WANS 23 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1958 PUBLIC HEALTH COMMITTEE Councillor S. J. Relph (Chairman) Alderman D. L. Forbes (Vice-Chairman) Alderman Mrs. E. F. M. Hollis Councillor J. W. Challis Councillor R. Mitchell Councillor E. V. Gardner Councillor Mrs. M. Owens Councillor Mrs. W. J. Roberts 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. Tempieman, 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) J. A. Orrell, M.A.P.H.I. (a) (b) (e) 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 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 Wanstead and Woodford Borough Council TO THE MAYOR, ALDERMEN AND COUNCILLORS, BOROUGH OF WANSTEAD AND WOODFORD. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health Services in the Borough for the year 1958. As in former years a section of this report is given to those services under the National Health Service Act which are administered by the Essex County Council and decentralised to the Forest Health Area Sub-Committee of the County Health Committee. An account of the work of the School Health Service is also included. Vital Statistics The Birth Rate increased by 35, total births reaching 748, the highest figure since 1953. The Birth Rate per 1,000 population was 12.2 contrasted with 15.1 for the country as a whole. While continuing to be well below the national average the Birth Rate of the Borough has risen during the past 2 years whereas the national rate has fallen. The Death Rate increased by 36 making a total of 696. Death Rate per 1,000 population was 11.37 which is slightly less than the figure for England and Wales—11.68. It is of interest to note that the increase in deaths was entirely among the female population, 38 more females dying than in 1957. The male rate was actually 2 deaths less than in the previous year. The Infant Mortality Rate i.e. the deaths of infants under one year of age per 1000 live births was 9.4 contrasted with a figure of 26.6 which was identical in the two previous years. This is by far the lowest figure ever recorded in the Borough the nearest approach to it being 14.2 in 1954 and in 1951. The figure for England and Wales is 22.6. It has been stated that the Infantile Mortality figure can be regarded as an index of the health of the population. To achieve a figure so far below the national average is most gratifying. Causes of Death. Deaths from cancer increased by 8 to a total of 127. This figure has remained fairlv constant during the past 10 years, varying between 119 and 134. Deaths from coronary thrombosis showed a striking increase rising from 87 to 123, the highest figure recorded. Infectious Disease. Incidence of infectious disease remained very low. One case of non-paralytic poliomyelitis was reported. 3 Food Poisoning. An outbreak of food poisoning occurred at a students' hostel, 9 persons being affected. Symptoms were moderately severe but of short duration. Enquiries revealed that all those taken ill had eaten a reheated fish dish of kedgeree from which an organism was isolated. A similar organism, a staphylococcus was found in a swab taken from the nose of the cook and there is little doubt that this was the cause of the outbreak. The fish in question had been cooked on the previous day and allowed to cool slowly being re-heated on the following morning, this process causing an ideal breeding ground for germs. A further outbreak, in which approximately 30 persons were affected, took place in a children's home. Symptoms were mild and did not last long. Here the cause was believed to be the eating of partially cooked and re-heated meat which had become contaminated. In my report for last year I reported on an outbreak of food poisoning in a school due to the consumption of re-heated food. It is proving almost impossible to impress upon those responsible for the running of canteens the danger to health arising from this practice. National Assistance Act, Compulsory Removal to Hospital. For the first time on record it was necessary to make application to a Justice of the Peace under Section 47 of the National Assistance Act; for the compulsory removal to hospital of an elderly man in urgent need of care and attention and who refused to enter hospital voluntarily. Fortunately when the ambulance arrived he went without demur and caused no further trouble. My thanks are due to the Chief Public Health Inspector and to the staff of the department for their work throughout the year. In conclusion, I am indebted to the Chairman and Members of the Public Health Committee for their unfailing 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: 4 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar-General's estimate mid-year 1958 61,220 „ Registrar-General's estimate mid-year 1957 60,970 Rateable Value £999,825 Sum represented by penny rate £4,016 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 377 Females 349 Total 726 Illegitimate Males 14 Females 8 Total 22 Total Males 391 Females 357 Total 748 Birth-rate per 1,000 of the estimated resident population—12.2 STILLBIRTHS Legitimate Males 9 Females 4 Total 13 Illegitimate Males — Females — Total - Total Males 9 Females 4 Total 13 Rate per 1,000 total (live and still) births—17.4. DEATHS Males—314 Females—382 Total—696. Death rate per 1,000 of the estimated resident population—11.37 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 9.36 Legitimate infants per 1000 legitimate live births 8.25 Illegitimate infants per 1,000 illegitimate live births 76.9 1957 1958 Deaths from Cancer 119 127 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 6 4 „ „ Suicide 6 9 „ „ Other Violent Causes 9 17 5 Population. The Registrar-General's estimate of the population for 1958 (midyear) was 61,220 an increase of 250 on the figure for 1957 (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. 6 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1958 England and Wales and London (Provisional Figures based on Quarterly Returns). England and Wales London Administrative County Borough of WANSTEAD and WOODFORD Births: (Rates per 1,000 Home Population) Live 15.1 16.7 12.2 Still 0.36 0.34 0.21 Deaths: All causes 11.68 11.8 11.37 Malignant Neoplasm Lung and Bronchus 0.44 0.64 0.55 Whooping Cough 0.00 0.00 — Diphtheria 0.00 0.00 — Tuberculosis 0.10 0.13 0.05 Influenza 0.05 0.05 0.05 Coronary Disease —Angina 1.86 1.84 2.01 Acute Poliomyelitis & Polioencephalitis 0.00 0.00 — Pneumonia 0.54 0.70 0.52 (Rates per 1,000 live births) All causes under 1 year of age 22.6 22.6 9.36 Enteritis and Diarrhoea under 2 years of age 0.44 * — *Figures not available. 