AC 4411(1) 1 div. 5m 2 Library WANS 22 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1957 PUBLIC HEALTH COMMITTEE Councillor S. J. Relph (Chairman) Alderman D. L. Forbes (Vice-Chairman) Alderman N. E. Britton Alderman R. W. Dale Alderman Mrs. E. F. M. Hollis Alderman V. E. Stevens Councillor Mrs. S. V. F. Ashton Councillor R. A. Dalton Councillor B. B. Dyer. age 21, The first paragraph, last sentence should reads "The total deaths from the weekly reports of the registrar General for the nine towns, Barking, Chigwell, agenham, East Ham, Hornsey, Ilford, Leyton, West Ham and wanstead and Woodford for the week ended 30th November was 4, while for the week ended 5th December the corresponding number was 283, an increase of 89". 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) (resigned 31-3-57) J. A. Orrell, M.A.P.H.I. (a) (b) (e) (appointed 1-5-57) Student Public Health Inspector: T. Matthews 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 or 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 Wanstend end 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 1957. 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 There was an increase by 40 in the number of births recorded, notifications rising from 677 in 1956 to 713. The Birth Rate per 1,000 population was 11.69, that for the country as a whole being 16.10. Still-births numbered 17 (10 in 1956). The number of deaths fell by 65 to a total of 660, making the Death Rate per 1,000 population 10.8, that for the country as a whole being 11.5. The Infantile Mortality Rate, i.e., the deaths of infants under one year of age per 1,000 live births was 26.6, this figure being identical with that of the previous year and contrasting with a figure of 23.1 for the country as a whole. Most of these deaths were due to prematurity or congenital defect. Causes of Death As is usual, the commonest causes of death were diseases of the heart and arteries and cancer. Deaths from cancer were 119, 26 fewer than during the previous year. Infectious Disease. Incidence of infectious disease remained low. There were 5 cases of poliomyelitis; 3 of the non-paralytic type, 2 paralytic cases being notified in children aged 13 years and 18 months. At the time of writing 4 have made a complete recovery and the infant child is responding to remedial treatment. 3 One case of typhoid fever in a boy aged 14 was recorded. The disease was contracted while on holiday in Eire. Fortunately he was the only member of his family to be affected and his recovery was uneventful. In the early part of the year an outbreak of food poisoning occurred at a school in the Borough, about 150 pupils and staff being affected. The organism responsible for the disease, a staphylococcus, was isolated from a sample of boiled beef and carrots which had formed part of a school meal. Following an inspection of the canteen staff it was noted that the canteen supervisor had a septic finger; a scraping from this finger produced a similar organism to that found in the meat and there is little doubt that this caused the outbreak. Contrary to repeated instructions the meat concerned had been cooked and re-heated. It is proving extremely difficult to eradicate this practice which is a most dangerous one, the re-heated meat constituting a favourable breeding ground for bacteria. In canteens and restaurants where this method of cooking is the rule, there is almost certain to be an outbreak of food poisoning sooner or later. Fortunately in this instance all cases were mild and symptoms of short duration. There was a further fall in the notifications of Tuberculosis. 27 cases being reported (32 in 1956). There were 3 deaths ( 7 in 1956). During the past decade, mainly due to the use of new drugs, the fall in the incidence of this disease has been dramatic. However, despite this, there are no grounds for complacency and every effort must still be made to segregate and treat the sputum positive case. National Health Service Act: Part 111 Services Details of those services administered by the Essex Countv Council through the Forest Area Health Sub-Committee are given in Section G. Attendances at the Infant Welfare Centres continued to increase. Owing to a rise in the child population in the northern end of the Borough a seventh centre was opened at All Saints Church Hall, Woodford Wells. It is a matter of regret that Wanstead and Woodford is almost the only part of the Forest Health Area with a density of population in which a modern Health Services Clinic has still to be established as, despite repeated efforts, it has not been possible to obtain a suitable site. An account of the immunisation campaign against poliomyelitis is given. Much delay and disappointment occurred owing to postponement of supply and irregular delivery of vaccine. At the time of writing I am pleased to say that almost immediate innoculation can be given to any child between the ages of 6 months and 15 years. 4 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. 22nd August, 1958. 5 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population —Registrar-General's estimate mid-year 1957 60,970 Registrar-General's estimate mid-year 1956 61,130 Rateable Value £986,385 Sum represented by penny rate £3,968 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 338 Females 351 Total 689 Illegitimate Males 15 Females 9 Total 24 Total Males 353 Females 360 Total 713 Birth-rate per 1,000 of the estimated resident population—11.69 STILLBIRTHS Legitimate Males 8 Females 8 Total 16 Illegitimate Males - Females 1 Total 1 Total Males 8 Females 9 Total 17 Rate per 1,000 total (live and still) births —23.3 DEATHS Males 316 Females .344 Total 660 Death rate per 1,000 of the estimated resident population— 10.8 Deaths from puerperal causes:— Puerperal and post-abortion sepsis — Other maternal causes 1 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 24.6 Illegitimate infants per 1,000 illegitimate live births 83.3 1956 1957 Deaths from Cancer 135 119 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 2 6 „ „ Suicide 9 6 „ „ Other Violent Causes 18 9 6 Population. The Registrar-General's estimate of the population for 1957 (midyear) was 60,970, a decrease of 160 on the figure for 1956 (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 1957 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 16.10 16.10 16.0 16.2 11.69 Still 0.37 0.37 0.38 0.29 0.28 Deaths: All causes 11.50 11.50 11.40 11.40 10.81 Malignant Neoplasm Lung and Bronchus 0.43 0.50 0.40 0.61 0.47 Whooping Cough 0.00 0.00 0.00 0.00 — Diphtheria 0.00 0.00 — 0.00 — Tuberculosis 0.11 0.12 0.10 0.13 0.05 Influenza 0.15 0.15 0.15 0.12 0.15 Coronary Disease —Angina 1.70 1.72 1.72 1.70 1.42 Acute Poliomyelitis & Polioencephalitis 0.01 0.00 0.00 0.00 - Pneumonia 0.52 0.58 0.47 0.65 0.46 (Rates per 1,000 live births) All causes under 1 year of age 23.1 23.5 23.5 21.9 26.6 Enteritis and Diarrhoea under 2 years 0.50 * * * - *Figures not available 8 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 0.01 Paratyphoid Fever 0.01 — Meningococcal Infection 0.02 — Scarlet Fever 0.52 0,19 Whooping Cough 1.19 2.69 Diphtheria 0.00 — Erysipelas 0.08 0.03 Smallpox 0.00 — Measles 14.10 7.33 Pneumonia 0.73 0.13 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.07 0.03 Non-Paralytic 0.04 0.05 Food Poisoning 0.20 0.05 Rates per 1,000 Total Births (Live and Still) Puerperal Fever & Pyrexia 16.00 53.28 9 Maternal Mortality Abortion Other Total England and Wales 0.07 0.47 0.54 Wanstead and Woodford 1.37 — 1.37 Causes of Death as given by the Registrar-General, 1957 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 2 — 2 2. Other Forms of Tuberculosis 1 - 1 3. Syphilitic Disease 1 2 3 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis .— — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — — — 10. Malignant Neoplasm—Stomach 10 6 16 11. Malignant Neoplasm—Lung and Bronchus 21 8 29 12. Malignant Neoplasm—Breast — 8 8 13. Malignant Neoplasm—Uterus — - — 14. Malignant Neoplasm—Others 38 28 66 15. Leukaemia 1 - 1 16. Diabetes 1 - 1 17. Vascular Lesions—Nervous System 30 74 104 18. Coronary Disease—Angina 60 27 87 19. Hypertension with Heart Disease 3 7 10 20. Other Heart Disease 36 67 103 21. Other Circulatory Disease 18 23 41 22. Influenza 3 6 9 23. Pneumonia 12 16 28 24. Bronchitis 23 16 39 25. Other Respiratory Diseases 1 2 3 26. Ulcer of Stomach or Duodenum 9 4 13 27. Gastritis, Enteritis and Diarrhoea 4 1 5 28. Nephritis and Nephrosis 1 3 4 29 Hyperplasia of Prostate 6 — 6 30. Pregnancy, Childbirth, Abortion — 1 1 31. Congenital Malformations 4 2 6 32. Other Diseases 20 33 53 33. Motor Vehicle Accidents 4 2 6 34. All Other Accidents 4 5 9 35. Suicide 3 3 6 36. Homicide and Operations of War - — — Totals, 1957 316 344 660 Totals, 1956 337 388 725 10 Infant Deaths, Neo-Natal Mortality and Stillbirths Stillbirths Neo-Natal Deaths Infant Deaths Year Live Births Birth Rate No. Per 1,000 Live Births Per 1,000 Population No. Per 1,000 Live Births No. Per 1,000 Live Births 1957 713 11.69 17 23.8 0.28 12 16.83 19 26.6 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Deaths Rates per 1,000 Births (Live and Still) Year Total Births Registered Puerperal Sepsis Other Maternal Causes Total Puerperal Sepsis Other Maternal Causes Total 1957 730 — 1 1 — 1.37 1.37 1956 687 — — — — - - 1955 705 — 1 1 — 1.42 1.42 1954 718 — 1 1 — 1.39 1.39 1953 802 — — — — - - Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1957 1956 1955 1954 1953 Maternal Mortality 1.37 — 1.44 1.42 - Stillbirths 23.8 14.8 15.80 21.3 13.9 Neo-Natal Mortality 16.8 14.8 12.90 9.9 15.2 During 1957 there was one death classified as being due to pregnancy, child bearing or associated therewith. 11 Comparative Statistics of Births, Mortality, etc., 1938 to 1957 Live Births Still Births Deaths Infant Death Maternal Deaths Year Population No: Rate No: Rate* No: Rate* No: Rate No: §Rate 1957 60970 713 11.7 17 23.3 660 10.8 19 26.6 1 1.37 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 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 — - *Per 1,000 Population 0134 †Per 1,000 Total Births §Per 1,000 Live Births 12 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 seven infant welfare centres in the Borough, sessions being held as under:— Baptist Church Hall, Alders brook, 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. All Saints Church Hall, Woodford Wells Monday, 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. 13 6. Chest Clinic Harts Hospital, Woodford Green. Sessions: Wednesday, 9.15—11 a.m. Alternate Thursdays 4—6.15 p.m. (appointment only) Fridays, 9.15—11 a.m. Refill sessions: Tuesday 2 p.m. B.C.G. Vaccinations—Saturday morning, once monthly. (by appointment only) 7. Ambulance Facilities The service is administered centrally by the County Council from Chelmsford; facilities are available locally through the depot at Chingford. 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 1957. 9. Funeral Arrangements In three cases was the Local Authority required to make arrangements for the burial of persons during the year 1957. 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 Major re-organisation in this service took place towards the end of the year. The service is now based on six teams working the gang system using six Dennis 18 cu.yd. dual tipping collection vehicles. Collections are made from all premises once weekly. 14 (b) Refuse Disposal The disposal of refuse continued by controlled tipping at sites within the Borough until the 18th November, 1957. The new Transfer Depot, which has been built at Chigwell Road during the year, was brought into operation after that date and all refuse collected is now taken there where is it transferred to large transporters. The refuse is then conveyed by a fleet of three 40 cu. yd. vehicles to a controlled tip at South Ockendon operated by a private firm. (c) Salvage Collection In conjunction with the major re-organisation which has taken place in the refuse collection and disposal service, salvage collections have been extended to include scrap metals and textiles in addition to waste paper. Sewerage The programme of reconstruction of old sewers in the Borough, including those in the Western Drainage Area, was revised in connection with the Council's five year capital works programme and no schemes were undertaken during the year. Minor works, however, were carried out including the provision of further manholes where such facilities are lacking. Sewage Works (a) Eastern. The urgency of improvement works continued to be apparent and the Essex River Board pressed for steps to be taken to bring the effluent to the standard to be imposed in 1958. In consequence, an outline scheme was submitted to the Ministry of Housing and Local Government for approval. The first stage of the scheme consists mainly of reconstruction of storm tanks, additional storm tank sludge drying beds, reconstruction of the circular percolating filters and renewal and extension of the main sludge drying beds. Although these works are considered essential to provide improved treatment and effluent it is appreciated that they may not result in the attainment of the new effluent standard required by the River Board, particularly with regard to suspended matter. A second stage of improvement may therefore be necessary, consisting of effluent polishing by micro-straining plant and possibly the recirculation of the effluent at the works. The Ministry appreciated this view but gave approval to the Council proceeding with the preparation of the detailed scheme for Stage 1 for which tenders will be obtained during the next few months. The question of the second Stage is to be considered by the Ministry when the results of the First Stage have been ascertained. 15 (b) Southern Progress on the preparation of the scheme for reconstruction and improvement of these works was affected by the higher priority which had to be allocated to the scheme for Eastern Sewage Works and technical staff was accordingly concentrated on the latter work. Some further progress has, however, been made in the preparation of details for the first stage of the major improvement scheme as previously discussed with the Ministry of Housing and Local Government. 16 SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:— HOUSING ACT, 1957 The reports of past years have shown considerable activity in the field of housing particularly insofar as clearance schemes, etc., are concerned. An easing in this direction is due to the fact that the proposals for the first five years' programme have been dealt with. Referring to the report for the year 1956 with reference to the Hall Road and Tilney Road clearance area it can now be recorded that the Minister subsequently gave his approval without modification to the scheme and during the year many tenants were rehoused by the local authority. Well-maintained allowances were made in two cases. 