BOROUGH OF Cheelam House WANSTEAD AND WOODFORD S. Library- S. Row Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1959 B PUBLIC HEALTH COMMITTEE Councillor S. J. Relph (Chairman) (to 3rd November, 1959) Alderman D. L. Forbes (Vice- Chairman) Alderman R. W. Dale Alderman R. A. Dalton Alderman Mrs. E. F. M. Hollis Councillor S. T. Appleton Councillor Mrs. E. Cooper Councillor E. V. Gardner Councillor Mrs. M. Owens STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: F. G. Brown, T.D., M.B., B.Ch., D.P.H Deputy Medical Officer of Health: J. T. Jones, B.Sc., M.B., B.Ch. D.P.H. (part time) (from April, 1959) 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) J. A. Orrell, M.A.P.H.I. (a) (b) (e) B. M. Rom, M.A.P.H.I. (a) (b) (from 21.9.1959) 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 otheT Foods. (c) First Class Certificate in Laboratory Technique of Meat Inspection oi 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. Wanstead and Woodford Borough Council TO THE MAYOR, ALDERMAN AND COUNCILLORS, BOROUGH OF WANSTEAD AND WOODFORD. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health Services in the Borough for the year 1959. 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 Birth Rate. The total number of births was 720 being 28 less than the figure for 1958 but greater by 11 births than the average for the past six years. The Birth Rate per 1,000 population was 11.7 as compared with a figure of 16.5 for the country as a whole. Death Rate. The total number of deaths was 692 an almost similar figure (696) to that of the previous year. The figure per 1,000 population was 11.5 being almost identical to that for England and Wales (11.6). Infant Mortality Rate i.e., the deaths of infants under one year per 1,000 live births. This figure, which, last year reached the record low figure of 9.6, reverted to the more usual figure of 25 which figure is less than that recorded in 1957 and 1956. When comparing these figures it must be bome in min dthat the numbers dealt with are small and that one or two additional deaths will cause a substantial rise in the mortality rate. Causes of Death No unusual trends became manifest. Deaths from cancer fell from 127 to 121. Infectious Disease and Food Poisoning There were two cases of paralytic poliomyelitis in voung children aged 3½ and 2 years. Both cases responded to hospital treatment and in neither was there any significent degree of residual paralysis. These two children had not been immunised previously, not because the parents had objected, but owing to apathy and postponement, despite repeated reminders by the Health Visitor. 1 643 cases of measles and 48 cases of scarlet fever were notified. Almost all these were mild cases. There were 35 cases of whooping cough; due to immunisation the incidence of this complaint has fallen considerably in recent years. 17 cases of food poisoning and 13 cases of dysentery were notified, All of these were either isolated cases or confined to the same household. An outbreak of food poisoning occurred at the Junior Occupation Centre for Mental Defectives in Wanstead. Eight children and two members of the Staff were affected. The causal organism was considered to be a staphylococcus which was harboured in the nose of a member of the Staff. The person concerned was suspended from duty and received treatment following which she was rendered non-infectious. Care of the Aged The problem of the elderly is an ever-increasing one. In the report of the Domestic Help Organiser mention is made of the difficulty which arises at times in maintaining an adequate service, Normally the recruitment of home helps will just enable us to do this but during holiday periods and in the first three months of the year when sickness among both the old people and the helps themselves is at its peak, the service given is less than one would wish. Every effort is made to recruit helps of whom 120 are employed in the Borough. I would pay tribute to the excellent work which these women are doing. In many cases they become friends of the recipients who look forward to their visits as a break in an otherwise lonely existence. Visits made by Health Visitors to aged persons more than doubled during the year—332 in 1959 compared with 161 in the previous year, Many of these visits are to patients who have been discharged from Langthorne Hospital and concerning whom the hospital receives reports as to how the patient is progressing at home. An excellent liaison is thus maintained and, should any deterioration in condition be noted, the question of readmission can be reviewed. By co-operation between family doctor, district nurse and home help many elderly chronic sick not in need of actual hospital treatment are being cared for adequately at home. Staff By arrangement with the Essex County Council Dr. J. T. Jones, an Assistant County Medical Officer of Health, whose work is mainly in Wanstead and Woodford, was appointed to act as my Deputy during my absence from the Borough. For these services he receives an honorarium. 2 In view of increased duties due to work in connection with the Clean Air Act the establishment of the Public Health Inspectors was increased by one and an appointment made, the Inspector commencing duty in September. The Deputy Chief Public Health Inspector, Mr. J. T. S. Templeman, was designated Smoke Control Officer. I am grateful to the Chief Public Health Inspector and all members of the Staff of the Department for the work they have carried out during the year. My sincere thanks are due to the Chairman, Vice-Chairman and members of the Public Health Committee for the support they have given me. 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, 26th August, 1960. 3 4 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population— Registrar-General's estimate mid-year 1959 61,620 Registrar-General's estimate mid-year 1958 61,220 Rateable Value £1,042,948 Sum represented by penny rate £4,251 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 339 Females 354 Total 693 Illegitimate Males 14 Females 13 Total 27 Total Males 353 Females 367 Total 720 Birth-rate per 1,000 of the estimated resident population— 11.7 STILLBIRTHS Legitimate Males 14 Females 3 Total 17 Illegitimate Males— Females 1 Total 1 Total Males 14 Females 4 Total 18 Rate per 1,000 total (live and still) births— 24.4 DEATHS Males 325 Females 367 Total 692 Death rate per 1,000 of the estimated resident population— 11.5 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 25.0 Legitimate infants per 1,000 legitimate live births 21.6 Illegitimate infants per 1,000 illegitimate live births 111.1 1958 1959 Deaths from Cancer 127 121 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 4 7 „ „ Suicide 9 10 „ „ Other Violent Causes 17 12 5 Population. The Registrar-General's estimate of the population for 1959 (midyear) was 61,620, an increase of 400 on the figure for 1958 (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. e Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1959 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 16. 5 17. 3 11. 7 Still 0.35 0.34 0.29 Deaths: All causes 11. 6 11. 9 11. 5 Malignant Neoplasm Lung and Bronchus 0.46 0.63 0.49 Whooping Cough 0.00 0.00 — Diptheria — — — Tuberculosis 0.08 0.10 0.08 Influenza 0.14 0.18 0.34 Coronary Disease, Angina 3.17 1.89 1.99 Acute Poliomyelitis & Polioencephalitis 0.00 0.00 Pneumonia 0.59 0.91 0.45 (Rates per 1,000 live births) All causes under 1 year of age 22.2 22.35 to OT -2- Enteritis and Diarrhoea under 2 years of age 'Figures not available. 0.46 9 — 7 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.01 0.01 Meningococcal Infection 0.02 0.00 Scarlet Fever 1.05 0.78 Whooping Cough 0.73 0.72 Diphtheria 0.00 — Erysipelas 0.07 0.05 Smallpox 0.00 — Measles 11.88 10.51 Pneumonia 0.59 0.51 Acute Poliomyelitis (including Polioencephalitis): Paralytic 0.02 0.03 Non-Paralytic 0.00 — Food Poisoning 0.22 0.28 Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 14.0 62.33 8 Maternal Mortality Abortion Other Total England and Wales 0.02 0.04 0.06 Wanstead and Woodford — — - Totals, 1958 314 382 696 | 9 Notifications: England and Borough of Wales Wanstead & Woodford 8 Maternal Mortality Abortion Other Total England and Wales 0.02 0.04 0.06 Wanstead and Woodford — — — Causes of Death as given by the Registrar-General, 1959 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 2 2 4 2. Other Forms of Tuberculosis - 1 1 3. Syphilitic Disease 2 2 4 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis — — — 8. Measles - - - 9. Other Infective and Parasitic Diseases - - - 10. Malignant Neoplasm— Stomach 9 6 15 11. Malignant Neoplasm— Lung and Bronchus 23 7 30 12. Malignant Neoplasm— Breast — 10 10 13. Malignant Neoplasm— Uterus — 4 4 14. Malignant Neoplasm— Others 34 28 62 15. Leukaemia 3 1 4 16. Diabetes 1 1 2 17. Vascular Lesions— Nervous System 34 60 94 18. Coronary Disease— Angina 73 50 123 19. Hypertension with Heart Disease 7 6 13 20. Other Heart Disease 26 62 88 21. Other Circulatory Disease 20 19 39 22. Influenza 6 15 21 23. Pneumonia 14 14 28 24. Bronchitis 18 15 33 25. Other Respiratory Diseases 3 — 3 26. Ulcer of Stomach or Duodenum 6 2 8 27. Gastritis, Enteritis and Diarrhoea — 5 5 28. Nephritis and Nephrosis — 2 2 29. Hyperplasia of Prostate 5 — 5 30. Pregnancy, Childbirth, Abortion — — — 31. Congenital Malformations 2 4 6 32. Other Diseases 26 33 59 33. Motor Vehicle Accidents 6 1 7 34. All Other Accidents 3 9 12 35. Suicide 2 8 10 36. Homicide and Operations of War — — — Totals, 1959 325 367 692 Totals, 1958 314 382 696 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 1959 720 11.7 18 25.0 0.29 14 19.45 18 25.0 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 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 1959 738 - - - - - - 1958 761 - - - - - - 1957 730 - 1 1 - 1.37 1.37 1956 687 - - - - - - 1955 705 - 1 1 - 1.42 1.42 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1959 1958 1957 1956 1955 Maternal Mortality - — 1.37 — 1.44 Stillbirths 25.0 17.38 23.8 14.8 15.80 Neo-Natal Mortality 19.45 9.36 16.8 14.8 12.90 During 1959 there were no deaths classified as being due to pregnancy, childbearing or associated therewith. 