BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1956 PUBLIC HEALTH COMMITTEE Alderman V. E. Stevens (Chairman) Councillor S. J. Relph (Vice-Chairman) Alderman R. W. Dale Alderman H. Hann Alderman Mrs. E. F. M. Hollis Councillor Mrs. S. V. F. Ashton Councillor I. G. Aylmer Councillor R. A. Dalton Councillor J. Morris. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: F. G. Brown, T.D., M.B., B.Ch., D.P.H. Chief Public Health Inspector: M. G. Crook, M.A.P.H.I. (a) (b) (c) (d) (f) Deputy Chief Public Health Inspector: J. T. S. Templeman, M.A.P.H.I. (a) (b) (g) Public Health Inspectors: A. J. Storer, M.A.P.H.I. (a) D. R. Chanin, M.A.P.H.I. (a) E. W. Patrick, M.R.S.H. (a) (b) (e) Clerks: R. M. Jamieson Mrs. V. Birkett (a). Royal Society of Health and Public Health Inspectors' Examination Joint Board Certificate. (b) Royal Society of Health Certificate of Meat and other Foods. (c) First Class Certificate in Laboratory Technique of Meat Inspection of Smithfield Technical Institute. (d) Diploma of the Royal Institute of Public Health and Hygiene. (e) Royal Society of Health's Smoke Inspector's Certificate. (f) General Instructor's (Special) Certificate, Home Office Civil Defence School, Falfield, Glos. (g) City and Guilds Boiler House Practice Certificate. 2 Wonsteid and Woodford Borough tail TO THE MAYOR, ALDERMEN AND COUNCILLORS, BOROUGH OF WANSTEAD AND WOODFORD. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health Services in the Borough for the year 1956. As previously, a section of the report is devoted to those personal health services under the National Health Service Act which are administered by the Essex County Council. A brief outline of the School Health Service is given. Vital Statistics Live births during the year fell by 17, the total number recorded being 677. The Birth Rate per 1.000 population was 11.2, that for the county as a whole being 15.3. There were 10 still-births, one fewer than in 1955. Deaths numbered 725, an increase of 76 over those occurring in the previous year. Thus the death rate was 11.8 per 1,000 population compared with a figure of 9.7 for 1955 and 11.7 for the whole county during 1956. The increase in the number of deaths would appear to be due to the effects of the extremely cold weather which was experienced in the early months of the year and which took its toll of the older population more especially those already suffering from chest complaints. The Infantile Mortality Rate, i.e., the deaths of infants under one year of age per 1,000 live births, rose from 17.9 to 26.6, this being the highest figure recorded during the past five years. At the first sight this increase would seem disturbing but it must be borne in mind that the totals dealt with are small and the figure is thus easily raised. Also, on analysing the causes of death, out of a total of 18, 11 were due to prematurity or congenital defect, some of these children surviving birth for a few days only. On the other hand 4 deaths were certainlv preventable being due to accidental suffocation. This will be referred to later when the question of accidents in the home is being discussed. There were no maternal deaths during the year. Causes of Death Commonest causes of death were 'diseases of the heart and arteries' and cancer, those from the latter cause increasing from 119 to 135. The figure of deaths from cancer is identical with that recorded two years ago. 3 There were 9 cases of suicide. Two deaths were caused by road traffic accidents and 16 by accidents in the home. 4 of the home accidents concerned children under one year and the majority of the remainder aged people. Home Accidents The prevention of accidents in the home has now become one of the most pressing problems for the Health Department. Every effort is being made to educate parents, and those who are concerned with the care of the elderly, regarding common household hazards and how they can be avoided. With this end in view the Council decided during the year to publish an illustrated booklet which is issued through child welfare centres and old peoples' clubs. It is also distributed by Health Visitors and District Nurses. Infectious Disease. The incidence of infectious disease was low. Early in the year a case of diphtheria occurred in a child aged 7. This boy had not been immunised and contracted the disease as a result of contact outside the Borough. Complete recovery took place and there was no further spread. At the end of the year there was one case of poliomyelitis in an infant aged 5 months. The disease was nonparalytic and recovery was uneventful. The cause of the infection could not be determined. During the Autumn a case of paratyphoid fever in an adult was notified. The exact cause of the infection was not ascertained but was considered to be associated with an incidence of the disease in the Greater London area due to the importation of dried egg product. In the early summer an outbreak of dysentery, mainly affecting children, occurred in the Woodford Bridge area when there were approximately 200 cases. The disease was mild and of short duration. Most cases were not treated by their doctors and, as a result, were never notified. Strict precautionary measures were instituted at the schools concerned and. by the end of term, the disease had abated. At the time this type of dysentery was very prevalent throughout the country and many outbreaks were reported. There was little change in the incidence of tuberculosis, 32 new cases being notified (36 in 1955). There were 7 deaths (4 in 1955). National Health Service Act: Part III Services. Details of those services administered by the Essex County Council through the Forest Area Health Sub-Committee are given in Section G. 4 Total attendances at the six Infant Welfare Centres in the Borough increased by 400. At the end of the year the Wanstead Day Nursery was closed. Reasons for closure are given in the appropriate section of the report. Visits paid by Home Nurses increased by close on 4,000. There was increased demand for the Domestic Help Service especially during the winter months. Every effort is made to meet this demand but there is still a shortage of Home Helps. Immunisation against poliomyelitis for selected groups of children was commenced during the year but, owing to strict limitation of supply of vaccine, the total numbers afforded protection was not large. My thanks are due to the staff of the Department for their cooperation during the year. It is with pleasure that I express to the Chairman and Members of the Public Health Committee my sincere appreciation of their continued support. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, F. G. BROWN, T.D., M.B., B.Ch., D.P.H. 16th August, 1957 5 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population— Registrar-General's estimate mid-year 1956 61,130 Registrar-General's estimate mid-year 1955 61,380 Rateable Value £1,020,398 Sum represented by penny rate £4,070 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 326 Females 329 Total 655 Illegitimate Males 11 Females 11 Total 22 Total Males 337 Females 340 Total 677 Rirth-rate per 1,000 of the estimated resident population—11.2 STILLBIRTHS Legitimate Males 3 Females 7 Total 10 Illegitimate Males — Females — Total — Total Males 3 Females 7 Total 10 Rate per 1,000 total (live and still) births—14.5 DEATHS Males—338 Females—387 Total—725 Death rate per 1,000 of the estimated resident population— 11.8 Deaths from puerperal causes:— Puerperal and post-abortion sepsis — Other maternal causes — Deaths of infants under one year of age:— All infants per 1,000 live births 26.6 Legitimate infants per 1,000 legitimate live births 24.4 Illegitimate infants per 1,000 illegitimate live births 90.9 1955 1956 Deaths from Cancer 119 135 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 7 2 „ „ Suicide 6 9 „ „ Other violent causes 6 18 6 Population. The Registrar General's estimate of the population for 1956 (midyear) was 61,130, a decrease of 250 on the figure for 1955 (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. 7 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1956. 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 15.7 15.60 15.6 15.9 11.20 Still 0.37 0.37 0.36 0.33 0.16 Deaths: All Causes 11.70 11.6 11.60 11.7 11.85 Malignant Neoplasm Lung and Bronchus 0.41 0.47 0,39 0.58 0.55 Whooping Cough 0.00 0.00 0.00 0.00 - Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.12 0.14 0.11 0.14 0.10 Influenza 0.06 0.04 0.05 0.04 — Coronary Disease —Angina 1.67 1.68 1.71 1.70 1.52 Acute Poliomyelitis & Polioencephalitis 0.00 0.00 0.00 0.00 - Pneumonia 0.52 0.57 0.45 0.67 0,36 (Rates per 1,000 Live Births) All causes under 1 year of age 23.8 24.0 24.1 21.4 26.6 Enteritis and Diarrhoea under 2 years 0.51 * * * - **Figures not available. 