2, 4, 6, Albert Road, E.18. These houses, in need of much repair, were visited by the Sub-Committee of the Public Health Committee with a view to their adaptation into flats. They were referred to the Housing Committee for such consideration who in turn referred them back to the Public Health Committee because they did not consider the structures suitable for conversion. The latter Committee authorised notices to be served upon the owners calling for repairs to be carried out. Further consideration was given by the Public Health Committee to the list of properties forming the proposed five year programme for slum clearance and it was decided to remove Nos. 2 to 8 (inclusive) Belgrave Terrace, Woodford Green from the list and to add Nos. 1 to 11 Saville Row (a block of tenements) to it. It was necessary in connection with No. 4 Burlington Place, a house included in a clearance area, to apply to a Magistrate's Court for an order for possession because the owner/occupier refused every offer of re-housing which the Council made him, was given only temporary accommodation when the order for possession was executed by the local authority. He eventually provided himself with alternative accommodation. Nos. 3 and 4 Burlington Place were demolished during the year completing the demolition of yet another clearance area. The Closing Order on Nos. 9 and 10 Belgrave Terrace was determined in July, 1957, after the two cottages had been converted into one with complete renovation. Following a report to secure the closure of the basement of the house, the owner of 56 Wellesley Road submitted proposals for executing works to remedy the dampness. The undertaking was accepted and the work subsequently carried out. An undertaking not to relet for human habitation was given in connection with a basement at 3 Grosvenor Road, Wanstead, the owners providing alternative accommodation for the tenant. 17 Three houses, 8 Woodbine Place, 45 Horn Lane and 55 Globe Road, were represented as individual unfit houses not capable of repair at reasonable expense. As these houses are semi-detached, action on them was delayed whilst inspections were made of the adjoining properties. The attached properties, 9 Woodbine Place, 43 Horn Lane and 57 Globe Road were similarly represented during Referring to the details set out in the 1956 report concerning 15 Victoria Road and 7 and 9 Voluntary Place, it can now be recorded that the owners applied in December, 1957 for the demolition orders to be reviewed so that the houses could be renovated. The owners were to submit specifications at a later date. Rent Act, 1957 This Act largely superseded the Housing Repairs and Rents Act, 1954, dealing to a considerable extent with the increase of rents and provisions whereby this is possible. To be able to increase a rent a landlord must comply with the Act and its Regulations in which various forms and certificates must be used. I give below details of the action taken by this Department in this connection since the inception of the Act in July, 1957 to the end of the year. Part I—Applications for Certificates of Disrepair 1. Number of applications for certificates (Form I) 46 2. Number of decisions not to issue certificates 1 3. Number of decisions to issue certificates (Form J) 45 (a) in respect of some but not all defects 36 (b) In respect of all defects 9 4. Number of undertaking given by landlord (Form K) 24 5. Number of undertakings refused by local authority Nil 6. Number of certificates issued (Form L) 11 Part II —Applications for cancellation of Certificates 7. Applications by landlords to local authority for cancellation of certificates (Form M) 2 8. Objections by tenants to cancellations of certificates Nil 9. Decisions by local authority to cancel in spite of tenant's objection Nil 10. Certificates cancelled by local authority 2 Overcrowding One case of overcrowding was dealt with by the Council rehousing the family. Initially the family abated the overcrowding for a period by sleeping out two children, but this unsatisfactory position has now been resolved. 18 Meat Inspection. Previous reports have mentioned the considerable amount of work involved in meat inspection at a wholesale meat depot within the Borough. During the latter part of 1957, following an arrangement with the Port of London Authority, a large number of frozen carcases which had been on board a ship damaged in transit were released to this depot. The inspection of the many thousands of carcases placed a severe strain on the inspectorial staff, but the condemnation figures reflect the need and importance of the attention devoted to this work. The quantity of meat and tinned foods handled by this depot is increasing and should this trend continue, in order that proper supervision can be exercised, consideration will have to be given to additional staff for this purpose. Works in Default In one case only was work executed because of default on the part of the owner. This case was referred to in the report for 1956 when it was recorded that a tender had been accepted by the Public Health Committee. Work was executed by the contractor early in 1957. Works executed by the Local Authority Reconstruction of four drainage systems was carried out involving 17 premises. Work was carried out by contractors engaged by the local authority. In one case the contractor by agreement with the owners executed the work by using the new pitch-fibre pipes instead of the conventional glazed ware pipes. These pipes can be obtained in 6' or 8' length and enable contractors to reduce the cost of the work. When firms become accustomed to this type of piping there is no reason why there should not be a considerable saving over the usual glazed ware pipes. Tenders were sent out for two other systems of drainage which were in need of reconstruction—one being a very old system comprising partly of a square culvert made with slates and stone slabs. Five inspection chamber covers were fitted on sewers without charge to the owners of the properties served by the run of pipes. In all other cases referred to above the cost of the work was recovered from the owners. Clean Air The measurement of smoke and sulphur dioxide by a daily volumetric apparatus at the Municipal Offices has continued this year. 19 Details of the average monthly reading are given below, with smoke expressed in milligrams per 100 cubic metres, and sulphur dioxide in parts per 100 million:— Year and Month Smoke Sulphur Dioxide Average Highest Average Highest 1957 January 27 74 8 21 February 41 80 11 21 March 32 66 8 20 April 12 30 4 17 May 7 14 3 7 June 4 10 2 6 July 3 4 1 4 August 2 5 1 5 September 3 5 2 5 October 14 44 5 10 November 17 45 6 17 December 47 205 18 69 The average yearly figures for 1955, 1956, and 1957 are given below: Smoke: 1955 1956 1957 Average for year 19 18 17 Average for winter months 32 29 31 Average for summer months 6 7 5 Highest daily recording 153 112 205 Sulphur Dioxide: Average for year 5.5 6 6 Average for winter months 8 9 9.3 Average for summer months 3 3 2.1 Highest daily recording 38 40 69 It will be noticed that there are considerable variations between winter and summer figures. This would appear to confirm that the pollution within the Borough is mainly from domestic sources, as industrial pollution occurs all the year round. Further, during periods of fog when there is very little wind, most of the pollution which builds up must come from local sources. From December 3rd—6th 1957, fog occurred and the following daily figures indicate the marked increase in pollution:— Smoke S02 December 2nd 21 7 December 3rd 52 20 December 4th 167 58 December 5th 205 69 December 6th 96 31 December 7th 46 16 20 In a paper on "The London Fog" of December 2nd—5th, 1957, Drs. Bradley, Logan and Martin, after an extensive study of death returns and meteorological conditions concluded that this fog caused between 800 and 1,000 deaths in Greater London. Conditions were worst in the eastern parts of London and a higher proportion of deaths was noted in these areas. The total deaths from the weekly reports of the Registrar-General for the nine towns Barking, Chigwell, Dagenham, East Ham, Hornsey, Ilford, Leyton, West Ham and Wanstead and Woodford for the week ended 5th December the corresponding number was 283, an increase of 89. Part of the Clean Air Act, 1956 came into operation on the 31st December, 1956 and provided the first legislation for dealing with domestic smoke. The Public Health (Clean Air Act) Sub-Committee after full consideration of the pollution in the Borough decided that further information on the establishment of a smoke control area