AC 4411(1) 1 the emgra dw 5b 2 lilrar wood ford BOROUGH OF WANS 19 WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1954 PUBLIC HEALTH COMMITTEE Councillor R. A. Dalton (Chairman) Councillor Mrs. S. V. F. Ashton (Vice-Chairman) Alderman R. W. Dale Alderman H. Hann Alderman H. E. Simpkins Alderman V. E. Stevens Councillor F. B. Baverstock Councillor N. E. Britton Councillor S. J. Relph STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: F. G. Brown, M.B., B.Ch., D.P.H. Chief Sanitary Inspector: M. G. Crook, M.S.I.A. (a) (b) (c) (d) (g) Deputy Chief Sanitary Inspector: J. T. S. Templeman, 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) (h) D. R. Chanin, M.S.I.A., (a) (from 15.3.'54) Clerks: A. M. Rowlatt Mrs. V. Birkett (a) Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board Certificate. (b) Royal Sanitary Institute Certificate of Meat and other Foods. (c) First Class Certificate in Laboratory Technique of Meat Inspection Smithfield Technical Institute. (d) Diploma of the Royal Institute of Public Health and Hygiene. (e) Diploma in Public Administration. (f) Diploma in Sanitary Science as applied to Buildings and Public Works. (g) General Instructors (Special) Certificate, Home Office Civil Defence School, Falfield, Glos. (h) Associate Member, Institute of Sanitary Engineers. 2 Wanstead and Woodford Borough Council to the mayor, alderman 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 1954. As in former years, a section this report is given to those services under the National Health Service Act which are administered by the Essex 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 included. Vital Statistics The total number of live births for the year was 703, 48 fewer than in the previous year. This is the lowest figure for the past 14 years, and gives an estimated rate of 11.3 per 1,000 of resident population, comparing with 15.2 per 1,000 for England and Wales as a whole. The figure of 11.3 is considerably lower than the average the six previous years, which was 13.2. The average figure for the whole country for the past few years has remained constant and it Would therefore appear that the lowered rate for this Borough is due to the increasing age of its population, and the fact that the Population now remains at the same figure, there having been no expansion during the past few years. 610 deaths occurred. This is 33 fewer than in the previous year, 36 fewer than the average for the past six years. The rate per 1,000 is 9.9, comparing with 11.3 for the country as a whole. I am pleased to report that the Infant Mortality Rate, i.e. the 'lumber of deaths of infants under 1 year per 1,000 of live births, again reached the low figure of 14.2. This is the lowest on record for the Borough, and was equalled only in 1951. The comparative figure for England and Wales is 25.5. This figure is regarded as being indicative of the health of the community as a whole, which can thus be regarded as satisfactory. There has been a small increase in the number of still-births, which was 15 as compared with 11, giving a rate of 0.24 per 1,000 Population, contrasting with the figure of 0.36 for the whole country. Causes of Death. As in previous years the main causes of death were diseases of the heart and arteries and cancer. The number of deaths from the latter cause increased from 124 to 135, this increase being in keeping With a national trend. 3 10 deaths occurred in children under one year of age; of these seven were in the first week of life and due either to prematurity or congenital defects. Of the remaining three, one death at three months was due to congenital heart disease, a second at one month due to an infection of the lung, and the last, a child of three months, was overlayed by its mother. This last death took place in a house in the Borough which is used by the East Ham Corporation for the accommodation of homeless persons. Of the ten infant deaths, eight can be described as unavoidable, i.e., due to congenital defects or prematurity. There were nine cases of suicide, one death due to a motor vehicle accident, and seven due to other accidents, of which five were accidents in the home. A graph showing deaths by age groups is given and it will be noted that the majority of deaths occurred in the 75—85 years group. Infectious Disease. There was a fall in infectious diseases generally as compared with the previous year. As is usual, the three most common diseases were measles, whooping cough and scarlet fever, the incidence of none of which increased to epidemic level. Six cases of poliomyelitis were notified, compared with 13 in 1953. One of these was an extremely doubtful case of the nonparalytic type in an adult. Two other cases were also non-paralytic, and of the paralytic cases all three made good recovery. It cannot be too strongly emphasised that cases of this disease should be admitted to an isolation hospital as early as possible. As well as provision for specialised medical and nursing care, facilities in these hospitals are available for physiotherapy to be commenced under expert supervision as soon as is practicable. This may make all the difference as regards the ultimate degree of paralysis. Notified cases of tuberculosis fell from 57 to 47, and the number of deaths from 5 to 3. A note regarding the administration of B.C.G. vaccine is given under the sections dealing with County Council services. Old Peoples Welfare—Chiropody. Early in the year a scheme to supplement the very inadequate services provided by the County Council for chiropody treatment for aged persons was commenced. Two chiropodists practicing in the Borough were approached and each agreed to set aside one afternoon per week to treat old persons at their surgeries. 125 persons were treated up to the end of the year, and the scheme has proved most popular. The cost works out at 6s. 6d. per treatment, 2s. 6d. of which is paid by the patient (when possible), 2s. is covered by a special grant for the purpose given by the Essex Old Peoples Welfare Association, and the remainder is paid from the funds of 4 the Wanstead and Woodford Old Peoples Welfare Association. It is a matter of regret that, despite repeated requests from Local Health Authorities and representations in Parliament, the Minister of Health cannot see his way to make financial provision for the extension of chiropody services. The aged among the population are increasing and, if incapacitated by conditions affecting the feet, soon become immobilised and consequently are a burden on the Welfare and hospital services. Slum Clearance. In the section of this report which is written by the Chief Sanitary Inspector, details of progress made in slum clearance are given. 51 houses were included in clearance areas which have subsequently been confirmed by the Minister. In addition two houses found unfit for habitation have been demolished. Members of the Public Health Committee have given much time to this subject and the results achieved are most gratifying. Clean Food Campaign. The attention of the District Sanitary Inspectors has again been focussed on retail food shops and catering establishments. During routine visits the Inspector sees the person responsible for the premises and also the individual food handler. Thus he is able to Point out what he finds to be wrong and explain to those responsible exactly why it is wrong. This must be regarded as the most important method of educating the food handler. In addition, however, it was felt that if a broader knowledge of food hygiene could be achieved, results would be justified. With this aim in view retailers and caterers were approached with the request that they should allow their employees to attend lecture demonstrations during Working hours. Details of the scheme are given in the appropriate section of this Report. Many cases of food poisoning are of short and sharp duration, and the notifications under this heading (17) do not give a true Picture of the situation, as often a doctor is not consulted. Each notified case is visited by the District Sanitary Inspector, but frequently, by the time of his arrival, symptoms have abated and no material is available for bacteriological examination. Often the food suspected has been eaten in restaurants or canteens outside the Borough. The remedy is largely in the hands of the public who should refuse to patronise dirty catering establishments or to accept cooked food, e.g., meat, which is known to have been touched by hand. The importance of thorough hand washing before the preparation or handling of food, and after using the lavatory, cannot be too. strongly emphasised. 5 Once again I would commend the Chief Sanitary Inspector and all members of the staff of the Department for their loyalty and hard work throughout the year. In conclusion, I would express my sincere thanks to the Chairman and Vice-Chairman of the Public Health Committee for their unfailing support, and to all members of the Committee for the consideration they have shown. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. G. BROWN, M.B., B.Ch., D.P.H. 2nd August, 1955. 6 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar-General's estimate mid-year 1954 61,550 Registrar-General's estimate mid-year 1953 61,540 Rateable value £638,302 Sum represented by penny rate £2,586 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 343 Females 336 Total 679 Illegitimate Males 13 Females 11 Total 24 Total Males 356 Females 347 Total 703 Birth-rate per 1,000 of the estimated resident population—11.3 STILLBIRTHS Legitimate Males 9 Females 4 Total 13 Illegitimate Males 2 Females 0 Total 2 Total Males 11 Females 4 Total 15 Rate per 1,000 total (live and still) births—20.9 DEATHS Males—305 Females—305 Total—610 Death-rate per 1,000 of the estimated resident population—9.9 Deaths from puerperal causes:— Puerperal and post-abortion sepsis — Other maternal causes 1 Total 1 Rate per 1,000 total (live and still) births—1.39 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 14.7 Illegitimate infants per 1,000 illegitimate live births — 1954 1953 Deaths from Cancer 135 124 ,, ,, Measles Nil Nil ,, ,, Whooping Cough Nil Nil ,, ,, Diarrhoea (under 2 years of age) Nil Nil ,, ,, Road Traffic Accidents 1 3 ,, ,, Suicide 9 7 ,, ,, Other violent causes 7 18 7 Population The Registrar General's estimate of the population for 1954 (midyear) was 61,550, an increase of 10 on the figure for 1953 (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 twenty years. 8 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1954 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 WANSTEAD and WOODFORD Births: (Rates per 1,000 Home Population) Live 15.2 15.2 14.9 15.2 11.3 Still 0.36 0.36 0.37 0.31 0.24 Deaths: All Causes 11.3 11.1 11.3 10.7 9.9 Malignant Neoplasm Lung and Bronchus 0.37 0.43 0.34 0.54 0.44 Whooping Cough 0.00 0.00 0.00 0.00 — Diphtheria 0.00 0.00 0.00 — — Tuberculosis 0.18 0.20 0.18 0.20 0.05 Influenza 0.04 0.03 0.04 0.02 0.02 Coronary Disease —Angina 1.51 1.52 1.52 1.50 1.43 Acute Poliomyelitis & Polioencephalitis 0.00 0.00 0.00 0.00 — Pneumonia 0.41 0.45 0.41 0.48 0.29 (Rates per 1,000 Live Births) All causes under 1 year of age 25.5 25.2 26.6 20.7 14.2 Enteritis and Diarrhoea under 2 years. 0.87 1.05 0.51 0.44 — 9 Notifications: England & Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.01 0.02 Meningococcal Infection 0.03 — Scarlet Fever 0.98 0.55 Whooping Cough 2.39 1.93 Diphtheria 0.00 — Erysipelas 0.12 0.18 Smallpox — — Measles 3.32 1.67 Pneumonia 0.60 0.39 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.03 0.06 Non-Paralytic 0.01 0.03 Food Poisoning 0.20 0.29 Rates per 1,000 Total Births (Live and Still) Puerperal Fever & Pyrexia 17.7 58.49 10 Maternal Mortality Abortion Other Total England and Wales 0.11 0.58 0.69 Wanstead and Woodford — 1.39 1.39 Causes of Death as given by the Registrar-General, 1954. Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 1 2 3 2. Other forms of Tuberculosis — — — 3. Syphilitic Disease 3 — 3 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — — — 10. Malignant Neoplasm—Stomach 12 5 17 11. Malignant Neoplasm—Lung and Bronchus 22 5 27 12. Malignant Neoplasm—Breast — 16 16 13. Malignant Neoplasm—Uterus — 6 6 14. Malignant Neoplasm—Others 37 32 69 15. Leukasmia 1 1 2 16. Diabetes 2 1 3 17. Vascular Lesions—Nervous System 32 67 99 18. Coronary Disease, Angina 60 28 88 19. Hypertension with Heart Disease 4 5 9 20. Other Heart Disease 25 59 84 21. Other Circulatory Disease 13 13 26 22. Influenza 1 — 1 23. Pneumonia 12 6 18 24. Bronchitis 23 14 37 25. Other Respiratory Diseases 3 1 4 26. Ulcer of Stomach or Duodenum — 2 2 27. Gastritis, Enteritis and Diarrhoea 2 4 6 28. Nephritis and Nephrosis 6 2 8 29. Hyperplasia of Prostate 10 — 10 30. Pregnancy, Childbirth, Abortion — 1 1 31. Congenital Malformations — 3 3 32. Other Diseases 25 26 51 33. Motor Vehicle Accidents 1 — 1 34. All Other Accidents 4 3 7 35. Suicide 6 3 9 36. Homicide and Operations of War — — — Totals, 1954 305 305 610 Totals, 1953 318 325 643 11 Infant Deaths, Neo-Natal Mortality and Stillbirths Stillbirths Neo-nfatal 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 1954 703 11.3 15 21.3 0.24 7 9.9 10 14.2 1953 791 12.9 11 13.9 0.18 12 15.2 20 25.2 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five vears 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 \ 1954 718 — 1 1 — 1.39 1.39 1953 802 — — — — — — 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 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate (per 1,000 Live Births) 1954 1953 1952 1951 1950 Maternal Mortality 1.42 — 1.33 2.60 1.18 Stillbirths 21.3 13.9 13.3 27.3 25.9 Neo-Natal Mortality 9.9 15.2 20.0 7.8 16.5 During 1954 there was one death classified as being due to pregnancy, childbearing or associated therewith. 12 . Comparative Statistics of Births, Mortality, etc. 1935 to 1954. Live Births Still Births Deaths infant Deaths Maternal Deaths Year Population No: Rate* No: Rate† No: Rate* No: Rate§ No: Rate † 1954 61550 703 11.3 15 20.9 610 9.9 10 14.2 1 1.39 1953 61540 791 12.9 11 13.7 643 10.4 20 25.2 — — 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 20.5 583 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 *Per 1,000 Population †Per 1,000 Total Births §Per 1,000 Live Births 13 SECTION B GENERAL PROVISION OF HEALTH SERVICES 1. Public Health Officers of the Authority See page two. 2. Laboratory Facilities 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.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. 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 term. By appointment only. †Controlled by the North East Metropolitan Regional Hospital Board and delegated to the Forest Group Hospital Management Committee. 14 6. Chest Clinic Harts Hospital, Woodford Green. Sessions: Wednesday, 9.30—11 a.m. 5.0—6.0 p.m. (appointment only) Friday, 9.30—11 a.m. Refill sessions: Tuesday and Thursday, 2 p.m. B.C.G. Vaccinations—Saturday morning, once monthly. (by appointment only) 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 1954. 9. Funeral arrangements In one instance the Local Authority was required to make arrangements for the burial of a person during the year 1954. 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. 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. The collection of waste paper for salvage has been continued. (c) Kitchen Waste Collection. The collection of kitchen waste in the Borough was discontinued in November, 1954. 15 3. Sewerage and Sewage Disposal. (a) Sewerage. A commencement has been made on recording dry weather flows at stormwater overflows to ascertain whether adjustment of the weir levels is required. (b) Eastern Sewage Disposal Works. Experimental work on the old circular filters has continued. Conclusions reached indicate that beds 1 and 2 will require complete renewal and the top two feet of media will require replacing with a coarser grade material on the remainder of the six beds. In order to prevent wear and blockages of pumps on the low level and high level West Works, a grit removal scheme has been carried out and now operates successfully. (c) Southern Sewage Disposal Works. The Ministry of Housing and Local Government have given approval in principle to the carrying out of the extension in one stage, since certain technical and economical advantages will be gained. It is anticipated that work will commence at the end of 1955. (d) Western Sewage Disposal Works. The intended diversion of the Western Drainage Area sewage into the East Middlesex system at Chingford has not yet been carried out although the detailed scheme has been prepared. It is hoped that this work will be completed, together with the demolition of the obsolete works, towards the end of 1955, when it is anticipated Chingford Borough Council will be ready to receive the flow. 16 SANITARY INSPECTION OF THE AREA The Chief Sanitary Inspector reports as follows: — Housing Act, 1936. Insanitary Houses. The Medical Officer's Report for 1953 recorded the fact that the Public Health Committee had supported the Department in its efforts to deal with this type of property, and it is pleasing to state that this support continued throughout 1954. Again the Sub-Committee consisting of Councillors Mrs. S. V. F. Ashton, R.A. Dalton and S. J. Relph, gave much time to attending discussions and visiting the premises. I will pick up the threads which were not tied last year and deal With them before passing on to new ventures. 1, 2, 3, 4. 5 and 6 Woodbine Place. The official 'representation made by the Medical Officer of Health was reported in his Annual Report for 1953. The Clearance Order was confirmed in April, 1954, and the properties demolished in October. 