E.W.WRIGHT, M.B.,Ch.B.,D.P.H. London Borough of Waltham Forest REPORT OF THE MEDICAL OFFICER OF HEALTH 1973 CONTENTS PRINTED BY THE LONDON BOROUGH OF WALTHAM FOREST MEMBERS OF THE HEALTH COMMITTEE DEPARTMENTAL STAFF INTRODUCTION BY MEDICAL OFFICER OF HEALTH THE WORK OF THE DEPARTMENT DURING 1973:- Health Communities Child Health Service Dental Service Environmental Health Services Community Nursing Service CONTRIBUTIONS FROM COLLEAGUES:- Rainfall and Sewerage Water Supplies STATISTICAL SECTION LONDON BOROUGH OF WALTHAM FOREST HEALTH COMMITTEE 1973 - 1974 Chairman: Councillor Mrs. E.Bartram Vice-Chairman: Councillor D.Eberst Members: Councillor H.M.Cohen „Miss H.E.Digby „ N.F.Gerrard „Mrs.E.L.Gordon „Mrs.M.I.Little „F.W.Marshall, J.P. „ Mrs.P.K.Williams Ex-officio: Councillor Mrs.L.D.Gurr, J.P. - I - - 2- STAFF OF THE HEALTH DEPARTMENT (at 31.12.T973) Medical Officer of Health and Principal School Medical Officer - E.Walter Wright, M.B.,Ch.B.,M.F.C.M.,D.P.H. Deputy Medical Officer of Health Geoffrey H.G.Poole, M.B.,B.S.,M.F.C.M.,D.P.H., D.(Obst.)R.C.O.G. Principal Medical Officer - Gwyneth Richards, L.R.C.P.,L.R.C.S ..M.F.C.M. L.R.F.P.S.,D.C.H.,D.(Obst.) R.C.O.G. Senior Medical Officers - Carmel P.Dooley, L.R.C.P. & S.I..D.P.H. Margaret E.Buckley, M.B.,B.Ch.,D.P.H. Josephine Werren, M.B.,B.S.,M.R.C.S.,L.R.C.P. D.C.H.,D(Obst.) R.C.O.G. Medical Officers in Department Eileen M.Cameron, M.B.,Ch.B. Scott Cameron, M.B.,Ch.B. Jean Chalk, M.B.,B.S.,L.R.C.P.,M.R.C.S. *Margaret Edwards, B.Sc.,M.B.,B.Ch.,D.P.H. *Jocelyn N.Newman, M.B.,Ch.B.,D.C.H., D.(Obst.) R.C.O.G. James Parkyn, M.S.,3.S.,M.D.,M.R.C.P.,D.T.M. & H. Bharat Sahi, M.B.,B.S.,M.S.,D.O. Santosh Sahi, M.B.,B.S.,D.G.O.,M.D.,D.R.C.O.G. Joan Whitaker, L.R.C.P..L.R.C.S..L.R.F.P.S., D.(Obst.) R.C.O.G. Plus sessional Medical Practitioners Psychiatric Adviser *W.R.Little, M.R.C.P.,M.B.,B.S.,D.P.M. *(Part-time) Principal Dental Officer - R.C.Ward, B.D.S.,L.D.S.,R.C.S. Senior Dental Officer . M.M.F.D'Souza, L.D.S.,R.C.S. 13 Dental Officers (Whole-time equivalent in past = 5.7;2 Dental Auxiliaries; 4 Dental Technicians (2 vacant posts) 17 Surgery Assistants (5 vacant posts) Chief Public Health Inspector J.H. Butler, F.R.S.H.,A.I.H.M.,M.A.P.H.I. Deputy Chief Public Health Inspector D R.King, M.A.P.H.I. Divisional Public Health Inspectors J. Coldwell, M.A.P.H.I. B.Dean, M.A.P.H.I..M.R.S.H. Specialist Inspector (Food) A.Bates, D.M.S.,A.M.B.I.M.,A.I.Sc.B.,M.A.P.H.I. Senior Inspector (Housing) E.Day, M.A.P.H.I. 9 Senior Public Health Inspectors; (3 posts vacant) I I Public Health Inspectors (4 posts vacant); 6 Technical Assistants; 6 Pest Control Assistants; 5 Pupil Public Health Inspectors. -3- Chief Nursing Officer - Gillian Pittom, S.R.N. ,S.C.M. H.V.,Cert., Cert. D.N Principal Nursing Officers - Gladys Thorburn, S.R.N.,S.C.M.,H.V,Cert. Kathleen McManus, S.R.N.,R.H.P.A.,Q.I.D.N.S. Midwifery Tutor - Amy M.Delves, S.R.N..S.C.M.,M.T.D.,Q.N. Nursing Officers (Health Visiting) - Brenda Buttle, S.R.N.,R.S.C.N.,H.V.Cert. Christina Egan, S.R.N.,S.C.M.,H.V.Cert. Evelyn M. Geary, S.R.N.,S.C.M.,H.V.Cert. Mary Young, S.R.N.,S.C.M.,H.V.Cert. Nursing Officers (Home Nursing) - Winifred Clinton, S.R.N..S.C.M.,Q.N. F.Griffiths, S.R.N..Q.N. Beatrice Hern, S.R.N..N.D.N.(Q.N.) Bridget Hunt, S.R.N..S.C.M. Nursing Officer (Midwifery) - Patricia Giles, S.R.N..S.C.M.,Q.D.N. 6 Field Work Instructors 21 Health Visitors(8 vacancies) 2 Tuberculosis Visitors 32 Clinic Nurses ( 6 vacancies) 9 Student Health Visitors (2 vacancies) I Control of Infection Sister l8Midwives 71 District Nurses 8 Night Sitters(4 vacancies) I 2 Auxiliary Nurses 3 Night Nursing Sisters Health Education Officer Mrs. M.Stephens (acting) Chief Chiropodist - R.J .King, M.Ch.S. 15 Chiropodists (6 vacant posts) Speech Therapists - Joan Maharaj, L.C.S.T. Satinig Powell, L.C.S.T.,L.R.A.M.,L.G.S.M. Mary Tippett, L.C.S.T. Chief Administrative Officer - F.J.Aylward Senior Administrative Assistants - S. Ames Mrs. E.BIythe A.Wade 10 Administrative Assistants; 43 Clerical Assistants; 16 Clinic Clerks; 2 Secretaries THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF WALTHAM FOREST Madam Mayor, Ladies and Gentlemen, I am pleased to present my ninth and final Annual Report on the health of the borough and of the services run by the local authority during 1973. By the time this report is published the services to which it relates will have passed, in the case of Environmental Services, to the Borough Solicitor and Secretary's department and for the rest out of local government altogether. So the story of the local authority health department is complete. The year 1973 was; at the top levels of the administration, dominated by reorganisation. Many committees and working parties of officers were striving to produce information and make plans against great difficulties. One problemwas that only those intimately concerned with it were at first able fully to understand the new structure. One met at every turn members, officers and others who had not had the opportunity to grasp the fundamental thinking on which all the planning was being based. The sense of being shut out of it all which I know many felt arose from these feelings and not from lack of information. In fact the quantity of paper issued giving information was so great that lack of time to read it was a greater problem than lack of access to it. The second problem was the impossible timetable. The democratic process is not easily compatible with a rapidly approaching deadline, and the fact that one clause in the NHS Bill related to Family Planning received in Parliament very full consideration meant that local government was deprived of time it would have liked on the District pattern for the Health Service. As one intimately concerned with the proposals for the district arrangements in Redbridge/Waltham Forest I imagine I shall be one of those blamed for the difficulties which will arise. The fact that the alternatives would have raised difficulties as great and in my view greater will be less heard. A situation where one cannot win is common in social affairs. So also are examples of goodwill being all that is required to make administrative complexities no hindrance to good services. The year was characterised by a number of emotive issues at local level. There was considerable debate around the subject of family planning and vasectomy and also on supplies of orange juice. I have always regarded local government as a most fruitful partnership of lay elected committees and professional officers and in any partnership one cannot expect that either will always get their own way. Nevertheless I was sorry that my last year as a local government officer should have included such a divergence of view as that produced by the Council's decision to provide free orange juice at a cost of over £1,600 a month. The opinion that this was a beneficial policy, though not shared by'me, was sincere and I do not think there can be criticism of elected members taking action they believe to be in the interests of those they represent. The duty of the MOH is to give medical advice, whether it is welcome or otherwise, and members are well aware of my view that a fraction of that sum spent on, for instance, fluoridation would have been, in health terms, far more productive. These differences of view were however only of little consequence when seen against the background of the service as a whole. - 4 - Broadly the year was one of great progress based on the extra nursing staff for home and school work which the Council authorised. I am sure the staff greatly appreciated the attitude of members that no obstacle should be allowed to stand in the way of producing the type of service which I and my colleagues could demonstrate was in the interests of the health of Waltham Forest inhabitants. The year was also characterised by the introduction of a different management structure for the borough as a whole and we will watch this with interest to see what we in the Health Services can learn from it. At the same time we are conscious of what radical new thinking has gone into setting up the Health Service structure and I have little doubt that we shall have lessons to teach local authorities both by our failures and our successes as to the most effective method of marrying very sophisticated sociological and technological techniques with public participation in decision making. I should like to express my thanks to all my colleagues both in the Health Department and in other departments for their help and support during the year, with particular emphasis perhaps on those who have been colleagues for years. I am at the time of writing the longest serving senior member of staff of Waltham Forest as such, and have been impressed by the helpfulness of colleagues on many occasions when problems have seemed daunting. I should also like to thank members for their support and help on all the committees which I or my staff attend, particularly Councillor Mrs. E.Bartram, Chairman of the Health Committee and Councillor C.W.G.Foxton, Chairman of the Community Welfare Committee - a committee to which fell some of the most controversial issues affecting the department during the year. I have the honour to have been, Madam Mayor, ladies and gentlemen, Your obedient servant, Walth Wight Medical Officer of Health. -5- THE WORK OF THE DEPARTMENT HEALTH COMMUNITIES Dr. Geoffrey Poole, Deputy Medical Officer of Health, writes. As befits an expiring Medical Officer of Health and aspiring Community Physician, I have substituted,for this last report, a more positive title than "Control of Community Diseases". There were no notable outbreaks of infective disease in Waltham Forest during 1973. Tuberculosis notifications, at 109 (105) showed a small increase but 78 (over 70% of them) occurred among immigrants compared with 19% of the III notifications in 1965. Clearly here is a sector of the population whose special vulnerability to this disease calls for special measures. With the cooperation of Dr. R.S.Francis, Physician to the Chest Department at Whipps Cross, all newly arrived immigrants notified to us are examined and, if appropriate, given B.C.G. vaccination and/ or anti-tuberculosis chemotherapy: a study of their diet and housing conditions as possible contributory factors could be rewarding and help our continued efforts to reduce the pool of infected persons in the community. Measles was much more prevalent with 1160 cases (297) but this was largely due to the return of the normal two year cycle of this disease, despite the immunisation of 1782 children during the year, 950 (I 160) at our clinics and 832 (1078) by family doctors. With approximately 4000 births a year these figures show just under 45% were immunised and clearly this is insufficient to prevent epidemic spread when, two years after the last epidemic incidence, there may be 4000 infants unprotected. Early measles vaccines did produce some adverse reactions in susceptible children but with progressive refinement of vaccines it is to be hoped that these side effects will be reduced or eliminated and a much higher acceptance rate result since, with the present incidence of measles, it is virtually certain that all unimmunised children will catch it and experience much more severe reactions to the wild virus than they would have done to the vaccine. With Whooping Cough, the vaccine against which also sometimes produces adverse reactions, the position is somewhat different. Only 37 (20) cases were notified during 1973 and the pertussis component of the usual "Triple Vaccine" can be omitted when immunising children thought to be at risk from possible side-effects — with such a low incidence their risk of contracting the disease is small but it is important that more robust children should continue to be immunised against pertussis since they form the protective barrier preventing whooping cough returning, like measles, to epidemic proportions. The socially contagious diseases, V.D. and Smoking, both show encouraging trends. 