frC. TOWER HAMLETS LONDON BOROUGH -to. 1.i HH-'fTxK * ***& •I. - SPITALFIELDST * - ■ •* '• * STEPNEY HOUSE -"TsiLuiv.'Ki, ; SHADWELL WAPPING m "i i. l v.v 'a rT: ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER LONDON BOROUGH OF TOWER HAMLETS ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER 1973 R. W. WATTON M.B., B.S., D.P.H., D.C.H.. D.I.H. CONTENTS PAGE Health Committee I Introductory 2 Staff 3 Summary of Statistics 1 Part I Statistics and Social Conditions of the Area 5 Part 11 Prevalence of and Control Over Infectious and Other Diseases II Part III Personal Health Services 17 Part IV Environmental Health Services 27 Part V Miscellaneous Services 37 Part VI School Health Services 13 Part VII Appendix of Statistical Tables 17 lilDEX. 85 TOWER HAMLETS HEALTH AND HOUSING MANAGEMENT COMMITTEE (as at 31st December, 1973) -Officio: The Worshipful the Mayor, Councillor G. T. Desmond Alderman John Orwell Councillor R. W. Ashkettle Councillor E. C. Winterflood /$'' ^ 4 4 s? ? \a %'' voi CHAIRMAN Councillor D. Kelly VICE-CHAIRMAN Councillor W. Leary ALDERMAN G.W. Negus COUNCILLORS E. Bishop H. T. E. Brazier Mrs. L. E. Brazier, J. P. R. Cockel Mrs. D.M. Couling T. W. Harvey J. Kennedy I. P. McDougall J. Milrood A.M. Praag B. Saunders F.G. Spearing R.J. Warner - 1 - Health Department, 227/233, Commercial Road, London, E1 2BU To: The Mayor, Aldermen and Councillors of the London Borough of Tower Hamlets Mr. Mayor, Ladies and Gentlemen, I present the Annual Report on the health of the borough for 1973, the last of such reports prior to the advent on the 1st April, 1974, of the reorganisation of the National Health Service. Included within the reorganisation arrangements is the demise of the office of medical officer of health, to be replaced by community physicians appointed to the staff of the Area Health Authority. Their duties will include that of named "proper officer" to the appropriate local authority in respect of medical advice and certain defined executive functions as and when required. Listed on page 6 are the Medical Officers of Health of the original three metropolitan boroughs, now forming Tower Hamlets, since their inception in 1901. When one considers the devoted work of these medical officers over many years, the hope springs to mind that the Community Physicians of the future will equally have the local interests at heart as their forebears in local government. In attempting to produce this report before going out of office certain statistics not yet to hand have had to be omitted, including those supplied by the Registrar General, relative to births and deaths where locally compiled figures have been used. My wish to staff joining the Area Health Authority is for a happy new future, as also to those who remain with the borough; may the division of responsiblity not reduce the effectiveness of them all as members of the wider health team. To the Chairmen and members of Committees my thanks for ready and encouraging assistance in carrying out policy. My appreciation goes to the Chief Executive and senior colleagues for another year's amicable and effective working together. I am, Yours faithfully, R.W Watton Medical Officer of Health and Principal School Medical Officer March, 1974. - 2 - PRINCIPAL MEDICAL OFFICER Dr. J. Richards STAFF OF HEALTH DEPARTMENT (as at 31st December, 1973) DIRECTOR OF COMMUNITY SERVICES AND MEDICAL OFFICER OF HEALTH Dr. R. W. Watton Medical Officers 36 (8. 8) C. H. Drake CHIEF PUBLIC HEALTH INSPECTOR H. S. Davies Technical Assistants 8 CHIEF DENTAL OFFICER T.H.H. Murray Dental Officers 5 (4.2) AREA NURSING OFFICER (HOME NURSING) Miss N. O. Humphris PRINCIPAL MEDICAL OFFICER Dr. K. Winship CO-ORDINATOR, DIRECTORATE OF COMMUNITY SERVICES E. P. Webber PRINCIPAL ADMINISTRATIVE OFFICER C. S. Stewart SENIOR ADMINISTRATIVE OFFICERS J. E. Pestell Administrative and Clerical Staff 55 (53. 6) Public Health Inspectors 19 Dental Auxiliaries 2 PRINCIPAL NURSING OFFICER Mrs. D. E. Marrin AREA NURSING OFFICER (PREVENTIVE) Mrs. I. E. Nicholls W. Crone PRINCIPAL PUBLIC HEALTH INSPECTOR W.E. Hart Pupil Public Health Inspectors SENIOR DENTAL OFFICER R. J. South Dental Surgery Assistants 9 AREA NURSING OFFICER (TRAINING) Miss J. R. Nash Nursing Officers, Health and Tuberculosis Visitors 34 (32. 9) CHIEF CHIROPODIST P. Twort Student Health Visitors 3 Social Workers 2 Chiropodists 11(4.1) Clinic and School Nurses 22 (20. 0) SUPERVISOR CLEANSING SERVICES Miss E. New NON-MEDICAL SUPERVISOR OF MIDWIVES Miss I. M. Clarke Midwives (Agency) 6 HEALTH EDUCATION OFFICER (Vacant) Nursing Officers and District Nurses (inc. Agency) 24(23. 25) ASSISTANT HEALTH EDUCATION OFFICER (Vacant) OTHER STAFF 21 (16,25) OTHER MANUAL STAFF 74 (60.41) Total staff of Department 365 (306. 51) Note - Numbers in brackets relate to equivalent whole-time r 3 - SUMMARY OF STATISTICS, 1973 Area of Borough (Acres) Population: Mid-year estimate Census, 1971 Census, 1961 Density of population (persons per acre) Number of inhabited dwellings according to Rate Books at 1st April 1973 58,412 " structurally separate dwellings - Census 1971 ... 55, 545 " private households - Census 1971 ... 57,465 Births (local returns) Total Male Female All Births 1,925 1,011 914 Live Births 1,898 992 906 Still Births 27 19 8 Deaths (local returns) All Causes 2,078 1,125 953 Maternal Infants under 1 year 35 21 14 Rates Live birth-rate per 1, 000 population Death rate per 1, 000 population Still-birth rate per 1, 000 total births Maternal death rate per 1, 000 total births Infant death rate (under 1 year) per 1, 000 live births Neo-natal death rate (under 4 weeks) per 1, 000 live births Early neo-natal death rate (under 1 week) per 1, 000 live births Perinatal death rate (still births plus deaths under 1 week) per 1, 000 total births Area Comparability Factors (1972) Births 1.10 Deaths 1. 4, 876 Rateable Value (1st April 1973) £40, 045, 059 153,360 Estimated product of a penny rate (1973-4) £ 365,000 164, 948 General Rate (1973-4) 205 682 Dwelling Houses 41.50 p in £ Mixed hereditaments 44. 50 p in £ 31.45 12.37 13.55 14.02 00. 00 18.44 10. 53 8.95 22.86 - 4 - PART I STATISTICS AND SOCIAL CONDITIONS OF THE AREA STATISTICS AND SOCIAL CONDITIONS OF THE AREA Since this year sees the last of the Annual Reports of Medical Officers of Health, it is perhaps interesting to look back to the first Annual Reports for the former Metropolitan boroughs which now comprise the borough of Tower Hamlets, namely those of the Medical Officers of Health of the boroughs of Bethnal Green, Poplar and Stepney for the year 1901. The population of the district was 597,106 or 4 times greater than at present, inhabiting 68, 080 houses. There were 21,481 births and 12,207 deaths, the latter including 3, 550 children under 1 year of age. Deaths from diarrhoea number 562, from enteritis 391,from measles 328, from diphtheria 223, whooping cough 201, scarlet fever 99 and from pulmonary tuberculosis 1,207. The Medical Officer of Health of Bethnal Green reported that 27% of the deaths from all causes were those of infants aged under 12 months, for out of 4, 608 births 708 died before their 1st birthday. Referring to the Housing of the Working Classes the Chief Sanitary Inspector stated that after 20 years of inquiry by Commissions or Committees, and Conferences, and endless meetings, and floods of ink and eloquence, this, the most important of all sanitary questions, stands just about where it did at the commencement. All shades of opinion and all parties appear to agree that the matter presses for immediate settlement, and yet no one has even introduced a measure that would in practice provide machinery less intricate, less costly, and much more capable of speedy application than any of the so-called Housing Acts yet in force. It is remarkable that whenever this question is pressed on the Government's attention, some member is put up to repeat the well-worn platitudes about the enormous powers already given the local authorities by the Act of 1890, and if the Municipal Boards would only use the powers they already possess there would not seem to be much more required. (Page 6) Reporting on the certification of 96 houses (housing 640 persons) as unfit for habitation under the Housing of the Working Classes Act 1890, the Medical Officer of Health stated that a number of trades are carried on by the female and younger members of families living there. Thirteen make boxes of various kinds (mostly for matches) six do tailoring, six make shoes, four take in mangling, two make underclothing, two make mouse traps, one makes brushes, one artificial flowers, one packs tea dust and one does silk weaving; eight are hawkers and keep donkeys or ponies. The health condition of the inhabitants of the area compares unfavourably with that of the rest of Bethnal Green, the mortality being 51% higher. The Chief Sanitary Inspector reporting on unsound food stated that regular systematic inspection was wanted throughout London - it did not benefit much to drive the bad meat out of our market to the cat's meat dealers of adjoining districts, if for want of proper inspection it is to be brought back in meat pies, sausages and the like. Referring to the seizure of 2,400 eggs, the Inspector stated that the defendant was found in a loft over some stables breaking eggs into a pail which was three parts full of liquid stinking eggs. The remainder of the eggs, in cases in a shed, was seized and candled that evening and a "filthy and offensive duty it was". Nothing amiss was found in the bakehouse and the place was watched with the above result which showed that for fear of detection he mixed his filthy confectionery in the shed over the stable and brought it to his bakehouse ready to cook as speedily as possible. The Medical Officer of Health for the Borough of Poplar stated that difficulty had been experienced in obtaining the removal of scarlet fever and diphtheria cases due to the loss of beds at the Gore Farm Hospital which were being prepared for the reception of smallpox convalescent patients and also on account of certain accommodation held in reserve for a possible outbreak of plague. Inspections were carried out and byelaws enforced at 20 licensed slaughterhouses and 17 cowhouses. The Medical Officer of Health for Stepney reported that vaccination against smallpox had been discarded and the Vaccination Acts so systematically evaded for many years that it was no wonder an epidemic of smallpox had broken out among the Boroughs teeming thousands. In three months 168 cases occurred, a quarter in common lodging houses, 31 proving fatal. Each case was reported in the following fashion "J. C. aged 3 was taken ill on June 6th and removed to hospital on June 10th. He was not vaccinated. This family consisted of the parents and another child in addition to the patient. They were immediately revaccinated. The room they lived in was illegally occupied, as it was an underground one and was overcrowded as well. It was also used as a workroom as well as a living room and bedroom. Certain articles of underclothing were being manufactured at the time and I distinctly informed the father through an interpreter, that he was not - 5 - on any consideration to take away anything from the room until it had been disinfected by us. In spite of this he removed some of the things and some were subsequently discovered in the yard at the rear of the premises. He was summonsed for this offence and fined the maximum penalty of £5 and 23 shillings costs". With regard to unsound food offences magistrates appeared to inflict heavier penalties than nowadays e.g. a baker, for having deposited for the purpose of preparation for sale 2 quarts of liquid eggs and a pail of sweetstuff, was sent to prison for 4 months in the second division without the option of a fine. On the other hand justice seemed to be tempered with commonsense - a summons against a trader for exposing for sale 4 baskets of cherries was dismissed, as in the Magistrate's opinion the cherries were in such a rotten state that no one would buy them. Referring to overcrowding the Medical Officer of Health for Stepney stated that the large number of immigrants annually was bound to complicate matters. "Poverty is the main cause of overcrowding, therefore the poorer the immigrants the greater their tendency to live in rooms inadequate to their number". The Medical Officers of Health for the area since 1901 have been as follows:- Metropolitan Borough of Bethnal Green Dr. G.P. Bate, M.D., F.R.C. S. , J. P. 1901 -1919 Dr. G. E. Oates , M. D., B. S., M. R. C. P. , D. P. H. 1919 - 1925 Dr. J. Bell Ferguson, M.D., M.R. C.P., D.P.H. 1926 - 1927 Dr. F. L. Keith, M.D., D.P.H., L.D.S. 1927 - 1929 Dr. Vynne Borland, M.B., B. Sc., D.P.H. 1929 - 1945 Dr. Murdoch MacGregor, M.D., Ch. B., D.P.H., D. L. O. 1946 - 1948 Barrister-at-Law Dr. C.J. Porter, M.D., B.Sc., M.R. C.P, Ed. Barrister-at-Law 1948 - 1949 (temporary joint with Poplar) Dr. W.T. Donovan, M.B., Ch. B., D.P.H. 1949 - 1951 Dr. G.O. Mitchell, M.D., M.R. C.P., D.P.H. 1951 - 1952 (temporary joint appointment) Dr. R. D. Dewar, B.Sc., M.B., Ch. B., D.P.H., Barrister-at-Law 1952 - 1956 Dr. S. A. Boyd, M. D. (Vienna)., D.P.H. 1956 - 1965 Metropolitan Borough of Poplar Dr. F.N. Alexander, M.R. C.S., L.R. C.P., D.P.H. 1901 - 1926 Dr. W. Allan Young, D.S.O. , M.D., Ch. B. . D.P.H. 1927 - 1943 Dr. G.O. Mitchell, M.D., M.R. C.P., D.P.H. 1944 - 1947 Dr. W.T. Donovan, M.B. , Ch. B., D.P.H. 1948 - 1951 Dr. R.D. Dewar, B.Sc., M.B. , Ch. B. , D.P.H. 1952 - 1955 Barrister-at-Law Dr. W.C. Turner, M.D., B. S., D.P.H., D.I.H. 1956 - 1965 Metropolitan Borough of Stepney Dr. D.L. Thomas, M.R. C.S. , L.R. C.P., D.P.H. 1901 - 1929 Dr. J.M. Browne, M.B., B. Ch., D.P.H. 1929 - 1933 Dr. A. Ferguson, M. B., D.P.H. 1933 - 1936 Dr. F.R. O'Shiel, L.R. C.P., L.M., D.P.H. 1936 - 1961 Dr. R. W. Watton, M. B., B. S., D. P. H., D. C. H., D. I. H. 1961 - 1965 London Borough of Tower Hamlets Dr. R.W. Watton, M.B., B. S., D.P.H., D.C.H., D.I.H. 1965 - 1973 - 6 - DESCRIPTION OF AREA The borough of Tower Hamlets is bounded on the west side by the City of London, on the east by the Borough of Newham, on the north by the Borough of Hackney and on the south by the River Thames. The river boundary is some seven miles in length along which exist numerous wharves engaged in transshipping activities. The area of the borough is 4, 876 acres, being approximately four miles long and four miles wide at the most distant points. Mileage of roads covered is 178. 5 Some 266 acres cover canals and enclosed docks including the East and West India Docks, and the Millwall Docks. The predominant geological stratum of the Borough is dark blue London clay found at a depth of between 20 and 30 feet from the surface; above this level are layers and patches of gravel and sand with brown and yellow clays found nearer the surface. In some parts of the borough there are layers of 'made' ground, the result of earlier habitation, and as is to be expected the flow of subsoil water is towards the river. This area is to a large extent industrial in character, factory premises being spread throughout the borough with light industry tending to concentrate in the western end and heavy industry in the east. One of the chief industries of the borough is the manufacture of clothing of all kinds and it is estimated that one-third of the tailoring industry of London is carried on in this area. Other major industries include brewing, engineering, the manufacture of furniture and ship repairs. Tower Hamlets is also one of the most important wholesale districts in London. Spitalfields wholesale fruit and vegetable market and the London Fruit Exchange are situated in the borough, and there are many wholesale food depots from which goods are distributed throughout the country. Notable landmarks in the borough include the Tower of London and the Royal Mint. POPULATION The Registrar General's estimated mid-year population of the borough was 153, 360, a decrease of 5,420 from last year's corrected figure. The decennial census of the population taken on 25th April 1971 revealed the borough population to be 164, 948, a reduction of 40,734 or 19.8% from the 1961 census. It is apparent that the estimated population of the borough during the intercensal years was too great, with the result that birth rates given in Annual Reports for those years were too low and the death rates too high. Deaths exceeded live births by 180 so that as the estimated population decrease was 5,420 the net estimated movement of residents out of the borough would normally amount to 5,240 persons. The density of population is 31.45 persons per acre, a reduction of over 10 persons per acre(25%) since 1965. LIVE BIRTHS There were 2,276 live births registered in the borough during the year. After correction for place of residence (inward transfers 165, outward transfers 543), the number allocated to the borough was 1, 898 comprising 992 boys and 906 girls, a decrease of 81 from 1972, giving a crude birth rate of 12.37 per 1, 000 population compared with 12.43 last year. STILLBIRTHS This year stillbirths numbered 27 equivalent to a rate of 14. 02 per 1, 000 total births, compared with 15. 42 in 1972. DEATHS The number of deaths registered - 2 , 078, shows a decrease of 131 from the figure of last year. The death rate was 13. 55 and when adjusted by the comparability factor becomes 14.22. - 7 - INFANT MORTALITY Deaths during the first year of life numbered 35 equivalent to a rate of 18.44 per 1, 000 live births. The rate for the previous year was 26.27. Fluctuations occur in years in the same decade but generally the downward trend continues: in 1931 the comparable rate for the area was 77 per 1, 000 live births and in 1921 almost 1 in 10 babies died before their first birthday. Details of causes of death at various ages under 1 year will be found in the Appendix on page 47. MATERNAL MORTALITY There were no maternal deaths this year. NEO-NATAL MORTALITY During the year there were 20 deaths of infants under 4 weeks representing a neo-natal mortality rate of 10. 53. Last year there were 30 deaths giving a rate of 15.15 per 1, 000 live births. PERI-NATAL MORTALITY This term is used to describe the combination of still births and deaths in the first week of life expressed as a rate per 1, 000 total live and still births. The rate for this year was 22. 86 compared with 26.86 in 1972. ACCIDENTAL DEATHS Deaths due to road accidents numbered 16 compared with 15 last year. Statistics supplied by the Road Safety Officer will be found on page 47. EXPECTATION OF LIFE The expectation of life at birth, based on the estimated home population and mortality experience over the three years 1970-1972, is 68. 9 years for a boy and 75.1 for a girl. This is an increase of 0. 9 years formalesand 1.4 years for females over the figures based on mortality during the years 1957 to 1959. Sixty years ago the expectation of life of a boy at birth was 48. 5 years and of a girl 52.4 years. MORBIDITY The number of first claims for sickness benefit are obtained from local offices of the Departments of Health and Social Security and are included for information in a weekly bulletin circulated by the department to all hospitals and general practitioners in the area. The Department's offices are not coterminous with the borough boundaries but rather with postal districts, so that these claims do not relate entirely to borough residents, they cover the E. 1, E. 2, E. 3, and E. 14 postal districts (monthly figures are to be found on page 51 . MARRIAGES The number of marriages solemnised in the borough during the year was 1, 275, or 89 less than last year, made up as follows:- Register Office 666 Church of England 389 Authorised persons and other denominations 220 The marriage rate per 1, 000 population was 16. 