AC 4411(1) WANSTEAD WOODFORD WANS 16 BOROUGH OF WANSTEAD AND WOODFORD ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1951. PUBLIC HEALTH COMMITTEE Councillor N. E. Britton (Chairman) Councillor R. A. Dalton (Vice-Chairman) Alderman R. W. Dale Alderman A. H. Southam Alderman C. Turner Councillor F. B. Baverstock Councillor A. G. Burness Councillor C. H. Moss Councillor Mrs. V. P. C. 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) (g) 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) (to 17.8.51) F. M. Flack, M.S.I.A. (a) (6) (to 31.3.51) G. F. Downing, M.R.San.I., M.S.I.A. (a) (b) (d) (/) (from 10.9.51) Clerks: Miss D. Howlett (to 13.12.51) Miss F. Woolf (to 5.5.51) Mrs. V. Birkett (from 11.6.51) (а) 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 of Smithfield Technical Institute. (d) Diploma of the Royal Institute of Public Health and Hygiene. (e) Diploma In Public Administration. (f) Diploma in Sanitary Science as applied to Buildings and Public Works. (g) General Instructors (Special) Certificate, Home Office Civil Defence School Falfield, Glos. 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 made the Borough for the year 1951. As in my report for 1950, reference is made 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. An account of the working of the School Health Service as it affects the borough is also submitted. Vital Statistics The total number of live births for the year was 768, this figure being 79 less than that of the previous year. From the tables on pages 6 and 8 it will be seen that there has been a drop in the birth rate since 1947 during Which year this rate reached the highest level in the history of the Borough. The present figure of 12.4 per 1,000 is lower than the average figure for the Pre-war year, 1934-1939, which was 13.2. The number of deaths occurring in 1951 was 668, an increase of 63 on the figure for 1950, but a decrease of 19 on that for 1949. The death rate per 1,000 is 10.8, which is slightly above the average for the post-war years (10.5). Contrasting these figures with those for England and Wales, it is found that the latter are 15.5 and 12.5 respectively. The infant mortality rate, i.e., the death rate of infants under one year of age per 1,000 live births, reached the unprecedented low level of 14.2 as cpmpared with 18.9 in 1950 and 29.6 for the whole of England and Wales in 1951. Infectious Disease For the third successive year no case of diphtheria occurred. Vigorous measures carried out to secure that a maximum number of children were protected by immunisation against this disease. The total number of children receiving primary immunisation was 810. No case of poliomyelitis (infantile paralysis) occurred during the year. 1,085 cases of measles were notified as compared with 293 in 1950; the disease was of a mild type. Cases of whooping cough also showed an Increase to 427 as contrasted with 157 in 1950. 3 49 new cases of tuberculosis were reported, there being 45 new cases in 1950. There were 13 deaths, 2 less than in the previous year. Housing Although it is now more than six years since the termination of hostilities, there are still well over 1,000 families on the Borough housing list. Many of these people are living with 'in-laws' in overcrowded conditions. In these cases of families living under the same roof there is seldom statutory overcrowding, as the total number of occupants of the home is considered in this connection, but it is sometimes found that the owner or tenant will only allow his relatives the use of one room, and as families increase living space becomes still more congested. Home Nursing Service Reference was made in my report for 1950 to the greatly increased demands made on the Home Nursing Service. This increase has continued during 1951, when 936 new cases were visited, a total of 15,508 visits being made. These figures compare with 738 new cases and 13,427 total visits in 1950. Reasons for this increase are two-fold. Firstly, new methods of treatment by modern drugs necessitate the giving of a large number of injections at frequent intervals; secondly, many patients who would formerly have been in hospital are now treated at home by their own doctors. They attend the out-patient departments of hospitals for specialised supervision. Owing to the high cost of maintaining a patient in hospital, this home treatment results in a considerable financial saving. Up to date it has been possible to meet the demands on this service, but only by the employment of part-time nurses in a temporary capacity. This proves unsatisfactory both for the patient and doctor, as it means that there are frequent changes of staff. Experience has shown that the only way to obtain and keep home nursing staff is by the provision of housing accommodation, and it is to be regretted that, so far, it has not been possible for this Council to let a house or flat to the County Council for the use of a home nurse. Old People's Welfare During the year the activities of the Wanstead and Woodford Old People's Welfare Association continued to expand. In May a new Dardy and Joan Club was opened, making a total of four clubs in the Borough. At the end of the year plans were in hand for the formation of a further two clubs. 180 old persons received regular visiting in their homes. Halfday coach outings and car rides were also arranged. I would pay tribute to the many voluntary workers who have expended much time and energy in various ways to further the interests of the old people and to relieve their loneliness. My thanks are due to the staff of the Public Health Department for their co-operation throughout the year and also for the assistance they have given me in the compilation of this report. 4 I am indebted to Councillor N. E. Britton, Chairman of the Public Health Committee for his unfailing help and for his understanding of the Problems which have arisen. Thanks are also due to members of the Committee for their continued support. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. G. BROWN, M.B., B.Ch., D.P.H. 6th August, 1952. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar-General's census 1951 61,850 Registrar-General's estimate mid-year 1950 62,460 Rateable value £620,050 Sum represented by penny rate £2,544 Extracts from Vital Statistics of the Year Live Births: Legitimate Males 378 Females 357 Total 735 Illegitimate Males 22 Females 11 Total 33 Total Males 400 Females 368 Total 768 Birth-rate per 1,000 of the estimated resident population- 12.4 Stillbirths:- Legitimate Males 8 Females 12 Total 20 Illegitimate Males 1 Females — Total \1 Total Males 9 Females 12 Total 21 Rate per 1,000 total (live and still) births—26.6 Deaths: Males — 329. Females — 339. Total — 668. Death-rate per 1,000 of the estimated resident population 10.8 Deaths from puerperal causes:— Puerperal and post-abortion sepsis - Other maternal causes 2 Total 2 Rate per 1,000 total (live and still) births — 2.54 Deaths of Infants under one year of age:— All infants per 1,000 live births 14.2 Legitimate infants per 1,000 legitimate live births 13.5 Illegitimate infants per 1,000 illegitimate live births 30.3 1951 1950 Deaths from Cancer 130 127 „ „ Measles Nil Nil „ „ Whooping Cough 1 Nil „ „ Diarrhoea (under 2 years of age) Nil 2 „ „ Road Traffic Accidents 5 5 „ Suicide 5 3 „ „ Other violent causes 6 5 6 Population The population at the 1951 census was 61,850, a decrease of 610 on the Registrar General's estimate for 1950 (mid-year). Extracts from vital statistics of the year Statistical tables have been included in this report to show the health of the community in the Borough over the past seventeen years. 