7 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.00 — Meningococcal Infection 0.02 0.03 Scarlet Fever 0.84 0.49 Whooping Cough 0.74 0.20 Diphtheria 0.00 — Erysipelas 0.07 0.03 Smallpox 0.00 — Measles 5.74 5.47 Pneumonia 0.49 0.18 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.03 — Non-Paralytic 0.01 0.01 Food Poisoning 0.2 0.57 Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 11.53 42.0 8 Maternal Mortality Abortion Other Total England and Wales 0.07 0.36 0.43 Wanstead and Woodford — — — 9 Notifications: England and Borough of Wales Wanstead and Woodford 8 Maternal Mortality Abortion Other Total England and Wales 0.07 0.36 0.43 Wanstead and Woodford - - - Causes of Death as given by the Registrar-General, 1958 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 2 1 3 2. Other Forms of Tuberculosis - - - 3. Syphilitic Disease — 1 1 4. Diphtheria - - - 5. Whooping Cough — — - 6. Meningococcal Infections — — - 7. Acute Poliomyelitis — — - 8. Measles — — - 9. Other Infective and Parasitic Diseases 2 1 3 10. Malignant Neoplasm—Stomach 7 5 12 11. Malignant Neoplasm—Lung and Bronchus 30 4 34 12. Malignant Neoplasm—Breast — 11 11 13. Malignant Neoplasm—Uterus — 9 9 14. Malignant Neoplasm—Others 29 32 61 15. Leukaemia — 3 3 16. Diabetes 1 3 4 17. Vascular Lesions—Nervous System 33 74 107 18. Coronary Disease—Angina 73 50 123 19. Hypertension with Heart Disease 6 12 18 20. Other Heart Disease 31 64 95 21. Other Circulatory Disease 17 27 44 22. Influenza 2 1 3 23. Pneumonia 13 19 32 24. Bronchitis 21 11 32 25. Other Respiratory Diseases 3 3 6 26. Ulcer of Stomach or Duodenum 3 3 6 27. Gastritis, Enteritis and Diarrhoea 2 — 2 28. Nephritis and Nephrosis 2 3 5 29. Hyperplasia of Prostate 6 — 6 30. Pregnancy. Childbirth. Abortion — — — 31. Congenital Malformations — 1 1 32. Other Diseases 18 27 45 33. Motor Vehicle Accidents 2 2 4 34. All Other Accidents 7 9 16 35. Suicide 3 6 9 36. Homicide and Operations of War 1 — 1 Totals, 1958 314 382 696 Totals, 1957 316 344 660 9 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. Per 1,000 Live Births 1958 748 12.2 13 17.38 0.21 7 9.36 7 9.36 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Year Total Births Registered Deaths Rates per 1,000 Births (Live and Still) Puerperal Sepsis Other Maternal Causes Total Puerperal Sepsis Other Maternal Causes Total 1958 761 - - - - - - 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 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1958 1957 1956 1955 1954 Maternal Mortality - 1.37 - 1.44 1.42 Stillbirths 17.38 23.8 14.8 15.80 21.3 Neo-Natal Mortality 9.36 16.8 14.8 12.90 9.9 During 1958 there were no deaths classified as being due to pregnancy, childbearing or associated therewith. 10 16.6 Comparative Statistics of Births, Mortality, etc., 1939 to 1958 Year Population Live Births Still Births Deaths Infant Death Maternal s Deaths No: Rate* No: Rate * No: Rate* No: †Rate No: §Rate 1958 61220 748 12.2 13 17.4 696 10.8 7 8.9 _ _ 1957 60970 713 11.7 17 23.3 660 10.8 19 26.6 l 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 l 1.42 1954 61550 703 11.3 15 20.9 610 9.9 10 14.2 l 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 l 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 *Per 1,000 Population. †Per 1,000 Total Births. §Per 1,000 Live Births. 11 SECTION B GENERAL PROVISION OF HEALTH SERVICES 1. Public Health Officers of the Authority See page two. 2. Laboratory Facilities 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, 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 Boad Sunday School. South Woodford, E.18 Wednesday, 2.30—4 p.m. Cromwell Hall, Nightingale Lane, Wanstead, E.11 Thursday, 2.30—4 p.m. Holy Trinity Church Hall, Hermon Hill, South Woodford, E.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. 12 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) Mondays 9.30—11 a.m.—X-ray 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) Action became necessary to secure the removal of one person in need of care and attention to suitable premises during 1958. 9. Funeral Arrangements In two cases was the Local Authority required to make arrangements for the burial of persons during the year 1958. SECTION C SANITARY CIRCUMSTANCES OF THE AREA Refuse and Salvage (a) Refuse Collection and disposal. The system inaugurated in 1957 whereby household refuse is transported to a privately controlled tip at South Ockenden continued quite satisfactorily. In connection with refuse collection from multi-storey flats it was decided by the appropriate Committee, that as far as Council flat development was concerned every effort should be made to ensure that the collection of refuse from communal bins should be operated and arrangements made for the installation of suitable facilities for this purpose. It is intended to request all private developers to provide similar facilities in their development proposals so that this method of dealing with refuse in new flat development may be effected. 13 (b) Salvage Collection and sale of salvage has continued, but owing to the uncertainty of the market at the present time scrap metal was not collected from October onwards. Sewerage No major sewerage works were undertaken or commenced during the year but minor improvements continued, including the provision of further manholes where such facilities are lacking. Sewage Works (a) Eastern. Tenders were obtained for Stage I of the improvement scheme mentioned in last years report and work commenced at the beginning of September. Although some delay occurred due to bad weather in the winter months, it is anticipated that this stage of the scheme will be completed in the early summer of 1959. It will then be necessary for a period to elapse in order that the results of the work may be fully assessed before proceeding with the possible second stage of the improvement works, which may include microstraining plant, in order that the effluent passing to the river may be improved to the standard required by the River Board. (b) Southern. Preparation of the detailed scheme for Stage I of the reconstruction and improvement of these works, was nearly completed by the end of 1958 and it was anticipated that the actual work would start in the ensuing spring. Originally, this first stage mainly included storm over-flows, detritus removal, screens, recorder, 2 clariflocculators, 3 humus tanks and all necessary pipe-lines and ancillary works. However in view of the Ministry of Housing and Local Government Circular requesting Local Authorities to bring forward Capital Works for early execution where possible, the very critical prevailing sludge drying facilities at the works and the importance attached to adequate final treatment in humus tanks, it was decided to bring forward from the second stage part of the new sludge drying beds and the fourth humus tank. These additional items in the first stage were incorporated in the detailed scheme being prepared and it is anticipated that tenders will be obtained early in financial year 1959/60. 14 SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows: Housing Act, 1957 In reporting upon the work performed by the Public Health Department during the year 1958, attention must be drawn to the continued activity in the field of housing. It will be noted that a number of individual houses were reported upon and dealt with by the Public Health Committee and two areas were represented by the Medical Officer of Health as Clearance areas. Further, reports were made upon the condition of a number of basement dwellings and it will be seen from the following details that these dwellings were dealt with in accordance with the provisions of the Housing Act. Referring to the Report of the Medical Officer of Health, 1957, Nos. 2, 4, and 6 Albert Road were considered further by the Committee and the owners, the latter finally coming to the conclusion that the cost of putting the houses into good habitable condition was more than they were prepared to spend. They eventually agreed to a Demolition Order being made against each house, which was done in accordance with the Act. Reference was made to properties in Belgrave Terrace being removed from the Council's list of sub-standard dwellings. It can now be reported that two of the houses were converted into one and reconditioned by the owner/occupier of one who purchased the adjoining property in order to achieve this improvement. Three houses, 8, Woodbine Place. 