1872 Waltham Forest residents attended V.D. clincs in 1973 — only 90 more than last year — a rise of 5% compared with increases of 35% and 14% between 1970/71 and 71/72. Lung Cancer deaths at 204 (171 M 33F) also show only a small increase over last year (188, I57M — 3IF) and it appears that the very rapid rise from this form of Smokers' Cancer is levelling off despite the increasing numbers of older people in the population. A similar trend has occurred in the other H»*t.hs associated with smoking. Ischaemic Heart Disease Killed 670 (339M 2711-) compared with 678 (400M 278F) in I 972; the figures for Bronchitis and Emphysema were I 973: 129 (101M 28F). I 972: I 80 (124M 56F). One can fairly hope that Health Educationand personal exampleareat leastholdingtheir ground against the monstrous advertising of cigarettes and the day will come when these diseases will follow the generality of infectious disease into decline. This will not come about, however, until one of the greatest -6- disease producers of our time — Mental Stress — is recognised and positive steps taken to combat it. Like the many headed hydra, stress is self-perpetuating — intolerable housing conditions, the frustration of traffic jams and resentment, justified or not, with conditions at work act synergestically to maintain a state of exasperation which is the antithesis of efficiency. This is increasingly recognised and most large companies employ personnel or welfare officers, often with the backing of a part-time medical officer, and find they have a more efficient staff as well as a happier one. In material wealth, the so-called consumer durables, we have "never had it so good" but so long as such a high proportion of our population are dependent for ability to cope upon tranquillisers and anti-depressants, we cannot rightly claim to be a healthy community. As I see it Mental Health is the great challenge of the 1970s. CHILD HEALTH SERVICE Dr. Gwyneth Richards, Principal Medical Officer, writes:- 1973 has been a sad year. It started well with a full staffing of Medical Officers but during the year doctors had to leave for family and health reasons and the well planned scheme of seeing most babies and toddlers in the Borough at regular intervals has not been able to be started in all the Clinics. This will, however, continue to be our aim and as new doctors join the staff they will be given the necessary training to enable them to examine each child fully. We have attempted to see all children regularly for their routine medical examination at school, other Medical Officers seeing children when requested for various reasons to do so. We look forward to 1974 in the hope that everything which had been started will be brought to our usual high standard and that the back-log of work will soon be overcome. - 7- In annual reports, the staff who stay in the background and keep the wheels moving are seldom mentioned yet without all the work they do Local Authority Services would cease to exist. In this final year of the Health Department of the London Borough of Waltham Forest the professional staff would like to pay tribute to them all and express gratitude for all they have done. Many of them for a very long time. Members of staff in Central Office dealing with general matters. - 8- Discussing appointments with Clinic Nurse -9- Clinic Clerk receiving patient Clinic Clerk filing School Health Service records Serving Welfare Foods -10- Prevention is better than Cure Refrigerated Vaccines being transferred to Clinics Immunisation against infectious diseases -II- THE DENTAL SERVICE Mr.R.C.Ward, Principal Dental Officer, writes As will be seen from the following comments 1973 has been a year of mixed blessings for the Dental Department. Recruitment At last the staffing situation in relation to dental officers has started to improve This is shown by the fact that a sessional officer has now become full-time; and we shall have a further full-time and sessional appointment early in 1974. This will bring our total full-time equivalent of dental officers to 7.3. It is unfortunate that this pattern of improved recruitment was not reflected in the dental surgery assistants. Indeed, it has proved difficult to attract applicants on the salary scales at present in force. School Inspections The number of children inspected at school rose from 14,635 in 1972 to 17,759 in 1973. Taking into account those pupils inspected at the clinics, a total of 58%of the school population received a dental inspection during the year compared with 51% in 1972. This now compares favourably with the national average of 59%; although of course this is no excuse for not trying to increase this figure in the future. Initially, we have concentrated on providing an annual inspection in the primary and special schools, and this has now been achieved. A start has now been made on the junior comprehensives and it is to be hoped that this can be expanded in the future. Ratio of Filled/Extracted Teeth Deciduous Number of General Anaesthetics as a % of total visits by all patients School Welfare School Welfare 1971 2.0 4.3 7 5 1972 2.5 8.0 4.5 2 1973 3.1 4.4 3.3 5.4 Child Welfare Service Although it will be seen that the ratio of filled to extracted deciduous teeth has risen in the school service this has not applied in the child welfare service. In addition the number of general anaesthetics as a percentage of the total visits by all children was 5.4 as compared with 2 in 1972. Combining this with a figure of 85.8% of children inspected requiring treatment a definite indication emerges that the service is not progressing. This is disappointing because we have made efforts to encourage parents to bring the under fives along for an inspection before any obvious treatment is required. -12- As the pre-school years are an essential time for the formation of good "dental habits" this service must receive extra attention in the future. It was disappointing to note that the dental suite at St. James Health Centre has not yet opened,as this area of the borough is in great need of this facility. The cut-back on the health centre building programme could affect us quite markedly as several obsolete dental units are still in use. However, it is to be hoped that future estimates will allow for their replacement. Modernisation of the previously unsatisfactory dental suite at Dawlish Road is now well under way. Health Centres and Clinics Fluoride Unfortunately the full Council have again rejected the policy of fluoridation of the borough's water supply. Although a vote in favour would not have brought this about owing to the Water Board reorganisation, it would have been encouraging to have moved into the Area Health Authority with this measure approved. Looking at the pattern of dental decay in children and the shortage of dental manpower, it is impossible to see how this pattern can be changed unless a change of attitude on fluoridation should occur in the future. If this change is not forthcoming, and as it is unlikely that the eating habits of children will change to any significant degree, perhaps a programme of mouth rinsing with a fluoride solution in schools could be considered although this must be counted as a poor second best. ENVIRONMENTAL HEALTH SERVICE Mr.J .H.Butler, Chief Public Health Inspector, writes Yet again I must report the year, as in 1971 and 1972, was marred by shortage of staff. Such a chronic shortage of Inspectors has insidious effects upon morale, which go beyond the immediately obvious. One of the danger signs can be said to be the adoption of a negative siege mentality; where staff become conditioned to deal only with complaints brought to their attention rather than going out to find problems to solve. The following action was taken early in the year to avoid such tendencies:- i) A broad policy of specialisation was decided upon, involving the establishment of four separate Divisions, dealing with Housing; Food Control including Office, Shop and Railway Premises Act; and Environment (North and South) Divisions. ii) The number of districts was reduced from sixteen to eleven to correspond to the Council's Computer programme following the Land use Survey as it -13- Food Control was also considered that increased area of each district would compensate for the decreased workload due to specialisation. This computer programme has also been adopted by several departments of the Council and thus common reference zones can be employed. It is anticipated that when the scheme is fully operational up-to-date details as to various types of businesses will become readily available at short notice on an area basis. Such information would prove invaluable in the event of the outbreak of notifiable disease, for example. iii) Additional technical assistants were also appointed to ensure that scarce Public Health Inspectors were relieved of routine work, although this has proved an additional burden on senior staff responsible for their supervision. While these changes had yet to be fully implemented by the end of the year, both staff morale and the quantity and quality of output had been greatly improved. All that is needed now is a full establishment — but that is where we came in. The lure of the 'big city' and the facilities for further study attracts some staff but when a Public Health Inspector reaches the age of about twenty-five, and marries, he is faced with the choice of renting a house or buying the best property he can afford at the time. Renting is unattractive for many reasons. Buying means, in practice, a journey to the office of many miles, and experience proves that staff travelling in regularly from distances of 20 to 30 miles are prone to leave within a relatively short time. The establishment of the Food Control Section was the most significant advance made during the year. Fortunately, the Council's approval was in advance of the annual report of the Chief Medical Officer of Health for 1972 (published November 1973) which made the case for a specialist section to deal with food control; and argued that:- "Food hygiene work demands considerable time and expertise which to be successful, have to be applied continuously and not merely when a crisis occurs or when there is a lull in other duties, moreover the Public Health Inspector carries a heavy burden of responsibility in the protection of the public against food borne diseases and in ensuring that food hygiene is maintained by all food trades." The report concluded that such work is best undertaken by specialists in a department devoted solely to food inspection. I am confident that the appointment of a Divisional Public Health Inspector to undertake these duties, supported by two Senior Inspectors to be appointed in April 1974, will enable food control to receive the amount of attention vital to thoroughly safeguarding the public. At the same time this will enable the District Public Health Inspectors to concentrate on other environmental health matters. -14- Food Control Functions The following is the area of food control in which the Public Health Inspectors have been engaged during the year. (a) Investigation of complaints regarding unsatisfactory foodstuffs purchased in Borough. (b) Routine inspections of food premises. (c) Lecturing about food hygiene to food workers and the general public. (d) Advising enquirers regarding food labelling legislation and compositional standards! (e) Inspecting foodstuffs to assess whether or not they are unfit for human consumption. (f) Sampling foodstuffs for chemical or bacteriological analysis. (g) Instigation of legal proceedings where necessary. Food Complaints Food complaints have been fully investigated as in previous years. Each investigation normally involves the purchaser, the retailer, the manufacturer and sometimes the wholesaler. The objective is to accumulate sufficient evidence to decide, in consultation with the Borough Solicitor, whether the facts would support a prosecution of the responsible party. 