7 8 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1951. 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 15.5 17.3 16.7 17 8 12.4 Still 0.36 0.45 0.38 0.37 0.34 Deaths: All Causes 12.5 13.4 12.5 13.1 10.8 Typhoid and Paratyphoid 0.00 0.00 0.00 - - Whooping Cough 0.01 0.01 0.01 0.01 0.02 Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.31 0.37 0.31 0.38 0.21 Influenza 0.38 0.36 0 38 0.23 0.26 Smallpox 0.00 0.00 0.00 — - Acute Poliomyelitis and Polioencephalitis 0.00 0.01 0.01 0.00 - Pneumonia 0.61 0.65 0.63 0.61 0.68 Notifications: Typhoid Fever 0.00 0.00 0.00 0.01 - Paratyphoid Fever 0.02 0.03 0.02 0.01 - Meningococcal Infection 0.03 0.04 0.03 0.03 - Scarlet Fever 1.11 1.20 1.20 1.10 0.76 Whooping Cough 3.87 3.62 4.00 3.11 6.90 Diphtheria 0.02 0.02 0.03 0.01 - Erysipelas 0.14 0.15 0.12 0.15 0.08 Smallpox 0.00 0.00 0.00 — - Measles 14.07 13.93 14.82 14.64 17.54 Pneumonia 0.99 1.04 0-96 0.72 0.79 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.03 0.03 0.03 0.02 - Non-Paralytic 0.02 0.02 0.03 0.02 - Food Poisoning 0.13 0.15 0.08 0.23 0.11 Deaths: (Rates per 1,000 Live Births) All causes under 1 year of age 29.6 33.9 27.6 26.4 14.2 Enteritis and Diarrhoea under 2 years 1.4 1.6 1.0 0.70 - Notifications: Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 10.66 13.77 8.08 14.90 26.6 Maternal Mortality Abortion with Sepsis Other Abortion Complication of Pregnancy Sepsis of Childbirth and the Pueperium Other England and Wales 0.09 0.05 0.37 0.10 0.18 Wanstead and Woodford 1.27 — — — 1.27 Causes of Death as given by the Registrar-General, 1951 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 7 3 10 2. Other forms of Tuberculosis 1 2 3 3. Syphilitic Disease 1 2 3 4. Diphtheria — — — 5. Whooping Cough — 1 1 6. Meningococcal Infections — 1 1 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — — — 10. Malignant Neoplasm— Stomach 9 10 19 11. Malignant Neoplasm— Lung and Bronchus 10 4 14 12. Malignant Neoplasm—Breast — 17 17 13. Malignant Neoplasm—Uterus — 4 4 14. Malignant Neoplasm—Others 37 39 76 15. Leukæmia 2 1 3 16. Diabetes — 4 4 17. Vascular Lesions — Nervous System ... 33 43 76 18. Coronary Disease, Angina 38 29 67 19. Hypertension with Heart Disease 13 11 24 20. Other Heart Disease 52 55 107 21. Other Circulatory Disease 14 19 33 22. Influenza 8 8 16 23. Pneumonia 20 22 42 24. Bronchitis 30 20 50 25. Other Respiratory Diseases 2 — 2 11 26. Ulcer of Stomach or Duodenum 9 2 27. Gastritis, Enteritis and Diarrhoea 1 2 3 28. Nephritis and Nephrosis 2 — 2 29. hyperplasia of Prostate 6 — 6 30. Pregnancy, Childbirth, Abortion — 2 2 31. Congenital Malformations 32. Other Diseases 4 20 2 30 6 50 33. Motor Vehicle Accidents 4 1 5 34. All Other Accidents 2 4 6 35. Suicide 4 1 5 36. homicide and Operations of War - - - Totals, 1951 329 339 668 Totals, 1950 283 322 605 9 Infant Deaths, Neo-Natal Mortality and Stillbirths Year hive Births Birth Rate Stillbirths Neo-Natal Deaths Infant Death No. Per 1,000 hive Births Per 1,000 Population No. Per 1,000 Live Births No. Per 1,000 Live Births 1951 768 12.4 21 27.3 0.34 6 7.8 11 14.2 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 30.9 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Year Total Births Registered Deaths Rates per 1,000 Births (Live and Still) Puerperal Sepsis Other Maternal Causes Total Puerperal Sepsis Other Maternal Causes ^Total 1951 789 1 1 2 1.27 1.27 2.54 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 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate (per 1,000 hive Births) 1951 1950 1949 1948 1947 Maternal Mortality 2.60 1.18 1.19 1.02 0.83 Stillbirths 27.3 25.9 26.2 20.4 24.1 Neo-Natal Mortality 7.8 16.5 14.3 15.3 15.0 During 1951 there were two deaths classified as being due to pregnancy childbearing or associated therewith. 10 TOTAL INFANT MORTALITY. 1934 TO 1951. This is defined as the sum oi the deaths that occur during child-birth and during the first year of life. Comparative Statistics of Births, Mortality, etc., 1934 to 1951 Year Population Live Births Still Births Deaths Infant Deaths Maternal Deaths No. Rate* No. Rate † No. Rate* No. Rate‡ No. Rate † 1951 61850 768 12.4 21 26.6 668 10.8 11 14.2 2 2.54 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 5.0 *Per 1,000 Population. †Per 1,000 Total Births. ‡Per 1,000 Live Births. 11 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 - 4 p.m. Ashton Playing Fields Pavilion, Woodford Bridge. Tuesday, 2.30 - 4 p.m. St. Barnabas Church Hall, Snakes Lane, Woodford Green. Wednesday, 2.30 - 4 p.m. Fullers Road Sunday School, South Woodford, E.18. Wednesday, 2.30 - 4 p.m. Cromwell Hall, Nightingale Lane, Wanstead, E.ll. Thursday, 2.30 - 4 p.m. Holy Trinity Church Hall, Hermon Hill, South Woodford, E-18 Friday, 2.30 - 4 p.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. Orthopaedic—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. 12 6. Chest Clinic Harts Hospital, Woodford Green. Wednesday, 9.30 - 11 a.m. and 5-6 p.m. Patients living North side of Southend Road. 180 High Road, Leyton, E.10. Monday, 9.30 - 11 a.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 1951. 9. Funeral arrangements In one instance the Local Authority was required to make arrangements for the burial of a person during the year 1951. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA 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 treated 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 method. (b) Salvage Collection. Following an increase in the price of wastepaper, collection was re-introduced in February, 1951. (c) Kitchen Waste Collection. The collection of kitchen waste in the Borugh is by means of individual container system. 13 3. Drainage and Sewerage (a) Eastern Sewage Disposal Works. Observations show that the total flow of sewage reaching these works is now nearing the full capacity for which the equipment was designed. In a number of the bacteria beds, the filtering medium is in an exhausted condition and is to be renewed in the near future, subject to such work being authorised by the Ministry of Housing and Local Government. (b) Southern Sewage Disposal Works. A scheme for modifying and extending 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. The intended diversion of the Western area sewage into the Chingford disposal system and the consequent abandonment of these obsolete works has not yet been made possible Negotiations are still proceeding between interested authorities. Meanwhile careful supervision is ensuring the discharge of a satisfactory effluent. SANITARY INSPECTION OF THE AREA The Senior Sanitary Inspector reports as follows:— Requisitioned Premises Referring to the report of the Medical Officer of Health for 1950, it can now be recorded that the duty of maintaining such property in good repair was transferred from the Public Health Department to the Department of the Borough Engineer and Surveyor. In consequence of this the staff of Sanitary Inspectors was reduced by one Inspector. Housing Act, 1936 As recorded in the report for 1950, it can again be noted that, generally speaking, works of repair are carried out by owners. The 'tie-up' between the Public Health and Housing Committees and their officers still works well. This has made possible the demolition of further insanitary dwellings. Restricted building and the long list of housing applicants make demolition of insanitary dwellings a very slow process; nevertheless figures in another part of the report indicate progress In November, 1951, a representation to the Council was made by the Medical Officer of Health in connection with five cottages at Wanstead known as Slaters Cottages. This being the commencement of the necessary procedure in connection with a Clearance Area under the Housing Act one must of necessity wait until 1952 to see the outcome of the official representation. 