8 Notifications: England & Borough of Wales Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.01 0.02 Meningococcal Infection 0.03 — Scarlet Fever 0.74 0.34 Whooping Cough 2.07 0.95 Diphtheria 0.00 0.02 Erysipelas 0.10 0.08 Smallpox — — Measles 3.59 2.56 Pneumonia 0.57 0.25 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.04 — Non-Paralytic 0.03 0.02 Food Poisoning 0.25 0.60 Rates per 1,000 Total Births (Live and Still) Puerperal Fever & Pyrexia 16.31 34.90 9 Maternal Mortality Abortion Other Total England and Wales 0.09 0.48 0.57 Wanstead and Woodford — — — Causes of Death as given by the Registrar-General, 1956 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 5 1 6 2. Other forms of Tuberculosis — 1 1 3. Syphilitic Disease 1 1 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — - - 10. Malignant Neoplasm—Stomach 11 6 17 11. Malignant Neoplasm—Lung and Bronchus 28 6 34 12. Malignant Neoplasm—Breast — 15 15 13. Malignant Neoplasm—Uterus — 7 7 14. Malignant Neoplasm—Others 32 30 62 15. Leukaemia — 2 2 16. Diabetes 3 2 5 17. Vascular Lesions—Nervous System 44 72 116 18. Coronary Disease—Angina 56 37 93 19. Hypertension with Heart Disease 5 10 15 20. Other Heart Disease 47 80 127 21. Other Circulatory Disease 6 23 29 22. Influenza — — — 23. Pneumonia 14 8 22 24. Bronchitis 24 21 45 25. Other Respiratory Diseases 5 2 7 26. Ulcer of Stomach or Duodenum 6 — 6 27. Gastritis, Enteritis and Diarrhoea — 2 2 28. Nephritis and Nephrosis 4 — 4 29. Hyperplasia of Prostate 5 — 5 30. Pregnancy, Childbirth, Abortion — — — 31. Congenital Malformations 5 3 8 32. Other Diseases 24 42 66 33. Motor Vehicle Accidents 1 1 2 34. All Other Accidents 5 13 18 35. Suicide 6 3 9 36. Homicide and Operations of War — — — Totals, 1956 337 388 725 Totals. 1955 308 341 649 10 Infant Deaths, Neo-Natal Mortality and Stillbirths Year Live Births Birth Rate Stillbirths Neo-Natal Deaths Infant Deaths No. Per 1,000 Live Births Per 1,000 Population No. Per 1,000 Live Births No. ,000 Live Births 1956 677 11.2 10 14.8 0.16 10 14.8 18 26.6 1955 694 11.4 11 15.8 0.18 9 12.9 12 17.3 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Year Total Births Registered Deaths Total Rates per 1,000 Births (Live and Still) Puerperal Sepsis Other Maternal Causes Puerperal Sepsis Other Maternal Causes Total 1956 687 - - - - - - 1955 705 - 1 1 — 1.42 1.42 1954 718 - 1 1 — 1.39 1,39 1953 802 - - - - - - 1952 761 - 1 1 — 1.31 1,31 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1956 1955 1954 1953 1952 Maternal Mortality — 1.44 1.42 — 1,33 Stillbirths 14.8 15.80 21.3 13.9 13.3 Neo-Natal Mortality 14.8 12.90 9.9 15.2 20.0 During 1956 there were no deaths classified as being due to pregnancy, childbearing or associated therewith. 11 Comparative Statistics of Births, Mortality etc., 1937 to 1956 Year Population Live Births Still Births Deaths Infant Deaths Maternal Deaths No: Rate* No: Rate† No: Rate* No: Rate§ No: Rate† 1956 61130 677 11.2 10 14.5 725 11.8 18 26.6 — — 1955 61380 694 11.4 11 15.6 649 9.7 12 17.3 1 1.42 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 18.1 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 - — *Per 1,000 Population †Per 1,000 Total Births §Per 1,000 Live Births 12 TOTAL INFANT MORTALITY 1937—1956 This is defined as the sum of the deaths that occur during child-birth and during the first year of life. The graph shows the position in the Borough since 1937. TREND OF BIRTH AND DEATH RATES 1936 TO 1956 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, Wanstead Hospital, Wanstead. 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. tOphthalmic—Wednesday mornings, By appointment only. t 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. tControlled by the North East Metropolitan Regional Hospital Board and delegated to the Forest Group Hospital Management Committee. 13 6. Chest Clinic Harts Hospital, Woodford Green. Sessions: Wednesday, 9.15—11 a.m. 5.0-—6.0 p.m. (appointment only) Friday, 9.15—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 were available through the local depot at VVanstead, the service being administered centrally by the County Council from Chelmsford. 3. 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 1956. 9. Funeral arrangements In no cases was the Local Authority required to make arrangements for the burial of a person during the year 1956. 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 (a) Refuse Collection A fleet of Shelvoke and Drewry freighters is operated for the collection of refuse. The collection service is organised on the basis of three teams working the relay system—each team covering one third of the Borough each week. 14 (b) Refuse Disposal Disposal of refuse continued by controlled tipping at sites within the Borough. However, as all available sites will soon be filled, arrangements have been made to take all the Council's refuse in the near future to a site at South Ockenden, Essex. This proposal entails the transportation of refuse to Ockenden by bulk vehicles and the construction of a Transfer Depot for which a site was selected at Eastern Sewage Works. Detailed plans for this scheme were commenced; it is envisaged that the new disposal arrangements will operate from early Autumn, 1957. Other methods of refuse disposal have been fully investigated but found to be more costly than the proposal as now finalised. (c) Salvage Collection. The separate collection of waste paper for salvage has been continued. Sewerage (a) It was not possible to commence preparation of the scheme for re-laying the very old sewers in the Western Drainage area. (b) The policy continued of constructing new manholes on lengths of sewers where such facilities are lacking and several additional manholes were installed. (c) Due to exceptionally heavy summer storms, flooding occurred in several places, particularly at four points in the Borough. Small schemes were undertaken at these places with a view to preventing or minimising flooding on future occasions. Eastern Sewage Disposal Works (a) It became increasingly evident that the improvements referred to in the previous year's report were becoming more urgent, and by the end of the year technical staff was available to commence preparation of the large capital schemes. In the meantime considerable difficulty was experienced in maintaining a satisfactory effluent. (b) A pilot scheme of effluent recirculation was installed at two of the circular filter beds as an experiment. (c) Two small schemes were carried out to improve the efficiency of the sedimentation tanks. 15 Southern Sewage Disposal Works It was learnt from the Ministry of Housing and Local Government that consideration would be given to loan sanction after 31st March, 1957 for the first stage of the Major Improvement Scheme. This includes the installation of detritor, new screens, two clariflocculators and three humus tanks, with the necessary ancillary works. Although considerable progress was made on preparing the detailed scheme it was again delayed by the technical staff position, but at the end of the year additional technical staff was obtained and work continued. Western Sewage Disposal Works Construction of the connecting sewer to Chingford, storm overflow and ancillaries was completed and the flow from the Western Drainage Area diverted to Chingford. This was followed by demolition of the old Sewage Works and a commencement of site reinstatement. 16 SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:— Insanitary Dwellings—Housing Acts and the Local Government (Miscellaneous Provisions) Act, 1953 Before giving details in this field of activity for 1956 it is well to consider matters outstanding when the Annual Report for 1955 was published. Chigwell Road— Clearance Order. It is gratifying to record that 1956 saw the rehousing of the occupiers of these dwellings and the demolition of many properties. Some difficulty was experienced in rehousing some occupiers particularly those persons living alone. 9 & 10, Belgrave Terrace. Reference was made to the fact that these two dwellings had remained unrepaired so it is interesting to note that in 1956 they were purchased by one person who proceeded to convert them into one property. By the end of the year the conversion was almost complete. The final product is pleasing to look at and will provide a home for some years to come. 5, 6, 7, 8. 9, Inmans Row. The Official Representation by the Medical Officer of Health was confirmed as a Clearance Order in 1956 by the Minister of Housing and Local Government. 99. High Road, E.18, the subject of a voluntary undertaking, was still standing at the end of 1956. 11, 13, 15, 17, Voluntary Place were demolished during 1956. 33, High Road, Woodford Green, the subject of a closing order, was purchased by a builder and at the conclusion of 1956 reconditioning was nearing completion. 1-27, Sultan Road. The Minister of Housing and Local Government has now confirmed the compulsory purchase order without modification. Aldersbrook Hutted Camp. Reference has been made in the last two Annual Reports to this hutted camp correctly referred to as a "blot on the landscape." The site, situated on the verge of Wanstead Flats, a vast area of grassed open space forming part of the Epping Forest land, was conspicuous against such a background. It is pleasing to report that at the end of 1956 one licensee only remained to be rehoused. Many huts had been demolished during the year and it is hoped that by the end of 1957 the site will be cleared completely and all evidence of the unsightly area removed. 