98 and 100, High Road, Woodford Bridge. Because of the type of occupier, some difficulty was experienced by the tenant in getting alternative accommodation and consequently demolition could not take place. 1, 2, 3 and 4 Wallers Cottages, Woodford Bridge. In 1953 the owners gave a Voluntary Undertaking in accordance with S.ll of the Housing Act in connection with 4 Wallers Cottages. Following this, the Public Health Committee again considered Nos. 1, 2 and 3 because of their age, dilapidated condition and the presence of dampness and served time and place notices on the agents and other interested parties. The agents made no representations to the Council, and consequently Demolition Orders were made in March, 1954. 1—10, Burlington Place, Woodford Green. Again referring to the Annual Report for 1953, mention may be made of these properties, 1—10, Burlington Place. These dwellings further deteriorated, and in the year under review the Medical Officer made an official representation to the Council, as the result of which they were made the subject of a Clearance Order. Unfortunately these properties were owned in three cases by people who had purchased either for their own occupation or for housing their children. It is regretted that people will invest their meagre savings in such property when it is obvious that the life of the dwelling is drawing to a close. The subsequent Ministry Inquiry into the fate of these houses did not take place until 1955 and cannot therefore be dealt with in this report. 99—125 and 129—169, Chigwell Road, South Woodford. Considerable space was devoted in the 1953 Report to these properties. 17 quently the Public Health Committee considered, in connection with the official representation of the Medical Officer, whether to acquire the houses and site by compulsory purchase or to deal with it as a clearance area, and finally it was decided to adopt the latter procedure. A Clearance Order was made and submitted to the Ministry for confirmation, and because of objections raised by several owners and tenants, an Inquiry was held early in November, the outcome of which is not within the scope of this report since it was not settled until 1955. Having dealt with matters carried over from 1953, reference can now be made to action taken in respect of insanitary houses during 1954. 174, 176, 178, 180 182 and 184 Hermon Hill South Woodford. This block of property was dealt with by an official representation and a Clearance Order was confirmed on 26th October, 1954. 9 and 10 Belgrave Terrace, Woodford Green. These two houses were originally the subject of a statutory notice, but high winds so damaged the roofs that action under S.ll was taken and Closing Orders made upon them. The tenants were housed by the Council. 99, High Road, E.18. This property was the subject of action under S.ll. The owner not wishing to demolish the house, gave a Voluntary Undertaking not to relet for human habitation. 103, High Road, E.18. This house was a different type to the above, being built mainly of timber and because of its dilapidated condition it became suitable for action under S.ll. The owner had no objection to demolition and an Order was made accordingly. In this case the Council decided not to rehouse the occupants. The Bungalow, Hepworth House, Whitehall Road. This was another case for demolition, the bungalow appearing to be a converted building of some kind. The owner made no representation to the Public Health Committee, and therefore a Demolition Order was made. 53 and 55 High Road, Woodford Bridge and 39 & 41 Globe Road, Woodford Green had Demolition Orders made against them. In both cases there was no objection from the owners to this course. 9 and 11 Radleys Lane, E.18. Because the owner made no representation to the Council in connection with these properties, Closing Orders were made. This was done in order not to affect detrimentally the adjoining property by works of demolition. Reports were made later to the Public Health Committee on other properties in Radleys Lane, but consideration was deferred, and further details will be given in the Annual Report for 1955. 18 One can now with satisfaction pass from 'true' housing matters to overcrowding. In this respect, three cases of overcrowding were reported to the Public Health Committee. In one case the tenants were rehoused by the Council as they had the required qualifications, whereas in another case the family were taken to Court by the owner-occupier and an order made against them for possession. This family was eventually accommodated in a 'half-way' house under the control of the Council. Referring again to the case housed by the Council, here overcrowding was caused by the marriage of one of the tenant's children, this being the cause of cramped conditions in many homes. It is to be hoped that such conditions will become less common now that private enterprise building is now in full swing, free from the restrictions of past years. The second case showed the effect of changed conditions in India, which seemed to have necessitated certain types of persons leaving their native land and seeking homes in other parts. This Eurasian family were accommodated by another similar family, but unfortunately in one room, which was grossly too small. Obviously such people have no residential qualification to assist them in getting a Council residence The third case resolved itself by the owner-occupier taking action against the sub-tenant, and here the Council had no occasion to take any action other than serving a notice on the owner. Aldersbrook Hutted Camp. In June a very full report was made on the condition of the 29 huts used for housing purposes and situated on Wanstead Flats in the Aldersbrook area of the Borough. These huts were erected as part of an anti-aircraft gun site during the last war, and are of very poor construction. They were built on concrete rafts, and consist of wooden framing with an outer shell of roofing felt and an inner lining of plasterboard. Alterations were made inside the huts in order to divide them into rooms, causing a great loss of light. On the whole these buildings were unfit for housing purposes. The Public Health Committee were informed, however, that the Housing Committee were endeavouring to rehouse the local people living in the camp, so it was decided to take no action for the time being. Before the end of the year the huts were being vacated but some misgivings were felt over those huts occupied by people from other boroughs. It is to be hoped that the fate of these deplorable places will soon be settled, for not only are they objectionable as living quarters, but they are an eyesore. 19 Housing Repairs and Rents Act, 1954. This Act, which came into force at the end of August, 1954, provided (with safeguards) for the increase of rents on appropriate properties. One of the conditions with which the owner had to comply was that the house had to be in good repair, and if this was not so and a demand for increased rent was made, then a certificate of disrepair could be issued to the tenant on his application to the Local Authority, which had the effect of stopping the increase demanded until such time as the house was put into good repair. It was anticipated that there would be many applications for these certificates, but there were only eight issued up to the end of December, 1954, six of which were in respect of the same owner's properties. Repairs under Section 9, Housing Act, 1936. Repairs to property under this Act were executed by the owners in all cases except one, and in that case tenders were obtained by agreement with the owner. Housing Repairs & Rents Act, 1954 Part 1, Section 1(1). Circular 55/54 The above Act and the circular issued in connection with it required Local Authorities to furnish the Minister, within a year after the commencement of the Act, with proposals for dealing with houses which appeared to the Authority to be unfit for human habitation, and with any houses which were, or in the opinion of the Local Authority ought to be, included in the clearance areas. After recommendation from the Sub-Committee and the Medical Officer of Health, the Public Health Committee decided that a survey should be made of the Borough. This was put in hand during the latter part of the year but obviously it could not be of such magnitude as to allow for every house to be inspected. The survey was carried out so as to provide more information than was required, and cards were used which would give an idea of the number of properties which might fall under the following headings: (a) good repair; (b) minor disrepair; (c) general disrepair; (d) improvement; (e)? flat conversion; (f) basement closure; (g) demolition; (h) clearance. This information may or may not be of use to the Council, but in any event the provision of such