AC 4411 (1) LIBRARY WANSTEAD (WOOD)FOR WANS 17 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1952. PUBLIC HEALTH COMMITTEE Councillor N. E. Britton (Chairman) Councillor R. A. Dalton (Vice-Chairman) Alderman R. W. Dale Alderman A. H. Southam Alderman V. E. Stevens Councillor Mrs. S. V. F. Ashton Councillor F. B. Baverstock Councillor C. H. Moss Councillor S. J. Relph 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) G. F. Downing, M.R.San.I., M.S.I.A. (a) (b) (d) (f) Clerks: A. M. Rowlatt (from 4.2.52) Mrs. V. Birkett (a) Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board Certificate. (6) 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. (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 Wansteud and Woodford Borough Council to 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 1952. In this report, as in previous years. reference is made to the personal health services controlled by the Esses County Council and decentralised to the Forest Health Area Sub-Committee of the County Health Committee. An account of the work of the School Health Service is also given. Vital Statistics the total number of live births for the year was 751 as compared with 768 for the previous year. This decline is smaller than in previous years and seem that, following the steep post-war rise and subsequent decline, this figure is now tending to become constant. The birth rate per thousand of the population is 12.1 compared with 15.3 for England and Wales. It is also somewhat lower than that for the average of six per-war years, which was 13.2. This may be accounted for by the continually increasing number of old people in the population. The number of teaths occurring was 666 as compared with 668 for 1951. This gives a death rate per 1,000 10.8 compared with a figure of 11.3 for England and Wales. of infant mortality rate, i.e., the death rate of infants under 1 year of agr per 1,000 live births was 22.6. This shows an increase on the figures for the two previous years, which were 14.2 and 18.9 respectively. It is however lower than the figure for England and Wales, i.e., 27.6. Infectious Disease For the fourth successive year no case of diphtheria occurred. Details of immunisation measures against this disease will be found on a subsequent page. Diphtheria is now becoming a rare disease and is unknown to may of the younger generation. Hence it is more than ever necessary to ensure that all children, by the time they have reached the age of one year, are adequately protected by immunisation, and that a further injection is giver at the time when the child commences to attend school. 3 The commonest of the infectious diseases to be notified were measles and whooping cough. 697 cases of measles occurred compared with 1,085 in 1951. The disease was mild generally, but one case proved fatal. Tuberculosis 51 new cases of tuberculosis were reported compared with 49 in 1951. There were 10 deaths compared with 13 in 1951. It is gratifying to note that in October, 1952, the Chest Clinic at Harts Hospital was able to extend its scope and to deal with patients from all parts of the Borough. Previously persons living south of the Southend Road were attending at Leyton. The present clinic is run on modern lines, possessing all facilities for diagnosis and out-patient treatment. An excellent liaison exists between the Chest Physician, Dr. Duff-Palmer, and myself. Such a liaison is very necessary, as under the conditions of the National Health Service Act, Regional Hospital Boards are responsible for the work of diagnosis and treatment undertaken at Chest Clinics, while the Local Authorities control preventive measures, including the work carried out by the Tuberculosis Health Visitors. Poliomyelitis Eight cases of poliomyelitis were confirmed during the year, seven of whom were normal residents of the Borough, the eighth, having been diagnosed in Wanstead Hospital, being a man whose home was at Chadwell Heath. Six of the seven cases were in children whose ages ranged from 4 to 14, the seventh being an adult female aged 33. No case proved fatal and there was no known contact between any two cases. All cases showed a degree of paralysis, five being classified as mild, one as moderate, and one as severe. The Borough constituted part of an area for which arrangements had been made early in the year by the Ministry of Health for a special pilot survey to be conducted. The object of this survey was to obtain accurate information regarding each case of poliomyelitis occurring, so that conclusions might be drawn regarding the mode of spread of the disease. It is understood that the result of the survey will be available at an early date. Weather conditions Mention must be made of the abnormal weather conditions during the earlier part of December, when, in common with the whole Metropolitan area, the Borough was enveloped in fog for five days. During the week ending 13th December deaths registered in Wanstead and Woodford totalled 34, whereas in the previous week the figure was 15. In the County of London these figures were 2,484 and 945 respectively. This comparatively high death rate persisted, though to a lesser degree, during the two 4 quent weeks. Most of the deaths were of elderly persons who had already suffered from disease of the heart or lungs. A request for details of the deaths in the Borough during this period has been made by the Department of Scientific and Industrial Research, to whom particulars have been sent. The results of an investigation at present being carried out regarding the pollution of the atmosphere at this time are awaited with interest. I would express my thanks to the staff of the Public Health Department for their loyalty and co-operation throughout the year. My sincere appreciation is given to the Chairman, Vice-Chairman and Members of the Public Health 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. 31st July, 1953. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3.824 Population—Registrar-General's estimate mid-year 1952 61,880 Registrar-General's census 1951 61.850 Rateable value £625,228 Sum represented by penny rate £2,540 Extracts from Vital Statistics of the Year Live Births: Legitimate Males 358 Females 371 Total 729 Illegitimate Males 14 Females 8 Total 22 Total Males 372 Females 379 Total 751 Birth-rate per 1,000 of the estimated resident population—12.1 Stillbirths: Legitimate Males 5 Females 4 Total 9 Illegitimate Males 1 Females — Total 1 Total ... Males 6 Females 4 Total 10 Rate per 1,000 total (live and still) births—13.1 Deaths: Males— 329 Females— 337 Total— 666 Death-rate per 1,000 of the estimated resident population— 10.8 Deaths from puerperal causes:— Puerperal and post-abortion sepsis — Other maternal causes 1 Total 1 Rate per 1,000 total (live and still) births— 1.31 Deaths of Infants under one year of age:— All infants per 1,000 live births 22.6 Legitimate infants per 1,000 legitimate live births 23.3 Illegitimate infants per 1,000 illegitimate live births — 1952 1951 Deaths from Cancer 127 130 „ „ Measles 1 Nil „ „ Whooping Cough 1 1 „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 4 5 „ „ Suicide 3 5 „ „ Other violent causes 10 6 6 Population The Registrar General's estimate of the population for 1952 (mid-year) was 61,880 an increase of 30 on the figure for the 1951 census. 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 nineteen years. 