17 The next section of this part of the Report deals with more current matters in the field of housing, again showing progress, and continued support by the Public Health Committee to the Medical Officer of Health and his staff. Hall Road and Tilney Road Clearance Area. Much consideration was given in the early part of the year to a suggested clearance area for the properties in Hall Road, Tilney Road and part of Eastern Avenue. In consequence, in March, the Medical Officer of Health made an Official Representation to the Public Health Committee of the Council concerning this area, the Representation embracing 1-15 and 8-14, Tilney Road, 1-11 and 2-46, Hall Road and 48-70 and 74-78, (even Nos.) Eastern Avenue. These 56 properties were later recommended to the Ministry as the subject of a compulsory purchase order. Some idea of the properties concerned is given in the photographs included in this Report. An Enquiry was held by the Minister on October 16th, 1956 into objections raised by a small number of owners. 15, Victoria Road, E.18 and 99, High Road, Woodford Green were considered by the Public Health Committee as being unfit houses in accordance with Section 11 of the Housing Act, 1936. Demolition Orders were made against both properties. 6, Trevor Road, Woodford Green was considered as a house unfit in accordance with Section 11 of the Housing Act, 1936. Refore any formal action was taken by the Council the tenant decided to purchase it with a view to reconditioning. Any further action was deferred so that work could proceed and by the end of the year much progress had been made. The obvious effect of the action by the tenant was the prevention of the closing or demolition of a house which could be restored to a good condition although at considerable expense; the continued occupation by him and his wife of a home of their own choice and liking, and the saving of close on £2,000 which would have been spent by the Council for accommodation for these people if closing or demolition was enforced. 33/35, Grove Road, E.18 were considered by the Committee as property suitable for dealing with under Section 11. Formal action was not necessary as the owner decided to execute repairs. 45a, Grove Road- basement flat. This flat, because of the presence of dampness and dry-rot, was closed in accordance with the conditions laid down under the Housing Act. 18 152, High Road, Salway Hill. This house and shop was demolished by informal action because of its condition. Such action became necessary because of the dangerous and defective condition of the roof. The structure was one of the few wood covered dwellings remaining in the Borough. 7 & 9, Voluntary Place. Because of a complaint received in the office an inspection revealed the bad condition of No. 9, in which the floor of the front room had collapsed. Action under Section 11 was taken whereupon demolition orders were made applying to the two houses. Housing Repairs and Rents Act, 1934, Section 11, Houses let in lodgings A report to the Public Health Committee under the above Act and Section was made, but the Committee decided to take no action in regard to a hall floor tenancy. Compulsory Purchase Orders; Housing Act, 1936 In cases of clearance areas it is necessary for the Council to rehouse the tenants; consequently the Housing Manager has the duty of catering, as near as possible, for the requirements of these persons. In one case in the Chigwell Road area it was necessary for the Town Clerk to serve on the owner/occupier a notice to quit because of the refusal of that person to accept offers of accommodation. This person did eventually find his own accommodation. Slum Clearance (Compensation) Act, 1956 This new Act, which came into force in the latter months of the year, when operated gave some indication of the amounts of compensation being awarded to similar types of property. Two houses in the Chigwell Road area separated from each other by only three houses were awarded £400 and £55 as compensation respectively. One in the Burlington Place area was awarded £315 whilst two others each forming the end house of a terrace of three were awarded a total of £160. Overcrowding Two cases of overcrowding were reported to the Public Health Committee, in both the families consisted of the parents and a number of children. In the first case notice to abate the overcrowding was served upon the occupier. His tenant complied by arranging for two of his children to sleep in another house. Regarding the second case it was found later that an offence did not exist because of technicalities contained in the Housing Act. 19 Housing Repairs and Rents Act, 1954 Remarks made in the report for 1955 concerning the working of this Act apply equally well to the year now under review. The number of applications for certificates of disrepair were very small, being no more than six, only one of which was subsequently revoked. Of the six applications made, four only were granted, the remaining two were refused. Two further certificates were revoked, one having been issued in 1954 and the other in 1955. Meat Inspection Reference was made last year to the necessity for providing for regular early morning inspections at a local meat wholesaler's premises. Arrangements were later made at the town where slaughtering took place for the adequate inspection of carcases and consequently it was possible in the early months of the year to relax the inspections in this Borough. The number of animal carcases examined locally is given below, together with the items of meat and offal condemned and surrendered: Inspected: Bulls 4 Boars and Sows 29 Bullocks 145 Lambs 428 Cows 164 Sheep 243 Calves 90 Pigs 1683 Total 2786 Condemnations: Hind 1 Septicaemia 183 lbs. Ox livers 6 Flukes 84 lbs. Ox livers 2½ Flukes and abscess 34 lbs. Ox livers 2 Tuberculosis 32 lbs. Ox kidney 1 Abscess l lb. Ox liver Abscess 24 lbs. Cow liver Cirrhosis 14 lbs. Pigs' heads 3 Tuberculosis 24 lbs. 396 lbs. 20 Slaughtering Facilities, In the report of the Medical Officer of Health for 1954 reference was made to the meeting of Local Authorities in Metropolitan Essex with a view to setting up an abattoir or joint abattoirs to serve the Boroughs in the area. Discussion of any contemplated action was deferred until the final report of the Interdepartmental Committee on Slaughtering was received. A further meeting was held at West Ham in January, 1956, when the conference deferred consideration of the matter until the Government policy was determined. The Council of West Ham County Borough, the convenor of the previous conferences, called another in December to discuss a recent circular from the Ministry of Agriculture, Fisheries and Food; which was accompanied by the White Paper announcing the Government's policy to regulate provision of slaughterhouses. Because the policy recommended that there should be a period during which meat traders would be free to provide slaughterhouses of a type and in places best suiting their requirements, it was agreed that there was little purpose in the conference considering further the provision of public slaughterhouses but that the present arrangements for convening a conference should continue in case altered circumstances made it desirable to have further discussions. The chairman was prepared to call a meeting on request. Works in default. In one case only was it necessary to ask permission of the Public Health Committee to execute works in default; this being a case where a notice had been partly complied with. Appeals to the owner to complete were not responded to and the Public Health Committee finally decided to obtain tenders for the remaining items, one of which was accepted at the end of the year. Works executed by the Local Authority. Such works were confined to the relaying of drainage systems, which were, in several cases, of considerable size. The defects in these larger systems were caused by the settlement of "made up" ground, whilst in smaller systems they were created by conditions due to the methods of construction considered good in the past but frowned upon when compared with modern practice. The cost of the works to these larger systems was recoverable from the owners. In other cases—the smaller systems—the expense was borne by the Council. 21 Smoke Abatement The recording of atmospheric pollution has continued throughout the year; the readings being confined to smoke and sulphur dioxide. Tabulated data is forwarded monthly to the Fuel Research Station at Greenwich. In January the Public Health Committee considered a request from the Essex County Council asking the Borough Council to supply a further recording instrument with a view to establishing throughout the county additional sites for recording instruments. The new set-up was designed by the Fuel Research Station in conjunction with the Essex County Council to cover as well as possible the whole of Essex with a chain of recording stations. This Authority, having provided one set of recording instruments, resolved not to provide a second mainly on the grounds that because of the geographical lay-out of the Borough any second set would be in close proximity to those in adjoining Boroughs. Wanstead and Woodford were not asked to set up a station with deposit gauge or lead peroxide apparatus. 