207 food complaints were received during 1973. The table below shows the clear increase in such complaints over the last five years. This may be due to increased public awareness of our food control function, and from higher standards demanded by the housewife. Number of Food Complaints Received 1973 207 1972 152 1971 135 1970 110 1969 90 13 Prosecutions were instigated and resulted in total fines of £230 being imposed by the magistrates. Examples of some of the cases are briefly described below:- Cases Result (Fines) (i) Mouse droppings found £50 with in bread. £15 costs. (ii) Mouldy tin of mixed £25 with vegetables. £10 costs (iii) Metal object embedded £15 with in loaf of bread. £6 costs (iv) Mouldy punnet of £10 with strawberries. £5 costs -15- Sampling Food sampling has proceeded on a routine basis throughout the year and has resulted in 263 samples being sent to the Public Analyst. Few examples of adulteration have been encountered, and it is planned to place more emphasis upon sampling the type of foods which encourage the growth of bacteria which might be harmful to the public. Licensed Premises During the latter part of the year, following the appointment of a Divisional Public Health Inspector responsible for food control, important progress has been achieved in the improvement of hygiene in 'icensed premises, which are increasingly selling food in addition to alcoholic liquor. Below are brief examples of some of the malpractices which, if seen, are taken up with the responsible party:- (i) The collection of spillage from beer pumps in glasses and re-serving thi to customers. This practice is unhygienic particularly when used glass< are refilled, allowing any bacteria to be washed over the rim together with saliva and dust. (ii) Inadequate glass washing techniques. In some instances cold or merely tepid water is used. In other instances double sinks are not used for correct purpose of washing and rinsing. (iii) The display of uncovered food in a position where customers can cough and sneeze over it. (iv) Smoking by staff who transfer bacteria from the mouth to the fingers and finally to food and drink. Routine Inspection In addition to the programme of inspections, the Council has been represented at the local Licensing Sessions to object when necessary to any applicationsto the justices for new on or off-licences. This is a most useful means of maintaining high standards of hygienic construction. The most effective food control safeguard is the routine inspection of premises where food is handled, with the objective of improving conditions where necessary. Summary Factors which have retarded our progress in this vital area are the shortage of inspectors and the growth of other duties. We are now receiving over twice as many food complaints as we were five years ago. Over the same period, due to staff shortage the time worked by District Public Health Inspectors has fallen by 40% of the 1969 figure. Partly due to this and partly to the proliferation of other duties, the attention given to the whole spectrum of food control has been made the responsibility of a specialist section. Already useful results have been achieved in relation to licensed premises. -16- Offices, Shops Rai I way Premises Act 1963 There are now 15,942 employees in the 2,522 registered premises within the Borough. The number of white collar workers continues to show a steady increase and there are now an average of ten workers per office as opposed to five workers per shop. Lack of cleanliness in offices is a problem which has been repeatedly drawn to the attention of employers. Sanitary accommodation especially that to the rear of shop premises is often dirty, neglected and upon occasions cluttered with extraneous materials. Reported accidents are thoroughly investigated in order to assess whether or not the Act has been contravened. In this respect we are still receiving a low annual number of reported accidents. It is apparent that many employers are not aware of their statutory obligation to report accidents at work which result either in death or in disablement which prevents the employees from carrying out their usual work for more than three days. For the reasons already described in the section outlining food control work, the inspection of offices and shops by Public Health Inspectors has been adversely affected during 1973. In the latter part of the year two technical assistants were engaged to give added momentum to the routine work involved and are responsible to the Divisional Public Health Inspector for food control. It is now ten years since the Offices, Shops & Railway Premises Act became law. The Secretary of State for the Department of Employment suggested that the annual report for 1973 should review the achievements and changes during the past decade. The following report was submitted:- INTRODUCTION 1973 has been primarily a year of consolidation and refinement both in respect of the internal administration of the Act and its subsequent external enforcement. It is hoped that this will facilitate the more effective improvement of the safety, health and welfare of employees in the premises to which the Act applies. This report is in three parts:- (i) Analysis of Progress since 1965 (ii) Effect of the Act upon Conditions. (iii) Statistical Information required by the Department of Employment, (i) ANALYSIS OF PROGRESS SINCE 1965 It can be seen from the table below that the Registered premises in the borough have been subject to three cycles of inspection. The first was of two years six months duration, and the second was of three years and six months duration. The final cycle ended in July, 1973. -17- Year No. Premises Inspected Total No. of Regi stered Premises Balance of Premises Un - inspected 1965 1066 2055 969 Mid 1967 1st Cycle Complete 1966 758 2207 363 1967 617 2317 1700 End 1970 2nd Cycle Completed 1968 190 2341 1534 1969 745 2357 805 1970 875 2432 5 1971 994 2498 1504 Mid 1973 final cycle completed 1972 835 2552 723 1973 1365 2515 642 Thus it can be inferred that on average, since this Local Authority was created in 1965 each premise has been inspected three times. However, it has not been possible to devote sufficient attention to the difficult problem of ensuring that the action necessary to remedy defects has in fact taken place. It has been found expedient to adopt a policy of informal persuasion and advice in order to secure compliance with statutory requirements. In practice such a policy imposes a heavy burden upon the inspectorate because numerous visits are often necessary to ensure that recommendations are complied with. It is estimated that three revisits are normally necessary before compliance with the Act can be secured. In one respect the figures relating to total visits of all kinds by Inspectors to registered premises may be misleading and biased in favour of food premises, which are visited by Public Health Inspectors who check whether or not the Food Hygiene (General) Regulations are being complied with and visit food premises following complaints of unsatisfactory foodstuffs purchased there. Moreover from the Inspectors point of view the visit to the food shop is more productive since it enables him to see whether the general public are being safeguarded, as well as the employees at the shop. Associated with this inevitable bias of visits in favour of food premises has been a dis-proportionate growth in the number of office employees over the last ten years. In 1965 there were 3757 employees in offices and 6537 in retail shops (a ratio of 4:7). In 1973 there were 5482 employees in offices and 7734 in retail shops (a ratio of 5:7). This no doubt reflects the national increase in whi te collar workers and can be expected to increase. Additionally there tends to be more workers employed in office units - ten per unit as opposed to five per unit in shops. The number of professional resources devoted to the enforcement of the Act have been influenced by: -18- (a) Staff shortages (b) Progress already achieved under the Act. (c) Other environmental health duties which compete for the attention of the inspectorate. A limited amount of specialisation was necessary during the formative years of the Act to further the registration and survey of business premises. In 1968 with the completion of the major portion of initial detailed inspections and registrations the emphasis was placed on other environmental health duties. Subsequently the enforcement of the Act was made the responsibility of the District Public Health Inspector, who undertook inspections when the burden of public health and other complaints permitted. During 1973 it became apparent that some of the momentum gained during the early years of the enforcement of the Act had been lost, particularly in the southern part of the Borough where environmental health problems are more acute. It also became clear that there needed to be a change of emphasis in assessment of our progress. Although it is meaningful to use the number of registered premises receiving one or more general inspections as a criterion of progress it is more meaningful to ascertain the number of employees who benefited (directly or indirectly) from the inspectors visit. This being the case it became necessary to divert the emphasis of our inspections from shops to offices, which contain more employees. At the same time initial steps were taken to ensure that the enforcement of the Act progressed in a more systematic and productive fashion. Two Technical Assistants were engaged for the purposes of undertaking routine inspections of non-food premises, supervised by a Divisional Public Health Inspector who is also responsible for food control. Although this arrangement was only instigated in the latter part of the year gratifying results have already been achieved. In April 1974 it is planned to develop the centralised internal enforcement of the Act with the employment of two Senior Public Health Inspectors who will supervise the day to day work of the Technical Assistants and carry out the more difficult inspections. The Senior Inspectors will also be responsible for food control duties. Thus, by the middle of 1974 a separate section will be in operation for the enforcement of the Act and of all aspects of food control. It is hoped that this arrangement will enable each registered premise to receive one general inspection and one revisit per year. (ii) EFFECT OF THE ACT UPON CONDITIONS Ventilation The majority of premises which come within the scope of the Act are small units without complex systems of mechanical ventilation. Nevertheless, some cases of difficulty have been found:- -19- (a) Betting shop managers often take great pains to fix bars to the windows at rear of the shop, thus preventing the windows from being opened. (b) Employees themselves often keep windows tightly shut to prevent draughts and minimise traffic noises. An encouraging trend has been the provision of coollngair in the region of cooking equipment in catering premises. This has been found most useful in alleviating employee discomfort, particularly in hot weather. Natural and Artificial Lighting Natural lighting in shop premises is typically good at the front and poor at rear. The same follows with artificial lighting where in rear rooms the sales promotion factor of good lighting is disregarded. A detailed survey was conducted in 1965/66 during which some 2,513 light meter readings were taken in shops and offices in the Borough and occupiers advised as to the suitability of their lighting arrangements. A general improvement has been achieved. Regulations prescribing statutory standards of lighting would be of assistance. Cleanliness Lack of cleanliness continues to be the major contravention of the Act. Those parts of office and shop premises open to public scrutiny are typically well maintained and clean. However, stockrooms, passages, offices, washrooms and toilets at the rear of premises are often found to be neglected. It is estimated that premises in regular use require cleaning and complete redecoration at least once every three years, and it is clear that the maintenance of clean conditions will continue to be a recurrent problem both for the employer and the enforcing authority. Overcrowding Although there is a steady increase in the number of office workers, instances of serious overcrowding have not been encountered except when extra temporary staff are present. In these circumstances it has been possible, by redeployment