7 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1952. England and Wales, London, 160 Great Towns and 160 Smaller Towns. (Provisional Figures based on Quarterly Returns) England and Wales 160 County Boroughs and Great Towns including London 160 Smaller Towns (Resident populations 25,000 to 50,000 at 1951 Census) London Administrative County Borough of l WANSTEAD and \ WOODFORD Births: (Rates per 1,000 Home Population) Live 15.3 16.9 15.5 17.6 12.1 Still 0.35 0.43 0.36 0.34 0.16 Deaths: All Causes 11.3 12.1 11.2 12.6 10.8 Typhoid and Paratyphoid 0.00 0.00 0.00 – – Whooping Cough 0.00 0.00 0.00 0.00 0.02 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.24 0.28 0.22 0.31 0.16 Influenza 0.04 0.04 0 04 0.05 0.03 Smallpox 0.00 — — — – Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.00 0.01 – Pneumonia 0.47 0.52 0.43 0.58 0.74 Notifications: Typhoid Fever 0.00 0.00 0.00 0.00 — Paratyphoid Fever 0.02 0.02 0.03 0.01 — Meningococcal Infection 0.03 0.03 0.03 0.02 0.03 Scarlet Fever 1.53 1.75 1.58 1.56 1.79 Whooping Cough 2.61 2.74 257 1.66 2.86 Diphtheria 0.01 0.01 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.14 0.10 Smallpox 0.00 0.00 0.00 — — Measles 8.86 10.11 8.49 9.23 11.10 Pneumonia 0.72 0.80 0.62 0.57 0.47 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.06 0.06 0.06 0.06 0.13 Non-Paralytic 0.03 0.03 0.02 0.03 — Food Poisoning 0.13 0.16 0.11 0.18 0.16 Deaths: (Rates per 1,000 Live Births) All causes under 1 year of age 27.6 31.2 25.8 23.8 22.6 Enteritis and Diarrhoea under 2 years 1.1 1.3 0.5 0.7 Notifications: Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 17.87 23.94 10.22 30.77 102.5 8 Materanal Mortality Abortion with Sepsis Other Abortion Complication of Pregnancy Sepsis of Childbirth and the Pueperium Other England and Wales 0.07 0.06 0.20 0.09 0.30 Wanstead and Woodford — — — — 1.31 Causes of Death as given by the Registrar-General, 1952 Causes of Death Males Females Total 1.Tuberculosis (Respiratory) 6 4 10 2. Other forms of Tuberculosis – – – 3. Syphilitic Disease 2 – 2 4. Diphtheria – – – 5. Whooping Cough — 1 1 6.Meningocecal Infections – — — 7.Acute Poliomyelitis – – – 8.Measles 1 – 1 9.Other Infective and Parasitic Diseases 1 1 2 10.Malignant Neoplasm—Stomach 6 16 22 11.Malignant Neoplasm—Lung and Bronchus 23 7 30 12.Mlalignant Neoplasm—Breast – 11 11 13. Malignant Neoplasm—Uterus – 4 4 14.Malignant Neoplasm—Others 28 32 60 15. Leukæmia – 2 2 16 Diabetes 1 5 6 17.Vascular Lesions—Nervous System 34 54 88 18. Coronary Disease, Angina 62 21 83 19. Hypertension with Heart Disease 7 7 14 20. Other Heart Disease 43 65 108 21. Other Circulatory Disease 11 15 26 22. Influenza – 2 2 23. Pneumonia 19 10 29 24.Bronchitis 30 23 53 25.Other Respiratory Diseases 4 2 6 26. Ulcer of Stomach or Duodenum 5 6 11 27. Gastritis, Enteritis and Diarrhoea 1 1 2 28. Nephritis and Nephrosis 2 2 4 29 Hyperplasia of Prostate 5 — 5 30. Pregnancy, Childbirth, Abortion – 1 1 31 Congenital Malformations 1 1 2 32. Other Diseases 26 38 64 33. Motor Vehicle Accidents 4 — 4 34. All Other Accidents 4 6 10 35. Suicide 3 — 3 36. Homicide and Operations of War — — — Totals, 1952 329 337 666 Totals, 1951 329 339 668 9 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. Per 1,000 Live Births 1952 751 12.1 10 13.3 0.16 15 20.0 17 22.6 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five year 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 Total 1952 761 — 1 1 — 1.31 1.31 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 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate (per 1,000 Live Births) 1952 1951 1950 1949 194 8 Maternal Mortality 1.33 2.60 1.18 1.19 1.02 Stillbirths 13.3 27.3 25.9 26.2 20.4 Neo-Natal Mortality 20.0 7.8 16.5 14.3 15.3 During 1952 there was one death classified as being due to pregnancy, childbearing or associated therewith. 10 TOTAL INTANT MORTALITY. 1934 to 1952. 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 sinnce 1934. TREND OF BIRTH AND DEATH RATES, 1934 TO 1952 Comparative Statistics of Births, Mortality, etc., 1934 to 1952 Live Births Still Births Deaths Infont Deaths Maternal Deaths Year Population No. Rate* No. Rate No. Rate* No. Rate‡ No. Rate 1952 61880 751 12.1 10 13.1 666 10.8 17 22.6 1 1.31 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 8.0 *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, and by the Counties Public Health Laboratories. 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.11. Thursday, 2.30-4 p.m. Holy Trinity Church Hall, Hermon Hill, South Woodford, E.l8. Friday, 2.30 - 4 p.m. 4. Ante-Natal Clinic 118 Hermon Hill, Wanstead. Thursday, 2.30 - 4 p.m. 5. School Clinic, 93 High Road, Woodford Dental—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. All day Tuesday and Thursday afternoon. For after-treatment by appointment only. Speech Therapy—Monday and Wednesday only during school By appointment only. †Controlled by the North-East Metropolitan Regional Hospital Board and delegated to the Forest Group Hospital Management Committee. 12 Chest Clinic Harts Hospital, Woodford Green. Wednesday, 9.30 - 12 a.m. and 5-6 p.m. Friday, 9.30 - 12 a.m. Ambulance Facilities These facilities are available through the local depot at Wanstead, the service being administered centrally by the County Council from Chelmsford. 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 1952. Funeral arrangements In one instance the Local Authority was required to make arrangements for the burial of a person during the year 1952. 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 treated water. The results obtained from treated water were satisfactory. Copies of these reports are received regularly from the Board. Refuse and Salvage Collection (a0 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. The collection of waste paper for salvage has been continued. (c) Kitchen Waste Collection. The collection of kitchen waste in the Borogh 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 bacteria beds, the filtering medium is in an exhausted condition and the Council has been asked by the Ministry of Housing and Local Government to consider the possibility of alternative methods of improving the degree of treatment with a view to obviating the expense of renewing the filters. Experimental work is in progress with this end in view. (b) Southern Sewage Disposal Works. A scheme in outline form for modifying and extending these works has been submitted to the Ministry of Housing and Local Government, 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 the impurity content of the effluent has been kept as low as possible having regard to the condition of the treatrnent plant. (c) Western Sewage Disposal Works. The intended diversion of 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:— Housing Act, 1936 Reference is made in the Report for 1951 to the Medical Officer's representation in connection with a set of cottage property known Slater's Cottages. The Clearance Order was confirmed by the Minister and arrangements were made for the rehousing of the occupants. Four Demolition Orders were made during the year and one Closing Order made on a basement flat. The owners of two other dwellings agreed not to relet the properties concerned after the tenants had been rehoused. These dwellings form Part of a terrace of sixteen, and when all are vacated the owners have agreed to demolish them and clear the