WANS 25 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1960 PUBLIC HEALTH COMMITTEE Alderman R. A. Dalton (Chairman). Councillor Mrs. S. V. F. Ashton (Vice-Chairman). Alderman D. L. Forbes. Alderman R. W. Dale. 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) 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) Student Public Health Inspector: T. Matthews Clerks: R. M. Jamieson Mrs. V. Birkett Miss T. D. Pennell (part time) (from 5.9.60) (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. 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 1960. 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 807, an increase of 87 over the previous year and the highest number recorded during the past ten years. This increase conforms with a national trend. Birth Rate per 1,000 population was 13.1 compared with a figure of 17.1 for the country as a whole. The still-birth rate dropped from 24.4 to 13.4 per 1,000 births. Death Rate. The total number of deaths was 738, an increase of 46 over those recorded in 1959 and the highest number ever recorded in the borough during a single year. When considering these figures it should be realised that the population is an ageing one, there being no extensive building nor new development. Death Rate per 1,000 population was 12.0 compared with 11.5 for the whole of England and Wales. Infant Mortality Rate. i.e. the deaths of infants under one year per 1,000 live births, was 19.8. This figure shows improvement on that recorded last year which was 25.0 and compares favourably with that for the whole of England and Wales, i.e. 21.9. Causes of Death As is usual, the commonest causes of death were diseases of the heart and arteries, and cancer. Deaths from cancer increased by 36 to reach a total of 157, mainly due to an increase of disease in the lung and breast. There was a slight increase, 9 cases, in the incidence of coronary disease. Deaths from Road Traffic Accidents were almost doubled, 13 in 1960 compared with 7 in 1959. There were 14 cases of suicide. There was a marked drop in deaths from influenza, only 3 cases being recorded compared with a previous figure of 21 1 Infectious Disease and Food Poisoning Incidence of infectious disease was low. There were two cases of poliomyelitis. The first to be notified was a male adult of 28 years occupying half-way house accommodation maintained by another authority. It was considered that he had become infected prior to residing in the Borough. The other case was an infant of 14 months in which a complete recovery took place. As far as could be ascertained neither patient had been immunised. Following a heavy incidence of measles in 1959 the rate for 1960 was low, only 35 cases being notified. There were 18 cases of scarlet fever (48 in 1959). An outbreak of sonne dysentery occurred in Dr. Barnardo's Homes in the latter part of the year, 8 cases being notified. all mild in character. The incidence of this infection was carried over into the present year when 42 further cases were reported. National Assistance Act. Compulsory Removal to Hospital For the second 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 person in need of care and attention and who refused to enter hospital voluntarily. The woman concerned, aged about 85, was living alone in a large house in conditions of indescribable filth. Every effort had been made to persuade her to accept help without avail. She was removed forcibly bv ambulance and, having been admitted to hospital, subsequently agreed to remain. Clean Air Act, 1956 There is little doubt that the implementation of this Act, particularly in respect of Smoke Control Areas, hps had a greater effect on the work of my Department than any other legislation in recent years. Visits have been made by the Public Health Inspectors to houses in the areas and will eventually be made to all houses in the borough. Therefore, a large section of the inhabitants who previously had little or no contact with the local authority find themselves involved in filling in forms and negotiations. From a local authority point of view this is obviously a public relations matter of the first importance. and I am happy to report that the procedure, whilst of necessity somewhat complicated, has generally worked smoothly. In the original programme the date of operation of the No. 1 Area was 1st October, 1960, but as a result of a Public Inquiry and delay in confirmation, the area now comes into operation on 1st October, 1961. The No. 2 Area has since been confirmed and comes into operation on the same date, the proposed date in the ten-year programme. 2 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. 16th August, 1961. 3 SECTION A j STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar-General's estimate mid-year 1960 61,500 Registrar-General's estimate mid-year 1959 61,620 Rateable Value £1,077,158 Sum represented by penny rate £4,315 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 407 Females 372 Total 779 Illegitimate Males 14 Females 14 Total 28 Total Males 421 Females 386 Total 807 Birth-rate per 1,000 of the estimated resident population - 13.1 STILLBIRTHS Legitimate Males 5 Females 3 Total 8 Illegitimate Males 1 Females 2 Total 3 Total Males 6 Females 5 Total 11 Rate per 1,000 total (live and still) births - 13.4 DEATHS Males 370 Females 368 Total 738 Death rate per 1,000 of the estimated resident population - 12.0 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 19.8 Legitimate infants per 1,000 legitimate live births 19.2 Illegitimate infants per 1,000 illegitimate live births 35.7 1960 1959 Deaths from Cancer 157 121 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 13 7 „ „ Suicide 14 10 „ „ Other Violent Causes 13 12 4 Population The Registrar-General's estimate of the population for 1960 (midyear) was 61,500, a decrease of 120 on the figure for 1959 (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. 5 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1960 England and Wales and London (Provisional Figures based on Quarterly Returns) England and Wales London Administrative County Borough of WANSTEAD and WOODFORD (Rates per 1,000 Home Population) Births: Live 17.1 17.8 13.1 Still 0.34 0.32 0.18 Deaths: All Causes 11.5 11.4 12.0 Malignant Neoplasm, Lung and Bronchus 0.48 0.70 0.60 Whooping Cough 0.00 0.00 — Diphtheria 0.00 0.00 — Tuberculosis 0.07 0.08 0.11 Influenza 0.02 0.01 0.05 Coronary Disease, Angina 2.01 2.02 2.14 Acute Poliomyelitis and Polioencephalitis 0.00 0.00 — Pneumonia 0.55 0.65 0.57 (Rates per 1,000 live births) All causes under 1 year of age 21.9 - 19.8 Enteritis and Diarrhoea under 2 years of age 0.52 * — *Figures not available 6 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.00 0.01 Meningococcal Infection 0.01 — Scarlet Fever 0.88 0.29 Whooping Cough 1.27 1.01 Diphtheria 0.00 — Erysipelas 0.05 0.16 Smallpox 0.00 — Measles 3.48 0.57 Pneumonia 0.32 0.09 Acute Poliomyelitis (including Polioencephalitis):- Paralytic 0.00 0.03 Non-Paralytic 0.00 — Food Poisoning 0.17 0.30 Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 11.04 33.46 7 Maternal Mortality Abortion Other Total England and Wales 0.08 0.30 0.38 Wanstead and Woodford — — — Causes of Death as given by the Registrar-General, 1960 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 7 — 7 2. Other forms of Tuberculosis — — — 3. Syphilitic Disease — — — 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases 1 — 1 10. Malignant Neoplasm—Stomach 10 7 17 11. Malignant Neoplasm—Lung & Bronchus 28 9 37 12. Malignant Neoplasm—Breast 2 22 24 13. Malignant Neoplasm—Uterus — 6 6 14. Malignant Neoplasm—Others 41 32 73 15. Leukaemia 2 1 3 16. Diabetes 2 — 2 17. Vascular Lesions—Nervous System 45 59 104 18. Coronary Disease—Angina 86 46 132 19. Hypertension with Heart Disease 5 10 15 20. Other Heart Disease 33 60 93 21. Other Circulatory Disease 11 23 34 22. Influenza 1 2 3 23. Pneumonia 16 19 35 24. Bronchitis 19 13 32 25. Other Respiratory Diseases 2 1 3 26. Ulcer of Stomach or Duodenum 2 5 7 27. Gastritis, Enteritis and