of staff to obviate overcrowding. Temperature In addition to problems of humidity, the temperature in hairdressing salons often increases considerably due to the effect of hair driers and room heaters. During 1972 a special inspection was made of every hairdressing establishment in the Borough to secure enforcement of the Act. Santitary Conveniences Lack of cleanliness has been a common defect, particularly where there are no female employees. The shortage of extraneous materials in sanitary -20- Housing Clean Air Act accommodation is also frequently encountered and access to sanitary accommodation through passages and rear yards has upon occasion been discovered to be seriously impeded by disused equipment and furniture, thus presenting an accident hazard. Accidents A lower number of accidents are still being reported, and of the accidents reported during 1973 several large firms made up the majority of reporting employers. Clearly the small employers are not aware of their statutory responsibilities. This is an area where publicity will be used to remind employers of their obligations. First Aid Many of the premises inspected during 1973 had not been visited for several years, and it was found that first aid kits were frequently either missing altogether or depleted. Most employers were quick to secure a replacement. Prosecutions Our objective where practicable has been to adopt a policy of informal persuasion and advice in order to secure good conditions. In 1967 ten prosecutions were instigated, and in the following year twenty three — some 15% of the National total. Subsequently prosecutions have declined in numbers as progress has been achieved, and in 1973 only one prosecution was necessary. During 1973 steady progress has been made with the programme for the clearance of unfit dwellings. House Condition Surveys have continued during this year and these are producing valuable information on the general condition of houses in the older parts of the Borough. The results have provided a basis for formulating the Council's overall strategy for dealing with the Borough's older stock and determining not only the extent and rate of its programme of replacement of the poorest housing but also whether any additional areas justify treatment as General Improvement Areas. I am pleased to report that during the year a fresh impetus was given to the Smoke Control Programme resulting in two areas being confirmed by the Secretary of State for the Environment and four further areas being submitted for confirmation. Provided energy and manpower resources are available, it is hoped to continue with this rate of progress which will result in the whole of the Borough being within smoke control areas in advance of 1980, the date previously forecast. -21- Reorganisation This report represents the end of an era. For nearly one hundred years the sanitary circumstances of the area have been the subject of annual report by the Medical Officer of Health and his staff. Within a few months the statutory post of Medical Officer of Health will be abolished. Unfortunately, whilst the Environmental Health Service has emerged strongly as a separate Department within the new local government areas outside London, there is certainly no uniformity within London Boroughs at present. The Council have decided that this Inspectorate will, together with the Trading Standards and Shop Act Inspectorates and the Road and Home Safety Officer form a new section headed by a Public Protection Officer responsible to the Borough Solicitor and Secretary. If I may be permitted to add a personal view I hope the voice of Public Health which is very much a voice of grass-roots will always have direct access to the upper echelons of the Council's policymakers. In these days when protection of the environment is of such importance, the traditionally wide view of the Public Health Inspector has much to offer. Finally I record my thanks to the staff of all other Council Departments and to the staff of the Public Health Inspectorate who by loyal service and assiduity assisted me to serve the inhabitants of this Borough. Midwifery COMMUNITY NURSING SERVICE Miss Gillian Pittom, Chief Nursing Officer, writes:- Much time this year has been spent on consolidating the work of the nursing services alongside that of the family practitioners. Midwifery has continued to change and is rapidly becoming a hospital based service for deliveries but requiring an increasing amount of domiciliary time, ante-natally and post-natally, as more family practitioners care for their own patients. Health visitors have worked closely with other members of the primary care team and their colleagues in the School Health Service. It remains as ever a difficult service to staff satisfactorily — recruitment is almost 100% from student training. District nursing is an ever-expanding service, and has over the year extended coverage for 2A hours following a small pilot scheme to assess .the needs. Great emphasis and energy has been channelled towards improving andeasingthe transfer of patients into and out of hospital. Regular visits from nursing officers to wards in Whipps Cross and Langthorne have helped increase understanding between the two services but much work still remains to be done in this area. Domiciliary midwives are playing an increasingly important part in the new integrated training — student midwives now gain their experiences in the community at a much earlier stage in their training. Midwives are participating more in the Maternity Unit at Whipps Cross and there has been an appreciable -22- Health Visiting School Nursing District Nursing interest by general practitioner obstetricians in using beds in the unit for their patients who are delivered by the domiciliary midwife. All midwives were invited to spend one week in the new unit to become acquainted with the geography, and the nursing officer responsible for midwifery has an office in the unit. Midwives are playing an increasingly enthusiastic role in parentcraft education alongside health visitors both in centres and in hospital. Much time is spent in attending an ever increasing number of family practitioner ante-natal clinics but this does prevent such long hospital visits for expectant mothers. This service continues to thrive over a wide field. More emphasis has been placed on working as a team member with general practitioners, district nurses and midwifery colleagues. In a few groups it has been possible to attach a clinic/ school nurse to this team to work closely with health visitors and general practitioners in the surveillance of school children and the handicapped. More recently trained health visitors spent more time with health education groups in centres and schbols, thus meeting a greater number of the public. This has been made possible by increasing the number of clinic/school nurses who are themselves beginning to participate in group work. This service is now able to give a wider and more professional service. The total number of visits has increased this year by 22,498 over 1972. At some times during the year as many as five terminally ill patients were remaining in their own homes in preference to hospital — one requiring two hourly visiting and one requiring continuous oxygen. These ill patients are nursed with the closest possible co-operation between family practitioners, hospital consultants and ward sisters and obviously place greatly increased demands on the nursing sisters but more State enrolled nurses are now being recruited a little more easily and make a most valuable contribution to caring for the more severely handicapped and chronically sick. The advent of nursing auxiliaries has lifted a great weight of routine hygiene baths from their more professionally skilled colleagues. A pilot scheme for a night nursing service based in Whipps Cross Casualty Department has proved a most valuable exercise and has made a considerable impact on all the community services. It is hoped to increase this service as sufficient resources are available. Recruitment has been mostly for part-time nurses. During the year it has been possible to make in-service training available for all levels of staff but the greatest demands necessarily come from those needing special skills. Nursing officers have participated in training student nurses from Whipps Cross and Claybury. One midwife, Miss Pearce, kindly consented to organise the teaching programme for student midwives whilst Miss Delves, Midwifery Tutor, was taking her Community Health Tutors' course at the Royal College of Nursing. -23- WATER SUPPLIES Contributed by Dr.E.Windle Taylor, C.B.E.,M.A.,M.D.,D.P.H.,F.R.C.Path. Director of Water Examination, Metropolitan Water Board. 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity out 1973. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, I 973, was 232,580. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:- River Lee/Thames Water from Coppermills works, and well water from Chingford Mill Pumping Station. A small portion of Lower Chingford adjoining Sewardstone Road north of King's Head Hill is supplied with Thames-derived water from the Thames Valley group of stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on pages 66 and 67. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. -24- Rainfall Sewerage Sewerage Disposal CONTRIBUTIONS BY COLLEAGUES RAINFALL AND SEWERAGE Contributed by W.Furness, B.Sc.(Econ.), Dip.T P-, M.R.T.P.I., Chief Planning and Highways Officer The rainfall recorded in the Borough was an average of 443.6 mm (16.46 inches). This was a very dry year, the average annual rainfall being about 600mm. The construction of a new foul sewage pumping station at Low Hall Depot and the Leytonstone Area Stage 11A Relief Surface Water Sewerage Scheme were completed. Construction work on the Highams Sewer Area Flood Relief Scheme continued throughout the year and work was started on the construction of the Chingford Mount Area (Southern Branch) Relief Scheme. Sewerage disposal is carried out by the Greater London Council. -25- STATISTICAL INFORMATION VITAL STATISTICS Area of Borough (in acres) 9,805 Population (Registrar General's Estimate, midyear 1973) 232,580 Number of Rate Assessments at 31st December, 1973 97,862 Total Assessable Value £30,922,082 Product of a penny rate £295,000 Live Births: waltham forest England & males females Legitimate 1586 1555 3141 Illegitimate 160 145 305 3446 Live Birth Rate per 1,000 population 14.8 13.7 " as adjusted by comparability factor (1.00) 14.8 Illegitimate live births per cent of total live births 9.0 Stillbirths: Number (24 males: 28 females) 52 Rate per 1,000 total live and stillbirths 15 12 Total live and stillbirths 3498 Infant deaths (deaths under one year) 74 Infant Mortality Rates: Total infant deaths per 1,000 total live births 21 17 Legitimate infant deaths per 1,000 legitimate live births 21 16 Illegitimate infant deaths per 1,000 illegitimate live births 23 22 Neo-Natal Mortality Rate (deaths under four weeks per 1,000 total live births) 15 II Early Neo-Natal Mortality Rate (deaths under one week J per 1,000 total live births) 13 10 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 28 21 Maternal Mortality: Number of deaths 2 Rate per 1,000 total live and stillbirths 0.57 Deaths: Total number Death rate per 1,000 population 13.0 12.0 " as adjusted by comparability factor (0.87) | 13 -27 - CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1973 I.C.D. CAUSE HEADING CAUSE OF DEATH TOTAL (ALL AGES) AGE GROUPS - MALES AGE GROUPS - FEMALES UNDER, 1 1-4 5-14 1524 2534 3544 4554 5564 6574 75 + TOTAL MALES UNDEF 1 1-4 5-1' 1524 2534 3544 4554 5564 6574 75+ TOTAL FEMALES B.4 Enteritis and other diarrhoeal diseases 3 2 - - - - - - - 1 - 3 - - - - - - - - - - - B.5 Tuberculosis of respiratory system 5 - - - - - - - 1 1 2 4 - - - - - - - - - 1 1 0.6(1) Late effects of respiratory tuberculosis 2 - - - - - - - - 1 - 1 - - - - - - - - - 1 1 B.6(2) Other tuberculosis 1 - - - - - - - - - - - - - - - 1 - - - - - 1 B.I 1 Meningococcal infection 1 1 - - - - - - - - - 1 - - - - - - - - - - - B. 17 Syphilis and its sequelae 2 - - - - - - - 1 1 - 2 - - - - - - - - - - - B. 