AC4411(A) WOODFORD WANS 15 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1950. PUBLIC HEALTH COMMITTEE Alderman V. E. Stevens (Chairman) Alderman A. H. Southam (Vice-Chairman) The late Alderman Mrs. J. Davey Councillor F. B. Baverstock „ N. E. Britton „ A. G. Burness „ R. A. Dalton „ C. H. Moss „ Mrs. Forbes 1 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: F. G. Brown, M.B., B.Ch., D.P.H. Senior Sanitary Inspector: M. G. Crook, M.S.I.A. (a) (b) (c) (d) Deputy Senior Sanitary Inspector: J. T. S. Templeman, M.R.San.I., M.S.I.A. (a) (b) Sanitary Inspectors: A. J. Storer, M.S.I.A. (a) H. L. Hughes, A.R.San.I., M.S.I.A., D.P.A. (a) (b) (e) F. M. Flack, M.S.I.A. (a) (b) Clerks: Miss D. Howlett Miss F. Woolf (from 23.1.50) (a) Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board Certificate. (b) Royal Sanitary Institute Certificate of Meat and other Foods. (c) First Class Certificate in Laboratory Technique of Meat Inspection Smithfield Technical Institute. (d) Diploma of the Royal Institute of Public Health and Hygiene, (e) Diploma in Public Administration. 2 WANSTEAD AND WOODFORD BOROUGH COUNCIL. TO THE MAYOR, ALDERMEN AND COUNCILLORS, BOROUGH OF WANSTEAD AND WOODFORD. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health Services in the Borough for the year 1950. I have made reference in this report to the personal health services under Part III of the National Health Service Act administered by the Essex County Council and decentralised to the Forest Health Area Sub-Committee of the County Health Committee. Particulars of the working in the Borough of the School Medical Service have also been given; this service is administered by the Essex County Council through the Forest Divisional Executive. Acting in a three-fold capacity as Medical Officer of Health for the Borough, Area Medical Officer for the forest Health Area and Divisional School Medical Officer for the Forest Divisional Executive I am fortunate in being in control of all three branches of the preventive health services as they affect the Borough. Vital Statistics show the health of persons residing in Wanstead and Woodford to be well above the average for England and Wales. The total number of live births for the year was 847, this figure being almost identical with that of the previous year, which was 839. The number of deaths occurring in 1950 was 605, this figure being 82 less than that of 1949, which was 687. Comparing these figures with the corresponding figures for England and Wales, we find that the birth rate for Wanstead and Woodford is 13.5 per 1,000 of the estimated population as contrasted with 15.8 for the whole of England and Wales. Comparative death rates are 9.6 per 1,000 of population for Wanstead and Woodford and 11.6 for the country as a whole. The Infant Mortality Rate, i.e., the death rate of infants under one year of age per 1,000 live births, may be regarded as an index of the health of the population and it is very gratifying to be able to record that this rate has reached the lowest figure on record for the Borough, 18.9 compared with 29.8 for England and Wales. Infectious Disease. It is pleasing to note that, for the second successive year, no case of diphtheria occurred. This is undoubtedly due to the success of our immunisation campaign. Despite the absence of diphtheria during the year there are no grounds for complacency and it is somewhat disconcerting to note that the number of children under five who were immunised during the year was only 641, a reduction of 204 from the previous year, the number of children born in both years being approximately similar. This is due to the fact that, during the months of August and September when poliomyelitis was prevalent, immunisation against 3 diphtheria was suspended, there being evidence available that, during epidemic periods of poliomyelitis, children who have been recently inoculated are more prone to develop this disease. Every effort is made to bring the protection up to standard during non-epidemic periods but there is some reason to believe that a very natural dread of their children developing poliomyelitis acts as a deterrent to parents from accepting diphtheria immunisation. 14 cases of poliomyelitis (infantile paralysis) were confirmed during the year; 13 were children or adolescents whose ages ranged from 2-17 years, the fourteenth being a male adult aged 26. 4 cases were of the nonparalytic type. No case proved fatal. As in former years, measles and whooping cough proved the most common of the notifiable diseases, 293 cases of measles and 157 cases of whooping cough being notified as compared with 800 and 167 respectively during 1949. With regard to tuberculosis, 380 cases remained on the register at the end of the year as compared with 363 at the end of 1949, the increase being due to cases transferred into the district. New cases notified decreased from 64 to 45 and deaths from 21 to 15. During the early part of the year the Woodford Chest Clinic (formerly known as the T.B. Dispensary) was transferred from 93 High Road, South Woodford, to the Harts Hospital, Woodford Green, where modern facilities for diagnosis and treatment are provided. Details are given in this report of the School Medical services provided by the Essex County Council. Owing to the acute shortage of dental officers undertaking school dental work due to low comparative salaries with other forms of dental practice, the standard of supervision and treatment available has deteriorated greatly. Only one dentist is now working in the whole of the Forest Area with a school population of 25,000. While it has become necessary to close some clinics in the area it has been possible to maintain a part-time service for more urgent cases at the Woodford Centre. The shortage of dentists willing to work for local authorities is a national problem. Particulars of the Home Nursing Service, given under the appropriate section, reveal a much increased demand. The number of new cases visited was 738 compared with 514 for 1949 and the total number of visits made 13,427 compared with 9,111. Many persons who would formerly have occupied hospital beds are now receiving treatment at home from the family doctor whose services are supplemented by the home nurse and the domestic help. A similar expansion is found in regard to the Domestic Help Service the number of hours help given during 1950 being 33,330 compared with 19,365 during 1949. The number of persons receiving help in 1950 was 248 compared with 181 in 1949. Much of this additional help has been given to persons of pensionable age. While, owing to the limited number of home helps available, it has not been possible to meet all the demands on this service, it has been found that a visit from a home help for a few 4 hours on two or three days of the week has been of great benefit to many aged Persons, not only in lightening domestic burdens, but also in providing companionship for those living alone. Under Section 28 of the National Health Service Act local Health Authorities are empowered to provide Recuperative Holidays of a convalescent nature for persons not needing medical or nursing care. During the year 14 persons were provided with convalescent holidays for a total period of 39 weeks, these persons being assessed in accordance with the country Council's scheme. Many applications for admission to the Wanstead Day Nursery continued to be received. In view of the lengthy waiting lists for the four nurseries in the area the Forest Health Area Sub-Committee decided to enforce a strict scheme of priorities and to review not only the circumstances of those families whose children were on the waiting list but also of those whose children were already in the nursery. Priority for admission is given to the children of mothers who must of necessity go out to work, e.g., windows, unmarried mothers, where parents are separated or where the father is totaly or partially disabled — also to cases where, owing to illness, the mother cannot undertake the care of her child. It was found that about half of the 50 places in the nursery could be filled by children coming under the above categories. The remainder of the applicants seek admission for their children on economic grounds and these cases have been carefully reviewed by a special Sub-Committee of the Health Area Sub-Committee, a statement as to the father's earnings being obtained from employers. Where it was considered that the parents' circumstances did not merit the admission of their children to the nursery, their names were either removed from the waiting list or, in the case of children already in the nursery, the parents were informed that they could no longer be received. In May, 1950, the Wanstead and Woodford Old People's Welfare Association was formed. It had become evident that many elderly persons were living alone and in unfavourable conditions. While much was being done by various voluntary organisations to assist these persons it was felt that a co-ordination of effort was required. A public meeting to which representatives of the voluntary associations were invited was called. Upwards of 50 members, representing 32 different bodies, attended the inaugural meeting at which it was decided that a constitution should be drawn up and an Executive Committee formed. By the end of the year a visiting Sub-Committee of the Executive Committee was operating and arrangements had been made for upwards of 40 old persons to receive visits. Other projects of the Association made during the year were the formation of a new Darby and Joan Club, coach outings and car rides for elderly folk. At the time of writing the activities of the Association have made good progress and tribute must be paid to the many voluntary workers who have devoted themselves in various ways to assist the old people in the borough. 