10 Comparative Statistics of Births, Mortality, etc., 1940 to 1959 Year Live Births Jtill Births Deaths Infant Deatt Maternal is Deaths Population No: Rate* No: Rate † No: Rate* No: †Rate No: S Rate 1959 61620 720 11.7 18 24.4 692 11.5 18 24.4 - 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 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 — — *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 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. George Lane Baptist Church Hall 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. tOphthalmic—Wednesday mornings, By appointment only. tOrthopaedic—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. B.C.G. Vaccinations— Saturday morning, once monthly. (by appointment only) Mondays 9.15—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) No action became necessary to secure the removal of any person in need of care and attention to suitable premises during 1959. 9. Funeral Arrangements In six cases was the Local Authority required to make arrangements for the burial of persons during the year 1959. SECTION C SANITARY CIRCUMSTANCES OF THE AREA Refuse and Salvage (a) Refuse Collection and Disposal The collection and disposal of refuse continued normally throughout the year. No special problems arose in connection with transportation and disposal at the South Ockendon tip. (b) Salvage Collection and sale of paper salvage continued and a commencement was made on bailing sorted paper to enable advantage to be taken of the more favourable prices for paper in this form. 13 (c) Accommodation In order that all vehicles and plant connected with the cleansing service should be accommodated at one place, it was decided that a new garage building should be provided at Chigwell Road Depot and that this building should incorporate paper sorting, baling and storage facilities, as the existing provision at the transfer loading platform is inadequate. This proposed salvage accommodation will result in more economical operation, being more conveniently situated in relation to the weighbridge and it will also facilitate collection of baled salvage. Sewerage No major sewerage works were commenced during the year but minor improvements continued, including the provision of additional manholes where such facilities are lacking. In order to provide a more thorough system of inspection, maintenance and repair of the sewerage systems, a regular sewer gang was established and engaged solely on all aspects of such work throughout the year. Sewage Works (a) Eastern. Stage I of the improvement and reconstruction scheme was completed in July. Subsequently, results of the work have been studied and by the end of the year it was already fairly clear that micro-straining plant would have to be provided in stage 2, to reduce the amount of suspended matter in the final effluent to the standard required by the Essex River Board. (b) Southern. Work commenced on Stage 1 of the reconstruction and improvement scheme in July and was anticipated to last 18 months. 14 SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:— Housing Act, 1957 In clearance of unfit houses, I am pleased to say that the major part of the five-year programme, originated in 1955, has been completed, and the properties named below include most of the few remaining dwellings on which action has been taken under that programme. There are, of course, several which have come to our notice since 1955. Properties which were considered in the Report of the Medical Officer of Health for 1958, but where no action was finalised will be dealt with before setting out the work done in 1959. 17, Victoria Road. This house was considered in 1958 as being suitable for demolition, but a final decision was deferred on account of the mortgagor's agent wishing to submit a specification for its reconditioning. The agents did not, however, submit a specification, and in January, 1959, the Public Health Committee made a demolition order. 63, Wynndale Road. The difficulty found in rehousing people in the borough was reflected in this case, consequently demolition was not possible during 1959. Demolitions. The following houses were demolished during 1959:— 14, Horn Lane, Woodford Green. 19, George Lane, E.18. 6, Albert Road, E.18. 62 and 62a, Prospect Road, Woodford Green. 7 and 9, Voluntary Place, Wanstead, E.ll. 17, Victoria Road, E.18. The demolition of Nos. 7 and 9, Voluntary Place was undertaken by contractors acting on behalf of the owners. The firm failed to complete the work consequently the Borough Engineer was asked to carry out the remainder of the demolition. Clearance Areas. Section 42 of the Housing Act, 1957, provides that a local authority, upon consideration of an official representation or other information are satisfied that the houses in that area are unfit for human habitation, etc., and that the most satisfactory method of dealing with the conditions is the demolition of the buildings within that area, may make a clearance order. 15 During 1959, the Medical Officer of Health represented one area— Nos. 3 to 17 (odd numbers inclusive) Grove Hill. E.18. The properties form four semi-detached pairs three storeys high. Four contained basements. They came within the scope of the Housing Act because of decay and neglect over many years. Unfit premises beyond repair at reasonable cost. Section 16 of the Housing Act, 1957, provides for property unfit for human habitation and which is not capable at reasonable expense of being rendered so fit. Unlike the section previously mentioned where a number of dwellings are dealt with as one area, this section is used where one dwelling or a small number of dwellings are involved. Under this section the owner may come before the Public Health Committee to state his proposals for the future use of the building. Should the owner not submit proposals then the Council must make a demolition or closing order. No. 28a, High Road, Woodford Green was dealt with under this section in 1959 and a closing order made. Section 18 of the Act provides for the treatment of part of a building in a similar way to that allowed for in Section 16 above. Basements can therefore be dealt with under this Section and in 1959 the following were dealt with and closed: 4, 6, and 10, Clarendon Road. 32 and 34, Grosvenor Road, E.ll. Further to the above the following basements were dealt with in the manner indicated: 8a, Clarendon Road, 11c and 31a, Hermon Hill. The owners appeared before the Public Health Committee and undertook to render the basements fit for human habitation within six months. The works were completed during that period. 39, Hermon Hill, E.ll. Specification of works were submitted to the Public Health Committee and accepted. Works rendering the flat fit for human habitation were executed. 55 and 57, Globe Road were the subject of demolition orders made in 1958. After some delay in re-housing the tenants because of a shortage of alternative accommodation, the owners were approached to demolish the houses. Their unfulfilled promises made it necessary for the local authority to obtain tenders for the demolition. 7, 9, 11 and 11a, Victoria Road and 64-72, Prospect Road were reported upon and visited by the Sub-Standard Dwellings SubCommittee of the Public Health Committee. 16 Basement at 3, Hermon Hill. An unusual request, by the local branch of Toc H, was made to the Public Health Committee for permission to use the basement rooms as a meeting place for that organisation. Permission was granted subject to works being executed to remedy the dampness. This basement was the subject of a closing order. 