Diarrhoea 2 3 5 28. Nephritis and Nephrosis 1 2 3 29. Hyperplasia of Prostate 7 — 7 .30. Pregnancy, Childbirth, Abortion — — — 31. Congenital Malformations 4 2 6 32. Other Diseases 21 28 49 33. Motor Vehicle Accidents 7 6 13 34. All Other Accidents 7 6 13 35. Suicide 8 6 14 36. Homicide and Operations of War — — — Totals, 1960 370 368 738 Totals, 1959 325 367 692 8 DEATHS IN WANSTEAD AND WOODFORD — 1960 Causes in Proportion Infant Deaths, Neo-Natal Mortality and Stillbirths Still births Neo-Natal Deaths Infant Deaths Year Live Births Birth Rate No. Per 1,000 Live Births Per 1,000 Population No. Per 1,000 Live Births No. Per 1.000 Live Births 1960 807 13.1 11 13.6 0.18 13 16.1 16 19.83 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:- Deaths Rates per 1,000 Births (Live and Still) Year Total Births Registered Puerperal Sepsis Other Maternal Causes Total Puerperal Sepsis Other Maternal Causes Total 1960 818 - - - - - - 1959 738 - - - - - - 1958 761 - — — — — — 1957 730 - 1 1 — 1.37 1.37 1956 687 — — — — — — Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1960 1959 1958 1957 1956 Maternal Mortality - - — 1.37 — Stillbirths 13.6 25.0 17.38 23.8 14.8 Neo-Natal Mortality 16.1 19.45 9.36 16.8 14.8 During 1960 there were no deaths classified as being due to pregnancy, childbearing or associated therewith. 9 Comparative Statistics of Births, Mortality, etc., 1941 to 1960 Live Births Still Births Deaths Infant Deaths Maternal Deaths Year Population No: Rate* No: Rate† No: Rate* No: Rate† No: Rate § 1960 61500 807 131 11 13.4 738 12.0 16 19.8 - - 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 •Per 1,000 Population. †Per 1,000 Total Births. §Per 1,000 Live Births. 10 - 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. P. S. Hall (Mr. Hall succeeded Mr. Taylor who died in February, 1960), 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 Creen 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. †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 omy. Speech Therapy—Monday and Wednesday only during school term. By appointment only. † Controlled by the North East Metropolitan Regional Hospital Borrd and delegated to the Forest Group Hospital Management Committee. 11 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) Action became necessary to secure the removal of one person in need of care and attention to suitable premises during 1960. 9. Funeral Arrangements In no case was the Local Authority required to make arrangements for the burial of persons during the year 1960. SECTION C SANITARY CIRCUMSTANCES OF THE AREA Water Supply The water supplied throughout the Borough by the Metropolitan Water Board was satisfactory both in regard to quality and quantity. Regular monthly bacteriological and chemical examinations are carried out by the Metropolitan Water Board, the examinations being of raw and treated water. The results obtained from treated water were satisfactory. Copies of these reports are received regularly from the Board. Refuse and Salvage (a) Refuse Collection 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 textile and paper salvage continued and baling proved successful. There was an increase in the quantity of salvaged material sold during the year. 12 Sewerage Occasional severe storms again caused flooding at certain places and the Council decided to employ a firm of Consulting Engineers to survey and report on main drainage in the Borough. In the meantime the Council continued to take all possible temporary measures and to give assistance where flooding occurs in heavy storms. Sewage Works (a) Eastern The detailed scheme for Stage II of the improvement of Eastern Sewage Works was prepared with a view to tenders being obtained early in 1961. The main items of work are the provision of microstraining equipment to reduce the amount of suspended solids in the final effluent to the standards required by Essex River Board, the complete renewal of the media in the rectangular filter beds and the provision of modern detritus removal plant. (b) Southern Work continued throughout the year on Stage I of the reconstruction and improvement scheme due to be completed early in 1961, but progress was adversely affected to some extent by the extremely bad weather conditions during the summer when maximum progress would otherwise have been achieved. SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:- Housing Act, 1957 As stated in the Report for 1959 the five year programme has been almost completed. The outstanding properties on that programme are to be incorporated in more comprehensive areas. I give details below of progress in the fiield of demolition and clearance work during 1960: 63 Wynndale Road The occupants of this house were re-housed during the year and the property demolished. 55 and 57 Globe Road The local authority acted in default of the owners and demolished both houses. 13 7, 9, 11 and 11a Victoria Road Nos. 7, 9 and 11 were purchased by agreement with the owners and the Medical Officer of Health certified that the houses were unfit for human habitation. The occupants were subsequently rehoused. No. 11a was also purchased, by agreement with the owner/occupier who found her own accommodation. 42/48 Victoria Road A report on these properties was submitted to the Housing Committee and it was decided to acquire them. Due to a number of difficulties encountered during negotiations for purchase, settlement had not been reached by the end of the year. 4 Washington Road The residential part of the property—which is used as a Spiritualist Church—was the subject of a Closing Order, the Council agreeing to re-house the occupants. 64/72 Prospect Road Acting within the terms of Section 42 of the Housing Act, 1957, the Medical Officer of Health represented the above properties as being unfit for human habitation and not repairable at reasonable cost. Accordingly the Council declared the area to be a Clearance Area and made a Compulsory Purchase Order which was submitted to the Minister for confirmation. 61 Wynndale Road Following the demolition of No. 63, the owner of the house undertook to take down and rebuild the party wall to make the house habitable. The owner took no action in this, respect and a Demolition Order was made. 7 and 8 Mallards Road These houses were reported to the Public Health Committee as being unfit for human habitation and Demolition Orders were made. 2 and 4 Albert Road were demolished during the year, in addition to those mentioned above. 3 Grosvenor Road and 18 Hermon Hill. Closing Orders on the basements of these two houses were determined following repairs and reconditioning carried out by the owners to render them fit for human habitation. 2, 3 and 6 Grove Crescent. I reported these houses as being unfit for human habitation but action was deferred to enable the Housing Committee to consider whether to purchase and redevelop the complete block. 10 Clarendon Road. The Council agreed to the request of the owner/ occupier of the house in which the basement was the subject of a Closing Order to vary the terms of the Order so as to permit the use of the rooms concerned for the storage of domestic articles. 31 Hermon Hill—Basement. The Closing Order on this basement was determined after the owner had rendered it fit for human habitation. 