45, Horn Lane and 55, Globe Road were reported to the Council as being unfit to repair at reasonable expense. These properties were considered in conjunction with their neighbours, being in all cases semi-detached pairs. Subsequently Demolition Orders were made on 8 and 9. Woodbine Place, 43 and 45, Horn Lane and 55 and 57 Globe Road. The owners gave much thought to the repair of 43 Horn Lane and 57 Globe Road, but finally informed the Council that the necessary work to render them fit for habitation would be too costly. The future of Nos. 15, Victoria Road and 7 and 9 Voluntary Place was carefully considered bv the owners who submitted schedules of repairs and improvements but because of the high cost involved in executing the necessary works Demolition Orders were enforced in all three cases. Below is given a list of properties dealt with during the year together with brief remarks where appropriate. 17 Victoria Road. The owner/occupier made complaint of the condition of the house and when inspected it was found to be suitable 15 for action under Section 16. He appeared before the Public Health Committee after being served with a Time and Place Notice and there agreed to the house being demolished. The agents for the mortgagors preferred to repair the house and at the end of the year submitted a specification of the repairs to the Council for consideration. 61 and 63 Wynndale Road. A Demolition Order was made on No. 63 and an undertaking accepted in connection with No. 61, the work at the latter to be executed after the demolition of No. 63. Demolition Orders were also made against the following:— 14, Horn Lane, Woodford Green. 19, George Lane, E.18. 62 and 62a, Prospect Road, Woodford Green. 2, Albert Road, E.18. 4 Albert Road, E.18. 6, Albert Road, E.18. The two Clearance Areas represented to the Council by the Medical Officer of Health are 305—343 (odd Numbers only) Snakes Lane, Woodford Green and 1—6, (consecutive) East Row, New Wanstead; the former being contained in three terraces and the latter in one. Referring to basement dwellings the following were dealt with under the Housing Act, Closing Orders being made against them in accordance with the provisions of the Act: 3, 5 and 7, Grove Hill, E.18. 41a, 42a and 43a, Grove Road, E.18. 3a, 11a, 18, 29, 31, 36, 39 and 45 Hermon Hill, E.ll. 2a, Clarendon Road, E.18. 3a and 15a, Grosvenor Road, E.ll. 19, 21, 29 and 35, Marlborough Road, E.18. 26, Chigwell Road, E.18. Insofar as No. 29 Hermon Hill was concerned the owner undertook to render and did render the basement again fit for habitation. 150, Snakes Lane was the subject of a Time and Place Notice over which much discussion took place with the result that the agents undertook to put the house in a condition fit for continued occupation. Rent Act, 1957. As can be seen from the following table, the Public Health Department received a considerable number of applications for certificates of disrepair during the year under review. Whilst it is not possible to indicate the effect of the Act on the maintenance of property it is surprising to note that of the 26 certificates of disrepair issued only seven applications for cancellation were made following tenants objections. The table below shows the overall situation at the end of the year, with last year's (1957) figures in brackets alongside. 16 Part I—Applications for Certificates of Disrepair. 1. Number of applications for Certificates 49 (46) 2. Number of decisions not to issue Certificates Nil (1) 3. Number of decisions to issue Certificates (Form 1) 46 (45) (a) in respect of some but not all defects 37 (36) (b) in respect of all defects 9 ( 9) 4. Number of undertakings given by landlord (Form K) 30 (24j 5. Number of undertakings refused by local authority Nil (Nil) 6. Number of Certificates issued (Form L) 26 (11) Part II—Applications for cancellation of Certificates 7. Applications by landlords to local authority for cancellation of Certificates (Form M) 17 ( 2) 8. Objections by tenants to cancellation of Certificates 10 (Nil) 9. Decisions by local authority to cancel in spite of tenants' objections 3 ( 3) 10. Certificates cancelled by local authority 12 ( 2) Overcrowding Overcrowding in its legal sense is an offence under the Housing Act, in which is set out details constituting overcrowding. During the year one case was reported to the Public Health Committee and one case abated. Meat Inspection. The arrangement made with the Port of London Authority, reported last year, continued and a large number of frozen carcases were inspected at a local wholesale meat depot in the early part of the year. The carcases had been on board ship and damaged in transit. Meat and canned foods are supplied to a large number of retailers on this side of London. It should be possible to ensure by regular inspections and with the co-operation of the firm concerned that all home-killed meat sold has been inspected at the proper place, i.e., the slaughterhouse, before arrival at the depot. The depot is a convenient place to check that retailers' vans which are used to collect the meat comply with the Food Hygiene Regulations. 17 Work in default. It was not necessary for the local authority to do any work because of default on the part of the owners of properties, in connection with the provisions of various Acts. Other Work Replacement of covers to manholes on public sewers were made in four cases. Work executed by local authority. The Public Health Act gives under its various provisions, power to local authorities to serve notices in regard to defective drainage, etc. Notices were served in connection with three drainage systems involving nine dwellings and three shops with living accommodation attached. Tenders were obtained in all these cases, the work being carried out by contractors engaged by the local authority. Costs have or will be recovered in all cases. CLEAN AIR The Measurement of smoke and sulphur dioxide by a daily volumetric apparatus at the Municipal Offices was continued during the year under review. Towards the end of the year a second and similar apparatus was installed in a block of flats at Oak Hall Court, Eastern Avenue, Wanstead. A reflectometer was purchased during the year to assess smoke stains with greater accuracy. Details of the average monthly readings are given below:— Woodford Municipal Offices 1958 Smoke (millegrams per 100 cub. metres) Sulphur Dioxide (Parts per 100 million) Average Highest Average Highest January 51 108 10 32 February 25 56 8 20 March 13 25 6 19 April 11 19 8 15 May 5 11 5 8 June 5 8 3 6 July Apparatus out of action. August September 5 10 3 6 October 11 31 6 14 November 30 108 10.2 31.6 December 34 78 11.6 39.6 18 Wanstead—Oak Hall Court 1958 November 35 131 10.8 33.4 December 39 99 12.9 38 Average yearly figures for Woodford from 1955 to 1958 are given below: Smoke 1955 1956 1957 1958 Average for year 19 18 17 19 Average for winter months 32 29 31 27.3 Average for summer months 6 7 5 6.5 Highest daily recording 153 112 205 108 Sulphur Dioxide Average for year 5.5 6 6 7 Average for winter months 8 9 9.3 8.6 Average for summer months 3 3 2.1 4.7 Highest daily recording 38 40 69 39.6 Attention is again drawn to the marked difference between the winter and summer figures of pollution, confirming that domestic smoke is the main pollutant within the Borough. No further action was authorised in connection with the proposed smoke control area in the Snaresbrook Ward, the Committee taking into account the apparent shortage of solid smokeless fuel other than coke. The possibility of the Borough being included in a black area may come as a shock to those who regard the Borough as a residential district of almost semi-rural character, although anyone who has studied the recorded measurements will have been aware for some considerable time that the 'country air' of Woodford is well and truly polluted. It is to be hoped that every effort will now be made to press forward as rapidly as possible towards making the whole Borough a smoke control area and thus ensure a substantial improvement in the living conditions of all residents. 