5 Once again I wish to thank the Chairman, Vice-Chairman and members of the Public Health Committee for the support they have given me. I would also mention with gratitude the help I have received from the voluntary workers at the infant welfare centres. Lastly, I would express my thanks to the staff of the Public Health Department for their co-operation throughout the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. G. BROWN, M.B., B.Ch., D.P.H. 1st August, 1951. 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar-General's estimate mid-year 1950 62,460 Registrar-General's estimate mid-year 1949 62,010 Rateable value £618,033 Sum represented by penny rate £2,504 Extracts from Vital Statistics of the Year Live Births: Legitimate Males 415 Females 417 Total 832 Illegitimate Males 4 Females 11 Total 15 Total Males 419 Females 428 Total 847 Birth-rate per 1,000 of the estimated resident population—13.5 Stillbirths. Legitimate Males 9 Females 13 Total 22 Illegitimate Males — Females — Total — Total Males 9 Females 13 Total 22 Rate per 1,000 total (live and still) births—25.3 Deaths: Males —283. Females-322. Total-605. Death-rate per 1,000 of the estimated resident population—9.6 Deaths from puerperal causes:— Puerperal and post-abortion sepsis — Other maternal causes 1 Total 1 Rate per 1,000 total (live and still) births 1.15 Deaths of Infants under one year of age:— All infants per 1,000 live births 18.9 Legitimate infants per 1,000 legitimate live births 18.0 Illegitimate infants per 1,000 illegitimate live births 66.6 1950 1949 Deaths from Cancer 127 119 „ „ Measles Nil 1 „ „ Whooping Cough Nil Nil „ „ Diarrhœa (under 2 years of age) 2 2 „ „ Road Traffic Accidents 5 5 „ „ Suicide 3 5 „ „ Other violent causes 5 6 7 Population The Registrar-General's estimate of the civilian population at mid-year 1950 is 62,460, an increase of 450 on the previous figure. This estimate has been used for the calculation of all vital statistics. Extracts from vital statistics of the year Additional statistical tables have been introduced in this report to show the health of the community in the Borough over the past sixteen years. 8 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1950. England and Wales, London, 126 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns 'Resident populations 25,000 to 50,000 at 1931 Census) London Administrative County Borough of WANSTEAD and WOODFORD Births: (Rates per 1,000 Home Population) Live 15 8 17.6 16.7 17 8 13.5 Still 0.37 0.45 0.38 0.36 0.35 Deaths: All Causes 11.6 12.3 11.6 11.8 9.6 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.01 0.01 0.01 — Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.36 0.42 0.33 0.39 0.21 Influenza 0.10 0.09 0.10 0.07 0.06 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 002 0:02 0.02 0.01 - Pneumonia 0.46 0.49 0.45 0.48 0.32 Notifications: Typhoid Fever 0.00 0.00 0.00 0.01 — Paratyphoid Fever 0 01 0.01 0.01 0.01 — Meningococcal Infection 0.03 0 03 0.02 0.03 Scarlet Fever 1.50 1.56 1.61 1.23 0.91 Whooping Cough 3.60 3.97 3 15 3.21 2.51 Diphtheria 0.02 0.03 0.02 0.03 — Erysipelas 0.17 0.19 0.16 0 17 0.11 Smallpox 0.00 0.00 — — — Measles 8.39 8.76 8.36 6 57 4.69 Pneumonia 0.70 0.77 0-61 0.50 0.56 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.13 0.12 0.11 0.08 0. i 4 Non-Paralytic 0.05 0.05 0.06 0.05 0.08 Food Poisoning 0 17 0.16 0.14 0.25 0 94 Deaths: (Rates per 1,000 Live Births) All causes under 1 year of age 29.8 33.8 29.4 26 3 18 9 Enteritis and Diarrhœa under 2 years 1.9 2.2 1.6 1.0 2.3 Notifications: Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 5.81 7.43 4.33 6.03 11.5 9 ]Maternal Mortality Abortion with Sepsis Other Abortion Complication of Pregnancy Sepsis of Childbirth and the Pueperium Other England and Wales 0.09 0.05 0.54 0.03 0.15 Wanstead and Woodford — — 1.15 — - Causes of Death as given by the Kegistrar-General, 1950 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 7 5 12 2. Other forms of Tuberculosis — 1 1 3. Syphilitic Disease 1 1 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — — — 10. Malignant Neoplasm—Stomach 8 5 13 11. Malignant Neoplasm—Lung and Bronchus 14 5 19 12. Malignant Neoplasm—Breast — 14 14 13. Malignant Neoplasm—Uterus — 5 5 14. Malignant Neoplasm—Others 36 40 76 15. Leukæmia — 2 2 16. Diabetes —• 2 2 17. Vascular Lesions—Nervous System 31 37 68 18. Coronary Disease, Angina 49 37 86 24 19. Hypertension with Heart Disease 14 10 20. Other Heart Disease 38 58 96 21. Other Circulatory Disease 8 13 21 22. Influenza 1 3 4 2? Pneumonia 9 11 20 24. Bronchitis 11 11 22 25. Other Respiratory Diseases 7 10 26. Ulcer of Stomach or Duodenum 3 1 4 27. Gastritis, Enteritis and Diarrhœa 1 1 2 28. Nephritis and Nephrosis 3 8 29. Hyperplasia of Prostate 6 — 6 30. Pregnancy, Childbirth, Abortion — 1 1 31. Congenital Malformations 2 5 7 32. Other Diseases 29 38 67 33. Motor Vehicle Accidents 2 3 5 34. All Other Accidents 2 3 5 35. Suicide 1 2 3 36. Homicide and Operations of War — — — Totals, 1950 283 322 605 Totals, 1949 324 363 687 10 Infant Deaths, Neo-Natal Mortality and Stillbirths Stillbirths Neo-Natal Deaths Infant Deaths Year Live Births Birth Rate No. Per 1,000 Live Births Per 1,000 Population No. Per 1,000 Live Births No. ,000 Live Births 1950 847 13.5 22 25.9 0.35 14 16.5 16 18.9 1949 839 13.5 22 26.2 0.35 12 14.3 31 36.9 1948 977 16.0 20 20.4 0.32 15 15.3 32 32.7 1947 1199 19.8 29 24.1 0.48 18 15.0 37 30.8 1946 1117 19.2 22 19.6 0.38 21 18.8 35 31.3 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Deaths Rates per 1,000 Births (Live and Still) Year Total Births Registered Puerperal Sepsis Other Maternal Causes Total Puerperal Sepsis Other Maternal Causes  1950 869 - 1 1 - 1.15 1.15 1949 861 1 - 1 1.2 — 1.2 1948 997 1 - 1 1.0 — 1.0 1947 1228 — 1 1 — 0.8 0.8 1139 — 3 3 — 2.6 2.6 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate (per 1,000 Live Births) 1950 1949 1948 1947 1946 Maternal Mortality 1.18 1.19 1.02 0.83 2.68 Stillbirths 25.9 26.2 20.4 24.1 19.6 Neo-Natal Mortality 16.5 14.3 15.3 15.0 18.8 During 1950 there was one death classified as being due to pregnancy, childbearing or associated therewith. 11 Comparative Statistics of Births, Mortality, etc., 1934 to 1950 Live Births Still Births Deaths Infant Deaths Maternal Deaths Year Population No. Rate* No. Rate† No. Rate* No. Rate‡ No. Rate† 1950 62460 847 13.5 22 25.3 605 9.6 16 18.9 1 1.15 1949 62010 839 13.5 22 25.5 687 11.0 31 36.9 1 1.2 1948 61150 977 16.0 20 20.1 618 10.1 32 32.7 1 1.0 1947 60280 1199 19.8 29 23.6 660 10.9 37 30.8 1 0.8 1946 57570 1117 19.2 22 19.3 611 11.1 35 31.3 3 2.6 1945 48230 759 16.0 15 19.3 627 13.0 24 31.6 1 1.29 1944 46670 878 18.8 24 26.6 591 12.8 27 30.7 — - 1943 50010 857 17.1 18 20.5 58.3 11.6 37 43.1 3 4.57 1942 49850 803 16.1 17 20.7 572 11.4 21 26.1 1 1.2 1941 46640 566 12.1 20 34.1 551 11.1 15 30.2 1 1.7 1940 48620 611 12.6 22 34.7 653 13.4 18 31.8 - - 1939 55880 763 13.7 36 45.1 555 10.1 28 37.8 2 2.7 1938 54810 744 13.6 20 26.2 521 9.5 23 30.9 — - 1937 53840 720 13.4 29 38.8 522 9.7 29 40.3 — - 1936 52010 699 13.4 30 41.1 471 9.1 27 38.6 2 2.7 1935 50010 605 12.1 23 36.6 488 9.8 22 36.4 3 4.8 1934 47885 612 12.8 13 20.8 500 10.4 29 47.4 5 8.0 *Per 1,000 Population. †Per 1,000 Total Births. ‡Per 1,000 Live Births. 12 TOTAL INFANT MORTALITY. 1934 TO 1950. This is defined as the sum of the deaths that occur during child-birth and during the first year of life. This graph shows the position in the Borough since 1934. TREND OF BIRTH AND DEATH RATES, 1934 TO 1950. SECTION B. GENERAL PROVISION OF HEALTH SERVICES 1. Public Health Officers of the Authority See page two. 2. Laboratory Facilities All Pathological and bacteriological services are provided at the Pathological Laboratory, St. Margaret's Hospital, Epping. The analysis of water, milk and food is carried out by Dr. J. H. Hamence and Mr. George Taylor, Public Analysts for the Borough. 3. Infant Welfare Centres There are six infant welfare centres in the Borough, sessions being held as under:- Baptist Church Hall, Aldersbrook, E.12. Monday, 2.30-4p.m. Ashton Playing Fields Pavilion, Woodford Bridge. Tuesday, 2.30-4p.m. St. Barnabas Church Hall, Snakes Lane, Woodford Green. Wednesday, 2.30-4p.m. fullers Road Sunday School, South Woodford, E.18. Wednesday, 2.30-4p.m. Cromwell Hall, Nightingale Lane, Wanstead, E.ll. Thursday, 2.30-4p.m. Holy Trinity Church Hall, Hermon Hill, South Woodford, E.18. Friday, 2.30-4p.m. 4.Ante-Natal Clinic 118 Hermon Hill, Wanstead. Tuesday and Thursday, 2.30-4 p.m. 5. School Clinic, 93 High Road, Woodford Dental-Monday, Thursday and Friday (all day). By appointment only. Minor Ailments—Every Friday morning. Ophthalmic—Wednesday mornings, by appointment only. Orthopœdic—First Thursday afternoon in each month. By appointment to see Surgeon only. Tuesday, Wednesday morning and 2nd and 4th Wednesday afternoon in each month. For after-treatment by appointment only. Speech Therapy—Monday and Wednesday afternoons only during school term. By appointment only. 13 6. Chest Clinic Harts Hospital, Woodford Green. Wednesday, 9.30-11a.m. and 5-6p.m. Patients living North side of Southend Road. 180 High Road, Leyton, E.10. Monday, 9.30-11a.m. Patients living South side of Southend Road. 7. Ambulance Facilities These facilities are available through the local depot at Wanstead, the service being administered centrally by the County Council from Chelmsford. 