18 Other infective and parasitic diseases 4 1 - - - - - - - - 1 2 - - 1 - - - - 1 - - 2 B. 19(1) Malignant neoplasm buccal cavity etc. 7 - - - - - - - - 1 3 4 - - - - - - - - 1 2 3 B. 19(2) Malignant neoplasm oesophagus 19 - - - - - 1 - 1 3 2 7 - - - - - 1 1 - 3 7 12 B. 19(B) Malignant neoplasm stomach 56 - - - - - 2 4 15 7 28 - - - - - - - 9 9 10 28 B. 19(4) Malignant neoplasm intestine 25 - - - - - - 3 5 1 1 6 25 - - - - 1 - 4 7 10 18 40 B. 19(5) Malignant neoplasm larynx 3 - - - - - - - - 1 1 2 - - - - - - - - - 1 1 B.I 9(6) Malignant neoplasm lung, bronchus 204 - - - 1 - 2 6 53 79 30 171 - - - - - - 6 5 4 18 33 B. 19(7) Malignant neoplasm breast 70 - - - - - - - - - 1 1 - - - - - 2 8 23 20 16 69 B. 19(8) Malignant neoplasm uterus 11 - - - - - - - - - - - - - - - - - 1 4 2 4 1 1 B. 19(9) Malignant neoplasm prostate 28 - - - - - - - 3 12 13 28 - - - - - - - - - - - B. 19(10) Leukaemia 18 - 2 - - - 2 - 1 4 1 10 - - - - - - 1 3 1 3 8 B.19(11) Other malignant neoplasms etc. 171 - - 1 - 2 6 9 24 20 12 74 - - - - 2 2 5 27 25 36 97 B.20 Benign and unspecified neoplasms 8 - - - - - - - - - 2 2 - - - 1 - - 1 1 3 - 6 B.2I Diabetes mellitis 46 - - - - - 1 - 4 7 7 19 - - - - - - - 2 9 16 27 B.46(l) Other endocrine etc. diseases 13 - - 1 - - - 3 1 - 5 - - 1 - - - 3 3 1 - 8 B.23 Anaemias 3 - - - - - - - - - 1 1 - - - - - - - - - - 2 B.46(2) Other diseases of blood etc. 1 - - - - - - - - - - - 1 - - - - - - - - - 1 B.46(3) Mental disorders 8 - - - - - 1 - - 1 - 2 - - - - - - - - - 6 6 B.24 Meningitis 2 1 - - - - - - - - - 1 1 - - - - - - - - - 1 B.46(4) Multiple sclerosis 5 - - - - - - - - 1 - 1 - - - - - 1 - 1 1 1 4 B.46(5) Other diseases of nervous system etc. 16 - - 1 - - - 1 - 3 3 9 - - 1 - 1 1 - - 2 2 7 B.26 Chronic rheumatic heart disease 35 - - - - 1 2 5 4 1 13 - - - - - - 2 5 8 7 22 B.27 Hypertensive heart disease 56 - - - - - - 3 2 5 14 24 - - - - - - - 2 6 24 32 B.28 Ischaemic heart disease 580 - - - - 1 6 43 109 146 94 399 - - - - - 1 5 17 79 169 271 B.29 Other forms of heart disease 171 - - - - 1 - - 4 17 42 64 - - - - - - - 2 10 95 107 B.30 Cerebrovascular disease 349 - - 1 - - - 2 18 37 66 124 - - - - - 1 6 18 34 166 225 B.46(6) Other diseases of circulation system 106 - - - - - - 2 6 17 19 44 - - - - - 2 3 5 14 38 62 B.3I Influenza 4 - - - - - - - - - 1 1 - - - - - - - - 1 2 3 B.32 Pneumonia 386 3 - - - 1 - 3 12 44 81 144 3 1 1 1 - - 4 3 31 198 242 B.33( 1) Bronchitis and emphysema 129 - - - - - - 1 16 41 43 101 - - - - - - 1 3 3 21 28 6.33(2) Asthma 10 - - - - 1 - 1 2 - 1 5 - - - - - 1 - - 3 1 5 B.46(7) Other diseases of respiratory system 27 - 1 - - - - 1 - 5 3 10 - - - - - - - 1 4 12 17 B.34 Peptic ulcer 24 - - - - - - 2 3 5 4 14 - - - - - 1 - 1 4 4 10 B. 36 Intestinal obstruction and hernia 15 1 - - - - - - - 1 3 5 - - - - - - - 1 2 7 10 B.37 Cirrhosis of liver 6 - - - - - 1 1 2 - 1 5 - - - - - - - 1 - 1 B.46(8) Other diseases of digestive system 24 - - - - - 1 - 3 5 3 12 - - - - 1 - - 2 3 6 12 B.38 Nephritis and nephrosis 17 1 1 - - - 1 2 1 2 - 8 - - - - 1 1 - - - 7 9 B.39 Hyperplasia of prostate 9 - - - - - - - 1 1 7 9 - - - - - - - - - - - B.46(9) Other diseases, genito urinary system 17 1 - - - - - - - 1 2 4 - - - - - - - 2 4 7 13 B.41 Other complications of pregnancy 7 - - - - - - - - - - - - - - - 2 - - - - - 2 B.46(10) Diseases of skin, subcutaneous tissue 3 - - - - - - - - - - - - - - - - - - - - 3 3 B.46(l1) Diseases of musculo - skeletal system 16 - - - - - - - 1 - 1 2 - - - 1 - - 2 1 1 9 14 B.42 Congenital abnormalities 29 5 4 1 - - - 3 1 2 - 16 10 - - - - 1 - - 2 - 13 B.43 Difficult del ivery and/or anoxic condition 26 19 - - - - - - - - - 19 7 - - - - - - - - - 7 B.44 Other causes of perinatal mortality 14 7 - - - - - - - - - 7 7 - - - - - - - - - 7 B.45 Symptoms and ill-defined conditions 13 - - - - - - - - 1 1 2 1 - 1 - - - - - 1 8 1 1 BE.47 Motor Vehicle accidents 23 - 1 1 1 - - 1 1 - 2 7 - - 1 3 1 1 1 1 2 6 16 BE.48 All other accidents 34 - 2 2 - 2 1 - 1 2 4 14 - 1 1 1 1 - 1 2 2 1 1 20 BE.49 Suicide and self inflicted injuries 17 - - - - 1 3 2 2 - 8 - - - - - 3 I 1 3 1 9 BE.50 All other external causes 9 1 - - 1 1 - 3 - - - 6 1 - - - - - 1 - 1 - 3 3013 43 1 1 8 3 10 25 94 290 501 485 1470 31 2 7 7 1 1 19 57 153 310 946 1543 -28- DEATHS FROM CANCER AGE AT DEATH MALES FEMALES TOTAL Under 5 years 2 _ 2 5 and under 15 years 1 - 1 15 and under 25 years 1 1 25 and under 45 years 13 8 21 45 and under 65 years 111 104 215 65 years and over 222 190 412 T otal 350 302 652 Previous years - 1972 336 291 627 1971 347 277 624 1970 367 289 656 BIRTHS During the year a total of 3,493 births were registered. In the same period 3,993 births were notified in accordance with Section 203 of the Public Health Act which were distributed as fallows DOMICILIARY INSTITUTIONAL LIVE STILL LIVE STILL Notified births which occurred in the Borough 384 2 2559 38 Birth notifications transferred outwards - - 430 6 Birth notifications transferred inwards . 3 - 991 16 Adjusted Total 387 2 3120 48 Previous years 1972 550 1 3079 54 1971 649 4 3440 49 1970 693 4 3332 66 CARE OF PREMATURE INFANTS (weighing 5½lbs or less) LIVE STILLBORN Number born at home 3 Number born in Hospital or Nursing Home 235 31 - 29 - MIDWIFERY The work of the Council's Midwives was as follows:- 1973 1972 1971 Domiciliary confinements attended under N.H.S. arrangements 394 543 659 Hospital confinements conducted by domiciliary midwives 37 40 - Cases delivered in hospital and other institutions but discharged and attended before tenth day 1,905 1,157 825 Miscarriages attended 6 7 1 New cases booked 1,304 1,317 857 Cases on the books at the end of the year 297 483 337 Medical aid notices issued 28 41 22 Visits paid (as midwife): (a) Ante-natal 4,014 4,012 4,315 (b) Nursing 14,839 15,348 16,081 (c) Other post-natal 1 ,104 1 ,098 1,134 T otal V i s i ts 19,957 20,458 21,530 Clinic Sessions Number of sessions attended: (a) General practitioner's clinics 1,399 1,31 1 1 ,369 (b) Midwife's clinics 262 324 371 Number of ante-natal examinations by the midwife: (a) General practitioner's clinics 1 1,072 12,267 12,900 (b) Midwife's clinics 91 1 1,438 1 ,750 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 404 868 810 -30 - Child Welfare Clinic Attendances ASSEMBLY HALL DAWLI SH RO AD EMMANUEL HALL GRANLEIGH ROAD HATCH L AN E HANDS WORTH AVE. HURST RO AD L EY TON GREEN ST. J AMES MARMION AVENUE PRIORY COURT Y AR DL EY L AN E WEST AVENUE TOTAL FOR THE YEAR-ALL CLINICS 1973 1972 1971 Children attending for the |9£8 first time 1973 who were born in 27 28 - 3 34 28 1 12 38 - 1 3 17 192 175 250 1969 25 88 2 14 17 .39 1 6 73 3 20 7 39 334 504 547 1970 15 1 16 2 47 17 1 1 1 3 27 167 8 33 8 78 632 874 872 197 1 40 218 5 91 25 198 8 26 203 23 66 22 100 1,025 1,299 1,472 1972 1 18 346 45 337 58 244 32 319 340 257 202 77 196 2,571 2,678 3,045 1973 74 355 39 455 60 179 213 299 349 274 220 43 258 2.818 3,135 3,174 Total attendances 2,482 5,447 460 5,286 1,048 4,939 3,153 4,065 4,734 3,857 3,360 1,313 4,098 44,242 44,778 55,342 Attendance of children seen by Medical Officer 344 1,507 61 1,142 396 1.127 961 781 1.640 534 1,160 122 1,625 1 1,400 12.504 14,605 No. of children referred elsewhere 10 111 4 177 14 26 17 29 55 51 106 4 29 633 719 757 No. of sessions 48 199 18 1 18 65 84 87 132 195 109 130 17 144 1,346 1, 199 1.259 (b) Sessional G.P's - - - - - 36 4 6 15 6 _ - - 67 138 143 (c) Health Visitors 44 6 16 29 3 12 9 15 2 1 14 5 35 2 292 333 311 -31 - 32 Distribution of Walfare Foods and Nutrients NUTRI ENTS WELFARE FOODS ORANGE JUI CE ADEXOLINE OPTROSE M ARMI TE COW 8c GATE OSTERMILK NO ' 2 S.M. A. HUMSD. T RU FOOD FAR EX GROATS GOLDEN O STERMILK N AT-DRI ED MILK A. D. & C. D ROPS A.D. fik C. T -ABLETS Assembly Hall .4,847 6 2,357 1,685 563 248 577 41 67 28 152 77 965 188 Hurst Road 4,333 50 2,500 1,095 1,754 270 529 52 81 88 242 133 1,250 204 Dawl ish Road 4,713 - 1,651 401 2,143 454 1,177 236 190 128 200 723 1,832 172 Emmanuel Hall 1,401 30 1,018 166 412 72 63 7 27 18 15 48 260 24 Granleigh Road 6.451 10 1,479 1,114 1,538 694 1,536 153 171 1 10 257 756 1,887 243 Handsworth Avenue 8,561 78 5,212 2,617 1,772 238 472 72 130 1 17 501 175 1.577 381 Hatch Lane 2,097 - 874 662 406 86 354 142 43 46 70 44 338 124 Leyton Green 7,648 195 1.548 1,007 2,192 283 1,01 1 1 17 258 1 18 220 486 1,463 128 Priory Court 6,230 24 3,668 1,441 2,457 249 780 190 1 16 94 251 420 1,623 297 St. James 5,679 3.854 1,273 4,731 156 1,085 86 123 1 16 148 447 1,93 1 333 Marmion Avenue 8,256 180 5,900 2.328 2,373 393 1,104 341 123 1 17 226 444 1.418 236 Y ardley Lane 1,691 1 797 561 442 80 121 88 47 33 102 138 293 26 West Avenue 2,721 16 1,843 560 3,164 143 864 170 100 76 326 230 1,352 145 Hospitals and Nurseries - - - - - - - - - - - 2 690 - 64,628 590 32,701 14,910 23,947 3,366 9,673 1,695 1,476 1,089 2,710 4,123 16,879 2,501 Previous Years - 1972 4,162 39,869 15,884 20,087 6,805 6,694 1,296 1,256 1,040 2,376 4,507 1 2,477 1,615 - 1971 10,784 49,745 16,938 19,545 13,817 6,716 564 1,690 1 ,160 811 5,882 5,357 2,406 - 1970 1 3,633 51,1 28 14,467 18,501 14,126 5,841 346 1,817 1,056 - 7,523 - 2.969 Mother craft and Relaxation Classes New cases 429 Attendances 1,093 No. of classes held 184 Congenital Malformation 151 cases of congenital malformation were notified to the Registrar General's office during the year. Cervical Cytology Clincs HATCH LANE GRANLEIGH ROAD No. of smears taken 792 442 No. of sessions 49 31 Dental Treatment of Expectant and Nursing Mothers and Children under five years CHILDREN UNDER S Y RS. EXPECTANT ft NURSING MOTHERS 1973 1972 1971 1973 1972 1971 Number of patients given first inspections during year 639 594 329 45 30 24 Number of patients who required treatment 548 582 213 38 28 21 Number of patients who were offered treatment 548 580 204 38 28 17 Attendances for treatment: First visit . 503 565 682 38 33 30 Subsequent visits . 323 376 832 25 35 42 Total visits 826 941 1,514 63 68 72 Treatment provided: Number of fiIIings 530 561 877 31 25 39 Teeth filled 489 514 792 29 24 36 Teeth extracted III 64 183 15 16 9 General anaesthetics given 45 20 72 1 - 1 Emergency visits by patients 22 42 36 2 1 - Patients X-rayed 4 6 12 7 6 6 Patients treated by scaling and /or removal of stains from the teeth (Prophylaxis) 217 246 258 9 21 14 Teeth otherwise conserved 141 128 171 - - - Teeth root filled - - - 1 2 1 Inlays - - - - - - Crowns - - - - - - Number of courses of treatment completed during the year 464 419 570 35 23 20 Patients supplied with full upper or ful 1 lower dentures - - - 1 - - Patients supplied with other dentures - - - 1 - 2 Number of dentures supplied - - - 2 - 2 -33- FAMILY PLANNING CONNAUGHT HOSP O. P. DEP 1 GR ANL El GH RO AD HATCH LANE HU RST ROAD LEYTON GREEN ST.J AMES Number of new patients 158 577 321 640 381 422 Number of persons treated 213 1,505 1,810 2,145 1,453 808 Number of attendances 328 3,666 4,054 5,373 2,894 1,873 Number of sessions 48 99 98 99 100 51 HEALTH VISITING (a) Sessions Worked Number of sessions (half days) devoted to: 1973 1972 1971 (i) Health visiting 6,763 6,743 7,427 (ii) Child welfare centres 3,672 3,468 3,315 (iii) Ante-natal, post-natal, relaxation etc. clinics 244 185 391 (iv) School clinics 965 767 764 (v) Other school nursing 2,761 2,140 1,647 (vi) Health education (including mothercraft) 279 188 499 (vii) Chest clinic sessions 617 716 (viii) G.P. surgeries 675 735 (ix) Other work (including clerical 4,750 4,658 5,514 Total sessions 20,726 19,600 19,557 (b) Cases visited for the first time in the year (i) children under 5 years 11,503 12,381 1 1,848 (ii) persons aged 65 or over 2,985 2,632 2,01 1 (iii) others (excluding school nursing cases) 2,987 3,485 1,322 Total 17,475 18,498 15,181 (c) Number included in item (b) who were visited at the special request of a G.P. or hospital: (i) persons aged 65 or over 677 829 572 (ii) mentally disordered persons 80 82 34 (iii) others 1,632 1,915 187 -34- (d) Total number of visits to: effective ineffective (i) children under 5 years of age 18,984 4 733 (ii) persons aged 65 or over 4,546 (iii) other (excluding school nursing cases) 4,884 1,787 Total visits 1973 28,414 6,520 Total visits 1972 28,565 6,714 Total visits 1971 30,574 7,616 HOME NURSING (a) Cases visited for the first time in the year: CASES TOTAL VISITS 1973 1 972 1971 1973 1972 1971 (i) aged under 5 2,215 1,898 1,336 2,849 3,546 3,162 (ii) aged 5 and under 65 6,259 7,28 2 4,53 9 39,3 5 6 3 9,52 5 3 8,080 (iii) aged 65 or over 6,212 4,701 2,625 135,504 112,140 107,055 Total cases 14,686 13,881 8,500 177,709 155,211 148,297 (b) Cases on the books at the end of the year: 1973 1,713 1972 1,660 1971 1,550 LOAN OF SICK ROOM EQUIPMENT New Issues in 1973 EQUIPMENT HEALTH & WEL FARE DEPTS. CHINGFORD RED CROSS EQUIPMENT HEALTH & WELFARE DEPTS. CHINGFORD RED CROSS Commodes 100 58 Urine Bottles 78 12 Wheelchairs 70 49 Hoists 5 - Bed Cradles 80 7 Feeding Cups 7 2 Air Rings 137 14 Crutches (pairs) 5 4 Bed Pans 140 20 Ripple beds 27 - Back Rests 133 27 Draw Sheets 27 6 Others 36 4 Plastic Sheets 154 - - -35- CHIROPODY TREATMENT NEW CASES CLINI C ATTENDANCES DOMICILIARY TREATMEN TS TREATMENTS AT OLD PEOPLES RESI DEN Tl AL HOM ES CASES TREATED DU RING TH E YEAR Children 728 3,631 - - 1,065 Expectant mothers 4 27 - - 4 Physically Handicapped 5 108 45 - 39 Aged (over 65 years of age) 407 15,948 3,697 1,817 6,129 Others 646 4,668 65 - 1,363 Total for 1973 1,790 24,382 3,807 1,817 8,600 Previous Years - 1972 1,771 28,222 3,744 1 ,968 - 1971 1,862 32,512 3,744 1,684 - 1 970 1,730 34,358 4,214 1 ,829 - LAUNDRY FOR THE INCONTINENT ARTICLES LAUNDERED DOMICILIARY RESIDENTIAL CASES HOMES 16,417 46,883 REGISTRATION OF PREMISES Public Health Act, 1936 - Nursing Homes Homes registered at 31 st December, 1973 — Nil. Essex Count/ Council Act, 1933 - Establishments for Massage and Special Treatment r- , , CHIROPODY MASSAGE ETC.' Establishments registered at 3'l.st December 1973 7 6 -36- INFECTIOUS DISEASES - NOTIFICATIONS DISEASE 1ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER TOTAL Scarlet Fever 21 17 4 13 55 Whooping Cough 19 2 3 13 37 Measles 436 547 165 12 1,160 Tuberculosis - Pulmonary 21 18 13 17 69 Tuberculosis - Non-pulmonary 9 12 9 10 40 Typhoid - 1 - - 1 Paratyphoid - - - - - Acute Meningitis 2 1 5 - 8 Dysentery 11 2 3 - 16 Ophthalmia Neonatorum - - - - - Food Poisoning - 1 1 1 3 Infective Jaundice 8 3 3 1 15 Malaria (contracted naturally abroad) - 1 2 - 3 Mumps encephalitis 1 - - - 1 Totals 528 605 208 67 1,408 TUBERCULOSIS New Notifications and Deaths during 1973 AGE PERIODS NEW CASES DEATHS PULMONARY NONPULMONARY PULMON ARY NONPULMON ARY M F M F M F M F Under 1 year - - - - - - - - 1 - 4 years 1 - - 1 - - - - 5-9 years - 2 - - - - - - 10-14 years 1 . 1 1 - - - - 15 - 19 years 3 1 1 1 - - - - 20 - 24 years 8 5 1 8 - - - - 25 - 34 years 8 2 8 7 - - - 1 35 - 44 years 8 4 3 2 - - - - 45 - 54 years 6 - 2 3 - - - - 55 - 64 years 5 1 - - 1 - - - 65 and over 11 3 1 - 4 2 - - Totals 51 18 17 23 5 2 - 1 69 40 7 1 109 8 -37- Tuberculosis among Immigrants Cases of tuberculosis among immigrants seen at the local Chest Clinic numbered 78 These occured in the following groups:- RESPIRATORY NON-RESPIRATORY Pakistani 16 20 Indian 12 14 Kenyan - 2 West Indian 1 1 Irish 5 - Others 3 4 Tuberculosis - Care and Aftercare (Work of Tuberculosis Visitors (i) Visits to new cases 316 (ii) Total visits to households 1,820 (iii) Sessions attended at Chest Clinic 850 MEDICAL EXAMINATIONS OF STAFF Completed during period 1st January to 31st December, 1973:- Medical Examinations 437 Medical Assessments 1,364 -38- VACCINATION AND IMMUNISATION TYPE OF COURSE OR DOSE YEAR OF 31 BIRTH OTHERS UNDER 16 YEARS TOTAL 1973 1972 1971 1970 1966-69 Diphtheria - Primary 39 1,859 581 74 105 12 2,670 Booster - 2 13 10 2,056 49 2,130 Whooping Cough - Primary 37 1,804 561 64 49 8 2,523 Booster - 2 12 3 253 13 283 Tetanus - Primary 39 1,859 582 75 131 33 2,719 Booster - 2 14 13 2,122 133 2,284 Poliomyelitis - Primary 39 1,876 582 72 104 12 2,685 Booster - 3 15 8 2,100 61 2,187 Measles - 738 800 147 127 1 1,813 Rubella - - - - - 960 960 TYPE OF VACCINE USED IMMUNISATIONS OR VACCINATIONS COMPLETED BY GENERAL PRACTITIONERS IMMUNISATIONS OR VACCINATIONS COMPLETED BY BOROUGH STAFF PRIMARY COURSES REINFORCING DOSES PRIMARY COURSES REIN FORCING DOSES Diphtheria, Whooping Cough, Tetanus and Poliomyelitis combined - - - - Diphtheria, Whooping Cough and Tetanus combined 1,395 231 1,128 52 Diphtheria and Whooping Cough combined - - - - Diphtheria and Tetanus combined 19 655 127 1,183 Diphtheria only - 1 1 8 Whooping Cough only - - - - Tetanus only 43 85 7 78 Poliomyelitis:- (a) Salk - - . - (b) Sabin 1,405 927 1,280 1,260 Smallpox 662 1,054 - - Measles 863 - 950 - Rubella 68 - 892 - -39- B.C.G. Vaccination of Children Results of Heaf Test:- (a) Tuberculin Positive 62 (b) Tuberculin Negative 1,742 Number vaccinated with B.C.G 1,742 GENERAL DENTAL SERVICE Number of Sessions 206 Number of appointments made 1,206 Number of new patients seen 213 Analysis of Treatments Provided Fillings - Plastic 161 Amalgam 335 Inlays 1 Crowns 4 Scaling and gum treatment 162 Dressings 90 Extractions 31 General Anaesthetic given - Local Anaesthetic given 164 X-rays 328 Dentures supplied 74 Dentures repaired 12 Impressions 206 Bites 77 Try-in 110 Minor Oral surgery 3 Other treatment 169 DENTAL LABORATORY DENTURES REPAIRS REMAKES OR RELINE APPLI ANCES CROWNS INLAYS STUDY MODEL TRAYS EAR INSERTS General Dental Service 52 45 10 1 2 1 - 73 - School Dental Service 9 9 - 74 9 - 335 3 572 Maternity and Child Welfare 2 - - - - - - - - - 40 - PUBLIC HEALTH INSPECTION A. INSPECTIONS, RE-INSPECTIONS, ACTION (1) GENERAL STATUTORY PROVISIONS COMPLAINTS RECEIVED INSPECTIONS AND RE-INSPECTIONS INFORMAL NOTICES SERVED FORMAL NOTI CES SERVED HOUSES CLASSIFIED Clean Air Act, 1956 144 2,067 31 20 - Housing Acts, 1936/69 and Regulations - 2,667 16 4 - Public Health Acts, 1936/64, and Noise Abatement Act, I960 2,274 16,934 621 214 - Prevention of Damage by Pests Act, 1949 4,966 19,748 13 1 - Food and Drugs Act, 1955 and Food Hygiene Regulations, 1960/66 458 3,162 164 - - Factories Act, 1961 - 203 3 1 - Pet Animals Act, 1951 , Riding Establishments Act, and Animal Boarding Establishments Act, 1963 - 83 - - - Offices, Shops and Railway Premises Act, 1963 - 2,812 252 - - -41- (ii) DETAILED (I) Housing Acts, 1957/72 (a) Individual Houses - Demolition/Closing Orders Undertakings accepted (Section 16) Nil Closing Orders made 1 Demolition Orders made (Section 17) Nil Closing Orders revoked and Demolition Orders substituted (Section 28) Nil Orders/Undertakings determined 3 (b) Slum Clearance Areas Number of areas represented (Sections 42 & 157 (1) 14 Houses unfit for human habitation 124 Houses included by reason of bad arrangement Nil Houses on land acquired under 43 (2) 173 Numbers of people to be displaced (a) individuals 558 (b) Fami lies 190 (c) Compulsory Purchase Orders confirmed The Waltham Forest Housing Part III (Markhouse Road Area South No. I) Compulsory Purchase Order 1972, and the Waltham Forest Housing Part III (Markhouse Road Area South No.2) Compulsory Purchase Order 1972, were confirmed by the Secretary of State for the Environment with minor modifications. The Waltham Forest Housing Part III (Markhouse Road Area North) Compulsory Purchase Order 1972, was confirmed by the Secretary of State for the Environment without amendment. Following Official Representations made during 1972, Public Inquiries were held during 1973, in respect of the Waltham Forest Housing Part I I I (Apsley Road, F.I 7.) Compulsory Purchase Order 1972, The Waltham Forest Housing Part I I I (Markhouse Road Area South, No.I I I) Compulsory Purchase Order 1972, and the Waltham Forest Housing Part I I I (Union Road/Queens Road, E.I 7.) Compulsory Purchase Order 1972. The decisions of the Secretary of State for the Environment are awaited. Following Official Representations the Council took the following action during the year:- (a) II Clearance Areas were declared in February, in respect of houses in Acacia Road, Beachcroft Road, Cecil Road, Cobden Road, Harrow Road, High Road and Howard Road, E.II. (b) 3 Clearance Areas were declared in November, in respect of houses in Lincoln Street and Norman Road, E.II. -42- (d) House Condition Surveys In conjunction with clearance area procedures, it became clear that there was a very considerable stock of housing which might not be statutorily unfit nor apparently ideal for extensive grant aid. Many of these properties were built prior to 1888 when building bye-law control was first introduced and were expected to have inherent defects, being in a poor structural condition and incapable of any real improvement. However, no precise information as to their condition was available in a statistical form. The Council authorised the implementation of a survey at its Committee for Resources at which future housing policies were reviewed, and accordingly areas consisting of some 3,500 dwelling ings were defined. The project had been implemented three months before the Secretary of State for the Environment in circular 56/72 asked Local Authorities to take steps to ascertain the age, condition and tenure of its present housing stock. The method adopted consisted of complete internal and external inspection of one dwelling in every four or five. This gave information as to condition of the structure, lack of facilities, occupancy and tenure. In addition a complete external survey of all the pre-1914 dwellings in the area was carried out. The table overleaf shows the results of five survey areas, indicates the general condition of the pre-1914 dwellings and the proposed action agreed by the Council. It must be emphasised that the classifications expressed as percentages are as a result of statistical sample only. The physical survey of six other areas has been completed and has yet to be presented to the Council for their consideration. (e) Housing Finance Act, 1972 - Qualification Certificates A total of 3593 applications have been received up to 31st December 1973, by this Department in connection with the conversion of Controlled Tenancies to Regulated Tenancies for the Dumose of recent control. Action has been taken as follows Section 28(1) Section 29(1) Section 29(5) Applications Received 2,941 439 213 Certificates Recommended 1,643 375 212 Certificates Not Recommended 1,196 41 1 Applications Withdrawn 54 22 Nil Applications Pending 48 1 Nil (2) Food and Drugs Act, 1955 (Inspection and Supervision of Food Premises) The following inspections were carried out at the undermentioned food premises in accordance with the requirements of the Public Health Act, 1936, Food and Drugs Act, and Food Hygiene (General) Regulations, 1960/70, Ice-Cream (Heat Treatment) Regulations, 1947/52, Factories Act, 1961, Leyton Coporation Act, 1950, Essex County Council Act, 1952, and relevant legislation. TYPE OF PREMISES NUMBER OF INSP ECTION S Retail Food Shops 1,795 Catering establishments (including factory canteen, hospital, nursing homes, school meals kitchens) 653 Food Hawkers/Street Traders/Fairgrounds 222 Food Manufacturers/Depots, Dairies, Bakehouses 343 Off-Licences 50 Public Houses 99 3.162 -43- HOUSING SURVEY AREAS DWELLINGS - PRE 1914 SURVEY AREA ACRES TOTAL POSSI BLY UNFIT POORLY M AIN T AINED NO. % LACKING B ATHROOM NO. % LACKING lNSIDEW.C. NO. % PROPOSED ACTION NO. % (SAMPLE DWELLING DATA) Crownfied Road 11.2 262 171 65 165 63 181 69 205 78 Part III Clearance (subject to detai led survey) Part V Redevelopment. 18.6 392 62 16 99 25 279 71 315 80 Cathall Road 3.9 44 13 30 26 59 31 70 28 64 Part III Clearance (subject to detailed survey) G.I.A. Programme 25.7 565 35 6 128 23 208 37 278 49 Springfield Road Part of Markhouse Road Frontage 15.3 405 61 15 147 36 217 54 222 55 No action other than possible clearance of small pockets of unfit housing (pending detailed survey) 1.7 17 - - 6 35 Not known Not known No action Netley Road 4.9 99 55 56 59 60 65 66 72 73 Part III Clearance (subject to detailed survey) 1.6 48 5 10 21 44 28 58 37 77 Part V Redevelopment (subject to detailed survey) 2.7 64 4 6 31 48 44 69 39 61 Redevelopment using other powers. Acacia Road 0.8 16 12 75 15 94 16 100 15 94 Part III Clearance (subject to detailed survey) 3.9 59 12 20 27 46 39 66 35 59 Redevelopment using Education powers 3.9 57 23 40 31 54 31 54 38 67 Redevelopment using other combined powers. 4.6 71 8 1 1 1 1 15 28 39 41 58 No action at present High Road Leytonstone Frontage 0.4 8 Not Known 18 100 Not Known Not Known Redevelopment using Housing and Social Services powers. 