42 to 54, Victoria Road, E.18. At the end of the year a request was received from the Housing Committee for a report on these houses. Details will be given in the report for 1960. Section 9— Work in default. It was necessary to obtain tenders for work of repair to one house— 126, West Grove, Woodford Green. For various reasons, i.e., illness, etc., it was not possible to do the work in 1959. Rent Act, 1957. The number of applications fell considerably during 1959, the number being 7; a contrast with the figure of 49 for the year 1958 and 46 for 1957. Other figures in connection with this Act are set out in the following table— the figures for 19.58 being in brackets: Part I— Applications for Certificates of Disrepair. 1. Number of applications for Certificates 7 (49) 2. Number of decisions not to issue Certificates Nil (Nil) 3. Number of decisions to issue Certificates (Form J) 8 (46) (a) in respect of some but not all defects 6 (37) (b) in respect of all defects 2 (9) 4. Number of undertakings given by landlord (Form K) 4 (30) 5. Number of undertakings refused by local authority Nil (Nil) 6. Number of Certificates issued (Form L) 4 (26) Part II— Applications for cancellation of Certificates 7. Applications by landlords to local authority for cancellation of Certificates (Form M) 15 (17) 8. Objections by tenants to cancellation of Certificates 5 (10) 9. Decisions by local authority to cancel in spite of tenants' objections 2 ( 3) 10. Certificates cancelled by local authority 10 (12) 17 Housing Act Overcrowding. There were no cases of overcrowding to report to the Public Health Committee during 1959. Work in default. Six dustbins were supplied to five houses under the provisions of Section 75 of the Public Health Act, 1936. Other work executed by the Local Authority. The Council undertook to renew eight manhole covers and frames on lengths of public sewers. One house was disinfested (bugs) under Section 83 of the Public Health Act, 1936. Wasps Nests. The work in destroying wasps nests continued during the year in which 216 nests were successfully destroyed. Meat Inspection. Inspections of the local wholesale meat depot have been made during the year. There has been a marked increase in the amount of meat preparation for manufacturing purposes. In general a reasonably high standard of hygiene has been maintained. As mentioned last year the Depot is a convenient place to check retailers' vans, and in two cases proceedings were instituted against retailers for unsatisfactory vehicles. CLEAN AIR I am pleased to report definite progress during 1959. In Circular No. 5/59 the Minister asked local authorities within "black" areas to consider their domestic smoke problem as a whole and to decide the Smoke Control Orders needed, in which priority they should be made and how many years it was likely to take to complete the job. Local authorities were then asked to prepare a phased programme for establishing Smoke Control areas over the next five years. 18 The Minister confirmed by letter that this Authority should regard its district as being in a "black" area for the purposes of Circular 5/59. The Council then decided to make the whole Borough smoke controlled within ten years, and the No. 1 Area should be that part of the Borough bounded by Grove Boad on the north, Woodford Boad and Hollybush Hill on the east and the Borough boundary on the west. It was further decided that the next four areas (which together with No. 1 area make up the five years programme) should be situated in the southern part of the Borough linking up with the No. 1 Area. The Deputy Chief Public Health Inspector was appointed Smoke Control Officer. The No. 1 Area was chosen, not because it was considered that the problem of atmospheric pollution was worse in that particular area than elsewhere in the Borough but because (a) owing to the shape of the Borough and the direction of the prevailing winds the greatest benefit will accrue to the Borough as a whole and (b) the area contains a large variety of properties varying from the largest houses in the Borough to small terraced houses. Valuable information will be obtained for the use on the remainder of the Smoke Control areas. The No. 1 Smoke Control Area covers 232 acres and has a total of 1,548 premises, as follow:s— Industrial premises 5 Commercial premises 15 Dwellings 1,524 Other premises 4 1,548 As the Minister had already given provisional clearance to the proposals in 1958, it was possible to proceed with the detailed survey, although this was held up for some time owing to shortage of staff. 19 The survey, carried out by the Public Health Inspectors, showed that the present annual consumption of bituminous coal amounted to 1,675 tons of which 275 tons were used on the central heating plant of a large block of flats, and 100 tons on small house boilers, etc. The remainder, i.e., 1,300 tons, was burnt on open fires. 1,184 new appliances would be required including 1,138 open fires, 37 open fires with boilers, 3 gas or electric cookers and 6 wash-boilers. In addition 1,194 gas points are required. It is estimated that the total cost of adapting or altering fireplaces will be £14,777. In connection with the figure of 1,300 tons of bituminous coal at present used in the area it is interesting to note the results of an investigation carried out by the British Coal Utilisation Research Association which showed that every 100 lbs. of coal burnt in an open domestic fire emits into the atmosphere from 2½ to 5 lbs. of smoke. Taking the lower figure of 2½ lbs. per 100 lbs. of coal, the weight of smoke emitted in the area is of the order of 32½ tons per year. The Smoke Control Order was made by the Council in December, and submitted to the Minister for confirmation. It was hoped to make the date of operation 1st November, 1960, but a few objections to the Order and a subsequent Public Inquiry has meant that it will not be possible to adhere to this date. The Council have been represented on the Joint Conference of Local Authorities in S.W. Essex by the Chairman of the Public Health Committee, Medical Officer of Health and the Smoke Control Officer. Two meetings were held during the year one at Walthamstow and the other at East Ham. It is clear that surrounding boroughs with one exception, are taking steps to implement the Clean Air Act and declare smoke control areas. The Chairman of the Public Health Committee and Smoke Control Officer are the Council's representatives on the Standing Conference of Co-operating Bodies of the Department of Scientific and Industrial Research. Two meetings were held during the year, one in London and the other at the Warren Spring Laboratories, Stevenage, at which technical lectures and discussions took place. The measurement of Smoke and SO2 by daily volumetric instruments at the Municipal Offices and Oak Hall Court, Wanstead, continued during the year. 20 Details of the average monthly readings are given below:— Woodford (Municipal Offices) 1959 Smoke (milligrams per 100 cub. metres) Sulphur Dioxide (Parts per 100 million) Average Highest Average Highest January 34 81 12.9 36.6 February 32 108 13.1 64.9 March 15 47 5.3 13.8 April 11 26 5.0 10.4 May 4 10 2.1 6.6 June 3 7 2.2 4.2 July 1 3 2.2 7.0 August 31 65 2.1 3.7 September 4 10 2.1 6.4 October 9 21 5.7 13.0 November 17 40 11.3 23.3 December 18.7 47 10.9 32.5 Wanstead (Oak Hall Court) 1959 Smoke (milligrams per 100 cub. metres) Sulphur Dioxide (Parts per 100 million) Average Highest Average Highest January 38 106 15.1 43.9 February 37 120 14.6 61.8 March 23 64 7.0 14.7 April 12 33 5.7 11.1 May 4 10 2.2 7.1 June 4 10 2.5 4.8 July 2 4 2.1 5.4 August 3 8 2.1 3.7 September 4 10 2.3 6.6 October 10 23 6.0 14.2 November 20 57 13.3 28.4 December 23.8 65 11.5 32.9 21 Average yearly figures for the two stations are given below:— Woodford (Municipal Offices) Smoke 1955 1956 1957 1958 1959 Average for year 19 18 17 19 13 Average for winter months 32 29 31 27.3 19 Average for summer months 6 7 5 6.5 4.3 Highest daily recording 153 112 205 108 108 Sulphur Dioxide Average for year 5.5 6 6.0 7.0 6.0 Average for winter months 8 9 9,3 8.6 9.9 Average for summer months 3 3 2.1 4.7 2.5 Highest daily recording 38 40 69 39.6 64.9 Wanstead (Oakhall Court) Smoke 1959 Average for year 15 Average for winter months 25 Average for summer months 5 Highest daily recording 120 Sulphur Dioxide Average for year 7.6 Average for winter months 11.0 Average for summer months 2.5 Average daily recording 45.7 Two periods of fog were recorded, one in January and the other in February, fortunately both were of fairly short duration. It was, of course, during the fogs that the highest daily reading occurred. It will be noticed that the average figures for 1959 have fallen from previous years. It is felt that this decrease is probably due to the very fine weather which extended for considerable periods over the year, and to a lesser degree, the voluntary change to smokeless fuels as people became more clean air conscious. I think the figures give further confirmation that the main pollutant within the Borough is domestic smoke. 