6 compared with 17.1 last year. 8 PUBLIC RELATIONS Activities of the Health Department are publicised in'Tower Hamlets News' which is published by the Council and issued to the public after each Council Meeting. Topics to which attention was drawn during the year related to Accidental poisoning, Food Hygiene, Houses in Multiple Occupation, Authentication of International Certificates of Inoculation and Vaccination, Family Planning Service, Home bathing arrangements, Opening of Housing Advisory Centre and Proposals for new Health Centre in Gill Street, Smoking and health, details of changes in Services provided at Clinic Centres and publicity for the Mass Radiography Unit's weekly Service in the Borough. In addition, the practise of circulating a weekly bulletin to general practitioners and hospitals in the borough giving information on infectious disease, morbidity and relevant topical matters was continued. PUBLIC TRANSPORT Public transport facilities in the borough include eleven District Metropolitan and Tube Railway Stations and 4 Suburban Railway Stations. UNEMPLOYMENT The number of wholly unemployed adult persons registered at the Poplar, Shoreditch and Stepney Employment Exchanges at 10th December totalled 2, 259 men and 115 women, or 1,158 less than last year. It must be borne in mind that the above figures do not apply solely to Tower Hamlets residents as one does not need to be a resident to registered with an unemployment exchange of a particular area. Furthermore, the Shoreditch Exchange figures include the Shoreditch areas of the London Borough of Hackney. Information supplied by the Youth Employment Service shows that unemployed young persons (under 18), numbered 56 boys and 16 girls, compared with 1972 figures of 89 and 27 respectively. OPEN SPACES The amount of parks and open spaces in the borough is now 356. 06 acres, equivalent to 2. 32 acres per 1, 000 population. A list of the sites is given on pages 60 and 61 . COMPARATIVE STATISTICS A table showing vital statistics for the area covered by the borough at various years from 1901 is on page 48 . HEALTH DEPARTMENT ESTABLISHMENTS A list of all Health Departments Establishments showing clinic sessions held and services provided is given in the Appendix on pages 82 and 83 . 9 * * * * * * * * * * PART I I PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES II. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES WEATHER CONDITIONS January was rather dull and very dry. Alternate mild and colder spells followed in February. March was dry. April was unsettled and cold with some snow. The unsettled weather continued into May, with some sunny days. The first half of June was mainly fine, then thundery spells occurred, July started hot but cool unsettled weather followed. The first week of August was stormy with a hot spell during the middle of the month. The highest September maximum temperature (30 C.) was recorded on the 5th. A warm dry September was followed by a dry October and November. December was also rather dry and mild. Rainfall for the year was below the average. INFECTIOUS DISEASES - NOTIFICATIONS The number of notified cases of infectious diseases, corrected for revised diagnoses and duplicate notifications, was 911 compared with 980 during the previous year. Liaison is maintained with general practitioners and hospitals in the area by a weekly bulletin which is circulated giving them information on the numbers of infectious diseases occurring in the borough during the week, the number of new claims for sickness benefit received at local offices of the Ministry of Social Security in the area, and other relevant information from time to time. A summary of notifications of infectious diseases received during the year will be found on page 51 and a list of diseases notifiable in the borough on page 50. ANTHRAX No case of anthrax was reported during the year. CHOLERA No case of cholera was notified during the year, DIPHTHERIA No cases of diphtheria were notified during the year. DYSENTERY Notified cases of dysentery totalled 162, compared with 96 during the previous year. FOOD POISONING Fifty one cases of food poisoning were notified during the year compared with 27 in 1972. Salmonella typhi-murium was isolated in 9 instances. Other Salmonella organisms isolated included 3 enteriditis, 1 agona, 1 oranienberg and 1 infantis. Clostridium welchii was discovered in 1 case. One family outbreak was reported to the Department of Health and Social Security as required by Memorandum 188/Med. INFECTIVE JAUNDICE Notifications of infective jaundice numbered 55 during the year, compared with 50 during 1972. MALARIA Two cases of malaria were notified during the year, in patients who had recently entered the country from abroad. - 11 - MEASLES Notified cases of measles totalled 448 during 1973. In the previous year 578 notifications were received. Children vaccinated against the disease during the year numbered 1, 513. ACUTE MENINGITIS Four notifications were received during the year, compared with two in 1972. OPHTHALMIA NEONATORUM No cases were notified during the year. POLIOMYELITIS Once again no cases of poliomyelitis occurred in the borough during the year. Details of vaccination against poliomyelitis will be found on page 52 . SCA3IES Cases of scabies which came to notice during the year totalled 162 compared with 245 in 1972. Patients and contacts were given medicinal baths and their clothing disinfected at the Council's cleansing station. The number of baths given was 291. Although scabies ceased to be a notifiable disease on 1st April, 1965, by the co-operation of the general practitioners and hospitals information is forwarded to the Health Department of persons suffering from the condition, and arrangements made for follow-up by home visits to ensure that the patients and their contacts receive treatment at the Council's cleansing station. SCARLET FEVER There were 52 confirmed cases notified, compared with 69 during 1972. SMALLPOX No cases of smallpox were notified during the year although the advice of the Medical Officer of Health was sought by general practitioners in some instances where the disease was suspected. Notifications are occasionally received from port and airport authorities of persons coming into the borough who may have been Li contact with smallpox. Observation is kept on such persons by officers of the Health Department for the necessary period. TYPHOID No cases of typhoid fever were notified during 1973. WHOOPING COUGH There were 5 notifications compared with 13 during 1972. Statistics relating to immunisation are on page 52. TUBERCULOSIS The number of primary notifications of pulmonary tuberculosis received during the year was 110, compared with 123 last year. The notification rate was 0.72 per 1, 000 population compared with 0.77 last year. Non-pulmonary cases notified numbered 22. Further statistical data will be found on page 53 . - 12 - 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. Mass Radiography The North-East Metropolitan Regional Hospital Board's Unit 6A's weekly session at Toynbee Hall continues to operate. I am indebted to the Medical Director and Organising Secretary for the information given on the work of the Unit which will be found on page 53 B.C.G. Vaccination The numbers of persons vaccinated during the year under the Council's scheme for the B. C. G. vaccination of susceptible (tuberculin negative) child contacts of known tuberculous patients, diabetic children, thirteen-year old schoolchildren, students at further education establishments and mentally subnormal persons at training centres, are shown in Table 13 on page 53 Other Preventive Measures In addition to the B. C. G. vaccination scheme, other preventive measures include the chest X-ray of all newly appointed staff and a triennial X-ray of those who are likely to work in close and frequent contact with children, staff at the Council's training centres for mentally subnormal persons and tuberculin reactors discovered among thirteen-year old schoolchildren, students and others tested with a view to B.C.G. vaccination. Epidemiological investigations are made among the contacts of cases of tuberculosis notified in children, staff or residents in the Council's establishments. Similar investigations are carried out at secondary schools where the reactor rates disclosed by tuberculin surveys are significantly higher than the average for secondary schools in the area. CHEST CLINICS In conjunction with the North-East Metropolitan Regional Hospital Board and the Brompton Hospital, and in accordance with proposals under Section 28 of the National Health Service Act 1946, tuberculosis prevention, care and after-care services for patients living at home are provided at the chest clinic in the borough situated in the London Chest Hospital and staffed by chest physicians, tuberculosis visitors, welfare officers and clerks. Services provided from the Chest Clinic include social work by welfare officers and assistance in cash or kind not available from official sources by chest clinic committees from their voluntary funds; these services are the responsibility of the Social Services Department of the Council. After Care Other services provided by the department for the care and after care of patients and contacts include - boarding-out of child contacts, home nursing, loan of bedding and nursing equipment and rehousing of selected tuberculous families. Chest Diseases Care Committee Dr. M. Caplin, Consultant Chest Physician to the Chest Clinic of the London Chest Hospital reports:- - 13 - "The work of the Chest Clinic at the London Chest Hospital followed the same pattern in 1973 as in the previous year, and the volume of work, which was increased by the absorption of all the local chest clinics in Tower Hamlets and Hackney in 1972, was also similar. Nearly 1, 800 residents of Tower Hamlets attended as new patients. Pulmonary tuberculosis, chronic bronchitis and asthma and lung cancer were the major serious diseases which were diagnosed. Pulmonary tuberculosis predominantly affected two quite distinct groups. The firstgroup was that of young immigrants, most of whom appeared to have developed the disease after arrival in this country, and who responded well to modern drug treatment. The second group consisted of homeless alcoholic men, mainly middle-aged, and most of whom had drifted to London and eventually into Tower Hamlets from Scotland, Ireland and the North of England. These homeless alcoholic tuberculous patients are extremely difficult to treat adequately. On discharge from hospital they are refused admission to hostels for alcoholics because they are tuberculous, and tuberculosis hostels refuse them because of their alcoholic problems. The change from being an in-patient in hospital to living rough or living in a common lodging house is a drastic one. They generally start drinking again and stop taking their anti-tuberculous drugs which in most cases should be continued on an out-patient basis for a further year or fifteen months. A further problem is that these alcoholic patients often have some associated liver disease which may restrict the type and dosage of the anti-tuberculous drugs that can safely be given to them, and therefore close supervision is essential. Breakdown of their tuberculous disease is common, and because they are often careless in their habits they may spread their disease to others with whom they come in contact. In the past I have found it difficult to get any real help for these patients. Now, with practical assistance from some Methodist Ministers from local Missions, a non-denominational Home for about eight of our alcoholic tuberculous patients has been established in Commercial Road. The Home is acting as a "halfway house", and there is very close liaison between the Home and the Chest Clinic medical, social and health visiting nursing staff. Fortunately most of our patients suffering from pulmonary tuberculosis respond rapidly to modern treatment and go back to leading completely normal lives. Lung cancer and chronic bronchitis are seen mainly in local middle-aged and elderly men. Treatment for both these conditions has not shown the same spectacular advance in recent years as we have seen in the treatment of tuberculosis. The social problems that many of these patients face are often very considerable, and there is often much need for financial help and advice beyond that available from statutory sources. I am very grateful for the help provided by our Chest Clinic Care Committee. " HEALTH CONTROL OF IMMIGRANTS During the year 788 advice notes of immigrant arrivals were received in the department from various ports of entry, and successful contact was made in 587 instances. Of the remaining 201 some had moved to addresses outside the borough, and details were forwarded to the authority concerned, but the majority were either not known or had never arrived at the address given. Five immigrants suffering from tuberculosis were admitted on condition that they reported to the Medical Officer of Health for examination. Arrangements were made for them to attend the Chest Clinic. COMPENSATION FOR STOPPING EMPLOYMENT Section 41 of the Public Health Act 1961 makes provision for a Medical Officer of Health to request any person to discontinue work with a view to preventing the spread of infectious disease, such person to be compensated for any loss suffered as a consequence. 3 notices under this section were served during the year. - 14 - VENEREAL DISEASE The annual return received from the Venereal Disease Clinic at the London Hospital shows the new cases attending the clinic during the year to be as follows:- Area of Res idence Tower Hamlets Other London Boroughs Other Areas Total Syph i 1 i s 65 120 17 Gonorrhoea 389 1, 010 125 Other Cond i t i oris 2,176 6,149 1.181 Total 2, 630 7,279 1, 323 202 1, 524 9. 506 11,232 (I 972) (2,472) (7,237) (1,178) (10,887) Returns received from 6 other hospitals in London of new patients attending their clinics during the year showed that 223 were residents of Tower Hamlets, comprising 4 syphilis, 28 gonorrhoea and 191 other venereal conditions. Two welfare officers appointed by the Council work from the Whitechapel Clinic under the direction of Dr. E. M. C. Dunlop, M.D., F. R. C. P., Senior Physician to the Department for tracing contacts and following up defaulters. - 15 - * * * * * * * * * * * - 16 - PART III PERSONAL HEALTH SERVICES Ill PERSONAL HEALTH SERVICES The Chief Nursing Officer reports as follows- "The demands on the community nursing services, both preventive and district nursing, continue to outstrip the resources due mainly to staff shortages and frequent staff changes. The 'Mayston' senior nursing structure was finally implemented in July 1973 but the nursing officers appointed to management grades, were unable to undertake fully their new duties due to pressure of work at field level. District Nursing A total of 89, 350 visits were paid by district nurses during the year, the home bathing service was transferred from Branch Road Cleansing Station and eight home bathers were absorbed into the district nursing service. To obtain the maximum efficiency from staff available, the district nursing service was finally decentralised into three clinics (four teams) thus improving opportunities for liaison with General Practitioners. Courses taken (District Nursing) Despite the pressures on the staff, efforts were made to release members to attend appropriate courses and to maintain a busy programme of student training. Both these measures give some boost to staff morale and it is hoped will lead to gaining future recruits. 20 Community Option students were given district experience for 6 weeks 16 Community Option students gained district experience for 5 weeks 15 Occupational Therapy students one day each 3 Degree course students for 1 day 1 H. V. student for one day The following number of pupils from the London Hospital undertook the State Enrolled Nurses Integrated course of training - 29 pupils for 2 days training 21 pupils for 2 weeks training 21 pupils for 8 weeks training 20 pupils sat for the National Certificate - 19 being successful. One Community Health Nurse Tutor Student, from the Royal College of Nursing joined the District Nurse Tutor for a period of 6 weeks, both in the Polytechnic and in community nurse training programmes, to gain experience for the course of training which she was taking. Preventive Nursing Services (Health Visiting and School Health) Staff changes during 1973 were as follows:- Health Visitors 6 appointed, 13 resigned School and Clinic Nurses 6 appointed, 10 resigned In Service training included Refresher Courses for six Health Visitors; plus numerous Study Days for Health Visitors and School Nurses covering a wide range of subjects. Some of the topics were as follows— - 17 - Educational and social implications of sexually transmitted diseases Family Planning Training Psychoprophylaxis Teaching Methods for Nurses Nutritional Defects in Children Working with Jamaican Children N. H. S, Reorganisation Clothing for Handicapped, Elderly and Incontinent patients Nursing Staff continued their liaison with General Practitioners and Hospitals, which both directly and indirectly benefits the community. The Urinary Research project, commenced last year in conjunction with the Queen Elizabeth Hospital, continues and thereby benefiting young children in this Borough. As in previous years a vast amount of work has gone into endeavouring to keep children free from infestation. Both Health Visitors and School Nurses have helped in this essential aspect of prevention with all age groups. Regrettably, our infestation rate still rises. Health Education in all forms has been carried out particularly in the School Health Service, and we hope benefits will be reaped in the years which lie ahead. During June 1973 a free family Planning Service was offered to residents and co-operation from the General Practitioners ensued. The volume of work following this increased three-fold to date. Preparations for the transfer of all nursing services to the new Area Boards continued throughout the year through joint nursing liaison committees with the local hospitals and increased liaison between all branches of the service wherever possible with Borough, hospital and General Practitioner services. Although the nursing staff are being transferred to a new authority, the community to be served will remain the same and liaison with the relevant departments of the Local Authority will be maintained." ANTE AND POST-NATAL CLINICS Sessions are conducted in Council clinics by midwives and medical officers for ante and postnatal examination. In addition four general practitioners undertake ante-natal work for their own patients in Council clinics which are made available to them free of charge and with a domiciliary midwife in attendance (Statistics on page 54 ) ANTE-NATAL, MOTHERCRAFT AND RELAXAT ION CLASSES These classes are held by domiciliary midwives and health visitors in Council clinics for both institutional and domiciliary booked cases. (Statistics on page 54) ADOPTION AND BOARDING-OUT OF CHILDREN Adopt i on Persons proposing to adopt children are required to submit medical certificates as to their health before a child is placed with them. These certificates are verified by the Medical Officer of Health before consent is given. Similarly, the medical records of the children to be adopted are scrutinised and the Director of Social Services advised on the child's suitability for adoption. Should the reports reveal any medical defects, inheritable disease or handicap in the child, further enquiries are made and, in the case of inheritable disease in the natural parents, the prospective parents are interviewed by their own practitioner. - 18 - Boarding Out The medical examination is given in accordance with the Boarding Out of Children Regulations, 1955, and includes the Wasserman and/or Kahn tests except where the child is over school leaving age or is boarded out in an emergency or in accordance with Part III of the Regulations. Again the result of these medical examinations are scrutinised in the Health Department and the Director of Social Services informed as to their suitability. The following is a summary of the cases dealt with from 1969-1973 Adoption cases 1973 1972 1971 1970 1969 