details took very little more time, if any, than was necessary to compile the demolition and clearance details required for the official return. Meat Inspection Suggested central abattoir serving S. W. Essex. In June, 1947, when the control of slaughtering was in the hands of the Ministry of Food, a conference was called by West Ham County Borough Council to put forward the suggestion that a municipal abattoir might be provided to serve the needs of the areas 20 of all or some of the Local Authorities in South West Essex. This conference was attended by representatives of Barking, Chigwell, Chingford, Dagenham, East Ham, Ilford, Leyton, Romford. Walthamstow, Wanstead and Woodford and West Ham. An exploratory committee was formed, and a technical advisory committee set up to deal with legal, veterinary, engineering and financial advice. The outcome was a meeting with the Ministry of Food, in which the Local Authorities representatives were informed that the arrangements were adequate, but if an extension was necessary they might make use of the L.C.S. abattoir at Leytonstone. The matter was not pursued further, it being considered advisable to await a decision of the Ministry of Food upon the future of slaughtering. On 22nd July, 1954, another meeting was called to reconsider the whole matter, this being held at the Town Hall, West Ham. After an outline of the past had been given by the chairman, each delegate gave details as to the position as to slaughtering in their areas, and although the area covered is so large, covering all Metropolitan Essex except Hornchurch, only 25 premises were licenced by Local Authorities, 4 applications were outstanding and 14 slaughterhouses were operating. The conference resolved to adjourn so that information on specific aspects relating to the provision of an abattoir could be collected and collated for report. It also agreed that this should be carried out by the Town Clerk of West Ham. A further meeting was held on 9th December, when Hornchurch U.D.C. joined the conference. The discussion centred around the facts collected after the previous meeting. The conference was informed that the final report of the InterDenartmental Committee on Slaughterhouses was expected shortly, and it was resolved 'That the conference stand adjourned and that a sub-committee consisting of one representative from each constituent I oral Authority be set up to consider the recommendations of the Inter-Departmental Committee on Slaughterhouses (when known) and report back to the conference. Slaughtering Facilities—Wanstead & Woodford Area Because of the Ministry of Food decision to decontrol slaughtering, a suggestion was made to Local Authorities that they ascertain what slaughtering facilities would be required to enable the distribution of home killed meat to proceed smoothly. A circular letter was sent to all butchers in the Borough inviting them to attend a meeting to be held on 18th April, 1954 at the Municipal Offices. Some 36 letters were sent out, but only 12 purveyors attended the meeting, which was conducted by the Chairman of the Public Health Committee. 21 Of these 12, only one wished to slaughter again, 3 others thought they might do if facilities were available, whilst the remainder were satisfied with the Smithfield facilities. It can be easily realised that the meeting did not provide much information, but it did lead the Local Authority to conclude that provision of slaughtering facilities were not necessary in the Borough, at least for the time being. Public Health Act, 1936. Forty-four premises were redrained and six public sewers were repaired during the year. The cost of these works to the owners of the affected properties was in the region of £2,900. Smoke Abatement. The Report for 1953 gave details concerning the formation of a South Eastern Divisional Council of the National Smoke Abatement Society. A number of meetings have been held in order to set up an executive committee and to draw up rules of procedure, etc., and it is hoped that this new Divisional Council will prove a live and active body. It is pleasing to note that this Council gives active support to any action leading to the improvement of the condition of the atmosphere. Proof of the interest taken in this work is shown by the fact that arising from the report submitted by the Deputy Chief Sanitary Inspector on the Annual Conference of the National Smoke Abatement Society, the Public Health Committee agreed to negotiations being made with the Fuel Research Station of the Department of Scientific and Industrial Research at Greenwich, with a view to setting up a recording station in the Borough. Every help was given by that Station, and in October, 1954, recordings were made, and have been made daily ever since. Records show the extent of the pollution of the atmosphere on special filter papers which are compared with a density chart, and further estimations are made as to the amount of sulphur dioxide present during the 24 hours between readings. Special returns are sent monthly to the Fuel Research Station for inclusion in a publication giving tabulated details recorded all over the country, copies of which are distributed to all authorities participating in the scheme. It may be possible later to make use of a deposit gauge, etc. 22 Food Hygiene During the year under review the Public Health Committee received a report concerning proposed lectures to managements and staffs engaged in food premises. About 300 premises were circularised by letter, with which was enclosed a questionnaire regarding these lectures. Only 49 replies were received, with the following results. Yes No No indication Employees to be allowed to attend lecures 31 15 3 Proprietor or Manager wishing to attend 28 — — Total number of employees engaged in food handling 171 It does not take long to form the opinion that the replies to the questionnaire were poor indeed, and indicates the lack of interest in the trade on this subject. However, it was decided to go ahead with the lectures, courses of three weekly lectures starting on 26th October, 1954 and 23rd November, 1954. A third course followed in 1955. The attendances at these lectures in Courses 1 and 2, for each of the following three weeks were as follows: Course No. 1. 15, 10 and 10. Course No. 2 .15, 8 and 8. A considerable amount of time was devoted to the preparation of the lectures, so as to make them attractive and interesting, and remarks from those who attended indicated their appreciation, although greater encouragement would have been given to the lecturer had there been better attendances. The Central Public Health Laboratories at Colindale loaned visual aids, and for the early lectures a film strip projector was borrowed from the Civil Defence Officer. Later the Public Health Committee sanctioned the purchase of a similar projector for general use in connection with health propaganda. The use of this apparatus has been, and will continue to be, of great help during lectures and talks to local organisations. We were pleased that both the Chairman of the Public Health Committee and the Medical Officer of Health were able to attend at some of the lectures. 23 Rodent Control There is not a great deal new to report on this branch of the Public Health Department's work, but it can be recorded that good work has been carried out by the rodent operator in dealing with surface treatments and by the gang engaged on the treatment of sewers. Infestations on the surface are not large, but time is taken up because of their scattered situations. The number of complaints during 1954 was 324. Compared with figures given in the 1953 report, they show a slight increase, which clearly shows that our efforts have not freed the area of rats, although it is safe to conclude that without the effort the rat population would greatly increase. The number of complaints received in the past is as follows:— 1946 — 346 1947 — 139 1948 — 210 1949 — 287 1950 — 284 1951 — 290 1952 — 330 1953 — 316 1954 — 324 Appreciation should be recorded of the co-operation given by the Borough Engineer and Surveyor and his Department in providing the necessary gang for the work on sewer treatment. A quick review of the results of the treatment for 1954 shows an improvement on the years 1952 and 1953, which should indicate a lower rat population in the sewers. The usual detailed charts are given on the following pages. Surface Treatment: The following table shows the result of the year's work. Number of inspections made by the Sanitary Inspectors 144 Complaints received 324 Retreatments — Revisits to oremises 340 Visits to adjacent oremises 135 Total premises visited 799 Number of baiting points 3505 Rats found dead 114 24 Sewer Treatment first treatment 1 2 3 4 5 6 7 8 Section No. of Manholes No. not baited No. baited Complete Average Pre-bait Takes Partial Total takes N.T. 1. 