14 The Cottages are of considerable age and are of a type similar to back-to-back houses, some bedrooms at the back having a small window looking out into a narrow, dark alley way. They consist of one room on the ground floor and two rooms on the first floor. Toilet and wash-house facilities exist at the end of the front gardens, water is supplied by standpipes and access to the cottages is gained by a narrow opening between the shops in the High Street. During the year 8 properties were subject to notices requiring repairs to be carried out and 15 properties were the subject of Demolition Orders. of these 4 were demolished and 10 closed by agreement pending demolition. In addition 4 other properties were closed by agreement, 2 formally and 2 inforrnally. As the result of these actions 16 families were rehoused in more congenial surroundings. Public Health Act Fourteen premises were redrained and three Public Sewers were repaired; this work involved expenditure on the part of the owners to close on £100. 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. Reference was made in the Report of the Medical Officer of Health for 1950 to the effect that works of repair were frequently held up because the owners or agents wished to negotiate with the War Damage Commission, Although another year has passed, it has to be recorded that similar conditions still exist, in fact, seeing that the war ceased over six years ago, one wonders just how the assessors of the Commission distinguish the difference between damage due to enemy action and normal dilapidations. Hopes were expressed in last year's report that property owners would receive some assistance towards maintaining their premises in a reasonable state of repair by legislation allowing for some increase in rent. Yet another year has passed without such relief being in sight, although Wages in the building industry have risen. Costs of material have also increased, consequently the amount which can be set aside for repairs, external decorations, etc., is reduced in value accordingly. It is pleasing, when considering the Housing and Public Health Acts, in record that the number of verminous premises remains very low, so low in fact that they can be considered non-existent. The few cases reported are mild in character and require no harsh efforts to eradicate bugs, etc. Food Hygiene Arrangements were made during the year for local cinemas to show the film "Another Case of Food Poisoning". It is pleasing to report that cinemas co-operated and thanks are due to them for showing the film. 15 No special exhibitions or lectures were given, but at its November meeting the Public Health Committee considered the terms of the Circular of the Ministry of Food dated 24th October, dealing with Dogs in Food Shops, Restaurants, etc. The terms of the Circular are rather remarkable in that the Minister of Food stated that he agreed that dogs should not be allowed into food shops, the taking of animals into shops being a most unhygienic practice, yet he follows on by saying that he could not feel that he would have any success if he tried to stop it by prohibitive regulations. The Minister considered the problem might be better solved by voluntary action, and therefore appealed to the public and the food trade to co-operate in keeping dogs out of shops. The Circular in its appendix sets out a form of notice for exhibition in shops. The Council accepted the recommendation of the Medical Officer of Health to provide and distribute such notices, which were distributed by the Sanitary Inspectors. In travelling about the Borough one saw that the notices were exhibited in the shops, and some multiple firms exhibited those of their own design. In considering the Circular one wonders if the Minister of Food was really convinced that the taking of a dog into a food shop, etc., was really unhygienic, for surely had he been he would have taken steps to prohibit the practice. No reference was made to the cat, which in many cases has not only the freedom of the shop to run and jump about in, but the privilege of sitting on the serving counter, sacks of food, etc. Surely the presence of this animal can be most unhygienic, yet it has escaped criticism. As the matter is now left to the co-operation of the public and the shop keepers one feels satisfied that not every member of the public considers taking their dog with them when shopping in food shops to be unhygienic. Rodent Control The Council employ a rodent operator on a full time scale. The infestations, although spread throughout the Borough, do not in any case reach the proportions of major infestations. As is often the case, infestations occur in or around chicken runs, and whereas rats are not always found nesting in such runs, the presence of poultry attracts the rats from surrounding gardens. The poisons available are still very effective, but a new one was added during the year to those previously used, and is known as "Warfarin".A circular concerning this poison was issued by the Ministry of Agriculture and Fisheries in November, 1951, and describes it as a blood anti-coagulant which, when ingested regularly in small doses over a period of time, induces fatal hæmorrhage in rats. It is slow in action and death occurs on the average after 5 to 8 days. 16 The technique is different from poisoning with arsenic and zinc Phosphide; Warfarin can be used for direct poisoning — pre-baiting is not necessary, it is used dry because it has to be left for relatively long periods, and in order to obtain a thorough mix it is mixed by the manufacturers with fine oatmeal as a master-mix, and when being used this master-mix is diluted in medium oatmeal in the proportion of 5 per cent. by weight. As with all poisons, care has to be exercised, particularly when other animals are about, although considerable quantities would have to be eaten before any of the larger mammals or chickens would be harmfully affected. Hospitals—The Ministry of Agriculture and Fisheries issued a circular in December, 1951, pointing out that Hospitals are Crown property and are therefore immune from the provisions of the Prevention of Damage by Pests Act, 1949. Nevertheless the Minister of Health has requested Boards to conform with the requirements of Part I of the Act. The Boards and Committees were being asked by the Ministry of Health to invite Local Authorities to inspect periodically the premises under their control and advise any necessary action. So far no invitation has been received from the local Hospital Boards and Committees, and one can only conclude that they are satisfied that rats do not exist on their premises. The Council's refuse tips were watched but no major infestation was observed, as the tips are well supervised and refuse covered so as to prevent any nuisance. surface treatment: The following table shows the result of the year's work. Number of inspections made by the Sanitary Inspectors 129 Complaints received 290 Retreatments 16 Total Premises visited 282 Number of baiting points 2,698 Rats found dead 79 The Council's sewers were treated twice during the year, the results being tabulated form in this report. This treatment was again supervised by the Deputy Senior Sanitary Inspector. 