1.3 22 Not Known 17 77 Not Known Not Known Redevelopment using Planning powers. -44- (3) The Offices, Shops and Railway Premises Act, 1963 (a) Registrations and General Inspections CLASS OF PREMISES NO. OF PREMI SES REGISTERED DURING THE YEAR TOTAL NO. OF REGISTERED PREMISES AT END OF YEAR NO. OF REGISTERED PREMISES RECEIVING A GENERAL INSPECTION DURING THE YEAR Offices 44 562 243 Retail shops 74 1,655 973 Wholesale shops, warehouses 3 100 35 Catering establishments open to the public, canteens 8 198 106 Fuel storage depots - 7 8 TotaIs 129 2,522 1,365 Number of visits of all kinds by Inspectors to registered premises 2,812 (b) Analysis of Contraventions Found SECTION NO. OF CONTRAVENTIONS FOUND SECTION NO. OF CONTRAVENTIONS FOUND 4 Cleanliness 43 12 Clothing Accommodation - 5 Overcrowding 1 13/14 Seating Facilities - 6 Temperature 72 15 Eating Facilities - 7 Venti lation 3 16 Floors, passages and stairs 63 8 Lighting 7 17/18/19 Machinery 5 9 Sanitary Conveniences 203 21 Noise and Vibration 2 10 Washing Facilities 85 24 First Aid General Provisions 35 11 Drinking Water 2 50 Exhibition of Forms 95 Hoists & Lifts 12 Total 628 - 45 - (c) Analysis of Persons Employed in Registered Premises by Workplace CLASS OF WORKPLACE NUMBER OF PERSONS EMPLOYED Offices 5,482 Retail shops 7,734 Wholesale departments, warehouses 1,308 Catering establishments open to the public 1,301 Canteens 80 Fuel storage depots 60 Total 15,965 Total Males 7,413 Total Females 8,552 (d) Reported Accidents WORKPLACE NUMBER REPORTED ACTION RECOMMENDED N O ACTION PROSECUTION FORMAL WARNING INFORMAL ADVICE Offices 1 - - 1 - Retail shops 25 - - 25 - Wholesale shops, warehouses 3 - - 3 - Catering establishments open to public, canteens 1 - - 1 - Fuel storage depots - - - - - Totals 30 - - 30 - -46- (4) Prevention of Damage by Pests Act. 1949 - Rodent Control Complaints received 4,005 Inspections and Re-inspections 18,289 Premises treated 3,485 (5) Caravan Sites Act 1968 The Council opened a site for 16 caravans in July, 1972 and all places were quickly filled. The Secretary of State has approved a Designation Order for the borough which came into force on 1st June 1973 B NUISANCES ABATED. DEFECTS REMEDIED. IMPROVEMENTS EFFECTED (1) Public Health Acts The total number of repairs and improvements carried out to dwellings and other premises is as follows, compared with the past two years:- 1971 1972 1973 2,760 2,404 2,598 (2) Food and Drugs Acts/Food Hygiene Regulations The total number of repairs and improvements carried out to food establishments and industrial premises is as follows, compared with the past two years:- 1971 1972 1973 1,490 1,982 2,137 C REGISTRATION AND/OR LICENSING OF BUSINESS PREMISES (1) Approximate number of business premises in the Borough and functions involved OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 NO: FOOD P R EMI SES BUSINESS DESIGNATION SUBSIDIARY FUNCTIONS NO: Registration Baker 69 Local Authority 2,522 Butcher 130 H.M.F. Inspector Exempt 779 1,823 Canteen/Staff* 51 Total 5,124 Canteen/School* 72 Catering/Public 229 Class of Premises Registered by Local Authority 562 Catering/Misc* 3 Office Chemist 57 Retail Shop 1,655 Confectionery 262 Wholesale 100 Fishmonger/Fish Frier 37 Catering/Public 198 Greengrocer 125 Fuel Store 7 Grocer/General 239 Factories Act, 1961 769 Off-Licence 86 Power Public House 85 Non-power 10 Clubs 18 Trade 3,680 Store/Multiple 25 Non-food Depots/Food Storage 63 Food 1,444 StalI/Vehicle 489 -47- (2) Details of Registrations/Licences ACT OR REGULATION ON REGISTER 31-12-1973 Food and Drugs Act, 1955 Ice-Cream Premises 959 Food Preparation, etc. Premises 114 Milk and Dairies (General) Regulations, 1959 Distributors 228 Dairies 8 Milk (Special Designation) Regulations, 1963 Pasteurised 186 Sterilised Untreated 162 6 Ultra Heat Treated 85 Essex County Council Act, 1952 Hawkers of Food 241 Hawkers' Storage Premises 51 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 23 Section 48 - Hairdressers' Premises 179 Pet Animals Act, 1951 Annual Licences 29 Animal Boarding Establishments Act, 1963 3 Rag Flock and other Filling Materials Act, 1 951 12 Riding Establishments Act, 1970 2 Total 2,288 - 48- D.LEGAL PROCEEDINGS (1) Public Health Acts. 1936/61 ; Clean Air Act, 1956 48 applications were made for legal proceedings to enforce the requirements of notices served. 9 cases were subsequently heard by the Court and abatement orders made. The remaining 39 cases were withdrawn before the court hearing or after adjournment, the work required by the notices having been completed. An Abatement Order was not complied with and in ordering the work to be carried out the Magistrate imposed a continuing fine of £2 a day in respect of 270 days. An appeal against the Order was dismissed by the Crown Court. (2) Food and Drugs Act, 1955 207 complaints regarding foodstuffs were investigated and reported for consideration of legal proceedings. A wide variety of food was implicated, i.e. milk, bread, cakes, sausages, tinned goods, bacon and confectionery. The reason for the complaint was either the presence of foreign matter or the appearance of mould growth on the food. 23 prosecutions were instituted and fines totalling £510 were imposed. (3) Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966/Hawking of Food and Pleasure Grounds Pleasure fairs operating at Chingford Plain, E.4., and Lea Bridge Road, E. I 0., were visited by members of the Public Health Inspectorate during the Bank Holiday periods. Food hawkers' stalls, mobile canteens and ice cream vendors etc., were inspected and registrations checked. While the general standard of hygiene practised by food vendors was reasonable for open air trading, it was necessary to issue a number of verbal warnings and written intimations regarding infringements of the Food Hygiene (General) Regulations, 1970. Legal proceedings were authorised in respect of one .contravention under Food Hygiene (General) Regulations 1970 and this resulted in a fine of £25 with £5 costs. -49- E. SAMPLING - FOOD AND DRUGS ACT, 1955 Samples Submitted for Chemical and Bacteriological Examination TYPE OF EXAMINATION AND ANALYSIS OF RESULTS MISC . FOODS MlLK iCE CREAM ICE LOLLI ES COOKED MEATS WATER DRINKING SWIMMING POOLS OTHER No. Chemical 173 - - - - 3 1 - No. Bacteriological 26 42 41 - 59 18 10 3 No. Satisfactory 112(C) 2(B) 38 27 - 33 7 10 - No. Fairly Satisfactory 3(B) - 7 - 9 - - - No. Unsatisfactory 61(C) 2(B) 4 7 - 17 14(B) 1(C) 3 The 14 unsatisfactory bacteriological samples of drinking water was due to pigeon contamination of a storage tank in a block of flats. F. MEAT AND FOOD CONDEMNED Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. COMMODITY TINS PACKETS BOXES BOTTLES QU ANTlTY TONS CWT . ST. LBS. Tinned Goods 1.202 - - - - - Tinned Meats 80 - - 2 3 - Tinned Fruits 427 - - 4 1 2 Frozen Foods - 16,563 - - - - Fish - - - 4 - 12 Meat/ Bacon - - 1 13 - 8 Poultry - - - 10 2 12 Fruit - - 6 17 9 13 Dried Goods - 1 ,648 pkts. - - - -50- G. FACTORIES ACT, 1961 The following are the prescribed particulars required by Section 153 (1) of the Factories Act, 1961, to be included in annual reports. (1) Inspections PREMISES NUMBER ON REGISTER NUMBER OF INSPEC TIONS WRITTEN NOTlCES OCCUPIERS PROSECUTED (1) (2) (3) (41 (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 10 5 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 769 158 4 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 35 40 - - Total 814 203 7 - (2) Cases in which defects were found PARTICULARS NUMBER OF CASES IN WHICH DEFECTS WERE FOUND NUMBER OF C ASES IN WHICH PROSECUTIONS WERE INSTITUTED FOUND REMEDIED REFERRED TO H.M. INSPECTOR BY H.M. INSPECTOR (1) (2) (3) (4) (5) (8) Want of cleanliness 2 1 - 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient - - - - - (b) Unsuitable or defective 7 6 - 7 - (c) Not separate for sexes - - - - - Other offences against the Act (Not including offences relating to out-work) - - - - - Total 9 1 - 8 - -51 - (3) Outwork NATURE OF WORK SECTION 133 SECTION 134 NO. OF OUTWORKERS IN AU GUST LIST RE QUI RED BY SECTION 133 (1) (C) NO. OF C ASES OF DEFAULT IN SENDING LISTS TO THE COUNCIL NO. O F PROSECUTIONS FOR FAILU RE TO SUPPLY LISTS NO. O F INSTANCES 0 F WORK IN UN WHOL E- SOME PREMISES NOTICES SERVED PROSECUTIONS Wearing apparel Making 336 - - - - - Footwear 2 " - - - - Umbrel las, etc. 6 - - - - - Handbags 4 - - - - - Artificial flowers 1 - - - - - Boxes, etc., wholly or partly of paper Making 8 - - - - - Brushes 2 - - - - - Toys 403 - - - - - Lampshades 3 - - - - - Household Linen 6 - - - - - Jewellery 8 - - - - - Total 779 - - - - - -52- SCHOOL HEALTH SERVICE SCHOOL POPULATION NUMBER OF SCHOOLS NUMBER OF PUPILS ON SCHOOL REGISTERS AT END OF YEAR Nursery 3 249 Primary 80 21,983 Secondary 27 15,376 Special 8 757 Totals 1973 118 38,365 1972 116 36,870 1971 115 35,848 SCHOOL MEDICAL INSPECTION (a) Periodic Medical Inspections 1973 1972 1971 5 year age group 2,858 3,111 2,888 10-11 year age group 1,399 1,346 1,277 14 years age group 1,375 1,529 1,925 Others 811 799 633 Total 6,443 6,785 6,723 No. of special inspections 1,121 1,062 1,380 No. of re-inspections 4,932 5,660 5,461 6,053 6,722 6,841 (b) Physical Condition of Children Inspected AGE GROUP INSPECTED (BY YEAR OF BIRTH) NO. O F PUPILS INSPECTED PUPILS WHOSE CONDITION WAS CLASSI FIED UNSATISFACTORY 1969 and later 214 - 1968 1,100 - 1967 1,544 - 1966 370 - 1965 111 - 1964 162 - * 1963 808 1 * 1962 493 - 1961 98 2 I960 57 - 1959 111 - 1958 and earlier 1,375 1 Total 6,443 4 ** Selective Medicals - A total of 649 children were found not to warrant a medical examination -53- (c) Individual Pupils found to require treatment at Periodic Medical Inspections during the /ear (excluding dental diseases and infestation with vermin) AGE GROUP INSPECTED (BY YEAR OF BIRTH) INDIVIDUAL PUPILS FOUND TO REQUIRE TREATMENT FOR DEFECTIVE VISION (EXCLUDING SQUINT) FOR ANY OTHER CONDITION TOTAL INDlVIDUAL PUPILS 1969 and later 71 10 28 1968 69 95 146 1967 64 138 191 1966 15 44 56 1965 5 3 8 1964 24 22 44 1963 83 98 164 1962 57 81 116 1961 9 12 19 I960 8 6 12 1959 70 3 73 1958 and earlier 168 126 264 Total 593 638 1,121 -54- (d) Pupils found to have undergone tonsillectomy AGE GROUP NO. INSPECTED NO. FOUND TO HAVE UNDERGONE TONSILLECTOMY BOYS GIRLS BOYS GIRLS Infant 1,522 1,336 25 18 Junior 734 665 44 29 Leaver 756 619 23 21 Other 478 333 15 6 Totals 3,490 2,953 107 74 (e) Pupils found to have defects of colour vision INTERMEDIATE INSPECTIONS LEAVER INSPECTIONS OTHERS Tested for Colour Vision 1,399 1,375 811 Found to have defects of colour vision 37 19 1 (f) Parents present at Medical Inspection NO. INSPECTED PARENT PRESENT PERCENT. Infant Boys Girls 1,522 1,372 90.1 1,336 1,252 93.7 Junior Boys 734 482 65.7 Girls 665 383 57.8 Leaver Boys 756 50 6.6 Girls 619 66 10.6 Other Boys 478 333 69.6 Girls 333 208 62.4 -55- (g) Defects found by Periodic and Special Inspections during the year DEFECT CODE NO. DEFECT OR DISEASE PERIODIC INSPECTIONS SPECI AL INSPECTIONS ENTRANTS LEAVERS OTH ERS TOTAL (ALL GROUPS) TREATMENT OBSERVATION TREATMENT OBSERVA¬TION TREATMENT OBSERVATION TREATMENT OBSERV ATION TREATMENT OBSERVATION 4 Skin 16 62 21 25 26 40 62 127 1 1 6 5 Eyes (a) Vision 154 171 168 36 271 103 593 310 88 61 (b) Squint 21 39 6 - 8 11 35 50 1 2 (c) Other 3 10 6 1 5 15 14 26 5 13 6 Ears (a) Hearing 49 184 4 21 22 153 75 358 32 52 (b) Otitis Media 9 56 28 21 8 27 45 104 4 9 (c) Other 3 39 - 1 7 34 10 74 6 4 7 Nose and Throat 47 215 9 16 27 107 83 338 15 29 8 Speech 24 134 2 2 10 36 36 172 14 15 9 Lymphatic Glands 2 57 1 9 3 29 6 95 - 4 10 Heart 4 33 4 7 3 19 11 59 1 3 M Lungs 10 48 5 7 1 1 41 26 96 4 8 12 Developmental (a) Hernia 6 18 - 1 2 6 8 25 - 2 (b) Other 13 89 5 22 28 85 46 196 8 20 13 Orthopaedic (a) Posture 5 21 3 14 5 38 13 73 5 5 (b) Feet 30 88 25 20 18 56 73 164 1 1 6 (c) Other 12 107 7 1 9 36 28 154 10 18 14 Nervous System (a) Epilepsy 1 14 2 1 4 11 7 26 4 2 (b) Other 4 36 1 3 9 26 14 65 9 18 15 Psychological (a) Development 4 89 - 21 9 113 13 223 7 53 (b) Stability 3 209 1 65 4 206 8 480 20 54 16 Abdomen 1 24 1 3 2 28 4 45 - 4 17 Other 15 69 25 15 7 20 47 104 47 