69 — 69 20 9 29 40 2. 86 4 82 27 1 28 54 3. 73 — 73 20 14 34 39 4. 75 1 74 23 12 35 39 5. 71 — 71 23 10 33 38 6. 80 3 77 21 11 33 45 7. 76 — 76 32 12 44 32 8. 66 — 66 25 8 33 33 9. 81 — 81 29 9 38 43 10. 78 — 78 28 6 24 54 11. 72 4 68 26 7 33 35 12. 70 — 70 11 12 23 47 13. 70 3 67 22 6 28 39 14. 69 2 67 38 4 42 25 15. 75 — 75 21 8 29 56 16. 71 71 39 7 46 25 17. 68 7 61 21 8 29 32 18. 75 — 75 30 8 38 37 19. 71 71 22 9 31 40 1396 24 1372 468 161 629 743 25 Sewer Treatment second treatment 1 2 3 4 5 6 7 8 Section No. of Manholes No. not Baited No. baited Complete Average Pre-bait takes Partial Total takes N.T. 1. 71 1 70 21 7 28 42 2. 86 — 86 26 13 39 47 3. 70 — 70 18 8 26 44 4. 75 — 75 17 20 37 38 5. 72 — 72 17 18 35 37 6. 80 — 80 20 19 39 41 7. 76 — 76 21 21 42 34 8. 67 — 67 24 13 37 30 9. 79 3 76 20 15 35 41 10. 77 — 77 14 6 20 57 11 69 1 68 23 12 35 33 12. 69 — 69 21 12 33 36 13. 71 4 67 25 11 36 31 14. 68 2 66 25 11 36 30 15. 75 10 65 23 10 33 32 16. 71 — 71 23 16 39 32 17. 68 7 61 22 8 30 31 18. 75 11 64 23 12 35 29 19. 71 — 71 21 10 31 40 1390 39 1351 404 242 646 705 26 Summary of Treatments Year No. of Manholes No. NOT baited No. baited Average Pre-bait Takes Complete Partial Total takes N.T. 1954 1st treatment 1396 24 1372 468 161 629 743 2nd „ 1390 39 1351 404 242 646 705 1953 1st treatment 1409 3 1406 550 294 844 562 2nd „ 1408 52 1356 407 367 774 582 1952 1st treatment 1419 5 1414 604 276 880 534 2nd „ 1418 — 1418 460 337 797 621 1951 1st treatment 1419 619 800 240 115 356 444 2nd „ 1419 19 1400 284 141 425 975 1950 1st treatment 1405 12 1393 210 85 295 1098 2nd „ 1396 33 1364 280 140 423 942 1949 1st treatment 1415 462 953 409 242 651 302 2nd „ 1417 123 1294 158 143 301 993 27 Pet Animals Act, 1951. There were in 1954 four registrations. One was not renewed on account of the firm going out of business. Inspections were made of the premises during the year, the shops all being maintained in a satisfactory condition. 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. Three visits were made under this Act during the year. Petroleum (Regulation) Acts, 1928 and 1936. Fifty-eight licences were renewed at the beginning of the year, and two new licences were granted during the year. Two storage places were discontinued during the year, one a can store and the other a tank storage below ground level. One garage added a new pump and two firms reduced the number of pumps, in one case from two to one and in the other case from five to four. One new station set up four pumps, and a contracting firm installed a one pump installation. 109 inspections were made of installations during the year. Game Licences. Sixteen licences to deal in Game were renewed in 1954. The Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949 and Raw Milk Regulations. The following licences were issued:— Dealers Licences Pasteurised 12 Sterilised 21 Tuberculin Tested 12 Dealers (Pasteurisers) Licence 1. Supplementary Licences Pasteurised 9 Sterilised 9 Tuberculin Tested 9 Shops Acti, 1950 Seventy-seven visits were made under this Act. No difficulty was experienced with hours of closing, shops close well before the time specified in the Act. One shop was fitted with additional sanitary and washing accommodation. 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 54 Visits in connection with contacts, disinfection, etc 34 Enquiries in connection with food poisoning 5 Verminous premises 7 28 General Environmental Public Health Drains and Sewers inspected 1016 Drain tests applied 193 Stables and manure pits inspected 9 Public Conveniences 5 Overcrowding 3 Factories (mechanical) 75 Factories (non-mechanical) 22 Hairdressers' premises 16 Schools 22 Ditches, Streams and Ponds 16 Open spaces and playing fields 2 Petrol Installations 114 Cesspools 1 Shop Act inspections 77 Outworkers premises 21 Massage establishments 12 Pet Animals Act 4 Merchandise Marks Act 2 Swimming Baths 3 Smoke observations 5 Workplaces 6 Cinemas 1 Housing Repairs and Rents Act 41 Piggeries 9 Rag Flock Act 3 Water sampling Miscellaneous 157 Inspection of Food Premises Meat Shops 161 Bakehouses 34 Fishmongers 32 Grocers 191 Restaurants and Cafes 98 Dairies and Milk Shops 15 Greengrocers 24 Ice Cream Premises 60 Hotels, Boarding Houses and Public Houses 7 Street Vendors 12 Fish Fryers 1 Food and Drugs Sampling 90 Ice Cream Sampling 47 Milk Sampling 33 Cooked Meats 5 Total 2,746 29 SECTION D. HOUSING No. of dwellings erected during 1954: 113 Council; 77 Private enterprise; No Cost of Works (rebuild) 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) 1765 (b) Number of inspections made for the purpose 2567 VISITS (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) Number of inspections made for the purpose (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 181 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 250 3. Action under Statutory Powers during the year:— (a) Proceedings under Section 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 5 (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 — (b) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 54 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 66 (b) By Local Authority in default of owners — 30 REAR OF CHIGWELL ROAD PROPERTY REAR OF CHIGWELL ROAD PROPERTY BURLINGTON PLACE, WOODFORD GREEN The Rural appearance of these properties is very deceptive. 98 & 100, HIGH ROAD, WOODFORD BRIDGE. (c) Proceedings under Section 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 9 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 Nuisances Abated and Improvement Effected Roofs repaired 59 External walls and chimney stacks repaired 40 Walls underpinned 1 Gutters and spouts repaired or renewed 39 Damp-proof courses provided 13 Dampness remedied 98 Yards paved or repaired 2 Internal walls and ceilings repaired 127 Doors and frames repaired or renewed 14 Windows repaired or renewed 51 Roofs repaired or renewed 34 Sub-floor ventilation provided or improved 7 Rooms cleansed or redecorated 5 Staircases repaired and handrails provided 2 Fireplaces and flues repaired or renewed 28 Washbasins and sinks provided or renewed 8 Wastepipes repaired or renewed 15 Dustbins provided or renewed 12 Water supply improved or reinstated 7 Water closet pans repaired, renewed, or cleansed 10 Water closet cisterns repaired or renewed 17 Water closet lighting and ventilation improved 1 Water closet flush pipe joints repaired 1 Water closet walls etc., cleansed 2 Water closet structures repaired 1 Drains cleansed from obstruction 159 Drains repaired or renewed 58 Miscellaneous 14 Disinfection and Disinfestation Number of rooms disinfected 59 Premises from which bedding removed for steam disinfection 65 Number of rooms disinfested 24 Essex County Council Act, 1952 During the year two persons were registered under Section 103 of the above Act as Hawkers of Food, and one premises for the storage of food intended for sale by a trader who was registered in another Borough. 31 FACTORIES ACT, 1937 1. Inspections for the purposes of provisions as to health (including Inspections made by Sanitary Inspectors). Premises (1) Number on Register Number of Occupiers prosecuted Inspections Written notices (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 42 22 3 — (ii) Factories not included in (i) to which Section 7 applies 140 75 2 — (iii) Other Premises under the Act (excluding out-workers' premises) — — — — TOTAL 162 97 5 — 2. 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 4 4 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate Ventilation — — — — Ineffective drainage of floors — — — — Sanitary Conveniences:— 1 Insufficient 1 1 — — 2 Unsuitable or defective — — — — 3 Not separate for sexes — — — — Other Offences 3 3 — — TOTAL 8 8 — — 32 3. Outwork Number of out-workers in August list required by Section 110(1) (c) Wearing apparel—making, etc 85 Furniture and Upholstery 1 Feather sorting 1 Paper Bags 6 Boxes 2 Brushes 2 Stuffed Toys 7 Xmas Crackers 3 107 One certificate of means of escape in case of fire under Section 34 was issued in 1954, and one was amended. 