17 First Treatment 1 2 3 4 5 6 7 8 Average Pre-bait Takes Section No of Manholes No. not baited No. baited Complete Partial Total takes N.T. 1 70 49 21 8 4 12 9 2 86 64 22 8 3 11 11 3 75 64 11 2 2 4 7 4 77 2 75 16 20 36 39 5 77 6 71 21 16 37 34 6 80 - 80 24 20 44 36 7 79 43 36 10 7 17 19 8 66 38 28 7 3 10 18 9 82 43 39 15 6 21 18 10 75 44 31 7 6 13 18 11 69 43 26 11 3 14 12 12 70 31 39 6 6 12 27 13 69 36 33 8 5 13 20 14 79 1 78 32 1 33 45 15 77 52 25 — — — 25 16 71 3 68 26 8 34 34 17 68 44 24 12 — 12 12 18 77 55 22 9 — 9 13 19 72 1 71 19 5 24 47 1419 619 800 241 115 356 444 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 1 69 9 3 12 57 2 86 — 86 10 4 14 72 3 75 - 75 3 3 6 69 4 77 - 77 14 13 27 50 5 77 2 75 10 15 25 50 6 80 — 80 18 19 37 43 7 79 — 79 9 15 24 55 8 66 4 62 17 5 22 40 9 82 — 82 13 7 20 62 10 75 3 72 13 11 24 48 11 69 2 67 14 2 16 51 12 70 1 69 17 11 28 41 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 — 71 24 5 29 42 17 68 2 66 13 — 13 53 18 77 1 76 14 1 15 61 19 72 — 72 20 5 25 47 1419 19 1400 284 141 425 975 19 Bag Flock and Other Filling Materials Act, 1951 This Act, reported upon under New Legislation, did not involve this Department in much additional work, for up to the end of the year the number of premises registered was one. Slaughter of Animals Act, 1933 One licence was issued during the year, that being issued to the local Inspector of the Royal Society for the Prevention of Cruelty to Animals. The Milk and Dairies Regulations, 1949 Because it was noted that crates of bottles filled with milk were being deposited on the grass verges of several roads, a report was made to the Public Health Committee, as an infringement of the Regulations had been committed. The Committee took a serious view of the offence, but because it was a first offence they decided to give a warning to the firm concerned. The practice ceased, for at that time the firm were taking delivery of large electric trucks for retail delivery. Petroleum (Regulation) Acts, 1928 and 1936 Fifty-two licences were renewed at the beginning of the year, and four new licences were granted. Game Licences Thirteen licences to deal in Game were renewed and one new licence was granted. 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 8 Shops Act, 1934 103 visits were made under this Act, and one Notice was served. 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. Ten visits were made during the year. 20 inspections carried out by Sanitary Inspectors Infectious disease enquiries, including enquiries in respect of scabies 57 Visits in connection with contacts, disinfection, etc. 33 Enquiries in connection with food poisoning 2 General Environmental Public Health Drains and Sewers inspected 474 Drain tests applied 157 Stables and manure pits inspected 54 Offices 1 Ponds 2 factories (mechanical) 2 factories (non-mechanical) 47 Hairdressers' premises 10 Schools 38 Ditches and Streams 11 Open spaces and playing fields 13 Tents, Vans and Sheds (including gipsy encampments) 15 Petrol Installations 19 Cinemas 6 Fish Fryers 1 Shops Act inspections 103 Outworkers premises 25 Massage establishments 10 Rag Flock Act 4 Merchandise Marks Act 1 Shimming Baths 2 Smoke observation 1 Miscellaneous visits 95 21 General Environmental Public Health—Continued. Inspection of Food Premises Meat Shops 202 Bakehouses 37 Fishmongers 113 Grocers 145 Restaurants and Cafes130 Dairies and Milk Shops 32 Greengrocers 43 Ice Cream premises 172 Hotels, Boarding Houses and Public Houses 8 Total 2,225 SECTION D. HOUSING No. of houses erected during 1951: 193 Council; 52 Private enterprise; 2 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) 928 (b) Number of inspections made for the purpose 2,357 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 8 (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 254 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 222 22 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 8 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 3 (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 31 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 15 (b) By Local Authority in default of owners 1 (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 15 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 Housing Act, 1936—Part IV—Overcrowding Twenty-seven 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 fined 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 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 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. 23 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 77 External walls and chimney stacks repaired 22 Walls underpinned 6 Gutters and spouts repaired or renewed 55 Damp-proof courses provided 4 Dampness remedied 51 Yards paved or repaired 1 Internal walls and ceilings repaired 90 Doors and frames repaired or renewed 13 Windows repaired or renewed 64 Floors repaired or renewed 17 Sub-floor ventilation provided or improved Rooms cleansed or redecorated 14 Passage and staircase redecorated 3 Staircases repaired and handrails provided 6 Fireplaces and flues repaired or renewed 27 Washbasins and sinks provided or renewed 9 Wastepipes repaired or renewed 16 Dustbins provided or renewed 3 Water supply improved or reinstated 8 Water closet walls and ceilings cleansed 12 Water closet pans repaired or renewed 8 Water closet cisterns repaired or renewed 13 Water closet structures repaired or rebuilt 7 Water closet flush pipe joints repaired 3 Drains cleansed from obstruction 120 Disinfection and Disinfestation Number of rooms disinfected 16 Premises from which bedding removed for steam disinfection 74 Number of rooms disinfested 31 24 1. FACTORIES ACT, 1937 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 55 47 - - ( ii) Factories not included in (i) to which Section 7 applies - - - - (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 175 162 - - (b) Others — - - — (iii) Other Premises under the Act Excluding out-workers' premises) — — — — Total 230 209 — — Defects found. Particulars. Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness 2 2 ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate Ventilation ... ... ... ... Ineffective drainage of floors ... ... ... ... Sanitary Conveniences:— 1. Insufficient ... ... ... ... 2. Unsuitable or defective 5 5 ... ... 3. Not separate for sexes ... ... ... ... Other Offences ... ... ... ... Total 7 7 ... ... In addition to the table shown above, it can be reported that 5 Certificates were issued in connection with Section 34 (Means of Escape in Case of Fire). 25 3. Outwork Number of out-workers in August list required by Section 110(l)(c).- Wearing apparel — making, etc. 77 Curtains and Furniture Hangings 3 Furniture and Upholstery 1 File Making 6 Umbrellas 2 Paper Bags 10 Boxes 5 Brushes 1 Stuffed Toys 2 Xmas Crackers 3 110 SECTION E. FOOD AND DRUGS ACT, 1938 As in previous years a watch was kept on the condition of food premises during the year under review. Three cases of offences were found which were contraventions of the Food and Drugs Act, 1938. The first was that of a cafe where the walls and ceiling of the kitchen required cleansing and redecorating. Eyery effort was made to get the work done without having to take proceeding against the proprietor, and although such action was not necessary, the work was executed only after the Council had threatened to take proceedings against him. The second and third cases concerned school canteens; at one school the walls and ceilings of the kitchen and stores were found to be in a very dirty condition and with wall distemper flaking badly, whilst at the other school the walls and ceiling of the store were dirty. As the schools concerned were under the control of the County Council the matters were referred to their Area Office. Because the year under review ended before redecorations were in hand, further details must be held over for the 1952 report. During the year the Department had its usual share of food containing foreign bodies, one bottle of milk which contained potato peelings was reported upon to the Public Health Committee, likewise a report was made concerning a slug in another bottle of milk. In the former case a warning letter was sent to the dairy firm, whilst in the latter no action was taken because the Committee was not satisfied that the slug was in the bottle at the time of bottling. Two cases of foreign matter in bread were reported to the Public Health Committee. 