14 Slum Clearance The Public Health Committee at its March meeting considered the Circular of the Ministry of Housing and Local Government in which local authorities were given further guidance about the next phase of the task of slum clearance. The Ministry estimated that by the time the present five year programme ended on 31st December, 1960, more than a quarter of a million houses would have been demolished or closed. The Minister suggested that local authorities should take stock of their individual progress and submit details of their position to him. The Medical Officer of Health reported upon the present position and the Committee resolved (i) That the Minister be informed that this Authority has substantially completed its first five year slum clearance programme and is preparing further proposals (ii) That the Medical Officer of Health report in due course on the properties to be dealt with under the next stage of the slum clearance programme. RENT ACT, 1957 Interest in this Act, from the point of view of obtaining rent relief for dilapidations, etc., has almost completely died out—only 3 applications for Certificates of Disrepair being received during 1963. A remarkable point is that since the inception of the Act in July 1957, of 41 Certificates issued only 25 have subsequently been cancelled on application by the landlord. The implication is that landlords are content to receive low rentals rather than carry out minor repairs. Where serious defects were brought to the notice of the Authority, remedial action was taken under other statutory powers. Other figures in connection with this Act are set out in the following table—the figures for 1959 being in brackets: Part I—Applications for Certificates of Disrepair 1. Number of applications for Certificates (7) 3 2. Number of decisions not to issue Certificates (Nil) Nil 3. Number of decisions to issue Certificates (Form J) (8) 4 (a) in respect of some but not all defects (6) 1 (b) in respect of all defects (2) 3 4. Number of undertakings given by landlord (Form K) (4) 3 5. Number of undertakings refused by local authority (Nil) Nil 6. Number of Certificates issued (Form L) (4) Nil Part II—Applications for cancellation of Certificates 7. Applications by landlords to local authority for cancellation of Certificates (Form M) (15) 2 8. Objections by tenants to cancellation of Certificates (5) 1 9. Decisions by local authority to cancel in spite of tenants' objections (2) Nil 10. Certificates cancelled by local authority (10) 1 15 Section 9—Work in Default The owners of eleven houses failed to carry out works of repair required by Statutory Notice and tenders were obtained from local builders to carry out the works in default of the owners. In three cases, however, the owners' contractors commenced work before those of the Council. The former were allowed to continue. Works of repair at No. 126 West Grove (reported in last year's Report) were completed during the early part of the year, the occupiers having provided themselves with temporary accommodation while the works were being carried out. Housing Act overcrowding Only one case of overcrowding was brought to the notice of the department during the year and reported to the Public Health Committee. Notice was served on the occupier to abate the overcrowding. No further action was taken as one of the occupants died. Work in Default Two dustbins were provided at one house after the failure of the owner to comply with a Statutory Notice to supply them. Other work executed by the local authority Under the provisions of Sections 24 and 39 of the Public Health Act, 1936, redrainage was carried out at two houses and a manhole cover and frame fixed on a sewer serving 4 houses. Costs were recovered from the owners in each case. Wasps Nests 153 wasps nests were destroyed during the year. MEAT INSPECTION Inspections of the local wholesale meat depot have been made during the year. A considerable amount of meat for manufacturing purposes has been prepared at the premises, and a reasonably high standard of hygiene has been maintained. The Public Health Committee agreed that one Public Health Inspector should attend a refresher course in meat inspection held at the College of Distributive Trades. CLEAN AIR The amount of time spent and work done on Clean Air by the Public Health Inspectors increased considerably during the year. In my report for 1959, I mentioned that as a result of objections, confirmation of No. 1 Smoke Control Order was delayed. There were four objectors and a Public Inquiry was held on the 26th May. There was little substance in the objections. 16 Considerable delay took place in the confirmation of the Order by the Minister, due, so it was stated, to the flush of Inquiries over the country. However, vigorous representations by the Town Clerk eventually bore fruit and the Order was confirmed on the 30th September with the date of operation 1st October 1961. This delay obviously placed the ten year programme in jeopardy, but after careful consideration, it was decided to proceed with the No. 2 Smoke Control Area according to schedule. The No. 2 Area is that part of the borough south of Cambridge Park, The Green and Redbridge Lane (West) and has an area of 800 acres. It contains 2,121 premises, made up as follows:- Commercial premises 2 Dwellings 2,104 Other premises 15 The detailed survey carried out bv the Inspectors showed that 1,600 tons of smokeless fuel for open fires and 100 tons of smokeless fuel for boilers will be required to replace bituminous coal at present used. It further revealed that 2,984 replacements or adaptations of existing fireplaces are necessary to burn smokeless fuel, at an estimated total cost of £25,383. At its meeting on the 13th September, the Public Health Committee made the Smoke Control Order for this area and submitted it to the Minister for confirmation. In accordance with Circular 28/60 from the Minister of Housing and Local Government. 22 premises which had no gas supply were given exemption on condition that "only authorised fuels, as declared by regulations under the Clean Air Act 1956, and kindling sticks and paper shall be used in the fireplaces." I would emphasise that the most satisfactory way of lighting smokeless fuel at present is by gas, preferably with a burner as part of the appliance. Several electric fire-lighters are now on the market, and when approved by the Minister for grant purposes, will fill a gap and may make exemptions unnecessary. Wood and paper are not really satisfactory for lighting smokeless fuels, and can oroduce considerable quantities of smoke during the ignition period. One objection to the No. 2 Smoke Control Order lodged with the Minister, was subsequently withdrawn. A Public Inquiry was not therefore necessary. Meanwhile, following confirmation of the No. 1 Smoke Control Order, application forms for approval of works of conversion or adaptation of fires were distributed to all householders and owners of houses with unsuitable appliances. By the end of the year. 71 applications had been received. Whilst only a small number of applications have been received, it is pleasing to note that some applicants who intend continuing to burn solid fuel, have decided to instal openable or closed stoves. 17 Although full grant cannot be paid on these appliances, there is no doubt that they make a marked contribution towards clean air with a much higher efficiency and lower fuel consumption that the open fire. In addition, they will operate on smokeless fuels which will not burn on the open fire. In December, the Public Health Committee decided in principle to proceed with the No. 3 Smoke Control Area and notification was sent to the Minister. The Joint Conference of Local Authorities in S.W. Essex held two meetings during the year, the first at West Ham and the second at Ilford. The Conference decided to set up a Technical Committee to investigate the possibility of submitting a scale of standard grants to the Minister for use in Smoke Control Areas. The Smoke Control Officer has served on this Committee. During the year, the Public Health Committee decided to join the London and Home Counties Clean Air Advisory Council, and were represented on the Standing Conference of Co-operating Bodies of the Department of Scientific and Industrial Research. The measurement of smoke and sulphur dioxide by daily volumetric instruments at the Municipal Offices and Oak Hall Court, Wanstead, continued during the year. Details of the average monthly readings are given below:- Woodford (Municipal Offices) 1960 Smoke Sulphur Dioxide (milligrams per Average 100 cub. metres) Highest (parts per Average 100 million) Highest January 23 67 11.0 34.4 February 17 42 9.7 22.1 March 13 28 4.6 8.7 April 12 29 5.5 10.9 May 