Children suitable for adoption 13 14 20 25 33 Children suitable for adoption subject to certain conditions _ _ - _ _ Children unsuitable for adoption - - - - - Couples suitable to adopt children 23 29 48 23 39 Couples unsuitable to adopt children 1 1 Children suitable for boarding out 29 39 34 44 44 CERVICAL CYTOLOGY The service for the collection of cervical smears for cytology investigation by hospital authorities continued during the year with sessions in the Council's clinics. In addition, a general practitioner continued holding regular sessions in his surgery, assisted by a member of the staff of the Health Department. From these 2,7 02 examinations were carried out. In addition hospitals in the area read 9, 7 50 slides and although all the latter did not refer to borough residents it can be assumed that the majority did. Details will be found on page 54. CONGENITAL DEFECTS Notification of congenital abnormalities under the national scheme recommended by the Ministry of Health in 1963 continued throughout the year. Defects found in stillborn and liveborn children within 36 hours of birth were noted on birth notification forms by hospital or domiciliary staff, details of which are as follows:- Number of babies notified as having one or more congenital defects 28 Number of stillbirths and livebirths notified over the same period 1, 925 The rate of notification per 1, 000 total births was 14.5 compared with 18.9 last year. There are obvious difficulties in assessing the real incidence of congenital defects under such a voluntary scheme, but some help does flow in maintaining observation registers and in follow-up to assess any handicap. CLINIC CENTRES There are 6 clinic centres in the borough, 2 school treatment centres and 7 combined clinic and school treatment centres. Clinic auxiliaries continued during the year to carry out various tasks in the clinic centres, thereby affording more time to the health visiting and nursing staffs to cope with their professional duties. The Clinic Centre at Tiller Road Baths transferred to other premises on the Isle of Dogs viz. Community Centre, Barkantine Estate. Services provided at each of the Centres are given on pages 82. and 83 - 19 - CRECHES Children can be placed in creches for an afternoon at eight of the clinic centres by mothers who wish to attend the mothers' club or sewing class at the centre, or who have hospital appointments. Creches also provide facilities for mothers to be relieved of their children for 2 or 3 hours during the day and provide an opportunity for an only child to associate with other children of the same age. No charge is made where the mother is attending a centre activity, but a charge is made of 9p per session if the mother wishes to leave her child whilst she attends to shopping or other domestic duties. ASSESSMENT CLINIC Almost six years ago a combined local authority and hospital assessment clinic was set up for the diagnosis and continuing assessment of infants and children suspected of having a delay in development The Assessment Clinic is based at the London Hospital Children's Outpatients Department, where a clinic for children with cerebral palsy was already in existence. The clinic functions on one day a week, and although it serves mainly Tower Hamlets, children from neighbouring boroughs are also seen. Children continue to be referred mainly by local authority medical officers, following agreement with the family doctor, and by consultant paediatricians from other hospitals in the borough as more doctors, health visitors and social workers concerned in the care of children realise the value of early assessment, treatment and training of not only physically and mentally handicapped children, but also those children who have a delay in language development due to emotional problems and adverse social and environmental conditions. The staff of the Assessment Clinic consists of a Consultant Paediatrician, a Principal Medical Officer of the Health Department, a Psychologist, two Physiotherapists, an Occupational Therapist, a Speech Therapist, a Medical Social Worker, a Health Visitor and a Nursing Sister. A Social Worker from the Social Services Department was seconded to the Clinic for some time. Apart from the diagnostic assessments, follow-up assessments are made to ensure comprehensive continuing care which includes parent guidance, counselling and integration of care and supervision provided by the professional staff concerned. A child with a physical handicap, e.g. cerebral palsy, and his/her parents, receive any necessary help and supervision by the Physiotherapists and Occupational Therapist, who also obtain special equipment or appliances considered necessary for the child. Referral to other departments of the hospital is made for the investigation and treatment of other problems, e. g. dental caries, squints, hearing loss and orthopaedic problems. The Principal Medical Officer and the Health Visitor co-ordinate the work of the clinic and health department, ensuring that these children, who are placed on the Observation Register, receiving continuing support from the community. Any help that can be given by local authority facilities is recommended, i.e. attendance at a day nursery, creche or playgroup. Social work support is recommended for many families and special educational help is required for many children. FAMILY PLANNING This year the Council introduced a completely free family planning service. Sessions continued to be conducted on behalf of the Council by the Family Planning Association at three of the Council's Clinic Centres, 292 sessions being held during the year. In addition, Council sessions staffed by Medical Officers and Health Visitors are operated at a further five clinic centres, a further clinic commencing at the Newmill Centre during the year. The Family Planning Association provide a Domiciliary Service. Preliminary visiting is carried out by the Non-medical Supervisor of Midwives. - 20 - This year new patients numbered 2, 434, an increase of 576 over last year. Statistics on page 56. FEEDING DIFFICULTIES Facilities are provided at a centre outside the Borough for in-patient treatment of mothers and babies when breast feeding difficulties are experienced or of babies with dietary problems. It was not found necessary to utilise these facilities during the year. HEALTH EDUCATION During 1973 the emphasis has remained on health education teaching in schools. The majority of requests come from secondary schools, but the marked lack of knowledge of some elementary health matters, i.e. smoking, suggests that health education should be extended to all primary schools to become truly preventative. In addition to the Health Education Officer, the Health Visitors continue to be involved in health education work in schools. Statistics of the work of the section are given on page 74. HEALTH VISITIG Health visitors maintain close liaison with the staff of statutory and voluntary bodies, general practitioners and hospitals in the borough. Their visits to expectant mothers and to children under five years of age are shown with other statistics on page 56. Health education work is carried out by means of personal contact as well as in group sessions held at the clinics. At the request of paediatricians concerned, health visitors attend out-patients departments at hospitals to provide a link between hospital and home. The numbers of health visitors including centre superintendents and tuberculosis visitors employee at the beginning and end of the year were 39 and 34 respectively, there being 13 resignations and 6 appointments during the year. Command Paper 1973 recommended an establishment for health and tuberculosis visitors, based on a proportion of 0.18 visitors per 1, 000 population, which ratio would equate to 28 staff for the current year. HOME NURSING One member of the senior staff completed the advanced course of Practical Work Instruction during the year. Two State Registered Nurses completed the District Nursing Training Course obtaining the National Certificate. Two State Enrolled Nurses undertook District Nurse Training and were successful in the examination. Statistics relating to the Home Nursing Services are on page 57. LAUNDRY SERVICE Soiled personal clothing, bed linen etc., is collected at least twice weekly from the homes of persons who are incontinent, and cleansed and laundered in the department's laundry at Branch Road Cleansing Station. Statistics on page 57. INCONTINENCE PADS Special commercially prepared disposable pads and/or knickers are supplied free in suitable cases for use by incontinent and chronically ill aged persons. Over 64, 000 pads plus 60, 000 linings were purchased during the year and issued to 227 persons. - 21 - LOAN OF NURSING EQUIPMENT Articles of nursing and sick room equipment are loaned at the request of the general practitioner, district nurse or hospital medico-social worker etc., free of charge for an indefinite period, to persons being nursed in their own homes. The Council purchased many items of additional equipment required to meet requests for loans. In addition equipment is loaned by the British Red Cross Society and by the Council's Social Services Department to handicapped persons. Statistics on page 58. MARIE CURIE MEMORIAL FOUNDATION The Council participates in both schemes operated by the Marie Curie Memorial Foundation for the welfare of persons suffering from cancer who are being nursed in their own homes, namely the Day and Night Nursing Service and the Area Grant Welfare Scheme. Nurses and/or "sitters in" are provided for short periods to patients who live alone and to others to enable relatives to obtain adequate rest periods from the responsibility of nursing. Under the Welfare Scheme, grants are made on behalf of the Foundation towards the cost of hire or supply of special equipment, linen, bedding etc. Ten patients received a total of 490 hours under the Day and Night Nursing Service, while a further 29 patients were provided with special equipment. A grant is made by the Council to the Foundation. DOMICILIARY MIDWIFERY SERVICE The Council operates a domiciliary midwifery service under Section 23 of the National Health Service Act 1946, by an arrangement for utilising the services of midwives employed by the London Hospital and by the Nursing Sisters of St. John the Divine. In addition the Council directly employs the non-medical supervisor of midwives. The joint scheme for training midwives by the Nursing Sisters of St. John the Divine and the Mile End Hospital, continued during the year. Pupils who completed the course numbered 16 with 4 pupils under training at the end of the year. The Council pays to the hospital 40 per cent of the expenditure involved under the provisions of the Ministry of Health Circular 8/56. There were 72 home confinements attended by the Midwives. Three general practitioners from practices in the borough provided ante-natal care with midwives, at four of the Council's clinics. Statistics on page 59. MIDWIVES ACT, 1951 The Council is a local supervising authority under the Midwives Act, 1951, supervising functions being carried out by the Council's non-medical Supervisor of midwives. The number of midwives who notified during the year their intention to practice as midwives within the borough, including those in hospitals, was 100 the number practising at the end of the year being 60. MATERNITY LIAISON COMMITTEES The department is represented on local maternity liaison committees by the Medical Officer of Health or Principal Medical Officer and the non-medical supervisor of midwives or the chief nursing officer. As the borough is served by two hospital management committees, there are separate maternity liaison committees for each group catchment area. VACCINATION AGAINST MEASLES Vaccination against measles for all children up to the age of 15 years continued, 1, 513 children being vaccinated during the year, including 161 by general practitioners. - 22 - VACCINATION AGAINST RUBELLA Vaccination against rubella continued to be offered to all girls between their 11th and 14th birthdays. The purpose is to ensure that as many girls as possible are offered protection against rubella by vaccination before reaching child-bearing age because of the known association of certain foetal abnormalities with rubella infection in pregnancy. During the year 680 girls were vaccinated. OBSERVATION REGISTER At the end of the year, the Observation Register totalled 5,433 persons comprising:- Children under 5 "at risk" 2, 378 Children under 5 handicapped 221 Young persons aged 5-21 years handicapped 2,557 Children non-resident but attending schools in the borough 277 The Principal Medical Officer keeps the register under constant review. Further details relating to the register will be found on page 49. A booklet produced by the department sets out details of the services available for the care of handicapped children and young persons provided by the Council, the Inner London Education Authority and by other statutory and voluntary bodies. PHENYLKETONURIA Tests for phenylketonuria are carried out by means of the Guthrie method on all babies. Co-operation is readily given by the hospitals in the borough having maternity wards both in regard to taking the specimens and the pathological examinations. Arrangements are made with regard to domiciliary births attending midwives and for health visitors to deal with other babies found not to have been tested. PREMATURE BABIES Any child weighing 5.5lbs (2, 500 grammes) or less when born is regarded as premature, and necessary advice and assistance is afforded to mothers with premature babies. Statistics relating to premature births occurring during the year will be found on page 56. RECUPERATIVE HOLIDAYS FOR SCHOOLCHILDREN Unaccompanied schoolchildren placed by the Inner London Education Authority on recuperative holidays numbered 233 and 6 schoolchildren accompanied by their parents were placed during the year. RESIDENTIAL ESTABLISHMENTS FOR CHILDREN IN CARE The Health Department's visiting medical officers regularly attend at the Social Services Department's residential establishments to examine the children, treat any cases of illness occurring and advise on medical aspects of child welfare, hygiene and the prevention of infection. The department is also responsible for the provision of relief nursing staff as required at these establishments. SURVEYS The department has taken part in a number of surveys during the year in association with various research studies being carried out by the following bodies/authorities:- - 23 - Department of Health and Social Security National Surveillance of Congenital Rubella Defects Department of Social Medicine, Survey of Childhood Cancers Oxford University Greater London Council Research and Spina Bifida Intelligence Unit Medical Research Council Measles British Births Survey Child study St. Pancras Coroner Foundation Study of Infant Deaths National Childrens Bureau National Child Development Study Queen Elizabeth Hospital Urinary Tract infections I am indebted to Dr. Saxena, Honorary Senior Medical Registrar, Queen Elizabeth Hospital for Children, Hackney Road, E. 2, for the following summary of the survey on urinary tract infections carried out in the Borough this year "Our study, the first of its kind in England, was carried out during 1973 on 1, 000 pre-school children (560 boys and 440 girls) their ages ranging from 2 weeks to 5 years, and attending 8 Welfare Centres, 5 Nursery Schools 4 Day Nurseries and 1 Baby Follow -up Clinic in the London Borough of Tower Hamlets. An incidence of 0. 05% (3 girls, 2 boys) was found, and this sample study does reveal the importance of routine urine examination at welfare centres in order that such cases can be treated earlier. Arneil et al (1973) found that 2.5% of British schoolgirls aged 5 years and above, had persisting bacteriuria, and of these l% had an underlying adrenal tract abnormality. This implies that if 300,000 girls start school annually in Great Britain then 7, 500 probably have persisting bacteriuria and that 3, 000 have an underlying radiological abnormality. An alarming figure indeed which, verily, should prompt health workers to test for urinary tract infection in pre-school children. In the borough of Tower Hamlets, the population of pre-school children is 10,400 and 2,400 births take place annually, so that applying our figures of 0. 05%, there are 42 potentially acute urinary tract infections in the borough, which is quite a large number. We hope that our present study will act as a lead and prove an impetus to health workers to carry out urine examinations in all the various welfare centres where pre-school children attend." DENTAL CARE FOR THE PRIORITY CLASSES Section 22 of the National Health Service Act 1946 puts local authorities under an obligation to provide dental care for children not yet at school and for nursing and expectant mothers. The same dental officers and dental auxiliaries who treat school children in the school health service carry out this part of their work in the same clinics and at the same time as they treat the schol children under the school dental service. This arrangement for mixing sessions to enable the family to attend together, has proved popular and is available at every dental surgery. Dental Auxiliaries trained to treat very young children as a speciality attend to the majority of pre-school children. Statistics are on page 55. WELFARE FOODS AND VITAMIN SUPPLEMENTS The distribution of dried milk, vitamin drops and vitamin tablets on behalf of the Department of Health and Social Security, continued at the Council's clinic Centres. Issues during the year (value £1, 062) included: - National Dried Milk Packets 3,622 Vitamin Tablets Packets 1,309 Vitamin Drops Bottles 5,185 - 24 - Additionally, various brands of proprietary cereals, dried milk and vitamin preparations recommended by Health Visitors or Medical Officers were available at Clinic Centres, sales of these amounting to £4, 566. 