44 11 (1) Librari WANS 26 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1961 PUBLIC HEALTH COMMITTEE Alderman R. A. Dalton (Chairman). Alderman G. C. E. Dixon (Vice-Chairman). Alderman Mrs. E. F. M. Hollis. Councillor S. T. Appleton. Councillor N. W. Chappell. Councillor Mrs. E. Cooper. Councillor E. V. Gardner. Councillor Miss E. V. Johnstone. Councillor G. E. Tovey. 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) (to 18.6.61) A.W. Tranter, M.B. B.S., M.R.C.S., L.R.C.P., D.C.H., D.P.H. (part time) (from 21.8.61) 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) (a) Royal Society of Health arid 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. I have the honour to submit my Annual Report on the Health Services in the Borough for the year 1961. This is the seventeenth report which I have compiled. As in former years details of the personal health services under the National Health Service Act, 1946 Part III, which are administered by the Essex County Council through the Forest Health Area Sub-Committee of the County Health Committee, are included. A short account of the School Health Service is also included. Vital Statistics Birth Rate. The total number of births was 801 being 6 less than in the previous year. Birth Rate per 1,000 of the population was almost identical with that of 1960, the figures being 13.07 and 13.1; the rate for the country as a whole was 17.4. Death Rate. The total number of deaths was 723, a decrease of 25 over those for 1960 which was the highest ever recorded. Death rate per 1,000 population was 11.8 compared with a figure of 12.0 for the whole country. Infant Mortality Rate, i.e. the deaths of infants under one year per 1,000 live births was 17.5. This compares with last year's figure of 19.8 and with that for England and Wales of 21.6. This figure is regarded as an indication of the adequacy of the services provided and can be regarded as very favourable. Causes of Death The commonest causes of death were diseases of the heart and arteries and cancer. A table is given on page 9 showing variations, in cause of death over the past 12 years. Due to an increase in the proportion of older people there is a greater number of deaths from disease due to vascular lesions of the nervous system, i.e. strokes. The number dying from heart disease has increased and there is a rise in deaths from coronary thrombosis - one of the main scourges of modern times. There is a tendency for deaths from cancer of the lung to rise although this is not as marked as might have been expected bearing in mind the national trend in the incidence of this disease. There is a very satisfactory decrease in deaths 1 from Tuberculosis - although, as will be seen from the report of the Chest Physician on page 52, this disease is still a danger and preventive measures cannot be relaxed. Deaths from Bronchitis increased in 1961. Bronchitis is exacerbated by smoke, both in the form of pollution of the atmosphere and from inhalation of cigarettes. Atmospheric pollution will be much reduced when the provisions of the Clean Air Act have become effective. I am glad to report that the number of deaths from road traffic accidents was almost halved. There was a decrease in the number of suicides. However, as the total numbers are small, I do not consider that any significant statistical conclusions can be drawn from these figures. Infectious Disease Salmonella Typihimurium An outbreak of Salmonella Typhimurium (an intestinal disease) occured in the Wanstead area, centring on Our Lady of Lourdes Roman Catholic School. The Disease was confirmed in five children and one member of the school staff. Examination of contacts of confirmed cases revealed three symptomless carriers. All practitioners in the area were alerted and" a report sent to the Director of the Enteric Reference Laboratory at Colindale. Dysentery. At the beginning of the year there was an outbreak of Dysentery at Dr. Barnardo's Homes, Woodford Bridge. This accounts for the increase in cases over those in 1960. No serious cases were reported. Measles. This disease usually visits us in alternate years and, as was to be expected, many cases were notified, all generally mild. Poliomyelitis. No cases of Poliomyelitis were reported. Although there have been pockets of disease in parts of England it would appear that the intense drive to have persons under the age of 40 years immunised has become effective, the national incidence having shown a marked decrease. Although the incidence and severity of infectious disease is low constant vigilance is necessary. Many doubtful cases and contacts have been referred to the department for investigation. An everpresent risk is the importation of smallpox usually from air travel. Clean Air Act The progress in the programme of Smoke Control Areas preceeded as planned, Areas No. 1 and 2 coming into operation on 1st October. A very good relationship with the nublic has been 2 maintained. Apart from owners and occupiers of houses in Smoke Control Areas, co-operation from the North Thames Gas Board, The London Electricity Board, the Solid Smokeless Fuels Federation (Mobile Exhibition), fuel merchants, builders' merchants and builders, helped to produce a successful programme. National Health Service Act, 1946, Part III Services (Essex County Council) Particulars of services provided in the Borough under this heading have been re-written and, for the first time, a short account of the chiropody service is given. As will be seen, this is a recently acquired service and, despite a general shortage of chiropodists, it is possible to give reasonable service to the old people with clinics functioning at South Woodford, Woodford Bridge and Wanstead. I would record appreciation to my Deputy, the Public Health Inspectorate and the clerical staff for their loyalty and help. Finally my thanks are due to the Chairman and members of the Public Health Committee for their unfailing support and the keen interest they have shown in the work of the department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, FREDERICK G. BROWN, T.D., M.B., B.Ch., D.P.H. Medical Officer of Health. 21st August, 1962. 3 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar General's Estimate mid-year 1960 61,500 Census—April, 1961 61,259 Registrar General's Estimate mid-year 1961 61,230 Rateable Value £1,063,523 Sum represented by penny rate £4,379 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 395 Females 369 Total 764 Illegitimate Males 19 Females 18 Total 37 Total Males 414 Females 387 Total 801 Birth-rate per 1,000 of the estimated resident population - 13.07 STILLBIRTHS Legitimate Males 1 Females 8 Total 9 Illegitimate Males — Females 1 Total 1 Total Males 1 Females 9 Total 10 Rate per 1,000 total (live and still) births 12.3 DEATHS Males 332 Females 391 Total 723 Death rate per 1,000 of the estimated resident population -11.8 Deaths from puerperal causes Puerperal and post-abortion sepsis Other maternal causes — Deaths of infants under one year of age:- All infants per 1,000 live births 17.5 Legitimate infants per 1,000 legitimate live births 18.3 Illegitimate infants per 1,000 illegitimate live births — 1960 1961 Deaths from Cancer 157 137 ,, ,, Measles Nil Nil Whooping Cough Nil Nil ,, ,, Diarrhoea (under 2 years of age) Nil Nil ,, ,, Road Traffic Accidents 13 7 Suicide 14 9 ,, ,, Other Violent Causes 13 8 4 Population The Registrar-General's estimate of the population for 1961 (midyear) was 61,230 a decrease of 270 on the figure for 1960 (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 1961 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 17.4 18.7 13.07 Still 0.34 0.34 0.16 Deaths: All Causes 12.0 11.9 11.8 Malignant Neoplasm, Lung and Bronchus 0.49 0.67 0.46 Whooping Cough 0.00 0.00 — Diphtheria 0.00 0.00 — Tuberculosis 0.07 0.10 0.02 Influenza 0.15 0.08 0.13 Coronary Disease, Angina 2.07 2.05 2.2 Acute Poliomyelitis and Polioencephalitis 0.00 0.00 Pneumonia 0.65 0.76 0.55 (Rates per 1,000 live births) All causes under 1 year of age 21.6 21.5 17.5 Enteritis and Diarrhoea under 2 years of age 0.56 0.34 — 6 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.00 — Meningococcal Infection 0.01 — Scarlet Fever 0.43 0.39 Whooping Cough 0.53 0.21 Diphtheria 0.00 — Dysentery 0.44 — Erysipelas 0.05 0.08 Smallpox 0.00 — Measles 16.51 12.6 Pneumonia 040 0.26 Acute Poliomyelitis (including Polioencephalitis):- Paralytic 0.2 — Non.Paralytic 0.00 — Food Poisoning 0.17 0.98 Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 10.09 30.82 7 Maternal Mortality Aborticn Other Total England and Wales 0.02 0.32 0.34 Wanstead and Woodford — — — Causes of Death as given by the Registrar-General, 1961 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 1 — 1 2. Other forms of Tubercuiosis — — — 3. Syphilitic Disease 2 — 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — — — 10. Malignant Neoplasm—Stomach 6 10 16 11. Malignant Neoplasm—Lung & Bronchus 23 5 28 12. Malignant Neoplasm—Breast — 21 21 13. Malignant Neoplasm—Uterus — 8 8 14. Malignant Neoplasm—Others 36 28 64 15. Leukaemia 2 1 3 16. Diabetes — 3 3 17. Vascular Lesions—Nervous System 37 66 103 18. Coronary Disease—Angina 77 58 135 19. Hypertension with Heart Disease 5 15 20 20. Other Heart Disease 32 65 97 21. Other Circulatory Disease 22 24 46 22. Influenza 2 6 8 23. Pneumonia 7 27 34 24. Bronchitis 28 14 42 25. Other Respiratory Diseases 3 3 6 26. Ulcer of Stomach or Duodenum 6 4 10 27. Gastritis, Enteritis and Diarrhoea 1 2 3 28. Nephritis and Nephrosis 1 1 2 29. Hyperplasia of Prostate 2 2 30. Pregnancy, Childbirth, Abortion — — 31. Congenital Malformations 2 2 4 32. Other Diseases 23 18 41 33. Motor Vehicle Accidents 5 2 7 34. All Other Accidents 2 5 7 35. Suicide 6 3 9 36. Homicide and Operations of War 1 — 1 Totals, 1961 332 391 723 Totals, 1960 370 368 738 8 9 Causes of Death in Wanstead and Woodford 1950 to 1961 YEAR Respiratory Tuberculosis Other Tuberculosis Cancer-Stomach Cancer-Lung & Bronchus Cancer-Other Vascular Lesion Nervous System Coronary Heart Disease All forms Heart Disease including Coronary Pneumonia Bronchitis Motor Vehicle Accidents All other Causes TOTAL 1950 14 1 13 19 95 68 86 206 20 22 5 144 605 1951 10 3 19 14 97 76 67 198 42 50 5 154 668 1952 10 — 22 30 75 88 83 205 29 53 4 150 666 1953 3 2 17 24 83 82 87 177 32 48 3 172 643 1954 2 1 17 27 91 99 88 181 18 37 1 131 610 1955 3 1 13 24 82 98 86 203 30 39 7 149 649 1956 6 1 17 34 84 116 93 235 22 45 2 163 725 1957 2 1 16 29 74 104 87 200 28 39 6 157 660 1958 3 — 12 34 81 107 123 236 32 32 4 155 696 1959 4 1 15 30 76 94 123 224 28 33 7 180 692 1960 7 — 17 37 103 104 132 240 35 32 13 150 738 1961 1 16 28 93 103 135 252 34 42 7 147 723 Infant Deaths, Neo-Natal Mortality and Stillbirths Stillbirths Neo-Natal Deaths Infant Deaths Year Live Births Birth Rate No. Per 1,000 Live Births Per 1,000 Population No. Per 1,000 Live Births No Per 1000 Live Births 1961 801 13.07 10 12.5 0.16 9 11.24 14 17.5 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 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 1961 901 — — — — — — 1960 818 — — — — — — 1959 738 — — — — — — 1958 761 — — — — — — 1957 730 — 1 1 — 1.37 1.37 Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Lave Births 1961 1960 1959 1958 1957 Maternal Mortality — — — — 1.37 Stillbirths 12.5 13.6 25.0 17.38 23.8 Neo-Natal Mortality 11.24 16.1 19.45 9.36 16.8 During 1961 there were no deaths classified as being due to pregnancy, childbearing or associated therewith. 