33 SECTION E. FOOD AND DRUGS ACT, 1938. One prosecution was made during the year. This was a case of a metal disc being found embedded in bread, and a fine was imposed on the baker. Beef sausages taken as samples showed meat contents varying from 56 per cent to 62 per cent. Pork sausages had meat contents varying from 50 per cent in one case to 82 per cent. Four samples of oranges were reported to be free of thiourea, but one sample showed thiourea to be present in the juice and skin to the extent of 5 and 10 p.p.m. respectively. Thirteen ice lollies showed a lead content not exceeding 1 p.p.m. a list of food samples is given below:— Whisky 6 Ice Lollies 13 Rum 1 Milk 19 Gin 3 Fruit Slice 1 Malt Vinegar 1 Hot Milk 4 Coffee 1 Glycerine 1 Ham 3 Olive Oil 1 Pressed Beef 1 Eucalyptus 1 Sausage Rolls 1 Boracic Powder 1 Brawn 1 Epsom Salts 1 Pork Sausages 16 Liquid Paraffin 1 Beef Dripping 2 Glaubers Salts 1 Butter 13 Fullers Earth Cream 1 Lard 5 Tincture of Iodine 1 Margarine 1 Camphorated Oil 1 Minced Beef 3 Quinine Bisulphate 1 Faggots 1 Salted Nuts 1 Dried Fruit Salad 1 Dried Peaches 1 Prunes 1 Ice Cream 5 Beef Sausages 2 Oranges 5 Pork Rissoles 1 Bacon 4 Rice 1 Ground Rice 1 Cheese 4 Pepper 1 Mineral Waters 2 Lemonade 1 140 Orange Juice 2 34 Five 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:— 10.7 per cent 13.3 per cent 11.2 per cent 10.3 per cent 10.6 per cent The following is a list of foods surrendered in 1954 because of unsound conditions. Fish, Fresh Damsons 3 tins Pears 4 tins Catfish 3 stone Gooseberries 1 tin Whiting 3 stone Rhubarb 1 tin Cod 5 stone Cherries 1 tin Skate 16 stone Strawberries 1 tin Sole 1 stone Fruit Salad 6 tins Grapefruit 18 tins Prunes 1 tin Fish, Smoked Kippers 2 stone Fruit, Dried Fish, Tinned Figs 29 lbs. Raisins 30 lbs. Herring Roes 1 tin Sultanas 56 lbs. Sardines 37 tins Apricots 18 lbs. Silds 1 tin Tuna 1 tin Lobster 2 tins Crab 1 tin Vegetables, Tinned Cape Fi.sh 2 tins Peas 60 tins Beans 4 tins Fruit, Tinned Carrots 3 tins Tomatoes 5 tins Bilberries 1 tin Vegetables, Mixed 5 tins Apples 4 tins Beetroot 1 tin Blackcurrants 3 tins Olives 1 tin Plums 68 tins Pineapple 16 tins Grapes 1 tin Peaches 10 tins Apricots 9 tins Vegetables, Fresh Raspberries 3 tins Oranges 5 tins Potatoes 3 cwt. 35 Meat, Tinned, Miscellaneous Luncheon Meat 24 tins Milk 277 tins Meat Loaf 2 tins Cheese 6 lbs. Veal, Jellied 4 tins Cheese 1 pkt. Corned Beef 139 tins Mincemeat 3 jars Ham 32 tins Soup 8 tins Ham 27½ lbs. Cream 5 jars Pork 5 tins Coffee 1 tin Meat Pudding 1 tin Jam .& Marmalade 10 jars Pressed Beef 10 tins Capers 1 jar Stewed Steak 31 tins Cornflower 14 lbs. Sponge Mixture 26 lbs. Blancmange Powder 42 lbs. Meat, Fresh Orange Juice 1 bot. Spaghetti 2 pkts. Beef 940 lbs. Ketchup 3 jars. Mutton 154 lbs. Oxtails 127 lbs. Lamb 929 lbs. Kidneys 140 lbs. Offal 214 lbs. Pork 67 lbs. Pork Sausages 13½ lbs. MANUFACTURE, STORAGE AND SALE OF ICE-CREAM Seventy-eight registrations of premises were in force at the beginning of the year, and a further five were added during the year. Sixty visits to premises were made during the year, in addition to forty-seven visits for the purpose of obtaining ice-cream samples. Ice-Cream Samples (Bacteriological examinations) The table given below shows a continued improvement in the bacterial quality of the ice cream; the Grade I percentage has increased from 80 per cent in 1953 to 88.7 per cent in 1954, and only 2 samples fell into Grade II. Against this 2 samples were classified as Grade III and one as Grade IV as compared with 1 and none respectively for 1953. For the 44 samples taken, the results are as follows:— Grade I — 39 samples, 88.7 per cent. Grade II — 2 samples, 4.5 per cent. Grade III — 2 samples, 4.5 per cent. Grade IV — 1 sample, 2.3 per cent. 36 A comparison is given below covering results of the last four years:— 1954 per cent 1953 per cent 1952 per cent per cent Grade I 88.7 80.0 71.8 66.0 Grade II 4.5 17.1 18.2 22.4 Grade III 4.5 2.9 6.4 8.9 Grade IV 2.3 0.0 3.6 2.7 Of the 44 samples taken, 14 were obtained from bulk supply. Two of these fell into Grade III and one into Grade IV. Of the 30 samples of packed ice cream, two only fell below Grade I, and these two were both in Grade II of the Ministry of Health s Provisional Gradings. , , Referring again to the bulk supply lower grade samples, two of these were from the same restaurant, from which similar lower grades were obtained in previous years. As these samples are all manufactured by one of the well-known companies whose products can be relied on, it would indicate that the fault lies in the cleansing technique at the retailers. From the above observations one can only conclude that the wrapped article is still to be preferred. Bulk Supply Wrapped Supplv 1954 19 samples 8 per cent 1953 samples 25 per cent 1954 samples 27 per cent 1953 samples per cent Grade I 84.2 87.5 92.0 77.7 Grade II 0.0 12.5 8.0 18.7 Grade III 10.5 — — 3.6 Grade IV 5.3 — — — In addition to the samples referred to above, 3 samples were taken of Ice Lollies, all of 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.l.) 66. Victoria Street, London, S.W.I. The Department is appreciative of the help given by these two Laboratories during the year. 37 NEW LEGISLATION Housing Repairs and Rents Act, 1954. Perhaps the most outstanding piece of new Legislation was the Housing Repairs and Rents Act, 1954, upon which so much could be written and which covers such a wide scope. The early part of the Act requires Local Authorities to submit within one year of its coming into effect proposals for dealing with slum properties. An innovation is the power given to Local Authorities to retain sub-standard houses for a time and for some patching to be carried out. The idea appears to be that such a scheme would assist the Local Authorities with a large and difficult housing and demolition problem. Further, an owner may now be able to reconstruct, enlarge, or improve a house which has been the subject of a demolition order— there are, of course, very suitable safeguards. Section 9 gives a standard of fitness of houses for human habitation and provisions in connection therewith, and briefly, in deciding whether a house is unfit, regard shall be had to its condition in respect of the following matters (a) repair; (b) stability; (c) freedom from dampness; (d) natural lighting; (e) ventilation; (f) water supply; (g) drainage and sanitary conveniences, and (h) facilities for storage, preparation and cooking of food and for the disposal of waste water. The house shall be deemed to be unfit if defective in one or more of the said matters, and it shall be considered not reasonably suitable for occupation in that condition. Part 2 deals with the means of obtaining increased rent for landlords and the means of preventing an increase for the tenant in cases where the house is not in good repair. The working of this part of the Act is quite complicated and has left many landlords and tenants in doubt as to their rights under it. Again many houses are requiring so much repair that landlords have not increased rents because so much would have to be spent on their properties before an increase would be justified. Part 3 covers miscellaneous and general provisions. The foregoing summary is very brief, but gives some idea of the scope of the Act from the Public Health point of view. This Act came into force at the end of August, 1954. Food and Drugs Amendment Act, 1954. This Act was passed in November, 1954, but does not come into force until a date to be approved by the Minister. As this has not been given at the end of the year under review, comment will be reserved until such time as the Act does come into effect. There is just one section (No. 28) which is an exception to the above, and that came into effect at the time of the passing of the Act. It deals with the restriction of private slaughterhouses, and because of local circumstances it does not apply to this Borough at present. 38 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 34 5 14.8 — — Diphtheria — — — — — Pneumonia 24 1 4.2 — — Cerebro-Spinal Fever — — — — — Acute Poliomyelitis 6 5 83.3 — — Acute Polioencephalits — — — — — Encephalitis Lethargic — — — — — Dysentery 1 1 100 — — Puerperal Pyrexia 42 42 †100 — — Paratyphoid Fever 1 1 100 — — Enteric or Typhoid Fever — — — — — Erysipelas 11 1 9.1 — — Malaria (contracted abroad) 1 1 100 — — Measles 104 1 .9 — — Whooping Cough 119 4 3.4 — — Ophthalmia Neonatorum — — — — — Food Poisoning 17 4 23.5 — — †se cases all occurred in Hospital. 39 These cases of infectious disease have been divided into age incidents and set out in the accompanying table:— Disease All Ages Under 1 yr. 1-5 yrs. 5-10 yrs. 10-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & yrs. Scarlet Fever 34 — 12 20 2 — — — — Pneumonia 24 — — 2 1 4 6 8 3 Paratyphoid Fever 1 — — — — 1 — — — Acute Poliomyelitis 6 — — 3 1 — 1 1 — Dysentery 1 — — 1 — — — — — Puerperal Pyrexia 42 — — — — 21 21 — — Erysipelas 11 — — — — — — 7 4 Measles 104 3 30 70 — — 1 — — Whooping Cough 119 6 46 60 3 1 1 2 — Malaria (contracted abroad) 1 — — — — 1 — — — Food Poisoning 17 — 1 — — 4 5 3 4 TOTALS 360 9 89 156 7 32 35 21 11 Poliomyelitis During 1954 six confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups:— 40 41 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1935—1954 Year Population No. Notified Notification Rate Under 1 1-5 5-10 Age 10-15 Group 15-25 25-45 Over 45 Deaths Death Rate 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 l 4 — 2 - — — 1953 61540 13 0.211 - - 4 3 3 3 - - - 1954 61550 6 0.097 - — 3 1 - 1 1 - — Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1954:— 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 - - - 1 - - — — 5-10 years — — — 1 — — — — 10-15 years - — — - - - — - 15-20 years 2 4 — 1 — - — — 20-25 years 3 2 - 1 - — — — 25-35 years 5 4 - - - 1 — — 35-45 years 1 3 — 1 — — — 1 45-55 years 4 2 1 - — - — — 55-65 years 2 1 - - - — - - 65 and over 1 2 - - 1 - - — TOTALS 18 20 1 5 1 1 - 1 38 6 2 1 44 3 The 3 deaths represent a death rate of 0.05 per 1,000 of the population. 