25 * * * * * * * * * * * - 26 - PART IV ENVIRONMENTAL HEALTH SERVICES IV. ENVIRONMENTAL HEALTH SERVICES The Chief Public Health Inspector, Mr. H. S. Davies, reports as follows:FOOD AND DRUGS Imported Food As was to be expected, with the implementation of the Labelling of Food Regulations on January 1st, most of the unsatisfactory samples were in respect of labelling irregularities. These were all taken up with the importers and producers. Honey from China contained large amounts of zinc. Whilst zinc is not generally regarded as a poisonous metal it is desirable to keep all such contaminants to a minimum and there is an accepted maximum amount. Where this is exceeded the honey is released under supervision for blending purposes. Basmati Rice and Walnut kernels were found to be insect-infested on arrival despite fumigation before shipment. The fumigant does not kill any eggs that may be present and, on a long sea voyage, there is often time for these to hatch out before the ship docks. The consignments were again fumigated and cleaned and subsequently released after examination Analysis of Food and Drug Samples 846 samples of food and drugs were submitted for analysis by the Public Analyst, 17 being purchased formally, and 829 informally. Irregular samples ascertained numbered 181. As in previous years, minced beef was found to contain added preservative and buttered rolls were spread with margarine. Legal proceedings were instituted on 2 occasions in respect of minced beef with sulphur dioxide added, buttered roll containing a piece of metal, and hazelnut yogurt found to be unsuitable for consumption. Matters taken up with manufacturers and importers included mango chutney containing excess lead; the consignment was destroyed; fruit drops containing a non-permitted colouring matter; bread containing mould spores; cloves coated with powdered aluminium, blackcurrant drinks containing nonpermitted colouring matters; investigations showed that this was due to the breakdown of the original colour Red 10G. This colour will be discontinued after next year due to amendment of the regulations; canned baby food containing lead in excess of the present maximum permitted level - this was an imported product made before the recent amendment of the regulations; the stock was withdrawn and the producing country's Trade Commission notified. The absence,inadequacy or improper declaration of ingredients on labels ascertained in 136 samples were also the subjects of correspondence and discussion with manufacturers or importers. During the year a committee was set up under the chairmanship of Mr. W. B. Chapman, the Public Analyst, consisting of representatives of the Food and Drugs authorities using the services of the same analyst, so that sampling might be co-ordinated over the whole area represented so as to ensure the maximum efficiency of both sampling and analysis. No modern guide-lines for sampling levels exist and the old suggestion of 3 samples per 1, 000 of the population take no account of modern methods of food distribution; and the entry of the United Kingdom into the European Economic Community is likely to affect the work on each sample to a considerable extent. Pie and Mash Shops No samples of meat pies were taken for the purpose of examination for meat content. Liquid Egg Pasteurisation There are two plants in the borough where liquid egg is pasteurised. The satisfactory standard of hygiene expected of these plants was maintained. The dearth of shell eggs for pasteurising continued resulting in short time working in one plant. The larger plant filled in by using frozen egg. Several consignments of liquid egg were imported from E. E. C. countries, the firm sending out their own road tankers for this purpose. - 27 - Seven samples of egg taken proved satisfactory when subjected to the alpha-amylase test. Milk Supply - Samples Eighteen samples were submitted for chemical analysis; of these three were slightly deficient in solids-not-fat content (two l.l% and one 2.2%) This was due to seasonal variations when the cows change from winter to summer feeding. The average fat and solids-not-fat content of the ordinary milk samples analysed was 3. 07 per cent and 8. 50 per cent respectively, and of the superfatted variety 4. 55 per cent and 8.85 per cent respectively. No raw milk is processed or sold within the borough, consequently no samples were taken for the purpose of examination for the presence of brucella abortus. Ice cream There are three premises in the borough registered for the manufacture of ice cream. These are regularly inspected under the Ice Cream (Heat Treatment, etc.) Regulations and Food Hygiene Regulations and, in all cases, found to be satisfactory. 17 samples of ice cream obtained in the borough and submitted to the methylene blue reduction test gave the following results- Grade No. I 8 II 3 III 0 IV 6 Of the unsatisfactory samples (Grades III and IV)only one was manufactured in the borough. In all cases investigations were carried out by the appropriate health authority. Food Hygiene (General) Regulations 1970 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 Food premises in the borough are subject to frequent inspection by the public health inspectors to ensure that the provisions of the Food Hygiene Regulations are being observed, and a public health inspector visits the borough's Sunday markets each week. There are 3,269 food premises, including stalls, in the area. Notices of requirements served numbered 318 and 209 summonses involving 30 premises/stalls were heard during the year. The Greater London Council (General Powers) Act 1973 makes provision for the closure by the Courts, in certain circumstances, of insanitary food premises and stalls. Bacteriological examination of foodstuffs Samples submitted for bacteriological examination numbered 106 comprising:- 7 Baby food 5 Liquid egg 1 Cake 28 Meats - prepared and cooked 1 Chicken 5 Prawns (frozen cooked and peeled) 1 Coconut (dessicated) 1 Prawn cocktail 17 Dried hen egg (pasteurised) 3 Shellfish 16 Frozen Ready Meals 1 Smoked salmon 17 Ice cream 3 Water - 28 - Of these the following 13 were unsatisfactory: 1 Frozen Ready Meal 3 Meats - prepared and cooked 6 Ice Cream 3 Water Unsound Food The following quantities of unsound foodstuffs were disposed of under the Public Health (Imported Food) Regulations and the Public Health Acts: Wharves, Container Depots, Food Factories and Wholesale Food Premises 101, 091 Kgs. London Fruit Exchange and Spitalfields Market 78,495 Kgs. Other premises 79, 000 Kgs. Total 258, 586 Kgs. These foodstuffs were delivered to or collected by the Council's Cleansing Department at whose riverside depot it was mixed with household refuse, under supervision, and removed by barge to a controlled tipping site in Essex. Condemnation certificates numbering 302 were issued in respect of unsound food in 1973. Unsound Food etc. - Complaints Complaints made by members of the public as to the alleged unsound condition etc. of foods and which were investigated during the year numbered 40. The complaints referred to - Alleged Unsound Conditions 1 Apple turnover, 3 Bread, 3 Cheese, 1 Chicken and bacon pie, 1 Chocolate, 2 Chocolate eclairs, 1 Gherkins, 1 Ham. 1 Jam tart, 5 Meat pies, 2 Milk, 2 Potatoes, 1 Prawns, 3 Sausages, 2 Spam spread. Alleged Dirty Condition and/or foreign Body or Deposit 4 Bread, 1 Butter, 1 Chocolate, 1 Mackerel, 2 Peas, 1 Rice, 1 Sausages. Food Export Certificates Certificates numbering 87 were issued in respect of a variety of foodstuffs exported to South Africa, South America, Belgium, Brazil, Canada, Canary Islands, Cyprus, Denmark, France, Greece, Italy, Japan, Madeira, Mexico, New Zealand, Panama, Singapore, Sweden, U.S.A. and West Indies. Before certificates are issued the foodstuffs destined for export are examined and where necessary samples taken for analysis. Relevant investigation is also made into the methods of production. DISEASES OF ANIMALS The Corporation of London, through its veterinary officers and inspectors continued to carry out on an agency basis duties imposed on the Council under the Diseases of Animals Act, 1951 and Performing Animals Act 1925. - 29 - OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Registration The total of registered premises has fallen from the figure of 3,197 for the first year after the amalgamation of the former Metropolitan Boroughs of Bethnal Green, Poplar and Stepney at 31st December 1966, to a total of 2,856 at 3lst December, 1973. I nspect i on 1, 857 general inspections were made during the year and 984 subsequent 'follow up' visits, 628 informal notices were served. Acc idents A total of 72 accidents were reported during the year, and such action taken as was found to be necessary following investigation. No fatal accidents were reported. Hoists and Lifts A total of 76 notices were served during the year requiring works of repair to be carried out, and generally the provisions of the Regulations are being satisfactorily complied with. CLEAN AIR Notices were given to the Council of proposals to install furnaces in 13 premises. Four applications for prior approval of furnace installations were received and approved. Seventeen applications for chimney height approval were received and approved, subject in some instances to the chimney heights being amended. The whole borough is covered by smoke control orders. In two cases, discretionary grants were approved on grounds of hardship, in respect of the 30°/o balance of cost of works of adaptation to heating appliances. These amounted to £10. 51 and £3. 30 respectively. HOUSING Slum Clearance During the year two Clearance areas were represented involving 44 houses. Two Public Inquiries were held and three Orders confirmed. Underground Rooms The closure of basement rooms continued throughout the year. 118 such rooms in 38 premises being closed. Undertakings not to relet were accepted in respect of six underground rooms. Closing and Demolition Orders During the year Closing Orders were made in respect of 11 houses which were unfit for human habitation, and 13 premises were the subjects of Closing Orders on parts of the premises, amounting to 76 rooms. Demolition Orders were made on five houses. Houses in Multiple Occupation The Tower Hamlets (Registration of Houses in Multiple Occupation) Informatory and Regulatory Scheme 1971 During the year it was found that two licensed premises were being used to accommodate lorrydrivers. Both licensees were asked to carry out work to make the accommodation suitable for such purposes. - 30 - In one case the owners refused to allow the licensee to carry out alterations and forbade him to use the premises for such purposes Many immigrant landlords are still ignoring the Council's Registration Scheme and Direction Notices, and unless these contraventions are detected within six months of the offence, no action can be taken against the offender. Because of staff shortage many multi-occupied houses are not being inspected and, therefore, unsatisfactory conditions, contraventions and overcrowding are not detected. The number of houses known to be in multiple occupation at the end of the year was 1,211. During the year 21 more premises were found to be deficient in means of escape in case of fire. At the end of the year 1,211 houses were under surveillance. Management Orders were made in respect of 32 premises and informal notices to remedy conditions caused by neglect of management were served with regard to 90 houses. In 28 cases the conditions were rectified. Summonses served for contraventions of the Management Regulations numbered 160, fines amounting to £422 being imposed. Overcrowding Overcrowding by immigrant landlords is still on the increase. Immigrant males arrive in this country without their families, and having found accommodation which in most cases consists of one or two rooms, arrange for their families to join them and thus overcrowding occurs. Notices in respect of overcrowding under the provisions of Section 90 of the Housing Act, 1957, were served in 14 instances. Visits in the late evening continue to be made to check that the notices are being complied with. 21 summonses were issued in respect of contraventions, resulting in fines amounting to £286. Directions to prevent or reduce overcrowding were served in 69 instances under Section 19 of the Housing Act 1961. Summonses numbering 11 were issued for contravention of the Directions, resulting in fines amounting to £230 being imposed. Owing to the constant change of management of houses in multiple occupation, notices frequently have to be re-served thus causing a prolonged delay in getting repairs and fire precautions work carried out and overcrowding abated. Standard and Improvement Grants 61 premises were inspected regarding applications made to the Council for standard or improvement grants. Qualification Certificates The Housing Act 1969, provides for the conversion from rent control to rent regulations of dwellings which satisfy qualifying conditions. Where a house which is subject to a controlled tenancy is in good repair and is provided with the standard amenities, a qualification certificate is issued to the owner which enables him to apply to the rent officer for a fair rent to be registered. During the year 2 such applications were received but were not approved. Applications for Rehousing At the end of the year, there were 6, 916 applications for rehousing on the Council waiting list, 692 more than last year. Tenants of Council dwellings who have applied for transfer to larger or smaller accommodation number 417. - 31 - Preferential Housing on Health Grounds Applications for preferential housing on health grounds investigated during the year numbered 693. An 'urgent assessment was granted in 77 cases and balancing points were awarded in a further 185. Tenant transfer was supported in the case of 240 tenants of Council dwellings. New Housing During the year 251 new permanent dwellings were completed by the Borough Council, 68 by other persons, and 425 by the Greater London Council. Details are given on page 64. At the end of the year units of accommodation owned by the Borough Council numbered 15, 972 comprising 14, 623 erected by the Council. 14 prefabricated bungalows and 1,335 properties acquired. FACTORIES Provision is made in Section 153 of the Factories Act 1961 for the Medical Officer of Health to include in his annual report prescribed particulars with respect to matters under the Act administered by the Council. These details are given on pages 65 and 66. A certificate of suitability under Section 70 of the Act continues in force in respect of one basement bakehouse in the borough. HAIRDRESSERS AND BARBERS Premises registered with the Council in accordance with Section 21 of the Greater London (General Powers) Act, 1967 numbered 163 at the end of the year. LEGAL PROCEEDINGS A summary of legal proceedings instituted during the year under various Acts and Regulations following ascertainment of contraventions by the public health inspectors and technical assistant will be found on page 67. PERSONAL CLEANSING STATION A cleansing service for verminous persons and persons suffering from scabies operates at Branch Road Cleansing Station, in addition to the service provided for schoolchildren at school treatment centres. Statistics on page 68. DISINFECTION AND DISINFESTATI ON These services are provided on site at Branch Road Disinfection Station where teams of operators are also based to deal with infection and infestations at premises. Premises and fomites are disinfected after the occurrence of certain infectious diseases, generally by means of steam under pressure or by formaldehyde. Articles of clothing etc. for export are also dealt with where the country to which the goods are being exported requires an official certificate. A service is provided for the disinfestation of premises infested by insects, etc. including ants, bedbugs, cockroaches, fleas, carpet beetles, woodlice, clovermites, firebrats, spider beetles, silverfish and dermestidae. Statistics on page 68. LICENSING ACT, 1961 Applications for registration of clubs under the Licensing Act 1961 are dealt with by a magistrates court, copies of the applications being sent to the Council for any observations it may wish to make. Public Health inspectors visit the premises to report on their suitability as regards the requirements - 32 - of public health and food and drugs legislation. Premises inspected and reported during the year numbered 22. LODGING HOUSES - COMMON There are three licensed common lodging houses in the borough, providing accommodation for 769 persons as follows: Salvation Army Hostel, Garford Street 218 men Salvation Army Women's Hostel, Hopetown Street 228 women Salvation Army Hostel, 177, Whitechapel Road 323 men The premises are inspected regularly including visits made at night to ensure compliance with the byelaws relating thereto. LODGING HOUSES - SEAMEN There are two premises in the borough which provide accommodation for 430 seamen as follows:- Queen Victoria Seamen's Home, 121/123, East India Dock Road 187 seamen Sailors' Home, Dock Street 243 seamen Regular inspections are carried out at these premises, including visits at night. MORTUARY SERVICE The Council's mortuary is situated in Cottage Street, Poplar High Street and adjoins the coroner's court. The mortuary has accommodation for 15 bodies and serves the Poplar and Stepney areas. Prior to the formation of the borough, Bethnal Green Council had an arrangement with Hackney Council for the use of the latter's mortuary, which arrangement continues in respect of mortuary accommodation for that part of the borough, the cost being shared on a population basis. A total of 752 bodies was received during the year by the Council's mortuary including the bodies of 339 persons who were resident in other areas. Other statistics will be found on page 67. OFFENSIVE BUSINESSES There are 17 offensive businesses in the borough as follows:- DRESSER OF FURSKINS (3) 34/38 Brodlove Lane 74 Florida Street * 419 Old Ford Road POULTRY SLAUGHTERHOUSES(14) * 17 Bell Lane *10b Leyden Street * 19 Bell Lane 13 Leyden Street 107 Bethnal Green Road 15 Leyden Street 28 Burslem Street *7 Lower Hessel Street * 14 Hessel Street *115/137 Monier Road 36 Hessel Street *4 Monthope Street * 7 Leyden Street *6 Monthope Street (* Establishment orders on these premises are subject to renewal from time to time) - 33 - MISCELLANEOUS REPORTS BY DISTRICT AND SPECIALIST PUBLIC HEALTH INSPECTORS Some 773 reports were submitted to the Director of Development in respect of applications for planning permission under the Town and Country Planning Act, 1962, for redevelopment or change of use. 72 reports in respect of the transfer of publicans licences under the Licensing Act, 1964, were submitted to the Licensing Justices. OUTWORKERS Employers of outworkers in the borough in certain specified occupations are required by the provisions of section 133 of the Factories Act 1961 to supply the Council, in February and August each year, with a list of the names and addresses of all persons employed by them as outworkers during the preceding six months. Where the outworker resides in another area, the Council is required to forward details to the local authority for that area. It is an offence to fail to submit lists of outworkers or to give outwork to be done in a place which is considered to be injurious to the health of the persons employed therein. The number of outworkers included in the August list was 1,014 compared with 735 in the corresponding list last year. PET ANIMALS ACT, 1951 There are 54 licensed pet shops in the borough including stalls in markets. PHARMACY AND POISONS ACT, 1933 The sale of certain poisons (chiefly those used for sanitary, domestic and horticultural purposes) by persons other than pharmacists is subject to provisions of this Act and of the Rules made thereunder. A person selling such poisons must have his name entered on a list kept by the Council, and must make application annually for re-entry and pay a prescribed fee . Compliance must be made with the requirements relating to storage, transport, labelling and containers. There are 63 names on the list, 7 being removed from and 4 added to the list during the year. POULTRY SLAUGHTER Statutory control over the slaughter of poultry has been effective since the coming into operation of the Slaughter of Poultry Act, 1967 on 1st January, 1970. It can effect rigid control over all poultry slaughtered except that which is slaughtered for the Muslim trade. In this area about .5 million birds are slaughtered annually for the Muslims. A person who slaughters poultry for the food of the Jew is required to be licensed by the Rabinnical Commission but any Muslim can slaughter poultry by the ritual method without licence, experience or any other control provided the birds are for a Muslim. This is a highly unsatisfactory state of affairs, not only from a slaughtering aspect but it can result in queues of persons in a slaughter hall waiting to cut the throat of a bird they have purchased, a very undesirable feature by any standard of hygiene. Inspection of birds under these circumstances is virtually impossible because the birds are purchased alive, slaughtered, plucked, and may or may not be eviscerated, skinned and chopped according to choice of the individual. Having regard to the fact that nearly all the birds are old hens inspection should have high priority. A further complication to this method of purchasing poultry is that it has attracted persons other than Muslims and whilst the Act appears to make this an offence enforcement would depend on proving the purchaser was not a Muslim. If standards are to improve the regulations now being prepared must have regard to this practice - 34 - to effect rigid control. The Slaughter of Poultry Act should also be amended and require a Muslim who slaughters poultry to be licensed on the same basis as a Jew. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act, designed to secure the use of clean filling materials in articles which are upholstered, stuffed or lined, requires the licensing or registration, as the case may be, of premises where rag flock is manufactured or stored or filling materials used. Regulations made under the Act prescribe standards of cleanliness for filling materials. 11 samples of filling materials were obtained from registered premises during the year and submitted to the prescribed Analyst for examination. All of these samples proved satisfactory. REFRESHMENT HOUSES: In connection with the provisions of Section 89 of the Public Health Act, 1936 and Section 80 of the Public Health Act, 1961 relating to sanitary conveniences in refreshment houses, 16 notices were served during the year requiring the provision of sanitary accommodation to comply with the Council's standardi RODENT CONTROL In accordance with the requirements of the Ministry of Agriculture, Fisheries and Food, statistics on rodent control work for surface infestations carried out by the Department during the year were submitted to the Ministry. In this period out of 3, 923 dwellings and other premises requiring inspection 1,770 were found to be infested with mice or rats compared with 2, 323 last year. Treatments were carried out by the department's rodent control staff in 1,692 properties the charges for servicing business premises amounting to £483. Statistics are given on page 70. SEWERAGE The arrangements in the area for sewerage and sewage disposal are satisfactory. The planned programme of reconstruction of defective sewers is proceeding. SWIMMING BATHS The water in the seven public swimming baths in the Borough and in the Bath at the Council's Homchurch Children's Home is sampled at monthly intervals by the Scientific Department of the Greater London Council on this Council's behalf. A total of 80 samples taken during the year proved satisfactory. 18 were unsatisfactory and appropriate action taken. In addition 33 samples were taken from 9 school swimming baths in the borough, 4 samples being unsatisfactory. VACANT SITES The development of some sites for open space and car parking has prevented recurring misuse of cleared and fenced sites and is a policy which should be encouraged on a temporary basis. Of the 118 sites which came to notice during the year 90 were cleared of rubbish and fenced by the end of the year. A further 80 from the previous year were also dealt with. - 35 - Ownership of the sites dealt with was as follows:- Sites requiring action Sites dealt with Greater London Council 134 119 Borough Council 48 38 Private Ownership 16 13 In 5 cases where the owners were not traced or who defaulted the work was carried out by the Council's contractor, and the cost made a charge on the land. WATER SUPPLY The domestic water supply in the borough is supplied by the Metropolitan Water Board. The supply to the area is derived from the Rivers Thames and Lea, and is not plumbo-solvent. Daily samples of the water are subjected for quality control to regular routine chemical and bacteriological examination at the Board's laboratories. The water supply to the borough has been satisfactory both in quality and quantity during 1973. No artificial fluoride was added and where fluoride is indicated in the analyses it represents the naturally occurring fluoride in the water. Immediate action is taken in respect of any form of contamination revealed by inspection or analysis. All new and repaired mains are disinfected with chlorine and the water subsequently checked as to quality, before the structures are restored to service. No houses are permanently supplied by standpipe. There are 18 deep wells in the borough in use. The Metropolitan Water Board was notified on 23 occasions where wastage of water was taking place. Notifications were received from the Board on 34 occasions of intention to withdraw the supply from premises because of non-payment of rates. In October 1965 the Council resolved in favour of fluoridation of the water supply. However, in this respect councils in the Greater London area do not have overall control of the water supplied to their boroughs which is provided by the Metropolitan and other Water Boards. Section 23 of the Greater London Council (General Powers) Act 1967 empowers the Council to carry out work and recover the reasonable expenses incurred thereby to secure that the supply of water to a building is restored by the statutory water undertakers where such supply has been disconnected by reason of the defective state of the supply pipes etc. The Medical Officer of Health is authorised by the Council to exercise its powers under this enactment in appropriate cases. WORKS IN DEFAULT Works were carried out by the Council on 32 occasions during the year in default of persons on whom notices were served requiring the execution of works. They comprised 21 instances of failure to comply with notices served under Section 17, Public Health Act, 1961 regarding choked drains, 5 instances of failure to comply with notices served under Section 4 of the Prevention of Damage by Pests Act, 1949 for clearance of refuse from sites and erection of corrugated steel fencing. There were also 5 instances where dustbins were provided under Section 75 of Public Health Act 1936, and one instance where work was carried out to an underground water service pipe after failure to comply with a notice under Greater London Council (General Powers) Act 1967, Section 23. STATISTICS Tables 28 to 46 of the Appendix give additional statistical information of the environmental health services. - 36 - PART V MISCELLANEOUS SERVICES 3 V. MISCELLANEOUS SERVICES ACCIDENTS IN THE HOME The powers and duties of the Council under the Home Safety Act 1961, relating to the dissemination of information and advice for promoting safety in the home and encouraging proper precautions against accidents, are exercisable by the Health Committee. Health education for the prevention of home accidents has continued throughout the year, with particular reference both to those groups at greatest risk and to the most prevalent causes. Inquests were held during the year on 27 fatalities in the borough arising from accidents which occurred in the home, including 4 from falls, 6 from poisoning, 6 from carbon monoxide and 3 from burns. Many children were admitted to hospital or treated as out patients after swallowing medicines in tablet or capsule form. Special publicity is arranged each year regarding home accident prevention including the necessity for preventing medicines and other dangerous materials from being accessible to children and for precautions to be taken during the "Firework season". AMBULANCE FACILITIES The Greater London Council is responsible under Section 27 of the National Health Service Act 1964 for the provision of ambulance transport in the area. ARTIFICIAL KIDNEY MACHINES During the year the Council undertook the work of carrying out necessary adaptations including plumbing, electricity and water supplies to a further dwelling in the borough where a renal dialysis machine was being installed. Modifications were also carried out to the services to six existing units in the Borough. The total cost to the Council of these works was £2, 300. AUTHENTICATION OF INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION Persons proceeding abroad are required in certain countries to produce a certificate of recent successful vaccination and/or inoculation, and in addition the signature of the vaccinating doctor must be verified by the Medical Officer of Health of the district. During the year 11, 928 signatures on certificates were verified as those of medical practitioners practising in the borough and the certificates endorsed accordingly. BLIND AND PARTIALLY SIGHTED PERSONS For the purpose of the Council's scheme for providing welfare services under the National Assistance Act 1948 for the blind and partially sighted, it is necessary to arrange medical examinations in connection with the certification of such persons. The department arranged 74 examinations by a consultant ophthalmologist during the year, and certificates accepted from other local authorities, hospitals and private ophthalmologists numbered 62. Transport to the clinic for examination is arranged for these persons where necessary. BURIALS Section 50 of the National Assistance Act 1948 places a duty on the Council to arrange for the burial of any person found dead within the borough where no private arrangements have been made. Burials undertaken during the year numbered 56 (Statistics on page 72). CHIROPODY Treatment is provided free to old persons in receipt of retirement pensions, expectant mothers, school children and the physically handicapped. - 37 - Foot clinics are held at 9 of the Health Department's establishments, and at 3 other establishments, providing a total of 42 sessions each week by the Chief Chiropodist, a full-time Senior chiropodist and eleven part-time chiropodists. For those unable to attend clinics, 6 of the chiropodists visit their homes to give treatment. The purpose-designed clinic for "transport" cases i.e. those with limited physical capabilities operated on four days each week throughout the year. The number of treatments carried out in Council clinics and in Social Services Homes for the Elderly are set out in Table 17. CONFERENCES Conferences attended by members of the Council and/or officers of the department are summarised on page 7 5. DECEASED PERSONS Inquests Inquests were held on 107 residents of the borough during the year, the verdicts being 18 deaths due to road accidents 27 other accidents, 6 suicide, 20 misadventure, 24 open verdicts, 7 natural causes, 2 chronic alcoholism, 1 murder, 1 manslaughter and 1 neglect. Transport of bodies abroad From time to time certificates are issued regarding bodies being transported abroad to the effect that the deceased had not died from an infectious disease and that the coffins were hermetically sealed. Twenty-three such certificates were issued this year, relating to 21 bodies flown to Israel, 1 to Italy and 1 to Malta. HOME BATHING Aged persons who are bedfast or homebound are given bed baths and, where the person is sufficiently agile, complete baths in their own homes by the Council's bathing attendants. This service continues to be of increasing assistance in relieving the district nurses of as much non-nursing duty as possible (Statistics on page 57.) HOSPITAL FACILITIES The undermentioned hospitals are situated within the borough; No. of beds Bethnal Green Hospital, Cambridge Heath Road, E.2. 308 London Hospital, Whitechapel Road, E. 1. 719 London Chest Hospital, Victoria Park, E. 2. 142 London Jewish Hospital, Stepney Green, E. 1. 128 Mildmay Mission Hospital, Austin Street, E.2. 7 0 London Hospital (Mile End) Bancroft Road, E.l. 410 Poplar Hospital, East India Dock Road, E. 14. 107 Queen Elizabeth Hospital for Children, Hackney Road, E.2. 146 St. Andrew's Hospital Devons Road, E. 3. 365 London Hospital (St. Clement's) Bow Road, E. 3. 128 LABORATORY FACILITIES Bacteriological investigations for infectious diseases are carried out on behalf of the health department by the Public Health Laboratory Service (directed by the Medical Research Council for the Department of Health and Social Security) at County Hall, S.E.I. - 38 - Investigations carried out by the Laboratory on specimens submitted by the department totalled 772, comprising 666 faeces and investigations on 106 food samples. LEGISLATION The following acts, orders and regulations affecting the department were made during the year:- Acts of Parliament Date made Date operative Breeding of Dogs Act 1973 25.10.73 1.4.74 Fair Trading Act 1973 25.7.73 14. 9.73 National Health Service Reorganisation Act 1973 5.7.73 1.4.74 Water Act 1973 16.7.73 1.4.74 Orders and Regulations Arsenic in Food (Amendment) Regulations 1973 14.6.73 14.7.73 Baking and Sausage Making (Christmas and New Year) Order 1973 6.11.73 8.12.73 Colouring Matter in Food Regulations 1973 26.7.73 30.8.73) 1.7.74) Common Agriculture Policy (Wine) Regulations 1973 26.7.73 1. 9.73 Counter Inflation (Prices and Pay Code) Order 1973 1.4.73 2.4.73 Disease of Animals (Waste Food) Order 1973 16.11.73 3.12.73) 1.4.74 ) Electricity (Lighting)(Control) Order 1973 10.12.73 12.12.73 Electricity (Heating)(Restrictions) Order 1973 14.11.73 15.11.73 Electricity (Advertising, Display etc.)(Restrictions) Order 1973 14.11.73 15.11.73 Electricity (Heating) (Restriction) Variation Order 1973 15.11.73 16.11.73 Electricity (Industrial and Commercial Use) (Control)(No. 2) Order 1973 21.12.73 31.12.73 Emergency Regulations 1973 13.11.73 14.11.73 Fertilisers and Feeding Stuffs Regulations 1973 29. 8.73 1.1.74 Fuel and Electricity (Heating)(Control) Order 1973 8.12.73 11.12.73 Heavy Goods Vehicles (Drivers Licences) (Amendment) Regulations 1973 12.7.73 13. 8.73 Housing (Payments for Well Maintained Houses) Order 1973 13.3.73 73 Imported Food (Amendment) Regulations 1973 27.7.73 1. 9.73 Lead in Food (Amendment) Regulations 1973 14. 6.73 14.7.73 Local Government Superannuation (Miscellaneous) Provisions 1973 26.2.73 30. 3.73 Local Government (Staff Transfer Scheme) Order 1973 5.11.73 5.12.73 Local Government (Retirement of Chief Officers) Regulation 1973 19.7.73 20. 8.73 Milk and Dairies (Semi-Skimmed and Skimmed Milk) (Heat Treatment and Labelling) Regulations 1973 15. 6.73 18.7.73 Milk and Dairies (Milk Bottle Caps) (Colour) Regulations 1973 18.6.73 1.12.73 Misuse of Drugs Regulations, 1973 19.4.73 1.7.73 National Health Service Reorganisation (Commencement No. 2) Order 1973 30. 8.73 28.9.73 National Health Service Reorganisation Act 1973 (Appointed Day) Order 1973 21.11.73 20.12.73 National Health Service (Constitution of Area Health Authorities) Order 1973 25.7.73 24.8.73 National Health Service (Determination of Areas) Order 1973 23.7.73 20. 8.73 National Health Service (Regional and Area Health Authorities Membership and Procedure) Regulations 1973 25.7.73 22.8.73 National Health Service (Constitution of Regional Health Authorities) Order 1973 9.7.73 6.8.73 National Health Service (Determination of Regions) Order 1973 9.7.73 6.8.73 - 39 Orders and Regulations (continued) Date made Date operative National Health Service (Variation of Membership of Certain 24.10.73 22.11.73 Family Practitioners Committees in London) Order 1973 Rent Regulation (Forms etc.) Amendment Regulation 1973 30.8.73 3.10.73 Separated Milk Regulations 1973 28.2.73 1.4.73 Skimmed Milk with Non-Milk Fat (Amendment) Regulations 1973 1.2.73 6.3.73 Smoke Control Areas (Exempted Fireplaces) Order 1973 19.12.73 31.1.73 Welfare Food (Amendment) Order 1973 22.2.73 1.4.73 C i rcu1ars Circulars on other matters relevant to the functions of the Department and issued by the various Government Departments during the year included those relating to the following subjects- Arrangements under Section 15 of the Water Act 1973 for the discharge of sewerage functions; Building Regulations 1972 - Clean Air Acts 1956 and 1968 - Maximum Cost Limits; Chest Radiography of Ante-Natal Patients; Community Services for Alcoholics; Criminal Justice Act 1973 - Section 30 - Increase in Maximum Penalties for Unlawful Eviction or Harassment of Residential Occupiers; Emergency Rehousing Procedure in the Event of Tidal Flooding of the Thames; Financial arrangements for Social Work and Training Details of Transfer of Responsibilities to Local Authorities; First Report of the Standing Committee on Research into Refuse Collection, Storage, and Disposal; House Improvement in Development and Intermediate Areas; Housing Accommodation outside a Local Authorities Area; House and Area Improvements; Lead and the Environment; Local Authority Health and Social Services Building Programme and Cost Allowance; Lorries and the Environment; Management Structure in the Local Authority Nursing Services First Line Management; Milk for Young Children in Day Care; Planning and Noise; Public Health Act 1961 - Building Regulations; River Pollution Survey of England and Wales Updated 1972 - discharge of sewage and industrial effluents; Report on the Survey of Discharges of Foul Sewage to the Coastal Waters of England and Wales. Recruiting for the Community Health Services; Safety of Structures; The Next Steps in Housing; The Next Priorities; Training in Community Medicine - Inter Regional Scheme. MEDICAL EXAMINATION OF STAFF The department's medical officers undertake for the Council the medical examination of new entrants to the Council's service, of staff and employees absent due to sickness exceeding one month, of employees considered for participation in the Sick Pay Scheme and for extension of service beyond the age of 65 years, as well as assessments for gratuities and other reasons as required. Examinations or assessments carried out during the year numbered 1,736(details on page 62 ). RADIOACTIVE SUBSTANCES Persons who keep or use radioactive materials, unless exempted, are required, under the provisions of the Radioactive Substances Act 1960, to register with the Department of the Environment and to obtain authority for the accumulation or disposal of radioactive waste. The Department has issued 16 registration certificates with respect to premises in the borough. REFRESHER COURSES Refresher and training courses attended by staff during the year are listed on pages 76 to 7 9 . REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION The Council is empowered by Section 47 of the National Assistance Act 1948, as amended by the National Assistance (Amendment) Act 1951, to make application to a Justice of the Peace for an Order for the removal to hospital or institution of any aged, infirm or physically incapacitated person living in insanitary conditions, and who is in need of care and attention. - 40 - It was found necessary this year to apply for Removal Orders under this enactment in respect of 10 persons, 8 of whom were removed to hospital and 2 to a Welfare home. An extension order was granted in respect of a person detained in a Welfare Home. STAFF CHANGES Appointments and resignations of members of the staff numbered 74 and 98 respectively, as follows:- Appointments Resignations Administrative and Clerical 25 23 Chiropodists 4 3 Dental Staff 13 14 Medical Officers 4 7 Nursing Staff: Health Visiting 6 13 Clinic and School 6 10 District Nurse 1 8 Public Health Inspectors and Pupils 9 11 Social Workers - 2 Miscellaneous 6 14 Total 74 98 TRAINING etc. FOR STUDENTS As part of their training and studies, student nurses, medical students and others need to make visits of observation to local Health Authority establishments and to spend time with certain field staff. Students accepted during the year numbered 409 comprising - 2 Administrative Students (Nurses) 54 Student Midwives 87 Student Nurses 162 Student Nurses 34 Medical Students 45 Degree and Integrated Nurse-Health Visitor Course Students 7 Student Health Visitors 1 Clinical Teacher 2 Sisters (Hospital) 8 Occupational Therapy Students 7 Physiotherapy Students London Hospital London Hospital, Community Option period. London, Mile End, Bethnal Green, St. Andrews, London Jewish and Great Ormond Street Hospitals. London and Middlesex Hospitals. Nursing Degree Course Polytechnic of North London, North East London Polytechnic and Polytechnic of the South Bank London Hospital London Hospital London Hospital London Hospital 41 *********** - 42 - PART VI REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE VI REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE The Inner London Education Authority is responsible for the School Health Service, but by virtue of an agreement by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the Council of professional staff, premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area of the borough and is responsible to that Authority for the day to day running of the Service. As in previous years, close liaison with the Medical Adviser and his central staff has maintained an effective service. At local divisional level, Mr. Peirce and his staff have been ever willing to continue good working relationships. SCHOOLS