site. Unfortunately the site is too small for building houses. During the year the representatives of the sub-committees of the Public Health and Housing Committees were presented with a list of sub-standard houses consisting of some 266 dwellings for consideration with a view taking action under the Housing Act. The list was divided into two sections, 14 the first containing houses which it was suggested should be dealt with in the near and the second premises for consideration in 5 - 10 years time The joint sub-committees, in discussing the list, selected a number of properties for inspection. These joint meetings of sub-committees have done good work in the past and a future report will indicate steady progress. As previously reported, this arrangement ensures the close co-operation of the Public Health and Housing Departments, which is so necessary when houses have to be demolished and tenants rehoused. It must be recorded here how much the co-operation of the Housing Manager and his staff has been appreciated. Two old cottages, which were the subject of demolition orders in 1951 were demolished during the year. Commenting on works under Section 9 of the Housing Act, it can be teported that the County Court Judges heard two appeals against the requirements of Notices. In the first case there appears to have been some misunderstanding on the part of the owner, who subsequently agreed that the Council should do the work. The Judge agreed to this arrangement. The second case was an appeal mainly against the provision of a food store and small items of redecoration. The Judge amended the Notice so as to exclude the food store and decoration after works to remedy dampness. He stated that he did not think the scullery was a suitable place for a food store. public Health Act, 1936 In one case only was it necessary to take proceedings for default on the part of the owner to comply with the requirements of a Statutory Notice An order was made requiring the work to be done, and it was duly executed by the Local Authority in agreement with the owner. Sixteen premises were redrained and five Public Sewers were repaired; this work involved expenditure on the part of the owners to close on £950. Roseny Control The Council still employ a full time rodent operative. He is not troubled with major infestations, the work involved being scattered about the Borough and consequently a good portion of his time is taken up in travelling. Treatment of business premises is on a small scale and involves mainly shop Premises. In this connection treatment is carried out for which a 15 charge is made in accordance with the instructions contained in the Ministry of Agriculture and Fisheries Circular. The treatment of sewers on the lines laid down by the Ministry of Agriculture and Fisheries was carried out twice during the year and the results are shown in another part of this Report. Arrangements were made and supervised as previously by the Deputy Senior Sanitary Inspector. Warfarin, the newest of the poisons, continued to be used with good effect. It must be remembered that Warfarin is an addition to the usual poisons, and is not used to replace them. It is used when difficulty is experienced with other poisons and is in most cases effective when other materials are less so. Warfarin has also been found to be effective against mice. Close co-operation and good harmony exists with the officials of the Ministry of Agriculture and Fisheries, and the quarterly meetings are most helpful. 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 98 Complaints received 333 Retreatments 5 Total Premises visited 541 Number of baiting points 3,857 Rats found dead 97 16 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 22 22 44 26 2 86 — 86 36 19 55 31 3 75 — 75 24 13 37 38 4 77 — 77 27 22 49 28 5 77 4 73 27 16 43 30 6 80 — 80 32 15 47 33 7 79 — 79 41 10 51 28 8 66 — 66 35 — 35 31 9 82 — 82 38 11 49 33 10 75 — 75 33 14 47 28 11 69 — 69 33 13 46 23 12 70 — 70 29 14 43 27 13 69 — 69 34 16 50 19 14 79 1 78 38 20 58 20 15 77 — 77 29 18 47 30 16 71 — 71 32 14 46 25 17 68 — 68 31 11 42 26 18 77 — 77 34 13 47 30 19 72 — 72 29 15 44 28 1419 5 1414 604 276 880 534 17 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 — 70 28 18 46 24 2 86 — 86 36 19 55 31 3 74 — 74 27 13 40 34 4 77 — 77 22 14 36 41 5 77 — 77 27 8 35 42 6 80 — 80 24 19 43 37 7 79 — 79 26 15 41 38 8 66 — 66 10 24 34 32 9 80 — 80 12 29 41 39 10 75 — 75 7 21 28 47 11 69 — 69 29 12 41 28 12 70 — 70 22 16 38 32 13 69 — 69 29 20 49 20 14 81 — 81 31 19 50 31 15 77 — 77 24 17 41 36 16 71 — 71 29 17 46 25 17 68 — 68 30 15 45 23 18 77 — 77 30 16 46 31 19 72 — 72 27 15 42 30 1418 — 1418 460 337 797 621 18 Rag Flock and Other Filling Materials Act, 1951 No additional registrations have been made under this Act, the number of Premises registered in the Borough remaining one. Petroleum (Regulation) Acts, 1928 and 1936 Fifty-five licences were renewed at the beginning of the year, and three new licences were granted. Game Licences Fourteen licences to deal in Game were renewed and two new licences were granted. The Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulation, 1949, and Raw Milk Regulations The following licences were issued:— Dealers Lincences Pasteurised 11 Sterilised 18 Tuberculin Tested 11 Supplementary Licences Pasteurised 8 Sterilised 9 Tuberculin Tested 8 Shops Act,1934 Thirty-seven visits were made under this Act. 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. Twelve visits were made during the year. Inspections carried out by Sanitary Inspectors Infectious disease enquiries, including enquiries in respect of scabies 100 Visits in connection with contacts, disinfection, etc. 24 Enquiries in connection with food poisoning 6 Verminous premises 12 19 General Environmental Public Health Drains and Sewers inspected 1014 Drain tests applied 211 Stables and manure pits inspected 12 Public Conveniences 2 Overcrowding 29 Factories (mechanical) 138 Factories (non-mechanical) 9 Hairdressers' premises 10 Schools 49 Ditches and Streams 22 Open spaces and playing fields 1 Tents, Vans and Sheds (including gipsy encampments) 3 Petrol Installations 82 Pig Styes 1 Cesspools 1 Shops Act inspections 37 Outworkers premises 21 Massage establishments 12 Pet Animals Act 10 Merchandise Marks Act 19 Swimming Baths 10 Smoke observations 11 Miscellaneous visits 135 Inspection of Food Premises Meat Shops 195 Bakehouses 41 Fishmongers 62 Grocers 186 Restaurants and Cafes 75 Dairies and Milk Shops 26 Greengrocers 57 Ice Cream premises 114 Hotels, Boarding Houses and Public Houses 1 Street Vendors 1 Total 2739 20 SECTION D. HOUSING No. of houses erected during 1952: 83 Council; 55 Private enterprise; 3 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) 1253 (b) Number of inspections made for the purpose 2422 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 219 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 221 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 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 6 (b) By Local Authority in default of owners 3 21 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 88 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 58 (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 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 Housing Act, 1936—Part IV—Overcrowding Twenty-nine 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 house two or more families, and it is difficult to visualise when normal conditions of one family per house will be resumed. 