8. National Assistance Act, 1948 (Section 47) No action became necessary to secure the removal of persons in need of care and attention to suitable premises during 1950. 9. Funeral arrangements In no instance was the Local Authority required to make arrangements for the burial of any person during the year 1950. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA 1. Water Supply The water supplied throughout the Borough by the Metropolitan Water Board was satisfactory both in regard to quality and quantity. Regular monthly bacteriological examinations are carried out by the Metropolitan Water Board, the examinations being of raw and treats water. The results obtained from treated water were satisfactory. Copies of these reports are received regularly from the Board. 2. Refuse and Salvage Collection (a) Refuse Collection. A fleet of modern vehicles is operated for the collection of refuse and disposal is by the controlled tipping metho (b) Salvage Collection. In my report for the year 1949 I reported that owing to the fall in the price of waste paper the Council were considering discontinuing this service. At the end of this year the price of waste paper showed an increase and the Council have, therefore, decided to re-introdudce this service. (c) Kitchen Waste Collection. The collection of kitchen waste in the Borough has been by means of the individual container system. The experiment conducted in the three trial areas proved successful and the system has been extended to cover the whole Borough. 14 Drainage and Sewerage (a) Eastern Sewage Disposal Works. There are indications that the flow into these works is approaching the maximum capacity for which the works were designed. Nevertheless a good standard of effluent is maintained. (b) Southern Sewage Disposal Works. A scheme for the extension of these works is in course of preparation but owing to general conditions it is not possible to state when the work will be carried out. Despite the fact that these works are heavily loaded a good standard of effluent is obtained by means of careful maintenance and supervision. (c) Western Sewage Disposal Works. Negotiations are still proceeding with a view to the disposal of these obsolete works and for the diversion of the sewage from the western area into the Chingford system. Fortunately the sewage from this area is mild in character and this, together with constant supervision has enabled a satisfactory standard of discharge to be maintained. SANITARY INSPECTION OF THE AREA The Senior Sanitary Inspector reports as follows:— Requisitioned Premises As reported on previous occasions, much of the time of the Sanitary Inspectors was devoted to works of maintenance of requisitioned property although discussions had taken place in the Public Health and the Housing Committees with a view to transferring the work to another Department which carried out works of maintenance to the Council-owned properties. One must again express appreciation of the help given by builders employed on this class of work, and of their willingness in tackling works in cases of emergency. Housing Act, 1936 In reflecting on the work of the Department in connection with the Housing Act, it is gratifying to find that work is carried out by the owners or their agents in practically all cases. In one case work was carried out by the Local Authority because of default on the part of the owners. Reference was made in a previous annual report of the Medical Officer of Health concerning the "tie-up" between the Public Health Committee and the housing Committee in order to deal with some of the unfit houses in the Borough. The year 1950 can again show that the agreement between the two committees was a good one and has enabled the Council to deal with some more unfit premises. One cannot expect a wholesale clearance of this type of dwelling, owing to the restricted supply of alternative accommodation,but it is gratifying to know that the Local Authority are able to at least "nibble" away at the problem. 15 During the year 17 properties were dealt with by the Public Health Committee and 4 were demolished. A further property, the subject of our undertakings made under the Housing Act in 1949, was demolished as it formed a part of a terrace with the 4 already mentioned. Another house was demolished, bringing the total to 6; in this case a Demolition Order was made in 1949. Three other properties were closed after the Housing Committee had rehoused the occupants. The premises dealt with meant that 9 families were housed in more congenial surroundings. Public Health Act Eighteen premises were redrained and one Public Sewer was repaired; this work involved expenditure on the part of the owners to close on £900. It was not necessary for the Council to take any cases of default to the Magistrates Court for hearing. Housing and Public Health Acts. General Remarks. Although the second world war has been over for five years, one is continually faced, when notices have been served under Public Health and Housing Acts, with requests from the owner(s) or agent(s) for the work to be held up while negotiations take place with the War Damage Commission. This means delay in practically all cases, because of the delay in getting assessors to visit. One would think that after so many years owners would have obtained settlement with the War Damage Commission in regard to the property, but this does not appear to be so, and it is only when the Local Authority are called in to take action that owners or their agents think about carrying out War Damage repairs. Obviously, assessors are in difficulty to establish which defects are dilapidation and which war damage Obviously, from the owners point of view, all defects are war damage. Attention must be drawn to the need for the Central Government to consider the question of allowing an increase in rents for privately-owned house property. In this Borough some rents for cottage property are as low as five shillings per week, inclusive. The nominal return to the owned is considerably reduced when rates (local and water), insurances, etc., are deducted. Owners of this type and even better property are reluctant to spend too heavily on property because of the loss of rent over many months, and in cases over a number of years. This minimum expenditure on property is gradually reducing the houses to a very poor condition, very much akin to slum property. For the average smaller type of house the bill for external painting would be in the region of £30 to £40 (minimum price). This is a considerable sum of money for property with a controlled rent and we must face up to the fact that painting is not applied purely to beautify the appearance of a house; it is applied in order to prevent the elements rotting the woodwork, etc. One hopes that in the future some relief will be allowed to owners so as to avoid further dilapidation of property. 16 Food Hygiene Owing to the lack of support from traders and public alike towards film shows, etc., the Public Health Committee agreed that it was futile to arrange any further shows. The Sanitary Inspectors did, however, give special attention to the condition of premises where food was handled and stored. The businesses in the Borough dealing in food are not sufficiently large to permit lectures to the staffs of individual shops, etc., consequently, activities in this direction were not justified. Rodent Control The work entailed in connection with the above Act was carried out steadily during the year. There was a little disorganisation caused by the resignation of the rodent operative. Fortunately, the Borough has had no bad or major infestations. The majority of the treatments are carried out at private dwellings and only in a few instances are business premises affected. The Council's tips are well maitained and cause no anxiety to the Department. Surface treatment: The following table shows the result of the year's work. Number of inspections made by the Sanitary Inspectors 112 Complaints received 281 Retreatments 48 Total Premises visited 286 Number of baiting points 1,479 Rats found dead 260 Estimated kill 1,455 1,715 The sewer treatment was again supervised by the Deputy Senior Sanitary Inspector. The results of the two treatments made during the year are given in the following tables:— 17 First Treatment 1 2 3 4 5 6 7 8 Section No. of Manholes No. not baited No. baited Average Pre-bait Takes Complete Partial Total takes N.T. 1 70 — 70 16 5 21 49 2 70 — 70 11 15 26 44 3 75 1 74 11 1 12 62 4 77 — 77 18 10 28 49 5 76 — 76 22 2 24 52 6 80 — 80 9 3 12 68 7 79 — 79 12 5 17 62 8 66 — 66 5 — 5 61 9 81 — 81 7 7 14 67 10 75 1 74 3 3 6 68 11 73 5 68 2 2 4 64 12 70 1 69 1 — 1 68 13 69 1 68 18 2 20 48 14 79 — 79 25 8 33 46 15 77 — 77 3 10 13 64 16 71 — 71 19 5 24 47 17 68 1 67 16 4 20 47 18 77 2 75 10 3 13 62 19 72 — 72 2 — 2 70 1405 12 1393 210 85 295 1098 18 Second Treatment 1 2 3 4 5 6 7 8 Section No. of Manholes No. not baited No. baited Average Pre-bait Takes Complete Partial Total takes N.T. 1 70 2 68 9 3 12 56 2 86 — 86 10 4 14 72 3 74 3 71 3 3 6 65 4 77 — 77 14 13 27 50 5 77 4 73 11 14 25 48 6 80 — 80 18 19 37 43 7 80 — 80 9 15 24 56 8 66 4 62 17 5 22 40 9 82 1 81 13 7 20 61 10 75 4 71 13 11 24 47 11 74 6 68 14 2 16 52 12 70 2 68 17 11 28 40 13 69 2 67 17 7 24 43 14 79 1 78 36 7 43 35 15 77 — 77 13 8 21 56 16 71 1 70 24 5 29 41 17 68 2 67 13 — 13 53 18 77 1 76 14 1 15 61 19 44 — 44 15 5 23 23 1396 33 1364 280 140 423 942 Petroleum (Regulation) Acts, 1928 and 1936 Fifty-two licences were renewed at the beginning of the year, and 4 new licences were granted. Game Licences Twelve licences to deal in Game were renewed and one new licence was granted. 