26 In the first case the Committee was informed that the foreign material was in fact edible oil used as a lubricant in the dough mixer, and consequently no further action was authorised. When, however, the second case was reported, legal proceedings were authorised because a cigarette end was found embedded in a loaf. During the proceedings the bakery firm laid information against their foreman, alleging neglect on his part, and to which charge he pleaded guilty. The Court fined him £1. The Company however failed to prove they had used all diligence to secure compliance with the Act and were fined £15 with 2 guineas costs and a further 7/6d. for witnesses fees. In considering the reports of the Public Analyst for the year 1951, it is fitting to mention the following which may be items of interest to the reader. 1. Sample of Crystallised Pineapple. This was preserved with sulphur dioxide to the extent of 250 parts per million. The quantity was 2i times that permitted by the Public Health (Preservatives, etc., in Food) Regulations, namely 100 parts per million. No further action was taken because this being an informal sample it was not possible to obtain a formal sample for dividing into three parts. 2. A specimen tin with every appearance of being blown, and containing Sugar Cane Molasses was submitted to the Public Analyst for his report. A copy of his report is given below in full. No further action was necessary. "This sample consisted of an unopened l¾lb. tin 'blown' at both ends. When the end was pierced however no internal pressure was observed. The smell of the molasses and the results of bacteriological examination suggested that fermentation was taking place, but the presence of only 0.2% of proof spirit indicated that any fermentation was insignificant. Analysis of the molasses for harmful arsenical and metallic contamination yielded negative results. I am therefore of the opinion that, as the molasses have not fermented, and as it has not taken up any metallic contamination, it is safe for human consumption in these respects." 3. Specimens of nuts were submitted for report because it was alleged that illness had been caused by their consumption. Again the Public Analyst's report is given in full as a matter of interest. "I have analysed these nuts for harmful arsenical and metallic contamination but with negative results. The oil extracted from these nuts is practically neutral and free from rancidity. I have therefore been unable to find any cause for the illness which followed consumption of these nuts. It should be noted however, as is natural, that these nuts contain a very high percentage of oil, namely 37.3%." 4. One sample of pork sausages was reported to contain 65% of meat, or 5% deficiency. It was not possible to repeat the sample because of the difficulty of supply. 27 5. A sample of Single Cream showed a deficiency in fat to the extent of 5½% of the minimum of 18%. The deficiency was so small and the Order so young that the Public Analyst recommended a caution. Further samples were unobtainable because of a standstill order on the supply of cream to the public. A list of food sampled is given below:— Butter 6 Margarine 4 Cooking Fat 4 Rice 1 Ground Rice 2 Cheese 4 Bacon 4 Tea 4 Sugar 4 Fish Paste 2 Table Jelly 2 White Pepper 1 Semolina 2 Jam 1 Cake and Pastry Mixture 2 Custard Powder 2 Pork Sausages 4 Breakfast Sausage 1 Flour 2 Artificial Cream 1 Cream 8 Desiccated Coco-nut 2 Pineapple (crystallized) 1 Ketchup 1 Oatmeal 1 Brawn 1 Luncheon Meat 4 Ham 1 Meat Pie 1 Ground Almonds 1 Ice Cream 8 Salad Cream 1 Cornflour 1 Ground Ginger 1 Baking Powder 1 Molasses 1 Nuts 1 Toast 1 Total 89 28 Eight samples of ice-cream were submitted to the Public Analysts to pertain the fat content of the mixture. These samples contained fat to the following extent: 12.0 per cent., 10.4 per cent., 11.3 per cent., 6.3 per cent., 10.7 per cent., 11.5 per cent., 13.6 per cent., 14.2 per cent. Four samples of cream were submitted to the Public Analysts to ascertain the fat content of the mixture. These samples contained fat to the following extent: 49.9 per cent., 17.0 per cent., 50.5 per cent., 51.0 per cent. Three of these samples, double cream, were satisfactory and the fourth, single cream, 17.0 per cent., was slightly below the required standard. No action was considered necessary in this case. The following is a list of foods surrendered in 1951 because of unsound conditions Fish, Fresh Milts 5 stone Skate 24 stone Roes 1½ stone Dover Soles 4 stone Whiting 12½ stone Haddock 6 stone Bream 2 stone Cod 2 stone Mackerel 3 stone Fish, Tinned Herrings 2 tins Sardines 9 tins Salmon 49 tins Pilchards 22 tins Fruit, Tinned Rhubarb 1 tin Apples 42 jars Plums 55 jars Plums 59 tins Pineapple 3 tins Grapefruit 8 tins Grapes 8 tins Peaches 1 tin Figs 1 tin Apple, sieved 10 tins Apricots 4 tins Raspberries and Redcurrants 1 tin Oranges 3 tins Damsons 1 tin Pears 4 tins Greengages 66 tins Cherries 5 tins Bananas 1 tin Vegetables, Fresh Potatoes 2¼ cwt. Vegetables, Tinned Peas 14 tins Beans 27 tins Carrots 37 tins Tomatoes 7 tins Vegetables, mixed 10 tins Spinach 7 tins Milk, Tinned Evaporated 45 tins Condensed 19 tins Dried 390 lbs. Full Cream 1 tin Meat, Tinned Luncheon Meat 111 tins Luncheon Meat 181 lbs. Veal, Jellied 3 tins Veal, Jellied 80 lbs. Beef Loaf 1 tin Veal Loaf 2 tins Ham and Veal Loaf 445 lbs. Ham 9 tins 29 Ham 9,084 lbs. Pork 1 tin Sausages 1 tin Corned Beef 40 lbs. Chicken and Ham 1 tin Chicken 4 tins Brawn 2 tins Tongue 14 tins Stewed Steak 2 tins Braised Steak 2 tins Braised Kidneys 2 tins Braised Hearts 2 tins Braised Hearts 18 lbs. Meat, Fresh Beef 177½ lbs. Mutton 53¾ lbs. Lamb 18½ lbs. Sweetbreads 14 lbs. Pigs Maws 974 lbs. Pigs Rinds 224 lbs. Pork Butts 36½ lbs. Chitterlings 587 lbs. Tongues 15½ lbs. Miscellaneous Cheese 59½ lbs. Tea 4 lbs. Suet 2 lbs. Icing Sugar 20 lbs. Mincemeat 40 lbs. Soup 87 tins Soup Powder 6½ lbs. Coffee 3 lbs. Potted meats and pastes 4 jars Christmas Pudding 1 Spaghetti 21 tins Jam and Marmalade 31 jars Tomato Juice 4 tins Sausage Rusk 2 cwt Pearl Barley 50 lbs. Currants, Sultanas and Raisins 142 lbs. Mint Sauce 1 bottle Macaroni 1 pkt. Baby foods, strained 8 tins Margarine and fats 6 lbs. Dried egg 2¼ lbs. Custard Powder 3 lbs. Baking Powder 9¼ lbs. Bicarbonate of Soda 6 lbs. Figs dried 2 lbs. Flavourings 2 lbs. Flour 65 lbs. Oatmeal 21 lbs. Rice, Semolina and Sago 8 lbs. Salt 56 lbs. Candied Peel 1 lb. Ginger 1½ lbs. Spice ½ lb. Mustard ¾ lb. Vinegar 5 pts. Treacle 6 lbs. Dates 62 boxes Nutmegs 8 Lemons 6 Jelly 5¾ lbs. Split and Dried Peas 164 lbs. Dried Potatoes 56 lbs. MANUFACTURE, STORAGE AND SALE OF ICE CREAM Fifty-nine registrations of premises were in force at the beginning the year and a further two were added during the year. A considerable amount of work is carried out in sampling ice-cream, and the following summaries show a steady improvement in the quality of the samples obtained. The Public Health Committee is to be congratulated upon the interest taken in the control of the sale, storage and manufacture of ice-cream and upon the support given to the officers of this Department. 