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 81 External walls and chimney stacks repaired 37 Gutters and spouts repaired or renewed 51 Damp-proof courses provided 5 22 Dampness remedied 131 Yards paved or repaired 8 Internal walls and ceilings repaired 150 Doors and frames repaired or renewed 18 windows repaired or renewed 63 Floors repaired or renewed 37 Sub- floor ventilation provided or improved 4 Rooms cleansed or redecorated 20 Stoves repaired or renewed 9 Staircases repaired and handrails provided 2 Fireplaces and flues repaired or renewed 21 Washbasins and sinks provided or renewed 3 Wastepipes repaired or renewed 10 Dustbins provided or renewed 7 Water supply improved or reinstated 6 water closet walls and ceilings cleansed 4 Water closet pans repaired, renewed or cleansed 4 water closet cisterns repaired or renewed 16 Water closet structures repaired or rebuilt 4 Water closet flush pipe joints repaired 4 Drains cleansed from obstruction 193 Drains repaired or renewed 20 Miscellaneous 9 disinfection and Disinfestation Number of rooms disinfected 85 Premises from which bedding removed for steam disinfection 81 Number of rooms disinfested 12 23 Essex County Council Act, 1933 Provision is made in this Act making it necessary to apply to the Local Authority for permission to place or keep on land moveable dwellings, such as caravans, etc. Two applications were made during the year to place caravans on sites in different parts of the Borough. The difficulty which young families have to face with regard to housing accommodation was reflected in the case of the first applicant. He could not get suitable accommodation for himself, his wife and baby son, so he resorted to considering the prospect of living in a caravan. The public Health Committee considered the case carefully and decided to refuse the application, whereupon he appealed to a Court of Summary Jurisdiction, which allowed the appeal, subject to the following conditions:— 1. A mains water supply to be provided on the site. 2. An internal chemical closet to be provided. 3. The carrying out of necessary additions, modifications and repairs. The second application was withdrawn. This was a case of housing temporarily an employee of an industrial undertaking. The appointment was terminated earlier than anticipated, thus the undertaking withdrew the application. 24 FACTORIES ACT, 1937 Inspections for the purposes of provisions as to health (including Inspections made by Sanitary Inspectors). Premises (1) Number of Number on Register Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 53 9 1 — (ii) Factories not included in (i) to which Section 7 applies — — — — (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 176 138 6 — (b) Other — — — — (iii) Other Premises under the Act (excludoing out-workers' premises) — — — — Total 229 147 7 — 2. Defects found. Particulars. Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector of Cleanliness 3 3 … … Overcrowding … … … … Unreasonable temperature … … … … Inadequate Ventilation … … … … Ineffective drainage of floors … … … … Sanitary Conveniences:— Insufficient 3 3 … … Unsuitable or defective 1 1 … … Not separate for sexes … … … … other Offences 2 2 … … Total 9 9 … ... In addition to the table shown above, it can be reported that 8 Certi- ficates were issued in connection with Section 34 (Means of Escape in Case of Fire). and two were amended following structural alterations. 25 SECTION E. FOOD AND DRUGS ACT, 1938 In considering the reports of the Public Analyst for the year 1952, it is fitting to mention the following items, which may be of interest to the reader. 1. Alleged horseflesh—stewing steak. In May a member of the Public brought a portion of meat bought in a local shop to this Department, alleginng that it was horseflesh. The inspector's view was that it was not horseflesh and a subsequent examination by the Public Analyst confirmed that this was so. 2. Imported Brawn. The Public Health Department was concerned for quite a long period with some imported tinned brawn, which when opened up showed a black surface. The Inspectors were not satisfied that the product was unfit for human consumption, consequently the advice of the Public Analyst was obtained, and he confirmed that opinion. The contents of two tins were examined, one having been opened and one unopened. As a matter of interest extracts from the Analysts reports are given below. “Opened can—The contents showed no external evidence of contamination by the metal of the can except on the bottom end where both the metal and the surface of the brawn were very black. 26 3. Outwork Number of out-workers in August list required by Section 110(1)(c).— Wearing apparel — making, etc. 86 Furniture and Upholstery 1 File Making 1 Artificial Flowers 1 Paper Bags 5 Boxes 5 Brushes 2 Stuffed Toys 3 Xmas Crackers 1 105 Metallic contamination Brawn at top Blackened brawn at end of can bottom end of can Lead 2.8 parts 3.0 parts per million per million Tin 0.6 grain 1.4 grain per pound per pound Unpened—When opened there was a slight 'metallic' or 'sulphury' smell. The appearance of the brawn, including the outside surface, was normal although the whole of the inside surfaces of the can were blackened. The taste of the brawn was satisfactory. Bacteriological examination—sterile. Metallic contamination—The thin sections of brawn against the blackened sides were analysed. Lead 3.5 parts per million. Tin 0.5 parts per million. Conclusions—The evidence afforded by our examination is that the discolouration of the brawn was not due to any bacteriological activity but to some interaction between the meat of the brawn or ingredients of the brawn and the metal of the cans. Such interaction even when slight would account for any 'sulphury' smell and blackening because the reaction between the iron of the can and the traces of sulphur naturally present in meat would yield black sulphide of iron and free sulphur. The amounts of tin and lead found to be present cannot be considered as harmful and there is therefore no reason other than the appearance of the brawn why it should not be used for human consumption." As 30-40 cases, each containing 12 tins were involved, consultations took place with the Public Health Department of Stepney and the Ministry of food during which time the local consignment was held by the whole- sale butcher. After about five months a further examination was made with the following result. “ This sample consisted of an unopened tin. When opened there was a strong sulphury smell faintly suggestive of decomposition. When turned out the roll was found to have a long black line on a thin fat layer with corresponding marks on the inside of the tin. There were also some black areas at one end of the roll. These black fatty areas were cut out and analysed in comparison with clean portions of meat taken from the centre of the roll with the following results— Tin Lead Black areas 0.3 grain per pound 0.5 part per million Sound areas 0.3 grain per pound 0.5 part per million Having regard to the objectional smell, and to the discolouration, I am opinion that this roll of meat was no longer suitable for human consumption though the contamination with tin and lead cannot be regarded as harmful.” The matter was finally closed by the withdrawal of the consignment. 