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 1958 was 286, as against 420 in 1957 and 430 in 1956. 19 The following table gives details of surface treatments:— Number of inspections made by Public Health Inspectors 130 Complaints received 286 Revisits to premises 228 Visits to adjacent premises 58 Total premises visited 562 Number of baiting points 2394 Two sewer treatments were carried out during the year. The first treatment using Warfarin with preservative (para-nitrophenol) was affected to a certain extent by very heavy rain. It was not possible to bait all manholes and some difficulty was experienced in deciding whether the bait had been washed away or consumed by the rats. 1318 manholes were baited, 508 showing complete prebait takes and 103 partial takes. The second treatment using bread rusk as bait base and zinc phosphide as poison was restricted mainly to those manholes which had shown prebait taken on the earlier treatment. Of the 615 manholes baited, 314 showed complete prebait takes and 43 partial takes. From the amount of poison consumed it is obvious that a heavy kill was made on both treatments. There can be little doubt that sewer treatments whilst not wiping out the sewer population help to keep it within reasonable limits and to reduce the number of surface infestations. Essex County Council Act, 1933, Section 109. During 1958 five further applications were made by caravan owners requesting permission to keep caravans on the site in the Woodford area of the Borough referred to in the Annual Report for 1957. Permission was granted in all these cases. Pet Animals Act, 1951 The number of persons registered as keepers of pet shops remained at four. All were maintained in a satisfactory condition. Rag Flock and other Filling Materials Act, 1951. No additional registrations were made, the number of premises registered remaining at one. 20 Petroleum (Consolidation) Act, 1928. 59 licences were issued during the year, of which 55 were renewal of existing licences. Three new licences were granted with a total storage capacity of 2,000 gallons. One garage installed further tanks to increase its capacity by 2,500 gallons. One engineering firm ceased operations during the year and its tanks, capable of holding 1,500 gallons were sealed off. 239 visits were made during the year. In one case a defective (leaking) tank was reported to the Department whose officer advised and supervised filling with suitable material. The Town Clerk reported to the Public Health Committee the contents of a Home Office Circular 91/1958 regarding anticipated hardship in connection with the Home Office codes of practice when in 1960 the local authority could call for the implementation of recommendations dealing with the flameproofing of apparatus on petrol pumps. Game Licences. Six licences to deal in game were issued during 1958; 3 previous licence holders not renewing. Shops Act, 1950. 53 visits were made during the year. In one case of a hairdressing salon, the position was resolved when, following a complaint about young persons working longer hours than permitted by the Act, it was established that the girls were trainees receiving instruction during these extra hours when the salon had closed. Essex County Council Act, 1933. Massage and Special Treatment Establishments. The Essex County Council again requested the Public Health Inspectors to visit and report upon the above, prior to licensing. All the 12 establishments were satisfactory. 15 visits were paid. 21 Heating Appliances (Fireguards) Act, 1952. Constant watch is maintained on premises retailing heating appliances, especially those where second-hand goods are on sale. Although possibly made prior to the coming into force of the Act, when resold the heaters must comply with the Act's requirements. The majority of manufacturers of heating appliances are complying with the Act in detail, often improving the appearance and efficiency of the heaters in so doing. 12 visits were made. Swimming Bath Water. The Borough does not possess a municipal swimming pool, although there exist within its boundaries four pools, 3 of which belong to schools and one to a well-known children's home. Five samples of swimming pool water were obtained during the year, the bacteriologist reporting that in three cases the water was suitable for bathing purposes. In the fourth he considered that a higher standard of bacterial purity should be aimed at together with an increase in the residuum of chlorine. Because of these observations the headmaster who was communicated with had the matter attended to. A further sample of water was obtained which indicated that the steps taken by the headmaster had improved the standard, the bacteriologist stating that it was of a very satisfactory organic quality for a swimming bath and that it was of a high standard of bacterial purity. The result indicated a water suitable for bathing purposes. Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 50 Visits in connection with contacts, disinfection, etc. 12 Enquiries in connection with food poisoning 52 Verminous Premises 39 22 General Environmental Public Health Drains and Sewers inspected Drain tests applied 659 Stables and manure pit inspected 18 Public Conveniences and Urinals 18 Factories (mechanical) 153 Factories (non-mechanical) 4 Hairdressers' Premises 23 Schools and School Canteens 48 Ditches, Streams and Ponds 7 Open Spaces and Playing Fields 29 Petrol Inspections 264 Shops Act Inspections 53 Outworkers' premises 38 Massage Establishments 15 Pet Animals Act 6 Fairgrounds 1 Swimming Baths 4 Smoke Observations 2 Workplaces 2 Rent Act 259 Tents, Vans and Sheds—Gypsies 51 Heating Appliances (Fireguards) Act and Regulations 12 Piggeries 9 Smoke Control Area (Proposed) 38 Miscellaneous 179 23 SECTION D. HOUSING No. of dwellings erected during 1957: Council 131 Private Enterprise 127 1. Inspection of Dwelling Houses during the year:— (1) (i) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1038 (b) Number of inspections made for the purpose 1869 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 — (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 114 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 77 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9 and 10 of the Housing Act, 1957: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 