30 Ice Cream Samples (Bacteriological examinations) Although there is no bacteriological standard for ice cream the Public Health Department nevertheless obtained 156 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 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 156 samples referred to above are grouped as follows:— 103 in Grade I; 35 in Grade II; 14 in Grade III; 4 in Grade IV. The approximate percentage in each Grade of the 156 samples is as follows:— Grade I, 66.0 per cent.; Grade II, 22.4 per cent.; Grade III, 8.9 per cent.; Grade IV, 2.7 per cent. A comparison is given below covering results of the last four years:— 1951 1950 1949 1948 % % % % Grade I 66.0 46.3 52.9 34.25 Grade II 22.4 28.7 21.8 32.81 Grade III 8.9 16.7 20.1 20.3 Grade IV 2.7 8.3 5.2 12.5 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. The comparisons for 1951 are given below, and the figures are based on samples relating to 57 obtained from bulk supplies and 99 wrapped:— Bulk Supply Wrapped Supply 57 Samples 99 Samples Grade I 42% 80% Grade II 30% 18% Grade III 21% 2% Grade IV 7% 0% 31 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. In addition to the samples referred to above, one sample was taken of an Ice Lolly, which proved to be satisfactory. 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.1. The Department is appreciative of the help given by these two Laboratories during the year. NEW LEGISLATION Rag Flock and Other Filling Materials Act, 1951 After some years of waiting for this Act to come into being, it became law on 1st August, 1951, and was enforcable by Local Authorities from three months after that date. In July 1946 the Minister of Health presented to the House of Commons the report of the Inter-departmental Committee on the Rag Flock Acts. This report contained some 36 pages and was largely based on evidence given by various trade and other bodies, including the Society of Medical Officers of Health and the Sanitary Inspectors Association This report was dated 12th April, 1946. The Act makes it necessary for businesses using certain filling materials to have their premises registered by a Local Authority. The filling material referred to are rag flock, unwoven cotton, cotton linters, cotton millpuffs and cotton felt, unwoven wool, woollen felt, woollen flock, jute, unwoven synthetic fibres and synthetic fibre flock, hair, feathers or down, kapok coir fibre, Algerian fibre, Mexican fibre and sisal, seaweed, seagrass, Spanish moss, straw or chaff, and such other materials as may be prescribed. It is an offence to have on such registered premises filling materials to which the Act applies which are not clean. Regulations made under the Act were issued, and came into operation on 1st November, 1951, which prescribed standards of cleanliness. The standards are too numerous, as can be imagined, to be reproduced here Regulations also set out lists of analysts who will analyse samples submitted by Local Authorities. 32 Referring to the above paragraph, the Act allows for samples to be taken of filling materials and it prescribes the procedure to be adopted when taking such samples. Further the Act makes it necessary for Local Authorities to licence Premises where rag flock is (a) manufactured, and (b) stored. Arrangements are made in cases where a licence has been refused by a Local Authority for the occupier of the premises concerned to appeal to the Minister of Local Government and Planning (now Housing and Local Government). The Act prescribes the records which have to be kept by the occupiers registered or licensed premises. Under the Act it is an offence to sell or offer or expose for sale any article which is upholstered, lined or stuffed with materials to which the ct applies and which are not clean. One regrets that in the Act the provisions which make it unlawful to use filling materials to which the Act applies do not apply to the remaking °r reconditioning of any article or to the upholstery of railway carriages, road vehicles, ships or aircraft. As with most Acts, power of entry and inspection is given to officers of Local Authorities, and also such things as penalties for offences, obstruction of officers, etc., are prescribed. Food Standards (Ice Cream) Order, 1951 March 1st, 1951, saw the coming into operation of the Food Standards (Ice Cream) Order, 1951, in which the minimum percentage of fat, sugar and non-fatty solids in ice-cream were laid down. The percentages given were 5 per cent. fat, 10 per cent. sugar and 7½ per cent. milk solids other than fat. Alternate percentages are allowed in the case of ice-cream containing fruit, fruit pulp or fruit puree and in "Parev" (kosher) ice-cream. Food Standards (Cream) Order, 1951 An Order came into force on 30th April, 1951, laying down the minimum standards of milk fat for various types of cream. As cream was soon taken off the market there is little need to give the various percentages. Milk (Special Designations) (Specified Areas) Order, 1951 The Public Health Service has for some years anticipated that all milk would eventually have to be pasteurised (heat treated) before distribution. Order called the Milk (Special Designations) (Specified Areas) Order, 1951, fulfilled that anticipation to a considerable degree, in that in certain Prescribed areas, London and Portsmouth, it was made illegal for any Person to sell by retail for human consumption any milk other than milk which may be sold as specially designated milk, e.g., T.T., Accredited, Pasteurised and sterilised milk. Some minor variations to the Order apply to catering sales. 33 One must look forward to the time when the provisions of the Order apply to the country as a whole, when the population can then be practically sure of safe milk. Further, most sanitarians, it can be safely said, will welcome the day when all milk will be pasteurised or sterilised. Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 The above-mentioned Act came into force on 1st January, 1951; brief account of some of the provisions follows:— Part I allows that provision may be made by regulation to secure the purity of milk, and covers the inspection of cattle on dairy farms and of dairies, for regulation in respect of ventilation, lighting, drainage and water supplies to dairies, etc. It also provides for the registration of dairymen, dairy farms and dairy farmers under regulations. Under the Act the sale of tuberculous milk is prohibited, as is the sale of milk from cows suffering from certain types of disease. Further, it is an offence to add water, dried milk, etc., to milk, and, what is more, milk with such additions is not to be sold, exposed for sale, etc. The Act allows for the making of regulations in connection with special designated milk, and for powers to enforce the same. Reference is made to the compulsory use of special designations, and it will be noted in the report that in the case of both the London and Portsmouth areas these powers have been implemented. A part of the Act is devoted to artificial cream, and provision is made for the regulation of the sale of artificial cream and for the registration of premises where it is manufactured, sold, etc. In