27 3. Pork Sausages. Three samples of pork sausages were reported upon by the Public Analysts as containing deficiencies in meat, the details are given below. 1. Meat content 58%, deficiency 10% of minimum quantity. 2. Meat content 45%, deficiency 30% of minimum quantity. 3. Meat content 57%, deficiency 12% of minimum quantity. These samples were informal and were purchased late in the year. Because of the difficulty of obtaining further specimens, repeat and forma samples could not be obtained until 1953. 4. Ice Creflm. Complaint was received of a sample of coffee flavoured ice cream which the purchaser alleged tasted of disinfectant. The result of the analysis did not confirm this allegation, the Public Analyst reporting it to be genuine ice cream. 28 A list of food sampled is given below:— Butter 1 Milk 10 Margarine 1 Glace Cherries 1 Cooking Fat 1 Ground Nutmegs 1 Semolina 1 Baking Powder 1 Ground Rice 1 Blancmange Powder 1 Cheese 1 Xmas Pudding 1 Bacon 1 Luncheon Meat 1 Coffee 1 Malt Vinegar 1 Sugar 1 Vermicelli 1 Meat Paste 1 Soup 2 Gelatine 1 Frying Oil 4 Pepper 2 Strawberry Jelly 1 Curry Powder 2 Saccharin Tablets 1 Mixed Spice 1 Olive Oil 1 Tarts 6 Lucozade 1 Mincemeat 1 Sulphur Tablets 1 Pork Sausages 11 Boracic Powder 1 Beef Suet 1 Liquid Paraffin 1 Flour, Self Raising 1 Syrup of Figs 1 Mixed Herbs 1 Cascara Sagrada 1 Sage and Onion Stuffing 1 Friars Balsam 1 Desiccated Coco-nut 1 Glaubers Salts 1 Stewing Steak 1 Bisurated Magnesia 1 Black Pudding 1 Cream of Magnesia 1 Pork Pie 1 Glycerin of Thymol 1 Pork Brawn 3 Zinc Ointment 1 Fish Cakes 1 Siedlitz Powder 1 Steak Pies 1 Tincture of Iodine 1 Meat Pie 2 Camphorated Oil 1 Ground Almonds 2 Quinine Bisulphate 1 Ice Cream 10 Total 104 Eight 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: 10.2 per cent., 11.8 per cent., 8.9 per cent., 4.8 per cent 10.8 per cent., 11.6 per cent., 10.1 per cent., 12.9 per cent. The following is a list of foods surrendered in 1952 because of unsound conditions Fish Fresh Milk, Tinned Whiting 3 stone Evaporated 22 tins Haddock Fillets 2 stone Skimmed 1 tin Bream 5 stone Full Cream 6 tins Lemon Soles 1 stone Meat, Tinned Luncheon Meat 135 tins Prawns 45 lbs. Fish Smoked kippers 1 box Luncheon Meat 3¼ lbs. Veal, Jellied 13 tins fish Tinned. herrings 1 tins Veal, Jellied 6 lbs. Beef Loaf 12 tins Sardines 9 tins Veal Loaf 12 tins Salmon 2 tins Ham and Veal Loaf 48 lbs. Pilchards 1 tins Ham 893½ lbs Shrimps 3 tins Ham 13 tins Lobster 2 tins Pork 13 tins Tinned Rhubarb Sausages 55 lbs Luncheon Sausage 2¼ lbs. Apples 26 tins Chicken 1 tin Gooseberries . 3 tins Pork Brawn 20 tins plums 109 tins Tongue 5 tins Pineapple Stewed Steak 15 tins Grapes 4 tins Tongues and Veal 1 tin Peaches 5 tins Braised Kidneys 7 tins Apricats . 3 tins Braised Hearts 1 tin Raspherries 5 tins Meat, Fresh Beef 1030 lbs. Oranges 11 tins Damsons 25 tins Mutton 801¾ lbs. Pears 2 tins Mutton, Cooked 8 lbs. Greengages 1 tin Lamb 345 lbs. Cherries 36 tins Pigs Maws 10 barrels Strawberries 2 tins Calves Heads 67 lbs. Fruit Salad 8 tins Pork Butts 16½ lbs. Grapefruit Juice 1 tins Rabbits 60 ibs Pineapple Juice 1 tins Bacon 47¼ lbs. Vegetables Tinned Peas 43 tins Miscellaneous Cheese 4 pkts. Beans 17 tins Mincemeat 4 jars Carrots 5 tins Soup 7 tins Tomatoes 22 tins Chocolate Tea Cakes 379 Vegetables, Mixed 1 tins Potted Meats and Pastes 11 jars 29 MANUFACTURE, STORAGE AND SALE OF ICE CREAM Sixty-one registrations of premises were in force at the beginning the year and a further nine were added during the year. In connection with unsatisfactory bacteriological results of samples ice cream, the Public Health Committee continued their policy of interviewing proprietors of premises where such samples were obtained. Three proprietors were so interviewed and their observations obtained on the samples. The interviews were again helpful because the desired result Was obtained — a far better sample, in keeping with good standards. One applicant for the registration of his premises for the sale of ice cream was interviewed to show cause why his premises should not be so registered. The Committee agreed not to register the premises and later the applicant withdrew his request for registration. Ice Cream Samples (Bacteriological examinations) Although there is no bacteriological standard for ice cream the Public Health Department nevertheless obtained 110 samples to submit to 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. It is generally recognised that the ice-cream is bacteriologically sound when1 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 30 Christmas Pudding 1 Butter ½ lbs. Jam and Marmalade 6 jars Custard Powder 35 lbs. Salad Cream 2 jars Prunes 291¼ lbs. Ketchup 2 bottles Flaked Rice 14 lbs- Pickles 1 jar Rice 25½ lbs. Macaroni 2 packets Semolina 10 lbs. Baby Foods, Strained 8 tins and should in all cases be carried out before sterilisation. When drawing the traders' attention to unsatisfactory samples one is given yet another P°rtunity to impress upon them the need for a thorough sterilising routine. The 110 samples referred to above are grouped as follows:— 79 in Grade I; 20 in Grade II; 7 in Grade III; 4 in Grade IV. The approximate percentage in each Grade of the 110 samples is as follows:— Grade I, 71.8 per cent.; Grade II, 18.2 per cent.; Grade III, 6.4 per cent.; Grade IV, 3.6 per cent. A comparison is given below covering results of the last four years:— 1952 °/ 1951 °/ 1950 °/ 1949 °/ Grade I /o 71.8 /o 66.0 /o 46.3 /o 52.9 Grade II 18.2 22.4 28.7 21.8 Grade III 6.4 8.9 16.7 20.1 Grade IV 3.6 2.7 8.3 5.2 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 bettre condition when passed to the public than that sold from a bulk supply. The comparisons for 1952 are given below, and the figures are on samples relating to 43 obtained from bulk supplies and 67 wrapped;— Bulk Supply Wrapped Supply 43 Samples 67 Samples Grade I 65.1% 76.1% Grade II 18.6% 17.9% Grade III 14.0% 1.5% Grade IV 2.3% 4.5% It seems clear from the above that the better article from a bacteriological standpoint is the wrapped ice, although there has been improvement in the bulk supplies. The Grades referred to are those suggested in the Ministry of Health's Provisional Grades. In addition to the samples referred to above, six samples were taken of Ice Lollies, all of which proved to be satisfactory. 31 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 two Laboratories during the year. NEW LEGISLATION The Food Standards (Coffee Mixtures) Order, 1952 1. The standard for coffee and chicory mixtures, including French coffee, shall be as follows:— Coffee and chicory mixtures, including French coffee, shall be mixtures of coffee and chicory only; each such mixture to contain not less than 51 per cent, by weight of pure coffee. 