AND SCHOOL ROLLS Pupils on school rolls numbered 30,7 63 attending 96 maintained schools in the borough which include four schools for the educationally subnormal, two for the maladjusted, one for delicate children, and one for the physically handicapped. There are no direct grant or independent schools included in the School Health Service. The registers were as follows - Type of School No of Schools Pupils Primary 63 17, 964 Secondary 18 11,201 Nursery 7 699 Special 8 899 MEDICAL INSPECTION OF SCHOOLCHILDREN Routine Medical Examinations These are carried out by medical officers of the department assisted by school nurses. Where further examinations are found to be required children are referred to special clinics, e. g. vision, hearing, dental, child guidance and special investigation clinics, etc. Non-routine Medical Examinations These examinations are carried out for various reasons, e.g. prior to departure on school journeys; for ascertainment of suitability for ordinary school and at the request of the head teacher, educational welfare officer, school nurse, parent or medical officer. Attendances for treatment of scabies at the bathing centres decreased from 180 last year to 109 in 1973. A combined approach with the co-operation of local schools, general practitioners and the borough cleansing station staff continued during the year to ensure where possible that all known cases, and their family and other contacts are given a complete course of treatment. HANDICAPPED PUPILS Every possible care is given to ensure that any child with a handicap which might affect his or her educational attainment is kept under careful review and consideration, where he or she is in an ordinary school or a special school, and a register of all handicapped children is maintained to ensure no child is lost sight of when he/she moves from school to school or borough to borough. Tower Hamlets children placed in special schools are as follows :- - 43 - Handicap No at Day Schools No. at Boarding Schools Blind - 6 Partially sighted 22 - Deaf 12 3 Partially hearing 47 5 Educationally subnormal 519 145 Epileptic - 1 Maladjusted 105 95 Physically handicapped 90 16 Delicate 133 20 Multiple handicaps - 5 Totals 928 296 INFECTIOUS DISEASE IN SCHOOLS Of the 911 cases of infectious disease notified 338 or 37% related to school-children. In addition 693 notifications were made by head teachers of pupils absent from school on account of infectious and other illnesses (see page 81). Where the notifications from any particular school warrant further investigation special visits are made and any necessary investigations carried out, including the taking of specimens for bacteriological examination, to ascertain the sources of, and contain, the outbreak. ENVIRONMENTAL HYGIENE IN SCHOOLS Each school in the borough is visited annually by public health inspectors for environmental hygiene inspection and results of their findings are reported to the Medical Adviser of the Inner London Education Authority. Visits are also made to schools by public health inspectors in connection with enquiries and investigations concerning infectious diseases. MINOR AILMENTS CLINICS Children suffering from minor ailments may be referred to minor ailments clinics where they are seen by a nurse and the appropriate treatment given. A doctor attends one of these clinics where vaccination and immunisation is also given. There are 6 such clinics situated in school treatment centres in the borough. Attendances this year totalled 13, 071 compared with 17, 305 last year. VACCINATION AND IMMUNISATION RECORDS OF SCHOOLCHILDREN The percentage of school-children on school rolls immunised and vaccinated is as follows:Diphtheria Tetanus Poliomyelitis 86.65 86.23 86.81 B.C.G. VACCINATION The arrangements continued during the year for vaccinating 13 year old school-children against tuberculosis using B.C.G., 2, 071 children being vaccinated. - 44 - PART TIME EMPLOYMENT OF SCHOOLCHILDREN It is a requirement of the Children and Young Persons Act 1933/Education Act 1944, where children wish to take up part-time employment such as delivering newspapers, etc., that they be medically examined to ensure that they are fit for the proposed employment. All children examined for this purpose during the year were found fit for the employment proposed. DEAF AND PARTIALLY-HEARING CHILDREN Children under 5 suspected of hearing loss are tested by the clinic medical officer at clinic centres. School children are normally tested during their first year at school. Where such a loss is confirmed or there is any doubt, the child is referred to an audiology clinic and seen by a teacher of the deaf and re-tested by a nurse audio-metrician. Action taken includes referral to hospital for treatment, or for the issue of a hearing aid, or keeping the child under observation where the loss is slight. Children may be recommended to attend a partially hearing unit in one of the primary schools in the Borough. There are no special schools for deaf children in the borough, children having to go to a school in Islington. EDUCATIONALLY SUBNORMAL CHILDREN From the 1st April 1971, under the Education (Handicapped Children) Act 197 0, the provision for notifying a child as unsuitable for education at school ceased, and the provisions of Section 34 of the Education Act 1944 regarding special educational treatment apply to such children. The Education Act 1944 makes provision for the statutory examination of children who may require special educational treatment and for review examinations of such children. Children examined for these purposes during the year by specially qualified medical officers numbered 56. There are four schools in the borough for the education of these children who are medically examined each year. HEALTH EDUCATION IN SCHOOLS Liaison with various schools in the borough continued to give good results. Teaching staff show more interest in the work of the Health Department and appreciate the need for health education. Health education sessions held at schools numbered 93 during the year, attended by 1,775 pupils. EDUCATION (MILK) ACT 1971 From the commencement of the autumn term 1971, this Act of Parliament restricted Education Authorities from providing school milk other than to children under 7 years of age, children attending special schools and children in primary schools for whom the school medical officer certified that such provision was necessary on medical grounds. Following the adoption of a resolution by this Council that expenditure be incurred under the provision of section 6 of the Local Government (Financial Provisions) Act 1963 for the provision of free milk to schoolchildren resident in the borough in the age group 7 to 11 years, these children continue to receive school milk hitherto provided by the Inner London Education Authority. SCHOOL DENTAL SERVICE The Principal School Dental Officer (Mr. T. H. H. Murray) reports as follows: "There are 7 dental clinics in the borough providing dental suites with a total of 12 surgeries, one surgery being used exclusively for orthodontics. All premises are provided w ith up-to-date equipment. During the year 24, 841 pupils were examined for the first time, those requiring treatment remaining constant at 63.9%. Treatment was offered to 10, 893 pupils, 6, 353 accepting. - 45 For adequate dental care of the children of the Borough the number of full-time dental officers in post is too low. I hope that in the new organisation there will be more incentive for full-time dental officers to join the Area Health Authority. Unfortunately, the dental clinic at the Bernhard Baron Settlement ceased to function in August due to termination of the lease. The loss will be replaced in the long term when the Health Centre in Watney Street is brought into being." STATISTICS Statistics relating to the School Health Service will be found on pages 80 and 81. 46 PART VII APPENDIX OF STATISTICAL TABLES table 1 summary of road accidents occurring in the borough Pedestrians Motor Cyclists Pedal Cyclists Other Road Users Total 1973 killed 10 1 3 2 16 injured 632 135 70 948 1,785 1972 killed 13 - 1 5 19 injured 592 121 70 939 1,722 table 2 infant mortality Deaths from stated causes at various ages under 1 year (compiled from local death returns) AGE PERIODS Under 24 hours 1-6 days Weeks Months Total Deaths under 1 year Per Cent of Total 1- 2- 3- 1- 4- 7- 10- Respiratory Distress Syndrome - 4 - - - - - - - (7) 4 10.8 Bronchitis - - - - - 1 1 - - (1) 2 5.4 Pneumonia - 1 - - - 4 1 - - (9) 6 16.2 Congenital Malformations 1 2 - 1 - 2 1 - 1 (5) 8 21. 6 Premature Birth 6 4 - - - - - - - (4) 10 27.1 Asphyxia, Atelectasis 1 - - - - - - - - (1) 1 2.7 Birth Injuries - 1 - - - 1 - - - 2 5.4 Other Causes - 1 - - - 2 1 - - (22) 4 10.8 TOTALS: 8 13 - 1 - 10 4 - 1 (49) 37 100. 0 (* Figures in parenthesis denote corresponding deaths in 1972) table 3 INFANT MORTALITY Comparative table showing deaths of infants at various ages under 1 year Year Under 24 hours 1 -6 days 1 - 4 weeks Total under 4 weeks 1 - 12 months Total under 1 year Percentage deaths under 4 weeks of total Infant deaths 1969 11 13 4 28 15 43 65 1970 16 13 4 33 16 49 67 1971 25 10 6 41 14 55 74 1972 7 10 12 29 20 49 59 1973 8 13 1 22 15 37 59 47 TABLE 4 COMPARATIVE VITAL STATISTICS Year Population Live Births Deaths Deaths under 1 year Maternal Deaths Cancer Deaths (all forms) Tuberculosis Deaths (all forms) No. Rate* No. Rate* No. * Rate * No. * Rate * No. Rate* No. Rate* 1901 597,106 21, 515 36.0 12,143 20.3 N/A N/A 420 0.7 1,670 2.8 1911 570,429 17,461 30.6 10,272 18.0 2,664 152.5 51 2.9 506 0.8 1,223 2.1 1921 530,656 13,283 25.0 6,863 12.9 1,219 91.8 29 2.1 571 1.1 751 1.4 1931 491, 300 8, 585 17.5 6,286 12.7 685 79.8 26 2.9 692 1.4 565 1.1 1941 174, 520 2,607 14. 9 6,733 21.4 117 44.8 5 1.8 399 2.2 272 1.5 1951 229,118 4, 092 17.8 3, 083 13.4 101 24.7 5 1.2 531 2.3 90 0.4 1961 204,340 4, 037 19.7 2,484 12.1 95 23.5 5 1.2 480 2.3 25 0.1 1962 204, 050 4, 086 20. 0 2.474 12.1 79 19. 3 0 0 503 2.5 24 0.1 1963 203.850 3, 988 19. 6 2, 531 12.4 96 24.1 2 0.5 510 2.5 24 0.1 1964 206, 080 4, 026 19. 5 2,256 10.9 92 22.8 1 0.2 523 2.5 12 0. 05 1965 204,560 3, 867 18.9 2,280 11.1 76 19.6 0 0 529 2. 6 21 0.1 1966 202, 560 3,703 18.3 2,245 11.1 62 16.7 0 0 481 2.4 22 0.1 1967 198,230 3,262 16.4 2,130 10.7 56 17.2 1 0.3 539 2.7 18 0.1 1968 192,250 2, 875 15. 0 2,382 12.4 69 24. 0 0 0 539 2.8 18 0.1 1969 188, 080 2, 612 13.9 2,315 12.3 46 17.6 2 0.8 493 2.6 15 0.1 1970 182,260 2,471 13.6 2,170 11.9 50 20.2 1 0.4 537 2.9 17 0.1 1971 164,650 2, 234 13.6 2,147 13.0 54 24.2 0 0 567 3.4 9 0. 05 1972 159,200 1, 979 12.4 2,209 13.9 52 26.3 0 0 546 3.4 18 0.1 1973 153,360 N/A N/A N/A N/A N/A N/A * * per 1, 000 population * per 1, 000 total births N. A. - Not available NOTE: Figures prior to 1965 relate to those of the former Metropolitan Boroughs of Bethnal Green, Poplar and Stepney TABLE 5 OBSERVATION REGISTER (i) Observation Register (Children under 5 years) No. on Register on 1st January 2,476 No. added during year 852 3,328 No. removed during year - died 7 - moved away 147 - no longer at risk 531 - transferred to ages 5-21 register 44 729 Total on Register at 3lst December 2, 599 No. of above total suffering from handicaps 221 Year of birth of those on Register at 31st December 1973 713 1972 688 1971 558 1970 394 1969 246 2, 599 (ii) Observation Register (5-21 years) Total on Register at 3lst December 2, 557 (iii) Handicaps of children and young persons on Observation Register 0-4 years 5-21 years Educationally subnormal - 750 Severely subnormal - 127 Physically handicapped 144 574 Mentally retarded 18 - Maladjusted - 278 Blind (Registered) - 5 Visual "defects 8 78 Speech defects (requiring special or other school) 18 27 Epileptic 13 126 Deaf and partially hearing 8 201 Delicate (including diabetic) - 136 Multiple handicaps 12 255 Total: 221 2, 557 In addition there are 277 children suffering from handicaps attending schools in the Borough, but living outside the Borough. 49 TABLE 6 DISEASES NOTIFIABLE IN THE BOROUGH Disease Authority for Notification Statutory Instrument No. Acute Encephalitis Health Services and Public Health Act 1968 (Section 56) 1968/1366 Acute Meningitis -do- -do- -do- Acute Poliomyelitis -do- -do- -do- Anthrax -do- -do- -do- Cholera -do- (Section 48) - Diphtheria -do- (Section 56) 1968/1366 Dysentery (Amoebic) -do- -do- -do- Dysentery (Bacillary) -do- -do- -do- Food Poisoning -do- (Section 48) - Infective Jaundice -do- (Section 56) 1968/1366 Leprosy -do- -do- -do- Leptospirosis -do- -do- -do- Malaria -do- -do- -do- Measles -do- -do- -do- Ophthalmia Neonatorum -do- -do- -do- Paratyphoid fever -do- -do- -do- Plague -do- (Section 48) - Relapsing fever -do- -do- - Scarlet fever -do- (Section 56) 1968A366 Smallpox -do- (Section 48) - Tetanus -do- (Section 56) 1968/1366 Tuberculosis -do- -do- -do- Typhoid fever -do- -do- -do- Typhus -do- (Section 48) - Whooping Cough -do- (Section 56) 1968/1366 Yellow fever -do- -do- -do- - 50 - TABLE 7 infectious disease notifications Corrected Notifications Removed to Hospital Notified in 1972 Notified in 1971 Acute Encephalitis Infective - - - - Post - infectious - - - - Acute Meningitis 4 4 2 8 Acute Poliomyelitis Paralytic - - - - Non-paralytic - - - - Anthrax - - - - Cholera - - - - Diphtheria - - - - Dysentery 162 10 96 39 Food Poisoning 51 8 27 68 Infective Jaundice 55 15 50 66 Leptospirosis - - 1 - Malaria 2 - 1 - Measles 448 13 578 238 Ophthalmia Neonatorum - - - - Plague - - - - Relapsing Fever - - - - Scarlet Fever 52 3 69 50 Smallpox - - - - Tetanus - - - - Tuberculosis Pulmonary 110 123 76 Non-pulmonary 22 20 18 Typhoid Fever - - - 2 Whooping Cough 5 - 13 54 Yellow Fever - - - - TOTALS: 911 53 980 619 TABLE 8 MORBIDITY - First Claims for Sickness Benefit The number of claims made to local offices of the Department of Health and Social Security covering postal districts E. 1., E. 2., E. 3. , and E. 14., were as follows: - 1973 1972 1971 1973 1972 1971 January 3,792 4,753 5, 074 July 2,862 2,823 2,371 February 3,163 3,107 2, 603 August 2,225 2, 094 2, 698 March 3,133 2,766 3,892 September 2, 354 3, 015 2, 383 April 2, 334 3, 003 2, 350 October 3, 682 2, 939 2,704 May 3,109 2,336 3, 050 November 2,7 91 3, 370 3,457 June 2, 284 2,442 2, 387 December 2, 693 4,609 2,718 TOTALS 34,422 37,257 35, 687 51 TABLE 9 VACCINATION AND IMMUNISATION Children vaccinated/immunised Others aged T O T A L Year of birth 1973 1972 1971 1970 1969 Under 16 Over 16 Diphtheria 665 955 117 55 135 51 - 1, 978 Re-inforcing 372 1, 014 188 1,482 248 - 3,304 Tetanus 665 955 117 55 136 101 15 2, 044 Re-inforcing Dose - 372 1, 016 189 1,494 538 45 3, 654 Whooping Cough 648 928 95 16 10 1 - 1,698 Re-inforcing Dose - 362 957 91 44 1 - 1,455 Poliomyelitis 67 0 942 122 59 137 66 4 2, 000 Re-inforcing Dose - 365 999 184 1,497 556 13 3,614 Measles - 1, 099 244 63 93 14 - 1,513 Rubella - - - - - 680 - 680 Diphtheria immunisation of children under 5 Children under 5 immunised during 1969/73 8, 619 Estimated population under 5 as at 30th June, 1973 9,400 Percentage protected 91.7 Vaccinations/immunisations(all ages) carried out at clinics/general practitioners surgeries At Council Clinics By General Practitioners °lo Primary by General Practitioners Primary Reinforcing Primary Reinforcing Diphtheria 1,777 2,849 201 455 10.16 Tetanus 1,789 3, 042 255 612 12.42 Whooping Cough 1, 523 1,255 17 5 200 10. 30 Poliomyelitis 1, 805 3, 089 195 525 10.50 Measles 1, 352 - 161 - 10.64 Rubella 632 - 48 - 5.20 - 52 - TABLE 10 TUBERCULOSIS - NOTIFICATIONS 1973 New Cases Primary notifications of 110 pulmonary and 22 non-pulmonary cases were received; 5 other cases came to light via death returns from Registrars. Age distribution of new cases is as follows- -1 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) (a) New Cases Pulmonary M - 1 9 1 2 5 1 10 18 17 12 8 4 88 F - 2 3 5 1 1 2 3 2 1 - - 2 22 Non-Pulmonary M - - - - - 1 - 2 3 2 2 - -- 10 F - - 1 - - 1 4 2 - 2 - 2 - 12 TABLE 11 TUBERCULOSIS - CARE AMD AFTER CARE Work of Tuberculosis Visitors No. of tuberculous households visited 1, 658 No. of visits to above and to contacts 6,168 No. of unsuccessful visits 349 Children No, child contacts boarded out during year Nil No. child contacts boarded out for segregation during B.C.G. Vaccination Nil TABLE 12 MASS RADIOGRAPHY - Unit 6A Mobile Surveys No. of factories, sites, etc. visited 8 Persons x-rayed - Males 702 Females 239 Total 941 No. referred for further investigation 37 Toynbee Hall - Weekly session Persons x-rayed - Males 2,887 Females 2, 307 Total 5,194 No. referred for further investigation 130 TABLE 13 TUBERCULIN TEST AND B.C.G. VACCINATION Contacts Schoolchildren and Students Total No. of skin tests 319 2,639 2, 958 No. found positive 118 266 384 No. found negative 201 2, 071 2,272 No. vaccinated 196 2, 071 2,267 - 53 - TABLE 14 ANTE AND POST NATAL SERVICES No. Ante and Post Natal Sessions held by: Medical Officers - Midwives 48 No. women attending for ante natal examination 36 No. women attending for post natal examination 15 Total attendances 275 No. General Practitioners holding sessions in Council clinics 4 Mothercraft and Relaxation Classes: No. women attending (a) Institutionally booked 23 (b) Domiciliary booked - No. attendances 86 No. sessions held by Health Visitors 37 TABLE 15 CHILD WELFARE CENTRES No. premises at end of year 14 No. sessions during year held by: Medical Officers 409 Health Visitors 67 Sessional General Practitioners 1,327 Hospital medical staff 52 Total sessions 1,855 No. children attending - born this year 1,498 - born last year 1, 917 -born 1968/71 2, 995 No. attendances of children of all ages 31,728 Average attendance per session 17.1 TABLE 16 CERVICAL CYTOLOGY Premises Number Sessions Examinations Council Clinics 6 551 2,490 General Practitioners Surgeries 1 47 212 Family Planning Clinics Details not available Other Slides read in Hospital Laboratories Submitted by G. P.'s Hospital Other Hospitals Mile End Hospital 809 865 516 London Hospital - 7, 560 - (Residents of all areas) 54 TABLE 17 CHIROPODY Treated at Clinics Domiciliary Treatment New patients during year 746 149 Total patients at end of year 4,155 739 Treatments - children 66 - - expectant mothers - - - physically and mentally handicapped 33 - - aged persons 14, 674 3, 088 No. of chiropodists employed 12 No. of clinic sessions held 1, 966 No. of patients treated per clinic session 7.2 Percentage of total patients receiving domiciliary treatment 15.1 No. of sessions held in Old People's Homes 100 Total No. of treatments 17,861 TABLE 18 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Expectant Mothers Children Persons examined 63 478 No. requiring and offered treatment 63 442 Visits during the year 174 1,467 Courses of completed treatment 63 240 Teeth extracted 10 15 Teeth filled 95 979 Emergencies treated 2 36 General anaesthetics given - - No. patients x-rayed 27 1 No. patients treated by scaling etc. 63 342 Dentures - full 1 - - partial 4 - No. of sessions for treatment 191 -do- for health education 17 No. of treatment Centres at end of year 8 - 55 - TABLE 19 FAMILY PLANNING SERVICE Attendances at Sessions held at Clinics in the borough during the year. New Cases Old Patients Total Patients Total Visits No. of Sessions Council Clinics St. Georges 313 - 313 1, 049 51 Island 345 - 345 1,102 101 Greenwood 407 - 407 1,201 99 Leopold Street 588 - 588 2,115 98 Newmill 35 - 35 49 4 Family Planning Association Clinics Domiciliary Service 31 48 79 - - Underwood Road 445 726 1,171 2,7 03 169 Wapping 14 56 70 158 24 Wellington Way 256 343 599 1,383 99 Totals: 2, 434 1,173 3, 607 9,760 645 1972 Statistics 1,858 1,159 3, 017 8, 037 635 TABLE 20 HEALTH VISITING No. Visited No. of Visits Children born this year 1,892 36,144 " ” under 5 6, 927 Aged persons 738 3,096 Mentally disordered persons 45 641 Tuberculous households 21 197 Households on account of other infectious diseases 21 74 Other Cases 2,465 6,489 Visits to expectant and nursing mothers - 2,220 Total effective visits 48,861 Unsuccessful visits 9,205 TABLE 21 PREMATURE BIRTHS Born in Hospital Bom at Home