22 Rodent Control. Two sewer treatments were carried out during the year. In the first treatment, using sausage rusk as bait base and zinc phosphide as poison, 1,382 manholes were baited. 462 showed complete prebait takes and 66 partial takes. The second treatment, using the same bait base and poison, was resiricted roughly to those manholes which had shown takes in the first treatment. 541 manholes were baited, 265 showed complete prebait takes anl 42 partial takes. The figures on both treatment show a slight reduction on 1958 figures, and it is hoped that this improvement will continue. The following table gives details of surface treatments:— Number of inspections made by Public Health Inspectors . 211 Complaints received 374 Revisits to premises 226 Visits to adjacent premises 99 Total premises visited 699 Number of baiting points 3,605 In April the Town Clerk reported to the Public Health Committee the receipt of a circular from the Ministry of Agriculture, Fisheries and Food informing local authorities of the cessation, after 31st March, 1959, of grants towards the cost of rodent control. On the 27th November, 1959, a one-day course for rodent operatives organised by the Ministry of Agriculture, Fisheries and Food, was held in the Council Chamber. About 15 operatives from this and neighbouring authorities attended. The course included lectures on the latest methods of pest destruction interspaced with appropriate films. Essex County Council Act, 1933, Section 109 There were no applications for permission to place or keep moveable dwellings on land situate within the borough. This section provides that no moveable dwellings shall be placed or kept on any land situate within any urban district in the County having a population of not less than twenty thousand without the prior approval of such urban council. 23 Pet Animals Act, 1951. The number of licences granted to persons enabling them to keep a pet shop remained at four. Three of the licences were renewed on the existing conditions, but, following an inspection by a Veterinary Surgeon to the fourth premises, the Public Health Committee placed a restriction on the number of puppies the proprietor could keep there at any one time, bearing in mind the staff available for their welfare. The proprietor subsequently made representations against this restriction, and after interview at the next meeting of the Committee, she was granted a licence containing only the usual conditions. The Committee asked, however, that the cleanliness of the kennels be improved. Rag Flock and Other Filling Materials Act, 1951. The only premises registered in the borough since the commencement of the Act closed down owing to expiration of the lease. Petroleum (Consolidation) Act, 1928. 67 licences were issued during the year, of which 56 were renewals, 8 new licences were granted to cover total storage of 873½ gallons and 3 garages increased their capacity by 10,400 gallons. 262 visits were made by the inspectors. The Home Office recommendations with regard to the provision of flameproof fittings and limiting devices to existing pumps were considered by the Public Health Committee. It was resolved to require that such fittings and devices be fitted by the 1st January, 1960, and all the firms concerned were accordingly notified by the Town Clerk. Four firms requested and were granted an extension of time to enable them to carry out the necessary works. A proprietor of a shop and filling station discontinued the use of his storage facilities without taking the requisite step of notifying the local authority ten days before such discontinuance. A breach of the conditions of the licence was thus created and reported to the Public Health Committee. Proceedings against the firm were authorised the case being heard at Stratford Magistrates' Court where a conviction was obtained and a fine of £5 imposed with one guinea costs. The Town Clerk was authorised to take action against another owner of a filling station who carried out alterations in connection with the storage of petroleum without notifying the local authority. In view of the highly inflammable and explosive nature of petroleum and its vapour, the Public Health Committee (acting for the Council) regarded the matter seriously. Developments will be recorded in the Annual Report for 1960. 24 Game Licences. The number of licences to sell game was further reduced this year, there now being only four licensees. Shops Act, 1950. The small number of minor infringements of the Act noted during the year mainly concerned the display of statutory notices and these were dealt with informally, no formal action being necessary. 73 visits were made during the year. Essex County Council Act, 1933. Massage and Special Treatment Establishments. The Public Health Inspectors were again requested by the Essex County Council to visit and report to them on the condition of the premises prior to licensing. All were satisfactory. 12 visits were paid. Heating Appliances (Fireguards) Act, 1952. During the year a local branch of a multiple store was found to be selling electric fires with inadequate guards. The manager immediately withdrew them from sale and subsequently we were informed that the fires were to be provided with a stronger guard before again being offered for sale. 24 visits were made to various shops in the district in order to ensure compliance with the Act and Regulations. Swimming Bath Water. Four samples of water were obtained from swimming baths in the area, three of the pools are situated within school premises and the fourth is in the grounds of a children's home. All the samples were of a satisfactory standard and suitable for swimming purposes. Open Spaces— Nuisances from travelling caravan dwellers (gypsy type). It became necessary to report to the Public Health Committee that unfenced land reserved for an open space and owned by the Council was being used at frequent intervals by dwellers in horsedrawn caravans. Because the land is under the control of the Highways and Open Spaces Committee the matter was referred to them. Subsequently proper fencing and padlocked gates were provided. 25 NEW LEGISLATION During the year the Public Health Committee noted, and where necessary, discussed the following: 1. Fabrics (Misdescription) Regulations, 1959. 2. Meat (Staining and Sterilising) Regulations, 1959. (These were cancelled by the appropriate Ministry soon after making). 3. Housing (Underground Rooms) Act, 1959, and Regulations made thereunder. 4. Slaughterhouses Act, 1958. Slaughterhouse (Report) Direction, 1959. Slaughterhouse Reports (Appointed Day) Order, 1959. The above Order and Direction (4) made under the Slaughterhouses Act, 1958, required the Council, by November, 1959, to report to the Minister of Agriculture, Fisheries and Food, after consultations with such organisations as appear to represent interests in the I butchery and allied trades on the following matters: (a) The existing and probable future requirements of their district for slaughtering facilities having regard both to the needs of persons [ requiring the use of such facilities and other persons and (b) The slaughtering facilities which are or are likely to become available to meet their requirements. To enable this authority to draw up the necessary details a ques- I tionnaire with accompanying explanatory letter was sent to all interested firms or people. 39 questionnaires were despatched of which 34 were returned. Generally speaking supplies of meat are obtained largely from the Smithfield Market and to a lesser degree from a local meat I wholesaler. Returns indicated that the butchers are satisfied with the standard of supply and with the present arrangements for obtaining it. Only one butcher stated that he would probably use a local slaughterhouse if one were available and that only at certain unspecified times. In the questionnaire the butchers were asked for suggestions as to the possible improvement in slaughtering or other facilities. Only two comments were received on this point— one to the effect that Smithfield was out-of-date and one that the Islington slaughterhouse required improving. One reply expressed the view that central slaughtering was preferred to private slaughtering. 26 In response to the request from one trade union to be consulted about the requirements of the Order and Direction a Divisional Officer was interviewed who pointed out the need, if slaughtering facilities were provided, for proper arrangements in the way of welfare and hygiene for the workers and for the humane handling of animals and the hygienic preparation of carcases, etc. The reply to the Minister by the Town Clerk after a report was submitted to the Council was as follows: (i) That having regard to both the needs of persons likely to require the use of slaughtering facilities, and of other persons, the Council is satisfied that the existing arrangements are satisfactory; that future requirements can be met thereby and that there is no need for slaughterhouses within its districts; (ii) That no slaughterhouses exist within the district; (iii) That there are no premises for which a slaughterhouse licence is in force or was in force at some date during the twelve months preceding the submission of this report. (iv) That there are no outstanding applications for new slaughterhouse licences. The Minister in acknowledging the receipt of the report indicated his acceptance thereof. Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 75 Visits in connection with contacts, disinfection, etc 8 Enquiries in connection with food poisoning 24 Verminous Premises 25 27 General Environmental Public Health Drains and Sewers inspected Drain tests applied 671 Stables and manure pits inspected 10 Public Conveniences and Urinals 12 Factories (mechanical) 133 Factories (non-mechanical) 12 Hairdressers' Premises 15 Schools and School Canteens 18 Ditches, Streams and Ponds 13 Open Spaces and Playing Fields 25 Petrol Inspections 262 Shops Act Inspections 73 Outworkers' premises 61 Massage Establishments 12 Pet Animals Act 6 Fairgrounds 4 Swimming Baths 11 Smoke Observations 18 Workplaces 2 Rent Act 151 Tents, Vans and Sheds— Gypsies Heating Appliances (Fireguards) Act and Regulations 24 Piggeries Smoke Control Area (Proposed) 2,201 Miscellaneous 162 28 SECTION D. HOUSING No. of dwellings erected during 1959: Council 46 Private Enterprise 140 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) 1,139 (b) Number of inspections made for the purpose 2,139 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 — (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 123 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 93 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 11 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 9 (b) By Local Authority in default of owners — 29 (b> Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3 (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 — (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 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 8 30 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 Inspections Written notices Occupiers prosecuted (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 38 12 - - (ii) Factories not included in (i) to which Section 7 applies 170 133 6 - liii) Other Premises under the Act (excluding out-workers' premises) — — — — TOTAL 208 145 6 — 2. Defects Found Particulars Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred by H.M. Inspector Want of cleanliness 3 3 3 - Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 1 1 1 — Ineffective drainage of floors — — — — Sanitary conveniences: 1 Insufficient 1 1 — — 2 Unsuitable or defective 3 3 1 — 3 Not separate for sexes — — — — Other offences — — — — TOTAL 8 8 4 — 31 3. Outwork Number of out-workers in August list required by Section 110 (1) (r) Boxes 25 25 Factories Act 1937, Section 34— Means of Escape in Case of Fire Four certificates of means of escape in case of fire were issued during the year. In one case the Public Health Committee refused to grant a certificate until work recommended by the Chief Public Health Inspector (with the support of Her Majesty's Inspector of Factories and the Fire Prevention Officer of the Essex County Council) had been executed. The proprietor objected to doing the work and asked to appear before the Public Health Committee. His request was refused because of the recommendations of the above officers. Following this refusal the proprietor carried out all the required works and a certificate was granted. 32 SECTION E. FOOD AND DRUGS Food and Drugs Act, 1955 The following cases were reported to the Public Health Committee with results as indicated: 1. Offences against provisions of the Food Hygiene Regulations: Proceedings against: (a) a street trader on four Fines: £10 plus 3 gns. costs occasions £5 plus 1 guinea costs £45 plus 20 guineas costs £20 plus 3 guineas costs (b) the trader's employee on Fine: £4 one occasion (c) a shop keeper and his wife Fines: 2 guineas each. (d) a shop keeper and his Fines £1 each. employee 2. Offences in connection with defective condition of meat vans: Proceedings against: (a) Two owners Fines: £5 plus 2 guineas costs each. (b) One driver Fine £2 3. Food Samples. Rice sample containing 1 per Resolved that no action be cent whole grains, other- taken. wise all broken grains 4. Food complaints: Proceedings against: (a) Baker— loaf of bread con- Fine 10 guineas plus 5 gns. costs taining screw (b) Producer of butter—½lb. Fine 10 guineas plus 5 gns. costs packet containing wood sliver (c) Vendor of above Case dismissed. Others. (a) Milk bottle containing a Warning letter sent to Dairypiece of broken glass man. (b) Half pound packet of Warning letter sent to Dairybutter containing glass man. sliver. (c) Bottles of milk containing No action foreign matter 33 The following is a list of foods surrendered in 1959 because of unsound conditions: Fish, Fresh Miscellaneous Tinned Foods Meat, Fresh 508 lbs. Fruit, Fresh 200 tins Pork 98 lbs. 20 lbs. Ox Crops (Australian) 168 lbs. Beef (Argentine) 125 lbs. Meat, Tinned Beef (English) 25 lbs. Ham 1,463 lbs. Lambs Livers 11 lbs. Chicken 24 lbs. Lamb (English) 68 lbs. Corned Beef 171 lbs. Lamb (New Zealand) 87 lbs. Steak 44 lbs. Mutton 34 lbs. Luncheon Meat 37 lbs. Babbit 55 lbs. Pilchards 4 lbs. Beef Sausages 24 lbs. Pressed Tongue Meat 96 lbs. Pork Sausages 44 lbs. Ox Tongues 340 lbs. Pigs Kidneys 22 lbs. Jellied Veal 12 lbs. Turkeys 40 lbs. Lambs Livers 10 lbs. The list of food sampled is given below:— Apples 3 Lard 1 Bacon 2 Lemon Cheese 1 Beef Steak with Gravy 1 Lemon Curd 1 Browning 1 Liver Paste 1 Butter 3 Lollies— Cream 3 Cake Mixture 1 Lollies— Ice 3 Chocolate Spread 1 Malt Vinegar 1 Chutney 1 Marmalade 1 Coffee and Chicory Essence 1 Milk 13 Currants 2 Minced Beef 5 Custard Powder 1 Minced Beef with Onions 1 Dandelion Coffee 1 Mincemeat 1 Dates 1 Mint in Vinegar 1 Demerara Sugar 2 Mint Sauce 4 Desiccated Coconut 1 Mixed Fruit 1 Faggots 1 Mixed Herbs 1 Figs 1 Mixed Peel 1 Flour— Plain 2 Mixed Spice 1 Glace Cherries 2 Oranges 4 Ground Almonds 2 Polish Sweetmeat 1 Ground Cinnamon 1 Pork Pie 1 Ground Nutmegs 1 Raisins 1 Ham 1 Rhubarb (Tinned) 1 Honey 1 Rice 2 Horseradish 1 Rice— Flaked 1 Horseradish— Grated 1 Salad Cream 1 Instant Icing 1 Salmon t Jellies 2 Sausage Rolls 1 34 Savormix 1 Tomato Sticks 1 Smoked Cheese 1 Washed Bran 1 Stem Ginger 1 White Pepper 1 Sultanas 1 Tea 2 104 Tomato Chutney 1 Manufacture, Storage and Sale of Ice Cream. Nine applications for premises to be registered for the storage and sale of ice cream were received and considered by the Public Health Committee. With two exceptions all were granted. In one case the firm's storage arrangements were considered unsatisfactory. They decided not to proceed with the application. The second application to which exception was taken came from a greengrocer. In accordance with the provisions of Section 19 of the Food and Drugs Act, 1955, the Committtee served a time and place notice upon the applicant inviting him to appear before them to show cause why the local authority should not, for reasons specified in the notice, refuse the application. The applicant did not avail himself of this opportunity, consequently no further action was taken. Ice Cream (Bacteriological Examination) Forty-three samples of ice cream and five of lollies 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. 43 .38 3 1 1 per cent 100 88.4 7.0 2.3 2.3 Lollies: The Bacteriologist reported:— "The samples are of satisfactory bacterial purity." Foods and Drugs and Bacteriological Examinations As in former years, the Food and Dnigs samples were submitted to Messrs. Bernard Dyer and Partners Ltd., (George Taylor, Esq., F.R.I.C., Dr. J. H. Hamence, F.BilC;, and P. S. Hall, Esq., F.R.I.C.) of 20 Eastcheap, London, E.C.3., and samples for bacteriological examination to the Counties Public Health Laboratories, (Roy C. Hoather, Esq., B.Sc., Ph.D., F.R.I.C:, F.R S H., W: A. Bullough, Esq., C.B.E., M.Sc., M.B., Ch.B., D:P H. Gordon Miles, Esq., B.Sc., F.B.I.C., F.R.S.H, R. F. Rackham, Esq;, B.Sc., M.R.S.H., and E. English, Esq., B.Phann., B.Sc., F.R.I.C:.) 66 Victoria Street, London, S.W.l. The Department is appreciative of the help given by these two laboratories during the year. 35 The food premises in the District may be classified as follows:— Confectioners (cakes, pastries) 29 Grocers 77 Greengrocers 35 Butchers 35 Confectioners and Tobacconists 72 Restaurants and cafes 34 Fishmongers 15 Dairies and Milkshops 10 Miscellaneous 33 of these 109 are registered for the storage and sale of ice cream; 55 are registered for the preparation of preserved foods. Disposal of unsound foodstuffs The unsound food condemned by the Public Health Inspectors is destroyed in the incinerator at Chingford. 