2. The standard for coffee with fig flavour or fig seasoning, including Viennese coffee, shall be a mixture of coffee and figs only; each such mixture to contain not less than 85 per cent, by weight of pure coffee. Ice Cream (Amendment) Order, 1952 It was regretted that the Ministry of Food issued an Order in July, 1952, to lower the standard of this popular commodity. Their circular state that it was made in order to avoid a reduction in the supply of ice cream The following table gives details of the former and new standards. Fat not less than Sugar not less than Milk solids other than fats not less than Former 5% 10% 7½% New 4% 10% 5% Two variations are allowed. In the case of ice cream containing fruit pulp and fruit puree it shall conform to the standard set forth above or alternatively the total content of fat, sugar and milk solids other than fat shall be not less than 21% of the ice cream including fruit, fruit pulp or puree, and such total of fat, sugar and milk solids, etc., shall include not less than 6% fat, 10% sugar and 2% milk solids other than fats. Parev (kosher) ice sold, offered or exposed for sale under that description shall contain not less than 8% fat, not less than 14% sugar, and the standard set forth above shall not apply to this product. 32 Meat Products Orders, 1952 These Orders have in 1953 been amended and/or revised, so their contents are not given herewith. Sulphur Dioxide in Imported Dehydrated Vegetables The Minister of Food in November, 1952, authorised the importation of some dehydrated vegetables containing various amounts of sulphur dioxide, and these quantities are listed below:— Parts per million by weight Dehydrated Cabbage 3,000 „ Potato (including mashed potato powder) 550 „ Runner Beans 2,000 „ Turnips 2,000 „ Spinach 2,000 „ Swedes 2,000 „ Peas 2,000 ,, Mixed vegetables 2,000 „ Parsnips 2,000 „ Carrots 2,000 Food Standards (Suet) Order, 1952 This Order, which came into operation on 28th December, 1952, revked the Food Standards (General Provisions) Order, 1944, as amended. Standards applying to Block Suet and Shredded Suet are— (a) Block Suet which shall consist of rendered beef suet, free from fibrous tissue— not less than 99% by weight of beef fat. (b) Shredded Suet which shall consist of rendered beef suet with farinaceous material free from fibrous tissue shredded, flaked or otherwise comminuted — not less than 83% by weight of beef fat. The Ice Cream (High Temperature, etc.) Amendment Regulations, 1952 p These regulations came into operation on the 5th May, 1952. They Provide for the manufacture of ice cream of an additional method to those allowed in the Ice Cream (Heat Treatment, etc.) Regulations of 1947. Those regulations provided for heat treatment of the mixture (a) by raising to and keeping at a temperature of not less than 150°F. for 30 minutes or (b) by raising to and keeping at a temperature of 160°F. for 10 33 The new regulations allow a third method (the High Temperature Short Time—H.T.S.T.) whereby the mixture is raised to and kept at a temperature of not less than 175°F. for 15 seconds. Certain safeguards are required so that the mixture is treated com pletely, and for the return for treatment of any mixture which has not been subjected to the temperature and time mentioned above. The Public Health (Meat) Amendment Regulations, 1952 The amendment to the regulations appears to be necessary because of the changed and changing standard of living. The Meat Regulations of 1924 defined meat as the flesh of cattle, swine, sheep or goats, including bacon and ham and edible offal and fat which is sold or intended for sale for human consumption, and animal means any animal from which meat is derived. In 1924 when the Mnistry made the Meat Regulations, horses and similar meat was not widely used for human consumption. Much more meat of this kind has been eaten during recent years because of the rationing. Consequently the definition of animal has been altered to meet the changed conditions. 'Animal' is still defined as above, but it now includes the following—Horse, mare, gelding, pony, foal, filly, stallion, ass, donkey or mule. The definition of meat is therefore really extended to cover the flesh of these animals. The word slaughterhouse is therefore construed accordingly. Methods and Criteria of Meat Inspection (Memo. 3/Meat) For many years the standard for the inspection of meat has been set by Memorandum 62 Foods, issued by the Ministry of Health. This mem orandum has been the Food Inspectors "yard stick" since 1922. The memorandum gave some recommendations as to steps to be taken by slaughtermen when preparing carcases of butchers meat when carcases have been damaged or found diseased. It also gave a suggested routine to be followed by the Meat Inspector when examining carcases and offals at the slaughterhouse or abbatoir, and finally further recommendations gave guidance on conditions which would justify total condemnation of carcases, parts of carcases, offals, etc. It will be noted that details of the memorandum given above are recommendations, and although generally accepted as standards by butcheers meats inspectors, and during and since the war by the Ministry of Food have no legal status. Because of the reasonableness of the memorandum it has been accepted as stated and in Magistrates Courts. It has for some time been realised that a revision of the memorandum was due, and many Public Health officers thought that any new one would be backed by law; those who advocated this have been disappointed because the new memorandum has again been issued for the "General Guidance of 34 Authorised Officers, Occupiers of Slaughterhouses and Slaughtermen", and has no legal backing, although it may be hoped that Magistrates' and other Courts will accept the memorandum as a standard. It was issued, together with an accompanying circular, early in December, 1952. Taken as a whole there appears to be nothing reactionary in the recommendations. A little more advice is given concerning animals to be slaughtered for emergency reasons, one of the recommendations being that such animals should be kept apart from others and organs, carcase, etc., be detained in order to have a bacteriological examination made. Concerning undressed carcases, it is now recommended (a) that no such carcases should be admitted to a slaughterhouse unless accompanied by certificate of a veterinary surgeon stating the reason for the slaughter of the animal and giving particulars of any drugs administered to the live which might affect the carcase, and (b) that the carcase, with or without the organs, etc., be accompanied by a certificate given by an authorised officer certifying that the carcase, etc., has been inspected and passed as fit for human consumption. Such recommendations will be helpful to inspectors carrying out meat inspection at abbatoirs or slaughterhouses. Very good recommendations are made concerning knives and wiping cloths it being suggested that a sufficient number of knives be made available to ensure that replacement is made after being in contact with lesinons of disease, when they should be cleansed and sterilised before being used again. Wiping cloths should be sterilised after contact with disease, or destroyed; in any case both knives and cloths should be sterilised at the end of each day's work. Generally speaking the memorandum is really a revision of Memorandum 62 Foods, with several additions, these being to meet recent developments in meat inspection. 