was required. The Act provides for grants towards the cost of adaptation of heating appliances to burn smokeless fuels. The financial implications of a smoke control area are therefore considerable, and to provide the necessary data a preliminary survey was carried out of approximately one house in five in the Snaresbrook Ward. The following information was obtained:— 1. Total number of houses and flats surveyed 381 2. Number of houses and flats where no alteration was required 113 3. Number of houses and flats where some adaptation or alteration was required 268 (a) Number of fireplaces which can be adapted by provision of a solid smokeless fuel grate 331 (b) Number of old fireplaces which can only be adapted by complete removal 44 (c) Number of gas ignition points required 331 As shown in 3(a) above the large majority of adaptations required are the relatively low cost replacement of stool bottom grates with approved smokeless fuel grates. The more expensive adaptations under 3(b) are the very old type of fireplace which can only be altered by complete removal or sealing off, and provision of a free standing appliance. The amount of fuel consumed averaged about 2 tons per annum per house or flat of which slightly more than 50 per cent was bituminous coal and the remainder smokeless fuel. It was estimated on the information provided by the survey that the average cost of adaptation in a smoke cpntrol area would be approximately £11—12 per house. 21 Following a recommendation from the Sub-Committee the Public Health Committee decided in principle to establish a smoke control area in that part of the Snaresbrook Ward enclosed by Grove Road, Woodford Road, Hollybush Hill and the western boundary. This area included 354 council flats and approximately 1,200 privately owned premises. The "decision in principle" was subsequently approved by the Minister of Housing and Local Government, but further action was deferred by the Public Health Committee. Although the financial implications of smoke control areas are important and must be given careful consideration, these should be secondary in matters of public health. The estimated cost in grants to make the whole Borough a smoke control area is £52,000, and whilst this is a considerable sum, it is completely dwarfed by the figure of £250 million annual cost of atmospheric pollution given in the Report of the Committee on Air Pollution. This latter figure is only of losses that can be given a monetary value. Whilst it would be ideal for a number of adjoining authorities to work together to plan smoke control areas, the difficulty of organising a combined effort was well illustrated by a conference held at Leyton in October. This was attended by a number of surrounding authorities, and except for providing a useful exchange of information and views, it was completely negative on any progressive steps towards the goal of clean air. The Clean Air Act thrusts a heavy responsibility on local authorities, and it is most important that each authority should examine its programme carefully, and satisfy itself that in the event of a repetition of the disastrous fog of 1952 it has done all that it possibly could to minimise the effects. Shortage of Public Health Inspectors —Training Both the Public Health Committee and Establishment Committee discussed the advisability of appointing a student to the Public Health Department and decided in the early part of the year under review to agree to the suggestion of the National Joint Committee and make such an appointment. In March an appointment was made from eight applicants for the post. NEW LEGISLATION Housing Act, 1957 This Act consolidated various enactments relating to housing and came into effect on the 1st September, 1957. Rent Act, 1957 The Rent Act, 1957, which came into effect on the 6th July, 1957 repealed Section 26 of the Housing Repairs and Rents Act, 1954, which dealt with Certificates of Disrepair and set out in the 1st Schedule Part II a revised procedure for granting such Certificates. 22 Rodent Control Arrangements for the destruction of rats and mice continued as for previous years with the employment of a full-time rodent operative. The number of complaints received during 1957 was 420, an increase of 49 over the figure for 1956 and 10 over the 1955 figure. The following table gives details of surface treatments:— Number of inspections made by the Public Health Inspectors 220 Complaints received 420 Revisits to Premises 305 Visits to adjacent premises 122 Total premises visited 847 Number of baiting points 3666 Two full sewer treatments of 1,400 manholes were carried out during the year. The first treatment using bread rusk as bait base and arsenic as poison resulted in 393 complete prebait takes and 105 partial takes. The scheme of baiting used was prebait on the 1st and 3rd days with poison on the 5th day. For the second treatment carried out at the end of the year and overlapping into 1958, warfarin with preservative (paranitrophenol) was used. 416 complete takes and 22 partial takes were recorded. The Borough Engineer and Surveyor provided the labour for the sewer treatments. The figures seem to indicate that the rat population in the sewers is now fairly constant and the twice yearly treatments whilst not reducing the number to any large extent, at least serve the purpose of preventing any increase. Essex County Council Act, 1933, Section 109 Six applications were received during the year seeking permission to keep caravans on a site known as "Riggs Retreat," Woodford, at a site used for part of the year for the storage of a showman's outfit. Permission was granted in each case. One further application was received and permission granted. In this latter case the use of the caravan was temporary and was removed when its owner took possession of a maisonette later in the year. 23 Pet Animals Act, 1951 Whilst the number of persons registered as keepers of pet shops remained the same (4) it must be recorded that one person ceased trading in pets whilst another opened a large warehouse wherein large numbers of goldfish etc., were stocked for sale by wholesale. Rag Flock and other Filling Materials Act, 1951 No additional registrations have been made under this Act, the number of premises registered remaining at one. Petroleum (Consolidation) Act, 1928 The number of licences decreased from 60 to 59. Visits made by inspectors during the year were 369. The increase in the number of visits over previous years is accounted for by the fact that previously the Chief Public Health Inspector was the only officer authorised by the Council to do petroleum work. Because of the advent of new regulations the Public Health Committee decided that inspections to premises should be made more frequently this being made possible by delegating to each inspector the duties as an inspector under the Act. During the period of petrol rationing at the beginning of the year a complaint made to the police was referred to the Council and concerned the storage without a licence of petroleum spirit at a dwelling house. A search warrant was obtained and at the premises 63 gallons of petrol was found stored in a forty gallon drum and other similar vessels. Proceedings were taken against the owner of this fuel. At the Magistrates Court he was fined £3 together with a sum of 10 guineas towards the cost of the Analysts fees. An order was made by the Magistrates for the confiscation of the petrol. Amendments to licences were necessary in 3 cases where the firms concerned increased their storage capacity by a total of 4750 gallons. In one case a transfer of a licence to store petroleum mixtures was made on account of the change of ownership of the factory. Game Licences 9 licences to deal in game were issued in 1956, two former licensees not renewing, one new licensee. 