. (infoiraal). 54.4 per cent deficient in meat. Pork Sausages. B283. (Informal). 51,2 per cent deficient in meat. Beef Sausage Meat. B291. (Informal). 49.6 per cent deficient in meat. Beef Sausage Meat. B285. (Informal). 17.4 per cent deficient in meat and contained 38 parts sulphur dioxide per million. Beef Sausage Moat. B337. (Formal). 54.0 per cent deficient in meat. Vendor fined £5 with £2-2-0 costs. Beef Sausages. B336. (Formal). 30.6 per cent deficient in meat. Vendor fined £5 with £2-2-0 costs. Vinegar, Non-Brewed. D235. (Informal). 17.5 per cent deficient in acetic acid. Vinegar, Non-Brewed. D260. (Informal). 15.0 per cent deficient in acetic acid. Artificial Vinegar. B307. (Informal). 17.5 per cent deficient in acetic acid. Contained a trace of paraffin. Wood Vinegar. D261. (Formal). 18.5 per cent deficient in acetic acid. Vendor cautioned. Tomato. Ketchup. B305. (Formal). Contained 256 parts sulphur dioxide per million. Imported Food Regulations. Frying Oil. B306. (Informal). Marked "Olive Oil Substitute". Consisted entirely of liquid paraffin. Frying Oil. B302. (Formal). Marked "Olive Oil Substitute. Formula Tea Seed Oil, Liquid Paraffin B.P., Apricot Kornol Oil." Consisted entirely of liquid paraffin. Summons dismissed under the Probation of Offenders Act. Vendor paid £7-7-0 costs. Milk. A325. (Formal). 10.3 per cent deficient in fat. Vendor fined £5-5-0 with £2-2-0 costs. Milk. D457. (Formal). Contained at least 5.7 per cent of added water. Strong caution sent to vendor. -62- Roll's and Butter. A526. (Formal). The fat consisted entirely of margarine fat. Vendor fined £2-2-0 with £3-4-0 costs. Rolls and Butter. A566. (Informal). The fat consisted entirely of margarine fat. Cloves, A570. (Informal). Contained 12.3.per cent stalk and dust. Tomato Paste. C20. (Formal). Contained 263 parts copper per million in the dried solids. No action. Tomato Paste. C21. (Formal). Contained 261 parts copper per million in the dried solids. No action. Tomato Paste. C22. (Formal). Contained 459 parts copper per million in the dried solids. No action. Cream Cheese. A655. (Formal). Consisted of whole milk cheese. Vendor cautioned. Private Foods Soya Flour. 3. Insect infested. Soya Flour. 8. Insect infested. Date Paste. 12. Excessive shell and sand. Date Paste. 13. Excessive shell and sand. Barley. 20. Insect residual matter. Barley. 24. Insect residual matter. Barley. 25. Insect residual matter. Tomato Paste. 76. Contained 150 parts copper per million in the dried solids. Tomato Paste. 77. Contained 235 parts copper per million in the dried solids. Tinned Melon and Lemon Jam. 39. Contained 2,5 grains tin per pound. Tinned Marmalade. 62. Contained 2.4 grains tin per pound. Tinned Plum Jam. 64. Contained 2.0 grains tin per pound. Tinned Melon. and Lemon Jam. 65. Contained 2.7 grains tin per pound. Drugs. Zinc Ointment. D1. (Formal). 12*0 per cent deficient in zinc Oxide. Vendor cautioned. Spirit: of Sal Volatile. A7. (Informal). 20.5 per cent deficient in ammonia. Spirit: of Sal Volatile. A37. (Formal). 16.7 per cent deficient in ammonia. Vendor cautioned, Boracic Powder. D108. (Informal). Contained 35 parts lead per million. Boracic Powder. D152. (Formal). Contained 40 parts lead per million. Vendor cautioned. Malt and Cod Liver Oil. D511. (Informal). 16.0 per cent deficient in malt protein. Glauber's Salt. A268. (Informal). Did not comply with the requirements. of the British Pharmacopoeia with regard to water content. -63- Glauber's Salt. A269. (Informal), Did not comply with the requirements of the British Pharmacopoeia with regard to water content. Glauber's Salt. A311. (Formal). - ditto - (Loss at 100°C - 10,7% of its weight). Vendor cautioned. Glauber's Salt. A312. (Formal). - ditto - (Loss at 100ºC - 17.2%. of its weight). Vendor cautioned. Poor Quality Samples. 37 samples were reported as being of inferior grade or doubtful quality. Those consisted of:Milk 10, Fish Paste 10, Cod Liver Oil and Malt 4; Sausages 3, Vinegar 3, Saccharin 2, Ammoniated Tincture of Quinine 1, Borax 1, Camphorated Oil 1, Buttered Rolls 1 and Suet 1. Miscellaneous Samples. 