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 29 Tuberculin Tested 12 Supplementary Licences: Pasteurised 9 Sterilised 10 Tuberculin Tested 9 Inspection of Food Premises and Vehicles Butchers' Shops, Stalls, etc 134 Wholesale Butchers' Depots 109 Cooked Meat Shops 4 Butchers' Carriers' Vans 18 Bakehouses 54 Fishmongers 34 Grocers 144 Restaurants and Cafes 55 Dairies and Milkshops 16 Greengrocers 92 Ice Cream Premises 48 Street Vendors 13 Food and Drugs Sampling 81 Ice Cream Sampling 48 Milk Sampling 27 Other Premises Food Hygiene Regulations 557 1,493 36 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 48 2 4.0 — — Diphtheria - — - — — Pneumonia 31 3 10 — — Cerebro-Spinal Fever - — — — — Acute Poliomyelitis 2 2 100 — — Acute Polioencephalitis — — — — — Encephalitis Lethargica — - - — — Dysentery 13 2 15 — — Puerperal Pyrexia 46 46 100* — — Paratyphoid Fever — — — — — Enteric or Typhoid Fever - - - - - Meningococcal Infection 1 — — — — Erysipelas 3 — — — — Measles 643 4 0.6 — — Whooping Cough 35 — — — — Ophthalmia Neonatorum 1 — — — — Food Poisoning . 17 — — — — "These cases all occurred in hospital. 37 These cases of infectious disease have been divided into age incidence and set out in the accompanying table: Disease All Ages Under 1 yi 1-5 . yrs 5-10 yrs 10-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & Over Scarlet Fever 48 1 16 21 8 2 — — - Pneumonia 31 — 4 1 2 1 6 10 7 Typhoid Fever - - - - - - - - - Dysentery 13 — 3 2 1 1 2 3 1 Acute Poliomyelitis 2 — 2 - - - - - - Puerperal Pyrexia 46 — — — — 19 27 — — Erysipelas 3 - - - - - 1 1 1 Measles 643 15 335 284 5 2 2 — — Whooping Cough 35 1 21 11 1 1 — - — Ophthalmia Neonatorum 1 1 - - - - - - - Meningococcal Infection 1 — - 1 - - - - - Food Poisoning 17 — — 4 2 5 4 2 - TOTALS 840 18 381 324 19 31 42 16 9 Poliomyelitis During 1959 two confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups. 38 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1939—1959 Year Population No. Notified Notification Rate Under 1 1-5 5-10 Age Group 25-45 Over 45 Deaths Death Rate 10-15 15-25 1939 55880 - - - - - - - - - - - 1940 48620 - - - - - - - - - - - 1941 46640 l 0.021 - - 1 - - - - - - 1942 49850 - - - - - - - - - - - 1943 50010 — - - — — - - - - - - 1944 46670 — - — — — — - - - - - 1945 48230 4 0.082 — — 4 - - - - - - 1946 57570 1 0.017 - - - - - - - - - 1947 60280 10 0.165 2 — 1 1 2 4 - - - 1948 61150 1 0.016 - - - - - - - - - 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 — — — — — — 1959 61620 2 0.033 - 2 - - - - - - — 39 Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1959. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 year — 1 - - - - - - 1-5 years — 1 - - - - - - 5-10 years — - — 1 — — - — 10-15 years - - - - - - - - 15-20 years 1 - - - - - - - 20-25 years 3 - - - - - - - 25-35 years 1 - - - - - - - 35-45 years 1 2 - - - - - - 45-55 years — 2 — — — 1 — — 55-65 years 2 2 - — — 1 — — 65 and over 1 - - — 2 — — 1 TOTALS 9 8 - 1 2 2 — 1 17 - 1 - 4 - 1 18 5 The 5 deaths represent a death rate of 0.08 per 1,000 of the population. A comparative summary over the past 20 years for the Borough is set out in the following table. 40 Year N otiricat ions Total Deaths Total Death Pulmonary Non-Pulmonary Tot#' Notification Pulmonary Non-Pulmonary Total No. Rate No. Rate cations Kate No. Rate No. Rate Deaths Rate 1940 24 0.49 7 0.14 31 0.63 22 0.45 3 0.06 25 0.51 1941 46 0.98 15 0.32 61 1.30 16 0.34 — 16 0.34 1942 42 0.84 21 0.42 63 1.26 33 0.66 4 0.08 37 0.74 1943 38 0.75 14 0.27 52 1.39 19 0.37 5 0.09 24 0.47 1944 43 0.92 13 0.27 56 1.19 16 0.34 4 0.08 20 0.43 1945 47 0.97 11 0.22 58 1.22 14 0.29 5 0.13 19 0.39 1946 50 0.86 7 0.12 57 0.99 28 0.48 4 0.06 32 0.55 1947 39 0.64 7 0.11 46 0.76 20 0,33 1 0.01 21 0.34 1948 38 0.62 5 0.08 43 0.71 16 0.26 3 0.04 19 0.34 1949 50 0.80 14 0.22 64 1.03 19 0.30 2 0.03 21 0.34 1950 41 0.65 4 0.06 45 0.72 14 0.22 1 0.02 15 0.24 1951 42 0.68 7 0.11 49 0.79 10 0.16 3 0.05 13 0.21 1952 47 0.76 4 0.06 51 0.82 10 0.16 - - 10 0.16 1953 48 0.78 4 0.06 52 0.84 3 0.05 2 0.03 5 0.08 1954 38 0.61 6 0.10 44 0.71 2 0.03 1 0.02 3 0.05 1955 25 0.42 11 0.17 36 0.59 3 0.03 1 0.02 4 0.05 19.56 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 1959 18 0.29 — — 18 0.29 4 0.C6 1 0.02 5 0.08 Rates per 1,000 population. 41 The register shows that at the end of the year:— 17 (82) Pulmonary and 1 (2) non-Pulmonary cases were notified during the year. 34 (34) cases were transferred into the District. 1 (2) cases were restored to the register. 4 (3) Pulmonary and 1 (No) non-Pulmonary died during the year 33 (32) other eases were removed from the register. 576(556) cases remained on the register at the close of the vear. The figures in brackets are the comparable figures for 1958 SECTION G. PART HI SERVICES FOREST HEALTH AREA SUB-COMMITTEE Chairman: County Councillor Mrs. E. F. M. Hollis Vice-Chairman: Councillor W. J. Bowstead, J.P. Membership: Chingford Borough Council Wanstead and Woodford Borough Council Chigwell Urban District Council Epping U.D.C. Harlow U.D.C. Valtham Holy Cross U.D.C. Epping & Ongar 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 Chigwell O.P.W. Committee Women's Voluntary Services Councillor Mrs. D. King Councillor W. J. Bowstead, J.P. Councillor Mrs. D. M. E. Linfoot Councillor Mrs. S. V. F. Ashton M.B., B.S., M.R.C.S., L.R.C.P. Councillor E. V. Gardner Councillor Mrs. I. E. C. Haselden Councillor S. J. Relph B.Pharm. (Hons.), F.P.S. F.L.S., A.C.T. (Birm.) Councillor W. J. Halford Councillor Mrs. V. L. M. Martin Councillor S. J. Palfreman. Councillor E. G. Perry Councillor A. J. Hyde Councillor Mrs. E. Druce Councillor Mrs. L. E. Davidson Councillor Mrs. J. M. Davies Councillor Mrs. H. E. Howard County Councillor Mrs. S. M. Bovill J. W. Bandall Nation, Esq. Dr. H. Grylls Alderman Mrs. M. Ball (ex-officio) Alderman A. E. Brown Councillor A. G. Cole Councillor Mrs. L. Fallaise (ex-officio) Councillor Miss D. D. Forster M.A. Councillor Mrs. E. F. M. Hollis Councillor F. A. Wortley Mrs. Vernon Walker Mrs. A. C. Murray Mrs. L. M. Scott Mrs. M. E. Clinch 42 STAFF In addition to my duties as Medical Officer of Health for the Borough I am in administrative control of Part III Services under the National Health Service Act, 1946, sections 21, 22, 23, 24, 25, 26, 28 and 29. There are normally two medical officers of the Essex County Council working in the Borough and undertaking duties appertaining to Maternity and Child Welfare as well as three practitioners who regularly attend Child Welfare Clinics being employed on a sessional basis. CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) There were 441 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 this surgery, with a Local Authority midwife in attendance. The scheme works well and achieves a maximum of cooperation 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 maintaind with the Maternity Department of Wanstead Hospital. RELAXATION EXERCISES These classes have retained their popularity with expectant mothers, and many mothers have expressed their appreciation of the advice they have been given and the help they have found the instruction to be at the time of their confinement. It is interesting to note that more requests are now being received from General Practitioners for their patients to attend these classes. Three weekly sessions are held in the Clinic at 118 Hermon Hill, the classes deliberately being kept numerically small to enable individual attention to be given. By this means the Health Visitor is enabled to maintain personal contact. At these classes short talks are given on preparation for the confinement and on various aspects of personal hygiene for mother and infant. 