AC 4411(1) BOROUGH OF WANS 27 WANSTEAD AND WOODFORD 3) Lilny F/4. Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December 1962 PUBLIC HEALTH COMMITTEE Alderman R. A. Dalton (Chairman). Alderman G. C. E. Dixon (Vice-Chairman). Alderman V. E. Stevens. Councillor N. W. Chappell. Councillor M. P. Abbott. Councillor E. V. Gardner. Councillor Miss E. V. Johnstone. Councillor G. E. Tovey. Councillor W. T. Smith. 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: A. W. Tranter, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H., D.P.H. (part time) Chief Public Health Inspector: M. G. Crook, (a) (b) (c) (d) (f) Deputy Chief Public Health Inspector: Smoke Control Officer J. T. S. Templeman, M.A.P.H.I. (a) (b) (g) Public Health Inspectors: A. J. Storer, (a) D. R. Chanin, M.A.P.H.I. (a) J. A. Orrell, M.A.P.H.I. (a) (b) (e) (resigned 30.4.62) B. M. Rom, M.A.P.H.I. (a) (b) Miss M. E. Boocock (a) (appointed 9.7.62) Student Public Health Inspector: T. Matthews (resigned 19.8.62) Clerks: R. M. Jamieson (resigned 26.8.62) Mrs. V. Birkett Mrs. E. Payton (appointed 22.10.62) Miss T. D. Pennell (part-time) H. E. M. Macalaster (appointed 18.6.62) (a) Royal Society of Health and Public Health Inspectors' Examination Joint Board Certificate. (b) Royal Society of Health Certificate of Meat and other Foods. (c) First Class Certificate in Laboratory Technique of Meat inspection of Smithfield Technical Institute. (d) Diploma of the Royal Institute of Public Health and Hygiene. (e) Royal Society of Health's Smoke Inspector's Certificate. (f) General Instructor's (Special) Certificate, Home Office Civil Defence School, Falfield, Glos. (g) City and Guilds Boiler House Praotice Certificate. Wanstead & 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 1962. This is the eighteenth 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 was administered by the Essex County Council 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 844, an increase of 43 over the previous year. Birth rate per 1,000 of the population increased from 13.07 to 13.8. As one would expect in a Borough with an ageing population and no large housing estates the birth rate was considerably lower than that for the country as a whole, which was 18.0. Death Rate. The total number of deaths was 764 and the highest aver recorded, showing an increase of 41 over the 1961 figure and of 26 over 1960. Death rate per 1,000 population was 12.5 compared with 11.9 for England and Wales. Infant Mortality Rate, i.e. the deaths of infants under one year per 1,000 live births was 20.2. This contrasts with last year's figure of 17.5 and with that for England and Wales of 21.6. Although the increase is disappointing, owing to the small numbers involved, it cannot be regarded as materially significant and is still below the national rate. Causes of Death As is usual, the commonest causes of death were diseases of the heart and arteries, and cancer. Deaths from cancer numbered 158, an increase of 21 over 1961 but only one more than the 1960 figure. There were 37 deaths from lung cancer (28 in 1961), 142 persons died as a result of coronary thrombosis (135 in 1961). Motor vehicle accidents numbered 7 and there were 4 cases of suicide (9 in 1961). Infectious Disease The incidence of infectious disease was exceptionally low. No cases of poliomyelitis were reported. There were 251 cases of measles (773 in 1961). Only 7 cases of whooping cough were notified (13 in 1961). A few years ago the incidence of this disease was high and there were serious complications in young children. Now, thanks to immunisation, whooping cough seems to be disappearing. An outbreak of food poisoning confined to a single family was found to be due to staphylococci in a can of rice pudding. The Council prosecuted the vendors on whom the magistrates imposed a fine of £20. 