9 24 3.9 9.9 June 4 8 2.4 4.5 July 3 4 2.4 4.9 August 5 8 2.9 4.8 September 5 8 31 6.9 October 7 15 5.5 8.8 November 16 48 6.0 11.4 December 22 63 10.3 18.8 18 Wanstead (Oak Hall Court) 1960 Smoke Sulphur Dioxide (milligrams per Average 100 cub. metres) Highest (parts per Average 100 million) Highest January 25 102 14.1 49.3 February 21 56 10.8 23.3 March 14 30 6.2 10.7 April 9 28 5.6 11.4 May 7 22 4.7 13.6 June 3 7 2.3 3.7 July 3 5 2.1 5.0 August 4 7 2.5 4.3 September 5 9 3.0 6.1 October 9 16 4.0 8.7 November 14 45 5.2 10.4 December 24 46 8.0 14.7 Average yearly figures for the two stations are given below:Woodford (Municipal Offices) 1955 1956 1957 1958 1959 1960 Smoke Average for year 19 18 17 19 13 11.3 Average for winter months 32 29 31 27.3 19 16.3 Average for summer months 6 7 5 6.5 4.3 6.3 Highest daily recording 153 112 205 108 108 67 Sulphur Dioxide Average for year 5.5 6 6.0 7.0 6.0 5.6 Average for winter months 8 9 9.3 8.6 9.9 7.8 Average for summer months 3 3 2.1 4.7 2.5 3.7 Hightest Daily recording 38 40 69 39.6 64.9 34.4 Wanstead (Oak Hall Court) 1959 1960 Smoke Average for year 15 11.5 Average for winter months 25 17.8 Average for summer months 5 51 Highest daily recording 120 102 Sulphur Dioxide Average for year 7.6 5.7 Average for winter months 11.0 8.0 Average for summer months 2.5 3.4 Highest daily recording 45.7 49.3 Fortunately, there were no serious fogs during the year. Some mist during January caused the highest readings. It will be noticed that there is little difference this year between the average figures for the two stations, whereas in 1959, the Wanstead figures were about 15% above Woodford. This alteration may be due 19 to the demolition of the old houses in Hall Road, Tilney Road and Eastern Avenue which were in fairly close proximity to the Wanstead station. It will also be noted that there is an encouraging general downward trend in the smoke pollution figures and this is in accord with readings taken throughout the country. It is generally agreed this is due to the voluntary change by householders from bituminous coal to gas, electricity and solid smokeless fuels. Rodent Control Two sewer treatments were carried out during the year. In both treatments, Warfarin with mould inhibitor was used, the first covered the complete borough, and the second was restricted mainly to those manholes showing takes in the first treatment. Results, with comparison with 1959, were as follows:- 1959 1960 1st 2nd 1st 2nd Treatment Treatment Treatment Treatment Manholes Treated 1,382 541 1,390 301 Complete Takes 462 265 257 142 Partial Takes 66 42 69 12 There is a marked reduction in the number of takes this year, and if this trend continues, treatments in the future can be restricted to those areas with persistent takes, and a check made every two or three years over the whole Borough to locate any new infestation. 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. Public Health Act, provision of food storage facilities A house converted so as to provide one ground floor flat and four first floor flatlets was found to be without adequate food storage accommodation. One refrigerator was sited on the staircase landing for the use of the tenants of the flatlets. Pressure was exerted upon the owner to provide the flatlets with food cupboards, but she reverted the premises back to a single dwelling. Factory odours Complaints were received at intervals during the year from residents of properties adjoining a factory in which cellulose mixtures were used and from which fumes and fine particles were discharged. The factory proprietors gave much thought to the trouble, finally providing a large water screen chamber which considerably improved conditions around the point of discharge. 20 Piggery On the site of the Eastern Sewage Works there is a piggery whose keeper is a tenant of the Council. Conditions generally had deteriorated to such an extent that it was necessary for a report to be made to the Public Health Committee in November, 1960. It was agreed by the Committee that action for forfeiture of the lease be taken if the breaches of the covenant were not remedied within a period of six months. Noise Abatement Society The Public Health Committee agreed to contribute to this new and enterprising society which has been before the public during the last year or so championing the cause of those looking for a lessening of the noise of modern times. Noise nuisance A complaint concerning noise was investigated, it being alleged by a resident near a factory estate that noise was created in an engineering works. Investigations made during the day and late evening did not substantiate the complaint. Radioactive Waste A conference of officers and members of eleven local authorities in Metropolitan Essex was held in March at which concern was displayed at the apparent lack of co.operation between the Government and local authorities regarding the disposal of radioactive waste. In reply to a letter from the Town Clerk of Barking (written on behalf of the Conference) the Minister stated that the Government would be the controlling body on all matters concerning such disposal, but that local authorities would, under the Radioactive Substances Bill, receive information on the amount and nature of materials stored and copies of documents authorising the disposal or accumulation of radioactive waste. The Bill received the Royal Assent on 2nd June, 1960. Emission of smoke from diesel engined vehicles At the public enquiry into Smoke Control Area No. 1, reference was made to the nuisance from black smoke emitted by these vehicles when passing through the borough. The Town Clerk subsequently raised the matter with the Commissioner of Metropolitan Police, who promised co.operation through the police patrols. The Public Health Inspectors reported details of offending vehicles to the Town Clerk who has drawn the attention of the owners to the nuisance. Several firms expressed concern at such occurrences and one invited the Committee to see their depot. The invitation was accented and the members were shown how everv effort was being made to prevent and cure emission of dark smoke. The drivers themselves 21 were often at fault because they tampered with the injection system in order to obtain extra power. Equipment is being designed to eliminate this cause of trouble in new vehicles. Little overall improvement is being made and apart from the smoke nuisance, such dense emissions from vehicles, especially when in low gear, are dangerous to following traffic. Pet Animals Act, 1951 The number of licences granted to persons enabling them to keep a pet shop increased to five. Rag Flock and Other Filling Materials Act, 1951 There are now no premises registered in the borough under this Act. Petroleum (Consolidation) Act, 1928 72 licences were issued during the year, of which 66 were renewals and six garages increased their capacity by 15,020 gallons. 371 visits were made by the inspectors. Game Licences Six licences to sell game were granted during the year. 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. 185 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. 36 visits were paid. Heating Appliances (Fireguards) Act, 1952 17 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 from swimming baths were submitted to the laboratories, three being from local schools and one from a children's home. Although all were reported upon as being suitable for use in swimming baths an improvement was called for in one case, and the attention of the headmaster was drawn to the matter. Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 76 Visits in connection with contacts, disinfection, etc 4 Enquiries in connection with food poisoning 17 Verminous Premises 17 22 General Environmental Public Health Drains and Sewers inspected Drain tests applied 621 Stables and manure pits inspected 1 Public Conveniences and Urinals 17 Factories (mechanical) 192 Factories (non-mechanical) 9 Hairdressers' Premises 25 Schools and School Canteens 49 Ditches, Streams and Ponds 9 Open Spaces and Playing Fields 9 Petrol Inspections 371 Shops Act Inspections 185 Outworkers' premises 73 Massage Establishments 36 Pet Animals Act 17 Fairgrounds 5 Swimming Baths 14 Smoke Observations 6 Workplaces 7 Rent Act 28 Tents, Vans and Sheds—Gypsies 14 Heating Appliances (Fireguards) Act and Regulations 17 Piggeries 3 Smoke Control Areas 3406 Miscellaneous 211 SECTION D HOUSING No. of dwellings erected during 1960:- Council 16 Private Enterprise 103 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) 1,321 (b) Number of inspections made for the purpose 2 514 23 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 115 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 82 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 46 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 23 (b) By Local Authority in default of owners 9 (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 — (c) Proceedings under Sections 16 and 18 of the Housing Act, 1957:- (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 24 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 9 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 110 192 6 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises - - - - TOTAL 148 201 6 — 2. Defects Found Particulars Number of Defects Number of defects in respect or which Prosecutions were instituted Found Remedied Referred by H.M. Inspector Want of cleanliness (S.l) 3 3 3 — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 1 1 1 — Ineffective drainage of floors (S.6) - - - - Sanitary conveniences (S.7):- 1 Insufficient 1 1 — — 2 Unsuitable or defective 3 3 1 — 3 Not separate for sexes — — — — Other offences against the Act (not including offences relating to outwork) - - - - TOTAL 8 8 5 — 25 3. Outwork Number of out-workers in August list required by Section 110(l)(c) Boxes 23 23 Factories Act, 1937, Section 34—Means of Escape in Case of Fire Eleven Certificates of Means: of Escape in Case of Fire were issued during the year. In December the Essex County Council implemented the Factories Act, 1959, in taking over, as Fire Authority, responsibility for the issue of such Certificates in the future. All existing copy Certificates and relative correspondence were handed over to the responsible officer of the Essex County Fire Brigade. SECTION E FOOD AND DRUGS Food and Drugs Act, 1955 The following cases were reported to the Public Health Committee, with results as indicated:- (a) Complaints Glass in bottle of ale Warning letter sent to bottlers Foreign matter in cake Warning letter sent to bakers Lemonade bottle smelling of paraffin Public Analyst found no traces of paraffin in bottle—no action Wasps in bottle of non-alcoholic beverage Prosecution: Vendor fined Dirt in bottle of milk Prosecution: Dairyman fined £5 Bread containing sliver of wood No action—insufficient evidence Tin of pineapple containing insect Proceedings under consideration Cheesecake containing foreign matter Proceedings instituted (b) Samples Mint Sauce containing per-centage of hazel leaves Prosecutions: (1) Vendor—case dismissed—plea of warrantry from manufacturers (2) Manufacturers—case dismissed—plea of warrantry from suppliers No further action taken because supplies were obtained from abroad Vinegar requested—non-brewed condiment supplied No action 26 The following is a list of food surrendered in 1960 because of unsound conditions:- Fish, Fresh 140 lbs. Frozen Foods Meat, Fresh Chicken 13 lbs. Beef 297 lbs. Egg 32 lbs. Lambs Livers 10 lbs. Miscellaneous 489 pkts. Pigs Livers 156 lbs. Miscellaneous Tinned Foods 336 tins Meat, Tinned Other Foods Ham 139 lbs. Beans 28 lbs. Chicken 52 lbs. Dried Peas 25 lbs. Corned Beef 198 lbs. White Flour 15 lbs. Steak & Kidney Pudding 19 lbs. Cochineal Colouring 1½ lb. Luncheon Meat 33 lbs. Cream Parmesan Cheese Ox Tongues 33 lbs. 183 lbs. Jellied Veal 12 lbs. The list of food sampled is given below:- Apple Tart 1 Lard 1 Bacon 1 Lemon Juice 1 Blackcurrant Drink 1 Liver Sausage 1 Blackcurrant Tarts 1 Luncheon Sausage 1 Black Grape Jelly 1 Malt Vinegar 1 Brawn 1 Marzipan 1 Butter 5 Mavonnaise 1 Cheese & Celery Spread 1 Milk 6 Chicken and Lentils 1 "Milkie" loaf 1 Chocolate Blancmange 1 Milk Shake Cordial— Chopped Pork 1 Coffee & Chicory Mixture 1 Blackcurrant Flavour 1 Corned Beef 1 Mince Tarts 1 Cream Slices 2 Minced Beef 4 Creamed Rice Pudding 1 Mint Sauce 5 Currants 2 Mustard Piccalilli 1 Custard Tarts 1 Oatmeal I Cut Peel 1 Peanut Butter 1 Dairy Cream Doughnuts 1 Pic kled Herrings 1 Danish Salami 1 Plain Flour 1 Desiccated Coconut 1 Pork Brawn 1 Faggots 1 Pork Chipolatas 1 French Jam Sandwich 1 Pork Luncheon Meat 1 French Mustard 1 Prawns 1 Fruit Cake 1 Rice—unpolished 1 Fruit and Nuts 1 Salad Cream 1 Grape and Blackcurrant Juice Health Drink 1 Salmon Spread 1 Sausage Rolls 1 Ham 1 Seeded Raisins 1 Haslet 1 Shredded Beef Suet 1 Horseradish Relish 2 Spaghetti Dinner 1 Jelly 1 Sparkup Glucose Drink 1 27 Strained Apple, Prune & Custard 1 Camphorated Oil 1 Codeine 1 Strawberry Jam 1 Gees Linctus 1 Strawberry Tarts 1 Glycerine, Honey & Lemon 2 Sugarless Table Jelly 3 Linctus of Codeine 1 Tomato Ketchup 2 Lung Tonic 1 Veal, Ham and Egg Loaf 1 Mu-cron Tablets 1 Vinegar 1 Saccharine Tablets 1 Whipped Cream 1 Totavite D.R. Vitamin Capsules 1 Aspirin 1 102 Manufacture, Storage and Sale of Ice Cream Thirteen applications for premises to be registered for the storage and sale of ice cream were received and considered by the Public Health Committee. All were granted. Ice Cream (Bacteriological Examination) Twenty samples of ice cream were obtained and the results were as follows:- Ministry of Health's Provisional Grading Taken Grade 1 Grade II Grade III Grade IV Nos. 20 19 1 — — Per cent 100 95 5 - - Food and Drugs and Bacteriological Examinations As in former years, the Food and Drugs samples were submitted to Messrs. Bernard Dyer and Partners Ltd., (George Taylor, Esq., F.R.I.C. (died February, 1960), Dr. J. H. Hamence, F.R.I.C., 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.R.I.C., F.R.S.H., R. F. Rackham, Esq., B.Sc., M.R.S.H., and E. English, Esq., B.Pharm., B.Sc., F.R.I.C.) 66 Victoria Street, London, S.W.1. The Department is appreciative of the help given by these two laboratories during the year. 28 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 122 are registered for the storage and sale of ice cream; 57 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 25 Tuberculin Tested 12 Supplementary Licences:- Pasteurised 6 Sterilised 7 Tuberculin Tested 5 Inspection of Food Premises and Vehicles Butchers' Shops Stalls, etc. 119 Wholesale Butchers' Depots 56 Cooked Meat Shops 2 Butchers' Carriers' Vans 8 Bakehouses 58 Fishmongers 41 Grocers 188 Restaurants and Cafes 136 Dairies and Milkshops 12 Greengrocers 87 Ice Cream Premises 41 Street Vendors 6 Food and Drugs Sampling 117 Ice Cream Sampling 19 Milk Sampling 3 Other Premises 90 Food Hygiene Regulations 538 1521 29 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 18 2 11 — — Diphtheria — — — — — Pneumonia 6 1 16.6 — — Cerebro-Spinal Fever — — — — — Acute Poliomyelitis 2 2 100 — — Acute Polioencephalitis — — — — — Encephalitis Lethargica - — — — — Dysentery 37 6 16 — — Puerperal Pyrexia 27 27 100° — Paratyphoid Fever 1 1 100 — Enteric or Typhoid Fever - - - - - Meningococcal Infection - - - - - Erysipelas 10 - - — — Measles 35 2 6 — - Whooping Cough 62 — — — — Ophthalmia Neonatorum - - - - - Food Poisoning 12 — — — — *These cases all occurred in hospital 30 These cases of infectious disease have been divided into age incidence and set out in the accompanying table:- Disease All Ages Under 1 yr. 1-4 yrs. 5-9 yrs. 10-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65 & Over Scarlet Fever 18 - 3 8 3 3 1 — — Pneumonia 6 - — — 1 1 1 3 — Typhoid Fever - - - - - - - - - Dysentery 37 2 4 17 6 3 3 2 — Acute Poliomyelitis 2 - 1 - - - 1 - - Puerperal Pyrexia 27 - - - - 14 13 - - Erysipelas 10 - - - - - 1 4 5 Measles 35 1 15 13 4 2 — — — Whooping Cough 62 3 27 27 4 1 - - - Ophthalmia Neonatorum - - - - - - - - - Meningococcal Infection - - - - - - - - - Food Poisoning 12 — 3 1 1 3 2 2 - TOTALS 209 6 53 66 19 27 22 11 5 Poliomyelitis During 1960 two confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups. 31 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1940-1960 Year Population No. Notified Notified Rate Age Group Deaths Death Rate Under 1 1-5 5-10 10-15 15-25 25-45 Over 45 1940 48620 - - - - - - - - - - - 1941 46640 1 0.021 - - 1 - - - - - - 1942 49850 - - - - - - - - - - - 1943 50010 - - - - - - - - - - - 1944 46670 - - - - - - — - - - - 1945 48230 4 0.082 - - 4 - - - - - - 1946 57570 1 0.017 - - - 1 - - - - - 1947 60280 10 0.165 2 - 1 1 2 4 - — - 1948 61150 1 0.016 - - — — 1 — - - — 1949 62010 9 0.144 - 1 — 4 3 1 - - — 1950 62460 14 0.224 - 5 2 3 3 1 - - — 1951 61850 — - — - — — — — - - — 1952 61880 8 0.129 — 1 1 4 — 2 - - — 1953 61540 13 0.211 - - 4 3 3 3 - - — 1954 61550 6 0.097 - - 3 1 — 1 1 - — 1955 61380 12 0.190 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 - - - - - - - 1960 61500 2 0.032 - 1 - - - 1 - - - 32 MASS RADIOGRAPHY SURVEY WANSTEAD & WOODFORD - 1960 Location Male Female Total Gates Corner 538 847 1385 Woodford Bridge 184 3.58 542 The Roundabout 275 99 374 Lambs Limited 93 21 114 Wanstead Station 282 371 653 Total Number X-rayed 1372 1696 3068 Groups Attending Male Female Total Referred by General Practitioner 22 28 50 Organised Groups 534 657 1191 General Public 816 1011 1827 Number recalled for further investigation 24 23 47 Pulmonary Tuberculosis Requiring immediate treatment 3 1 4 Requiring occasional clinic supervision 4 3 7 Presumed healed—no further action required 7 4 11 Groups in which Pulmonary Tuberculosis was discovered Requiring immediate treatment Organised Groups 2 — 2 General Public 1 1 0 Requiring Occasional Clinic Supervision Referred by G.P. — 1 1 Organised Groups — 1 1 General Public 4 1 0 Presumed Healed—no further action required Referred by G.P. 1 — 1 Organised Groups 3 1 4 General Public 3 3 6 Bronchial Carcinoma 4 1 5 Among Other Abnormalities Discovered were Congenital abnormalities of heart & vessels 2 2 Acquired abnormalities of heart & vessels — 1 1 Pneumonia 1 4 5 Bronchiectasis 1 — 1 Emphysema 2 — 2 Pneumoconiosis 1 — 1 Eventration of left hemi-diaphragm — 1 1 Congenital abnormalities of Bony Thorax and soft tisiues — 1 1 5 9 14 33 Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1960. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F. M F M F M F Under 1 year - - - - - - - - 1-5 years - - - - - - - — 5-10 years — 2 — — — — - — 10-15 years - - - - - - - — 15-20 years - 1 — — — — - — 20-25 years 1 1 — — — — - - 25-35 years 4 3 — — — — - — 35-45 years 3 2 - — 1 — - — 45-55 years 3 1 - — 2 - — 55-65 years — 1 - — 2 — - — 65 and over 2 - - 2 2 — - — TOTALS 13 11 - 2 7 — ~ - 24 2 7 — 26 7 The 7 deaths represent a death rate of 0.11 per 1,000 of the population. A comparative summary over the past 20 years for the Borough is set out in the following table. 34 Year Notifications Total Deaths Total Deaths Total Death Rate Pulmonary No. Rate Non-Pulmonary No. Rate Total Notification Notification Rate Pulmonary No Rate Non-Pulmonary No. Rate 1941 46 0.98 15 0.32 61 1.30 16 0.34 - — 16 0.34 1942 42 0.84 21 0.42 63 1.26 33 0.66 4 0.08 37 0.74 1943 38 0.75 14 0.27 52 1.39 19 0.37 5 0.09 24 0.47 1944 43 0.92 13 0.27 56 1.19 16 0.34 4 0.08 20 0.43 1945 47 0.97 11 0.22 58 1.22 14 0.29 5 0.13 19 0.39 1946 50 0.86 7 0.12 57 0.99 28 0.48 4 0.06 32 0.55 1947 39 0.64 7 0.11 46 0.76 20 0.33 1 0.01 21 0.34 1948 38 0.62 5 0.08 43 0.71 16 0.26 3 0.04 19 0.34 1949 50 0.80 14 0.22 64 1.03 19 0.30 2 0.03 21 0.34 1950 41 0.65 4 0.06 45 0.72 14 0.22 1 0.02 15 0.24 1951 42 0.68 7 0.11 49 0.79 10 0.16 3 0.05 13 0.21 1952 47 0.76 4 0.06 51 0.82 10 0.16 — — 10 0.16 1953 48 0.78 4 0.06 52 0.84 3 0.05 2 0.03 5 0.08 1954 38 0.61 6 0.10 44 0.71 2 0.03 1 0.02 3 0.05 1955 25 0.42 11 0.17 36 0.59 3 0.03 1 0.02 4 0.05 1956 30 0.49 2 0.03 32 0.52 6 0.09 1 0.02 7 0.11 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 0.06 1 0.02 5 0.08 1960 24 0.39 2 0.03 26 0.42 7 0.11 — — 7 0.11 Rates per 1,000 population The register shows that at the end of the year:- 24 (17) Pulmonary and 2 (1) non-Pulmonarv cases were notified during the year. 32 (34) cases were transferred into the District. 2 (1) cases were restored to the register. 8 (4) Pulmonary and No (1) non-Pulmonary died during the year. 29 (33) other cases were removed from the register. 599 (576) cases remained on the register at the close of the year. The figures in brackets are the comparable figures for 1959. 35 SECTION G. PART III 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 Councillor Mrs. D. King Councillor W. J. Bowstead Councillor Mrs. D. M. E. Linfoot Wanstead and Woodford Borough Council Councillor Mrs. S. V. F. Ashton, M.B., B.S., M.R.C.S., L.R.C.P. Councillor Mrs. M. Owens Councillor Mrs. I. E. C. Haselden Councillor J. A. Vane Chigwell Urban District Council Councillor W. J. Halford Councillor Mrs. V. L. M. Martin, TP. Councillor R. C. O'Malley. M.Inst.B.E., A.M.I.M.I. Councillor R. W. Spurge. F.R.I.C.S. Epping Urban District Council Councillor R. W. Low Harlow Urban District Council Councillor Mrs. M. Bass Councillor Mrs. E. Druce Waltham Holy Cross Urban District Council Councillor Mrs. J. M. Davies Epping and Ongar Rural District Council Councillor Mrs. H. E. Howard Hospital Management Committee Mrs. S. M. Bovill Executive Council for Essex Mr. J. W. R. Nation Local Medical Committee for Essex Dr. H. Grylls Essex County Council Alderman Mrs. M. Ball Alderman A. E. Brown Councillor A. G. Cole Councillor Mrs. L. Fallaize Councillor Miss D. D. Forster, M.A. Councillor Mrs. E. F. M. Hollis Councillor F. A. Wortley British Red Cross Society Mrs. Vefnon Walker Tuberculosis Care Association Mrs. A. C. Murray Women's Voluntary Services Mrs. M. E. Clinch Chigwell O.P.W. Committee Mrs. L. M. Scott 36 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 Services 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 644 attendances at the ante-natal clinic at 118 Hermon Hill. At this Clinic sessions are held weekly on an appointments system, midwives examining their own patients and working in close cooperation 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 co-operation between doctor and midwife. Mothers booked for hospital confinement attend the local authority ante-natal clinic for routine intermediate examinations. In die event of any abnormality becoming manifest, the case is referred at once to the Obstetrician at the Hospital. About 60 per cent of the births in the Borough take place in hospital. Discharges are notified promptly and are followed up bv 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 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. 37 It is interesting to note that in a recent publication of the Ministry of Health, "Human Relations in Obstetrics," which covered the general running of the maternity services, specific reference was made to possible delays to patients in attending ante-natal clinics and to the facilities available for dealing with health education by individual advice and group teaching. So far as the ante-natal clinics are concerned, as I mentioned in the previous paragraph, they are run on an appointments system, thereby avoiding as far as possible any delay to patients, and the classes held for expectant mothers provide an ideal opportunity for dealing with any individual queries and advising them on any points regarding their forthcoming confinement. VITAL STATISTICS Wanstead & Woodford England & Wales Live birth rate per 1,000 population 13.1 17.1 Still birth rate per 1,000 population 0.18 0.34 Infant Mortality Rate per 1,000 Live Births 19.8 21.9 NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1960, 13 infants died in the first four weeks of life, a rate of 161. CARE OF PREMATURE INFANTS During 1960, 38 premature infants were born to residents in the Borough, 8 of these births taking place at home and 30 in hospital or nursing home. 5 of the 8 born at home were alive at the end of one month; 21 of the 30 born in hospital or private nursing home survived. CHILD WELFARE CENTRES Attendances at the Child Welfare Clinics again show a slight fall during the year. This decrease follows a national trend. 