42 43 A comparative summary over the past 20 years for the Borough is set out in the following table:— 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 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 1952 47 0.76 4 0.06 51 0.82 10 0.16 — — 10 0.16 1953 48 0.78 4 0.06 52 0.84 3 0.05 2 0.03 5 0.08 1954 38 0.81 6 0.10 44 0.71 2 0.03 1 0.02 3 0.05 Rates per 1,000 population. The register shows that at the end of the year:— 38 (48) Pulmonary and 6 (4) non-Pulmonary cases were notified for the first time during the year. 14 (13) cases were transferred into the district. No (No) cases were restored to the register. 2 (3) Pulmonary and 1(2)non-Pulmonary cases died during the year. 73 (11) other cases were removed from the register. 456 (474) cases remained on the register at the close of the year. The figures in brackets are the comparable figures for the year 1953. 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: Wanstead and Woodford Borough: Chigwell U.D.C: Epping U.D.C: Waltham Holy Cross U.D.C: Epping R.D.C: Hospital Management Committee: Executive Council for Essex: Local Medical Committee for Essex: Essex County Council: British Red Cross and St. John Ambulance Organisations: Councillor W. J. Bowstead. Councillor Dr. J. Wagstaff. Alderman Mrs. S. L. Oakes. Councillor Mrs. S. V. F. Ashton Councillor Mrs. I. C. Haseldon. Councillor J. Relph. Councillor R. Drew. Councillor Mrs. J. Edmondson. Councillor Mrs. M. Smith. Councillor Mrs. L. M. Scott. Councillor A. J. Hyde. Councillor A. G. Verrall. Councillor Mrs. D. R. E. Dye. Councillor C. O. Gabriel. Councillor Mrs. H. Howard. Councillor Mrs. P. N. Fox- Edwards. G. Gray, Esq. Alderman J. W. R. Nation. Dr. H. Grylls. Alderman Mrs. M. Ball. Alderman C. E. S. Blackmore. Councillor Mrs. E. F. M. Hollis. Alderman Mrs. B. K. Lowton. Councillor P. Powell. Councillor C. F. H. Green. Alderman F. D. Smith, J.P. Mrs. M. Tucker. Mrs. J. Broome. Tuberculosis After-Care Association: Mrs. A. C. Murray. 44 Care of Mothers and Young Children. Ante-Natal Services: There were 561 attendances at the Ante-Natal Clinic at 118, Hermon Hill, Wanstead. Sessions at this Clinic are conducted by the Municipal Midwives, who work in close conjunction with the general practitioners. At the request of a general practitioner who conducts an antenatal clinic for his own patients, it was arranged that a Municipal Midwife should attend at the doctor's surgery. This arrangement has worked well, and proves an excellent means of co-operation between doctor and midwife. Relaxation Exercises: Relaxation classes for expectant mothers are held regularly at the ante-natal clinics. At these classes talks are given by a Health Visitor on preparation for the confinement and on various aspects of personal hygiene for mother and infant. Birth Control Clinics. At these clinics contraceptive advice is given for medical or sociomedical reasons. A medical officer with special experience in gynaecology advises. The number of attendances at the clinic during 1954 was 317. Vital Statistics These are given in Section A of this report. The birth rate of 11.3 is below that for England and Wales. The infant mortality rate was 14.2, as against 25.5 for England and Wales, and the neo-natal mortality rate was 9.9 per 1,000 live births. The deaths of infants under one year were:— Males Females Total Rate per 1,000 Live Births Legitimate 5 5 10 14.2 Illegitimate — — — - 15 Stillbirths were notified, giving a stillbirth rate of 20.9 per 1,000 total births and 0.24 per 1,000 population. Care of Premature Infants During 1954, 38 premature infants were born to residents of the Borough, 5 of these births taking place at home and 33 in hospital or nursing home. Of those born at home all were alive at the end of one month; 30 of the 33 born in hospital or private nursing home survived. In all cases of premature birth, special supervision is given after the 14th day or after discharge from hospital. 45 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 1639 Ashton Playing Fields, Woodford Bridge 2158 St. Barnabas Church Hall, Snakes Lane 4251 Fullers Road, South Woodford 3330 Cromwell Hall, Nightingale Lane, Wanstead 2607 Holy Trinity, Hermon Hill, South Woodford 3178 TOTAL 17,163 Welfare Foods With the closing of the Ministry of Food, the responsibility for the distribution of welfare foods, i.e. National Dried Milk, Orange Juice, Cod Liver Oil and Vitamin Tablets was transferred to Local Health Authorities as part of their functions under Section 22 of the National Health Service Act. So far as the Forest Health Area is concerned, it was decided to take advantage of the offer of voluntary assistance and, in the Borough of Wanstead and Woodford, distribution is undertaken practically entirely by members of the Women's Voluntary Services. Distribution is undertaken at all the Child Welfare Clinics as set out on page 14 of this report. In addition, distribution is also undertaken at the former Food Office at 79, High Street, Wanstead every Monday, Wednesday and Friday from 10 a.m. to 4 p.m. I should like to express my thanks to these ladies who give up so much of their time voluntarily in helping to provide this service for the public. 46 Child Welfare Centres Total attendances at the Child Welfare Centres increased during the year. Day Nursery The average daily attendance at the Day Nursery, which has accommodation for 50 children, was 23.5, being much the same as that for 1953. The following table shows the attendances made, together with the daily average. Quarter Ending Attendances Under 1 year 1-2 years 2-3 years Over 3 years TOTAL Days Open Average Daily Attendances 31st March 97 244 412 731 1484 65 22.8 30th June 201 284 428 749 1662 62 26.8 30th September 226 212 444 802 1684 64 26.3 31st December 192 350 576 1028 2146 63 34.0 TOTAL 716 1090 1860 3310 6976 254 23.5 47 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:— Premises No. of Children Premises Nil Nil Child Minders 3 9 The Daily Guardian scheme in operation in the Borough has been continued and at the end of the year one guardian was registered with and subsidised financially by the County Council. Health Visiting. A feature of the Health Visiting Service was the increase in the number of visits paid to aged persons, many of whom are living alone and in need of social advice and supervision. As time goes on it is anticipated that the need of these visits will further increase. This branch of her work illustrates the increased scope of the Health Visitor's duties. She now advises on problems affecting persons of all ages, her work being no longer confined to children and expectant mothers. 48 The following table sets out statistically the work of the Health Visitors in the Borough during 1954:— Expectant Mothers (first visits) 143 Expectant iMothers (re-visits) 65 Infants under 1 year (first visits) 694 Infants under 1 year (re-visits) 1469 Infants 1 to 5 years (first visits) 35 Infants 1 to 5 years (re-visits) 1929 Stillbirth enquiries 9 Infant Deaths 5 Tuberculosis Patients 1235 Aged and Infirm 71 Day Nursery Applications 4 School Children 318 Other Visits 480 Ineffective Calls 583 TOTAL 7040 Midwifery and Home Nursing The number of domiciliary confinements in the Borough attended by the County Council's midwives was 166, 104 in their capacity as midwife and 62 as maternity nurse. Puerperal Pyrexia Regulations, 1951 During the year 42 cases of puerperal pyrexia were notified, all of them following hospital confinement. This figure of 42 gives a notification rate of 58.49 for the Borough compared to 17.7 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 26 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, 16 cases occurred, which would produce a true notification rate to residents per 1,000 total births of 22.28. 49 Maternal Mortality. One death occurred as a result of pregnancy, child bearing or associated therewith. Opthalmia Neonatorum No cases of opthalmia neonatorum occurred in the Borough during the year 1954. Home Nursing. There was a further increase in the number of visits paid by the Home Nurses in the Borough, and, despite a general shortage of nurses, we have been fortunate in recruiting staff to meet all demands. Vaccination and Immunisation. In addition to being given by general practitioners, vaccination and immunisation are both available to those desiring it at all six Child Welfare Centres in the Borough. 