addition to the main part of the Act there are four schedules dealing with such things as the refusal and cancellation of registrations of dairy men, dairy farmers and farmers; the revocation or suspension of licences to use special designations, etc. The Sanitary Officers (Outside London) Regulations, 1951. Medical Officer of Health, England. Sanitary Inspector. This Order came into operation on the 1st day of July, 1951, and together with the Sanitary Officers (Outside London) Regulations, 1935, is now cited as the Sanitary Officers (Outside London) Regulations, 1935 and 1951. The explanatory note to the Order I think describes how the new Order affects the old, and this note is therefore given in full as set out in the Order. These Regulations amend the Sanitary Officers (Outside London) Regulations, 1935. They apply throughout England and Wales, excluding London. The amendments are designed to relax central controls by removing the obligation to which local authorities have been subject of obtaining the 34 Minister's consent to the appointment and salaries of medical officers of health, and to proposals for the filling of vacancies, but to retain the measure of security of tenure which these officers have enjoyed. By virtue of applied Provisions of the Regulations of 1935 for which provisions are substituted by these Regulations, the position has been similar in relation to sanitary inspectors, and will be similarly affected by these regulations. In the case of medical officers of health, however, the Minister's consent to proposals for filling vacant appointments will still be required, unless the vacancies are to be filled in accordance with arrangements formulated under the Local Government Act, 1929, or the Local Government Act, 1933, for securing that medical officers of health shall not engage in private practice. 35 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 47 6 12.8 — — Diphtheria — — — — - Pneumonia 49 3 6.1 4 8.2 Cerebro-Spinal Fever — — — — — Acute Poliomyelitis — — — — — Acute Polioencephalitis — — — — — Encephalitis Lethargica — — — — — Dysentery 41 3 7.3 — —- Puerperal Pyrexia 21 20 95.2 — — Paratyphoid Fever — — — — — Enteric or Typhoid Fever - —. - — — Erysipelas 5 2 40.0 — — Malaria (contracted abroad) — — — — — Measles 1085 15 1.3 - —- Whooping Cough 427 6 1.4 1 0.23 Ophthalmia Neonatorum 1 1 100.0 - - Food Poisoning 7 — — — - 36 These cases of infectious disease have been divided into age incidence 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 47 13 28 3 3 pneumonia 49 1 4 5 2 4 8 17 8 Acute Poliomyelitis – – – – – – – – – Dysentery 41 — 14 10 1 9 5 2 — Puerperal Pyrexia 21 – – – – 7 14 – – Erysipelas 5 – – – – – – 4 1 Measles 1085 26 555 480 11 7 3 3 – Whooping Cough 427 32 211 169 3 1 6 3 2 Ophthalmia Neonatorum 1 1 – – – – – – – Food Poisoning 7 — 1 — 1 1 3 1 — Totals 1683 60 798 692 21 32 39 30 11 Pol1iomyelitis During 1951 no confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups: — 37 38 poliomyelitis incidence in wanstead and woodford, 1934 -1951 Year Population No. Notified Notification Rate Age Group Deaths Death Rate  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 — — 1951 61850 – – – – – – – – – – Tuberculosis The following table shows particulars of new cases of tuberculosis and deaths from the disease in the Borough during 1951: — New Cases Deaths Pulmonary N on-Pulmonary Pulmonary Non-Pulmonary  Age Periods M. F. M. F. M. F. M. F. Under 1 year – – – – – – – – 1-5 years 1 1 — 1 — — — — 5-10 years 1 — — 1 — — — 10-15 years — 2 – – – – – – 15-20 years 2 2 1 – – – – – 20-25 years 5 1 — 2 — —. — — 25-35 years 3 4 — 2 — — — 2 35-45 years 4 4 – – – – – – 45-55 years 6 1 — — 2 2 1 — 55-65 years 3 — — — 3 — — — 65 and over 2 — — — 2 1 — — Totals 27 15 1 6 7 3 1 2 42 7 10 3 49 13 The 13 deaths represent a death rate of 0.21 per 1,000 of the population. 39 A comparative summary over the past 17 years for the Borough is set out in the following table: — 40 Year N otifications Total Notifications Total Notification Rate Deaths Total Deaths Total Death Rate Pulmonary Non-Pulmonary Pulmonary N on-Pulmonary No. Rate No. Rate No. Rate No. Rate 1934 33 0.68 18 0.37 51 1.06 18 0.37 3 006 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 0.24 1951 42 0.68 7 0.11 49 0.79 10 0.16 3 0.05 13 0.21 Rates per 1,000 population. The register shows that at the end of the year:— 42 (41) Pulmonary and 7 (4) non-Pulmonary cases were notified for the first time during the year, 17 (26) cases were transferred into the district. No (1) cases were restored to the register. 10 (14) Pulmonary and 3 (1) non-Pulmonary cases died during the year. 28 (40) other cases were removed from the register. 405 (380) cases remained on the register at the close of the year. The figures in brackets are the comparable figures for the year 1950. 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 D. 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. Stonebank. 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: Councillor Mrs. V. P. C. Forbes. 41 Care of Mothers and Young Childre. Ante-Natal and Post-Natal Services. The following table summarises the attendances of the Ante-nata Clinic, 118 Hermon Hill, Wanstead: — Ante-Natal Post-natal Gynæcological Birth Control 781 13 19 244 Vital Statistics. These are given in Section A of this report. The birth rate of 12.4 is below that for England and Wales. The infant mortality rate was 14.2 the lowest on record for the Borough, as against 29.6 for England and Wales, and the neo-natal mortality rate was 7.8 per 1,000 live births. The deaths of infants under one year were: — Males Females Total Rate per 1,000 Live Births Legitimate 3 7 10 13.6 Illegitimate — 1 1 33.3 21 Stillbirths were notified, giving a stillbirth rate of 26.6 per 1.000 total births and 0.34 per 1,000 population. Care of Premature Infants. During 1951, 22 premature infants were born to residents of Borough, 12 of these births taking place at home and 10 in hospital or nursing home. Of those born at home 11 were alive at the end of one month; 8 of the 10 born in hospital or private nursing home survived. Child Welfare Centres The Child Welfare Centre continues to play an important part in Health Service of the Borough and by the end of the year 17,296 attedances had been made by children at the six centres, in comparison to 18,499 during the year 1950. These figures were made up as follows: Baptist Church Hall, Aldersbrook 1906 Ashton Playing Fields, Woodford Bridge 2496 St. Barnabas Church Hall, Snakes Lane 1317 Fullers Road, South Woodford 4192 Cromwell Hall, Nightingale Lane, Wanstead 3945 Holy Trinity, Hermon Hill, South Woodford 3440 TOTAL 17,296 Provision of Nuitrients 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 42 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 2 2 2 1 Nursing Mothers 1 1 5 Nil Pre-school Children 45 41 73 38 FORMS OF DENTAL TREATMENT Extractions Anaesth etics Fillings Scalings, etc. Silver Nitrate Treatment Dressings Dentures Provided Local General Complete j Partial Expectant Mothers 2 2 Nil Nil Nil Nil Nil Nil Nil Nursing Mothers 1 1 Nil 1 Nil Nil 2 Nil Nil Pre-school Children 27 1 22 24 1 72 23 Nil Nil Nursery The admission of children to the day nursery in Spratt Hall Road, Wanstead has continued on the same lines as in 1950, 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 30 per cent. of the places are occupied by applicants in this group. 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. 