7 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 5 (b) By Local Authority in default of owners — 24 (b) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 3 (b) By Local Authority in default of owners 8 (c) Proceedings under Section 16 and 18 of the Housing Act, 1957: — (1) Number of dwelling-houses in respect of which Demolition Orders were made 15 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 5 25 FACTORIES ACT, 1937 1. Inspections for the purposes of provisions as to health (including Inspections made by Public Health Inspectors). Premises (1) Number on Register Number of Occupiers prosecuted Inspections Written notices (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 37 4 - - (ii) Factories not included in (i) to which Section 7 applies 167 153 5 - (iii) Other Premises under the Act (excluding out-workers' premises) - - - - TOTAL 204 157 5 - 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 4 3 2 — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 1 1 1 — Ineffective drainage of floors — — — — Sanitary conveniences: 1 Insufficient — — — — 2 Unsuitable or defective 2 2 — — 3 Not separate for sexes — — — — Other offences — — — — TOTAL 7 6 3 — 26 3. Outwork Number of out-workers in August list required by Section 110(l)(c) Boxes 27 27 Factories Act 1937, Section 34—Means of Escape in Case of Fire Five certificates as required by the Factories Act, 1937 were issued a portion of this number being in the nature of amendments to previous certificates. 27 SECTION E. FOOD AND DRUGS Food and Drugs Act, 1955 The following cases were reported to the Public Health Committee with the results as indicated:— Bread: 1. Dark foreign matter therein Warning letter sent. 2. Foreign matter therein Fine £5. Costs £5/5/-. 3. Cigarette end therein Warning letter sent. Oranges: Contaminated with thiourea Referred to Ministry of ture, Fisheries and Food. Milk Bottle: Dirty Warning letter to dairy. Contraventions of Food Hygiene Regulations: Cafe Fines totalling £12. Costs £2. Fish Fryer Fines totalling £8. Street Vendor Stallholder fined total of £20. with £3/3/-. costs Case against assistant pending. A packet of sherbet brought to the office in the nature of a complaint by a member of the public caused the Public Analyst to report that it contained foreign matter in the form of a yellowish-brown tablet and two portions of similar tablets. His investigation showed that the tablet contained substances similar to those in tablets recommended for the treatment of tuberculosis. The complainant when seen agreed that tablets similar to those described were being taken by a member of the household and had by some means or other become mixed with the sherbet. He then withdrew his complaint. This case shows once again how essential it is to take the utmost care in the storage of drugs and medicine. 28 The list of food sampled is given below:— Bacon 1 "Mikky" Beef—Minced 2 (chocolate milk drink) 1 Beef—Shredded 1 Milk 9 Bread 1 Mincemeat . 1 Butter 10 Mince Pies 1 Butter Brazils 1 Old Fashioned Winter Cheese—Cheddar 2 Candy 1 "Cheez-Wiz" 1 Orange Squash 1 "Citrose" 1 Oranges 2 Cochineal 2 Raspberry Flavouring 1 Cockles 1 Rice 3 Coffee 2 Salmon and Shrimp Paste 1 Currants 1 Sherbet 1 Custard Powder 1 Steak and Kidney Pudding 1 Dressed Crab 1 Sultanas 1 Dried Mint 1 Table Jelly 1 Fish Cakes 2 Tea 2 Flour—Plain 2 Toasted Tea Cakes 1 Flour—Self Raising 1 Tongue 1 Fruit Cake 1 Veal and Ham Pie 1 Frying Oil 1 Brandy 1 Ground Almonds 2 Cherry Brandy 1 Ground Ginger 1 Gin 2 Ground Nutmegs 3 Rum 1 Jam—Blackcurrant 1 Sherry 1 Jam—Plum 1 Whisky 2 Jam—Raspberry 1 Aspirin 1 Lard 1 Blue Master Winter Tablets 1 Lemon Curd 1 Boric Ointment 1 Lemon Flavouring 1 Camphorated Oil 1 Lemon, Honey and Gees Linctus 1 Glycerine Sweets 1 Glycerine 1 Margarine 3 Olive Oil 1 Meat Patties 1 Saccharin Tablets 1 Total 99 29 The following is a list of foods surrendered in 1958 because of unsound conditions:— Fish, Fresh: Meat, Fresh (cont.): 9 stone Beef, Cow, Imported 90 lbs. Pork 19 lbs. Fruit and Vegetables, Tinned: Lamb 219 lbs. 198 tins Liver, Calves 100 lbs. Liver, Ox 18,½, lbs. Meat, Tinned: Liver, Lambs 12 lbs. Kidneys, Ox 762 lbs. Corned Beef 112 lbs. Kidneys, Pig 135 lbs. Luncheon Meat 144 lbs. Ox Tails (Imported) 357 lbs. Ox Tongues 38 lbs. Pigs Melt 28 lbs. Ham 111 lbs. Sweetbreads 16 lbs. Chicken 38 lbs. Hog Meat 32 lbs. Jellied Veal 6 lbs. Meat, Fresh: Miscellaneous: Beef—English 514 lbs. Milk 1 tin Beef—Argentine 134 lbs. Soup 3 tins Beef—Australian 3,968 lbs. Jam 1 tin Beef—Salt 4 lbs. Cheeses 12 boxes 30 Manufacture, Storage and Sale of Ice Cream. 100 registrations were in force at the beginning of the year, and a further two were added during the year. The proprietor of a boathouse which is situated adjacent to lakes in a public park applied for the registration of the premises for the storage and sale of ice cream. Conditions at the premises made it impossible to recommend the registration to the Public Health Committee and a notice was served upon the proprietor indicating the time and place at which the Public Health Committee proposed to take the matter into consideration and informing him that he may attend before them to show cause why the authority should not, for reasons specified in the notice refuse the application. The applicant, appearing before the Committee, stated the work he was doing and proposed doing in order to meet our requirements. Although he was informed that his premises would be registered for the sale of wrapped ice cream upon the completion of the agreed works he never pressed his request for the registration. Ice Cream (Bacteriological Examination) Twenty-six samples of ice cream and one of water ice were obtained and the results were as follows:— Ice Cream: Ministry of Health's Provisional Grading. Taken Grade I Grade II Grade III Grade IV Nos. 26 22 1 1 2 per cent 100 84.7 3.8 3.8 7.7 Water Ice: The Bacteriologist reported:— "This sample is of satisfactory bacterial purity." 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. 31 The food premises in the District may be classified as follows:— Confectioners (cakes, pastries) 28 * Grocers 75 Greengrocers 35 Butchers 34 Confectioners and Tobacconists 70 Restaurants and cafes 35 Fishmongers 15 Dairies and Milkshops 9 Miscellaneous 31 of these 102 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 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 18 Sterilised 32 Tuberculin Tested 15 Supplementary licences: Pasteurised 8 Sterilised 9 Tuberculin Tested 8 Inspection of Food Premises Meat Shops 204 Bakehouses 59 Fishmongers 35 Grocers 146 Restaurants and Cafes 73 Dairies and Milk Shops 26 Greengrocers 54 Ice Cream Premises 43 Street Vendors 19 Food and Drugs Sampling 84 Ice Cream Sampling 35 Milk Sampling 11 Other Premises 68 Food Hygiene Regulations 487 TOTAL 1344 32 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 11 — — — — Cerebral-Spinal Fever — — — — — Acute Poliomyelitis 1 1 100 — — Acute Polioencephalitis — — — — — Encephalitis Lethargica — — — — — Dysentery 8 1 12.5 — — Puerperal Pyrexia 32 32* 100 — — Paratyphoid Fever — — — — — Enteric or Typhoid Fever — — — — — Meningococcal Infection 2 1 50 — — Erysipelas 2 — — — — Malaria (contracted abroad) — — — — — Measles 335 1 0.3 — — Whooping Cough 12 — — — — Opthalmia Neonatorum — — — — — Food Poisoning 35 3 8.7 — — *These cases all occurred in hospital 33 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. 