10 Comparative Statistics of Births, Mortality, etc., 1942 to 1961 Live Births Still Births Deaths Infant Deaths Maternal Deaths Year Population No: Rate* No: Ratet No: Rate* No: Rate§ No: Rate § 1961 61230 801 13.07 10 12.3 723 11.8 14 17.5 — — 1960 61500 807 13.1 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 *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. P. S. Hall, 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. Ash ton Playing Fields Pavilion, Woodford Bridge Tuesday, 2.30—4 p.m. St. Barnabas Church Hall. Snakes Lanr, 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.11 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 mottling. †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 onty. 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) Action became necessary to secure the removal of one person in need of care and attention to suitable premises during 1961. 9. Funeral Arrangements In six cases the Local Authority was required to make arrangements for the burial of persons during the year 1961. SECTION C SANITARY CIRCUMSTANCES OF THE AREA Water Supply the Director of Water Examination, Metropolitan Water Board has supplied me with the following information: The water supply to the Borough of Wanstead and Woodford has been satisfactory both in quantity and quality during the year 1961. The Borough is supplied mostly with River Lee derived water from Lee Bridge Works, but there is a small amount of additional water from the Wanstead, Ferry Lane and Chingford wells. Samples are collected on five days in every week or more often if necessary at each stage of the purification process, and from the distribution system. Tests include physical, chemical and micro-biological examination. The analytical results of the water passing into supply from the above sources were satisfactory. All new and repaired mains are disinfected with chlorine before being put into service and the samples of water from them are tested bacteriologically to ensure that its quality is up to that normally supplied. The water to this area is not plumbo-solvent. 13 No new sources of supply have been instituted, nor have there been any important extensions to trunk mains, and there were no changes in the general scheme of supply to the area, but new mains were laid in the borough to the extent of 404 yards. The supply is in all cases direct to the houses and not by means of standpipes. The population of the Borough as at mid-year 1961 was 61,230 and there are 19,443 dwelling houses therein. 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 textiles and paper salvage continued and baling proved successful, but towards the end of the year trends of the paper market were unpredictable. SEWERAGE AND SEWAGE DISPOSAL General Arrangements for sewerage and sewage disposal in the Borough are reasonably adequate and the modernisation of the two Sewage Works continued as indicated below. At times there is some flooding at various points in the Borough as a result of sewers surcharging and this is also referred to below. Sewerage The firm of Consulting Engineers employed by the Council in connection with main drainage and flood relief submitted its report in July, 1961. It recommended works estimated to cost £1¼ million divided into several sections. The Council decided that the Consulting Engineers should prepare a detailed scheme for that section of the work required for flood relief in the central area of the Borough, estimated to cost £570,000 and the Consulting Engineers have proceeded accordingly. Sewage Works (a) Eastern Stage II of the reconstruction and improvement scheme commenced in June, 1961, and continued throughout the year, being due for completion in June, 1962. The main items of work are the provision of micro-straining equipment to reduce the amount of suspended solids in the final effluent to the standard required by Essex River Board, the provision of comminutors and detritors and the renewal of the media in the rectangular filter beds. 14 (b) Southern Stage I of the modernisation scheme was completed in June, 1961, providing clariflocculators, new humus tanks and new sludge drying beds. The effluent, although now much improved, still falls below the required standard because of the poor condition of the filter bed midia. The renewal of this media will be included in the second stage of the scheme, preparation of which continued. It will also include new sludge treatment and drying facilities. SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:- Housing Act, 1957 The amount of work carried out by the Department with particular reference to the clearance of sub-standard properties is small when compared with former years because (a) most of such property has been dealt with in past years and (b) it is becoming increasingly difficult to provide alternative accomodation for the occupiers. In connection with the latter remark one must point to the difficulty experienced by the local authority in finding sites suitable for redevelopment both from the aspect of size and suitablity and the economic angle. It has been possible during the year to carry out some house-to-house inspections and in this connection 58 houses have been inspected. It is pleasing to report that work in addition to that called for including external painting, has been carried out. Not only does this preserve the fabric of the house, it improves the general appearance and tone of the houses and neighbourhood. Referring to details outstanding in last year's report, progress has been as follows: 42/48, Victoria Road Difficulties in negotiations in connection with these houses continued and it became necessary in the case of Nos. 46 and 48 (the pair were in a bad state of repair) for the Public Health Committe to take action under Section 16 of the Housing Act and make demolition orders after hearing the owner's representations at the committee meeting. 64/72, Prospect Road The Compulsory Purchase Orders referred to in the Report for 1960 was confirmed by the Minister of Housing and Local Government. 15 6, Clarendon Road (Basement) The Closing Order on this basement was removed after the owner had carried out repairs to the Council's satisfaction. Properties not previously reported upon: 25/63, Ray Lodge Road The condition of these dwellings was reported to the Public Health Committee and referred to the Housing Committee. No decision on their future had been made by the end of the year. 110, High Road, E.18 Part of a house. A report was made on the condition of the part of the building used for habitation, the remaining portion being used for business purposes. A recommendation was made to the Public Health Committee that the part in question should be dealt with under Section 16 (Closing Order). Rent Act, 1957 Mention was made in the Report for 1960 of the decrease in the use of the above Act. Still less use was made of the Act in 1961 as the figures below indicate. Part I—Applications for Certificates of Disrepair 1. Number of applications for Certificates (3) 3 1A. Number of applicants withdrawn Nil 1 2. Number of decisions not to issue Certificates (Nil) Nil 3. Number of decisions to issue Certificates (Form J) (4) 2 (a) in respect of some but not all defects (1) Nil (b) in respect of all defects (3) 2 4. Number of undertakings given by landlord (Form K) (3) 1 5. Number of undertakings refused by local authority (Nil) Nil 6. Number of Certificates issued (Form L) (Nil) 1 Part II—Applications for cancellation of Certificates 7. Applications by landlords to local authority for cancellation of Certificates (Form M) (2) Nil 8. Objections by tenants to cancellation of Certificates (1) Nil 9. Decisions by local authority to cancel in spite of tenants' objections (Nil) Nil 10. Certificates cancelled by local authority (1) Nil 16 Work in Default It was not necessary to do works of repair to houses in default as all owners on whom notices were served under the Housing and Public Health Acts carried out their obligations satisfactorily. The reconstruction of drains and a public sewer serving two houses and repair of a length of sewer also serving these and adjacent houses were carried out to remedy serious defects in the lengths. Work in connection with the repair of the public sewer above was held up for several months as the. owner of one house denied ownership until served with a court summons for failing to supply the Council with information as to his interest in the property. A public sewer serving four houses had to be partly re-made because the faulty construction of the existing one had permitted tree roots to enter and cause obstruction. Minor repairs to a manhole on a further length of public sewer were also carried out. All the works were carried out by private contractors on behalf of the Council. Costs have been or are in the process of being recovered from the owners. Notice was served upon the owner of a large house under Section 72 of the Essex County Council Act, 1952 to clear the obstruction from the drainage system. The Public Health Committee authorised the Chief Public Health Inspector to carry out the work in default if necessary. After much persuasion the owner arranged for his contractor to carry out the necessary work and for the insertion of two new manholes to faciliate rodding in future. Overcrowding It is pleasing to note that the Department did not receive any complaints regarding overcrowding during 1961. Wasps Nests 82 wasps nests were destroyed during the year. Meat Inspection Frequent inspections of the local wholesale meat depot have been made during the year, and of vans and vehicles using the premises. Minor infringements of the Food Hygiene Regulations have been dealt with informally. In general, the premises and the vehicles maintained a satisfactory standard of hygiene. 