31 - 56 - OTHER MEDICAL INSPECTIONS (a) Employment of children (other than in entertainment) (i) initial examinations 436 (ii) re-examinations 6 (b) Employment of children in entertainment (i) initial examinations 4 (ii) re-examinations 1 EXAMINATIONS BY SCHOOL NURSES Head Inspections Number of examinations 36,324 Number of children found to be unclean 348 Vision Testing at School Number of children tested 23,650 Number referred to Eye Clinic 1,000 Foot Inspections at School Number of children inspected 2,337 Number referred for treatment 101 MINOR AILMENT CLINICS New Cases Boys Girls Ringworm - Head - - Body - - Scabies 4 2 Impetigo - - Other Skin Diseases 21 20 Defective Vision and Squint 192 224 Other Eye Defects 14 13 Defective Hearing 366 341 Other Ear Diseases 28 39 Nose and Throat Defects 65 81 Speech Defects 58 33 Lymphatic Giands 21 7 Heart and Circulation 6 16 Respiratory Diseases 19 7 Developmental Defects 88 39 Orthopaedic Defects 81 95 Nervous Disorders 66 40 Psychological Disorders 187 147 Other Defects and Diseases 163 157 1,385 1.261 Total attendances 4,950 -57- SPECIALIST CLINICS 1973 1972 1971 (a) Audiology New cases _ 226 - Total attendances - 431 - (b) Aural Sessions 68 73 66 New cases 225 201 287 Total attendances 706 658 739 Referred to hospital for operative treatment 109 195 231 (c) Ophthalmic Sessions 353 363 360 New cases 792 934 794 Attendances 4,774 5,060 5,103 Glasses prescribed 1,139 1,220 1,285 Glasses obtained (i) through H.M.C. optician 565 864 986 (ii) privately 594 356 299 (d) Orthoptic Sessions 459 492 461 New cases 258 275 236 Attendances 1,824 2,134 2,208 (e) Orthopaedic Sessions 74 76 49 New cases 463 467 437 Attendances 1,532 1,653 1,543 Appliances provided 236 41 1 489 (f) Physiotherapy Sessions 476 391 534 New cases 159 120 176 Attendances 2,161 2,141 2,882 (g) Paediatric Sessions 21 14 19 New cases 53 66 51 Attendances 143 142 129 (h) Child Guidance Psychiatric Sessions 926 882 792 New cases 282 271 3 F4 Attendances 2,1 13 2,1 19 2,558 -58- DENTAL INSPECTION AND TREATMENT (a) Attendances and Treatment AGES 5 TO 9 AGES 10 TO 14 AGES 15 AND OVER TOTALS 1973 1972 197 1 First visit 4,348 2,603 393 7,344 6,743 7,293 Subsequent visits 5,705 4,124 762 10,591 1 1 ,736 ( 1,936 Total visits 10,053 6,727 1,155 17,935 18,479 19,229 Additional courses of treatment commenced 469 217 42 728 1 ,271 569 Fillings in permanent teeth 2,343 4, 183 1 .092 7,618 9,053 8,179 Fillings in deciduous teeth 7,408 1 ,037 - 8,445 7,691 8,186 Permanent teeth filled 2,106 3,627 937 6,67a 7,751 7,036 Deciduous teeth filled 6,953 979 7,932 7,135 7,616 Permanent teeth extracted 78 428 78 584 69 1 1,012 Deciduous teeth extracted 1 ,822 738 - 2,560 2,773 3,739 General anaesthetics 435 160 4 599 846 1 ,267 Emergencies 233 105 19 357 443 479 1973 1972 1971 Pupils X-rayed 684 623 425 Prophylaxis 2,403 2,860 3,292 Teeth otherwise conserved 1,153 1 ,061 1 ,275 Teeeth root filled 18 42 82 IInlays 2 1 Crowns 33 24 64 Courses of treatment completed 5,809 6,016 5,551 -59- (b) Orthodontics 1973 1972 1971 New cases commenced during year 78 94 88 Cases completed during year 65 55 71 Cases discontinued during year 1 1 - Removable appliances fitted 81 104 93 Fixed appliances fitted 3 4 6 Pupils referred to Hospital Consultant 60 28 - (c) Prosthetics 5 TO 9 10 TO 14 15 & OVER TOTAL Pupils supplied with F.U. or F.L. (first time) - - - - Pupils supplied with other dentures (first time) 1 3 4 8 Numbers of dentures supplied 1 3 4 8 1973 1972 1971 (d) Anaesthetics General Anaesthetics administered by:- Dental Officers - - - Medical Officers 616 846 1,267 (e) Inspections (i) First inspection at school:- Number of PupiIs 17,759 14,635 10,239 (ii) First inspection at clinic:- Number of pupils 4,306 3,493 3,124 Number found to require treatment 1 1 ,375 10,269 9,833 Number offered treatment 1 1,375 9,789 8,746 (iii) Pupils re-inspected at school clinic 1 ,319 1,065 543 Number found to require treatment 754 682 489 (f) Sessions Sessions devoted to treatment 2,715 3,079 3,229 Sessions devoted to inspection 126 92 88 Sessions devoted to Dental Health Education 7 12 37 SPEECH THERAPY (a) Attendances OAWLISH ROAD HURST RO AD TOTAL Number in attendance at beginning of year 1 1 1 77 188 Number under observation at beginning of year 159 31 190 New Cases 86 64 150 Re-admitted 2 1 3 Transfer from other clinics 1 5 6 Number in attendance at end of year 92 67 159 Number under observation at end of year 74 49 123 (b) Analysis of defects treated D AWLISH ROAD HURST ROAD TOTAL Stammer 10 10 20 Dysilal ia 77 71 148 Stammering and dyslalia 3 8 1 1 Delayed language development 14 42 56 Cleft palate speech 1 - 1 Voice defects 1 4 5 Speech defects due to deafness 1 26 27 Defects of neurological origin - 12 12 Unclassified 1 5 6 New cases referred 157 Attendances during year 5,479 -61- HANDICAPPED PUPILS BLIND PARTIALLY SIGHTED DEAF P ARTi AL H EARING PHYSICALLY HANDICAPPED DELI CATE M ALADJUSTED E.S.N. EPiL EPTIC SP EECH DEFECT TOTAL Children newly assessed as capped during year ended 31.12.1973 Boys - l - 2 8 _ 9 28 - _ 48 Girls - - - 5 5 l 2 22 - - 35 Children who on 25. 1.74 were receiving special education treatment:- (i) at maintained special schools (a) Day. - 10 19 37 55 . 21 403 - _ 545 (b) Boarding - 2 - - - - 6 - - - 8 (ii) at non-maintained special schools:- (a) Day - - - - - - - - - - - (b) Boarding - - - - 6 I 5 - 1 - 13 (iii) at independent schools - - - - - - 6 3 - - 9 (iv) special classes or units - - - - - - - - - - - Children awaiting placement in special schools 25.1.74 - - - - 2 I 2 1 - - 6 Children who, at 25.1.74 were being educated:- (i) at hospital - - - - - . - - - - - (ii) at home - - - - - - - - - - - -62- SPECIAL SCHOOLS Brookfield House School for Physically Handicapped Children At the end of 1973 the medical classification of the 70 children on the roll was as follows:- Congenital Deformities 4 Cerebral Palsy 20 Cardiac Disabilities 8 Muscular Dystrophy 1 Perthes Disease 4 Spina Bifida 7 Asthma6 Fragiltras Ossium 4 Osteomyelitis 1 Still's Disease2 Poliomyelitis Epilepsy 2 Brailsford Morquio Syndrome1 Miscellaneous 9 Joseph Clarke School for Partially Sighted Children The ophthalmic condition on admission of the 96 children who attended the school during 1973 were as follows:- Albinism 9 Aniridia 9 Cataracts 22 Anterior Synechia Detached Retina 3 Disclocation of the Lenses 3 High Myopia 10 Iridocyclitis 2 Microphthalmos Nystagmus 11 Optic Atrophy 10 Retinal Degeneration 2 Retinoblastoma Damage to visual cortex 1 Coloboma 2 Macular degeneration 1 Optic nerve glioma Glaucoma 1 Retinitis pigmentosa 2 Retrolental fibroplasia 2 Batten's disease 1 Cone disfunction syndrome 1 William Morris School for the Deaf Of the 84 children on the roll at the end of the year 72 were classified as deaf and 12 as having partial hearing. -63- 1 HOUSING (a) Contributed by N.P. Astins, Esq., A.R.I.B.A., Borough Architect Dwellings completed during 1973 FLATS HOUSES By the Local Authority 309 23 By Private Enterprise 37 30 By Housing Associations 52 NOTE: All were permanent houses and flats. In addition to the main building programme, improvements and conversions were carried out at a number of Council owned properties. IMPROVEMENT GRANTS Applications received 1,369 DISCRETIONARY STANDARD Total number of grants approved 878 90 Total amount of grants approved £467,663 £14,784 (b) Contributed by H.Thorne, Esq,, A.I.H.M., Borough Housing Manager. (a) Houses & Flats 18,788 Properties under management at 3 1.12.73 (b) Garages 4 221 Properties made available for letting during 1973 I ,512 Number of families rehoused during 1973 1,598 -65- METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST DURING 1973 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs. at 27C. B.O.D. 5 days at 20°- C. Hardness (total) CaC03 Hardness (non-carbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CL Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Thames-derived 357 0.039 0.080 7.4 1 .00 - 276 74 5.7 27.5 6.1 41 3.0 9 62 0.15 0.02 - 0.1 8 7.8 580 Chingford Mill 4 0.23 0-037 0.7 0.24 - 288 68 - - - 27 - - - 0.43 - - 0.1 4 7 3 550 Coppermills 51 0.049 0.100 8.7 1 .24 - 281 84 6.0 37.1 7.5 50 4.3 10 66 0.18 0.04 - 0.2 9 7.8 610 -66- BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1973 OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST BEFORE TREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Eschericia coli count Agar plate count per ml. Col iform count E. coli count Source of supply Number of samples 20-24 hours at 37° C. 3 days at 22° C. Percent. samples negative in 100 ml. Count per 100 ml. Percent. samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37° C. 3 days at 22° C. Percent. samples negative in 100 ml. Percent. samples negative in 100 ml. Chingford Mill 246 0.2 3 1 00.0 - 100.0 - 238 0.2 3 100.0 100.0 Thames-derived 8.064 43.4 - 30.78 15.7 53.58 4.1 3,858 9.9 - 99.92 100.0 Coppermills 1 ,356 1 10.1 - 27.58 17.0 53.24 3.4 255 10.0 - 100.0 100.0 -67- 1 INDEX A Pages Animal Boarding Establishments Act 1963 41, 48 Ante-Natal Clinics 30 Audiology 58 Aural Clinics 58 B B.C.G. Vaccination 40 Births 27,29 Births - Congenital abnormalities 33 Brookfield House School for Physically Handicapped children 63 Business premises, registration and licensing of 47 C Cancer 6, 29 Caravan Site Act 1968 47 Causes of Death 28 Cervical Cytology 33 Child Guidance Clinics 58 Child Hen 7 Child Welfare Clinic Attendances 31 Chingford Red Cross 35 Chiropody Treatment 36 Cigarette Smoking 6 Clean Air Act 1956 21,41 Committee I Compulsory Purchase Orders 42 Condemned meat and food 50 Congenital Malformation 33 D Deaths 27 Deaths - Causes of 28 Deaths - from Cancer 29 Dental Laboratory 34 D (cont.) Pages Dental Service12,33,59 District Nurses 23,35 E Environmental Services 13 Essex Gounty Council Act 1933 - Establishments for Massage and Special Treatment 36 Examinations by School Nurses 57 Expectant and Nursing mothers, dental treatment 33 F Factories Act 1961 41,51 Families Rehoused 65 Family Planning 34 Food Inspection and Sampling 14,50 Food and Drugs Act 1955 41,43,47,49,50 Food and meat condemned 50 Food Hygiene Regulations 41,47,49 Food Poisoning 31 H Handicapped Children 62 Health Committee I Health Communities 6 Health Visiting 23,34 Home Nursing 35 Housing 21,65 Housing Acts 1957/72 41,42 Housing Associations 65 Housing Surveys 43 I Immigrants, tuberculosis among 38 Immunisation and vaccination 39 Improvement Grants 65 Incontinent Laundry Service 36 I (cont.) Pages Infectious Diseases 6,37 Infant Mortality 27 Infants and Toddlers Clinics 31 Infants, premature 29 J Joseph Clarke School for Partially Sighted Children 63 L Laundry for the Incontinent 36 M Massage and Special Treatment, establishments for 36 Maternal Mortality 27 Medical examinations of staff 38 Medical inspections, school 53 Medical inspections, other 57 Midwifery 22,30 Milk and Dairies (General) Regulations 1959 48 Milk (Special Designation) Regulations 1960 43 Minor AiIments Clinics 57 Mortality Rates 27 Mothercraft and Relaxation Classes 33 Nursing Homes, registration of 36 Nursing Services 22 o Offices, Shops and Railway Premises Act 1963 17,41,45 Ophthalmic Clinics 58 Orthopaedic Clinics 58 Orthoptic Clinics 58 Outwork 52 P Paediatric Clinics 58 P (cont.) Pages Pet Animals Act 1951 41 Physiotherapy Clinics 58 Population 27 Population - School53 Premature Infants, care of 29 Prevention of Damage by Pests Act 1949 41,47 Public Health Acts 41,47,49 Public Health Act 1936 - registration of Nursing Homes 36 Public Health Inspection Q Qualification Certificates 43 R Rainfall 25 Red Cross, Chingford 35 Redevelopment and Slum Clearance 42 Registration of Premises 47 Riding Establishments Act 1970 48 S School Dental Service 12,59 School Health Service 53 School Medical Inspections 53 School Population 53 Sewerage 25 Sickroom Equipment 35 Slum Clearance and Redevelopment Schemes 42 Specialist Clinics 58 Special Schools 63 Speech Therapy 61 Staff 23 Staff - Medical Examinations 38 Statistics 27 T Tuberculosis 6,37,38 V Vaccination and Immunisation 39 V (cont.) Pages Venereal Disease 6 Vital Statistics 27 W Water Supplies 24,66,67 Welfare Foods and Nutrients 32 William Morris School for Deaf 63 1 1 1