55 & O yrs. Scarlet Fever 30 — 5 20 2 1 2 — — Pneumonia 11 — 1 1 1 1 3 4 — Typhoid Fever — — — — — — — — — Dysentery 8 1 1 1 2 — 1 2 — Acute Poliomyelitis 1 — — 1 — — — — — Puerperal Pyrexia 32 — — — — 16 16 — Erysipelas 2 — — — — — — 2 — Measles 335 3 100 226 5 1 — — — Whooping Cough 12 — 6 6 — — — — — Malaria (contracted abroad) — — — — — — — — — Meningococcal Infection 2 — 1 — 1 — — — — Food Poisoning 35 — 7 6 3 10 4 5 — TOTALS 468 4 121 261 14 29 26 13 — Poliomyelitis During 1958 one confirmed case of poliomyelitis was notified. The accompanying table shows the cases notified in previous years classified under age groups. 34 35 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1938—1958 Year Population No. Notified Notification Rate Age Group Deaths Death Rate Under 1 1-5 5-10 10-15 15-25 25-45 Over 45 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 — — — — — — — — 1957 60970 5 0.079 1 — — 1 2 1 — — — 1958 61220 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 1958. Age Periods New Cases Deaths Pulmonary N on-Pulmonary Pulmonary on-Pulmonary M F M F M F M F Under 1 year — — — — — — — — 1-5 years — — — — — — — — 5-10 years 1 — — 1 — — — — 10-15 years — — — — — — — — 15-20 years — 1 — — — — — — 20-25 years 1 1 — — — — — — 25-35 years 3 4 — — — — — — 35-45 years 2 — — — 1 — — — 45-55 years 7 2 — 1 — 1 — — 55-65 years 5 1 — — 1 — — — 65 and over 4 — — — — — — — TOTALS 23 9 — 2 2 1 — — 32 2 3 — 34 3 The 3 deaths represent a death rate of 0.05 per 1,000 of the population. 36 37 A comparative summary over the past 20 years for the Borough is set out in the following table. Year Notifications Total Notifi¬- Total Notification Rate Deaths Total Death Rate Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Total Deaths No. Rate No. Rate No. Rate No. Rate 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 0.17 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 1957 26 0.42 1 0.01 27 0.43 2 0.03 1 0.01 3 0.01 1958 32 0.52 2 0.03 34 0.55 3 0.05 — — 3 0.05 Rates per 1,000 population. The register shows that at the end of the year:— 32(26) Pulmonary and 2(1) non-Pulmonary cases were notified during the year. 34 (33) cases were transferred into the District. 2 (1) cases were restored to the register. 3 (2) Pulmonary and No (1) non-Pulmonary died during the year. 32(14) Other cases were removed from the register. 556(521) Cases remained on the register at the close of the year. The figures in brackets are the comparable figures for 1957. SECTION G. PART III SERVICES FOREST HEALTH AREA SUB-COMMITTEE Chairman: County Councillor Mrs. E. F. M. Hollis Vice-Chairman: Councillor W. J. Bowstead Membership: Chingford Borough Council Councillor A. T. H. Austin Councillor W. J. Bowstead Councillor Mrs. I. Titley Wanstead and Woodford Councillor Mrs. S. V. F. Ashton Borough Council M.B., B.S., M.R.C.S., L.R.C.P. Councillor B. B. Dyer Councillor Mrs. I. E. C. Haselden Councillor S. J. Relph B.Pharm. (Hons.), F.P.S. F.L.S., F.R.S.H. Chigwell Urban District Council Councillor J. Fisher, B.A. Councillor Mrs. V. L. M. Martin Councillor S. J. Palfreman. Councillor E. G. Perry Epping U.D.C. Councillor A. J. Hyde Harlow U.D.C. Councillor W. Jarvis Councillor Mrs. E. Druce Waltham Holy Cross U.D.C. Councillor Mrs. J. M. Davies Epping & Ongar R.D.C. Councillor Mrs. H. E. Howard Hospital Management Committee County Councillor Mrs. S. M. Bovill Executive Council for Essex J. W. Randall Nation, Esq. Local Medical Committee for Dr. H. Grylls Essex Essex County Council Alderman Mrs. M. Ball Alderman A. E. Brown Councillor A. G. Cole Councillor Mrs. L. Fallaise Councillor Miss D. D. Forster Councillor Mrs. E. F. M. Hollis Councillor F. A. Wortley British Red Cross Society Mrs. Vernon Walker Tuberculosis Care Association Mrs. A. C. Murray Mrs. L. M. Scott Women's Voluntary Services Mrs. M. E. Clinch 38 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. In my report for 1957 I referred to the retirement of Dr. E. L. Ewan who had been employed as School Medical Officer in the Borough of Wanstead and Woodford for over 29 years. Dr. Ewan was replaced by Dr. J. W. Kirkbride who subsequently resigned to take up an appointment abroad and who has now been succeeded by Dr. T. T. Jones. Dr. Jones has since been appointed as Deputy Medical Officer of Health to act in my absence from the Borough. CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) There were 645 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 These classes are becoming more and more popular with expectant mothers and three weekly sessions are now held at 118 Hermon Hill. Normally 6—8 women constitute a class, these classes forming a means whereby the Health Visitor can give short talks on preparation 39 for the confinement and on various aspects of personal hygiene for mother and infant and by keeping the class numerically small there is ample opportunity for individual queries and difficulties to receive attention. VITAL STATISTICS Wanstead and Woodford England and Wales Live birth rate per 1,000 population 12.2 15.1 Still birth rate per 1,000 population 0.21 0.36 Infant Mortality Rate per 1,000 Live Births 9.36 22.6 NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1958 7 infants died in the first four weeks of life, a rate of 9.36. CARE OF PREMATURE INFANTS During 1958, 35 premature infants were born to residents in the Borough, 5 of these births taking place at home and 30 in hospital or nursing home. 4 of the 5 born at home were alive at the end of one month; 27 of the 30 born in hospital or private nursing home survived. CHILD WELFARE CENTRES Attendance at the Child Welfare Clinics has increased slightly during 1958, no doubt in large measure due to the additional clinic which was commenced at All Saints Church Hall, Woodford Wells during 1957 for the benefit of the population in the northern part of the Area. 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, Aldersbrook 1,611 Ashton Playing Fields. Woodford Bridge 2,522 St. Barnabas' Church Hall, Snakes Lane 3,640 Fullers Road, South Woodford 2,456 Cromwell Hall. Nightingale Lane. Wanstead 2,285 Holy Trinitv, Hermon Hill, South Woodford 3,490 All Saints Church Hall Woodford Wells 1,211 17,215 40 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 undertakng this service. NURSERY AND CHILD MINDERS REGULATIONS 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 2 28 Child Minders 2 7 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 147 attendances during the year. MIDWIFERY (Section 23) There were three domiciliary midwives practising in the Borough during 1958, supervision being carried out by Miss A. Williams, NonMedical Supervisor of Midwives who is on the staff of the Area Medical Officer. No. of confinements attended as midwife 132 No. of confinements attended as maternity nurse i.e. doctor also present 56 188 41 GAS AND AIR ANALGESIA A total of 168 patients in the district received gas and air analgesia. TRAINING OF PUPIL MIDWIVES The one District Midwife in Wanstead and Woodford who is approved as a Midwifery Teacher continued to take pupils for their Part II Midwifery Training during 1958, and this training will be continued during 1959. HEALTH VISITING (Secton 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. One student Health Visitor received practical training in Tuberculosis Health Visiting and Chest Clinic experience at Harts Hospital. Talks to Youth Clubs, Young Wives Clubs and Townswomen's Guild have been given when requested. The three Relaxation and Mothercraft Classes for ante-natal mothers have maintained a regular attendance at each session. 