17 CLEAN AIR This year has been one of intense activity with the first two Smoke Control Areas coming into operation on the 1st October, and the Order for the third area submitted to the Ministry for confirmation. Although one can hear and read of the considerable advantages of Smoke Control Areas in other districts, there is bound to be a feeling of "Will it work?" when the first areas come into operation in our own district. I am happy to report that in my opinion the scheme is working well and tours of the areas during cold winter spells showed a very favourable comparison with other parts of the borough. The residents within these two areas are to be congratulated on their co-operation. Whilst many, before the Orders came into operation, mourned the loss of their coal fire, after a winter's experience they are now converted and in many cases show a considerable enthusiasm for the scheme. In fact, it is quite common to hear a person say that they cannot understand why they had not changed to smokeless fuel before. It is anticipated that the enlightened in the existing areas will spread their enthusiasm to others, and it is already noticed that enquiries from all parts of the borough are increasing. The Ministry of Housing and Local Government decided that notification of the decision in principle to make a Smoke Control Area was not now necessary, and it is hoped that this minor relaxation in Ministry requirements is the forerunner of more drastic simplification of the present complicated system. I give below details of applications received and grants approved and paid for Nos. 1 and 2 Smoke Control Areas: - Smoke Control Area No. 1 Applications for approval of works 434 Grants approved £2,978 18 2 Claims received 331 Amount of claims paidz £1,992 12 3 Smoke Control Area No.2 Applications for approval of works 847 Grants approved £7,354 18 1 Claims received 403 Amount of claims paid £3,592 7 6 18 The number of applications for approval of works is below 50% of those eligible to make application. It can only be presumed that the remainder have either made adaptations or changed their method of heating at their own expense, or are using the specially reative types of solid fuel such as "Coalite", "Cleanglow", and "Rexco" on their existing appliances. Whilst from the financial aspect, it is pleasant to pay fewer grants than anticipated, one wonders whether the supply of the specially reactive solid fuels can be maintained. During the past winter, practicallv no complaints were received of inability to obtain smokeless fuel and it would appear, therefore, that the fuel distributors are co-operating fully. I would strongly advise all residents within proposed Smoke Control Areas who have unsuitable grates to have them adapted with the assistance of the errant, whilst it is available. With an approved appliance, the specially reative solid fuels, if preferred, can be burnt more economically. In the event of supplv difficulties, the appliance will be fully capable of operating satisfactorily with the cheaper open fire coke "Gloco" which is in ample supply. Smoke Control Area No. 3 The detailed survey of this area of 318 acres, which lies to the north of the No.2 Area and links with No. 1 Area in Hollybush Hill, was completed. The Smoke Control Order with proposed date of operation 1st October, 1962 was made at the July meeting and submitted to the Ministry for confirmation. The area includes: - Dwellings (including Council houses) 2,086 Industrial Premises 10 Commercial premises 117 Other premises 15 2,228 It was estimated that 2,000 tons of smokeless fuel would be required to replace bituminous coal at present used. It further revealed that 3,096 replacements or adaptations of existing fireplaces are necessary to burn smokeless fuel, at an estimated total cost of £31,025. Conferences Two meetings of the Joint Conference of Local Authorities in S.W. Essex have been held during the year, one at Dagenham and the other at Hackney. Matters of general interest to the local authorities concerned were discussed. This authority continued to be represented on the Standing Conference of bodies co-operating in the investigation of air pollution (D.S.I.R.) and the London and Home Counties Clean Air Advisory Council. 19 Measurement of Air Pollution There have been some major changes in the measurement of atmospheric pollution during the year. The Department of Scientific and Industrial Research, Warren Spring Laboratory asked this Council to participate in a national Survey of atmcspheric pollution. The importance of an accurate survey of pollution throughout the country was emphasized at a meeting of the conference of bodies co-operating in the investigation of air pollution by the Minister of Housing and Local Government. He said "We have now certainly reached a stage where we need some national standard by which the results of all these local measurements can be judge" "The aim of this National Survey is to provide the objective standard we need by which we can judge the progress made towards clean air throughout the country. To get at this, measurements must be taken by a representative sample of towns in various categories". The National Survey consists of two parts (1) A representative sample of some 120 towns. Measurements in these towns are to be made in the following five types of district, so far as examples are to be found in each town: - (a) Residential area with high population density. (b) Residential area with low population density. (c) Industrial area. (d) Commercial area. (e) Smoke Control area. (2) Any other towns now measuring Smoke and Sulphur Dioxide pollution and who decide to do so in future. In selecting the town for the representative samples all towns in England and Wales were classified according to domestic coal consumption per unit area, industrial coal consumption per unit area, national ventilation, and total population: random samples were then taken. The Public Health Committee agreed to take part in the Survey and following consultations with scientific officers of Warren Spring Laboratory it was decided that the two instruments at present in the borough would be sufficient to give measurements of a residential area and a smoke control area. It was further decided that the intrument which has been operating since 1954 at the Municipal Offices was too near No. 1 Smoke Control Area and it was therefore moved to Croft Lodge Close, Snakes Lane, Woodford Green. The number 2 instrument at Oakhall Court, Wanstead remains at the same site as it is on the borders of No. 2 Smoke Control Area, and is in Smoke Control Area No. 3 which becomes operative on the 1st October, 1962. 20 During the year the Department of Scientific & Industrial Research, Warren Spring Laboratory produced a simplified eight part valve for use with the daily volumetric instruments for measurement of smoke and sulphur dioxide. This device eliminates the need for daily replacement of the smoke filter and hydrogen bubbler by automatically switching the air intake every 24 hours so that it passes through a different filter and bubbler. A sequence of up to eight consecutive daily measurements can be made in this way without attention, this ensuring complete records over week-ends and holidays. In addition considerable time is saved in visiting the instruments. About 12 valves were produced and loaned to local authorities for trial use. One was installed at Croft Lodge Close and has operated satisfactorily to date. 21 It will be noticed that the average yearly figures for the two Stations given below are different from those quoted previously. This is due to the introduction of new units - micrograms per cubic metre - for expressing concentrations of both smoke and sulphur dioxide. The figures for earlier years have been converted so that comparisions can be made. WOODFORD (Municipal Offices and Croft Lodge Close) SMOKE Year 1955 1956 1957 1958 1959 1960 1961 190 180 170 190 130 113 98 Average for year. 320 290 310 273 190 163 178 Average for winter months. 60 70 50 65 43 63 44 Average for summer months. 1530 1120 2050 1080 1080 670 720 Highest daily recording. SULPHUR DIOXIDE Year 1955 1956 1957 1958 1959 1960 1961 157.3 171.6 171.6 200.2 171.6 160.16 124 Average for year 228.8 257.4 265.98 245.96 283.14 222.08 195 Average for winter months. 85.8 85.8 60.06 134.42 71.5 105.82 77 Average for summer months. 1086.8 1144 31973.4 1132.56 1856.14 983.84 652 Highest daily recording. OAKHALL COURT SMOKE Year 1955 1956 1957 1958 1959 1960 1961 — — — — 150 115 101 Average for year. — — — — 250 178 194 Average for winter months. — — — — 50 51 40 Average for summer months. — — — — 1200 1020 752 Highest daily recording. 22 SULPHUR DIOXIDE Year 1955 1956 1957 1958 1959 1960 1961 — — — — 217.36 163.02 126 Average for year. — — — — 314.6 228.8 207 Average for winter months. — — — — 71.5 97.24 71 Average for summer months. — — — — 1307.02 1409.98 710 Highest daily recording. It is interesting to note that the steady decrease in pollution has continued during the year. Now that Smoke Control Areas generally are coming into operation in a steady stream this trend should be maintained. Industrial Premises An application from a large firm of provision merchants to install a bacon curing plant at their new premises in Roding Lane (South) was received. The firm agreed to install a Holmes Catalytic plant for treating the effluent and submitted detailed plans and specifications. "Prior approval" was given by the Committee for the installation and also for an oil fired boiler. Rodent Control Two treatments of the sewers were carried out during the year. The treatments have been restricted to those areas showing persistent takes in earlier years. Results with comparison with 1960 were as follows 1st Treatment 1960 2nd Treatment 1961 1st Treatment 2nd Treatment M.H. treated 1,390 301 313 284 Complete takes 257 142 81 45 Partial takes 69 12 5 18 Zinc phosphide was used for the first treatment, and Warfarin with mould inhibitor for the second. The figures indicate that the rat population in the sewers continues to diminish as a result of the treatments. 23 Essex County Council Act, 1933, Section 109 There were no applications to keep or place moveable dwellings on land within the borough during the year. Agreement was reached between the owner of a long-standing site, the Borough Engineer and the Public Health Department concerning details to be included in a licence under the Caravan Sites and Control of Development Act, 1960. The site now has a licence for six caravans and is used also by the showman-owner as an off-season base for his vehicles and equipment. Piggery In the Annual Report for 1960 reference was made to the bad condition of the piggery adjacent to the Eastern Sewage Works. Breaches of covenant made with the Council were not remedied and the Council, acting by the Public Health Committee commenced action for the forfeiture of the lease. Proceedings were still in hand at the end of the year. Noise Abatement Act, 1960 This Act of Parliament, which came into operation at the end of No.ember, 1960, made noise and \ibration, subject to certain provisions, which were nuisances, Statutory Nuisances for the purposes of Part III of the Public Health Act, 1936. A number of complaints were dealt with during 1961, details of which are given below: (1) A factory manufacturing plastic articles installed a compressor which was enclosed in a corrugated iron shed, the machinery being fixed directly to the site concrete. The compressor operated in short bursts and was a nuisance to occupiers of adjacent houses only a few yards away. The management rebedded the machine on special pads and fitted sound absorbent material to the shed covering. These steps reduced the noise level considerably and mitigated the cause of complaint. (2) The occupants of a flat over a greengrocer's shop and store complained about the noise from an electric motor and compressor which operated a large refrigerator. On the advice of officers of this department the proprietor had the machinery overhauled. No further complaints were received after the work was completed. (3) Noise from a circular saw in a builders' works was the cause of complaints from occupiers of neighbouring houses. After the builder had been interviewed it would seem that the saw was put out of action. (4) Complaints from a residents' association concerning noise from a small factory estate could not be substantiated. Visits in connection with this complaint and (1) above were made during the day and late evening. 