43 The following table shows the attendances made, together with the daily average: — Quarter Ending Attendances A Under 1 year 1-2 years 2-3 years Over 3 years TOTAL Days Open Average Daily Attendance 31st March 102 400 389 1326 2217 63 35.2 30th June 74 555 632 1342 2603 64 40.6 30th September 66 397 463 1442 2368 64 37.0 31st December 80 309 507 1454 2350 62 37.9 TOTAL 322 1661 1991 5564 9538 253 37.7 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 Authoritv. At the end of the year the number of premises and child minders in the Borough registered with the County Council were: — Registered No. of children Premises 1 25 Child Minders 2 6 The Daily Guardian scheme in operation in the Borough has been continued and at the end of the year three guardians were registered with and subsidised financially by the County Council. Health Visiting. The following table sets out statistically the work of the Health VisitorS in the Borough during 1951: — Expectant Mothers (first visits) 125 Expectant Mothers (re-visits) 37 Infants under 1 year (first visits) 749 Infants under 1 year (re-visits) 1896 Infants 1 to 5 years (first visits) 257 Infants 1 to 5 years (re-visits) 3039 Stillbirth enquiries 15 44 Infant Deaths 7 Tuberculous Patients 1452 Aged and Infirm 8 Day Nursery Applications 68 School Children 397 Other Visits 260 TOTAL 8310 Midwifery and Home Nursing. The number of domiciliary confinements in the Borough attended by the County Council's midwives was 193, 130 in their capacity as midwife and 63 as maternity nurse. Of this total 127 received gas and air analgesia, a percentage of 66.3. Puerperal Pyrexia Regulations, 1939. During the year 21 cases of puerperal pyrexia were notified, 20 of these following hospital confinement and one domiciliary. This figure of gives a notification rate of 26.6 for the Borough as compared to 10.66 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 12 of these cases occurred in patients who reside outside the Borough but whose confinement took place in a hospital within the Borough. The regulations provide that the notification must be accepted by the Authority in whose area the hospital is situated since the disease occurs at that address. So far as residents of this district are concerned, nine cases Occurred which would produce a true notification rate to residents, per 1,000 total births, of 11.4. Maternal Mortality. Two deaths occurred as a result of pregnancy, child-bearing or associated therewith and are referred to in Section A of this report. ophthalmia Neonatorum. One case of ophthalmia neonatorum occurred in the Borough during the year 1951. Home Nursing. 45 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: 1951 1950 Pre-school cases 51 36 School children 46 20 Adults 839 682 936 738 Number of Visits: Pre-school cases 160 175 School children 293 88 Adults 14815 13074 15268 13337 Last Offices performed 47 52 Advisory or Casual Visits: Pre-school cases 1 3 School children 4 1 Adults 235 86 240 90 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 who completed a full course of primary immunisation against diphtheria during the year is set out below: — Under 5 years of age 667 5 to 15 years of age 143 810 The number of children who received a secondary or re-inforcing infection was 403. The number of persons vaccinated or re-vaccinated during the year 1951 were: — Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 400 78 127 86 691 Re-vaccination 3 10 35 295 343 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, 1951:— 46 Year of birth Number Year of birth Number 1951 105 1943 476 1950 377 1942 613 1949 587 1941 725 1948 860 1940 649 1947 785 1939 574 1946 767 1938 419 1945 845 1937 341 1944 584 1936 345 TOTAL 9052 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. 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 19 cases from the Borough have been sent away. The length of convalescence was: — Two weeks 11 Three weeks 7 Four weeks 1 Domestic Help Service. The demands on the Domestic Help service have been maintained during the year, a total of 30,916 hours of help being supplied in comparison with 33,330 hours in 1950. 47 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. 1. School Medical Inspections. All children in maintained schools are examined three times during their school life; (i) soon after their admission to school for the first time (ii) during their last year in the primary school and (iii) during their last year at school. Pupils may also be specially examined at any other time during school life at the request of the parent or Head Teacher. During 1951, a Medical Officer made 95 visits to schools in Wansted and Woodford (including Forest View Temporary School at Chingford which accommodates children from this Borough) for the purpose of carrying out medical examinations. 2. Minor Ailment Clinics. 405 individual pupils made 633 attendances at the School Clinic at 93 High Road, South Woodford, during 1951. 352 defects were discovered, particulars of which are given in a table later in this report. 3. Ophthalmic Service. This service is one of the Regional Hospital Board's Specialist Services and is known as the Hospital Eye Service. One of the Board's ophthalmologists regularly visits the School Clinic at South Woodford to see schoolchildren recommended by School Medical Inspectors for investigation of eye defects. During the year under review, the ophthalmologist visited on 42 occasions, saw 735 children and prescribed spectacles for 276. 4. Poliomyelitis. No schoolchildren were affected. 5. Diphtheria Immunisation. All schoolchildren, on admission to school for the first time at the age of five years, are given a leaflet to take home to their parents, which 48 emphasises the need for protection against diphtheria by means of immunisation, and every facility is made for the child to be immunised once the Parent has given consent. Trials of Anti-Tuberculosis Vaccine. In conjunction with the Medical Research Council, investigations as to the value of B.G.C. (Bacillus Calmette-Guerin) immunisation have continued during the year. All the participants are volunteers and are selected from children aged 14½, who are about to leave secondary modern schools. Two schools in this Division are involved. The first part of the scheme (initial tuberculin testing, x-raying and inoculation of selected volunteers) is now nearing completion, and the last of the present series of these trials will take place in January, 1952. The second part of the scheme, that of following up the volunteers by regular annual inspection after they leave school, will then commence, and continue for a period of three years. In the meantime, with the object of keeping in contact with every participant, and reminding him of his part in the scheme, Health Visitors visit the home twice a year to enquire of the health of the volunteer and the nature of his employment, and to record any illnesses or contact with tuberculosis. 49 Defects found by medical examination of school children. The following table shows the defects found in school children as 3 result of examination by Medical Officers: — Defect No. found to require treatment No. treated at Clinic No. to be kept under observation Skin 17 2 4 Eyes (a) Vision 26 2 27 (b) Squint 4 — — (c) Other 15 1 4 Ears (a) Hearing 5 — 3 (b) Otitis Media — — — (c) Other 4 — 2 Nose or Throat 16 — 8 Speech 7 — 4 Cervical Glands — — 2 Heart and Circulation 3 — 1 Lungs 8 — 17 Developmental (a) Hernia — — — (b) Other 2 — — Orthopaedic (a) Posture 4 — 1 (b) Flat Foot 6 — 1 (c) Other 11 — 10 Nervous System (a) Epilepsy — — 1 (b) Other 3 — 3 Psychological (a) Development 6 — 3 (b) Stability 7 — 6 Other 203 62 26 50