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. The South Woodford Centre formerly held in Holy Trinity Church Hall was transferred to more satisfactory premises at the Baptist Church Hall, George Lane. This transfer has resulted in increased attendance. 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 Welfare Clinic changing more to one of health education. The Health Visitors devote considerable time to giving short talks to small groups of mothers, often illustrated by film strips, on child care. 38 Attendance figures were made up as follows:- Baptist Church Hall, Aldersbrook 1,250 Ashton Playing Fields, Woodford Bridge 2,600 St. Barnabas' Church Hall, Snakes Lane 2,232 Fullers Road. South Woodford 1,971 Cromwell Hall, Nightingale Lane, Wanstead 1,676 Baptist Church Hall, George Lane, South Woodford 3.478 All Saints' Church Hall, Woodford Wells 1,457 14,664 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 Fridav from 10 a.m. to 4 p.m. Mv sincere thanks are due to the Women's Voluntary Services members for the great assistance they give by undertaking this service. NURSERY AND CHILD MINDERS REGULATION ACT, 1948 Under this Act any person who receives into her home for reward three or more childen 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 3 121 Child Minders 4 17 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 142 attendances during the year. MIDWIFERY (Section 23) There were two practising midwives in the borough of Wanstead and Woodford until the end of the year, when two new midwives were appointed, making a total of 4. A satisfactory midwifery service has been maintained. 39 Two of the midwives are approved midwifery Teachers and have continued to take pupils for their midwifery training during 1960. Trilene analgesia is now being used. 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. 1960 No. of confinements attended as midwife 171 No. of confinements attended as maternity nurse, i.e. doctor also present 43 181 Patients in the district received Gas & Air analgesia 5 „ Trilene 155 „ Pethedine 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. We have lost the services of Miss Harrington, T.B. Health Visitor at Harts Hospital, owing to retirement and Mrs. Goff, T.B. Nurse from East Ham, has been appointed. With the implementation of the Mental Health Act in November, 1960, the Health Visitors will play their part in helping to rehabilitate the Mentally sick person. With this in view a discussion group has been formed with Dr. Martin, Medical Superintendent, Claybury Hospital, which the Health Visitors attend once a month at Wanstead Hospital. The Health Visitors also attended a 2-day In-Service Training Course on Mental Health given by the Central Council for Health Education. To keep up-to-date with modern treatment of children in Hospital, the Health Visitors attend on rota a Ward Round in Wanstead Hospital with Dr. Savage, the Consultant Paediatrician. With reference to elderly patients, the Health Visitors also attend on rota Dr. DeLargy's Ward Rounds at Langthorne Hospital, thus seeing, where applicable, patients in hospital, and, when visiting, in their own homes. One student Health Visitor from Battersea School of Technology received practical training in the Borough. The following table sets out statistically the work of the Health Visitors in the Borough during 1960:- Expectant Mothers (first visits) 156 Expectant Mothers (re-visits) 122 Infants under one year (first visits) 630 Infants under one year (re-visits) 1321 40 Infants 1 to 5 years (first visits) 20 Infants 1 to 5 years (re-visits) 1935 Stillbirth enquiries 12 Infant Deaths 5 Tuberculosis Patients 843 Aged and infirm 430 Day Nursery Applications — School Children 279 Other visits 303 Ineffective calls 823 5879 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:- Six whole time Nursing Sisters, and one whole time Male Nurse have given a good nursing service in the Borough of Wanstead and Woodford during 1960. The work has mainly been concerned with the elderlv and the chronic sick. 1960 Number of New Cases 511 Number of Nursing visits 17570 Advisory or casual visits 683 Last Offices 12 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 the 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. It is impossible to give an accurate figure of the protection rate 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 41 Under 5 years of age 645 5 to 15 years of age 85 730 The number of children who received a secondary or re-inforcing injection was 561. The number of persons vaccinated or re-vaccinated during the year 1960 was:- Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 219 233 23 68 543 Re-Vaccination — 10 18 171 199 The number of children immunised against Whooping Cough during the year 1960 was:- Under 6-12 5 years 6 months months 1 year 2 years 3 years 4 years & over 173 120 20 1 3 — 7 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 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 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 1960, 2.292 persons received their primary course of two injections and 5,297 received a third injection. The Minister has now decided that a fourth injection can be given to children reaching school entry age and under the age of 12 years, and also that through the General Medical Service persons over 40 years of age may, if their General Practitioner considers it desirable, receive vaccination. 42 PREVENTION OF ILLNESS, CARE AND AFTER-CARE The work under this section of the Act is mainly concerned with Tuberculosis and I am indebted to Dr. H. Duff-Palmer, Consultant Physician to the Wanstead and Woodford Chest Clinic at Harts Hospital for the following report:- "The work of the Chest Clinic continues to increase, as shown by the following statistics for 1959 and 1960:- 1959 I960 Number of X-ray examinations 3851 4034 New Cases Notified 29 31 New Contacts 165 222 Old Contacts 751 819 B.C.G. Vaccinations 90 97 The number of new cases of tuberculosis remains practically constant. One case of routine investigation is of special interest. The mother was referred by her Doctor for a chest X-ray, because he' daughters had Erythema Nodosum, a manifestation of childhood tuberculosis. The Mother was found to have pulmonary tuberculo is and subsequently, the two daughters were investigated and found to have primary lung tuberculosis: both were admitted to Black Notley Hospital. They have all done well. This case illustrates the fact that tuberculosis is a family disease and again shows the importance of contact examination. In November and December the clinic participated in a new Influenza Vaccine Trial organised by the British Tuberculosis Association and the Medical Research Council. This has entailed a considerable amount of work, but it was felt that such a trial was necessary and worthwhile. The cases chosen for protection and investigation all suffered from varying degrees of chronic bronchitis, as experience has shown that this group of patients is particularly susceptible to the influenza virus and, in the past, the mortality return has been heavy." In my Annual Report for 1959 I referred to a separate Tuberculosis Care Association being set up for the Wanstead and Woodford Area alone and I am indebted to Mrs. M. L. Carter, Hon. Secretary of this Association who has supplied me with the following information regarding the cases assisted during the first full year's working:- Total income for the year from the County Grant, Sunday Cinema Fund, Sale of Christmas Seals, donations and various functions organised by the Committee, £639.8s.7d. During the year 63 cases have been assisted, involving an expenditure of £553.16s.5d. 43 The allocation of expenditure is set out below:- Amount No. of eases Assisted £ s. d. Transport 1 0 0 2 Christmas Grants 38 10 0 47 Special Grants 28 0 10 5 Home Help 4 11 0 1 Loan 19 9 7 1 Extra Nourishment Vouchers 462 5 0 21 Total £553 16 5 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 10 cases from the Borough have been sent away. The length of convalescence was two weeks in each case. DOMESTIC HELP SERVICE 1960 once again showed an increase in applications for Domestic Help. 3667 visits were made, all cases being visited as frequently as possible. 