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 1ll 14 12.6 — — Diphtheria — — — — — Pneumonia 29 4 13.8 2 6.9 Cerebro-Spinal Fever 2 2 100.0 — — Acute Poliomyelitis 8 8 100.0 — — Acute Polioencephalitis — — — — — Encephalitis Lethargic. — — — — — Dysentery 25 5 20.0 — —- Puerperal Pyrexia 78 *76 97.5 — — Paratyphoid Fever — — — — — Enteric or Typhoid Fever — — — — — Erysipelas 6 1 16.6 — — Malaria (contracted abroad) — — — — — Measles 697 14 2.0 1 0.14 Whooping Cough 177 5 2.8 1 0.57 Ophthalmia Neonatorum 2 2 100.0 Food Poisoning 10 — — — — * These cases all occurred in hospital 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 111 — 15 85 8 2 1 — — Pneumonia 29 1 4 3 1 1 4 9 6 Cerebro-Spinal Fever 2 — — — — — 1 1 — Acute Poliomyelitis 8 — 1 1 4 — 2 — — dysentery 25 1 15 3 — — 3 3 — Puerperal pyrexia 78 — — — — 22 56 — — Erysipelas 6 — — — — — 2 2 2 Measles 697 10 311 369 3 — 4 — — Whooping Cough 177 17 73 79 3 — 5 — Ophthalmia Neonatorum 2 2 — — — — — — — Poisoning 10 2 1 1 2 4 — — Totals 1145 31 421 541 20 27 82 15 8 37 Poliomyelitis During 1952 eight confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups:— 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 — — — — — — — — — — 1952 61880 8 0.129 – 1 1 4 – 2 – – Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1952:— 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 — — — — — — — — 10-15 years 2 — — 2 — — — — 15-20 years — — — — — — — — 20-25 years 1 6 — 1 1 — _— —_ 25-35 years 4 5 — — — 1 — — 35-45 years 10 5 1 — 1 2 — — 45-55 years 4 — — 2 — — 55-65 years 4 1 — — 1 — — — and over 3 — — — 1 1 — — Totals 30 17 1 3 6 4 — — 47 4 10 — 51 10 The 10 deaths represent a death rate of 0.16 per 1,000 of the Population. A comparetive summary over the past 19 years for the Borough is set out in the following table:— 39 40 Year Notifications Total Notifications Total Notification Rate Deaths Total Deaths Total Death Rate Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary 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 5 009 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 1952 47 0.76 4 0.06 51 0.82 10 0.16 — — 10 0.16 Rates per 1,000 population. The register shows that at the end of the year:— 47 (42) Pulmonary and 4 (7) non-Pulmonary cases were notified for the first time during the year. 8 (17) cases were transferred into the district. No (No) cases were restored to the register. 10 (10) Pulmonary and no (3) non-Pulmonary cases died during the year. 29 (28) other cases were removed from the register. 425 (405) cases remained on the register at the close of the year. The figures in brackets are the comparable fugres for the. year 1951. SECTION G. PART III SERVICES. FOREST HEALTH AREA SUB-COMMITTEE Chairman: County Councillor Mrs. E. F. M. Hollis. Vice-Chairman: Councillor Mrs. L. M. Scott. Membership: Chingford Borough Council: Councillor W. J. Bowstead. Councillor Dr. J. Wagstaff. Alderman Mrs. S. L. Oakes. Wanstead and Woodford Borough: Councillor R. A. Dalton. Councillor Mrs. M. Farlow. Councillor J. Relph. Councillor F. B. Baverstock. Chigwell U.D.C.: Councillor K. F. Alder. Councillor E. G. Perry. ouncillor Mrs. L. M. Scott. Epping U.D.C.: Councillor A. J. Hyde Councillor A. G. Verrall. waltham Holy Cross U.D.C.: Councillor Mrs. D. R. E. Dye. Councillor C. Wood Epping R.D.C.: Councillor Mrs. H. Howard. Councillor A. J. Chesterton. Hospital Management Committee: G. Gray, Esq. Executive Council for Essex: G. F. Deeth, Esq., M.P.S. Local Medical Committee for Essex: Dr. H. Grylls. Essex County Council: Alderman Mrs. M. Ball. Alderman C. E. S. Blackmore. Councillor Mrs. E. F. M. Hollis Alderman Mrs. B. K. Lowton. Councillor P. Powell. Councillor Dr. C. Skinner. Alderman F, D. Smith, J.P. Local District Nursing Association: Mrs. J. Swire. Miss H. M. Mathieson. British Red Cross and St. John Ambulance Organisations: Mrs. L. Hammond. Tuberculosis After-Care Associations: Councillor Mrs. A. C. Murray. 41 Care of Mothers and Young Children. Ante-Natal and Post-Natal Services. The following table summarises the attendances of the Ante-natal Clinic, 118 Hermon Hill, Wanstead:— Ante-Natal Post-natal Gyncecological Birth Control 619 17 1 203 Vital Statistics These are given in Section A of this report. The birth rate of 12.1 is below that for England and Wales. The infant mortality rate was 22.6 as against 27.6 for England and Wales, and the neo-natal mortality rate was 20.0 per 1,000 live births. The deaths of infants under one year were:— Males Females Toted Rate per Live Births Legitimate 10 7 17 22.6 Illegitimate — — — — 10 Stillbirths were notified, giving a stillbirth rate of 13.1 per 1,000 total births and 0.16 per 1,000 population. Care of Premature Infants During 1952, 44 premature infants were born to residents of the Borough, 12 of these births taking place at home and 32 in hospital or nursing home. Of those born at home 11 were alive at the end of one month; 25 of the 32 born in hospital or private nursing home survived. Child Welfare Centres Attendance at the six Child Welfare Centres has been well maintained. Although some of the Centres are conducted in old buildings, it can be said that the Borough is well catered for, as apart from the northern area with its more scattered population, generally there is a Centre within a mile radius of every home. Attendance figures were made up as follows:— Baptist Church Hall, Aldersbrook 1938 Ash ton Playing Fields, Woodford Bridge 2689 St. Barnabas Church Hall, Snakes Lane 1212 Fullers Road, South Woodford 4496 Cromwell Hall, Nightingale Lane, Wanstead 3425 Holy Trinity, Hermon Hill, South Woodford 3442 TOTAL 17,202 42 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 the distribution of orange juice, cod liver oil and Vitamin A and D tablets from the child welfare centres has continued to operate through- 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 Although there has been some increase in the number of dental surgeons Willing to undertake the treatment of priority classes as defined in the National Health Service Act, i.e., nursing and expectant mothers and children of pre-school age, it has still been possible to provide a limited service only. However, the dental condition of the expectant mother has considerably improved as a result of the facilities for treatment afforded since the coming into force of the Act. The following tables show the extent of treatment which it has been possible to provide:— Examined Needing Treatment Treated Made Dentally Fit Expectant Mothers 1 1 1 1 Nursing Mothers 1 1 1 1 "re-school Children 24 20 20 19 FORMS OF DENTAL TREATMENT Extractions Anaesthetics Fillings Scalings, etc. Silver Nitrate Treatment Dressings Dentures Provided Local General Complete Partial Expectant Mothers — — — 8 — — 1 — — Cursing Mothers — — — 3 — — — — — ^re-school Children 10 1 7 19 — 23 14 — — Day Nursery Applications for admission to the Wanstead Day Nursery were dealt with as in previous years. Immediate priority is given to the children of widows separated and divorced women and where the mother is the sole Support of the family. 