24 Shops Act, 1950 201 inspections were made during the year. Again no difficulties were experienced in connection with closing hours. One application for a certificate of exemption was received and refused. The application was later renewed and when submitted to the Public Health Committee its consideration was deferred so that the Building and Town Planning Committee could consider the position of the business from the Town Planning angle. 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, one to each of the registered premises. All were satisfactory. Heating Appliances (Fireguards) Act, 1952 Frequent inspections have been made of premises selling heating appliances, and in nearly all cases the guard fitted satisfied the tests prescribed in the Regulations. A second-hand furniture dealer was summonsed for exposing for sale two fires, one electric and one gas, with insufficient fireguards. The Magistrates imposed a fine of £2 for each offence. Swimming Bath Water Three samples of water from swimming baths were taken from schools. In all cases the bacteriologist reported that the water was suitable for use in a swimming bath although there was a need for residual chlorine. Two of the three schools dose the water manually whilst the third has a filtration and chlorination plant. Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 58 Visits in connection with contacts, disinfection, etc 54 Enquiries in connection with food poisoning 10 Verminous Premises 19 25 General Environmental Public Health Drains and Sewers inspected Drain tests applied 1232 Stables and manure pits inspected 48 Public Conveniences and Urinals 19 Factories (mechanical) 243 Factories (non-mechanical) 14 Hairdressers' Premises 27 Schools and School Canteens 77 Ditches, Streams and Ponds 57 Open Spaces and Playing Fields 26 Petrol Inspections 369 Shops Act inspections 201 Outworkers' premises 51 Massage Establishments 13 Pet Animals Act 4 Fairgrounds 2 Swimming Baths 8 Smoke observations 5 Workplaces 4 Housing Repairs and Rents Act 94 Tents, Vans and Sheds—Gypsies 25 Heating Appliances (Fireguards) Act and Regulations 53 Miscellaneous 255 26 SECTION D. HOUSING No. of dwellings erected during 1957: Council 123 Private Enterprise 124 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) 920 (b) Number of inspections made for the purpose 2584 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 — 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 14 (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 68 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 59 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 — (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 1 (b) By Local Authority in default of owners 1 27 (b) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 5 (b) By Local Authority in default of owners 20 (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 — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 28 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 37 14 - - (ii) Factories not included in (i) to which Section 7 applies 165 243 4 - (iii) Other Premises under the Act (excluding out-workers' premises) — — - - TOTAL 202 257 4 — 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 2 - Overcrowding — — — — Unreasonable temperature — — — - Inadequate ventilation — 1 1 — Ineffective drainage of floors — — — — Sanitary conveniences: 1 Insufficient — — — — 2 Unsuitable or defective — 2 2 — 3 Not separate for sexes — — — — Other offences — — — — TOTAL 2 6 5 — 29 3. Outwork Number of out-workers in August list required by Section 110(l)(c) Paper Bags 8 Boxes 16 24 Factories Act 1937, Section 34 Means of Escape in Case of Fire Six certificates as required by the Factories Act, 1937 were issued a portion of this number being in the nature of amendments to previous certificates. 30 SECTION E. FOOD AND DRUGS Food and Drugs Act, 1955 Reference was made in the report of the Medical Officer of Health for the year 1956 to the fact that proceedings were to be instituted against a greengrocer in regard to offences under the Food Hygiene Regulations which were made under the above Act. Action was taken early in the year under Regulations 14(l)(a), 14(5), 16(1), 16(3), 17, 20, 23 and 24 at the Magistrates Court the owner of the business was fined 10/- on each summons. The following cases were reported to the Public Health Committee with the results indicated:— Sample of Flour:— Deficiency in creta-praeparata to the extent Warning to of 23 per cent of the minimum required by Manufacturers the Flour (Composition) Regs., 1951 French Jam Sandwich:— Query association with cases of food poisoning Reported to Hammersmith M.B.C. No further action after Report from Borough Sample of Sausages:— Extraneous matter contained therein Case dismissed by Magistrates Court Sample of Malt Vinegar:— Not malt vinegar Informal sample unable to repeat for formal sample Apple Strudel:— Extraneous matter (nail) contained therein £10 fine at Magistrates Court Hawkers of Food (Essex County Council Act 1952, Section 103) During the vear 2 vendors were added to the register. 31 The list of food sampled is given below; together with samples of ice lollies:— Brandy 2 Gin 2 Rum 3 Sherry 2 Whisky 3 Angelica 1 Aspirins 1 Bacon 5 Beef Suet—Shredded 2 Beef—Pickled 2 Brine—Pickling 2 Butter 13 Butter Mixture 1 Buttered Coconut 1 Cheese 1 Cheese—Cheshire 1 Cheese—Gorgonzola 1 Chicklettes 1 Christmas Pudding 2 Cod Roe—Smoked 1 Corned Beef 1 Cream—Double 1 Currants 2 Currie Powder 2 Fish Cakes 2 Flour—Plain 6 Flour—Self Raising 1 Golden Cutlets 1 Ground Almonds 3 Ground Rice 1 Ham 1 Honey 1 Ice Lollies 7 jellied Veal 1 Lard 3 Luncheon Meat 1 Margarine 1 Milk 13 Mincemeat 2 Oranges 5 Pepper 2 Pork Pie 1 Raisins—Stoned 1 Salad Cream 1 Sardines 1 Sausages—Pork 2 Squash—Orange 1 Sultanas 2 Tea 2 Vinegar—Malt 2 32 The following is a list of foods surrendered in 1957 because of unsound conditions:— Fish Fresh 12 stone Fish Tinned Salmon 2 tins Crab 3 tins Pilchards 4 tins Sardines 1 tin Shrimps 1 tin fruit, Tinned Cherries 6 tins Plums 27 tins Pineapples 42 tins Peaches 22 tins Apricots 6 tins Oranges 9 tins Pears 6 tins Loganberries 2 tins Gooseberries 1 tin Strawberries 7 tins Grapefruit 4 tins Fruit Salad 10 tins Fruit Dried Prunes 90 lbs. Vegetables, Tinned Peas 20 tins Beans 15 tins Tomatoes 33 tins Potato Salad 1 tin Carrots 2 tins Meat, Tinned Luncheon Meat 77 tins Meat Loaf 2 tins Corned Beef 279 tins Ham 24 tins Stewed Steak 2 tins Ox Tongue 101 tins Jellied Veal 1 tin Meat, Fresh Pork 54 lbs. Lamb 4652 lbs. Veal 33 lbs. York Ham 19 lbs. Beef 819 lbs. Sausages 14 lbs. Liver 23½ lbs. Bacon 100 lbs. Bovine Plucks 6 lbs. Part Sow Carcase 1130 lbs. Miscellaneous Milk, tinned 8 tins Cereals 1 tin Soup 6 tins Tarn & Marmalade 11 tins Spaghetti 3 tins Tomato Juice 1 tin Semolina 28 lbs. Pickles 2 jars Jelly 6 tins Ginger 1 tin Horseradish relish 2 jars Mint sauce 1 jar Porridge Oats 1½ lbs. Babies Food 66 tins Dried Milk 56 lbs 33 Manufacture, storage and sale of Ice Cream Ninety-four registrations of premises were in force at the beginning of the year, and a further six were added during the year. An application to store and sell ice cream was made by the proprietor of a shop selling groceries, provisions and greengrocery. The Public Health Committee decided that in this case registration should be granted provided the sale of vegetables ceased. The shopkeeper was interviewed and after due consideration he decided to continue with the sale of greengrocery and withdrew his application. Sixty-seven visits to premises were made during the year in addition to seventeen visits for the purpose of obtaining ice-cream samples. Ice Cream Samples (Bacteriological Examinations) Eighteen samples of ice cream were obtained and the results are as follows:— Ice Cream: Taken Ministry of Health's Provisional Grading Grade 1 Grade II Grade III Grade IV Nos. 18 16 2 Nil Nil per cent 100 89 11 Nil Nil 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. 