24 The Public Health Committee authorised the Chief and Deputy Chief Public Health Inspectors to attend courses on noise abatement at the South East Technical College. the courses were interesting and informative, lecturers being drawn from industrial and national laboratories. A very interesting conference held at the National Physical Laboratory in June was attended by the Chief Public Health Inspector. The Conference was organised by the Laboratory under its Director, Sir Gordon Sutherland, F.R.S., and in conjunction with the National Engineering Laboratory and the Building Research Station. Numerous and varied subjects were dealt with covering many aspects of noise, e.g. aero-engines, gears and ball-bearings, internal combustion engines and so on. Noise problems in factories, sound insulation and absorption, legislation, damage risk, industrial deafness, basic instrumentation and sound level meters were among other subjects covered. The printed list of acceptances at 16th June showed that over 300 delegates, (quite a number of whom were from overseas), were to attend. Many eminent scientists from government and industrial laboratories, universities and from industry in general were to be there. A number of Chief Public Health Inspectors also had the pleasure of attending. The newly passed Noise Abatement Act had been much publicised and it was not surprising to see Mr. John Connell, founder and Secretary of the Noise Abatement Society amongst the acceptors for the conference. All the sessions were held in the Glazebrook Hall, a new building constructed and fitted out as a meeting place for scientific conferences. Radioactive Waste The Annual Report for 1960 contained an item dealing with the conference of members of councils and their officers in connection with radioactive waste. Two further conferences were held in Hornchurch in April and November, 1961. The first was addressed by D. G. Arnott, B.Sc., Director of Radioisotopes Laboratory, London Hospital on the Factory Acts, Radioactive Substances Act, 1960, N.H.S. Codes of Practice and the M.R.C. report. Mr. Arnott referred to the shortage of trained staff even in the Health and Safety branches of the Atomic Energy Establishments and considered that any initiative by local authorities in training staff against radioactivity was to be commended. Certain training courses are now available at Polytechnic colleges so it is possible to have officers trained in this field. Mr. Arnott considered that a centralised body was not in a position to take immediate action in a local incident and that unless local authorities were local watchdogs satisfactory safety schemes could not be operated. A low level of training could be the means of preventing a minor disaster. 25 In the discussion it was thought that there should be a course adapted to the needs of local authority staff. It was agreed that the conference should be established as a permanent body and that a further meeting to be held later in the year. The feeling was expressed that the next meeting would be assisted if the officers were first to formulate proposals as a basis for discussions. A meeting of officers of local authorities was held at Hornchurch on 9th November, 1961, details of which will be given in the Report for 1962 after the Council have considered the findings of the discussions. Emission of Smoke from Diesel Engined Vehicles The procedure whereby the Town Clerk was supplied with details of emission of smoke from diesel engined vehicles continued. The Report for 1960 mentioned a promise of co-operation by the Metropolitan Police in dealing with these nuisances, but it appears that in this borough they have taken little or no action. A patrol car was observed following an offender but even then it was ignored. Until some offenders are brought to book it is doubtful if any improvement will be effected, especially as it appears that letters from the Town Clerk to the owners of vehicles have been ineffective in most of the 15 cases reported to him. One hopes for an improvement with the advent of proposed new legislation for it must be recognised that the emision of smoke from the engines of these vehicles is unecessary and contributes to the problem of atmospheric pollution. Pet Animals Act, 1951 The holder of a licence restricted to the sale of birds and aquarium fish successfully made application for a general licence enabling him to sell puppies, cats, etc., after his premises had been altered, inspected and found satisfactory. The four previously issued licences were renewed for a further year. Rag Flock and Other Filling Materials Act, 1951 There are still no premises registered under the above Act. Petroleum (Consolidation) Act, 1928 68 licences were issued during the year of which 64 were renewals. A garage increased its capacity by 3,000 gallons, a second installed a petroiler whilst a third was licensed for the storage of 100 gallons of petroleum mixtures. A warehouse installed a storage tank for 750 gallons of petroleum for the use of its own vehicles. The Council requires that underground storage tanks installed for over 20 years are tested periodically and 21 such tests were carried out during the year. All were satisfactory. 26 Game Licenses Six licences to sell game were issued during the year. Shops Act, 1950 Although 85 visits were made during the year, no infringements of importance were observed. As in previous years shopkeepers had to be reminded that certain notices must be exhibited in accordance with the Act. No difficulties were experienced concerning hours of closing. Essex County Council Act, 1933 Massage and Special Treatment Establishments In accordance with Section 65 of the Act inspections were made to premises which had been licensed by the Essex County Council. 13 such inspections were made by the Borough's public health inspectors and no objections were made to the renewal of the licences. Heating Appliances (Fireguards) Act, 1952 The above Act was repealed by the Consumer Protection Act, 1961, which came into effect in August, 1961. Under it, regulations may be made by the Secretary of State as respects "any prescribed class of goods whether as to composition or content, design, construction, finish or packing of or relating to, goods of that class or component part thereof, as are in his opinion expedient to prevent or reduce risk of death of personal injury and any such requirements for securing that goods of that class or any component part thereof are in the prescribed manner marked with or accompanied by any prescribed warning or instructions, or any prescribed form of warning or instructions, which in the opinion of the Secretary of State is or are expedient as aforesaid''. Existing Regulations made under the 1952 Act or 1960 Act (Oil Burners (Standards)) shall apply as if they had been made under section 1 of the new Act and any references in the Regulations to either of the above mentioned Acts are to be accepted as references to the Act of 1961. No further regulations had been made by the end of 1961. 24 visits were made to shops to ensure that the requirements of the Regulations were being complied with. No prosecutions were necessary. Swimming Bath Water 5 samples of water from school swimming baths were taken and reported upon by the bacteriologist as suitable for swimming purposes. One sample was from the new type of prefabricated swimming pool now being erected at schools. These pools are constructed above ground level and are provided with filtration and sterilisation plant. Advice was given on aspects of design, layout, etc., in connection with another bath to be erected at a school. 27 There is at present a desire on the part of school staffs and Parent Teacher Associations to provide swimming pools at the schools. Such provision, in the absence of municipally owned baths, is welcome and oeneficial to the pupils provided that the staff in charge keep a careful check on the filtration, chlorination and general condition of the water. Care, too, must be taken to see that adequate water is maintained in the foot baths and to the cleanliness of the bath surrounds. The local authority, for their part, must keep an eye on these pools and sample them periodically for chemical and bacteriological examination. Testing by the use of a colour comparator is also useful. Public Health Act, 1961, Section 74 Power to reduce numbers of pigeons and other birds in built-up areas Subject to certain provisions under this section of the new Public Health Act, a local authority shall have powers to take any steps for the purpose of abating or mitigating any nuisance or damage caused by the congregation in any built-up area of house doves or pigeons or starlings or sparrows. For some years one shopping area has been troubled oy a considerable number of these birds which not only do damage of a structural nature but foul the roofs and front elevations of the buildings. A second area became affected at a later date where it was alleged that rainwater gutters were being choked, with the dropings of the birds. Complaints from occupiers of the affected areas could not in past years be dealt with because of the lack of legal powers, but when the provisions of this section became known these occupiers sought the aid of the Council in ridding them of this bird nuisance. After much information had been obtained from adjoining areas and from officers of the metropolitan boroughs a report was made by the Chief Public Health Inspector to the Council through the Public Health Committee setting out the problem and the steps which could be taken by shooting, trapping, etc. Although the matter was thoroughly discussed the Committee at that time decided to take no action. Civil Defence Staff College (Course for Public Health Inspectors) The Chief and Deputy Chief Public Health Inspectors attended the courses at Sunningdale arranged by the Ministry of Health in conjunction with the Home Office. The courses which started on Sunday evening and finished on the afternoon of the following Friday, covered some of the general principles of civil defence and matters designed to deal with mass movement of population and problems associated therewith such as provision of water supply, its purification and protection; removal of refuse and safe treatment; mass feeding; protection and examination of foodstuffs in relation to radiation "fall-out", etc. 28 The courses were instructive and interesting; much care and thought being put into the planning and presentation of the various subjects. The main critism is the fact that insufficient time was devoted to the demonstration and practical examinations, etc., of foodstuffs contaminated by fall-out. Public Relation - Admissions to Meetings The Public Health Committee at its meeting in July, considered, as did other