1 In the early part of the year Smallpox was brought into the country from Pakistan. There were a number of suspected cases in the Borough, all of which proved negative. During this period constant vigilance was necessary. Clean Air Act Considerable strides forward in the elimination of domestic smoke have been taken during the year. In the light of Ministerial relaxation in procedure, the programme of smoke control areas was re-examined and reduced from 10 years to 8 years with a completion date of October, 1967. A map of the Borough indicating the areas in operation and others proposed is included in this report. A recurrence of "smog" during December served as a timely reminder that atmospheric pollution is still with us, and as a spur to our efforts towards clean air. Care of the Elderly Considerable progress was made in the sphere of Old Peoples Welfare. During her year of office as Mayor, Councillor Mrs. S. Ashton instituted a fund which enabled her to purchase a dual purpose van to be used for extension of the Meals on Wheels service and for transport of elderly or handicapped persons to clubs, entertainments, etc. The meals service has now been expanded to provide meals regularly on four days per week. A Christmas Draw in December, 1961 resulted in a profit of almost £60. This money was placed in a Special Comforts Fund and, during September eight old people, who would not otherwise have had a holiday, were taken to Margate in the van and accommodated in a guest house for a week, free of cost to themselves. My thanks are due to the Public Health Inspectorate and the Clerical Staff for their work throughout the year. Finally I would record my appreciation of the support I have received from the Chairman and Members of the Public Health Committee. 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. 20th August, 1963. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar General's estimate mid-year 1961 61,230 Registrar General's estimate mid-year 1962 61,410 Rateable Value £1,072,857 Sum represented by penny rate £4,435 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 388 Females 409 Total 797 Illegitimate Males 25 Females 22 Total 47 Total Males 413 Females 431 Total 844 Birth-rate per 1,000 of the estimated resident population-13.8 STILLBIRTHS Legitimate Males 5 Females 7 Total 12 Illegitimate Males — Females — Total — Total Males 5 Females 7 Total 12 Rate per 1,000 total (live and still) births-14.03 DEATHS Males 391 Females 373 Total 764 Death rate per 1,000 of the estimated resident population-12.5 Deaths from puerperal causes:— Puerperal and post-abortion sepis — Other maternal causes 2 Deaths of infants under one year of age:— All infants per 1,000 live births 20.2 Legitimate infants per 1,000 legitimate live births 19.04 Illegitimate infants per 1,000 illegitimate live births 1.19 1961 1962 Deaths from Cancer 137 158 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 7 6 „ „ Suicide 9 4 „ „ Other Violent Causes 8 11 3 Population The Registrar-General's estimate of the population for 1962 (midyear) was 61,410, an increase of 180 on the figure for 1961 (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. 4 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1962 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 18.0 19.6 13.8 Still 0.35 0.33 0.19 Deaths: All Causes 11.9 12.0 12.5 Malignant Neoplasm, Lung and Bronchus 0.51 0.68 0.60 Whooping Cough 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 Tuberculosis 0.07 0.09 0.08 Influenza 0.07 0.05 0.09 Coronary Disease, Angina 2.20 2.26 2.3 Acute Poliomyelitis and Polioencephalitis 0.00 0.00 0.00 Pneumonia 0.68 0.83 0.80 (Rates per 1,000 live births) All causes under 1 year of age 21.6 21.1 20.2 Enteritis and Diarrhoea under 2 years of age 0.64 0.35 — 5 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.00 — Paratyphoid Fever 0.00 - Meningococcal Infection 0.01 — Scarlet Fever 0.33 0.26 Whooping Cough 0.18 0.11 Diphtheria 0.00 — Dysentery 0.66 0.16 Erysipelas 0.04 0.03 Smallpox — — Measles 3.96 4.11 Pneumonia 0.26 0.16 Acute Poliomyelitis (including Polioencephalitis):— Paralytic 0.00 — Non-Paralytic 0.00 — Food Poisoning 0.10 0.03 Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 8.03 40.88 6 Maternal Mortality Abortion Other Total England and Wales 0.08 0.27 0.35 Wanstead and Woodford 1.17 1.17 2.34 Causes of Death as given by the Registrar-General, 1962 Causes of Death Males Female  1. Tuberculosis (Respiratory) 3 1 4 2. Other forms of Tuberculosis 1 — 1 3. Syphilitic Disease — 1 1 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — — — 10. Malignant Neoplasm—Stomach 14 9 23 11. Malignant Neoplasm—Lung & Bronchus 31 6 37 12. Malignant Neoplasm—Breast — 11 11 13. Malignant Neoplasm—Uterus — 10 10 14. Malignant Neoplasm—Others 41 36 77 15. Leukaemia 1 2 3 16. Diabetes 2 3 5 17. Vascular Lesions—Nervous System 40 60 100 18. Coronary Disease—Angina 88 54 142 19. Hypertension with Heart Disease 7 10 17 20. Other Heart Disease 36 55 91 21. Other Circulatory Disease 19 26 45 22. Influenza 3 3 6 23. Pneumonia 25 24 49 24. Bronchitis 29 10 39 25. Other Respiratory Diseases 5 1 6 26. Ulcer