43 VITAL STATISTICS Wanstead and England and Woodford Wales Live birth rate per 1,000 population 11.7 16.5 Still birth rate per 1,000 population 0.29 0.35 Infant Mortality Rate per 1,000 Live Births 25.0 22.2 NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1959 14 infants died in the first four weeks of life, a rate of 19.45. INFANT MORTALITY Deaths of children under 1 year during 1959 - 18 Cause of death Number Anencephalic 1 Asphyxia 2 Atelectasis 3 Broncho-pneumonia 1 Congenital morbus cordis 1 Erythroblastosis foetal is 1 Intra cranial haemorrage 3 Meningitis 1 Prematurity 3 Staphlococcal pneumonia 1 CARE OF PREMATURE INFANTS During 1959, 39 premature infants were born to residents in the Borough, 8 of these births taking place at home and 31 in hospital or nursing home. 7 of the 8 born at home were alive at the end of one month; 28 of the 31 born in hospital or private nursing home survived. CHILD WELFARE CENTRES Attendance at the Child Welfare Clinics has shown a slight fall during 1959. The seven centres are held in hired premises, some of them old buildings. Every attempt is being made to find a suitable site upon which to erect a modern building. Nevertheless, it can be said that the Borough is well catered for in this respect. The number of mothers consulting the medical officers at the clinics is falling, and in some cases the doctor is now attending only alternate sessions. This follows the general trend since the introduction of the National Health Service, the function of the Child 44 fare Clinic changing more to one of health education. The Health Visitors devote cpnsiderable time to giving short talks to small groups of mothers, often illustrated by film strips, on child care. Attendance figures were made up as follows:- Baptist Church Hall, Aldersbrook 1,372 Ashton Playing Fields, Woodford Bridge 2,222 St. Barnabas' Church Hall, Snakes Lane 3,685 Fullers Road, South Woodford 2,557 Cromwell Hall, Nightingale Lane, Wanstead 1,799 Holy Trinity, Hermon Hill, South Woodford 3,076 All Saints Church Hall, Woodford Wells 1,248 15,959 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, 9 Cambridge Park, 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 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 3 13 WOMEN'S WELFARE CLINIC 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 176 attendances during the year. 45 MIDWIFERY (Section 23) There were only two domiciliary midwives practising in the Borough of Wanstead and Woodford during 1959, but with the help of neighbouring midwives, a good midwifery service was maintained. Both midwives are approved midwifery teachers and continued to take pupils for their Part II Midwifery Training during 1959. A third midwife has now been appointed and will commence her duties when a new bungalow which is in process of erection is completed. Supervision of the midwifery staff is carried out by Miss A. Williams, Non-Medical Supervisor of Midwives, on the staff of the Area Medical Officer. No. of confinements attended as midwife 146 No. of confinements attended as maternity nurse, i.e. doctor also present 64 210 GAS AND AIR ANALGESIA A total of 184 patients in the district received gas and air analgesia, TRAINING OF PUPIL MIDWIVES The two District Midwives in Wanstead and Woodford who are approved as Midwifery Teachers continued to take pupils for their Part II Midwifery Training during 1959. 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 and one Tuberculosis Health Visitor—has remained at full establishment during the year. In addition, a Clinic Nurse helps Health Visitors with Poliomyelitis Clinics, School Medical Inspections, Hygiene Inspections, Minor Ailment Clinics, Gas Sessions for 3½ days per week, thus relieving the Health Visitors for more educational work, i.e. Relaxation Classes, Health Education in Schools and talks to various Clubs, Townswomen's Guilds. The Health Visitors have derived great benefit by a 2-day In-Service Training Course on Human Relations given by the Central Council for Health Education, thus keeping them up-to-date with modern trends. 46 Two Student Health Visitors received practical training in Tuberculosis Health Visiting and Chest Clinic experience at Harts Hospital. One Student from the University of Southampton on a Social Studies Course also received practical training. Twenty-four Student Nurses from Wanstead Hospital have each received two days practical training in the Public Health field during the year (May and October 1959). Relaxation and Mothercraft classes continue to be popular. The following table sets out statistically the work of the Health Visitors in the Borough during 1959:— Expectant Mothers (first visits) 135 Expectant Mothers (re-visits) 110 Infants under one year (first visits) 699 Infants under one year (re-visits) 1,449 Infants 1 to 5 years (first visits) 83 Infants 1 to 5 years (re-visits) 2,202 Stillbirth enquiries 24 Infant death 14 Tuberculosis Patients 895 Aged and infirm 332 Day Nursery Applications 5 School Children 280 Other visits 412 Ineffective Calls 846 7,486 HOME NURSING (Section 25) The Nursing 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, two whole-time Male Nurses, one part-time Nursing Sister and one part-time Male Nurse, have been employed on General Nursing duties in the Borough of Wanstead and Woodford during the year 1959. A good nursing service has been given throughout the year, the work undertaken has been mainly concerned with the elderly and chronic sick, although there has been an increase in the requests for domiciliary chiropody treatment, which the nursing staff have adequately dealt with. A domiciliary chiropody service to meet this need would be greatly appreciated. 1959 1958 Number of new cases 621 596 Number of visits 22,377 20,448 Last Offices performed 19 25 Advisory or Casual Visits 368 308 47 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. Immunisation against whooping cough is normally carried out from the 3rd-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 562 5 to 15 years of age 38 600 The number of children who received a secondary or re-inforcing injection was 320. The number of persons vaccinated or re-vaccinated during the year 1959 was:— Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 410 57 32 65 564 Re-Vaccination - 8 27 147 182 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, 1959. 48 Year of Birth Number Year of Birth Number 1959 132 1951 506 1958 535 1950 650 1957 587 1949 665 1956 553 1948 931 1955 880 1947 932 1954 331 1946 794 1953 666 1945 865 1952 556 1944 590 1053 Number of children immunised against Whooping Cough during the year 1959 was:— Under 6 months 6-12 months 1 year 2 years 3 years 4 years 5 years & over 162 156 17 4 2 2 9 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 inlusive, but during 1958 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. 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. Further extensions have been made which 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 up to the age of 40 years. The acceptance rate in the age group 26 to 40 years could well be very much higher. During 1959, 7,179 persons received their primary course of two injections and 7,179 received a third injection. 49 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:— During the year under review, twenty-nine new cases of tuberculosis were notified as compared with thirty-two in 1958. One hundred and sixty-five new contacts and seven hundred and fifty-one old contacts were examined. B.C.G. was given to ninety children, an increase of twenty-six on the previous year. Three thousand eight hundred and fifty-one X-ray examinations were carried out. It is interesting to note that sixty notified cases of tuberculosis were transferred into the area, as compared with twenty-eight notified cases transferred out. In my previous reports, I have constantly referred to the importance of contact examinations and the following cases may be of interest in this connection:— (1) A child of four and a half months examined as a contact to her father, who had pulmonary tuberculosis, was found to have a primary tuberculous lung lesion. She was immediately admitted to a Children's Sanatorium and has done very well. (2) A girl, aged 19 years, was followed up as a contact to her father and brother, who were both notified as cases of pulmonary tuberculosis in 1954. She herself was found to have pulmonary tuberculosis in 1959 and was given hospital treatment. This case emphasises the importance of prolonged supervision in certain cases. (3) Another similar case is one where a child aged 2½ years was found to have primary lung tuberculosis in 1959. Her mother was treated for pulmonary tuberculosis in 1954 and after the child was born, B.C.G. was offered but unfortunately the parents refused. (4) The final case to be described is one of unusual interest. A boy aged 9 years was admitted to a local hospital and was treated for pleurisy. He returned home and within a few weeks, his sister developed pleurisy. At that stage, I was then asked to see the children and examination at the Chest Clinic revealed that they both suffered from tuberculous pleurisy. Arrangements were made for them to be admitted to a Children's Sanatorium. Routine examination of the parents revealed the father to be suffering from chronic pulmonary tuberculosis of an infectious type. 50 These cases illustrate that, although contact examinations may appear to be tedious and dull work, it is most important to detect the early case of tuberculosis and thus help in the eradication of the disease. In October, 1959, the Leyton, Wanstead and Woodford Care Committee divided into two new associations, one to be responsible for the Leyton area, the other to look after the interests of chest patients in Woodford and Wanstead. I am glad to report that the latter association is working very successfully and the Executive Committee contains many representatives of Voluntary Organisations in the Borough. 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 9 cases from the Borough have been sent away. The length of convalescence was two weeks in each case. DOMESTIC HELP SERVICE The Domestic Help Organiser reports as follows:— The year 1959 showed a steady increase in applications for Domestic Help. The service continues to be administered as in previous years, and all cases are visited as frequently as possible. 