19 The Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949, and Raw Milk Regulations The following licences were issued:— Dealers Licences Pasteurised 11 Sterilised 12 Tuberculin Tested 11 Supplementary Licences Pasteurised 8 Sterilised 8 Tuberculin Tested 10 Shops Act, 1934 137 visits were made under this Act, and no Notices were served. One case of a shopkeeper remaining open after hours was observed and attention of the occupier was drawn to the offence. The fact was reported to the Public Health Committee and it was decided to take no further action, as the shopkeeper ceased to remain open after the prescribed time. Essex County Council Act, 1933, Massage and Special Treatment Establishments As in previous years, the Sanitary Inspectors carried out the usual routine inspections to these premises. They were all found to be quite satisfactory. Thirty-four visits were made during the year. Inspections carried out by Sanitary Inspectors Infectious disease enquiries, including enquiries in respect of scabies 35 Visits in connection with contacts 55 Enquiries in connection with food poisoning 18 General Environmental Public Health Drains and Sewers inspected 1,050 Drain tests applied 15 Stables and manure pits inspected 22 Workplaces 7 Ponds 8 Factories (mechanical) 124 Factories (non-mechanical) 47 Hairdressers' premises 40 Schools 28 Ditches and Streams 8 Open spaces 11 Tents, Vans and Sheds (including gipsy encampments) 31 Petrol Installations 42 Sewage Works 6 Fish Fryers 9 Shops Act inspections 113 20 General Environmental Public Health —Continued. Outworkers premises 25 passage establishments 34 Yards 2 River Pollutions 3 Swimming Baths 2 Sports Field 1 Muse Tips 6 Offensive Accumulations 3 Smoke observations 4 Inspection of Food Premises Meat Shops 138 Bakehouses 49 Fishmongers 124 Grocers 208 Restaurants and Cafes 160 Dairies and Milk Shops 11 Greengrocers 63 Ice Cream premises 217 Hotels, Boarding Houses and Public Houses 17 Total 987 SECTION D. HOUSING No of houses erected during 1950: 205 Council; 61 Private enterprise; 29 Cost of Works (rebuilds). 1. Inspection of Dwelling Houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,128 (b) Number of inspections made for the purpose 2,980 VISITS (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 17 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 344 21 2. Remedy of Defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 184 3. Action under Statutory Powers during the year:— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 17 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 16 (b) By Local Authority in default of owners 1 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 23 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 23 (b) By Local Authority in default of owners Nil (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 7 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 Housing Act, 1936—Part IV—Overcrowding Sixty-two inspections were made of suspected cases of overcrowding It might be appropriate here to draw attention to the fact that in the majority of the cases investigated it was found that overcrowding, as defined in the Housing Act, did not exist. Investigation of these alleged cases of overcrowding again brings to one's notice the conditions arising from the shortage of housing accommodation. As has already been stated, no actual overcrowding existed, but very cramped conditions prevailed owing to the fact that two or more families were occupying a house normally accommodating one family. Such conditions are fully appreciated by Public Health officials and other welfare workers, but unfortunately the general masses of the population do not realise the extent to which houses formerly occupied by one family now 22 house two or more families, and it is difficult to visualise when normal conditions of one family per house will be resumed. The cramped condition of some of these houses has to be seen to be believed, because the young married people purchase furniture for their own use and squeeze it into the limited accommodation at their disposal. Cases have been known when it has been difficult for a small child to even crawl about the floor because of lack of space. The standard laid down in the Housing Act does not draw attention to the conditions mentioned above because of the fact that all living rooms have to be taken into consideration when investigating cases of overcrowding. Nuisances Abated and Improvements Effected Roofs repaired 110 External walls and chimney stacks repaired 56 Walls underpinned 9 Gutters and spouts repaired or renewed 66 Damp-proof courses provided 6 Dampness remedied 62 Yards paved or repaired 4 Internal walls and ceilings repaired 251 Doors and frames repaired or renewed 18 Windows repaired or renewed 190 Floors repaired or renewed 56 Sub-floor ventilation provided or improved 3 Rooms cleansed or redecorated 174 Rooms with improved lighting 9 Passage and staircase redecorated 2 Staircases repaired and handrails provided 13 Fireplaces and flues repaired or renewed 67 Wash coppers repaired or renewed 3 Washbasins and sinks provided or renewed 4 Wastepipes repaired or renewed 44 Food stores provided or renewed 2 Dustbins provided or renewed 7 Water supply improved or reinstated 5 Water closet walls and ceilings cleansed 23 Water closet pans cleansed 3 Water closet pans repaired or renewed 15 Water closet cisterns repaired or renewed 11 Water closet structures repaired or rebuilt 12 Water closet flush pipe joints repaired 20 Drains cleansed from obstruction 130 Disinfection and Disinfestation Number of rooms disinfected 67 Bedding removed from premises for steam disinfection 92 Number of rooms disinfested 33 23 FACTORIES ACT, 1937 1. Inspections for the purposes of provisions as to health (including Inspections made by Sanitary Inspectors). Premises (1) Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 62 47 8 - (ii) Factories not included in (i) to which Section 7 applies — — — — (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 258 124 - - (b) Others — — — — (iii) Other Premises under the Act (excluding out-workers' premises) — - - - Total 320 171 8 — 2. Defects found. Particulars. Number of Defects Number defects in respect ot which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness 2 2 ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate Ventilation 1 1 ... ... Ineffective drainage of floors ... ... ... ... Sanitary Conveniences:— 1. Insufficient ... ... ... ... 2. Unsuitable or defective 4 4 ... ... 3. Not separate for sexes 1 1 ... ... Other Offences ... ... ... ... Total 8 8 ... ... In addition to the table shown above, it can be reported that 6 Certificates were issued in connection with Section 34 (Means of Escape in Case of Fire). 24 Outwork Number of out-workers in August list required by Section 110 (1) (c):— Wearing apparel—making, etc. 64 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 23 Household linens and furnishings 8 Total 95 SECTION E. FOOD AND DRUGS ACT, 1938 Whilst details are given later in this report in regard to sampling, it is neccessary to report that complaints have been received concerning foreign bodies being found in various articles of food. Such complaints have been investigated and reports made to the Public Health Committee concerning them. Details of such cases are given below:— Offence Action taken by Local Authority Nail in scone Town Clerk communicated with baker. Nail in cake Warning letter sent. Wire in bread Warning letter sent. Copper gauze in bread Warning letter sent. Sausage deficiency Warning letter sent. Ninety-three samples of food were submitted to the Public Analysts for examination. Three samples of sausages were found to contain preservatives (sulphur dioxide) to the extent of 140 and 200 parts per million (pork sausages) and 270 Parts per million (beef). The permitted amount must not exceed 400 parts per million. An offence was committed in the above cases because the sausages were not so labelled as to indicate that a preservative had been added. All the samples were informal. Two tins of milk were submitted because of a complaint from the trader. The analyst reported that the milk was stale. Other than those indicated above, the samples were all reported to be genuine. In the report of the Medical Officer of Health for 1949, mention was made of a sample of sausages reported to the Public Health Committee as being deficient in meat to the extent of 10 per cent. This case was considered by the Committee in January, 1950, and a warning letter was sent to the firm concerned. 