34 The food premises in the District may be classified as follows:— Confectioners (cakes, pastries) 27 Grocers 76 Greengrocers 35 Butchers 34 Confectioners and tobacconists 68 Restaurants and cafes 36 Fishmongers 15 Dairies and Milk shops 10 Miscellaneous 28 of these 100 are registered for the storage and sale of ice cream; 55 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 28 Tuberculin Tested 13 Supplementary Licences: Pasteurised 14 Sterilised 15 Tuberculin Tested 14 Inspection of Food Premises Meat Shops 331 Bakehouses 83 Fishmongers 57 Grocers 247 Restaurants and Cafes 143 Dairies and Milk Shops 51 Greengrocers 80 Ice Cream Premises 67 Street Vendors 12 Food and Drugs Sampling 118 Ice Cream Sampling 17 Milk Sampling 23 Other Premises 178 Food Hygiene Regulations 704 TOTAL 2111 35 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease during the year, together with the number and percentages 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 30 2 6.6 — — Diphtheria - - - - - Pneumonia 8 - — — — Cerebral-Spinal Fever - - - - - Acute Poliomyelitis 5 5 100 — — Acute Polioencephalitis — — — — — Encephalitis Lethargica - - - - - Dysentery - - - - - Puerperal Pyrexia 38 38° 100 — — Paratyphoid Fever - - - - - Enteric or Typhoid Fever 1 1 100 - - Erysipelas 2 — — — — Malaria (contracted abroad) 1 1 100 - - Measles 448 1 0.2 — — Whooping Cough 164 2 1.2 — — Opthalmia Neonatorum - - - - - Food Poisoning 3 — — — — *These cases all occurred in hospital 36 These cases of infectious disease have been divided into age incidence and set out in the accompanying table: Disease All Ages Under 1yrs. 1-5 yrs. 5-10 yrs. 10-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & 0 yrs. Scarlet Fever 30 — 4 13 11 2 — — — Pneumonia 8 - 1 3 — — — 2 2 Typhoid Fever 1 — — — 1 — — — — Acute Poliomyelitis 5 1 — — 1 2 1 — — Puerperal Pyrexia 38 — — - — 19 18 1 — Erysipelas 2 - - - - - - - 2 Measles 448 10 236 193 6 2 1 — — Whooping Cough 164 9 54 90 4 — 7 — — Malaria (contracted abroad) 1 - - - - 1 - - - Food Poisoning 3 — — — — 1 — 2 — TOTALS 700 20 295 299 23 27 27 5 4 Poliomyelitis During 1957 five confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups. 37 38 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1937 to 1957 Year Population No. "Notified Notification Hate Under 1 1-5 5-10 Age 10-15 Group 15-25 25-45 Over 45 Deaths Death Rate 1937 53840 3 0.055 - 2 1 - - - - - - 1938 54810 2 0.035 — — - — 2 — - - - 1939 55880 - - - - - - - - - - - 1940 48620 - - - - - - - - - - - 194] 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 - - - - - - - - 1957 60970 5 0.079 1 - - 1 2 1 - — - Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1957. | 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 — 1 1 - - - - - 15-20 years 1 3 - - - - - - 20-25 years - - - - - - — - 25-35 years 4 2 — — 1 — — — 35-45 years 4 3 — — — - - — 45-55 years 2 2 — — 1 — - — 55-65 years 3 1 - — — — 1 - 65 and over - - - - - - - - TOTALS 16 10 1 - 2 - 1 — 26 1 2 1 27 3 The 3 deaths represent a death rate of 0.04 per 1,000 of the population. A comparative summary over the past 20 years for the Borough is set out in the following table. 39 40 Year Notifications Total Notification Kate Deaths Total Death Rate Pulmonary Non-Pulmonary Total Notifications Pulmonary Non-PUlmonary Total Deaths No. Rate No. Rate No. Rate No. Rate 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 40 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 1957 26 0.42 1 0.01 27 0.43 2 0.03 1 0.01 3 0.01 Rates per 1,000 population. The register shows that at the end of the year:— 26(30) Pulmonary and 1. (2) non-Pulmonary cases were notified during the year. 33 (13) cases were transferred into the District. l(no) cases were restored to the register. 2(6) Pulmonary and 1(1) non-Pulmonary died during the year. 14(39) Other cases were removed from the register 521(477) Cases remained on the register at the close of the year. The figures in brackets are the comparable figures for 1950. 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 Wanstead and Woodford Borough Council Chigwell U.D.C. Epping U.D.C. Waltham Holy Cross U.D.C. Harlow 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 Society Tuberculosis Care Association Women's Voluntary Services 1 vacancy Councillor W. J. Bowstead Alderman Mrs. S. L. Oakes Councillor Mrs. I. Titley Councillor Mrs. S. V. F. Ashton Councillor B. B. Dyer Councillor Mrs. I. E. C. Haselden Councillor S. J. Relph Councillor M. W. Juniper Councillor Mrs. V. L. M. Martin Councillor S. J. Palfreman. Councillor E. G. Perry Councillor A. J. Hyde Councillor Mrs. J. M. Davies Councillor Mrs. S. Anderson Councillor Mrs. E. Druce Councillor Mrs. H. E. Howard G. Gray, Esq. J. W. Randall Nation, Esq. Dr. H. Grylls Councillor Mrs. S. M. Bovill Councillor A. G. Cole Councillor Miss D. D. Forster Alderman K. E. B. Glenny Councillor F. A. Wortley (1 vacancy). Mrs. V. Walker Mrs. A. C. Murray Mrs. M. E. Clinch 41 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. Dr. E. L. Ewan, who had been employed by the County Council as a School Medical Officer in the Borough of Wanstead and Woodford for over 29 years, retired in July. CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) There were 564 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 prompty 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 Owing to the popularity of these classes it was found necessary during the year to increase the sessions from two to three times 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. 42 Vital Statistics Wanstead & Woodford England & Wales Live birth rate per 1,000 population 11.69 16.1 Still birth rate per 1,000 population 0.28 0.37 Infant Mortality Rate per 1,000 Live Births 26.6 23.1 Neo-natal mortality The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1957, 12 infants died in the first four weeks of life, a rate of 16.8. Care of Premature Infants During 1957, 45 premature infants were born to residents in the Borough, 5 of these births taking place at home and 40 in hospital or nursing home. 3 of the 5 born at home were alive at the end of one month; 28 of the 40 born in hospital or private nursing home survived. In all cases of premature birth, special supervision is given after the 14th day or atter discharge from hospital. Child Welfare Centres Attendances at the Child Welfare Clinics has been well mairitained. During the year it was decided to hold an additional clinic at All Saints Church Hall, Woodford Wells, for the benefit of the population in the northern part of the area, who previously had some considerable distance to walk. Although some of the centres are conducted in old buildings, it can be said that the Borough is well catered for and generally there is a centre within a mile radius of every home. Attendance figures were made up as follows: Baptist Church Hall, Alders brook 1441 Ashton Playing Fields, Woodford Bridge 2546 St. Barnabas' Church Hall, Snakes Lane 3982 Fullers Road, South Woodford 2925 Cromwell Hall, Nightingale Lane, Wanstead 2217 Holy Trinity, Hermon Hill, South Woodford 3317 All Saints Church Hall, Woodford Wells 229 16657 Welfare Foods The distribution of Welfare Floods continued on the lines indicated in my last report, being undertaken entirely by members of the Women's Voluntary Services. 43 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. 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. 