of Stomach or Duodenum 3 2 5 27. Gastritis, Enteritis and Diarrhoea 1 — 1 28. Nephritis and Nephrosis 2 — 2 29. Hyperplasia of Prostate 1 — 1 30. Pregnancy, Childbirth, Abortion — 2 2 31. Congenital Malformations — 4 4 32. Other Diseases 29 32 61 33. Motor Vehicle Accidents 3 3 6 34. All Other Accidents 5 6 11 35. Suicide 2 2 4 36. Homicide and Operations of War — — — Totals, 1962 391 373 764 Totals, 1961 332 391 723 7 8 Causes of Death in Wanstead and Woodford 1951 to 1962 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 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 1962 4 l 23 37 98 100 142 250 49 39 6 157 764 Infant Deaths, Neo-Natal Mortality and Stillbirths hs 3 st Neo-Natal Mortality 16.6 11.24 16.1 19.45 9.36 During 1962 there were two deaths classified as being due to pregnancy, childbearing or associated therewith. 9 - (S ir> ir> *o vo r- oo IT) V) ^ (N vi « « « ON ON Infant Deaths, Neo-Natal Mortality and Stillbirths Year Live Births Birth Rate No. Stillbirths Neo-Natal Deaths Infant Deaths Per 1,000 Live Births Per 1,000 Population No. Per 1,000 Live Births No. Per 1,000 Live Births 1962 844 13.8 12 14.2 0.19 14 16.6 17 20.2 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 Maternal Mortality The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Year Total Births Registered Deaths Total Rates per 1,000 Birth. (Live and Still) Total Puerperal Sepsis Other Maternal Causes Puerperal Sepsis Other Maternal Causes 1962 856 - 2 2 - 2.34 2.34 1961 811 - - - - - - 1960 818 - - - - - - 1959 738 - — — - — — 1958 761 - - - - - - Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1962 1961 1960 1959 1958 Maternal Mortality 2.34 — — — — Stillbirths 14.2 12.5 13.6 25.0 17.38 Neo-Natal Mortality 16.6 11.24 16.1 19.45 9.36 During 1962 there were two deaths classified as being due to pregnancy, childbearing or associated therewith. 9 Comparative Statistics of Births, Mortality, etc., 1943 to 1962 Year Live Biiths Still Births Deaths Infant Death Maternal Deathi Population No: Rate* No: Rate† No: Rate* No: Rate§ No: Rate§ 1962 61410 844 13.8 12 14.2 764 12.5 17 20.2 2 2.34 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 *Per 1,000 Population. †Per 1,000 Total Births. §Per 1,000 Live Births. 10 11 10 SECTION B GENERAL PROVISION OF HEALTH SERVICES 1. Public Health Officers of the Authority 2. Laboratory Facilities Pathological and bacteriological services are provided at the Pathological Laboratories, Wanstead Hospital, Wanstead, and Connaught Hospital, Walthamstow. 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. Ashton Playing Fields Pavilion, Woodford Bridge Tuesday, 2.30—4 p.m. St. Barnabas Church Hall, Snakes Lane, Woodford Green Wednesday, 2.30—4 p.m. St. Mary's Memorial Hall, South Woodford, E.18 Wednesday, 2.30—4 p.m. Cromwell Hall, Nightingale Lane, Wanstead, E.l 1 Thursday, 2.30—4 p.m. George Lane Baptist Church Hall Friday, 2.30—4 p.m. All Saints Church Hall, Woodford Wells Monday, 2.30—4 p.m. 4. Ante-Natal Clinic 118 Hermon Hill, Wanstead Thursday, 2.30—4 p.m. 5. School Clinic, 93 High Road, Woodford Dental—By appointment only. Minor Ailments—Every Friday morning. †Oph'thalmic—Wednesday mornings, By appointment only. †Orthopaedic—First Thursday afternoon in each month. By appointment to see Surgeon only. All day Tuesday and Thursday afternoon. For after-treatment by appointment only. Speech Therapy—Monday and Wednesday only during school term. By appointment only. tControlled by the North East Metropolitan Regional Hospital Board and delegated to the Forest Group Hospital Management Committee. 11 6. Chest Clinic Harts Hospital, Woodford Green. Sessions: Wednesday, 9.15-11 a.m. Alternate Thursdays, 4-6 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; facilities are available locally through the depot at Ilford. 8. National Assistance Act, 1948 (Section 47) No action became necessary to secure the removal of persons in need of care and attention to suitable premises during 1962. 9. Funeral Arrangements In three cases the Local Authority was required to make arrangements for the burial of persons during the year 1962. 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 supplied to the Borough of Wanstead and Woodford has been satisfactory both in quantity and quality during the year 1962. The Borough is supplied mostly with River Lec-derived water from Lee Bridge works, but there is a small amount of additional water from the Wanstead, Ferry Lane and Chingford wells from time to time. The analytical results of the waters passing into supply from these sources were satisfactory. 