committees whether members of the public should be admitted to its meetings and resolved that in the interests of the public generally it did not favour such admission. In September the Committee passed a similar resolution insofar as the press was concerned. Week-end School A District Public Health Inspector attended the annual Week-end School organised by the Association of Public Health Inspectors. New Legislation Lead in Foods Regulations, 1961 The Schedule to the Regulations lists specified foods and the maximum permissible percentage of lead which may be contained therein. The Regulations provide that, with certain exceptions, no other foods shall contain lead in excess of two per cent. The Regulations are effective from 16th April, 1962. Factories Act, 1961 This Act which comes into effect on the 1st April, 1962 consolidated the various Factories Acts from 1937 onwards. The sections enforceable by the local authority deal mainly with sanitary conveniences in all classes of factories and with cleanliness, overcrowding, temperature, ventilation, etc., in factories without power. Although the Act is one of some 185 sections with seven schedules, local authorities generally are concerned with the matters listed above and those applying to basement bakehouses only (9 sections). Local authorities which are also fire authorities also deal with the relevent provisions concerning means of escape in case of fire from factories. The major part of the Act is administered by H.M. Inspector of Factories who is on the staff of the Ministry of Labour. Consumer Protection Act, 1961 This Act, which came into force on 19th August, 1961, is referred to earlier in this Report under the heading Heating Appliances (Fireguards) Act, 1952. 29 Housing Act, 1961 This Act came into force in November, 1961. It is divided into three parts - Part I dealing with Exchequer subsidies for new housing accommodation; Part II with amendments of the Housing Act, 1957 and Part III with private improvements in housing, repaing obligations, etc. the Public Health Department is concerned mainly with Parts II and III. Part II give local authorities the much sought after powers to deal with the vexed problem of houses let in multiple occupation. Under this part of the Act power is given to local authorities to apply regulations, which the Mnister of Housing and Local Government is empowered to make, to houses or parts of houses let in lodgings which are occupied by members of more than one family and in an unsatisfactory state in consequence of failure to maintain standards of management, etc. Section 14 prescribes the means by which local authorities can enforce works of repair to these properties which they consider necessary to make good neglect due to bad management. Work envisaged under this section is that required to ensure repair, maintenance, cleansing and good order of all means of water supply and drainage, of kitchens, bathrooms, etc., of sinks and staircases. Section 15 gives powers to local authorities io deal with lighting (natural and artificial), ventilation, water supply, personal washing facilities, heating appliances and for the preparation and cooking of food, etc. Other sections deal with means of escape in case of fire, right of appeal by management against notice requiring execution of works, etc., the carrying out of work by a local authority in default and for fixing the highest number of individuals who should live in the house. Provision is made whereby a local authority may apply to the Minister to confirm a scheme for compiling and maintaining a register of houses or parts of houses let in lodgings, etc., but such a scheme cannot be put into effect until three years has elapsed since the commencement of the Act. Obligations to keep in good repair the structure, exterior of the dwelling house (drains, gutters, etc.) and installations for the supply of water, gas and electricity and similar items are contained in Section 32 of Part III of the Act. No Regulations were made during 1961. Public Health Act, 1961 This Act differs from the Public Health Act of 1936 in that the Minister of Housing and Local Government has been given power to make building regulations for the whole of England and Wales to supercede building byelaws made by each local authority. This part of the Act comes into force on such a date as the Minister may appoint, following which the local authorities will no longer have powers to make building byelaws. 30 Other parts of the Act came into force on the 3rd October, 1961. These deal with a variety of subjects, some new, some just extensions of the 1936 Act. In the latter category powers are given to local authorities to reduce the time lag in dealing with the examination and testing of dra'ns, the removal of stoppages and the repair thereof. It also extends local authority powers with regard to food storage accommodation, verminous premises and articles and notification of infectious disease. A part of the Act deals with new and amended legislation concerning streets, open spaces, etc., whilst new powers are given for dealing with derelict petrol tanks and reducing the number of pigeons and other birds. The section concerning derelict petrol tanks provides that "Where a fixed tank or other fixed container which has been used for the storage of petroleum spirit, and is no longer used for that purpose, is kept on any premises, the occupier of such premises shall take all such steps as may be reasonably necessary to prevent danger from the container". A duly authorised officer of the local authority shall have powers to inspect such tanks and if they have not been rendered safe then the local authority shall by notice require such steps to be taken. If the premises be unoccupied then the owner will be responsible. Enforcement powers are similar to those given in Part XII of the Public Health Act, 1936. Power to take action to reduce the number of pigeons and certain other birds is contained in section 74. Although a number of local authorities have had powers for some years through local Acts of Parliament to deal with this nuisance, no such authority has previously been given in a general Act. Nuisance from pigeons has developed considerably in the last few years to the extent that steps have had to be taken to eradicate them or at least reduce the r numbers. Reference to the situation in this borough is made in another part of this Report. The Milk (Special Designation) Regulations, 1960 These Regulations, which came into force on the 1st January, 1961 supercede previous legislation on the subject of designated milks, i.e. pasteurised, sterilised and tuberculin tested milk, by (a) discontinuing supplementary licences and permitting holders of Dealer's licences to sell outside the area of the licensing authority as well as inside (b) introducing a dealer's (pre-packed) licence where milk is sold in the same sealed containers as purchased; or is pasteurised or sterilised by the dealer (c) extending from one to five years the period for which a licence is granted. Other provisions of the Regulations concern methods of sampling, testing, storage of tuberculin tested milk, etc. Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 113 Visits in connection with contacts, disinfection, etc. 18 Enquiries in connection with food poisoning 23 Verminous Premises 12 31 General Environmental Public Health Drains and Sewers inspected Drain tests applied J 913 Stables and manure pits inspected 10 Public Conveniences and Urinals 8 Factories (mechanical) 112 Factories (non-mechanical) 2 Hairdressers' Premises 19 Schools and School Canteens 55 Ditches, Streams and Ponds 8 Open Spaces and Playing Fields 7 Petrol Inspections 283 Shops Act Inspections 85 Outworkers' premises 58 Massage Establishments 13 Pet Animals Act 9 Fairgrounds 2 Swimming Baths 5 Smoke Observations 34 Cinemas etc. 11 Rent Act 14 Tents, Vans and Sheds—Gypsies 12 Heating Appliances (Fireguards) Act and Regulations 24 Piggeries 7 Smoke Control Areas 5108 Miscellaneous 304 SECTION D HOUSING No. of dwellings erected during 1961 Council Private Enterprise 122 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) 660 (b) Number of inspections made for the purpose 1,183 32 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 58 (b) Number of inspections made for the purpose ... 72 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 114 2. Remedy of Defects during the year without service of formal notices:- Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority of their Officers 89 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 22 (2) Number of dwelling-houses which were rendered fit after service of formal notices: - (a) By owners 28 (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1 (2) Number of dwelling-houses in which defects were remedied after service of informal 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 demoli hed in pursuance of Demolition Orders 2 33 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 Occupies prosecuted (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 38 2 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 110 112 5 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises — — — — TOTAL 148 114 5 — 2. Defects Found Particulars Number of Defects Number of defects in respect of which Prosecutions were institutec Found Remedied Referred by H.M Inspector Want of cleanliness (S.l) 3 3 1 — 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 Not separate for sexes — — — — Other offences against the Act (not including offences relating to outwork) — — — — TOTAL 5 5 2 — 34 3. Outwork Number of out-workers in August list required by Section 110(l)(c) Boxes 25 25 SECTION E FOOD AND DRUGS Food and Drugs Act, 1955 the following matters were reported to the Public Health Committee with results as indicated: (a) Complaints (1) Mouldy Sausages the remains of two packets of skinless pork chipolata sausages with surface mould on them were received in the department and report made on them to tne Public Health Committee. the complainant alleged that several sausages had been cooked and thrown away because of a peculiar taste. the Committee authorised proceedings to be taken subject to satisfactory evidence being forthcoming. the prosecution was made under the Food and Drugs Act, 1955, alleging that the sausages were not of the quality demanded. The case, which was heard at Stratford Magistrates' Court, was dismissed on a submission by the defence that there was no case to answer. It would appear that the existence of a warranty between the retailer and manufacturer had led to this decision. The Town Clerk sought Counsel's opinion and in the light of this was instructed to brief Counsel and enter into a recognisance to present an appeal in the High Court. The case had not been heard at the end of the year. (2) Burnt dough in sausage roll Fined £5 plus 3 quineas costs. (3) Skinless sausages with mould Warning letter sent. (4) Bottle of pickle containing coloured string Warning letter sent. (5) Wasp in piece of cake Warning letter sent. (6) Piece of bread with alleged mouse excreta No action taken; foreign matter detached from bread. (7) Wasp in tin of pineapple No action. (8) Foreign matter in cheesecake Fined £5. (b) Samples No reports on samples taken during the year merited the attention of the Public Health Committee. 