22 NEW LEGISLATION Food & Drugs Act, 1955 & Food Hygiene Regulations, 1955 As mentioned in other parts of this Report these two important pieces of legislation came into force on January 1st, although several parts of the Regulations, which were made under the Act, did not become effective until July 1st. These latter Regulations dealt with the provision of wash hand basins, sinks for washing equipment, cupboards for staff clothing, etc. Clean Air Act, 1956 The Bill designed to remove atmospheric pollution became an Act of Parliament in July, 1956. The Clean Air Act (Appointed Day) Order, 1956, brought into operation certain sections of the Act as from 31st December, 1956. An Appointed Day has still to be declared for the remaining part of the Act. The Act, when working more fully, should be the means of keeping the atmosphere free of smoke, etc., for, in addition to giving powers to local authorities to control the emission of smoke, it contains provisions enabling Smoke Control Orders to be made creating what were formerly known as smokeless zones. Although the Act is not as strong as many would wish, it is to be hoped that "smog" will be a thing of the past and that local authorities will implement the "provisions of the Act making the breathing of clean air a reality. Sanitary Inspectors (Change of Designation) Act, 1956. For some years past many inspectors have hoped for a change of name and efforts have been made on various occasions to this end. A Private Member's Bill enabled the Act to receive the Royal Assent on the 2nd August, 1956. It stated that sanitary inspectors appointed under the Local Government Acts, etc., shall henceforth be designated public health inspectors. Slum Clearance (Compensation) Act, 1956 set out provisions for paying compensation for loss of dwellings in slum clearance schemes. 23 RODENT CONTROL Arrangements for the destruction of rats and mice continued, and as in previous years, complaints and retreatments were sufficient to warrant the employment of a full-time operative. The number of complaints received during 1956 has decreased slightly, being 371 as compared with 410 for 1955. Although the number of visits by the Rodent Operative decreased from 860 in 1955 to 762 in 1956, those made by Inspectors increased from 217 in 1955 to 257 in 1956, therefore one must conclude that many of the complaints were such as to necessitate more expert attention than that required during routine treatments. Two notices were served under the Prevention of Damage by Pests Act, 1949; both were complied with by the persons concerned. Good relationship still exists between the Officers of the Local Authority and Officers of the Ministry of Agriculture and Fisheries, and the meetings of the Workable Area Committee held three times per year still give scope for useful discussion. The number of complaints received in the past is as follows: 1948 210 1949 287 1950 284 1951 290 1952 330 1953 316 1954 324 1955 410 1956 371 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 1956 shows an improvement on the years 1954 and 1955 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 results of the years work Number of inspections made by the Public Health Inspectors 257 Complaints received 371 Revisits to premises 292 Visits to adjacent premises 107 Total premises visited 762 Number of baiting points 3556 24 Sewer Treatment 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 NT 1 71 — 71 15 3 18 53 2 86 — 86 5 7 12 74 3 72 3 69 12 11 23 46 4 73 1 72 13 9 22 50 5 77 — 77 15 9 24 53 6 79 — 79 11 6 17 62 7 77 — 77 18 10 28 49 8 67 1 66 20 8 28 38 9 78 — 78 19 10 29 49 10 77 — 77 17 9 26 51 11 77 1 76 23 9 32 44 12 70 — 70 15 12 27 43 13 71 — 71 25 12 37 34 14 67 - 67 36 6 42 25 15 75 — 75 12 6 18 57 16 71 — 71 37 9 46 25 17 68 — 68 23 4 27 41 18 72 6 66 22 5 27 39 19 70 — 70 18 8 26 44 1398 12 1386 356 153 509 877 25 Sewer Treatment 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 NT 1 56 - 56 18 10 28 28 2 73 - 73 20 9 29 44 3 62 - 62 22 9 31 31 4 68 - 68 21 11 32 36 5 74 74 28 9 37 37 6 63 — 63 23 10 33 30 7 70 - 70 33 8 41 29 8 67 — 67 31 8 39 28 9 71 — 71 35 7 42 29 10 68 — 68 29 10 39 29 11 72 - 72 28 11 39 33 12 69 - 69 19 12 31 38 813 - 813 307 114 421 392 26 27 Summary of Treatments Year No. of Manholes No. NOT baited No. baited Average Pre-bait Takes Complete Partial Total takes N.T. 1956 1st treatment 1398 12 1386 356 153 509 877 2nd „ 813 - 813 307 114 421 392 1955 1st treatment 1388 11 1377 427 283 710 667 2nd „ 1392 33 1359 159 371 530 829 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 1 284 141 425 975 Essex County Council Act, 1933, Section 109. Permission was granted to an applicant to keep a caravan on a site within the Wanstead area of the Borough. Pet Animals Act, 1951. The number of registered keepers of pet shops remained at four. All were maintained in a satisfactory condition. In two cases only could the business of dealing in pets be said to be substantial, the other two selling only the occasional cage-bird. 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 at one. Petroleum (Consolidation) Act, 1928 The number of licences increased from 58 to 60. A large children's home which was vacated during the year discontinued storage of petroleum whilst a firm of building contractors took out a licence to store petroleum for use in their vehicles and plant. One petrol station put in new tanks to hold 5,000 gallons and in another case storage was increased by putting an existing tank back into service. 161 visits were made during the year. Game Licences Ten licences to deal in Game were renewed in 1956. Shops Act, 1950 269 inspections of shops were made in connection with this Act, an increase on the number for 1955. Again no difficulty was experienced in the closing hours. Four applications for certificates of exemption were received under Section 38 of the Act, the grounds of the applications being that the provision of sanitary conveniences was not possible because of restricted accommodation. The Public Health Committee agreed to certificates being granted in three cases. Essex County Council Act, 1933 Massage and Special Treatment Establishments These premises were again visited under the above Act and Section by the Public Health Inspectors, although registration is in the hands of the County Council itself. 13 visits were made, indicating an additional two registrations over the previous year. All were satisfactory. 28 Swimming Bath Water Four samples of water from swimming baths were taken; three from schools and one from a well known national orphanage. In all cases the bacteriologist reported that the water was suitable for use in a swimming bath although in three cases there was a need for residual chlorine. Addition of alkali was recommended in the fourth case because the water had a reaction on the acid side of neutrality. Two of the three schools and the orphanage dose the water manually whilst the third school has a filtration and chlorination plant. Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 30 Visits in connection with contacts, disinfection, etc. 21 Enquiries in connection with food poisoning 62 Verminous Premises 23 General Environmental Public Health Drains and Sewers inspected Drain tests applied 1218 Stables and manure pits inspected 22 Public Conveniences 16 Urinals 6 Factories (mechanical) 235 Factories (non-mechanical) 14 Hairdressers' premises 22 Schools and School Canteens 83 Ditches, Streams and Ponds 39 Open Spaces and Playing Fields 39 Petrol Installations 161 Shops Act inspections 269 Outworkers' premises 56 Massage Establishments 13 Pet Animals Act 4 Merchandise Marks Act 21 Swimming Baths 4 Smoke observations 14 Workplaces 11 Housing Repairs and Rents Act 11 Offices 11 Tents, Vans and Sheds—Gypsies 10 Heating Appliances (Fireguards) Act and Regulations 19 Miscellaneous 125 29 SECTION D. HOUSING No. of dwellings erected during 1956: Council: 28 (providing 48 units of accommodation); Private Enterprise: 96. 