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 during the year, but new mains were laid in the Borough to the extent of 475 yards. 12 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 middle of the year the market for waste paper deteriorated and at the end of the year only a very slight improvement had occurred and conditions were unpredictable. SEWERAGE AND SEWAGE DISPOSAL General Arrangements for sewerage and sewage disposal in the borough continue to be reasonably adequate although at times there is some flooding at various places as the result of sewers surcharging in heavy storms and the modernisation of Southern Sewage Works has not yet been completed. These matters are referred to below. Sewerage The firm of consulting engineers employed by the Council for main drainage and flood relief continued with the detailed preparation of schemes I (Tavistock Road Area), II (South Woodford Station area) and III (George Lane and Gates Corner), and were due to present the proposals to the Council early in 1963. The estimated cost of these two schemes is £570,000. The total cost of all the schemes will be about £1¼ million. Sewage Works (a) Eastern 1962 saw the completion of the second and final stage of the reconstruction and improvement scheme at Eastern Sewage Works. The main items of work undertaken in the second stage were the provision of micro-straining equipment which reduces the amount of suspended solids in the final effluent, the provision of comminutors and detritors and the renewal of media in the rectangular filter beds. The effect of the scheme became apparent late in 1962 when a much improved standard of effluent was obtained. 13 (b) Southern Detailed preparation of the second and final stage of the improvement scheme continued and an application for loan sanction to the Ministry of Housing and Local Government was submitted in the sum of £154,500. One of the main improvements to be afforded relates to sludge treatment and drying. Alternative modern methods were investigated and eventually it was decided that a comparatively new system known as coilfiltration should be adopted. This relies on a vacuum principle for drying the liquid sludge to a consistency suitable for easy disposal. The other main items of work to be undertaken are renewal and extension of the filter beds, improvement of the storm tanks and the reclamation and landscaping of the old drying beds and adjacent areas. Improved facilities for the sewage works staff will also be provided. 14 SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:— Housing Act, 1957 and 1961 Closing Orders In picking up the threads of the work which was started in 1961 it is now possible to report that 110 High Road was again considered and because the owner made no representation to the Public Health Committee a Closing Order on the part of the premises used for human habitation was made. 2 Clarendon Road, (Basement). The basement at this house had been unoccupied for some years because of the existence of a Closing Order made on account of dampness and general repairs. The owner eventually decided to carry out work to overcome these troubles and finally applied to the Council for the Order to be determined. The Public Health Committee, at its June meeting, agreed to this request and determined the Order. 28a High Road, Woodford Green. In this case, the ground floor back rooms and the first floor rooms were closed on account of general defects and some dampness. Before applying for the determination of the Closing Order, the owner converted the first floor accommodation into a self-contained flat, sealing off from it the ground floor room. The order was determined by the Council. Rent Act, 1957 The report of the Medical Officer of Health for 1961 stated that there was a decrease in the use made of the Act by occupiers of premises in need of repair. In studying the details of the table set out below, one must come to the conclusion that the Act is a forgotten piece of legislation. Two Certificates of Disrepair were issued in 1962, one being cancelled in the same year together with one issued before 1962. Part I—Applications for Certificates of Disrepair 1. Number of applications for Certificates (3) 2 2. Number of decisions not to issue Certificates (Nil) Nil 3. Number of decisions to issue Certificates (Form J) (2) 2 (a) in respect of some but not all defects (Nil) Nil (b) in respect of all defects (2) 2 4. Number of undertakings given by landlord (Form K) (1) Nil 5. Number of undertakings refused by local authority (Nil) Nil 6. Number of Certificates issued (Form L) (1) 2 Part II—Applications for cancellation of Certificates 7. Applications by landlords to local authority for cancellation of Certificates (Form M) (Nil) I 8. Objections by tenants to cancellation of Certificates (Nil) Nil 9. Decisions by local authority to cancel in spite of tenants' objections (Nil) Nil 10. Certificates cancelled by local authority (Nil) Nil 15 Works in default It was not necessary for the Council to do work because of default of owners, although tenders were obtained in one case. On this occasion, work commenced at a time when tenders were to be opened. Overcrowding In four cases only did the department have necessity to investigate overcrowded conditions, these being to the extent of 2½, 1 and ½ adult units respectively. The fourth case was one where the sexes were mixed. Housing Act, 1961, Part II Houses in Multiple Occupation In the changing condition in the mode of living, many people no longer occupy a whole house for their family, but rent rooms or as in many cases, a single room. What is even worse, many owners and occupiers of houses (mainly the large older type of houses) receive lodgers who share a room and all other facilities. Because of these changed conditions, the Government in the Housing Act, 1961 set aside part two in order that some wider control of such premises could be provided. To assist in this direction, the Minister of Housing and Local Government, under the powers given to him in Section 13, made regulations called the Housing (Management of Houses in Multiple Occupation) Regulations, 1962 which came into operation on 22nd May, 1962. These regulations apply where an Order as provided in Section 12 has been made. Section 15 empowers the local authority by the serving of a notice to require works dealing with natural and artificial lighting, ventilation, water supply, etc. (where such things are defective) to be provided or maintained in good condition. They must take into consideration the number of individuals or households or both, accommodated for the time being on the premises. Section 16 empowers the local authority where appropriate, to require provision of means of escape from fire. Spot checks were made during October on a number of houses where it was thought that the provisions of the Housing Act, 1961 could apply. Eighteen houses were visited and of there eleven were found to house more than two families each, the number of families varying from three to sixteen. It was during the survey that three of the overcrowding cases were found. One large house in the Wanstead area was found to have in its grounds a summer house in which a family lived without any form of sanitation or without a water supply from the Water Board's main. The Public Health Committee dealt with this case as provided for in the 1957 Housing Act. 16 Before taking any further steps, or before making further surveys, to deal with this problem it was necessary to set out standards in order that the district inspectors could work to similar requirements. The Public Health Committee at its meeting in December, considered and approved standards dealing with natural and artificial lighting, ventilation, water supply, personal washing facilities, drainage and sanitary conveniences, facilities for storage, preparation and cooking of foods, disposal of waste water and installations for space heating or for the use of space heating appliances. To conform with Section 19 of the 1961 Housing Act, a separate part of the standards approved dealt with overcrowding and the standard accepted was higher than as set out in the 1957 Housing Act, this being done because one must realise that the rooms referred to were no longer used solely for sleeping purposes, but used as bed-sitters, in which cooking and washing facilities were incorporated. Removal Expenses (Slum Clearance Houses) Payment for removal expenses are made to the occupants. In certain circumstances, payment is made in full or in part towards removal expenses incurred by occupiers moving from "slum" dwellings to alternative accommodation provided by the Council. Seventeen applications were received during the year involving the payment of £88 10s. 0d. Factories Act, 1937 A factory belonging to a builder was found to be without sufficient sanitary accommodation