85 miscellaneous samples were submitted for analysis. Of these 76 were foods, 14 or 18.4 per cent of which were unsatisfactory. The samples were submitted by:- Public Health Department: 73 samples submitted by the Public Health Department comprised the following:- Metallic Contamination;- 22 samples were examined and of these 7 were unsatisfactory. Satisfactory samples were Tinned Carrots, Beans, Pate do Foie, Peas, Tomato Puree, Marmalade(2), Apricot Jam, Black Currant Jam and Apple Jelly, all examined for tin: Onion Powder(2) examined for lead and Tomato Sauce(2) and Edible Dye examined for copper. Unsatisfactory samples wore:Tinned Melon and Lemon Jam(2), Tinned-Marmalade and Tinned Plum Jam (contained 2.5, 2.7, 2.4 and 2.0 grains tin per pound respectively) Tomato Paste(2) contained 150 and 235 parte copper per million respectively in the dried solids and Grease (contained copper). Preservatives:- 11 samples examined for preservative were:Meat Cubes, Kippered Herrings, Tinned Peas(2), Currants (2), Sultanas(4) and Polony. All were free from preservatives. Fit for Food:- 24 samples were examined with regard to their fitness for human consumption: 7 of these samples were unsatisfactory. Satisfactory samples were:- Milk, Oatmeal(2), Barley(3), Chicory(7), Fruit Quenchers, Bun, Tea and Wine. Unsatisfactory samples were:- Soya Flour(2) (insect infested), Barley( 3) (Insect infested) and Date Paste(2), (excessive shell and sand). -64- Other Samples. Other samples were:- Emulsion Base(3) and Fat examined for rancidity, Mussels(6) (examined for acidity), Rusks(3), Jam, Paste and Disinfectant Fluid. Borough Engineer. 5 samples examined for the Borough Engineer comprised Sewer Deposit(2), Sewer Slime, Seepage Water and Carbolic Powder. Food Executive Officer. 1 sample of Moal (barley) and 1 sample of Oil (arachis) were examined. Police. 1 sample of Motor Spirit consisted of Commercial Petrol. Private Samples. 4 samples consisted of:- Wire and Dust (copper), Mowrah Meal, Milk and Moat (horseflesh). Douglas Henvillo, F.R.I.C. PUBLIC ANALYST. -65- INDEX Page Aged persons, Welfare of 6 — Removal of 26 Analyst's Report 60-65 Ante-Natal and Post Natal Clinics 13 Area of Borough 4 Bakehouses 43 Births 4—5 " Notification Act ½3.17 Bug Eradication 53 Burial of Dead Bodies 27 Cafes 40 Care Committee (Tuberculosis) 12 Child Life-Protection. 15.17 Christian Street Nursery 15 Cleansing of Persons 54 Complaints of nuisances 22 Conferences 29 Day Nurseries 14-16 Deaths 4.5.58 Debris Clearance 28 Dental Clinic 12 Dinners, Free, to expectant and nursing mothers 17 Diphtheria Immunisation 51 Disinfection 53 Drainage 22 Extra Nourishment,Supply of,to tuberculous persons 10 Factories Act 33 Food Inspection and Supervision 40-50 “ Salvage 45 “ Sampling 42.60—65 " -Unsound 40.44.46-50 " -Zee brugge-Harwich Ferry 50 Foster Mothers and. Children 17 Health Propaganda 9 Health Services, General provision of 8 Health Visitors, Work of 13.18 Home Helps Service 9.14 Houses let in Lodgings 37 Housing: Statistics 38.39 Inspections and visits 40 Ice Cream 43 Illegitimate Births. 4 Infant Mortality 4 Infant Welfare Centres, Work at 13.17.21 Infants,. Feeding of. 17 Infectious Disease 51.52.55 Information Service. 6 Inhabited Houses 4 Insulin 8 Laboratory facilities 8 Legal proceedings 26 Page Lodging Houses 24 Marriages 5 Maternal Mortality. 4.14 Maternity and Child Welfare. 13 “ -Review of Services Preface Milk and Vitamins,. Supply of 20 Milk Supply. 42,60 Mortuary 27 National Assistance Act, 1948. 26 National Health Service Act, 1946 - Transfer of Services 2-3 and Staff Preface National Insurance Act, 1946 27 Nursery Creche 16 Nursery Hostel 16 Nursing in the Home 8 Offensive Businesses. 22 Outworkers. 37 Pharmacy and Poisons Act 22 Population. 4—5 Premature Infants 14 Public Assistance 5 Public Cleansing 24 Puerperal Fever and Pyrexia 15 Rateable Value 4 Rats and Mice Destruction 25 Rent and Mortgage Interest Restrictions Act 23 Rodent Control 25—26 Sanitary Inspectors:Inspections 30-32 Return of Sanitary Work 34-36 Post War Training 26 Sanitary Circumstances of Area 22 Scabies 53—54 “ - Diagnostic Clinic 53 Shops Act,. 1934 22 Social Conditions of Area 5 Smallpox 54 Staff 1.2.3.8 Statistics, Summary. of 4 Stillbirths. 4 Sunlights Treatment 17 Tuberculosis: Dispensaries, Report of 10-12 Notifications 56-57 Review. of Services Preface Underground. Rooms 39 Unemployment. 5 Unsound Food 40.44.4 6-50 Vaccination. 20 " -Authentication of Certificates 52 Verminous Persons and Premises 52.64 Vitamins, Supply of 20 Water Supply 23 Whooping Cough Immunisation 52 Overcrowdings 39