25 A list of food sampled is given below:— sample(s) Butter 6 Margarine 6 Cooking Fat 6 Rice 3 Ground Rice 2 Cheese 6 Bacon 6 Tea 6 Sugar 5 Salmon and Shrimp paste 2 Coffee 1 Pepper substitute 1 Sago 2 Jam 2 Lemon Powder 1 Custard Powder 4 Pork Sausages 4 Beef Sausages 5 Flour, self-raising 2 Vinegar 1 Peas, split 1 Desiccated cocoanut 2 Pineapple (crystallized) 1 Vermicelli 1 Rolled oats 1 Brawn 1 Luncheon meat 1 Lemon curd 1 Steak pie 1 Ground almonds 2 Ice Cream 8 Milk, condensed 2 Total 93 Seven samples of ice-cream were submitted to the Public Analysts to ascertain the fat content of the mixture. These samples contained fat to the following extent: 9.6 per cent., 6.5 per cent., 11.3 per cent., 9.7 per cent., 8.4 per cent., 14.5 per cent., 12.5 per cent. Details were submitted to the Ministry of Food, as requested by the Ministry. It should be noted that at that time there did not exist a standard of ice-cream. 26 It was necessary to report to the Public Health Committee an offence under Section 13 of the Act. This was in the case of a cafe at which the walls and ceiling required cleansing. Repeated attempts on the parts of the Senior Sanitary Inspector and District Sanitary Inspector failed to Produce the desired result and it was necessary for the Council to threaten to take proceedings against the proprietor in order to get the walls and ceilings cleansed and redecorated. The following is a list of foods surrendered in 1950 because of unsound conditions Fish. Fresh Orange slices 1 tin Prawns 22 lbs. Damsons 18 tins Halibut 16 lbs. Gooseberries 4 tin Dogfish 6 stone Pears 7 tins Skate 93 stone Greengages 7 tins Burgils (Norwegian) 2½ stone Cherries 2 tins Roes 6 stone Pie Apple 2 tins Dover Soles 4 stone Apricot conserve 1 jar Chats 6 stone Pears 94 jars Whiting 3 stone Tomatoes 57 tins Haddock 4 stone Hake 4 stone Vegetables, Tinned Cod 5½ stone Plaice 4 stone Peas 58 tins Shrimps 6 galls. Beetroot 55 tins Fish Tinned Beans 20 tins Carrots 17 tins Tomato juice 3 tins Mackerel 1 tin Butter beans 1 tin Sardines 3 tins Vegetables, creamed 13 tins Crawfish 3 tins Vegetables, mixed 2 tins Salmon 4 tins Spinach 1 tin Pilchards 13 tins Fruit, Tinned Milk, Tinned Rhubarb 4 tins Evaporated 79 tins Condensed 141 tins Apples 5 tins Dried 56 lbs. Strawberries 1 tin Meat, Tinned Plums 86 tins Pineapple 4 tins Grapefruit Juice 6 tins Luncheon meat 39 tins Pineapple 3 tins Veal 15 tins Peaches 2 tins Beef loaf 3 tins Grapefruit (sliced) 1 tin Pork 1 tin Apple, sieved 3 tins Steak 2 tins Apricots 1 tin Pork sausages 27 Chicken 1 tin Mincemeat 1 tin Meat and Gravy 4 tins Lemon curd 1 tin Beef and Carrots 1 tin Cocoanut (shredded) 1 tin Corned beef 126 lbs. Soup 18 tins Chopped Pork 3½ lbs. Coffee 14 tins Meat, Fresh Potted meat 3 jars Honey 1 jar Pork 25½ lbs. Pickle 1 jar Beef 73 lbs. Coffee, liquid 1 bottle Rabbits 14 lbs Soup powder 75 pkts. Miscellaneous Christmas pudding 1 basin Lemon squash 1 bottle Cheese 5 lbs. Salad Cream 34 bottles Bacon 62 lbs Spaghetti 4 tins Ham 127 lbs. Jam and marmalade 9 tins Tea 6 lbs Chocolate spread 3 tins Beef suet 7 lbs. Butter 23 lbs- Sugar 2 lbs. Cod roe paste 37 tins ESSEX COUNTY COUNCIL ACT, 1933 MANUFACTURE, STORAGE AND SALE OF ICE CREAM The continued popularity of ice-cream encouraged more traders to consider selling it and 23 new applications were received for registration, of these 20 were accordingly registered. Five of the applicants were interviewed by the Public Health Committee who refused registration in three cases. The remaining two were granted. In one case the applicant made it clear that a vendor's licence only was required, and in respect of the other, the Committee granted registration subject to certain safeguards which the vendor had agreed to in writing. In considering the cases interviewed, the Committee took into consideration the nature of the main business, and registration was refused in the three cases mentioned above because the businesses were greengrocers who could not adequately guarantee reasonable separation of the two types of commodity (ice-cream and vegetables). As can be noted, a considerable amount of work is carried out in sampling ice-cream and because of the number of unsatisfactory sample obtained from one cafe, the Committee decided to interview the proprietor with a view to cancelling the registration. At that time the management of the cafe was changing hands. Consequently, the new proprietor was interviewed and told of the Committee's concern over these samples. The new proprietor undertook to rectify matters and he was accordingly given an opportunity to improve conditions at the shop. The Public Health Committee is to be congratulated upon the interest taken over the control of the sale, etc., of ice-cream and for the support given to their officers. 28 Arising out of the last case mentioned above, the Committee considered the merits of registration under the Essex County Council Act as compared with the Food and Drugs Act. Upon considering the Report of the Town Clerk it was realised that some better control could be gained, particularly in regard to implements (servers, etc.) used in connection with the sale of ice-cream. Consequently it was decided, with the concurrence of the Ministry of Health, that all registrations should be made under the Food and Drugs Act. Ice Cream Samples (Bacteriological examinations) Although there is no bacteriological standard for ice cream the Public Health Department nevertheless obtained 149 samples to submit to the Public Health Laboratories. The results received from such examinations are helpful to the officials concerned and to the vendors, because one is often able to discover unsatisfactory samples and find the reason for the unsatisfactory result. Although practically all ices are made by large and medium size firms, unsatisfactory results are often obtained from the product delivered to local shops in the form of a bulk supply (normally 7 lb. tins). It is generally recognised that the ice-cream is bacteriologically sound when first delivered, but results from examinations indicate some contamination after delivery. Such contamination is most frequently caused by the use of metal servers which are not sterilised or are kept in jars of water of which neither the water nor the jar is sterile. It is still very difficult to impress upon dealers of this commodity what exactly is meant by sterilisation. So often one is told that boiling water is used in the process, but it is not generally appreciated that the use of boiling water is insufficient unless the utensil is in water maintained at boiling point for at least five minutes. The necessity for thoroughly cleansing the servers, jars, etc., before sterilisation seems to be even less appreciated and should in all cases be carried out before sterilisation. When drawing the traders' attention to unsatisfactory samples one is given yet another opportunity to impress upon them the need for a thorough sterilising routine. The 149 samples referred to above are grouped as follows:— 69 in Grade I; 43 in Grade II; 25 in Grade III; 12 in Grade IV. The approximate percentage in each Grade of the 149 samples is as follows:— Grade I, 46.3 per cent.; Grade II, 28.7 per cent.; Grade III, 16.7 per cent.; Grade IV, 8 per cent. A comparison is given below covering results of the last four years:— 1950 1949 1948 1947 % % % % Grade I 46.3 52.9 34.25 8 Grade II 28.7 21.8 32.81 24 Grade III 16.7 20.1 20.3 32 Grade IV 8 5.2 12.5 36 29 When reviewing the results of the samples taken during the year one is apt to be curious to know whether or not the wrapped ice-cream is in a better condition when passed to the public than that sold from a bulk supply. Excluding the choc-ice, the comparisons for 1950 are given below, and the figures are based on samples relating to 50 obtained from bulk supplies and 72 wrapped:— Bulk Supply 50 Samples Wrapped Supply 72 Samples Grade I 28% 57% Grade II 28% 28% approx. Grade III 34% 12½% Grade IV 10% 3% approx. It seems clear from the above that the better article from a bacteriological standpoint is the wrapped ice. The Grades referred to are those suggested in the Ministry of Health's Provisional Grades. A table given below shows the reports of the Laboratories:— 30 METHYLENE BLUE REACTION ter After Lobation preincubation Ministry's 84. O½ — II 85. Ou 4½ I 86. Ou — II 87. Ou½ — II 88. Ou½ 4½ I 89. Oi — III 90. Oi — IV 91. Ou 4½ I 92. Ou½ — III 93. Ou½ — III 94. O-' — III Thirty-nine registrations were in force at the beginning of the year, and a further 20 were added during the year. Food and Drugs and Bacteriological Examinations As in former years, the Food and Drugs samples were submitted to Messrs. Bernard Dyer and Partners, Ltd. (George Taylor, Esq., F.R.I.C., and Dr. J. H. Hammence, F.R.I.C.) of 20 Eastcheap, London, E..C..3, and samples for bacteriological examination to The Counties Public Health Laboratories (Roy C. Hoather, Esq., B.Sc., Ph.D., F.R.I.C., F,R.San,I., W. A. Bullough, Esq., C.B.E., M.Sc., M.B., Ch.B., D.P