and difficulties existed which made such provision on the premises impossible, although accommodation was available in adjoining premises. After consultation with H.M. Inspector of factories, the Public Health Committee accepted a recommendation submitted to them that this arrangement be approved. Written agreement had been obtained from the occupants of the dwelling adjoining the factory. Public Health Act, 1936 Sections 92 and 93—Keeping of chickens Although a nuisance could not be confirmed, the runs were dug over and nesting places cleaned at premises where poultry was kept and concerning which a complaint was received by the Public Health Department. No other action was necessary. Public Health Act, 1936 Redrainage Two tenders were accepted for work of redrainage involving lengths of public sewer and drains. 17 CLEAN AIR The Smoke Control Officer reports:— Last year I referred to the intense activity on Clean Air, and this has continued during 1962. The work can be divided into three main groups, i.e. (a) Measurement of pollution. (b) Control of Pollution—Smoke Control Areas, and (c) Other activities, such as conferences and exhibitions. (a) Measurement of Pollution The department has continued measurement of pollution as part of the National Survey by means of the two daily volumetric instruments, one at Croft Lodge Close, Snakes Lane, Woodford Green, and the other at Oakhall Court, Wanstead (within No. 3 Smoke Control Area). The instrument at Croft Lodge Close is fitted with an eight port valve which automatically changes every twenty-four hours, thus ensuring complete records over week-ends and holiday periods. This device has operated satisfactorily during the year, and it is hoped to provide a similar valve for the instrument at Wanstead shortly. Details of the average yearly figures for 1962 are given below, together with the earlier years for comparison. The figures are expressed in micrograms per cubic metre:— Woodford (Croft Lodge Close) Smoke Year 1955 1956 1957 1958 1959 1960 1961 1962 Average for year 190 180 170 190 130 113 98 126 Average for winter months 320 290 310 273 190 163 178 206 Average for summer months 60 70 50 65 43 63 44 45 Highest daily recording 1530 1120 2050 1080 1080 670 720 2392 Sulphur Dioxide Year 1955 1956 1957 1958 1959 1960 1961 1962 Average for year 157 172 172 200 172 160 124 149 Average for winter months 229 257 266 245 283 222 195 221 Average for summer months 85 86 60 134 71 106 77 77 Highest daily recording 1086 1144 1973 1133 1856 984 652 2503 18 Wanstead (Oakhall Court) Smoke Year 1955 1956 1957 1958 1959 1960 1961 1962 Average for year — — — — 150 115 101 111 Average for winter months — — — — 250 178 194 179 Average for summer months — — — — 50 51 40 42 Highest daily recording — — — — 1200 1020 752 1560 Sulphur Dioxide Year 1955 1956 1957 1958 1959 1960 1961 1962 Average for year — — — — 217 163 126 147 Average for winter months — — — — 315 229 207 222 Average for summer months — — — — 71 97 71 72 Highest daily recording — — — — 1307 1410 710 1619 It will be observed that at Woodford both the smoke and S.O2 average figures for the winter months show an increase on those of 1961, with the summer figures remaining very similar. At Wanstead, the winter smoke figures showed a decrease, whilst the S.02 an increase, the summer figures as at Woodford remaining almost the same as 1961. The increase was due to a period of fog with accumulated pollution in December, similar in most respects to that of 1952. During the week prior to the fog, the readings at Woodford averaged 276 for smoke and 310 for sulphur dioxide. The highest reading of the fog period on Wednesday, 5th December, was 2,392 for smoke and 2,503 for sulphur dioxide. In other words, the smoke concentration increased by almost nine times and the S.02 by eight times. At Wanstead, the average for the week prior to the fog was 223 for smoke and 266 for S.02. The highest reading here also on Wednesday, the 5th December, was 1,560 for smoke and 1,619 for S.02. The smoke concentration in this case was increased by seven times and the sulphur by six times. 