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 1958:— Expectant Mothers (first visits) 144 Expectant Mothers (re-visits) 114 Infants under one year (first visits) 637 Infants under one year (re-visits) 1,445 Infants 1 to 5 years (first visits) 57 Infants 1 to 5 years (re-visits) 1,912 Stillbirth enquiries 11 Infant death 10 Tuberculosis Patients 983 Aged and infirm 161 Day Nursery Applications 6 School Children '363 Other visits 379 Ineffective Calls 773 7,025 42 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:— Five Whole-time nursing sisters and one part-time have been employed on general nursing duties in the Rorough of Wanstead and Woodford during 1958, together with two male nurses and the addition of the part-time services of a third male nurse. The staff, therefore, has remained at full establishment during the year, a good standard of nursing being maintained, a high percentage of which is concerned with the elderly and chronic sick. Miss A. C. Mills who had worked in the Rorough as a nursing sister since 1946 was compelled to retire on grounds of ill-health. The following statistics show a comparison of work undertaken by the District Nurses during the years 1957 and 1958: 1958 1957 Number of new cases 596 659 Number of visits 20,443 24,072 Last Offices performed 25 30 Advisory or Casual Visits 308 531 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 the 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-6th month. 43 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 720 5 to 15 years of age 44 764 The number of children who received a secondary or re-inforcing injection was 357. The number of persons vaccinated or re-vaccinated during the year 1958 was: Under 1 1-4 yrs. 5-14 yrs. 15 or Total over Primary 446 64 60 73 643 Re-Vaccination Nil 6 35 168 209 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, 1958. Year of Birth Number Year of Birth Number 1958 157 1950 646 1957 565 1949 664 1956 539 1948 928 1955 876 1947 931 1954 301 1946 793 1953 656 1945 864 1952 552 1944 589 1951 505 1943 890 10,4.56 Number of children immunised against Whooping Cough during the year 1958 was: Under 6 months 6-12 months 1 year 2 years 3 years 4 years 5 years & over 25 246 32 4 8 7 2 In my report for 1957 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 bom in the years 1947 to 1954 to register them if they had not hitherto accepted the offer of vaccination. 44 In November of the same year it was announced that the scheme for vaccination could be further extended to include children born in the years 1943 to 1946 inclusive. A further extension has been made to include young persons born in the years 1933 to 1942. This means that in addition to the normal priority groups of expectant mothers and certain special groups of individuals particularly exposed to the risk of infection, such as general medical practitioners, vaccination is available to all persons born in the years 1933 to 1958 inclusive. It is interesting to note that when the last extension of the eligible age groups was made a particularly poor acceptance rate was attained until such time as the death of a noted sportsman occurred, when a heavy increase in applications was received. During 1958 5,562 persons received their primary course of two injections and 294 received a third injection. 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-two new cases of tuberculosis were notified during the year as compared with thirty in 1957. One hundred and eighty-one new contacts and six hundred and forty-seven old contacts were examined. B.C.G. Vaccination was given to sixty-four children. The value of a contact examination, tedious and unspectacular as it is, is shown in the following case:- a girl of sixteen was found to have a tuberculous pleural effusion. Investigation of the family contacts was carried out, and as a result the father was proved to be suffering from tuberculosis. Four thousand two hundred and eighty-one X-ray examinations were made as compared with four thousand two hundred and sixty-five in the previous year. The close liaison with the Medical Officer of Health and his Department has been referred to in a previous report. This co-operation ensures that tuberculous patients have the maximum amount of social help that can be provided, which is so necessary to the maintenance of their health and morale. Although I am glad to report that tuberculosis is a declining disease, it still presents many problems necessitating continual vigilance and there is certainly no room for a complacent attitude. The reduction and eventual elimination of all sources of infection requires efficient treatment, often going on as long as two years and followed up by long term supervision of the tuberculous patient, his family and their home environment. 45 The ever widening scope of the work of the Chest Clinic has already been commented upon. There is an ever increasing number of patients being referred for investigation of heart disease, as well as chronic respiratory disorders. Also, more and more children are being investigated, chiefly under the label "Catarrhal Children". Apart from the immediate need to diagnose the children's complaints and improve their health so that schooling is not interrupted, the object of efficient treatment is to prevent the chest condition from becoming chronic and persisting into adult life, thereby causing much invalidism and loss of working ability." Miss R. Carrington, Secretary of the Leyton Wanstead and Woodford Tuberculosis After-Care Association, reports as follows: "During 1958 the Association spent £1,550 on assistance to 108 necessitous cases. This is £186 more than the previous year. An analysis of the help given is shown below: Particulars No. of Patients Amount spent £ Grocery vouchers 72 1226 Fares 15 164 Clothing, furniture, etc. 2 8 Holidays 4 19 Occupational Therapy 4 12 Hire Purchase payments 3 14 Furniture storage 1 17 Wireless licences and repairs 2 8 Financial assistance 5 26 In addition to the above Christmas Grants were given to 96 56 During the year the income of the Association was £1,440 and our thanks are recorded to the Essex County Council for their continued financial support. Grants valued £644 were received from the County Council, and the remaining £796 was raised by donations, collecting boxes and the Christmas Seal Sale. 