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) 1613 (b) Number of inspections made for the purpose 2328 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 62 (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 134 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 78 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 4 (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 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 12 (b) By Local Authority in default of owners — 30 A number of properties in Tilney Road included in the Hall Road/Tilney Road Clearance Order. Note general perishing of brickwork, pointing and the rendering of flank wall. Rear view of the property indicated in photograph 1 showing additions restricting light and air and deterioration of structure Rear view of some of the properties in Hall Road. Photograph taken from garden of dwelling in Tilney Road. Note settlement of roof and general deterioration of brickwork, pointing, etc. View of the property in the long section of Hall Road. (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 6 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 Nuisances Abated and Improvement Effected Roofs repaired 33 External walls and chimney stacks repaired 15 Walls underpinned 1 Gutters and spouts repaired or renewed 21 Damp-proof courses provided 2 Dampness remedied 45 Yards paved or repaired 1 Internal walls and ceilings repaired 41 Doors and frames repaired or renewed 4 Windows repaired or renewed 30 Floors repaired or renewed 13 Sub-floor ventilation provided or improved 3 Rooms cleansed or redecorated 2 Fireplaces and flues repaired or renewed 11 Washbasins and sinks provided or renewed 3 Wastepipes repaired or renewed 2 Dustbins provided or renewed 1 Water supply improved or reinstated 8 Water closet pans repaired, renewed or cleansed 1 Water closet cisterns repaired or renewed 7 Water closet lighting and ventilation improved — Water closet flush pipe joints repaired 3 Water closet walls etc., cleansed 1 Water closet structures repaired 2 Drains cleansed from obstruction 181 Drains repaired or renewed 14 Miscellaneous 9 Disinfection and Disinfestation Number of rooms disinfected 46 Premises from which bedding removed for steam disinfection 38 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 Inspections Written notices Occupiers prosecuted (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 36 14 - - (ii) Factories not included in (i) to which Section 7 applies 163 235 6 - (iii) Other Premises under the Act (excluding out-workers' premises) - - - - TOTAL 199 249 6 - 2. Defects found. Particulars Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred by H.M. Inspector Want of cleanliness 2 3 l - Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — 1 l — Ineffective drainage of floors — 1 l — Sanitary conveniences: 1 Insufficient - 1 2 - 2 Unsuitable or defective — 2 2 — 3 Not separate for sexes — 1 1 — Other offences — — — — TOTAL 2 9 8 — 32 3. Outwork Number of out-workers in August list required by Section 110(1)(c) Paper Bags 6 Boxes 14 20 Twelve certificates of means of escape in case of fire under Section 34 were issued in 1956. 33 SECTION E. FOOD AND DRUGS In January, 1956, the Food and Drugs Act, 1955 came into effect and with it a considerable portion of the Food Hygiene Regulations, 1955. The latter created much work in the Department by inspections of food premises to ascertain whether or not the standards set by the Regulations were complied with. Further, after July 1st, reports had to be made to the Public Health Committee in connection with applications for exemption from providing such things as wash hand basins, sinks, clothing cupboards, etc. In all some 17 applications were considered, three were deferred and the remaining 14 refused. Some difficulties were met in the administration of these new Regulations, the worst being the interpretation of the meaning of wash hand basin. Some people consider that a bowl can be interpreted as a wash hand basin; others that it is a fixed basin with trapped waste. The Council referred this matter to the Association of Municipal Corporations with a view to getting the term clarified. Proceedings were authorised against a greengrocer for offences against Regulations 14(l)(a); 14 (5); 16(1); 16(2); 16(3); 17;20;23 and 24. The result of action in this case must be held over until the report for 1957. Reports were made in regard to the following: (1) glass in a loaf; (2) nail in bread; (3) mould in a jar of raspberry jam; (4) deficiency of fat in beef suet and (5) deficiency of fat in hot milk. Successful proceedings can be recorded in regard to items Nos. 1 and 2 above. Proceedings were unsuccessful in case 5 and although the Council did decide to appeal against the decision of the Court it was finally resolved not to take action in the High Court. It was felt that justice would be done in cases 3 and 4 by communicating with the vendor and the manufacturer. Hawkers of Food Under Section 103 of the Essex County Council Act, 1952, two vendors were registered for the sale of (a) ice cream and (b) hot dogs respectively. 34 The list of food sampled is given below, together with samples of ice cream and ice lollies. Brandy 1 Meat pie 1 Gin 2 Milk 21 Sherry 2 Minced beef 1 Whisky 8 Mincemeat 1 Apricots—dried 1 Mixed peel 1 Arrowroot 1 Mustard pickle 1 Bacon 6 Orange Crush 1 Beef suet—shredded 2 Pears—dried 1 Brawn 1 Pepper 1 Bread and Butter 2 Porridge oats 2 Butter 14 Prepared garden peas 1 Coffee 3 Raisins 1 Corned Beef 2 Salmon spread 1 Crystallised Ginger 1 Sponge mixture 2 Curry Powder 2 Stewing steak 1 Dandelion Coffee 1 Sugar 1 Double Cream 3 Tea 6 Figs 1 Tongue 2 Fish Cakes 1 Veal and ham pie 1 Fish Fingers 1 Yoghourt 1 Flavour—cherry 1 Boric Acid ointment 2 Flavour—orange 1 Brewers yeast tablets 1 Flour—self-raising 2 Castor oil 1 Fruit salad 1 Charcoal tablets 1 Glace cherries 1 Chlorodyne tablets 2 Gravy browning 1 Cod liver oil 2 Ground almonds 1 Gees linctus 2 Ground ginger 1 Glaubers salts 1 Ground rice 3 Glucose 1 Ham 1 Halibut oil capsules 1 Hot milk 1 Iron ielloids 1 Ice Cream 8 Menthol and eucalyptol Ice lollies 3 pastilles 1 Jam—plum 1 Oil of peppermint 1 Jam—raspberry 1 Olive oil 2 Lard 3 Rheumatism tablets 1 Lemon juice 2 Soda mints 1 Luncheon meat 3 Sulphur ointment 1 Eight samples of ice cream were submitted to the Public Analysts to ascertain the fat content of the mixture. The samples contained fat to the following extent: 13.5 percent; 12.4 per cent; 7.8 per cent; 12.9 per cent; 10.2 per cent; 13.2 percent; 12.5 per cent and 11.2 per cent. 35 The following is a list of foods surrendered in 1956 because of unsound conditions: Meat, Tinned Fish, Fresh Luncheon Meat 38 tins 7 stone Meat Loaf 4 tins Corned Beef 52 tins Fish, Tinned Ham 1 tin Salmon 4 tins Stewed Steak 3 tins Lobsters 12 tins Ox Tongue 1 tin Pilchards 3 tins Lambs' Livers 9 tins Sardines 1 tin Jellied Veal 1 tin Fruit, Tinned Meat, Fresh Cherries 1 tin Ox Tongues 12 lbs. Plums 5 tins Ox Cheek 14 lbs. Pineapples 22 tins Pigs' Heads 47 lbs. Peaches 23 tins Beef 252 lbs. Apricots 29 tins Pork Sausages 1 lb. Oranges 10 tins Liver 210 lbs. Pears 4 tins Bacon 8 lbs. Raspberries 7 tins Kidney 1 lb. Gooseberries 7 tins Strawberries 5 tins Miscellaneous Grapefruit 4 tins Milk, Tinned 43 tins Blackberries 3 tins Milk, Fresh 13 pints Cakes 13 No. Fruit, Dried Cereals 2 pkts. Currants 12 pkts. Soup 12 tins Fruit Pie Filling 2 tins Vegetables, Tinned Mixed Fruit Pudding 2 tins Peas 30 tins Jam and Marmalade 8 jars Beans 18 tins Spaghetti 2 tins Tomatoes 87 tins Sandwich Spread 1 jar Tomato Juice 4 tins Semolina 1 pkt. Pickles 9 jars Jelly 1 pkt. 36 Manufacture, storage and sale of Ice Cream Eighty-seven registrations of premises were in force at the beginning of the year, and a further seven were added during the year. Sixty-eight 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) Fifty-one samples of ice cream and ice lollies were obtained and the results are as follows: Ice Cream: Ministry of Health's Provisional Grading Taken Grade 1 Grade II Grade III Grade IV Nos. 43 34 6 3 per cent. 100 79 14 7 Ice Lollies: Taken Satisfactory Unsatisfactory 8 7 1 Of the nine unsatisfactory samples of ice cream, five (one Grade III and four Grade II) were taken from a cafe which, following representations by the Public Health Department, changed their sales from loose to wrapped ice cream. Follow up samples were taken from two other premises where a Grade III report had been received and all proved satisfactory. Foods 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., Dr. J. H. Hamence, F.R.I.C., and P. S. Hall, Esq., A.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. 37 The food premises in the District may be classified as follows: Confectioners (cakes, pastries) 27 Grocers 77 Greengrocers 36 Butchers 34 Confectioners and tobacconists 67 Restaurants and cafes 38 Fishmongers 15 Dairies and Milkshops 11 Miscellaneous 25 of these 94 are registered for the storage and sale of ice cream; 54 are registered for the preparation of preserved foods. Disposal of unsound foodstuffs The great majority of the unsound food condemned by the Public Health Inspectors is destroyed in the incinerator at Chingford, whilst some is taken to the controlled tips in the Borough where care is taken to make it inaccessible to rodents and insects. The Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949 and 1953 and Raw Milk Regulations The following licences were issued: Dealers' Licences: Pasteurised 14 Sterilised 27 Tuberculin Tested 13 Supplementary Licences: Pasteurised 13 Sterilised 14 Tuberculin Tested 13 Inspection of Food Premises Meat Shops 258 Bakehouses 129 Fishmongers 88 Grocers 305 Restaurants and Cafes 138 Dairies and Milk Shops 19 Greengrocers 168 Ice Cream Premises 68 Street Vendors 32 Fish Fryers 1 Food and Drugs Sampling 114 Ice Cream Sampling 47 Milk Sampling 30 Other Premises 163 Food Hygiene Regulations 237 TOTAL 3243 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 percent of cases Notified Smallpox - - - - - Scarlet Fever 24 2 8.5 — — Diphtheria 1 1 100 — — Pneumonia 15 