35 The following is a list of food surrendered during the year because of unsound conditions: Fish, Fresh 42 lbs. Meat, Fresh Beef 1,964 lbs. Lamb 1,251 lbs. Lambs Livers 30 lbs. Lambs Hearts 75 lbs. Ox Livers 78 lbs. Ox Kidneys 9 lbs. Pigs Melts 85 lbs. Pigs Kidneys 64 lbs. Chickens 448 lbs. Turkeys 23 lbs. Meat, Tinned Chicken 12 lbs. Pork Luncheon Meat 140 lbs. Corned Beef 106 lbs. Ham 149 lbs. Steak 1 lb Ox Tongues 18 lbs. Jellied Veal 6 lbs. Miscellaneous Tinned Foods 687 tins Other Foods Sweet confectionery 24 cartons 3 cases A list of food sampled is given below: Almond Marzipan 1 Aspirin 1 Bacon 2 Banana Flavour 1 Batter pancake flour 1 Beef curry with rice 1 Beef suet 1 Black pudding 1 Bloater paste 1 Brandy 1 Brewer's yeast 1 Butter 7 Cheese 2 Cheese spread with mushroom 1 Chicken and ham paste 1 Chocolate honeycomb 1 Cinnamon 1 Cocktail cherries 1 Coffee and chicory essence 1 Corned beef 1 Currants 1 Curry powder 1 Danish blue cheese 1 Danish Salami 1 Dates stoned 1 Demerara sugar 1 Double cream 2 Dressed Crab 1 Ground rice 1 Hamburger steak dinner 1 Honey l Instant Coffee 1 Jellied Veal 1 Jelly 2 Lard 3 Lemon curd 1 Liver sausage 2 Margarine 3 Marzipan 1 Mincemeat 1 Mint sauce 2 Minute steakettes 1 Mixed Spice 1 Nestea instant tea 1 Nutmeg 1 Olive oil 1 Onion sauce 1 Parmesan cheese 1 Pineapple 1 Plain flour 2 Pork pie 1 Potted Salmon with butter ! Pressed pork 1 Raspberry jam 2 Rum 1 Salad cream 2 36 Fish Cakes 1 School milk 1 Gin 1 Shredded beef suet 4 Gorganzola cheese 1 Skimmed milk powder 1 Ground almonds 2 Tea 2 Ground cashew nuts 1 Tomato ketchup 2 Ham 1 Whisky 2 Hamburger mince 1 White pepper 1 Yoghurt 1 98 Manufacture, Storage and Sale of Ice Cream Four 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) 31 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 31 28 2 — 1 Per cent 100 90.3 6.5 — 3.2 The unsatisfactory sample appeared to be due to the condition of the scoup. A subsequent sample was satisfactory. Food and Drugs and Bacteriological Examinations As in former years, the Food and Drugs samples were submitted to Messrs. Bernard Dyer and Partners Ltd., (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. 37 The food premises in the District may be classified as follows: - Confectioners (cakes, pasties) 32 Grocers 78 Greengrocers 34 Butchers 37 Confectioners and Tobacconists 70 Restaurants and cafes 35 Fishmongers 16 Dairies and Milkshops 10 Miscellaneous 35 of these 126 are registered for the storage and sale of ice cream; 58 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 Designation) Regulations, 1960 The following licences were issued":Dealers' Licences:- Pasteurised 18 Sterilised 26 Tuberculin Tested 15 Inspection of Food Premises and Vehicles Butchers' Shops, Stalls, etc 83 Wholesale Butchers' Depots 48 Cooked Meat Shops 7 Hotels, Boarding Houses, Etc. 13 Bakehouses 33 Fishmongers 19 Grocers 146 Restaurants and Cafes 83 Dairies and Milkshops 8 Greengrocers 59 Ice Cream Premises 17 Street Vendors 15 Food and Drugs Sampling 98 Ice Cream Sampling 35 Milk Sampling 12 Other Premises 45 Food Hygiene Regulations 552 1273 38 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease dining 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 24 4 17 — — Diphtheria — — — — — Pneumonia 16 4 25 — — Cerebrospinal Fever — — — — — Acute Poliomyelitis — — — — — Acute Polioencephalitis — — — — — Encephalitis Lethargica — — — — — Dysentery 100 30 30 — — Puerperal Pyrexia 25 25 100* — — Paratyphoid Fever — — — — — Enteric or Typhoid — — — — — Fever — — — — — Meningococcal Infection — — — — — Erysipelas 5 2 40 — — Measles 773 12 1.5 — — Whooping Cough 13 — — — — Ophthalmia Neonatorum 1 1 100* Food Poisoning 6 — — — — * These cases all occurred in hospital 39 These cases of infectious disease have been divided into age incidence and set out in the accompanying table: - Disease All Ages Under 1 yr. 1-4 yrs. 5-9 yrs. 10-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65 & Over Scarlet Fever 24 — 5 14 3 1 1 — — Pneumonia 16 — — 1 2 3 7 3 Typhoid Fever — — — — — — — — — Dysentery 100 — 13 41 16 10 11 6 3 Acute Polimyelitis — — — — — — — — — Puerperal Pyrexia 25 — — — — 13 12 — — Erysipelas 5 — — — — — 1 2 2 Measles 773 12 370 366 14 6 5 — — Whooping Cough 13 — 6 4 1 — 2 — — Ophthalmia Neonatorum 1 1 — — — — — — — Meningococcal Infection — — — — — — — — — Food Poisoning 6 — 1 1 — 1 2 1 — TOTALS 963 13 395 426 35 33 37 16 8 Poliomyelitis During 1961 no confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups. 40 41 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1941 - 1961 Year Population No. Notified Notification Rate Age Group Death Rate Under 1 1-5 5-10 10-15 15-25 25-45 Over 45 Deaths 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 0016 — — — — 1 — — — — 1949 62010 9 0.144 — 1 — 4 3 1 — — — 1950 62460 14 0.224 — 5 2 3 3 1 — — — 1951 618.50 — — — — — — — — — — — 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 — — — 1961 61230 — — — — — — — — — — — Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1961. Age Periods New Cases Deaths Pulmonary non-Pulmonary Pulmonary N on-Pulmonary M F M F M F M F Under 1 year — — — — — — — — 1-5 years — — — — — — — — 5-10 years 1 — — — — — — — 10-15 years — 1 — — — — — — 15-20 years 1 — — — — — — — 20-25 years — — — — — — — — 25-35 years 2 1 — — — — — — 35-45 years 1 — — 1 — — — — 45-55 years 6 — 1 — — — — — 55-65 years 1 — — — 1 — — — 65 and over — — — — — — — — TOTALS 12 2 1 1 1 — — — 14 2 1 — 16 1 The 1 death represents a death rate of 0.02 per 1,000 of the population. A comparative summary over the past 20 years for the Borough is set out in the following table. 42 43 Year Notifications Total Notiification Total Notification Rate Deaths Total Deaths Total Death Rate Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary No. Rate No. Rate No Rate No Rate 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 7 012 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 1961 14 0.23 2 0.03 16 0.26 1 0.02 — — 1 0.02 Rates per 1,000 population The register shows that at the end of the year:. 14 (24) Pulmonary and 2 (2) non.Pulmonary cases were notified during the year. 17 (32) cases were transferred into the District. 1 (2) cases were restored to the register. Nil (8) Pulmonary and 1 (Nil) non-Pulmonary died during the year. 24 (29) other cases were removed from the register. 604 (599) cases were remained on the register at the close of the year. The figures in brackets are the comparable figures for 1960. SECTION G PART III SERVICES FOREST HEALTH AREA SUB-COMMITTEE Membership 1961/62 Nominated by:- Name Chingford Borough Council Councillor Mrs. O.M. Game Councillor Mrs. D. King Councillor Mrs. D.M. E. Linfoot Wanstead and Woodford Alderman Mrs. E. F. M. Hollis Borough Council Councillor Mrs. I. E. C. Haselden Councillor Mrs. M. J. Thorp Councillor J. A. Vane Chigwell Urban District Councillor Mrs. V. L. M. Martin, Council J.p. 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. S. Anderson Councillor Mrs. E. Druce Waltham Holy Cross Urban Councillor Mrs. J. M. Davies District Council Epping and Ongar Rural Councillor Mrs. H. E. Howard District Council Appropriate Hospital Mrs. A. J. Morris Management Committees Executive Council for Essex Mr. J. W. R. Nation Local Medical Committee for Dr. H. Grylls Essex Essex County Council + Alderman K. E. B. Glenny Alderman A. E. Brown + Councillor Mrs. S. M. Bovill (E) Councillor W. J. Bowstead Councillor Mrs. A. E. Welch Councillor Mrs. V. L. Wilson Councillor F. A. Wortley + ex-officio members (E) Members nominated by Education Committee Voluntary Organisations Mrs. Vernon Walker Mrs. L. M. Scott Two vacancies 44 CARE OF MOTHERS AND YOUNG CHILDREN Child Welfare Clinics Attendances at Child Welfare Clinics show an increase during the year. The seven centres are held in hired premises. Doctors and Health Visitors who, sometimes work under difficult conditions, endeavour to satisfy the public in all the preventive aspects of family health. In this work they are assisted by willing groups of voluntary helpers without whom it would be difficult to run the clinics. One might well ask whether the mothers really value the advise they receive from the Clinic staff and come back for more, or is it only that the babies' dried milk and other foods can be obtained there at a more reasonable price? Perhaps it is the various injections to protect the infant from whooping cough, diphtheria and tetanus, smallpox and poliomyelitis which attract the mother. On the other hand it may be the friendly atmosphere at the clinic and the opportunity to meet with other mothers which helps to maintain the attendances. The national trend shows a decrease in attendances at Child Welfare Clinics. The number of mothers consulting the medical officers at the clinics is falling. What are the functions of the Medical Officer at the Child Welfare centre? The following views on this point have been supplied by Dr. G. Eisner, one of the Medical Officers attending Child Welfare Clinics in the Borough "The reassurance of a young mother after the great emotional experience of childbirth, at a Centre where she can talk freely to experienced personnel about every small matter which, often trivial, may assume mountainous proportions in her bewildered inexperience, provides an important stage in preventive mental health. The Child Welfare Clinic is the centre where careful watch is kept particularly during the perinatal period with its feeding difficulties and early symptoms of disorders not detected at birth. The Child Welfare Clinic is the centre where the foundation stone is laid to a positive approach to health. Regular observation of physical and mental development leads to early detection of deviation from the normal: preventive measures, immunisation, etc. I should like to stress the importance of careful listening to mothers' observations. Examples: one mother's observation that the child (aged 7 months at the time) was not kicking as vigourously with one leg as with the other, led to the detection of congenital dislocation of hip (treated successfully). The remark "is there anything wrong with my baby's eyes?" led to the diagnosis of congenital absence of irises (an extremely rare occurence) and contact lenses for a baby aged 9 months were provided at Moorfields Hospital. 