H., and Gordon Miles, Esq., B.Sc., F.R.I.C., M.R.San.I,), 66 Victoria Street, London, S.W.I. The Department is appreciative of the help given by these Laboratories during the year. NEW LEGISLATION Byelaws made under Section 15 of the Food and Drugs Act, 1938, relating to the Handling, Wrapping and Delivery of Food, and Sale of Food in the Open Air. Byelaws relating to the handling, wrapping and delivery of food in the open air were approved by the Ministry of Food on the 23rd August, 1950, and came into operation on 25th September, 1950. Whilst these byelaws were not so revolutionary as many would wish, one must accept them as a step in the right direction in matters relating to food hygiene. Part I of the byelaws deals with interpretations. Part II deals with handling, wrapping and delivery of foods and requires the cleanliness of the food handler and his clothing, the protection from contamination of food whilst it is being handled, packed and delivered, the cleaning of counters, slabs, etc., and the interior of vehicles, etc. This part also calls for the use of clean paper, the cleaning of empty fish and other containers,, and for the efficient lighting of places where food is handled, etc. Provisions are made for the proper storage of refuse. Part III deals with the sale and exposure for sale of food in the open air and provision is made for protecting the food from contamination from dirt and flies, etc., for cleaning counters, slabs, etc., and for storage of refuse. This is a brief outline of the requirements of the byelaws set out so as to give the reader an insight into the requirements of the byelaws. A copy of the byelaws was delivered to every food trader in the Borough by the Sanitary Inspectors. 32 The Labelling of Food Order 1950, Statutory Instrument 1950 No. 1061 Briefly, the Order requires that no person shall sell by retail display, etc., any pre-packed food without a label attached specifying the name of the packer or labeller and address of his business. Certain foods are exempted from this provision, and there are some alternative labels acceptable. A statement must give certain details as to ingredients, and specified types of labels are laid down for pre-packed and intoxicating liquors. Similar provisions are laid down for dealing with pre-packed food pursuant to a sale otherwise than by retail, but foods may be delivered unlabelled provided an invoice or other document is delivered within fourteen days to enable the retail trade to comply with the Order. The purchaser is safeguarded against the labels being liable to mislead or to be ambiguous, insofar as the ingredients, sweetening, etc., are concerned. Provisions are included so that where claims are printed concerning the presence of vitamins the article must contain substances and quantities specified in a schedule to the Order. Other details in the Order deal with the labelling of certain foods which before canning, etc., were processed, and for labelling tonic food. Further provision is made for dealing with cases where labels have been defaced. As in the Food and Drugs Act, provision is made whereby a certificate of a Public Analyst can be accepted as evidence concerning the fact stated therein. This is a very breif account of the Order, which is contained in twelve pages of print, with six pages covering two schedules. 33 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease during the year, together with the number and percentage of cases admitted to hospital and the number and percentage of deaths:— Disease Total Notified Removed to Hospital Per cent. Removed to Hospital Deaths Deaths per cent. of cases Notified Smallpox — — — — — Scarlet Fever 57 8 14.0 — — Diphtheria — — — — — Pneumonia 35 2 5.7 20 57.1 Cerebro-Spinal Fever — — — — — Acute Poliomyelitis 14 11 78.5 — — Acute Polioencephalitis — — — — Encephalitis Lethargica — — — — — Dysentery 24 — — — — Puerperal Pyrexia 10 9 90.0 — — Paratyphoid Fever — — —- — — Enteric or Typhoid Fever - - - - - Erysipelas 7 1 14.3 — — Malaria (contracted abroad) - - - - - Measles 293 1 0.4 — - Whooping Cough 157 — — — - These cases of infectious disease have been divided into age incident and set out in the accompanying table:- Disease All Ages Under 1 year 1-5 yrs. 5-10 yrs. 10-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 and over Scarlet Fever 57 — 21 26 7 3 — — - Pneumonia 35 — 5 4 1 — 8 9 8 Acute Poliomyelitis 14 — 5 2 3 3 1 — - Dysentery 24 - 16 — — 4 3 1 - Puerperal Pyrexia 10 — — — — 5 5 — - Erysipelas 7 — — — 1 — 1 2 3 Measles 293 4 144 140 5 — — — - Whooping Cough 157 6 63 83 2 — 3 — - TOTALS 597 10 254 255 19 15 21 12 11 Poliomyelitis During 1950 a total of 14 confirmed cases of poliomyelitis were notified, the highest figure recorded in the Borough. No case proved fatal. The accompanying table shows the cases notified classified under age groups:- 34 35 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1934-1950 Year Population No. Notified Notification Rate Age Group Deaths Death Rate V Under 1 1-5 5-10 10-15 15-25 25-45 1934 47885 2 0.041 — — 1 — — 1 - - 1935 50010 2 0.039 — 2 — - — — - — 1936 52010 2 0.038 — 1 1 - - - - - 1937 53840 3 0.055 — 2 1 - - - - - 1938 54810 2 0.036 — — — — 2 - — — 1939 55880 - - — — — - — - - — 1940 48620 - - — — — — — - - — 1941 46640 1 0.021 — - 1 - - - - - 1942 49850 - - — - — — - — — - 1943 50010 - - — — — — — — - — 1944 46670 - - — — - — - - - — 1945 48230 4 0.082 — — 4 — — — - - 1946 57570 1 0.017 — — — 1 - — — — 1947 60280 10 0.165 2 — 1 1 2 4 - - 1948 61150 1 0.016 — — — - 1 — - - 1949 62010 9 0.144 — 1 — 4 3 1 - - 1950 62460 14 0.224 — 5 2 3 3 1 — - Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1950:— Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1-5 years - 2 - - - - - - 5- 10 years - 1 1 - - - - - 10 - 15 years 1 2 - - - - - - 15-20 years 1 - - - - 1 - - 20 - 25 years 3 3 1 1 - - - - 25 - 35 years 1 6 - - 2 1 - - 35 - 45 years 5 4 1 - 2 1 - - 45 - 55 years 5 2 - - 1 2 1 - 55 - 65 years 2 2 - - 1 1 - - 65 and over - 1 - - - 2 - - Totals 18 23 3 1 6 8 1 - 41 4 14 1 45 15 The 15 deaths represent a death rate of 0.21 per 1,000 of the population. A comparative summary over the past 16 years for the Borough is set out in the following table:— 36 37 Year Notification Total Notifications Total Notification Rate Deaths Total Death Rate Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Total Deaths No. Rate No. Rate No. Rate No. Rate 1934 33 0.68 18 0.37 51 1.06 18 0.37 3 0.06 21 0.43 1935 35 0.69 13 0.25 48 0.95 19 0.37 2 0.03 21 0.41 1936 33 0.63 12 0.23 45 0.86 16 0.30 3 0.05 19 0.36 1937 37 0.68 10 0.18 47 0.87 26 0.48 5 0.09 31 0.57 1938 37 0.67 22 0.40 59 1.07 24 0.43 5 0.09 29 0.52 1939 28 0.50 9 0.16 37 0.66 22 0.39 3 0.05 25 0.44 1940 24 0.49 7 0.14 31 0.63 22 0.45 3 0.06 25 0.51 1941 46 0.98 15 0.32 61 1.30 16 0.34 — — 16 0.34 1942 42 0.84 21 0.42 63 1.26 33 0.66 4 0.08 37 0.74 1943 38 0.75 14 0.27 52 1.39 19 0.37 5 0.09 24 0.47 1944 43 0.92 13 0.27 56 1.19 16 0.34 4 0.08 20 0.43 1945 47 0.97 11 0.22 58 1.22 14 0.29 5 0.13 19 0.39 1946 50 0.86 7 0.12 57 0.99 28 0.48 4 0.06 32 0.55 1947 39 0.64 7 0.11 46 0.76 20 0.33 1 0.01 21 0.34 1948 38 0.62 5 0.08 43 0.71 16 0.26 3 0.04 19 0.34 1949 50 0.80 14 0.22 64 1.03 19 0.30 2 0.03 21 0.34 1950 41 0.65 4 0.06 45 0.72 14 0.22 1 0.02 15 0.21 Rates per 1,000 population. The register shows that at the end of the year:— 41 (SO) Pulmonary and 4 (14) non-Pulmonary cases were notified for the first time during the year. 26 (18) cases were transferred into the district. 1 (2) case was restored to the register. 14 (19) Pulmonary and 1 (2) non-Pulmonary cases died during the year. 40 (20) other cases were removed from the register. 380 (363) cases remained on the register at the close of the year. The figures in brackets are the comparable figures for the year 1949. SECTION G. PART III SERVICES. FOREST HEALTH AREA SUB-COMMITTEE. Chairman: County Councillor Mrs. E. F. M. Hollis. Vice-Chairman: Councillor J. W. R. Nation (Chingford Borough Council). Membership: Chingford Borough Council: Councillor J. W. R. Nation. Councillor Dr. J. Wagstaff. Alderman Mrs. S. L. Oakes. Wanstead and Woodford Borough: Councillor R. A. Dalton. Councillor E. H. Day. Alderman A. H. Southam. Councillor F. B. Baverstock. Chigwell U.D.C.: Councillor G. P. Guyatt. Councillor W. A. Nicholls, J.P. Councillor Mrs. L. M. Scott. Epping U.D.C.: Councillor C. G. Lowe. Councillor Mrs. F. M. Pollitt. Waltham Holy Cross U.D.C.: Councillor Mrs. M. Bird. Councillor F. Harvey. Epping R.D.C.: Councillor Mrs. H. Howard. Councillor A. F. Joseph, M.A. Hospital Management Committee: W. F. Erskine, M.A., M.D., D.P.H Executive Council for Essex: G. F. Deeth, Esq., M.P.S. Local Medical Committee for Essex: Dr. H. Grylls. Essex County Council: Alderman C. E. S. Blackmore. Alderman C. W. Fisher. Councillor K. E. B. Glenny. Councillor Mrs. E. F. M. Hollis. Councillor P. Porter. Alderman F. D. Smith, J.P. Councillor K. Stonehank. Local District Nursing Association: Mrs. J. Swire. Miss H. M. Mathieson. British Red Cross and St. John Ambulance Organisations: Mrs. M. Mackenzie Brown. Tuberculosis After-Care Associations: The late Alderman Mrs. J. Davey. 