or in Nursing Home 1973 1972 1971 1970 1973 1972 1971 1970 No. of Births 165 156 166 211 - 7 10 9 Died within 24 hours 4 5 18 11 - 2 1 - Died within 1/28 days 8 10 7 8 - - - -- Premature still births 20 18 20 23 2 2 - - 56 - TABLE 22 HOME BATHING Persons serviced during the year: Male 104 Female 321 Total 425 Persons receiving service at end of year: Male 81 Female 271 Total 352 Total baths given during year 6,269 TABLE 23 HOME NURSING Number of patients nursed during year 3,403 Number aged under 5 64 Number aged over 65 1,836 Number of visits during year 89,350 TABLE 24 LAUNDERING FOR AGED AND INCONTINENT No. of articles cleansed and laundered during year 72,231 No. of collections made during year 6,389 No. of persons who received service during year 112 No. of persons receiving service at end of year 71 TABLE 25 RECUPERATIVE HOLIDAYS Category No. for whom holiday arranged Accompanied children: At School 6 Pre-school - Unaccompanied children: Placed by Inner London Education Authority: At School 233 Pre-school Total 239 - 57 - TABLE 26 LOAN OF NURSING EQUIPMENT AND FIREGUARDS Nursing equipment and fireguards loaned, by the Council, free of charge to residents of the borough during the year were as follows:- Article No. on loan at 1/1/73 No. loaned during year No. returned during year No. on loan at 31/12/73 Air Rings 27 17 24 20 Back rests 21 31 24 28 Bed cradles 26 23 19 30 Beds - Hospital 9 5 7 7 Bed pans 31 40 28 43 Bottles 42 52 40 54 Commodes - Chair 171 140 129 182 Commodes - Stool 8 7 4 11 Commode pans - - - - Crutches, Elbow 4 1 3 2 Cushions - Sponge - 8 3 5 Fracture boards 22 15 2 35 Mattresses - ordinary 2 3 4 1 Mattresses - Dunlopillo 9 6 4 11 Sheets - Rubber 48 42 24 66 Walking frames 30 17 12 35 Walking frames - wheeled 1 - - 1 Walking frames - Zimmer adjustable 2 1 1 2 Walking sticks - tripod 17 7 7 17 Walking sticks - Quadruped 1 1 1 1 Water Closet Seats inflatable 5 - - 5 TOTALS: 476 427 340 563 OTHER EQUIPMENT LOANED Fireguards 615 62 6 671 - 58 - TABLE 27 DOMICILIARY MIDWIFERY Category Midwives of the Nursing Sisters of St. John the Divine District Nurses Midwives of the London Hospital Total Home Confinements 1973 66 - 6 72 1972 92 - 32 124 1971 85 - 57 142 1970 118 - 76 194 1969 112 - 121 233 1968 119 - 151 270 1967 146 - 202 348 Early Discharges 1973 215 82 416 713 1972 112 133 164 409 1971 77 148 132 357 1970 75 198 68 341 1969 48 117 60 225 1968 53 93 43 189 1967 59 - 52 111 - 59 - TABLE 28 PARKS AND OPEN SPACES IN THE BOROUGH (a) Administered by Borough Council Location Area in Acres Abbott Road .103 Albert Square Gardens .660 All Saints (Poplar) 1.060 Allen Gardens 2.000 Alton Street 3.000 Arbour Square .660 Arnold Circus .072 Bartlett Park 11.570 Bazeley Street 1.303 Bethnal Green Gardens 11.970 Blackwall Tunnel Commemoration Park 3.000 Bromley 1.520 Cable Street/Schoolhouse Lane .177 Chicksand Street 1.600 Carlton Square 1.950 Christchurch (Spitalfields) .150 Dee Street .449 Ford Square .400 Furze Green 1.930 Gale Street .240 Glaucus Street .700 Globe Road .079 Gosling Gardens 2.500 Grove Hall Park 4.500 Hewlett Road .050 Holy Trinity, Morgan Street .680 Ion Square 2.500 Island Gardens 3.000 Jodrell Road .105 King Edward Memorial 8.500 Kingsley Hall .133 Kirkwall Place .123 Langdon Park 2.610 Mallon (Commercial Street) .190 Meath Gardens 10.540 Mile End .500 - 60 - TABLE 28 (Continued) PARKS AND OPEN SPACES IN THE BOROUGH (Continued) (a) Administered by Borough Council (continued) Location in Acres Millwall Park 14.060 Newby Place .490 Peel Grove 1.118 Pelter Street .122 Poplar 4.409 Prescot Street .230 Rochelle Street .073 Ropewalk Gardens 1.750 St. Bartholomew's (Bethnal Green) 1.117 St. George's-in-the-East 2.250 St. James's (Bethnal Green) 2.000 St. James's (Ratcliffe) 2.500 St. John's Parish 2.500 St. Mary's Churchyard 1.260 St. Matthew's (Bethnal Green) 2.065 Shacklewell Street .610 Shandy Park 3.180 Sidney Square .330 Sir John Mcdougall Gardens 6.320 Stepney Churchyard 6.960 Stepney Green 6.920 Swanfield Street .227 Swedenborg Square .670 Trafalgar Square . 600 Tredegar Square 1.240 The Triangle, Columbia Road . 066 Trinity Gardens 1.030 Trinity Square 1.230 Tunnel (Blackwall) .857 Vallance Road 3.440 Wakefield (Tower Hill) .060 Wapping Gardens 3.560 Waterside Gardens 1.920 Weavers Fields 15.120 Whitehorse Road 2.500 Wick Lane Promenade 1.500 Wyvis Street .257 York Square .200 175.265 (b) Administered by Greater London Council Location Area in Acres Brickfield Gardens 5.730 Burdett Gardens 4.140 King George's Field, East London Stadium 15.930 Limehouse Churchyard 2.000 Victoria Park 148.500 Tower Hamlets Cemetery Gardens 4.500 180.800 356.065 - 61 - TABLE 29 MEDICAL EXAMINATIONS OF COUNCIL STAFF (a) Medical Examinations Number New appointees 49 Transfers to permanent staff 6 Entry to Council's Sick Pay Scheme 49 Sickness absence exceeding one month 308 Extension of service beyond 65 years of age 37 Reviews, heavy goods vehicle drivers, etc. 27 Student Teachers 87 Examinations arranged with other authorities 1 Total 564 Abortive appointments 191 (b) Medical Assessments For entry to Sick Pay Scheme 523 New appointees 556 Transfers to permanent staff 51 LOLA staff 42 1,172 TABLE 30 VISITS BY PUBLIC HEALTH INSPECTOR (CLEAN AIR) To premises regarding complaints 354 Smoke Control Orders 89 for smoke observations 690 regarding installation of boilers and chimneys 312 routine boiler inspections 188 No. of notices served under Sec. 12(2) Clean Air Act 1 Sec. 16 -do- - - 62 - TABLE 31 SUMMARY OF PUBLIC ANALYST'S QUARTERLY REPORTS The following is a summary of the samples analysed and included in reports submitted each quarter of the year by the Council's Public Analyst in compliance with Section 99 of the Food and Drugs Act, 1955. A copy of each quarterly report is submitted to the Minister of Agriculture, Fisheries and Food in accordance with the Act. During the year 846 samples were submitted for analysis, as follows - 14 Baby foods 9 Liqueurs 1 Brandy 94 Meat and meat preparations 4 Bread 3 Meat pies and sausage rolls 12 Bread and Butter 15 Meat products (canned) 1 Breakfast cereals 27 Milk 2 Butter 1 Milk preparations 37 Cereals and starch products 7 Miscellaneous samples 13 Cheese and cheese preparations 63 Nuts and nut preparations 2 Cider 12 Oils fats and fatty foods 45 Cocoa and chocolate preparations 46 Pickles and sauces 2 Coffee and coffee preparations 3 Rum 5 Cream 12 Salad cream 38 Drugs 9 Sausages and other meat products 26 Eggs and Egg Products 2 Shandy 10 Fish and fish preparations 34 Soft drinks 1 Flavourings 13 Soup and soup mixes 9 Flour and flour products 19 Spices and condiments 8 Flour confectionery 4 Sugars, syrups, etc. 1 Food additives 40 Sugar confectionery 120 Fruit and fruit preparations 9 Table jelly preparations 1 Gin 2 Tea 16 Herbs and herb preparations 21 Vegetables and vegetable preparations 3 Ice cream 2 Vinegar and acetic acid 1 Ice lollies, etc. 3 Whisky 18 Jam and preserves 6 Wine - 63 - TABLE 32 HOUSING INSPECTORS AND TECHNICAL ASSISTANTS VISITS AND NOTICES VISITS Housing Act, 1957 (Sections 16, 17 and 18) 259 Slum Clearance 681 Overcrowding 142 Town Planning applications 81 Houses in Multiple Occupation 6,237 Preferential re-housing 656 Sites 3, 07 0 Qualification Certificates 32 Improvement Grants 19 Miscellaneous 448 TOTAL 11, 625 NOTICES, ORDERS, ETC. HOUSING ACTS 1957-64 Informal Notices 90 Requiring Additional Services (Section 15) - Management Orders made 32 revoked 1 Intention to make directions 26 Directions made (Section 19 69 Directions revoked - Overcrowding (Section 90 Housing Act, 1957) 14 Means of Escape in Case of Fire (Section 16) - No. Registered Part I Registration Scheme 41 No. Registered Part II Registration Scheme 1 No. Registered Registration Scheme. Subject to conditions 6 TABLE 33 DWELLINGS ERECTED DURING 1973 (a) By Borough Council Ardent House 320 Roman Road 20 Conyer Street 1-2 2 Crane House 352 Roman Road 30 Derwent House 2 Southern Grove 56 Exmoor House 1 Gernon Road 22 Hyperion House 35 Arbery Road 41 Leslie Street 1-8 and 10-30 (consec.) Block A. O'Leary Estate 29 Teviot Street 90 - 162 (even) 37 Wager Street 156 - 182 (even) 14 251 (b) By Greater London Council Details not available (c) By Others St. Thomas House 4 West Arbour Street 36 30 East Arbour Street 16 392, 394, 396 Bethnal Green Road 3 Christchurch Spitalfields 2 Tarrant House 1-10 9 Roman Road 10 The Vicarage 7 Roman Road 1 68 TOTAL 319 - 64 - TABLE 31 PRESCRIBED PARTICULARS OH THE ADMINISTRATION OF THE FACTORIES ACT, 1961 1. Inspections for purposes of provisions as to health Type of Factory No. on Register Inspections Written Notices Factories without mechanical power 94 20 - Factories with mechanical power 1, 626 1,458 100 Other premises under the Act (Electrical stations, institutions, and sites of building operations and works of engineering and construction) 89 6 — Total 1,809 1,484 100 2. Cases in which defects were found Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 3 2 - - Overcrowding 1 1 - - Unreasonable temperature - - - - Inadequate ventilation 2 2 - - Ineffective drainage of floors - - - - Sanitary conveniences: (a) Insufficient 2 2 - - (b) unsuitable or defective 137 107 - 1 (c) not separate for sexes 2 1 - 3 Other offences against the Act (not including those relating to outwork) 7 . 4 Total: 154 115 4 4 - 65 - TA3LE 35 PART VIII OF THE ACT - OUTWORK Section 133 No. of outworkers in August list No. Cases of default in sending lists to the Council No. of prosecutions for failure to supply lists to the Council Nature of work Wearing apparel: Making etc. Cleaning and washing 899 _ _ Household linen - - - Lace, lace curtains and nets - - - Curtains and furniture hangings 14 - - Furniture and upholstery 7 - - Electro-plate 4 - - File making - - - Brass and brass articles - - - Fur pulling - - - Iron and steel cables and chains - - - Iron and steel anchors and Grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc. - - - Artificial flowers ll - - Nets (other than wire nets) - - - Tents - - - Sacks - - - Racquet and tennis balls - - - Paper bags - - - Making of boxes and other receptacles or parts thereof made wholly or partially of paper 58 - _ Brush making - - - Pea Picking - - - Feather sorting - - - Carding, etc. of buttons, etc. 18 - - Stuffed toys - - - Basket making - - - Chocolates and sweetmeats - - - Cosaques, Christmas stockings - - - Textile weaving - - - Lampshades 3 - - Total: 1,014 - - Section 134, There were no instances of work found in unwholesome premises - 66 - TABLE 36 LEGAL PROCEEDINGS INSTITUTED DURING THE YEAR No. of Summonses Fines £ Costs £ Housing Act 1961: Houses in Multiple Occupation: Contravention of Direction 11 230 50 Contravention of Regulations 160 422 75 Means of escape from fire not provided 5 115 40 Housing Acts, 1961/69: Contravention of Tower Hamlets (Registration of Houses in Multiple Occupation) Informatory and Regulatory Scheme, 1971 50 572 155 Housing Act, 1957 Overcrowding in Houses in Multiple Occupation 21 286 71 Contraventions of Closing or Demolition Orders 18 285 70 Offences against the Person Act 1861 1 10 - Public Health Act, 1936 Nuisance Orders 16 10 79 Non-compliance with Nuisance Orders 2 35 10 Obstructing Public Health Inspector in execution of his duties 2 10 10 Public Health (Recurring Nuisances) Act, 1969 2* - 10 Clean Air Act, 1956 1 20 10 Food and Drugs Act, 1955 27 757 151 Food Hygiene (General) Regulations 1970 24 223 20 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 185 1,309 198 L. C. C. Byelaws respecting business of a Slaughterer of Poultry 1923 2 20 - L. C. C. Drainage Byelaws 1962 2 4 - L. C. C. Water Closet Byelaws 1930 1 2 - Total: 528 4,290 949 ★ Prohibition Orders obtained in both cases TABLE 37 MORTUARY SERVICE Bodies received 752 Post-mortems only 630 Inquests 120 Deposit only 2 - 67 - TABLE 38 CLEANSING STATION Persons treated for scabies Men 44 Women 39 School children 57 Children under 5 22 Total: 162 No. treatments given 291 Persons treated for verminous conditions Men 177 Women 49 School children 521 Children under 5 51 798 TABLE 39 DISINFECTING STATION Disinfection: No. of dwellings disinfected for infectious diseases 55 No. of dwellings disinfected for other reasons 834 No. of articles disinfected by steam 7,880 No. of articles disinfected by formaldehyde - No. of premises other than dwellings disinfected 149 Disinfestation: No. of dwellings disinfested for bed bugs 387 for other vermin 201 No. of rooms involved 3, 374 No. of other premises and sites disinfested 613 No. of articles disinfested by steam 13,442 No. of articles disinfested by formaldehyde 1,244 Drainage No. of premises where drains tested 44 No. found defective 19 - 68 - TABLE 40 OFFICES , SHOPS AND RAILWAY PREMISES ACT, 1963 Type of Premises Registered during year Total No. of Registered Premises at end of year Registered Premises receiving general inspections during year Persons employed Offices 72 1, 006 654 17,110 Retail Shops 29 983 552 3, 343 Wholesale shops 34 578 385 5,215 Catering establishments/ Staff canteens 9 288 266 1, 569 Full Storage Depots - 1 - 5 Total 144 2,856 1,857 27,242 (Males 18,215) (Females 9,027) - 69 - Other visits to registered premises 984 Visits to non-registered premises 877 Informal Notices served Offices, Shops and Railway Premises Act, 1963 502 Notification of Employment of Persons Order, 1964 126 Lifts and Hoists Regulations 1968 76 Accidents notified - Causes Machinery Non-power driven machinery or relevant part in motion 3 Transport: Vehicle in motion not moved by power 2 Vehicle in motion moved by power 1 Fire and Explosion Hand Tools 2 Falls of persons: On or from fixed stairs 9 On or from ladders or step ladders 1 Other falls from one level to another 6 Falls on the same level 13 Stepping on or striking against object or person 5 Handling Goods (not otherwise classifiable) 17 Struck by falling object 5 Not otherwise specified 8 Total: 72 TABLE 41 RODENT CONTROL Properties inspected Number Number found to be infested by inspected Rats Mice On complaint 2, 042 306 1,423 Otherwise 5, 049 2 8 Total 7, 091 308 1,431 Properties treated by Council (including 97 business premises) 1,692 Visits by Rodent Operatives 12,054 Notices served under Section 4 of the Act (a) treatment - (b) structural work 27 (proofing) Cases where default action taken following service of notice 3 Number of "Block Control" schemes carried out 6 Sewer Treatments No. of Manholes No. Treated 4, 941 18,214 - 70 - TABLE 42 VISITS BY PU3LIC HEALTH INSPECTORS Type of Premises No. Visits or inspections Registered and Licensed Premises Common Lodging Houses 3 13 Fur Skin Dressers 1 6 Hairdressers 163 102 Ice-Cream 362 273 Massage Establishments 3 9 Milk Distributors 255 184 Pet Shops and Stalls 55 121 Pharmacy and Poisons 63 87 Poultry Slaughterhouses 14 85 Prepared Food - Meat 100 79 - Fish 72 129 Rag Flock 30 32 Seamen's Lodging Houses 2 3 Dwellings No. of visits on complaint; 7,035 No. of visits for drainage 58,412 3,539 No. of revisits; 5,837 No. of other visits 1,735 Other Premises Bakehouses 33 108 Baker Shops and Stalls 79 153 Butcher Shops and Stalls 161 272 Canteens and Clubs 617 242 Chemists 50 46 Confectionery Shops and Stalls 332 292 Fish Shops and Stalls 113 150 Greengrocers and Fruiterers Shops and Stalls 452 494 Grocers Shops and Stalls 359 505 Hospitals, Institutions and Day Nurseries 40 3 Public Houses 429 640 Poultry Shops and Stalls 100 62 Restaurants, Cafes and Stalls 544 675 School Meal Centres 139 48 Wholesale Food Depots, Markets and Wharves 142 1,095 Other Food Premises 157 265 Food Delivery Vehicles 6 Factores (Mechanical) 1,626 1,458 Factories (Non-Mechanical) 94 20 Factories (other) 89 6 Outworkers 1, 014 275 Schools 101 57 Drainage Works - 1,958 28,099 There are 3,269 food premises including stalls in the Borough, some of the premises listed above are included under more than one trade category. - 71 - TABLE 43 MISCELLANEOUS WORK OF PUBLIC HEALTH INSPECTORS Complaints Number received at Office 5,127 Dangerous Structures Number of premises notified to District Surveyor 51 Drainage Plans Number of plans on which observations submitted to Director of Technical Services 320 Land Charges Number of premises reported upon to Chief Executive 1,918 Town Planning Applications No. of premises reported upon to Director of Development 773 Public Houses Number of premises reported upon to Licensing Justices 72 Licensed Clubs No. of premises reported upon to the Chief Officer of Public Control 22 TABLE 44 BURIALS UNDERTAKEN Under Section 50, National Assistance Act, 1948 Number of Adults 50 Number of Children 5 Number of Stillborn 1 Total Cost £1, 566 Burials requested by - Coroner 35 - Relatives 19 - Others 2 - 72 - TA3LE 45 NOTICES SERVED BY DISTRICT PUBLIC HEALTH INSPECTORS Factories Act 1961 110 Food Hygiene (General) Regulations 1970 283 Food Hygiene (Markets, Stalls, and Delivery Vehicles) Regulations 1966 35 Hairdressers and Barbers Byelaws - Informal Notices to Local Authority Housing Departments 2,244 Prevention of Damage by Pests Act 1949 27 Public Health Act, 1936, Section 39 5 -do- 44 1 -do- 45 1 -do- 48 - -do- 75 9 -do- 89 16 -do- 93 786 Public Health Act, 1961, Section 17 89 Public Health (Recurring Nuisances) Act, 1969 3 Staircase Lighting Byelaws 3 Total: 3,612 TA3LE 46 OUTWORKERS Firms in the borough employing outworkers 464 Outworkers residing in, and employed by firms in the borough 7 67 Outworkers residing outside the borough employed by firms in the borough 1,484 Outworkers residing in the borough employed by firms outside the borough 247 Total outworkers in the borough 1,014 - 73 - TABLE 47 HEALTH EDUCATION ACTIVITIES Discussion groups or talks on the following subjects were arranged during the year: Subject No. of Occasions Persons Participating General Health Subjects - Schools 93 1,775 - Other 117 997 Mothercraft 246 1,583 Cancer Prevention 15 185 Psychoprophylaxis 24 82 Total 495 4,622 Films or filmstrips were shown on 103 of the above occasions. Posters on health subjects are displayed on poster sites and in clinics and public buildings throughout the borough, the topic being changed in accordance with a monthly programme. The distribution of leaflets is planned to coincide with the poster displays and topical health education activities. During the year 3,887 posters were exhibited and 28,456 leaflets distributed. - 74 - TABLE 48 CONFERENCES Conference Venue Dates Representatives Association of Public Health Inspectors - Annual Conference Eastbourne 1-5 October Councillor Mrs. Crook Councillor Stock Chief Public Health Inspector Association of Sea and Air Port Health Authorities - Annual Conference Manchester 27-29 June Councillor Mrs. Crook Councillor Tuson Public Health Inspector Health Visitors Association Annual Conference Brighton 1-3 November Centre Superintendent Institute of Water Pollution Control - Annual Conference Torquay 10-14 September Councillor J. O'Connor Councillor Mrs. O'Connor Co-ordinator, Directorate of Community Services Land Institute "Prospects for Rented Housing" London 30 November Councillor Kennedy Housing Advisory Officer London Boroughs Association Homeless Families Conference London 24 September Councillor J. O'Connor Housing Advisory Officer National Association for Maternal and Child Welfare - Annual Conference London 27-29 June Councillor Phillips National Society for Clean Air Spring Seminar Oxford 3-4 April Councillor Miss Morsman Public Health Inspector Annual Conference Torbay 15-17 October Councillor Miss Morsman Councillor White Public Health Inspector Pollution Control Congress London 5-8 June Councillor Brazier Public Health Inspector Royal Institute of Public Health and Hygiene - Annual Conference Paignton 9-12 October Councillor Ashkettle Councillor McDougall Principal Medical Officer (Child Health) Royal Society of Health Congress Eastbourne 30 April 4 May Alderman Orwell Councillor Winterflood Director of Community Services and Medical Officer of Health R.O.S.P.A. National Home Safety Conference London 7-8 November Councillor Hegarty Health Education Officer - 75 - TABLE 49 REFRESHER AND TRAINING COURSES Courses attended