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 1 36 Child Minders 3 14 Women's 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 152 attendances during the year. MIDWIFERY (Section 23) There are three domiciliary midwives practicing in the Borough. Supervision is carried out by Miss A. Williams, Non-Medical Supervisor of Midwives who is on the staff of the Area Medical Officer. No. of confinements attended as midwife 143 No. of confinements attended as maternity nurse i.e. doctor also present 53 TOTAL 196 Gas and Air Analgesia A total of 167 patients in the district received gas and air analgesia. Training of Pupil Midwives One district nurse in Wanstead and Woodford is approved as a midwifery teacher, and during the year took four pupils for their Part II Midwifery Training. These pupils were successful in passing their examination. Part II Midwifery Training will be continued during 1958. 44 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:— The Health Visiting staff, numbering five, has remained at full establishment during the year. An additional Infant Welfare Clinic was opened at All Saints Church Hall, Woodford, on Monday afternoons, which has proved very popular. Relaxation and Mothercraft classes at 118 Hermon Hill on Monday and Tuesday afternoons still maintain the high level of attendance, numbering 8 to 10 per session, and as there was a waiting list, a third session was opened on Thursday mornings. Health Education is an important part of the Health Visitors' work, and talks have been given in the Borough to the Young Wives' Club, and the Townswomens’ Guild when requested. One Health Visitor student from the South East Essex Technical College, and also Mr. Thorpe, a N.A.P.T. scholar from Gambia, received practical training in Tuberculosis Health Visiting and Chest Clinic experience at Harts Hospital. One student taking Social Studies Course at the University of Southampton received practical training in Public Health Visiting and attendance at Infant Welfare Clinics. The practice of student Nurses from Wanstead Hospital being given practical training in the Public Health field has been continued throughout the year. The following table sets out statistically the work of the Health Visitors in the Borough during 1957:— Expectant Mothers (first visits) 176 Expectant Mothers (re-visits) 94 Infants under one year (first visits) 721 Infants under one year (re-visits) 1673 Infants 1 to 5 years (first visits) 143 Infants 1 to 5 years (re-visits) 2404 Stillbirth enquiries 19 Infant Death 17 Tuberculosis Patients 1015 Aged and Infirm 260 Day Nursery Applications 3 School Children 380 Other Visits 352 Ineffective Calls 843 8100 45 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 the part time services of two male nurses. The staff remained at full establishment during the year and a good nursing service was rendered to the acute and chronic sick including the care of the aged. Patients requiring various types of hypodermic injections are decreasing. The following statistics show a comparison of work undertaken by the District Nurses during the years 1956 and 1957:— 1957 1956 Number of new cases 659 769 Number of visits 24072 23658 Last Offices performed 30 51 Advisory or Casual Visits 531 467 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 641 5 to 15 years of age 38 679 The number of children who received a secondary or re-inforcing injection was 343. 46 The number of persons vaccinated or re-vaccinated during the year 1957 was:— Under 1 1—4 yrs. 5—14 yrs. 15 or over Total Primary 463 134 225 238 1060 Re-Vaccination Nil 6 148 487 641 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, 1957 Year of Birth Number Year of Birth Number 1957 106 1946 792 1956 472 1945 860 1955 854 1944 589 1954 293 1943 489 1953 639 1942 618 1952 540 1951 502 1950 644 1949 660 1948 926 1947 928 TOTAL 9912 Number of children immunised against Whooping Cough during the year 1957 was:— Under 6/12 6—12 months 1 year 2 years 3 years 4 years 5 years 6 over 59 184 34 11 3 2 7 In my annual report for 1956 I referred to the scheme introduced by the Ministry of Health for the vaccination of children against Poliomyelitis. Initially the scheme provided for the vaccination of children born only in the years 1947 to 1954 inclusive, but during this year the scheme was extended to include children born in the years 1955 and 1956, and also recommended that a further opportunity should be given to the parents of children born in the years 1947 to 1954 to register them if they had not hitherto accepted the offer of vaccination. During 1957, 1,531 children in the Borough received the complete course of vaccination against Poliomyelitis. 47 During November 1957, it was announced that the scheme for vaccination could be further extended to include children born in the years 1943 to 1946 inclusive, and to those born in 1957 who had reached the age of six months, so that vaccination is now available to all children born in the years 1943 to 1957 inclusive. In addition, expectant mothers are now a first priority for vaccination and certain special groups of individuals, such as general medical practitioners who are particularly exposed to the risk of infection are also eligible. During the year, the number of children vaccinated has been governed by the availability of supplies of vaccine, which at first was produced in England by only one firm. Recently, however, production of vaccine has been commenced by a second British manufacturer, and the supplies of vaccine have been supplemented considerably with Salk vaccine manufactured in Canada and the U.S.A., the first supplies of which were received in January, 1958. 48 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: The decrease in tuberculosis continues, thirty new cases being discovered as compared with thirty-four the previous year. One hundred and eighty-three new contacts were examined. The value of this type of examination is well illustrated by the following case: one child, examined as a contact of his mother, herself an open case of tuberculosis, was found to have a primary infection and was at once admitted to High Wood Hospital. X-ray investigations discover these early cases which otherwise would go into more advanced disease before being detected. During the year, six hundred and sixteen old contacts were examined and it is interesting to note that of these, three patients were consequently notified and treated as cases of pulmonary tuberculosis. The increased use being made of the Clinic facilities by the area served (Wanstead, Woodford and Buckhurst Hill) is reflected in the X-ray examinations—four thousand two hundred and sixty-five as compared with three thousand four hundred and thirty six in 1956. Ninety one children received B.C.G. vaccination. These were mainly children in close contact with cases of pulmonary tuberculosis and consequently very vulnerable to the disease. The close co-operation with the Medical Officer of Health and his Department continues and much help is given to needy families, particularly in the field of re-housing. As is now well-known, Chest Clinics are no longer Tuberculosis Dispensaries. All types of diseases of the chest are dealt with, both from the preventative and curative angle. Many cases can be treated as out patients, returning to work as quickly as possible and the final saving of hospital bed accommodation is very considerable. In the field of non-tuberculous chest conditions, cancer of the lung continues to increase and the need for early chest investigation is vital. Chronic bronchitis, often called the "English Disease", is of great importance in the Nation's economy and demands long and continuous treatment. The fight against tuberculosis is being won, but it is necessary not to relax any of our efforts, until we have virtually eliminated what has been called the "White Plague." 