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 578 5 to 15 years of age 43 621 During the year the following visits were paid by the Home Nurses:— 1954 1953 Number of New Cases 767 1028 Number of Visits 22184 20014 Last Offices performed 33 21 Advisory or Casual Visits 496 419 50 The number of children who received a secondary or re-inforcing injection was 312. The number of persons vaccinated or re-vaccinated during the year 1954 was:— Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 365 48 53 45 511 Re-vaccination Nil 5 6 135 146 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, 1954: Year of Birth Number Year of Birth Number 1954 72 1945 856 1953 586 1944 586 1952 507 1943 485 1951 465 1942 616 1950 511 1941 729 1949 640 1940 660 1948 900 1939 575 1947 718 TOTAL 9692 1946 786 Preventative 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 preventative medicine and includes both direct and indirect help. The main preventative 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 tuberculosis patients, and where possible child contacts of patients are boarded out. Rehabilitation of Tuberculosis Patients. During the year the Area Sub-Committee accepted financial responsibility in one case for a patient undergoing rehabilitation at Preston Hall Settlement. No charge is made to the patient. 51 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 52 cases from the Borough have been sent away. The length of convalescence was:— Two weeks 36 Three weeks 12 Four weeks 4 Domestic Help Service The demands on the Domestic Help Service have been maintained during the year. Cases assisted have been maternity, acute sick, chronic sick, aged, tuberculosis 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. As, for some time past, owing to the increase in the number of cases receiving help, it had been evident that one organiser was insufficient to cope with the work in the whole of the Forest Area, representations were made to the County Council for the appointment of a second organiser. This was duly approved, and the organiser commenced duty in October, 1954. Her work is confined to an area comprising the Boroughs of Wanstead and Woodford and Chingford, with part of the Urban District of Chigwell. 52 SECTION H. SCHOOL HEALTH SERVICES With the opening of Nightingale County Primary School, in Ashbourne Avenue, South Woodford, in September, the schools in the Borough numbered 15. Woodford Garden City Temporary County Primary School, which had been accommodating pupils from Loughton, was released for use as an annexe to North Woodford County Primary (Junior) School. At the end of the year, the number of pupils attending these schools was 6,866, an increase of nearly 600 over the figure in December 1953. School Medical Inspections. As in previous years a School Medical Officer visited all schools in the Borough to carry out the routine medical inspection of pupils who were due for examination and others referred for a "special" inspection by the Head Teacher or parent. The total number of children seen at these inspections was 2,768, in the following categories:— Routine inspection No. esxamined No. referred for treatment No. referred for examination 1st Group (5-7 years) 1045 181 122 2nd Group (10-11 yrs.) 917 116 65 3rd Group (14-16 yrs.) 793 73 73 Special Inspections 13 2 3 Minor Ailment Clinics. During the year 490 children made 639 attendances to see the School Medical Officer at the School Clinic, 93 High Road, South Woodford. Particulars of the defects recorded at these inspections are given in the Appendix. Cleanliness Surveys. 16,148 inspections of pupils attending primary and secondary schools were carried out by School Nurses during the year. Arising from these inspections, 115 children were found to be suffering from head infestation and the parents were notified and advised how to deal with the matter. Of these, the parents' efforts did not effect the desired result in five instances and arrangements were made by the Education Authority for the pupils to be cleansed. Specialist Services. As I have mentioned in my reports for previous years, these services are the responsibility of the Regional Hospital Board, who provide specialists in orthopaedic surgery and opthalmology to attend at the clinic at 93, High Road, South Woodford, at regular intervals to see children referred to them by the School Medical Officers. These arrangements have not been altered during the past year. 53 Diphtheria Immunisation The number of children of school age who were immunised by the School Medical Officer was only 37. Of these, 3 were given a complete course of injections and 34 a reinforcing dose. It is known that many more children were immunised by their own doctor, but it is not possible to give an accurate number of immunisations carried out as in many cases the general practitioners having done the work do not trouble to claim the fee due to them. The Health Visitors estimate that 75—80 per cent of children approaching the age of 5 are protected. Short Term Convalescent Treatment. There is provision under the Education Act, 1944 for school children to have a recuperative holiday, and during 1954, 27 pupils who attend schools in this Borough were sent for periods varying from three to six weeks. Each child was examined on return and reported to have benefited from the change. Dental Inspection and Treatment. A summary of the work carried out by the Dental Officer at the Woodford School Clinic is shown at Appendix "A." Anti-Tuberculosis Vaccine Clinical Trials. In my reports for the past three years, I have referred to the trials which are being conducted by the Medical Research Council to determine by investigation the degree of protection afforded by B.C.G. vaccines and their value if used on a wide scale for the population at large. The scheme commenced in this Borough in 1950, by seeking volunteers from children who were then in their last year at school. Contact is still kept with each volunteer, who is asked to attend for a skin test and X-ray examination each year. In addition a Health Visitor/School Nurse visits the home of each person participating in the trials to record details of any change in his or her employment, and illnesses since the date of the last examination. Many of the male volunteers have now reached the age of 18 years and are entering the Forces for their period of National Service. The three Services have agreed to assist the Medical Research Council in these trials and are making arrangements for those concerned to be followed up during their period in the Forces. 54 B.C.G. Vaccination. Following upon the investigation referred to in the preceding paragraph, the Minister of Health, in conjunction with the Minister of Education, approved proposals by Local Health Authorities for the extension of the arrangements so that B.C.G. vaccination could be offered to older school children. The County Council agreed that B.C.G. vaccination should be offered to those pupils who have passed their thirteenth birthday, but not attained the age of fourteen years, and that the arrangements be reviewed in six months time. The scheme commenced in the Forest Division in June 1954, and the parents of pupils attending Secondary Modern and Secondary Grammar Schools in this Borough were invited to consent to their child's participation. The results obtained during the Summer and Autumn Terms, 1954 were as follows:— No. of school children to whom offered 277 No. undergoing skin (Mantoux) tests after parents consent had been received 171 No. who received B.C.G. vaccination 136 55 Defects found by medical examination of school children. The following table shows the defects found in school children as a result of examination by Medical Officers at the Clinic:— Defect No. to be kept under observation No. found to require treatment Skin 14 - Eyes (a) Vision 39 2 (b) Squint 1 — (c) Other 1 — Ears (a) Hearing 12 — (b) Otitis Media — — (c) Other — — Nose or Throat 10 3 Speech 21 — Cervical Glands 1 — Heart and Circulation — — Lungs 6 2 Developmental (a) Hernia — — (b) Other — — Orthopaedic (a) Posture 6 — (b) Flat Foot 5 1 (c) Other 13 1 Nervous system (a) Epilepsy 2 — (b) Other — — Psychological (a) Development 8 1 (b) Stability 9 — Other 45 1 56 APPENDIX "A" Dental Inspections and Treatment. Number of pupils inspected (Periodic and Specials) 1863 Number found to require treatment: (a) Periodic 854 (b) Specials 421 Total 1275 Number of individual pupils actually treated 694 Attendances made by pupils for treatment 2803 Fillings: Permanent teeth 1795 Temporary 441 Total 2236 No. of Teeth Filled Permanent teeth 1669 Temporary 406 Total 2075 Extractions: Permanent teeth 40 Temporary 986 Total 1026 Administration of anaesthetics: (a) Local 99 (b) General 307 Total 406 Other Operations: (a) Permanent teeth 941 (b) Temporary 496 Total 1437 57 PN/72