2 13.2 — — Cerebro-Spinal Fever - - - - - Acute Poliomyelitis 1 1 100 — - Acute Polioencephalitis - - - - - Encephalitis Lethargica — - — — - Dysentery 38 25 66 — — Puerperal Pyrexia 24 24* 100 — — Paratyphoid Fever 1 1 100 - — Enteric or Typhoid Fever - - - - - Erysipelas 5 2 40 - - Malaria (contracted abroad) — - — - - Measles 154 — — — — Whooping Cough 57 3 6 - — Opthalmia Neonatorum - - - - - Food Poisoning 36 3 8.5 — — * These cases all occurred in hospital 39 These cases of infectious disease have been divided into age incidence 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 24 — 9 13 1 1 - — Diphtheria 1 - - 1 — - — — — Pneumonia 15 - - - - - 5 8 2 Paratyphoid Fever 1 - - - - - - 1 - Acute Poliomyelitis 1 l - - - - - - - Dysentery 38 - 18 6 2 2 8 2 — Puerperal Pyrexia 24 - - - - 13 11 - - Erysipelas 5 - - - - 1 - 4 - Measles 154 5 56 88 2 3 — - - Whooping Cough 57 4 29 23 — — 1 — — Malaria (contracted abroad) - - - - - - - - - Food Poisoning 36 — 2 9 2 7 13 2 1 TOTALS 356 10 14 140 7 26 39 17 3 Poliomyelitis During 1956, one confirmed case of poliomyelitis was notified. The accompanying table shows the cases notified in previous years classified under age groups: 40 41 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1936-1956 Year Population No. Notified Notification Rate Age Group Deaths Death Rate Under 1-5 5-10 10-15 15-25 25- Over 45 45 1936 52010 2 0.038 - 1 1 1 - - - - - 1937 53840 3 0.055 - 2 1 - - - - - - 1938 54810 2 0.036 - - - - 2 - - - - 1939 55880 - - - - - - - - - - - 1940 48620 - - - - - - - - - - - 1941 46640 1 0.021 - - l - - - - - - 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 - — — 1953 61540 13 0.211 — - 4 3 3 3 - — — 1954 61550 6 0.097 — - 3 1 — 1 1 — — 1955 61380 12 0.19 1 3 5 - 2 1 - - - 1956 61130 1 0.016 1 - - - - - - - — Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1956: 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 - - - - - - - - 10-15 years 2 1 - - - - - - 15-20 years 1 3 - 1 - - - - 20-25 years 1 - - - - - - - 25-35 years 3 2 — 1 — — — — 35-45 years 3 2 — — 3 — — - 45-55 years 4 1 — — — 1 — — 55-65 years 3 — — — 1 — — 1 65 and over 1 2 — — 1 — — — TOTALS 19 11 — 2 5 1 1 30 2 6 1 32 7 The 7 deaths represent a death rate of 0.11 per 1,000 of the population. A comparative summary over the past 20 years for the Borough is set out in the following table: 42 43 Year .Notifications Total Notification Rate Deaths Total Death Rate Pulmonary Non-Pulmonary Total Notifications Pulmonary Non-Pulmonary Total Deaths No. Rate No. Rate No. Rate No. Rate 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 61 6 0.10 44 0.71 2 0.03 1 0.02 3 0.05 1955 25 0.42 11 0.17 36 0.59 3 0.03 1 0.02 4 0.05 1956 30 0.49 2 0.03 32 0.52 6 0.09 1 0.02 7 0.11 Rates per 1,000 population. The register shows that at the end of the year: 30 (25) Pulmonary and 2 (11) non-Pulmonary cases were notified during the year. 13 (10) cases were transferred into the District. No (No) cases were restored to the Register. 6 (3) Pulmonary and 1 (1) non-Pulmonary died during the year. 39 (23) other cases were removed from the Register. 477 (476) cases remained on the Register at the close of the year. The figures in brackets are the comparable figures for 1955. SECTION G. PART III SERVICES FOREST HEALTH AREA SUB-COMMITTEE Chairman: County Councillor Mrs. E. F. M. Hollis Vice-Chairman: Mr. G. Gray Membership: Chingford Borough Council Councillor W. J. Bowstead Alderman Mrs. S. L. Oakes Councillor Mrs. I. Titley Wanstead and Woodford Borough Council Councillor Mrs. S. V. F. Ashton Councillor Mrs. I. C. Haseldon Councillor S. J. Relph Alderman V. E. Stevens Chigwell U.D.C. Councillor Mrs. V. L. M. Martin Councillor W. A. Nicholls Councillor Mrs. L. M. Scott Epping U.D.C. Councillor L. B. Foskett Councillor Mrs. F. Pollitt Waltham Holy Cross U.D.C. Councillor O. Edwards Councillor C. O. Gabriel Epping R.D.C. Councillor Mrs. H. Howard Harlow U.D.C. Councillor F. J. James, J.P. Hospital Management Committee G. Gray, Esq. Executive Council for Essex Alderman J. W. R. Nation Local Medical Committee for Essex Dr. H. Grylls Essex County Council Councillor Mrs. S. M. Bovill Councillor A. G. Cole Councillor Mrs. D. D. Forster Alderman K. E. B. Glenny Councillor F. J. Vaughan Councillor F. A. Wortley British Red Cross and St. John Ambulance Organisations Mrs. V. Walker Mr. G. F. Henrico Tuberculosis After-Care Association Mrs. A. C. Murray Women's Voluntary Services Mrs. M. E. Clinch 44 STAFF In addition to my duties as Medical Officer of Health for the Borough, I am in administrative control of Part III Services under the National Health Service Act, 1946, sections 21, 22, 23, 24, 25, 26, 28 and 29. There are normally two medical officers of the Essex County Council working in the Borough and undertaking duties appertaining to Maternity and Child Welfare as well as three practitioners who regularly attend Child Welfare Clinics being employed on a sessional basis. CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) There were 496 attendances at the ante-natal clinic at 118, Hermon Hill. At this clinic, sessions are held weekly, midwives examining their own patients and working in close co-operation with the general practitioners concerned. One general practitioner conducts an ante-natal clinic for his own patients at his surgery, with a Local Authority midwife in attendance. The scheme works well and achieves a maximum of co-operation between doctor and midwife. All expectant mothers have a blood specimen taken for examination and all with a rhesus negative result are advised to have their confinement in hospital. Mothers booked for hospital confinement attend the ante-natal clinic for routine intermediate examinations. In the event of any abnormality becoming manifest, the case is referred at once to the Obstetrician at the Hospital. About 65 per cent of the births in the Borough take place in hospital. Discharges are notified promptly and are followed up by either the Midwife or Health Visitor depending on the day following delivery on which the discharge takes place. A very good liaison is maintained with the Maternity Department of Wanstead Hospital. Relaxation Exercises Belaxation classes have been continued at the Hermon Hill ante-natal clinic, and are held twice weekly. Normally six to eight women constitute a class. The classes also form a means whereby the Health Visitor can give short talks on preparation for the confinement and on various aspects of personal hygiene for mother and infant. By keeping classes small opportunity is afforded for individual queries and difficulties to receive attention. 45 Vital Statistics Wanstead & England & Woodford Wales Live birth rate per 1,000 population 11.2 15.7 Still birth rate per 1,000 population 0.16 0.37 Infant Mortality Rate per 1,000 live births 26.6 23.8 Neo-natal mortality The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1956, 10 infants died in the first four weeks of life, a rate of 14.8. Care of Premature Infants During 1956, 33 premature infants were born to residents in the Borough, 7 of these births taking place at home and 26 in hospital or nursing home. 4 of the 7 born at home were alive at the end of one month; 19 of the 26 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. Child Welfare Centres Attendances at the six Child Welfare Centres have 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 1385 Ashton Playing Fields, Woodford Bridge 2328 St. Barnabas' Church Hall, Snakes Lane 3658 Fullers Road, South Woodford 3126 Cromwell Hall, Nightingale Lane, Wanstead 2561 Holy Trinity, Hermon Hill, South Woodford 3177 TOTAL 16,235 Welfare Foods The distribution of Welfare Foods continued on the lines indicated in my last report, being undertaken entirely by members of the Women's Voluntary Services. Foods are available at all the Child Welfare centres in the Borough during hours of session and also at the W.V.S. Headquarters, 79 High Street, Wanstead, Monday, Wednesday and Friday 10 a.m. to 4 p.m. My sincere thanks are due to the Women's Voluntary Services members for the great assistance they give by undertaking this service. 46 Day Nursery The following table shows the attendances made, together with the daily average. Attendances Quarter Ending Under 1 year 1-2 years 2-3 years Over 3 years TOTAL Days Open Average Daily Attendances 31st March 143 239 595 1037 2014 64 30.5 30th June 220 315 482 1119 2136 63 33.9 30th September 180 325 563 1062 2130 64 33.2 31st December 19 263 497 893 1672 62 27.0 TOTALS 562 1142 2137 4111 7952 253 31.4 The County Council as the Local Health Authority had, for some time, been considering the position of Day Nurseries in the Administrative County in view of the reduced attendances and the degree of priority allocated to the various cases for admission. At this Day Nursery there were 7 children only whose family circumstances fell in the priority categories and in view of this the nursery was closed on the 31st December, 1956. Alternative arrangements were made for these seven children at a neighbouring day nursery. The parents of the remaining children made their own private arrangements for the care of the children, or where this was requested they were put in touch with a registered Child Minder. Nursery 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. 