3 full-time and 104 part-time domestic helps are employed to attend 599 patients- The amount of help per patient or family per week varies from as litte as two hours to as much at 40 hours per week. 71% of the patients receiving help are in the chronic aged category. Once again during the holiday period it was necessary to cut the hours, and relatives were encouraged to help out wherever possible. The aged chronic sick still continue to grow in number and as much help as possible is given to those who live alone. 44 SCHOOL HEALTH SERVICE 1960 WANSTEAD AND WOODFORD At 31st December 1960 the total number of children in attendance at schools maintained by the Local Education Authority in this Borough was 6,743 (3,539 at primary schools and 3,204 at secondary schools). 1. SCHOOL MEDICAL INSPECTIONS In my report for last year I referred to an experimental change in the arrangements for carrying out the second routine medical inspection of children at schools. The new arrangements provided for the second routine examination, which used to take place during the pupil's last year in the primary school, to be deferred until shortly after admission to the secondary school. This has proved to be a much better arrangement, which has now been made permanent and the routine medical inspection of pupils attending schools in this Borough now takes place at the following ages:- First: As soon as possible after admission (5-6 year age group). Second: As soon as possible after admission to secondary school (11-12 year age group). Third: 14-15 year age group. Re-examinations (i.e. the follow-up of defects noted at routine inspection): As indicated by the School Medical Officer. Children may be examined at any other time at the request of the parent. Head Teacher, Medical Officer, etc., and these are known as "special" examinations. During the year 2,426 pupils were examined at school, as follows:- No. Examined No. Referred (a) treatment (b) observation 1st age group 533 61 91 2nd age group 801 95 99 3rd age group 769 91 63 Other 6 — — Specials 23 8 4 Re-examination 294 — — Total (all groups) 2426 255 257 2. CLEANLINESS SURVEYS School nurses made several visits to schools for the purpose of carrying out routine inspections of the heads of children up to 14 years of age—known offenders over this age are inspected more 45 frequently. Of 4,083 pupils inspected 8 had some head infestation and in every case the parents were informed of the condition and with one exeception the child was cleansed by the parent to the satisfaction of the school nurse; this child was cleansed under arrangements made by the Local Education Authority. 3. B.C.G. VACCINATION OF 13 YEAR PUPILS Although this is a well established scheme which, after extensive trials by the Medical Research Council with the use of B.C.G. (Bacille Calmette-Guerin) vaccine has shown, without doubt, that such vaccination in the early teen years confers a considerable measure of protection against tuberculosis; the response this year has been very poor. The parents of every child (including those attending independent schools) of thirteen years of age is invited to agree to their child's participation in the scheme and last year only 421 (55% of those eligible) gave their consent. This compares very unfavourably with the 66.21% response obtained in 1959 and 61.17% in 1958. There was a decrease in the response from parents in all districts comprising the Forest Division but none so great as in this Borough. 4. TUBERCULOSIS CASE FINDING AMONG SCHOOL ENTRANTS The purpose of this scheme is to trace, by giving a child a simple skin test, the possible source of a tuberculous infection in an adult, which may not have previously been discovered. Here again parents are invited to give their consent and where this is given, the skin testing is carried out at the school as part of the child's first routine medical inspection. There is always a high rate of acceptance for participation in this scheme and this year 382 (72.21%) were tested. In 1959 the acceptance rate was 71.7%. Of the number tested, nine gave a positive reaction; two proved to be contacts of patients known to the Chest Clinic and the remaining seven, with their family contacts, were investigated but nothing of any significance was discovered. 5. DEFECTIVE HEARING In the Summer it was decided to conduct an experiment of testing the hearing of some of the children just before they commenced attendance at school for the first time. Children who were due to be admitted to two infant schools in September were chosen and parents were invited to bring their child to the clinic during August and, most surprisingly, 53 out of 56 invited, attended for a test with the following results:- 46 (i) Normal hearing 42 (ii) Refered to E.N.T. Consultant 1 (iii) To be kept under observation 7 (iv) Could not be tested (lack of co-operation) 3 Also tested were 54 children, discovered at routine school medical inspections, to have some loss of hearing. The results of these tests were:- (i) Normal hearing 6 (ii) Referred to E.N.T. Consultant 26 (iii) To be kept under observation 22 Results of investigations by E.N.T. Consultants:- (iv) Normal hearing 9 (v) Remove Tonsils and Adenoids 11 (vi) Wax removed 1 (vii) To be observed 5 6. SCHOOL CLINIC A School Medical Officer is in attendance every Friday morning and children may attend without an appointment. A summary of the results of the examinations is given at Appendix "A". 7. SCHOOL DENTAL SERVICE There was no change in the dental service provided at the clinic in High Road, Woodford. A summary of the work carried out is given at Appendix "B". 8. SPEECH THERAPY In September a new clinic was established at the centre at 118 Hermon Hill, South Woodford, and two sessions a week are held there. This was made possible by reducing the number of sessions at the High Road, South Woodford, Clinic from four to two sessions a week. The new clinic, being situated on a main bus route, is greatly appreciated by the many parents who live that side of the Rorough. 9. SPECIALIST SERVICES The following services are held at the High Road, South Woodford, by arrangement between the North East Metropolitan Regional Hospital Roard and the Essex County Council:- (a) Ophthalmology. Three sessions a month. (b) Orthoptics (correction of squint). Two sessions a week. 47 (c) Physiotherapy. Two sessions a week. (d) Orthopaedic. A consultant visits once a month to examine children and to advise the Physiotherapist on the course of treatment. 48 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 10 4 Eyes (a) Vision 10 6 (b) Squint — 1 (c) Other 3 1 Ears (a) Hearing 6 1 (b) Otitis Media — — (c) Other — — Nose or Throat 1 3 Speech 16 10 Cervical Glands 1 — Heart and Circulation 1 2 Lungs — 8 Development (a) Hernia — — (b) Other 4 2 Orthopaedic (a) Posture 1 1 (b) Flat Foot — 2 (c) Other 13 5 Nervous System (a) Epilepsy 1 2 (b) Other — — Psychological (a) Development 22 11 (b) Stability 7 10 Other 2 5 49 APPENDIX "B" Dental Inspections and Treatment: Number of pupils inspected (periodic and specials) 3300 Number found to require treatment: (a) Periodic 1803 (b) Specials 388 Total 2191 Number of individual pupils actually treated 578 Attendances made by pupils for treatment 2436 Fillings: Permanent teeth 1745 Temporary 414 Total 2159 No. of Teeth Filled: Permanent Teeth 1602 Temporary 355 Total 1957 Extractions: Permanent Teeth 44 Temporary 659 Total 703 Administration of anaesthetics: (a) Local 87 (b) General 234 Total 321 Other Operations: (a) Permanent Teeth 636 (b) Temporary 205 Total 841 50