45 The observation that an infant aged 10 months was bringing objects very close to his eyes led to the detection of high grade myopia, for which the infant was given spectacles at the age of 14 months. So happy is the little boy with his glasses that he cries when they are taken away from him before going to bed. Two infants with severe squint were found to have congenital cataract. Not least is the valuable observation on the attainment of "milestones" in the early detection of mental retardation." Attendance figures at the Clinics were made up as follows:- Baptist Church Hall, Aldersbrook 1,521 Ashton Playing Fields, Woodford Bridge 2,469 St. Barnabas Church Hall, Snakes Lane 3,521 Fullers Road, South Woodford 2,477 Cromwell Hall, Nightingale Lane, Wanstead 2,282 Baptist Church Hall, George Lane, S. Woodford 3,037 All Saints' Church Hall, Woodford Wells 1,256 16,563 Nurseries and Child Minders Regulation Act, 1948 Under this Act any person who receives into her home for reward three or more children under the age of five years to be looked after for the day or a substantial part of the day, and premises, other than those wholly or mainly used as a privete 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 4 135 Child Minders 2 9 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 105 attendances during the year. 46 WELFARE FOODS The distribution of Welfare Foods continued on the lines indicated in the 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 sessions and also at the W.V.S. Headquarters, 9 Cambridge Park, Wanstead, Monday, Wednesday and Friday from 10 a.m. to 4 p.m. My sincere thanks are due to the Women's Voluntary Service's members for the great assistance they give by undertaking this service. During the year the Government amended the scheme in connection with the distribution of Welfare Foods imposing a charge for the supply of Vitamin tablets and Cod Liver Oil which had previously been supplied free, and increased the price of Orange Juice. The prices for these commodities are now 6d. for the vitamin tablets, 1/- for the Cod Liver Oil and l/6d. for Orange Juice. The result of the introduction of these prices has produced a considerable reduction in the take-up of Cod Liver Oil and, to a more limited extent, Orange Juice. At the end of the year at the request of the Ministry of Health an emergency scheme was prepared to bring into operation the supply of processed milk to all infants under one year of age should this be required in connection with the results of Russian nuclear tests. VITAL STATISTICS Borough of England and Wanstead & Woodford Wales Live birth rate per 1,000 population 13.07 17.4 Still birth rate per 1,000 population 0.34 0.16 Infant Mortality Rate per 1,000 21.6 17.5 NEO NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1961 9 infants died in the first four weeks of life, a rate of 11.24. CARE OF PREMATURE INFANTS During 1961, 37 premature infants were born to residents in the Borough, 9 of these births taking place at home and 28 in hospital or nursing home. 6 of the 9 born at home were alive at the end of one month. Of the 28 born in hospital or private nursing home 24 survived. 47 MIDWIFERY There were four practising midwives in the Borough of Wanstead and Woodford during the year 1961 until May when one resigned and for the remainder of the year there were three. A good midwifery service was maintained. Training of pupil midwives in the district was continued throughout the year and good examination results were obtained by the pupils. No. of confinements attended as midwife 184 No. of confinements attended as maternity nurse, i.e. doctor also present 67 184 patients in the district received Gas & Air analgesia 48 ,, Trilene 178 ,, Pethedine Ante-Natal Clinic There were 592 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 co-operation with the general practitioners concerned. One general practitioner conducts an ante-natal clinic for his own patients at his surgery, with a Local Authority midwife in attendance. The scheme works well and achieves a maximum of co-operation between doctor and midwife. Relaxation Classes Many requests have been received from general practitioners for their patients to attend these classes which 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 the classes. Three weekly sessions are held in the Clinic at 118 Hermon Hill the classes being deliberately 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. 48 Local Obstetric Liaison Committee Three meetings of the Local Obstetric Liaison Committee of the Forest Group, of which the Medical Officer of Health is a Vice-Chairman, were held during 1961. At these meetings have been discussed the whole or certain aspects of ante-natal care, including the Pathological Service, the procedure by midwives in the use of drugs, the recruitment of domiciliary midwives and the question of short stay in hospitals for confinements. HEALTH VISITING The following table sets out statistically the work of the Health Visitors in the Borough during 1961: - Expectant mothers (first visits) 185 Expectant mothers (re-visits) 119 Infants under one year (first visits) 752 Infants under one year (re-visits) 1,278 Infants 1-5 years (first visits) 96 Infants 1-5 years (re-visits) 1,772 Stillbirth enquiries 13 Infant deaths 5 Tuberculosis patients 1,163 Aged and infirm 454 Day Nursery applications — School children 327 Other visits 383 Ineffective calls 945 7,492 The Superintendent Health Visitor, Miss C. M. W. Court, A.R.R.C., S.R.N., S.C.M., H.V.Cert., report as follows:- The Health Visiting Staff numbering 5, plus 1 Tuberculosis Health Visitor has remained at full establishment during the year. During the year a 2-day In-Service Training Course was held on Cancer Education and the New Mental Health Act. These were greatly appreciated and help to keep the Health Visitors up to date. A talk was also given by Mr. Raven of the National Assistance Board. 49 Talks to Youth Clubs, Young Wives' Clubs and Townswomen's Guilds have been given when requested. The 3 Relaxation and Mothercraft Classes for mothers-to-be have maintained a regular attendance at each session. The practice of student nurses from Wanstead Hospital being given practical training in the public health field has continued throughout the year. Two student Health Visitors (1 from Battersea School of Technology and 1 from South East Essex Technical College) received practical training in Health Visiting to correlate the practical and theoretical work of the students. HOME NURSING The Superintendent of District Nurses, Miss A. Williams, S.R.N., S.C.M., Q.I., H.V.Cert., reports as follows:- During 1961 one of the District Nurses, Miss Wade, transferred from general nursing service to take up an appointment as Domestc Help Organiser covering the Borough of Wanstead and Woodford. This left five whole-time nursing sisters and one male nurse, who have given a good nursing service. The general nursing work in the area is increasing, particularly of the elderly and chronic sick. Good co-operation has been maintained with Langthorne Hospital for the care of patients discharged on the six weeks in and six weeks out basis. Number of new cases 552 Number of nursing visits 21,996 Advisory or casual visits 491 Last offices 12 VACCINATION AND IMMUNISATION During 1961 the County Council amended their arrangements for immunisation and vaccination to provide for the use of triple antigens and also for immunisation against tetanus. This should help considerably parents who are confused by the considerable number of injections to which the infant is subjected. It is also the intention to bring into use the Sabin Oral poliomyelitis vaccine which will be considerably easier to administer. 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. Vaccination and immunisation is undertaken mainly by the family doctor but is also available at all Child Welfare Clinics. The following statistics summarise the vaccination and immunisation procedures carried out during the year: 50 Diphtheria The number of children who completed a full course of primary immunisation against diptheria is set out below:- Under 5 years of age 668 5 to 15 years of age 23 691 The number of children who received a secondary or re-inforcing injection was 817. Vaccination against Smallpox The number of persons vaccinated or re-vaccinated was:- Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary 420 87 49 67 623 Re-vaccination — 2 21 197 220 Whooping Cough The number of children immunised against Whooping Cough during the year 1961 was:- Under 6 months 6-12 months 1 year 2 years 3 years 4 years 5 years & over 119 128 5 4 1 — 3 Poliomyelitis During 1961 2,035 persons received their primary course of two injections and 2,073 received a third injection. The Minister decided that a fourth injection can be given to children reaching school entry age and under the age of 12 years, and 2,675 fourth injections were given during the year, and also that through the General Medical Service persons over 40 years of age may, if their General Practitioner considers it desirable, receive vaccination. 51 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 as shown by the following Number of X-ray Examinations 3,910 New cases notified 23 New contacts 161 Old contacts 732 B.C.G. Vaccinations 73 Notified cases transferred in 40 Notified cases transferred out 29 The Influenza Vaccine Trial, details of which were given in last year's report, was continued for another year. Much of the Chest Clinic work is now concerned with treatment and alleviation of chronic bronchitis. In Great Britain, over two million suffer from this debilitating disease and over thirty thousand die every year. Each year, chronic bronchitis causes the loss of about twenty-six million working days. The causes are varied and complicated, but there are three very important contributory factors (1) Cigarette smoking (2) Atmospheric pollution (3) Germ infection of the bronchial tubes Patients suffering from chronic bronchitis, who can be persuaded to give up smoking, invariably feel better. At the Chest Clinic, every effort is made to help patients give up smoking by example, persuasion, medical treatment and advice. In particular, we try to prevent young people and teenagers from starting the tobacco habit, which also causes or aggravates, other serious diseases, such as carcinoma and coronary heart disease. All types of lung disease, acute and chronic, are seen and those requiring further investigation and treatment are admitted to the Chest Unit of Harts Hospital. Thus, a complete in-patient and out-patient service is provided for the Borough of Wanstead and Woodford. In the field of tuberculosis, it will be seen that the notified cases have fallen from thirty-one to twenty-three. Thus, the downward trend continues to be very satisfactory. 