by staff during the year were as follows - Course Venue Date Attended by Association of Public Health Inspectors - Annual Weekend Seminar Canterbury 13-15 April 2 Public Health Inspectors Bethnal Green Hospital Developmental Paediatrics Course London Tuesdays, 14 February 18 April Medical Officer 2 Sessional Medical Officers British Association of Dental Auxiliaries - Scientific Meeting London 25-26 October 3 Dental Auxiliaries Building Societies Association Courses for Housing Advisory Personnel Ware, Herts 31 July 1 August 18 - 19 December Housing Advisory Assistant Housing Advisory Assistant Croydon Technical College Fieldwork Instructors course London 30 days 1973-4 Health Visitor Department of Health and Social Security Training for National Health Service Reorganisation Birmingham 5-16 Director of Community Services and Medical Officer of Health Course for Medical Administrators on National Health Reorganisation London 24 September 19 October Principal Medical Officer National Health Service Reorganisation Seminar London 31 October Chief Dental Officer Disabled Living Foundation Clothing for Handicapped, Elderly and Incontinent in the Community London p. m. 26 June Non-medical Supervisory of Midwives School Nurse Family Planning Association Nurses Training Courses London 26-28 March 21-23 May 15-17 Sept. 15-17 Oct. 19-21 Nov. Health Visitor Health Visitor Health Visitor Health Visitor Health Visitor Griffiths Mental Development Scales Course Buckinghamshire 10-14 September Principal Medical Officer Hackney Technical College Diploma in Housing Management London Day release course commencing May commencing September 2 Public Health Inspectors 3 Public Health Inspectors - 76 - TA3LE 49 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Date Attended by Health Visitors Association Refresher Courses London 2-12 January 2 Health Visitors Exeter 3-13 April Centre Superintendent Cambridge 18-27 July Health Visitor Lincoln 4-14 September Health Visitor Higher National Certificate in Public Administration Kingston Polytechnic commencing October Administrative Assistant Day release course South East London Technical College commencing September Clerical Assistant Inner London Education Authority Clinical Dentistry Course London 2, 9,16,23 March Dental Officer Drug taking amongst Schoolchildren London 5-6 June Principal Medical Officer School Health Social Worker Sexual Problems in Adolescence London 28 June 2 Sessional Medical Officer Drug taking amongst Schoolchildren London 23 August 2 Sessional Medical Officers 5 School Nurses Inner London Education Authority sponsored courses Third International Orthodontic Congress London 13-18 August Orthodontist British Dental Association post-graduate course on Preventive Dentistry London 21-23 March Chief Dental Officer British Dental Association Annual Conference Southport 11-14 June Dental Officer London Boroughs Training Committee Course for School Nurses on loss of Hearing/Screening for Deafness London 0 12-13 March School Nurse Introductory course for Clinic Nurses London 10,11,17,18, 31 May 1 June School Nurse Study day for educational and s ocial implications of sexually transmitted diseases London 15 June 2 Health Visitors Introduction to teaching methods for Nurses London 28 June School Nurse - 77 - TABLE 49 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Date Attended by London Boroughs Training Committee (continued) Nutritional defects of schoolchildren London 29 June Health Visitor Course for School Nurses with 3 years experience London 2 - 6 July 2 School Nurses Working with Jamaican children London a.m. 3 August Health Visitor London Boroughs Training Committee sponsored course Institute of Advanced Nursing Education-Staff Appraisal Seminar Cardiff 16-18 April Chief Nursing Officer Ministry of Agriculture, Fisheries and Food-Rodent Control Basic Course London 11-13 December 2 Rodent Operatives National Childbirth Trust Seminar on Preparation for Parenthood London 27-29 July Health Visitor North East London Polytechnic Practical Work Instructors Course London 15 - 26 January 10 May 2 District Nurses District Nurse training course London Commencing Jan - May Commencing February - May District Nurse District Nurse Seminar on the primary Care team London 24 May District Nurse Practical Work Instructors Course London 24 September 5 October District Nurse Queens Institute of District Nursing S. R. N. Refresher Course London 12-16 February District Nurse First Line Management Course London 19 February 2 March Senior District Nurse S. E. N. Refresher Course London 24-28 February District Nurse Royal College of Nursing Refresher Course Canterbury 8-13 April Centre Superintendent - 78 - TABLE 49 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Date Attended by Society of Medical Officers Symposium on 1974 Community Care and After London 2 March Principal Medical Officer In-Service Training Courses Town Hall Value Added Tax 2 day in February 3 Administrative Assistants 2 Clerical Assistants National Health Service Reorganisation and implications for Social Services 25 April 2 Principal Medical Officers Health Visitor District Nurse Administrative Assistant Pre-Retirement course 6 lectures May-June Senior Administrative Officer Clerical Assistant 6 lectures Oct-Nov. Supervisor of Cleansing Services Middle Management Day release May-June Senior Administrative Assistant You and the Public 6 September Housing Advisory Assistant General Clerk Trade Union Congress Day-release course on Industrial Relations London Tuesdays,1 May to 10 July Technical Assistant University of London Reynell Developmental Scales London 7-8 June Principal Medical Officer - 79 - TABLE 50 SCHOOL HEALTH STATISTICS Pupils on School Rolls (May 1973) Under 5 years - full time 1,082 part-time 1,506 Infants 6,281 Junior 9,794 Seniors 11,201 Special 899 30,763 Recuperative Holiday Homes Number of schoolchildren (including Nursery schoolchildren) admitted during the year 239 School Medical Treatment Clinic No. of premises Sessions in year New Cases Attendances Audiology 1 87 157 515 Bathing 2 532* 611 1,200 Minor Ailments-Medical Officer 1 20 177 - Nurse 6 592 949 13, 071 Ophthalmic 4 279 1,321 3, 054 Orthoptic 1 79 97 174 Special investigation 3 199 122 1,295 *includes also adult sessions - 80 - Health Surveys No. examined Occasions vermin found Percentage (a) Comprehensive 17,7 00 609 3.4 (b) Selective 13, 612 1,226 9. 0 No. of individual pupils found verminous 657 Percentage of school roll 2.13 Vermin - occasions advice and/or shampoo given 1,525 - occasions attendance at bathing centre 310 (c) Communicable disease - No. examined for 596 Routine Audiometer Testing No. of children given screening test 3, 069 No. failing screening test and given pure tone test 189 No. failing pure tone test and referred to Otologis 114 TABLE 5.0 (Continued) Defects treated at School Treatment Centres and Hospital Clinics Errors of refraction and squint 929 Other eye defects 31 Spectacles ordered 719 Athlete's foot 18 Verrucae 229 Ringworm - body 4 Impetigo 5 Other skin diseases 171 Eye diseases 45 Ear diseases 13 Miscellaneous lacerations etc. 640 Orthopaedic and postural defects (treated at schools) - B. C.G. Vaccination - Schoolchildren Number of schools visited 33 Number of 13-year old children offered test 3,351 Number of consents received 2,879 Number of children tested 2,639 Number of positive reactors 266 Number of children vaccinated 2,071 Infectious and Other Diseases notified by Schools Disease No. of Notifications Chickenpox 119 Dermatitis 1 Dysentery, Diarrhoea 73 Ear Infection 2 German Measles 52 Glandular Fever 2 Impetigo 30 Influenza 24 Jaundice 10 Measles 192 Meningitis 2 Mumps 57 Ophthalmic conjunctivitis 7 Ringworm 18 Scabies 20 Scarlet Fever 33 Tonsillitis 44 Tuberculosis 1 Whooping Cough 6 693 (Number notified last year 1, 318) - 81 - TABLE 61 HEALTH DEPARTMENT ESTABLISHMENTS Particulars of Clinics held and Services provided as at 31st December, 1973. (a) CLINICS AND SCHOOL TREATMENT CENTRES Address Clinics and other activities held Clinic and School Treatment Centre, Club Row, E. 2. Infant Welfare, Minor Ailments, Toddlers, Vaccination and Immunisation, Mothers' Club and Creche Clinic Centre, 673, Commercial Road, E. 14. Infant Welfare, Occasional Creches, Toddlers, Mothers' Club, Vaccination and Immunisation. Clinic Centre, 1-2 Newmill House, Empson Street, E. 3. Infant Welfare, Toddlers, Dressmaking Class, Creche, Vaccination and Immunisation, Family Planning. Clinic and School Treatment Centre, Leopold Street, E. 3. Dental Infant Welfare, Minor Ailments, Special Investigation, Toddlers, Vaccination and Immunisation, Vision, G. P. Obstetrician, Auditory Training Orthoptic, Family Planning. Clinic Centre, Library Place, Cable Street, E. 1. Chiropody, Infant Welfare, Toddlers, Family Planning, Vaccination and Immunisation. Clinic Centre, Peel Grove, E. 2. Ante-Natal, Infant Welfare, Occasional Creches, Toddler, Vaccination and Immunisation. Cervical Cytology Psychoprophylaxis, Dressmaking, Keep fit Class, G. P. Obstetrician. Mothers' Club, Post-Natal, Family Planning. Clinic and School Treatment Centre, 32, Riverside Mansions, E.1. Infant Welfare, Minor Ailments, Family Planning, Vaccination and Immunisation. Clinic Centre, 35, Stepney Green, E.1. Chiropody, Infant Welfare, Toddlers, Vaccination and Immunisation Clinic and School Treatment Centre, Roserton Street, E. 14. Ante-Natal, Chiropody, Dental, Infant Welfare, Occasional Creches, Toddlers, Mothers' Club, Cervical Cytology, Dressmaking, Family Planning, Vaccination and Immunisation. Clinic Centre, Community Centre, Barkantine Estate, E. 14. Infant Welfare, Toddlers, Vaccination and Immunisation. - 82 - TABLE 62 (Continued) (a) CLINICS AND SCHOOL TREATMENT CENTRES (contd.) Address Clinics and other activities held Clinic and School Treatment Centre, Ruston Street, E. 3. Chiropody, Dental, Infant Welfare, Occasional Creches, Toddlers, Vision. Dressmaking, Special Advisory, Speech Therapy, Vaccination and Immunisation. Clinic Centre, 1-2 Wigram House, Wades Place, E. 14. Infant Welfare, Toddlers, Speech Therapy, Chiropody, Vaccination and Immunisation. Clinic and School Treatment Centre, Wellington Way, E.3. Dental, Infant Welfare, Occasional Creches, Toddlers, Vaccination and Immunisation, G.P. Obstetrician, Cervical Cytology, Dressmaking, Family Planning, Cookery Class, Chiropody. Clinic and School Treatment Centre, Underwood Road, E. 1. Chiropody Dental, Infant Welfare, Minor Ailments, Special Investigation, Toddlers, Vaccination and Immunisation Family Planning, Occasional Creches, Sewing Class. School Treatment Centre, 3-4 Phillips House, Coventry Cross, E. 3. Dental, Minor Ailments, Special Investigations. School Treatment Centre, Wadeson Street, E. 2. Audiology, Chiropody, Dental, Minor Ailments, Vision. Mission House, (Nursing Sisters of St. John the Divine) Lodore Street, E.14. Ante-Natal, Post-Natal. London Chest Hospital, Victoria Park, E.2. Chest Clinic. - 83 - ********** - 84 - INDEX A Page Nos. Accidental Deaths 8 Accidents in the Home 37 Adoption and Boarding Out 18 Ambulance Facilities 37 Analysis of Food and Drug Samples 27,63 Ante-Natal Clinics 18,54 Anthrax 11 Area of Borough 4 Artificial Kidney Machines 37 B Bacteriological Examination - Food 28 B. C.G. Vaccination 13,44,53 Births 4,7 Blind, Partially Sighted 37 Burials 37,72 C Cervical Cytology 19,54 Chest Clinics 13 Chief Nursing Officer's Report 17 Chief Public Health Inspector's Report 27 Child Welfare Clinics 54 Chiropody 37,55 Cholera 11 Circulars - Ministry 40 Clean Air 30,62 Cleansing Station 32,68 Clinic Centres 19 Common Lodging Houses 33 Comparative Statistics 9,48 Compensation for Stopping Employment 14 Conferences and Courses 38,40,48,49 Congenital Defects 19 Creches 20 D Deaf Children 45 Deaths 4,7 - 85 - D (Cont'd.) Page Nos. Deceased Persons 38 Dental Services 24,55 Description of Area 7 Development Assessment Clinic 20 Diphtheria 11 Diseases of Animals 29 Diseases - Notifiable 50 Disinfection/Disinfestation 32,68 Dysentery 11 E Educationally Sub-Normal Children 45 Employment of Schoolchildren 45 Environmental Health Services 27 Establishments 82-83 Expectation of Life 8 F Factories 32,65 Family Planning 20,56 Food and Drugs 27 Food Hygiene 28 Food - Imported 27 Food - Unsound 29 Food Poisoning 11 H & I Hairdressers 32 Handicapped Pupils 43 Health Committee 1 Health Education 21,45,74 Health Visiting 21,56 Home Bathing 38,57 Home Nursing 21,57 Hospital Facilities 38 Houses in Multiple Occupation 30 Housing 4,30,64 Hygiene in Schools 44 Ice-Cream 28 Immigrants, Health Control 14 Immunisation 44,52 - 86 - H & I (Cont'd) Page Nos. Incontinence Pads 21 Infant Mortality 8,47 Infectious Diseases 11.44,51 Infective Jaundice 11 Inquests 38 L Laboratory Facilities 38 Laundry Service — 21,57 Legal Proceedings 32,67 Legislation 39 Licensing Act, 1961 32 Loan of Nursing Equipment 22,58 Lodging Houses 33 M Malaria — 11 Marie Curie Memorial Foundation 22 Marriages 8 Mass Radiography 13,53 Maternal Mortality 8 Measles 11,22 Medical Inspection of Schoolchildren 43 Meningitis 11 Midwifery — 22,59 Milk Supply 28 Minor Ailments Clinics 44,82,83 Miscellaneous Services 37 Morbidity 8,51 Mortuary 33,67 Mothercraft Classes 18 N Neo-Natal Mortality 8 New Houses 32, 64 Notices served by Public Health Inspectors 73 Nursing Equipment - Loan of 22, 58 0 Observation Register 23,49 Offensive Businesses 33 Offices, Shops and Railway Premises 30,69 - 87 - 0 (Cont'd.) Page Nos. Open Spaces 9,60,61 Ophthalmia Neonatorum 11 Outwork and Outworkers 34,66,73 P Partially Hearing Children 45 Partially Sighted Persons 37 Peri-Natal Mortality 8 Personal Health Services 17 Pet Animals Act 34 Pharmacy and Poisons Act 34 Phenylketonuria 23 Poliomyelitis 11,52 Population 7 Post Natal Clinics 54 Poultry Slaughter 34 Premature Babies 23,56 Principal School Medical Officer's Report 43 Public Analyst's Quarterly Reports 63 Public Health Inspectors - Visits 62,64,69,71 Public Relations 9 Public Transport 9 R Radioactive Substances 40 Rag Flock etc. Act 34 Recuperative Holidays 23,57 Refreshment Houses 34 Relaxation Classes 18 Removal of Persons in Need of Care 40 Renal Dialysis 37 Residential Establishments for Children in Care 23 Road Accidents 47 Rodent Control 34,7 0 Rubella 23 S Scabies 11 Scarlet Fever 11 School Dental Service 45 - 88 - S (Cont'd.) Page Nos. School Health Service 43,80,81 Seamen's Lodging Houses 33 Sewerage 34 Slum Clearance 30 Smallpox Social Conditions of the Area 5 Staff 3,41,62 Statistics and Social Conditions 5 Statistics - Summary 4 Students - Training of 41 Surveys 23 Swimming Baths 34 T Tuberculosis 11,53 Typhoid 11 U Underground Rooms 30 Unemployment 9 V Vacant Sites 34 Vaccination 44,52 Venereal Diseases 15 W Water Supply 35 Weather Conditions 11 Welfare Foods 24 Whooping Cough 11 Works in Default 35 - 89 - AC43393 AMENDMENTS TO TABLE 4 - PAGE 48 Add Live Births No. 1,911 Rate 12.5 Deaths No. 2, 097 Rate 13.7 Deaths under 1 year No. 40 Rate 20.7 Maternal Deaths No. 0 Rate 0 Cancer Deaths No. 497 Rate 3.2 Tuberculosis Deaths No. 11 Rate 0.1 The foregoing amendments will also affect the information contained in the context of the Annual Report as follows- Page 7: paragraphs "Live Births", "Still Births" and "Deaths" Page 8: paragraphs "Infant Mortality", "Neo-Natal Mortality" and "Peri-Natal Mortality" SUMMARY OF STATISTICS, 1973 Area of Borough (Acres) 4,876 Rateable Value (1st April 1973) £40, 045,059 Population: Mid-year estimate 153,360 Estimated product of a penny rate (1973-4) £ 365,000 Census, 1971 164,948 General Rate(l973-4) Dwelling Houses 41. 50 p in £ Census, 1961 205,682 Mixed hereditaments 44. 50 p in £ Density of population (persons per acre) 31.45 Number of inhabited dwellings according to Rate Books at 1st April 1973 58,412 " " structurally separate dwellings - Census 1971 55,545 " " private households - Census 1971 57,465 Births Total Male Female All Births 1,934 1,015 919 Live Births - Legitimate 1,633 855 778 - Illegitimate 278 147 131 Total 1,911 1,002 909 Still Births - Legitimate 21 12 9 - Illegitimate 2 1 1 Total 23 13 10 Deaths All Causes 2,097 1,137 960 Maternal - - - Infants under 1 year - Legitimate 35 22 13 - Illegitimate 5 4 1 Total 40 26 14 Rates Live birth-rate per 1,000 population 12.46 Death rate per 1, 000 population 13.67 Still-birth rate per 1,000 total births 11.89 Maternal death rate 00.00 Infant death rate (under 1 year) per 1, 000 live births 20.93 Legitimate infant death rate per 1, 000 legitimate live births 21.43 Illegitimate infant death rate per 1, 000 illegitimate live births 17.98 Neo-natal death rate (under 4 weeks) per 1, 000 live births 12.55 Early neo-natal death rate (under 1 week) per 1, 000 live births 10.98 Perinatal death rate (still birth plus deaths under 1 week) per 1, 000 total births 27.75 Illegitimate live births per cent of total live births 14.54 - 4 - TABLE 62 TOTAL DEATHS BY CAUSE AND AGE OF TOWER HAMLETS RESIDENTS r 1973 (Registrar-General's Return) All ages Age Group Total M F -1 1- 5- 15- 25- 35- -45- 55- 65- 75- Enteritis and other diarrhoeal diseases 1 - 1 - - - - - - - - 1 - Tuberculosis of Respiratory System 9 9 - - - - - - 1 2 2 2 2 Other Tuberculosis 2 2 - - - - - - - 2 - - - Whooping Cough 1 1 - 1 - - - - - - - - - Other Infective and Parasitic Diseases 4 3 1 - - - - - - 1 1 - 2 Malignant Neoplasm Buccal Cavity etc. 5 1 4 - - - - - - 1 1 2 1 Malignant Neoplasm Oesophagus 8 4 4 - - - - - - - 2 3 3 Malignant Neoplasm Stomach 59 28 31 - - - - - 1 5 7 26 20 Malignant Neoplasm Intestine 58 25 33 - - - - 1 2 2 9 15 29 Malignant Neoplasm Larynx 4 4 - - - - - - - - - 2 2 Malignant Neoplasm Lung, Bronchus 156 131 25 - - - - - 2 12 49 67 26 Malignant Neoplasm Breast 36 - 36 - - - - - 2 11 6 10 7 Malignant Neoplasm Uterus 12 - 12 - - - - - - 5 3 2 2 Malignant Neoplasm Prostate 13 13 - - - - - - - - 1 4 8 Leukaemia 7 3 4 - - - - - - - 1 4 2 Other Malignant Neoplasms, etc. 135 65 70 - - - 2 - 5 15 28 49 36 Benign and Unsuspected Neoplasms 4 2 2 - - - - - - 1 - 2 1 Diabetes Mellitus 21 9 12 - - - 1 - - 1 1 9 9 Avitaminoses, etc. 1 - 1 - - - - - - - - - 1 Other Endocrine, etc. Diseases 6 2 4 1 1 - - - - - - 2 2 Anaemias 7 1 6 - - - - - - - 1 - 6 Other Diseases of Blood, etc. 1 1 - - - - - - - - 1 - - Mental Disorders 6 4 2 - - - 1 1 2 - 2 - - Meningitis 1 1 - 1 - - - - - - - - - Multiple Sclerosis 3 1 2 - - - - - 1 - - 2 - Other Diseases of Nervous System etc. 13 10 3 - - - - 1 2 3 1 2 4 Chronic Rheumatic Heart Disease 17 7 10 - - - - - - 4 5 5 3 Hypertensive Heart Disease 32 14 18 - - - - 1 - 2 5 14 10 Ischaemic Heart Disease 474 274 200 - - - - - 9 56 88 144 177 Other Forms of Heart Disease 73 33 40 - - - - 1 1 1 7 10 53 Cerebrovascular Disease 193 67 126 - - - - 1 4 9 21 58 100 Other Diseases of Circulatory System 82 32 50 - - - - - - 7 8 26 41 Influenza 2 1 1 - - - - - - - - - 2 Pneumonia 256 121 135 7 1 - - - - 8 10 45 185 Bronchitis and Emphysema 141 113 28 - - - - - 2 6 19 63 51 Asthma 6 5 1 - 2 - - - - 1 2 - 1 Other Diseases of Respiratory System 19 14 5 3 - - 1 - - 1 2 7 5 Peptic Ulcer 26 15 11 - - - - - 1 2 4 9 10 Appendicitis 1 1 - - - - - - - - - 1 - Intestinal Obstruction and Hernia 6 2 4 - - - - - - - 2 1 3 Cirrhosis of Liver 5 1 4 - - - - - - 1 3 1 - Other Diseases of Digestive System 23 10 13 1 - - - 1 - 1 4 9 7 Nephritis and Nephrosis 11 5 6 - - - - - - 1 1 6 3 Hyperplasia of Prostate 8 8 - - - - - - - - - 2 6 Other Diseases, Genito-Urinary System 6 3 3 - - - - - - 1 1 1 3 Diseases of Skin, Subcutaneous Tissue 1 1 - - - - - - - - - 1 - Diseases of Musculo-Skeletal System 7 1 6 - - - - 1 - 1 1 - 4 Congenital Anomalies 7 6 1 4 1 - - 1 - - - - 1 Difficult Delivery and/or Anoxic Condition 12 10 2 12 - - - - - - - - - Other Causes of Perinatal Mortality 7 2 5 7 - - - - - - - - - Symptoms and ill-defined Conditions 13 8 5 2 - - - - _ 2 2 2 5 Motor Vehicle Accidents 22 17 5 - 2 3 6 - 1 2 2 4 2 All other Accidents 52 28 24 - 4 1 4 6 3 8 9 6 11 Suicide and Self-inflicted Injuries 7 6 1 - - - - 2 2 1 1 - 1 All Other External Causes 15 12 3 1 - - 1 3 - 5 2 3 - TOTAL OF ALL CAUSES 2097 1137 960 40 11 4 16 20 41 181 315 622 847