49 Miss R. Carrington, Secretary of the Leyton, Wanstead and Woodford Tuberculosis After-Care Association, reports as follows: During the year 1957 the T.B. Care Association continued to give assistance wherever possible to patients suffering financial loss because of treatment for Tuberculosis. Altogether 124 patients received help from the Association and the following is a summary of the assistance given: Particulars No. of Patients Assisted Amount Spent Grocery vouchers 86 £1127 Fares 12 96 Clothing, furniture, etc. 9 35 Holidays 6 13 Occupational Therapy 3 7 Wireless Licences 1 1 Payment of Rates 1 8 Financial Grants 6 22 124 £1309 In addition to the above Christmas gifts were given to 96 £56 A typewriter was purchased during the year and this was loaned to patients during their period of convalescence at home, and two patients were thus able to accept a post as typist when they were fit for work. The 1957 Seal Sale was again very successful and the Association collected altogether a sum of £817. The T.B. Helping Hand Association raised £175 for the funds and the Committee is grateful to the County Council for their Annual Grants. 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 13 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 provision of help to homes deprived of one parent, a scheme started towards the end of 1956 has proved a valuable addition to the Home Help Service. With this help the families have been able to remain together rather than the children being separated and sent to foster homes. 50 In general the service continues to be provided as in previous years, and all cases are visited as frequently as possible—a total of 1140 visits being made throughout the year. Difficulty has been experienced in recruiting the number of home helps required to give a complete service. There does not appear to be any immediate answer to the problem. Two new requests for help have been received from T.B. households and those already receiving help are frequently visited and assistance given in accordance with the recommendations of the Chest Clinic. The number of aged chronic sick continue to increase and forms approximately 80 per cent of the patients receiving help. The amount of help provided varies with the individual needs from two hours per week for heavy cleaning to as much as twenty hours per week which provides for meals and personal hygiene. Relations are encouraged to help bedridden and aged patients in the evening and week-ends. The W.V.S. "Meals on Wheels" service continues to render invaluable assistance providing meals on Wednesdays and Fridays Liaison with the Child Care Officers, District Nurses, Health Visitors and Hospital Almoners is maintained. 51 SCHOOL HEALTH SERVICE, 1957 Wanstead and Woodford A new secondary modern school—Nightingale County Secondary School—opened in September bringing the number of schools in the Borough maintained by the Local Education Authority to seventeen, with a school population of approximately 7,000. 1. School Medical Inspections As in previous years, every school in the Borough was visited by a School Medical Officer during the year to examine pupils whose routine examination was due, and others who had been referred by Head Teachers, parents, etc. for a "special" examination. 2,073 children were inspected in the following categories:— No. examined No. referred for (a) treatment (b) observation 1st age group (5-7 years) 437 54 84 2nd age group (10-11 years) 451 56 37 3rd age group (14-16 years) 476 81 34 Other age groups and "Specials" 430 7 1 "Re-examinations" 279 — 2. Cleanliness Surveys The usual termly cleanliness inspection was carried out by the School Nurses at each primary and secondary modern school. 11,902 inspections were made and 24 individual children were found to be suffering from infestation of the head; the parents were notified and given advice on how to deal with the condition. Despite this help, the parents of one child were unable to satisfactorily cleanse the child and it was necessary to send the pupil to the Cleansing Centre for attention. 3. Clinics—93 High Road, E.18 (a) Minor Ailments. A School Medical Officer is in attendance every Friday morning, and any child may attend for examination, without the necessity of making an appointment. Particulars of the defects noted at the Clinic inspections are given at Appendix "A" 52 (b) Dental In view of the national shortage of Local Authority Dental Officers the Borough is fortunate to have a full-time dental officer in attendance at the local clinic, and pupils have the advantage of having their teeth periodically inspected when the Dental Officer visits the schools. A summary of attendances and work carried out at the dental clinic is given at Appendix "B". (c) Speech Therapy. The Speech Therapist attends at the clinic for two days each week and assistance is given by students from recognised training colleges for Speech Therapists. The following specialist clinics are staffed by Officers of the Regional Hospital Board: (d) Ophthalmic An ophthalmologist attends once each week to see children who have been referred by School Medical Officers for investigation of defects of vision. (e) Orthopaedic An Orthopaedic Surgeon visits once a month. The School Medical Officer and a School Nurse are also in attendance at this session. (f) Physiotherapy Three sessions a week are held with a qualified Physiotherapist in attendance. Treatment is supervised by the School Medical Officer. 4. Child Guidance Service This service continues to expand and outpace the facilities available with an ever-increasing number of children referred for psychiatric treatment. At the end of the year the waiting period for most cases was 6—9 months; each case is dealt with on its merits and urgent cases treated accordingly. Steps have been taken to reduce the case load at the Walthamstow Child Guidance next year, which should result in a considerable reduction in the waiting time for children from this Borough. 5. B.C.G. Vaccination of Schoolchildren The parents of 484 pupils of 13 years of age were invited to consent to their child being vaccinated with B.C.G.; 323 (66.7 per cent) did so. In view of the many other preventative vaccinations now being offered to schoolchildren, the acceptance rate for the B.C.G. scheme can be regarded as satisfactory. 53 6. Tuberculosis Case Finding Tlx: purpose of this scheme, which is limited to pupils in the 5—6 year age group, is to discover tuberculosis in adults by means of Mantoux (skin) testing these children. All 5 year old children attending primary schools in the Borough are eligible to participate and during the year 64 per cent of the parents gave consent for their child to be tested. Here again the scheme clashed with the Poliomyelitis vaccination scheme, and adversely affected the response. 2 children gave a positive reaction to the Mantoux test and the parents and other close contacts to the children were invited to attend at the Chest Clinic for X-ray examination. No findings of any significance were reported. 54 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 12 — Eyes (a) Vision 40 — (b) Squint 1 — (c) Other 3 — Ears (a) Hearing 3 — (b) Otitis Media — — (c) Other — — Nose or Throat 1 — Speech 27 — Cervical Glands — — Heart and Circulation 1 — Lungs 3 1 Development (a) Hernia — — (b) Other — — Orthopaedic (a) Posture — — (b) Flat Foot 5 — (c) Other 21 — Nervous System (a) Epilepsy 1 2 (b) Other 1 — Psychological (a) Development 9 — (b) Stability 8 — Other 9 — 55 APPENDIX “B” Dental Inspections and Treatment Number of pupils inspected (periodic and specials) 2737 Number found to require treatment: (a) Periodic 1136 (b) Specials 536 Total 1672 Number of individual pupils actually treated 793 Attendances made by pupils for treatment 2968 Fillings: Permanent teeth 1752 Temporary 423 Total 2175 No. of Teeth Filled: Permanent teeth 1648 Temporary 374 Total 2022 Extractions: Permanent teeth 76 Temporary 665 Total 741 Administration of anaesthetics: (a) Local 138 (b) General 326 Total 464 Other Operations: (a) Permanent teeth 1145 (b) Temporary 416 Total 1561 56