38 Health Centres. The earmarking of Health Centre sites within the Borough is a difficult one in view of the built-up area and housing needs. Originally seven sites were considered but this has now been reduced to four. One of the greatest problems has been to consider whether it is Justified to sterilize sites for a long term policy of this nature in view of the acute housing shortage and the use to which these sites could be put. Care of Mothers and Young Children. Ante-Natal and Post-Natal Services. The following table summarises the attendances at the Ante-natal Clinic, 118 Hermon Hill, Wanstead: — Ante-Natal Post-natal Gynaecolgical Birth Control 1126 27 9 148 Vital Statistics. These are given in Section A of this report. The birth rate of 13.5 is below that for England and Wales. The infant mortality rate was 18.9, the lowest on record for the Borough, as against 29.8 for England and Wales, and the neo-natal mortality rate was 16.5 per 1000 live births. The deaths of infants under one year were:— Males Females Total Rate per 1000 Live Births Legitimate 9 6 15 18.0 Illegitimate — 1 1 66.6 22 Stillbirths were notified, giving a stillbirth rate of 25.3 per 1000 total births and 0.35 per 1000 population. Care of Premature Infants. During 1950, 31 premature infants were born to residents of the Borough, 4 of these births taking place at home and 27 in hospital or nursing home. Of those born at home 3 were alive at the end of one month; 24 of the 27 born in hospital or private nursing home survived. Child Welfare Centres. The Child Welfare Centre continues to play an important part in the Health Service of the Borough and by the end of the year 18,499 attendances had been made by children at the six centres, in comparison to 21,783 during the year 1949. These figures were made up as follows: Baptist Church Hall, Aldersbrook 1388 Ashton Playing Fields, Woodford Bridge 2427 St. Barnabas Church Hall, Snakes Lane 2708 Fullers Road, South Woodford 4898 Cromwell Hall, Nightingale Lane, Wanstead 3022 Holy Trinity, Hermon Hill, South Woodford 4056 TOTAL 18,499 39 Provision of Nutrients and Medicaments. The supply of nutrients and medicaments in accordance with the County Council's scheme and the facilities provided by the Ministry of Food for the distribution of orange juice, cod liver oil and Vitamin A and D tablets from the child welfare centres has continued to operate throughout the year, this work being undertaken by voluntary helpers. It is fitting here to record an appreciation of the excellent work carried out by voluntary helpers in this branch of the work. Dental Treatment and Dentures. Every endeavour has been made to ensure that expectant and nursing mothers and children of pre-school age can obtain priority dental treatment but the acute shortage of dental surgeons has presented a grave difficulty and far from being able to expand this service as visualised by the County Council in their proposals under the National Health Service Act it has been necessary to curtail it within the limits of the staff available. The following tables show the extent of treatment which it has been possible to provide:— Examined Needing Treatment Treated Made Dentally Fit Expectant Mothers 9 9 33 9 Nursing Mothers 6 6 12 6 Pre-school Children 40 38 57 34 FORMS OF DENTAL TREATMENT Extractions Anaesthetics Fillings Scalings, etc. Silver Nitrate Treatment Dressings Dentures Provided Local General Complete Partial Expectant Mothers 19 10 5 15 10 Nil 2 Nil 4 Nursing Mothers 7 2 3 6 3 Nil Nil 2 1 Pre-school Children 23 Nil 17 24 2 35 19 Nil Nil Day Nursery. The admission of children to the day nursery in Spratt Hall Road Wanstead has continued on the same lines as in 1949, applicants being classified priority or non-priority according to the domestic circumstances of the family. The priority group includes the widow, separated, divorced and cases where the mother is the sole support of the family. It is estimated that approximately 50% of the places are occupied by applicants in this Periodic reviews have been carried out throughout the year by a SubCommittee appointed specially for the purpose to ensure that the best use is made of the accommodation. 40 The following table shows the attendances made, together with the daily average:— Quarter Ending Attendances Under 1 year 1—2 years 2—3 years Over 3 years TOTAL Days Open Average Daily Attendance 31st March 52 532 690 1565 2839 65 43.7 30th June 58 444 632 1662 2796 62 45.1 30th September 133 444 548 1515 2640 64 41.2 31st December 221 416 504 1525 2666 63 42.3 TOTAL 464 1836 2374 6267 10941 251 43.6 Nurseries and Child Minders Regulation Act, 1948. Under this Act any person who receives into her home for reward three or more children under the age of five years to be looked after for the day or a substantial part of the day, and premises, other than those wholly or mainly used as a private dwelling, are required to be registered with the Local Health Authority. At the end of the year the number of premises and child minders in Borough registered with the County Council were:— Registered No. of children Premises 1 25 Child Minders 3 10 The Daily Guardian scheme in operation in the Borough has been continued and at the end of the year 3 guardians were registered with and subsidised financially by the County Council. Health Visiting The work of the Health Visitors has increased considerably during the year end although staff changes have not allowed for the fullest development Which can be expected of this service, four Health Visitors have worked entirely in this Borough. It is interesting to note that whereas the Health Visitor before the introduction of the National Health Service Act was concerned mainly with the visiting of the expectant and nursing mother and children under five year of age, apart from her duties as School Nurse, this officer now visits families as a whole dealing with the needs of the aged and infirm as well as advising on matters concerning social conditions of the home. 41 The following table sets out statistically the work of the Health Visitors in the Borough during 1950:— Expectant Mothers (first visits) 147 Expectant Mothers (re-visits) 72 Infants under 1 year (first visits) 867 Infants under 1 year (re-visits) 234 Infants 1 to 5 years (first visits) 1926 Infants 1 to 5 years (re-visits) 3352 Stillbirth enquiries 8 Infant Deaths 13 Tuberculous Patients 42 Aged and Infirm 17 Day Nursery Applications 168 School Children 271 Other Visits 108 TOTAL 7225 Midwifery and Home Nursing The number of domiciliary confinements in the Borough attended by the County Council's midwives was 207, 141 in their capacity as midwife and 66 as maternity nurse. Of this total 142 received gas and air analgesia, a percentage of 68.6. Puerperal Pyrexia Regulations, 1939. During the year 10 cases of puerperal pyrexia were notified, nine of these following hospital confinement and one domiciliary. This figure of 10 gives a notification rate of 11.5 for the Borough as compared to 5.81 for England and Wales. It should be pointed out, however, that this notification rate does not present a true picture of the position so far as it affects residents of the Borough for 4 of these cases occurred in patients who reside outside the Borough but whose confinement took place in a hospital within the BoroughThe regulations provide that the notification must be accepted by the Authority in whose area the hospital in situated since the disease occurs at that address. So far as residents of this district are concerned 6 cases occurred which would produce a true notification rate to residents, per 1000 total births, of 6.9. Maternal Mortality. One death occurred as a result of pregnancy, child-bearing or associated therewith and is referred to in Section A of this report. Ophthalmia Neonatorum. No cases of ophthalmia neonatorum occurred in the Borough during the year 1950. 42 Home Nursing. The work of the general nurse in the Borough has continued to increase during the year, more and more visits being paid to patients being discharged from hospital and requiring injections and dressings. During the year the following visits were paid by the Home Nurses:— Number of New Cases: 1950 1949 Pre-school cases 36 35 School children 20 10 Adults 682 469 738 514 Advisory or Casual Visits: Pre-school cases 175 174 School children 88 44 Adults 13074 8755 13337 8973 Last Offices performed 52 29 Advisory of Casual Visits: Pre-school cases 3 2 School children 1 — Adults 86 36 90 38 Vaccination and Immunisation. The scheme for vaccination and diphtheria immunisation has been Carried out largely by means of the medical practitioner service. The number of children under 5 years of age who were immunised against diphtheria shows a drop of over 200, but this is due to the fact that immunisation was stopped during the months of August and September during the outbreak of poliomyelitis. The number of children who completed a full course of primary immunisation against diphtheria during the year is set out below:— Under 5 years of age 641 5 to 15 years of age 120 761 The number of children who received a secondary or re-inforcing Injection was 402. 