43 All cases on the waiting list, as well as those already in the Nursery, were kept under periodic review by a special sub-committee of the Arwa Health Committee. By this means the best use was made of the fifty places available. The following table shows the attendances made, together with daily average:— Quarter Ending Attendances A. Days Open Average Daily Attendance Under 1 year 1 - 2 years 2-3 years Over 3 years TOTAL 31st March 110 371 630 1347 2458 64 38.4 30th June 116 353 551 1437 2457 62 39.6 30th September 33 313 471 1271 2088 64 32.6 31st December 77 340 357 1318 2092 63 33.2 TOTAL 336 1377 2009 5373 9095 253 35.9 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 the Borough registered with the County Council were:— Registered No. of childen Premises 1 30 Child Minders 3 8 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 1952:— Expectant Mothers (first visits) 161 Expectant Mothers (re-visits) 60 Infants under 1 year (first visits) 710 44 Infants under 1 year (re-visits) 2152 Infants 1 to 5 years (first visits) 18 Infants 1 to 5 years (re-visits) 3028 Stillbirth enquiries 12 Infant Deaths 13 Tuberculous Patients 1360 Aged and Infirm 44 Day Nursery Applications 59 School Children 644 Other Visits 304 TOTAL 8565 Midwifery and Home Nursing The number of domiciliary confinements in the Borough attended by the County Council's midwives was 212, 118 in their capacity as midwife and 94 as maternity nurse. Of this total 139 received gas and air analgesia, a Percentage of 65.5. Puerperal Pyrexia Regulations, 1951 During the year 78 cases of puerperal pyrexia were notified, 76 of them following hospital confinement, and 2 domiciliary. This figure of 78 gives a notification rate of 102.5 for the Borough as compared to 17.87 for England and Wales. The discrepancy here shown is not considered to be of any great significance. Very many of the notifications under the above regulations were in respect of raised temperatures caused by conditions such as colds and influenza which have no connection with child bearing. It should be pointed out, also, that this notification rate does not present a true picture of the position so far as it affects the residents of the Borough, for 36 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, 42 cases occurred, which would produce a true notification rate to residents, per 1,000 total births, of 55.06. Maternal Mortality One death occurred as a result of pregnancy, child-bearing or associtherewith and is referred to in Section A of this report. Ophthalmia Neonatorum Two cases of ophthalmia neonatorum occurred in the Borough during The year 1952. 45 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 hosnital and renuirinp injections and dressings. Durino-the year the following visits were paid by the Home Nurses:— 1952 1951 Number of New Cases: Pre-school cases 15 51 School children 13 46 Adults 910 839 938 936 Number of Visits: 160 Pre-school cases 82 293 School children 58 14815 Adults 13372 1481 13512 15268 Last Offices performed 18 47 Advisory or Casual Visits: Pre-school cases — 1 School children — 4 Adults 22 235 22 240 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 600 5 to 15 years of age 66 666 The number of children who received a secondary or re-inforcing injection was 419. The number of persons vaccinated or re-vaccinated during the year 1952 was:— Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 347 68 36 69 520 Re-vaccination — 7 8 138 153 46 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, 1952:— Year of birth Number Year of birth Number 1952 132 1944 584 1951 423 1943 481 1950 488 1942 614 1949 615 1941 731 1948 871 1940 658 1947 807 1939 575 1946 779 1938 421 1945 852 1937 344 TOTAL 9375 Preventive Medicine, Care and Alter-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 17 cases from the Borough have been sent away. The length of convalescence was: — Two weeks 12 Three weeks 4 Four weeks 1 47 Domestic Help Service The demands on the Domestic Help service have been maintained during the year, a total of 29,081 hours of help being supplied in comparison with 30,916 hours in 1951. 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-Committee. SECTION H. SCHOOL HEALTH SERVICES The School Health Service for the Borough is administered by Essex County Council through the Forest Divisional Executive. There are 8 primary, 1 secondary modern and 1 secondary grammar schools in Borough. 1. School Medical Inspections During the year under review a School Medical Inspector made periodic visits to all maintained schools in Wanstead and Woodford (includiing Cowslip Road County Primary School temporarily accommodated at Forest View, Chingford), for the purpose of carrying out the medical inspection of those pupils due for routine inspection and others referred for special inspection by the Head Teacher or parent. 2003 pupils were inspected at routine examinations, as follows:— Age Group No. examined No. referred for treatment No. referrd for observation 1st group (5-7 years) 492 51 37 2nd group (10-11 years) 620 103 53 3rd group (14-16 years) 891 87 53 Total 2003 241 143 2. Minor Ailment Clinics The Minor Ailment Clinic is held at the School Clinic at 93 High Road, South Woodford, every Friday morning. 400 individual pupils made 624 attendances during 1952. 3. Dental Treatment A part-time dental service has continued to operate at the Woodford Clinic during this year. I am pleased to report that about the middle of the year the list of pupils who had been awaiting treatment for many 48 months was finally cleared and it then became possible for the Dental Officer to visit a school to inspect the teeth of all children and arrange treatment sa equired. Visits to other schools will be arranged whenever possible. Specialist Services The Orthopaedic and Ophthalmic services became the entire responsibility of the Regional Hospital Board on 1st April, 1952. The sessions for schoolchildren, however, continue to be held at the local clinic and are regularly visited by an Ophthalmologist and Orthopaedic Surgeon. A Physiotherapist attends at the clinic for 3 half days a week to give remedial exercises. 5 Poliomyelitis Three children (all girls) of school age contracted this disease. At the of the year, two were still in hospital; the other one, who had no disability, had resumed attendance at school. 6 Diphtheria Immunisation Immunisation sessions have been held at intervals throughout the year. the distribution of propaganda leaflets to all new entrants to infant schools has been continued and serves as a useful reminder to parents of young children of the need to have their children immunised. 7 Tonsils and Adenoids There is still a very long waiting list for this type of operation. In this Borough it varies from 6 months to 2 years. 8 B.C.G. In my report for last year, I referred to the investigation being carried out in conjunction with the Medical Research Council to determine the value of B.C.G., an anti-tuberculosis vaccine, with a view to its general use throughout Britain. The first part of the scheme (initial tuberculin testing, X-raying and inoculation of selected volunteers) having been completed in January, 1952, the second stage, to follow up the volunteers by regular inspection, has commenced and will be continued for another two years. Valuable work is being done in this investigation by the Health Visitors; they visit the home of each volunteer twice a year and generally assi the Physician in charge of the trials when the unit is visiting this Borough. 49 Defects found by medical examination of school children. The following table shows the defects found in school children school 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 – Eyes (a) Vision 28 — 1 (b) Squint 9 — – (c) Other 7 — — Ears (a) Hearing 4 2 — (b) Otitis Media 2 — – (c) Other 5 1 — Nose or Throat 10 — 1 Speech 37 – — Cervical Glands — — – Heart and Circulation — – – Lungs 3 — 3 Developmental (a) Hernia — — – (b) Other 1 — – Orthopaedic (a) Posture 2 — – (b) Flat Foot 16 — 1 (c) Other 12 — 2 Nervous System (a) Epilepsy — — – (b) Other 3 — 1 Psychological (a) Development 2 — – (b) Stability 5 – 1 Other 85 – – 50