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 11 cases from the Borough have been sent away. The length of convalescence was two weeks in each case. 46 DOMESTIC HELP SERVICE The Domestic Help Organiser reports as follows:— The call for the provision of Home Helps continues to increase and the recruiting of suitable Helps presents a difficult problem. The service has expanded in all sections particularly in the provision of help for the Aged Chronic Sick. The Aged Chronic Sick form 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. Three new requests for help have been received from tuberculous households, and those already receiving help, are visited frequently and assistance given in accordance with the recommendation of the Chest Physician. The provision of Helps to homes deprived of one parent continues to increase. With this help, the families have been able to remain together, rather than the children having to be sent to foster homes. This is proving a most valuable service but the shortage of suitable Home Helps is most keenly felt in this section of the service. The W.V.S. "Meals on Wheels" service continues, rendering invaluable assistance, providing meals on Wednesdays and Fridays. In general, the service provided is similar to that of previous years, all cases being visited as frequently as possible. A total of 1165 visits has been made in the year. Liaison with the Child Care Officers. District Nurses, Health Visitors and Hospital Almoners is being maintained. 47 SCHOOL HEALTH SERVICES 1958 WANSTEAD AND WOODFORD There are 18 schools in the Borough—13 Primary, 4 Secondary Modern and one Secondary Grammar—which are maintained by the Local Education Authority. The number of pupils in attendance remains about the same, i.e. approximately 7,000. 1. SCHOOL MEDICAL INSPECTIONS Early in the year approval was given by the Forest Divisional Executive to vary the arrangement for the routine medical inspection of pupils attending schools in this Borough and other districts. Under the new arrangements, which commenced in the Autumn term pupils now have their second routine medical inspection after their admission to the Secondary School instead of during the last year in the Primary School and this seems to be working very well. The obvious advantage of this arrangement is that the Head Teacher and Class Teachers are able to consult the medical officers about children who will in the majority of cases, remain in the school for the remainder of their school life. The other routine inspections are carried out in the infant school at the age of 5 years and in the Secondary Schools at 14½ years. Those who remain at school after the age of fifteen years are examined again just before they leave school. During the year, 1,840 pupils were examined at school as follows:- No. examined No. referred for (a) treatment (b) observation 1st age group (5-7 years) 534 41 96 2nd age group (10-11 years) 144 14 34 3rd age group (14-16 years) 654 58 71 Other age groups and "Specials" 136 16 29 Re-examinations 372 - - 2. CLEANLINESS SURVEYS The school nurses visited the Primary and Secondary Modern Schools and carried out 11,526 inspections of the heads of pupils. 39 children—15 more than in 1957—were found to be suffering from head infestation. The normal procedure of notifying the parent and offering advice on how to deal with the condition was followed and with one exception parents were able to cleanse the child themselves to the satisfaction of the school nurse. The other child was sent to the Cleansing Centre at Hackney for treatment. 48 3. CLINICS The following clinics at 93, High Road, E.18 provide facilities for the medical and dental inspection and treatment of school children. (a) School Clinics 418 individual children attended to see the School Medical Officer and a summary of the defects noted is given at Appendix "A". (b) Dental A whole-time dental service is provided and a summary of the work carried out by the Dental Officer is given in Appendix "B". The Dental Officer also visited a few schools to inspect the teeth of every child in attendance. (c) Speech Therapy Four sessions a week are devoted to Speech Therapy. The Speech Therapist also visits schools in the Borough to discuss the progress of children with the teachers, and, where necessary, to offer advice. (d) Specialist Services Under an arrangement with the Essex County Council, the North East Metropolitan Regional Hospital Board provide staff for the following clinic services at the School Clinic. (i) Ophthalmic An Opthalmologist attends three times a month. (ii) Orthoptic This service (for the correction of squints) commenced in January with an Orthoptist attending for two sessions a week. Unfortunately four changes of staff occurred during the year and in between these changes, the clinic had to be closed and this, of course, interrupted the patients treatment. (iii) Orthopaedic A consultant from Wanstead Hospital attends regularly once each month to examine children referred by the School Medical Officer, who is usually present at these visits. The Consultant also advises the Physiotherapist on the treatment to be given. (iv) Physiotherapy A Physiotherapist attends regularly three times a week. 49 4. CHILD GUIDANCE SERVICE In my report for last year I said that steps had been taken to reduce the case load at the Walthamstow Child Guidance Clinic which should result in children from this Borough being seen more quickly. The action taken was to transfer some of the patients from the Walthamstow Clinic to a new clinic at Harlow; although this achieved the aim of reducing the case load, illness and changes of staff at the Child Guidance Clinic prevented the quicker consultations it was hoped would result. However, each case is dealt with on its merits and urgent cases do receive priority. 5. B.C.G. VACCINATION OF SCHOOL CHILDREN 461 pupils of 13 years of age were eligible to participate in this scheme and parents of 282 pupils (61.17 per cent.) gave consent for their child to be vaccinated. Although the consent rate is lower than that obtained in 1957 (66.7 per cent) it is higher than the rates obtained in all other districts in the Forest Division. The reduction is general and can, I think, be attributed to the greater importance being given by parents to vaccination against poliomyelitis. 6. TUBERCULOSIS CASE FINDING All five year old children due for their first routine medical inspection at school are eligible to participate in this scheme, the purpose of which is to discover tuberculosis in adults by means of Mantoux (skin) testing these children. Of the 539 children to whom it was offered, 316 (58.63 per cent) were tested. 3 children gave a positive reaction to the test and the Chest Physician was notified and asked to investigate each case. Children and family contacts were seen at the Chest Clinic but no abnormalities of any significance were discovered. Here again for the same reasons as given in the preceding paragraph the rate of consent was lower than that obtained in 1958 (64 per cent). 50 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 14 1 Eyes (a) Vision 25 3 (b) Squint 1 — (c) Other 1 2 Ears (a) Hearing 4 2 (b) Otitis Media — — (c) Other 1 — Nose or Throat 3 1 Speech 23 — Cervical Glands — — Heart and Circulation 1 1 Lungs — — Development (a) Hernia — — (b) Other 1 — Orthopaedic (a) Posture 5 — (b) Flat food 9 1 (c) Other 5 2 Nervous System (a) Epilepsy 1 — (b) Other 1 1 Psychological (a) Development 15 2 (b) Stability 4 — Other 3 — 51 APPENDIX "B" Dental Inspections and Treatment: Number of pupils inspected (periodic and specials) 2193 Number found to require treatment: (a) Periodic 916 (b) Specials 464 Total 1380 Number of individual pupils actually treated 522 Attendances made by pupils for treatment 2331 Fillings: Permanent teeth 1636 Temporary 385 Total 2021 No. of Teeth Filled: Permanent Teeth 1519 Temporary 344 Total 1863 Extractions: Permanent Teeth 65 Temporary 673 Total 738 Administration of anaesthetics: (a) Local 139 (b) General 243 Total 382 Other Operations: (a) Permanent Teeth 793 (b) Temporary 299 Total 1092 52