47 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 — — Child Minders 2 11 Womens' Welfare Clinics This clinic was held at 118 Hermon Hill monthly, with extra sessions as necessary. Contraceptive advice is given on medical grounds on receipt of a doctor's certificate. There were 199 attendances during the year. MIDWIFERY (Section 23) There are three domicilary midwives practising in the Borough. Supervision is carried out by Miss A. Williams, Non-Medical Sunervisor of Midwives who is on the staff of the Area Medical Officer. No. of confinements attended as midwife 108 No. of confinements attended as maternity nurse i.e. doctor also present 71 TOTAL 179 Gas and Air Analgesia A total of 158 patients in the district received gas and air analgesia. Training of Pupil Midwives One District Midwife in Wanstead and Woodford was approved as a Midwifery Teacher and took one pupil for her Part II Midwifery training during the year. This pupil was successful in passing her examinations.. During 1957 Part II Midwifery training will be continued. HEALTH VISITING (Section 24) The Superintendent Health Visitor, Miss C. M. W. Court, A.R.R.C., S.R.N., S.C.M., H.V. Cert., reports as follows: Five Health Visitors were employed in the Borough during 1956, and in addition during the last six months of the year a temporary Clinic Nurse has been appointed for the Area to undertake ancillary clinics, i.e. Ophthalmic, Minor Ailments and Gas Sessions, thus relieving the Health Visitors for Visiting and School work. A series of talks on "Accidents in the Home" was given to Old People's Welfare Clubs, together with demonstrations by a film projector. The practice of Student Nurses from Wanstead Hospital being given practical training in the Public Health field has been continued throughout the year. 48 The following table sets out statistically the work of the Health Visitors in the Borough during 1956:— Expectant Mothers (first visits) 96 Expectant Mothers (re-visits) 49 Infants under one year (first visits) 637 Infants under one year (re-visits) 1065 Infants 1 to 5 years (first visits) 137 Infants 1 to 5 years (re-visits) 1671 Stillbirth enquiries 7 Infant Death 16 Tuberculosis Patients 1078 Aged and Infirm 102 Day Nursery Applications 10 School Children 665 Other Visits 386 Ineffective Calls 547 6477 Home Nursing (Section 25) The Superintendent of District Nurses, Miss A. Williams, S.R.N., S.C.M., Q.I., H.V.Cert., reports as follows: The equivalent of 6½ Nursing Sisters are employed on General Nursing duties in the Borough of Wanstead and Woodford, with the addition of part time services of two males nurses. The staff remained at full establishment during the year and a good nursing service was rendered to the acute and chronic sick including care of the aged and patients requiring various types of hypodermic injections. The following statistics show a comparison of work undertaken by the District Nurses during the years 1955 and 1956:— 1956 1955 Number of new cases 769 617 Number of visits 23658 19760 Last Offices performed 51 35 Advisory or Casual Visits 467 471 49 VACCINATION AND IMMUNISATION (Section 26) Vaccination and immunisation is available at all Child Welfare Clinics, but in the majority of cases is carried out by the family doctor. Intensive propaganda, both personal on the part of clinic doctors and Health Visitors, and by means of leaflets and birthday cards, is maintained to ensure that all infants are immunised against Diphtheria. During the past 10 years the incidence of this disease has fallen to a minimum with the result that never having experienced it, present day parents tend to become complacent, and to postpone immunisation. Nevertheless it is estimated that 75—80 per cent of children are being protected. It is impossible to give an accurate figure as many practitioners do not trouble to claim the small fee available to them for recording the immunisation. Primary immunisation is usually carried out during the 6th—9th month, and a "booster" dose is given at 5 years, on entry to school. Immunisation against whooping cough is normally carried out from the 3rd to 6th month. 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 593 5 to 15 years of age 62 655 The number of children who received a secondary or re-inforcing injection was 577. • The number of persons vaccinated or re-vaccinated during the year 1956 was:— Under 1 1—4 yrs 5—14 yrs. 15 or over Total Primary 270 154 54 71 549 Re-vaccination Nil 5 25 177 207 The following information shows the total number of children under 16 years of age who have at any time received a primary course of immunisation against diphtheria, as at 31st December, 1956 Year of Birth Number Year of Birth Number 1956 71 1945 859 1955 773 1944 589 1954 270 1943 488 1953 626 1942 618 1952 525 1941 731 1951 496 1950 535 1949 655 1948 922 1947 926 Total 9,875 1946 791 50 Number of children immunised against Whooping Cough during the year 1956 was:— Under 6—12 1 year 2 years 3 years 4 years 5 years 6/12 months and over 30 196 30 4 8 8 6 During the year the Ministry of Health announced its scheme for the protection of children against poliomyelitis by means of vaccination indicating, at the beginning of the year, that Local Health Authorities should proceed to register all children whose parents requested vaccination. Registration forms were sent out from this office and through the schools to the parents of all known children in the group selected, i.e. children born between the years 1947 to 1954 inclusive. Approximately 32.8 per cent of the total forms issued produced acceptances and the Ministry planned that as many children as possible in selected age groups should be vaccinated during the months of May and June, before the normal poliomyelitis season commenced, vaccination to be continued at the end of the year. The age groups selected by the Ministry for the first vaccinations were children born in the months of August and November, 1947 to 1954 and March and October, 1951 to 1954, with the Month of May as the reserve month. PREVENTION OF ILLNESS, CARE AND AFTER-CARE The work under this Section of the Act is mainly concerned with Tuberculosis and I am indebted to Dr. H. Duff-Palmer, Consultant Physician to the Wanstead and Woodford Chest Clinic at Harts Hospital for the following report: Thirty-four new cases of Tuberculosis were discovered, a decrease of nine from the previous year. One hundred and eighty new contacts were investigated and of these, one adult and one child were found to have active tuberculous disease. These figures show the value of contact investigations. It is tedious and unspectacular work, but well worth while. The importance of Mass Radiography, followed by contact investigations, is shown by the following case: One adult was referred by the Mass Radiography Unit and clinical, radiological and bacteriological examinations proved him to be a positive sputum case of active tuberculosis of the lungs. The family was followed up and the son was diagnosed as having primary lung tuberculosis—he was treated at the Children's Sanatorium at High Wood Hospital. 51 The Clinic has a very close liaison with the Medical Officer of Health and his Department; also with the local offices of the National Assistance Board, the Ministry of National Insurance and the many Voluntary bodies in the Borough who provide help and assistance to numerous patients. It must never be forgotten that tuberculosis is a social and economic disease, affecting not only the patient, but also the entire family. The Clinic also deals with all types of diseases of the chest, many of which are now recognised as being of national importance, such as cancer of the lung and chronic bronchitis. The total attendances amounted to nine thousand and eighty-three (9083), three thousand four hundred and thirty-six (3436) X-Ray investigations were carried out and fifty-two (52) children were vaccinated with B.C.G. Miss R. Carrington, Secretary of the Leyton, Wanstead and Woodford Tuberculosis Care Association, reports as follows: During the year the Association has done all in its power to help those suffering from tuberculosis, and no application for assistance has been refused because of the lack of funds. Below is a summary of cases assisted. Particulars Jan. 1st—Dec. 31st, 1956 No. of Cases Amount Assisted Spent £ Groceries 102 1438 Fares 20 117 Clothing 3 16 Holidays 3 8 Occupational Therapy materials 2 13 Wireless Licence 2 2 Dentures 1 1 Removals 1 6 Financial Grants 3 37 Training Course 1 10 The T.B. Helping Hand Association has continued to organise fund raising activities, and during the year donated £175 to the Association. This year's Christmas Seal Sale has been very successful and the final figure collected is £811:10:6. The Essex County Council continues to finance the Care Association with annual per capita grants of £2 per thousand population, and Sunday Entertainment Tax Grants. 52 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. 