80 per cent of the patients receiving help are in the category Chronic Aged, and help varies for these from as little as two hours per week for the heavy cleaning to 20 hours per week, which provides a split service, covering three meals a day. Relations are encouraged to help bedridden aged patients on Sundays. A total of 2 full-time and 118 part-time domestic helps is employed to attend to the varied wants of 370 patients. During the holiday it was necessary to drastically cut, and in some cases leave the patients without, assistance. This however, was kept to the minimum, and care was taken to see that no one completely dependent on the Domestic Help Service was left unattended. 3 new requests for help in T.B. households have been received and those already receiving help are closely watched and assistance given in accordance with the recommendations of the Chest Clinic. The aged chronic sick continue to grow in numbers, and are an increasing problem. Every effort is made to provide help according to the essential needs of these people, but many would benefit from a little extra help were the labour situation not so acute. Liaison with the District Nurse, Health Visitors and Hospital Almoners is good, the aged and sick benefitting from the joint effort. The W.V.S. "Meals on Wheels" service continues to render invaluable assistance, providing meals on Wednesdays and Fridays. 51 SCHOOL HEALTH SERVICES 1959 WANSTEAD AND WOODFORD No new schools were opened in the Borough during 1959 and the number of pupils in attendance at the 18 schools, remains about the same, i.e. approximately 7,000. 1. SCHOOL MEDICAL INSPECTIONS The new arrangement whereby the second routine medical inspection of pupils takes place soon after the child's admission to the secondary school (instead of during the last year in the primary school) has worked very smoothly. As I mentioned in my report for last year, the obvious advantage of this arrangement is that the Head Teacher and Class Teachers are themselves able to consult the Medical Officer about children who are to remain in their charge for the remainder of their school life. The first routine medical inspection of children is carried out at five years of age, soon after admission to school for the first time, and the third or final inspection is at 14½ years. If, at the latter examination, a pupil is found to be suffering from a condition which demands that he/she should avoid certain types of employment, e.g. an epileptic who should avoid work with machinery, the Youth Employment Officer is notified accordingly. During the year 2,243 pupils were examined at school as follows:— No. examined No. referred for (a) treatment (b) observation 1st age group (5-6 years) 508 47 113 2nd age group (11-12 years) 749 84 94 3rd age group (14-15 years) 753 49 40 Other age groups and "specials" 33 5 3 Re-examinations 200 — — Total (all groups) 2,243 185 250 2. CLEANLINESS SURVEYS In view of the considerable improvement in the standard of cleanliness among children, it was decided that an inspection of the head of every pupil at the beginning of each term, was no longer necessary. Therefore, head inspections are now carried out twice a year only at the commencement of the Spring and Autumn Terms 52 —and no child over the age of fourteen years is inspected unless there are special reasons for doing so. Children who are known to offend in this respect are kept under observation, by the School Nurse, and inspected at more frequent intervals. During 1959, the School Nurses carried out 8,100 inspections and found 11 individual children to have dirty heads. In each case, the parent was able to deal with the condition to the satisfaction of the school nurse. 3. CLINICS The Local Education Authority provide the following services for school children at the clinic. 93, High Road, E.18. (a) School Clinic The School Medical Officer is in attendance one morning each week and children are seen without an appointment. During 1959, 578 individual children made 772 attendances and a summary of the defects noted is given at Appendix 'A'. (b) Dental This Borough is fortunate in having a whole-time dental service provided for its school children. An "open" session is held every Monday morning when children considered to be in need of treatment can be seen by the dental officer. Inspections are also carried out at schools when time permits. A summary of the work carried out by the Dental Staff is given at appendix 'B'. (c) Speech Therapy The Speech Therapist attends at the clinic for four sessions each week of school term and occasionally visits schools to discuss the progress of pupils with their teachers. A summary of the results of the year's working is given below:— No. sessions held 149 No. individual children treated 95 No. attendances made 930 No discharged (a) cured 23 (b) unsuccessful Nil No. failed to continue 14 No. under treatment at end of year 58 53 (d) Specialist Services The following services are provided by arrangement between the North East Metropolitan Regional Hospital Board and the Esses County Council. (i) Ophthalmic The ophthalmologist visits the clinic three times each month to see pupils referred by the School Medical Officer. (ii) Orthoptic (Correction of Squint) Two sessions a week are held. (iii) Physiotherapy Two sessions a week are sufficient. Once a month the Orthopaedic Consultant from Wanstead Hospital visits to examine patients and advise the physiotherapist on the course of treatment. 4. CHILD GUIDANCE SERVICE The Child Guidance Clinic for this borough is situated at High Street, Walthamstow, and the wide area covered by this clinic puts a very heavy burden on the staff there. Representations have been made for the establishment of a new clinic in the southern half of the Forest Division which, if it materialises, will be of considerable benefit to patients referred from this Borough. Although there is normally a long delay in getting appointments for children to see the Psychiatrist—not only at Walthamstow but at child guidance clinics generally—those who present problems requiring very urgent investigation are given priority. 5. B.C.G. VACCINATION OF SCHOOL CHILDREN (Protection against Tuberculosis) There was an increase of 5% in the number of parents who gave consent for their child to participate in this scheme which is offered to all children over 13 years of age. Of 586 pupils eligible, 372 (66.21%) accepted; this compares with a 61.17% response in 1958. Although I should like to see a much higher rate of acceptance, the response from this Borough compares very favourably with other districts in the Forest Division. 54 6. TUBERCULOSIS CASE FINDING AMONG SCHOOL ENTRANTS For the benefit of new members, this is a scheme which is, I believe, being operated only in the Forest Division of Essex and consists of inviting the parents of all infants entering school for the first time to give consent for their child to have a skin test, the purpose of which is to trace, through the child, instances of tuberculosis in an adult, e.g. parent or close relative, etc., which may not have previously been discovered. The test is carried out as part of the child's first routine medical inspection at school. The scheme, has been carried out at schools in Wanstead and Woodford since 1954 and the response from parents is much higher than that obtained for the B.C.G. Scheme, mentioned in the preceding paragraph. In 1959, 366 (71.7%) children were tested and 8 showed a positive re-action. All these were fully investigated (including examination of parents and other close contacts) by the Chest Physician and in two cases only were abnormalities detected neither being of any significance. All the children however were to be kept under observation. 55 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 52 1 Eyes (a) Vision 15 12 (b) Squint — 1 (c) Other — 1 Ears (a) Hearing 7 24 (b) Otitis Media — — (c) Other 2 1 Nose or Throat 2 3 Speech 32 7 Cervical Glands — — Heart and Circulation — 3 Lungs — 4 Development (a) Hernia — — (b) Other 4 — Orthopaedic (a) Posture — 2 (b) Flat Foot 3 5 (c) Other 12 13 Nervous System (a) Epilepsy 2 1 (b) Other 2 2 Psychological (a) Development 24 4 (b) Stability — 3 Other 3 1 56 APPENDIX "B" Dental Inspections and Treatment: Number of pupils inspected (periodic and specials) 1959 Number found to require treatment: (a) Periodic 816 (b) Specials 510 Total 1326 Number of individual pupils actually treated 585 Attendances made by pupils for treatment 2491 Fillings: Permanent teeth 1723 Temporary 487 Total 2210 No. of Teeth Filled: Permanent Teeth 1631 Temporary 430 Total 2061 Extractions: Permanent Teeth 86 Temporary 655 Total 741 Administration of anaesthetics: (a) Local 96 (b) General 309 Total 405 Other Operations: (a) Permanent Teeth 628 (b) Temporary 270 Total 898 57