52 Two cases are of general interest: - One young man attended in 1958, after Mass Radiography examination for his National Service, which revealed old inactive chest disease. He was kept under supervision and in April 1961, developed a tuberculous pleurisy. He was treated in Harts Hospital and discharged fit for work. Incidentally, he was subsequently rehoused as a result of Clinic representations. Another older patient attended a Mass Radiography Unit in 1956 and was found to have old-standing trouble in both lungs. He was kept under review and remained well until March 1961, when the lesion spread. He too, was admitted to Harts Hospital and later, did well with surgical treatment. He is now back at work. These two cases illustrate the value of Mass Radiography and followup Clinic supervision. There exists a close liaison between the Clinic and the Wanstead and Woodford Care Association. Patients in financial difficulties are helped in many ways - grocery vouchers, money grants, payment of certain debts (rent, clothes eic.). Besides being the centre for diagnosing, investigating and treating chest disease, the Clinic is a central bureau of information to help with the many social and economic problems that are associated with long term illness. On behalf of patients, approach is made to the National Assistance Board, the local Housing Department and the many Voluntary bodies, such as the W.V.S., for the appropriate and necessary help required." Mrs. N. L. Carter, the Honorary Secretary of the Wanstead and Woodford Tuberculosis Care Association has informed me that during the year the total income of the Association from all sources has amounted to £551 13 4d. and during the year 73 patients have been assisted in ways varying from the issue of vouchers to obtain additional nourishment, to the provision of Christmas parcels. A total of £606 19 0d. was expended on the work of the Association during the year. Income from the sale of Seals, from donations and from special functions arranged by the Association has shown considerable increase as compared to the vear 1960. Chiropody Service During 1960 the County Council amended their proposals under Section 28 of the National Health Service Act to provide for a chiropody service over the whole of the administrative County, the service to be provided by means of appointing whole-time chiropodists to work from County Council premises. 53 It is extremely difficult to obtain whole-time chiropodists qualified in accordance with the requirments of the Ministry of Health who are prepared to accept a salary in accordance with the National Scale of Salaries when it is undoubtedly more lucrative, from the individual's point of view, to establish their own private practice. The Borough, however, has been fortunate in-as-much as it has been possible to obtain the equivalent of 1½ full-time chiropodists providing a service which covers the whole of the Borough with the exception of the Woodford Bridge district. Patients requiring treatment in this district are continuing to obtain it through arrangements made by the Old People's Welfare Association in conjunction with one of the Clubs. The chiropody service provides treatment for persons of pensionable age and certain other priority categories, which includes expectant mothers and the physically handicapped. 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 12 cases from the Borough have been sent away. The length of convalescence was two weeks in each case. DOMESTIC HELP SERVICE During 1961 the Domestic Help Organiser covering the Borough of Wanstead and Woodford resigned her appointment in the area and was replaced by Miss B. Wade. The service has continued to help those in the Borough requiring coverage of household duties during acute illness and in all maternity cases where application has been made. Requests for service have also been received from Hospitals for patients returning home after treatment and needing domestic assistance in the home; these requests have had immediate attention. The Health Visitors and District Nursing Satff have been in close co-operation with the service and have brought to light patients who needed help but who otherwise might have been hesitant in asking for assistance. The W.V.S. have arranged certain days for 'Meals on Wheels' for many patients whose meals otherwise would be the entire responsibility of the Domestic Help Service; this has freed many hours of the service for other patients. The W.V.S. have also kindly visited a number of invalids and elderly patients, and have supplied bedding and clothing where urgently needed. 54 The aged, blind and handicapped in the area have received the service according to their individual needs and circumstances, varying from two hours help weekly to twc or three hours daily help. It is gratifying to report that a number of persons residing in the Borough have during the year applied to undertake duties as Domestic Helps. The number of Helps employed daily in the Borough is 104, and the average weekly number of patients receiving assistance varies between 350 and 400. 55 SCHOOL HEALTH SERVICES 1961 WANSTEAD & WOODFORD 1. School Medical Inspections There were no changes in the arrangements for the periodic examination of pupils in the schools maintained by the Local Education Authority during the year. 860 children were examined in the primary schools and 2191 in the secondary schools as follows: - 1. As entrants (5-6 years) 656 2. After admission to secondary schools (11-12 years) 880 3. At 14-15 year age range 996 4. Others 264 5. Specials (at request of Head Teacher, parent, school nurse etc.) 11 6. Re-examinations (i.e. follow-up of a defect previously noted) 244 TOTAL (All groups) 3,051 2. Cleanliness Surveys As in previous years School Nurses continued to visit primary and secondary schools at the commencement of each term for the purpose of carrying out head inspections in the Spring and Autumn terms. The nurse inspects every child up to the age of fourteen years. Children over this age are of course inspected if it is considered necessary to do so. A full survey is not carried out in the Summer term but known offenders are inspected, not only at the commencement of this and other terms, but at more frequent intervals throughout the year. 4,972 inspections were carried out and six pupils had some head infestation but all were satisfactorily cleansed by the parents. 3. B.C.G. Vaccination of 13 year old pupils In my report for last year I referred to the poor response from parents to the invitation to consent to their child's vaccination as a protection against tuberculosis and I am pleased to be able to record an increase of 7%; - 62% as compared with 55% in 1960. Whilst it is gratifying to report this improved response, I should like to see a much higher figure. Vaccination with B.C.G. was offered to 922 pupils and 579 accepted. 56 4. Tuberculosis Case Finding Among School Entrants Parents of 5 year old children who are due for their first routine medical inspection at school, are invited to give their consent, in writing to their child's participation in this scheme which has been in operation in this Borough for eight years. The purpose of the scheme is to trace, by applying a simple skin test to the child, instances of tuberculosis in an adult which may not have previously been discovered. The scheme is easy to operate and as the skin test is not done by injection but by simplified apparatus, which does not frighten or cause the child any inconvenience, the response is usually fairly high. This year 422 (68.6%) out of 615 participated. This represents a slight reduction in comparison with the previous two years - 72.21% in 1960 and 71.7% in 1959. Eight of the children tested gave a positive re-action to the test and details were given to the Chest Physician so that family contacts could be investigated. In no case was anything of significance discovered. 5. Child Guidance Service There is a growing demand for psychiatric treatment for school children and children from this Borough are referred to the clinic in High Street, Walthamstow. Unfortunately there is a lengthy list of children awaiting appointments and, except for cases of the utmost urgency which are given priority, there is a delay of at least four months. C. Defective Hearing The importance of the early detection of the loss of hearing, however slight, is apparent and I hope that in 1962 it will be possible to go a long way towards testing the hearing of every infant child entering school for the first time. I should like to see this done before the child starts school so that any hearing loss can be fully investigated and possibly alleviated before it becomes a handicap educationally. This could be of tremendous value to the teachers: for instance, if a child known to have normal hearing does not make progress educationally, then the cause of the retardation must be looked for elsewhere. The tests applied during the year fall into three categories and the results are set out below under the respective headings :- (i) Children considered to be 'At risk' (i.e. suspected to have some loss of hearing) Total No. referred 42 Results of test:- Normal hearing 14 For observation (in 1962) 21 To ENT Consultant 7 Result of ENT Examination No defect 2 Remove tonsils and/or adenoids 2 Some loss of hearing but no treatment required 3 57 (ii) Pre School Entrants No. tested 100 Normal 91 No apparent defect but observe 9 (iii) Routine tests (5-6 year age group) No. tested 40 Normal 33 No apparent defect but observe 7 (iv) Routine tests (10-11 year age group) No. tested 227 Normal 213 To be re-tested 14 Twenty nine of the thirty children in groups (ii) (iii) and (iv) were re-tested during the Xmas holiday and seen by a School Medical Officer with the following results:- Normal hearing 8 Re-test in 1962 20 Referred to ENT Consultant 1 7. School Clinic A summary of the results of the examinations carried out by the School Medical Officer at his weekly clinic at 93, High Road, South Woodford, is given at Appendix "A". 8. School Dental Service A summary of the work carried out by the Dental Staff at the clinic at 93, High Road, South Woodford is given at Appendix "B". The Dental Officer was away ill for several weeks during the year and in consequence the number of children inspected and treated is considerably lower than in previous years. 9. Speech Therapy A speech Therapist attends at two centres in the Borough - at 93, High Road, South Woodford and 118, Hermon Hill, South Woodford and two sessions (one whole day) are held at each centre. 80 individual children were treated (both centres) and between them they made 1007 attendances at the clinic. 49 were still under treatment at the end of the year. 58 10. Specialist Services By arrangement between the Essex County Council and North East Metropolitan Regional Hospital Board, the following services are provided for school children at the clinic at 93, High Road, South Woodford :- (a) Ophthalmology. (b) Orthoptic (treatment of squint). (c) Orthopaedic. (d) Physiotherapy. The services provided are adequate and there is no waiting list. 59 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 13 3 Eyes (a) Vision 23 7 (b) Squint 1 — (c) Other — — Ears (a) Hearing 4 — (b) Otitis Media — — (c) Other — — Nose or Throat — 2 Speech 24 1 Cervical Glands — — Heart and Circulation — 1 Lungs 2 — Development (a) Hernia — — (b) Other — 6 Orthopaedic (a) Posture 1 1 (b) Flat Foot i 3 (c) Other 8 4 Nervous System (a) Epilepsy — 1 (b) Other 1 1 Psychological (a) Development 12 7 (b) Stability 4 2 Other 4 1 60 APPENDIX "B" Dental Inspections and Treatment: Number of pupils inspected (periodic and specials) ... 1647 Number found to require treatment: (a) Periodic 715 1015 (b) Specials 300 Total Attendances made by pupils for treatment 1769 Fillings: Permanent teeth 1245 1628 Temporary 383 Total No. of Teeth Filled: Permanent Teeth 1176 1536 Temporary 360 Total Extractions: Permanent Teeth 20 414 Temporary 394 Total Administration of anaesthetics: (a) Local 42 185 (b) General 143 Total Other Operations: (a) Permanent Teeth 326 442 (b) Temporary 116 Total 61