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 15 cases from the Borough have been sent away. The length of convalescence was two weeks in each case. Domestic Help Service The Domestic Help Organiser reports as follows: The year 1956 showed a steady increase in applications for Domestic Help. The service continues to be administered as in previous years, and all cases are visited as frequently as possible—a total of 730 visits being made throughout the year. 50 per cent of the patients receiving help are in the category Chronic Aged, and help varies for these from as little as two hours per week for the heavy cleaning to 20 hours per week, which provides a split service, covering three meals a day. Belations are encouraged to help bedridden aged patients on Sundays. A total of 9 full-time and 45 part-time domestic helps is employed to attend to the varied wants of 196 patients. During the holiday period it was necessary to drastically cut, and in some cases leave the patients without, assistance. This, however, was kept to the minimum, and care was taken to see that no one completely dependent on the Domestic Help service was left unattended. No new requests for help in T.B. households have been received, and those already receiving help are closely watched and assistance given in accordance with the recommendations of the Chest Clinic. The aged chronic sick continue to grow in numbers, and are an increasing problem. Every effort is made to provide help according to the essential needs of these people, but many would benefit from a little extra help were the labour situation not so acute. Liaison with the District Nurses, Health Visitors and Hospital Almoners is good, the aged and sick benefitting from the joint effort. The W.V.S. "Meals on Wheels" service continues to render invaluable assistance, providing meals on Wednesdays and Fridays. During the last few months of the year, the scope of the Domestic Help service has widened to include homes deprived of one parent, thus enabling the family to remain as a complete unit, rather than that the children are separated and sent to Foster homes. One can foresee this side of the service developing rapidly in the near future. 53 SCHOOL HEALTH SERVICES, 1956 Wanstead and Woodford The number of children attending sixteen maintained schools in the Borough was, at the end of the year, 6,908. 1. School Medical Inspections A School Medical Officer visited each school in the Borough during the year for the purpose of examining all the pupils due for a routine inspection and any others brought forward for a special examination at the request of the parent or Head Teacher. The total number of children inspected was 2,382, in the age groups set out below: No. examined No. referred for treatment No. referred for observation 1st age group (5-7 years) 746 137 114 2nd age group (10-11 years) 713 77 63 3rd age group (14-16 years) 399 35 20 Other age groups 469 39 78 Special inspections 55 4 17 2. Minor Ailment Clinic A medical officer was in attendance every Friday morning at the School Clinic, 93 High Road, S. Woodford, E.18., to examine pupils referred for special examination. Particulars of the defects noted at these examinations are given in Appendix "A." 3. Cleanliness Surveys Owing to the shortage of nursing staff, it was not possible to undertake the usual termly cleanliness survey of pupils attending all the primary and secondary modern schools in the Borough. However, 12,757 inspections were carried out and 16 individual children were found to be suffering from head infestation. The parents were informed and subsequent inspection of the children concerned proved satisfactory. 4. Dental Inspection and Treatment The facilities for providing dental inspection and treatment for children attending the schools maintained by the Local Education Authority remained unchanged. A whole-time dental officer and dental attendant are in attendance every day at the School Clinic, High Boad, South Woodford. A summary of the work carried out at this clinic during 1956 is shown in Appendix "B." 54 5. Child Guidance Clinic The Educational Psychologist frequently visits schools to give advice to teachers on the problems of children referred to her. The majority of the problems relate to the child's educational difficulties, but occasionally there are behaviour and emotional problems, which require further investigation, and these cases are referred to the Child Guidance Clinic at Walthamstow for psychiatric treatment. This clinic serves a school population from a very wide area and in consequence the waiting list is very long and, unless the case is one of great urgency (and is treated accordingly), children have to wait several months for an appointment. 6. Specialist Services There has been no change as regards the three specialist services namely, ophthalmic, orthopaedic and physiotherapy, provided by the Regional Hospital Board, in conjunction with the Essex County Council, at the School Clinic, High Road, South Woodford. The facilities are adequate and compare very favourably with those provided in adjacent districts. 7. Speech Therapy This is not a specialist service, but one provided by the Essex County Council as Local Education Authority. A speech therapist, assisted by students from recognised Training Colleges for Speech Therapists, are in attendance at the Woodford Clinic, four times a week during school terms. Every effort is made to refer children with speech defects to the clinic at a very early age to enable treatment to commence at the earliest possible time with a view to eradicating the defect by the time the child is ready to enter school. With this aim in view, a new method of treatment was introduced for the very young children attending the Woodford Clinic. This method is known as group speech therapy which, as its name implies, is the treatment of children in small groups as opposed to the more general idea of individual training. In the groups, children play with sand, water, puzzles and other toys for most of the time, having only a few minutes individual therapy. The Speech Therapist is of the opinion that this method of treating young children with retarded speech is preferable to the child being treated solely by himself for the reasons set out in the following extract from her report: "At home he is different from the others in the family circle, frequently he is frustrated and highly nervous, and the parents' over-anxiety about his speech only increases his nervouspess and reluctance to speak. 55 Being with other children similarly handicapped encourages him to try and express himself, he develops a social awareness and gains a feeling of security in the quiet happy atmosphere of the clinic. The important factor in my opinion is that the child comes to the clinic to play with other children, and does not feel speech conscious, the emphasis is on play not speech." 8. B.C.G. Vaccination of School children The scheme for offering B.C.G. vaccination to pupils who have attained the age of thirteen years was continued with the following results: No. of schools 4 No. of pupils to whom offered . 519 No. given skin test after parents' consent received 323 (62.23 %) No. vaccinated with B.C.G. 279 9. Tuberculosis Case Finding A pilot scheme to discover tuberculosis in adults by means of mantoux (skin) testing school entrants was introduced in the Autumn, and one of the infant schools in this borough was selected to participate. The parents of all the five-year-old children due for their first routine medical inspection at school were given particulars and invited to give their consent, in writing, for their child to participate. The offer was made to the parents of 74 pupils and 62 (83.78%) gave their consent, a highly satisfactory response. Only one child (a girl) gave a positive reaction to the test, i.e. proof of infection with T.B., and was referred to the Chest Clinic for investigation. X-Ray did not reveal anything abnormal; her parents were also X-Rayed with satisfactory result. 56 APPENDIX "A" 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. found to require treatment No. to be kept under observation Skin 6 - Eyes (a) Vision 27 — (b) Squint — — (c) Other 2 — Ears (a) Hearing 2 — (b) Otitis Media 1 — (c) Other — — Nose or Throat 4 — Speech 14 — Cervical Glands — — Heart and Circulation 1 — Lungs 4 — Development (a) Hernia 1 — (b) Other — — Orthopaedic (a) Posture 1 — (b) Flat Foot 8 — (c) Other 14 — Nervous system (a) Epilepsy 4 — (b) Other 3 — Psychological (a) Development 10 — (b) Stability 4 — Other 17 — 57 APPENDIX "B" Dental Inspections and Treatment Number of pupils inspected (Periodic and Specials) 3077 Number found to require treatment: (a) Periodic 1331 (b) Specials 451 Total 1782 Number of individual pupils actually treated 676 Attendances made by pupils for treatment 2817 Fillings: Permanent teeth 1722 Temporary 467 Total 2189 No. of Teeth Filled: Permanent teeth 1583 Temporary 414 Total 1997 Extractions: Permanent teeth 61 Temporary 577 Total 638 Administration of anaesthetics: (a) Local 132 (b) General 273 Total 405 Other Operations: (a) Permanent teeth 1069 (b) Temporary 369 Total 1438 58