43 The number of persons vaccinated or re-vaccinated during the year 1950 were:— Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 191 305 159 42 697 Re-vaccination Nil 2 26 132 160 The following information shows the total number of children under 16 years of age who have at any time received a course of immunisation against diphtheria, as at 31st December, 1950:— Year of Birth Number Year of Birth Number 1950 18 1942 603 1949 431 1941 718 1948 837 1940 643 1947 761 1939 569 1946 730 1938 414 1945 807 1937 340 1944 569 1936 339 1943 463 1935 301 TOTAL 8543 Preventive Medicine, Care and After-Care. This work can largely be divided into two classes of patient, those suffering from Tuberculosis and those suffering from other forms of illness. The prevention of tuberculosis must be looked upon as one of the most urgent problems of preventive medicine and includes both direct and indirect help. The main preventive measures in operation are the close supervision of patient and contact, Mass Radiography Surveys, B.C.G. vaccination and Health education and propaganda. Each case of tuberculosis notified is visited at regular intervals by the Tuberculosis Visitor who arranges for all members of the family to visit the Chest Clinic for examination and advises the patient and contacts on measures to be taken in the home to prevent the spread of infection. Open air shelters and extra nourishment are provided for tuberculous patients, and where possible child contacts of patients are boarded out. Re-habilitation of Tuberculous Patients. During the year the Area Sub-Committee accepted financial responsibility in two cases for patients undergoing re-habilitation at either Papworth or Preston Hall Settlements. No charge is made to the patient. 44 Mass Radiography Investigation. In July the Mass Radiography Unit of the North East Metropolitan Regional Hospital Board visited the Borough and carried out an investigation on at public sessions and in organised groups. The public sessions were well attended. I am setting out below the numbers attending: — ADULTS CHILDREN Male Female Total Male Female Total Number X-rayed 685 888 1573 679 370 1049 Requiring Large Films 31 44 75 11 7 18 The number of active cases of the disease discovered was very small indeed, but there were a number of other interesting abnormalities which are set out below:— ADULTS Abnormality Discovered Male Female Total Bony Abnormalities 4 6 10 Bronchitis and Emphysema 1 3 4 Bronchiectasis 1 — 1 Pulmonary Fibrosis (non Tubercular) 1 1 2 Basal Fibrosis 2 1 3 Pleural Thickening 12 4 16 Carcinoma of Bronchus 1 — 1 Cardiovascular lesions — congenital 1 — 1 Cardiovascular lesions— acquired 1 6 7 Foreign Body 1 — 1 Bullous Emphysema 1 — 1 Left upper lobe Emphysema 1 — 1 Elevation left hemi-diaphragm — 1 1 Cystic lung 1 1 2 Unfolding aorta with kyphosis — 1 1 Neurofibroma of the 7th intercostal nerve... —. 1 1 P.T. Inactive primary lesions 17 14 31 P.T. Active post-primary unilateral — 1 1 P.T. Inactive post-primary 11 16 27 CHILDREN Bony Abnormalities 1 3 4 Cardiovascular lesions — congenital 1 — 1 P.T. Inactive primary lesions 6 5 11 P.T. Inactive post-primary lesions 1 — 1 Four adults (men) failed to attend for large films or further investigation. 45 Recuperative Holidays. The Local Health Authority are empowered to provide recuperative holidays for persons not in need of medical or nursing attention, and during the year 14 cases from the Borough have been sent away. The length of convalescence was:— Two weeks 6 Three weeks 5 Four weeks 3 Domestic Help Service. The demands on the Domestic Help service have been considerably increased during the year, a total of 248 cases being supplied with 33,330 hours of help in comparison to 19,365 hours in 1949. Cases assisted have been maternity, acute sick, chronic sick, aged, tuberculous and other infectious cases. All applications are supported by a medical certificate and in the case of the chronic sick, which are long term cases, they are reviewed every three months by the Area Sub-Commitee. SECTION H. SCHOOL HEALTH SERVICES. The School Health Service for the Borough is administered by the Essex County Council through the Forest Divisional Executive. There are 8 primary, 1 secondary modern and 1 secondary grammar schools in the Borough. Medical Inspection of School Children. During the year 85 visits were paid to schools by Medical Officers to examine the children who were due for routine medical examination under the arrangements made by the authority under the Education Act, 1944 or for special examination at the request of Head Teacher or parent. Minor Ailments Clinic. 441 children attended the Minor Ailment Clinic at 93 High Road Woodford and 290 defects were found which required treatment. A total of 747 attendances were made at this clinic during 1950. During the year the Executive Council for Essex ceased to be responsible for the dispensing and supply of spectacles to school children, this service being transferred to the North East Metropolitan Regional Hospital Board. Ophthalmic Treatment. The Ophthalmologist visited the clinic on 47 occasions and carried out 797 examinations. Spectacles were prescribed in 285 cases. Orthopaedic Treatment. The Orthopaedic Surgeon attended the clinic on 9 occasions during year, 216 attendances by children being made for examination by Surgeon. 119 sessions were held by the Physiotherapist for after-treatment 172 attendances for this purpose being made by 524 children. 46 Poliomyelitis. Six of the 14 cases of poliomyelitis notified occurred amongst school children all of whom have been followed up by Medical Officers. In four cases the children were found to be free of any disability; in the two remaining cases one, a boy of 8 has some paralysis of the left upper limbs and wears an abduction splint, the other, a boy of 12 has a wasting of the right leg and walks with a very slight limp. Special arrangements were made for both these children to continue to attend school. Handicapped Pupils. Regulations made under the Education Act, 1944, places upon Local Education Authorities responsibilities for the provision of suitable education for children suffering from disability of mind or body from the age of two years, cases being brought to the notice of the Authority by Head Teachers or from other sources. Any case so notified is medically examined with a view to ascertaining their suitability or otherwise for attendance at and ordinary school. The categories of pupils requiring special educational treatment are set out below:— (a) Blind pupils, that is to say, pupils who have no sight or whose sight is or is likely to become so defective that they require education by methods not involving the use of sight. (b) Partially Sighted Pupils, that is to say, pupils who by reason of defective vision cannot follow the ordinary curriculum without detriment to their sight or to their educational development, but can be educated by special methods involving the use of sight. (c) Deaf Pupils, that is to say, pupils who have no hearing or whose hearing is so defective that they require education by methods used for deaf pupils without naturally acquired speech or language. (d) Partially Deaf Pupils, that is to say, pupils whose hearing is so defective that they require for their education special arrangements or facilities but not all the educational methods used for deaf pupils. (e) Delicate Pupils, that is to say, pupils who by reason of impaired physical condition cannot, without risk to their health, be educated under the normal regime of an ordinary school. (f) Diabetic Pupils, that is to say, pupils suffering from diabetes, who cannot obtain the treatment they need while living at home and require residential care. (g) Educationally Subnormal Pupils, that is to say, pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. 47 (h) Epileptic Pupils, that is to say, pupils who by reason of epilepsy cannot be educated in an ordinary school without detriment to the interests of themselves or other pupils and require education in a special school. (i) Maladjusted Pupils, that is to say. pupils who show evidence of emotional instability or psychological disturbance and require special educational treatment in order to effect their personal, social or educational readjustment. (j) Physically Handicapped Pupils, that is to say, pupils, not being pupils suffering solely from a defect of sight or hearing, who by reason of disease or crippling defect cannot be satisfactorily educated in an ordinary school, or cannot be educated in such a school without detriment to their health or educational development. (k) Pupils suffering from Speech Defect, that is to say, pupils who on account of stammering, afcphasia, or defect of voice or articulation not due to deafness, require special educational treatment. Defects found by medical examination of school children. The following table shows the defects found in school children as a result of examination by Medical Officers:— Defect. No. found to require treatment No. treated at Clinic No. to be kept under observation Skin 62 11 9 Eyes (a) Vision 23 - 9 (b) Squint 8 - — (c) Other 9 - — Ears (a) Hearing 5 - — (b) Otitis Media 2 - - (c) Other 5 1 — Nose or Throat 13 - 1 Speech 18 - — Cervical Glands 1 - 1 Heart and Circulation 1 - 1 Lungs 8 - 2 Developmental (a) Hernia — - — (b) Other 2 - 9 Orthopaedic (a) Posture 1 - 3 (b) Flat Foot 12 - 4 (c) Other 15 2 5 Nervous System (a) Epilepsy 3 — 1 (b) Other 2 — 6 Psychological (a) Development 5 — 1 (b) Stability 11 — — Other 84 26 15 48