19 Bearing in mind that before the days of smoke control areas, the average pollution in Wanstead was higher than Woodford, and that our neighbours have no smoke control areas adjoining the boundary, these figures indicate that not only is There a considerable reduction in smoke concentration, but also in sulphur content within smoke control areas. We can look forward to further improvement as the smoke control areas of our neighbours link up with our own. (b) Smoke Control Areas As mentioned in the foreword of this report, the programme for the borough has been reduced from 10 years to 8 years, and this speed-up will mean that it will be completed by October, 1967. The first three areas are in operation, covering 5,897 premises and 1,264 acres. The Order for the third area was confirmed by the Minister early in the year and came into operation on the 1st October, 1962. I give below details of applications received, grants approved and paid for Nos. 1-3 Smoke Control Areas:— Smoke Control Smoke Control Smoke Control Area No. 1 Area No. 2 Area No. 3 Applications for approval of works 438 853 979 Grants approved £3,016.10. 2 £7,403.11. 2 £8,939. 1. 3 Claims received 3% 741 565 Amount of Claims paid £2,563.19. 1 £6,846. 6. 1 £4,339.19.10 The detailed survey of the fourth area of 235 acres was completed. The area includes:— Dwellings (including Council houses) 2,142 Industrial premises 26 Commercial premises 180 Other premises 13 2,361 20 It was estimated that 2,100 tons of smokeless fuel would be required to replace bituminous coal at present used, and that the estimated lata! post of renlacine and adaotinc existing fireplaces would be cerned were discussed. 21 Bearing in mind that before the days of smoke control areas, the average pollution in Wanstead was higher than Woodford, and that 20 It was estimated that 2,100 tons of smokeless fuel would be required to replace bituminous coal at present used, and that the estimated total cost of replacing and adapting existing fireplaces would be £19,435. The Order was submitted to the Minister and was confirmed at the end of the year with date of operation, 1st October, 1963. At the latter part of the year and continuing some time into 1963,extremely cold weather with snow was experienced, which placed a very severe strain upon fuel supplies and distribution. There was some shortage of smokeless fuels, particularly the specially reactive cokes such as Coalite, Rexco and Cleanglow, and practically all complaints received by this office related to delay in delivery of these fuels. I again impress on all residents within proposed smoke control areas who have unsuitable grates, to have them adapted with the assistance of grant whilst it is available. With an approved appliance, the specially reactive solid fuels, if preferred and available, can be burned more economically. In the event of supply difficulties, the appliance will operate as efficiently and at less cost with the open fire coke "Gloco" of which, even during the severe winter, supplies were available. I would also advise anyone who intends to continue burning solid fuel to consider fitting either a closed or openable stove. Not only do these appliances operate far more efficiently than an open fire, they also burn fuels—in addition to the cokes mentioned above—such as Sunbrite, Anthracite and Phurnacite. Whilst it is difficult to imagine another winter of such severity, a wise precaution in any case is to ensure that adequate fuel storage facilities are available so that fuel can be purchased during the summer at reduced prices. This will help to relieve the demand during peak winter periods and ensure supplies to those who cannot increase their storage space. Other Matters— Industrial Premises 9 notifications of intention to install new furnaces have been received during the year and in 6 cases "prior approval" of the plant was given. Conferences Two meetings of the Joint Conference of local authorities in South West Essex were held during the year, one at Chingford and the other at Ilford. Matters of general interest to the local authorities concerned were discussed. 21 This authority continued to be represented on the following bodies:— National Society for Clean Air. Standing Conference of Co-operating Bodies in the Investigation of Atmospheric Pollution (D.S.I.R.). London and Home Counties Clean Air Advisory Council. Exhibitions The mobile exhibition of the Solid Smokeless Fuel Federation was sited within smoke control area No. 3 from the 2nd-7th July, 1962. Considerable interest was shown by residents. This is a valuable service provided by the Federation, particularly as the only cost to the authority is a small amount of publicity. During September, the department contributed a Clean Air Exhibit to the Silver Jubilee Exhibition in the Council Chamber. Rodent Control Two treatments of the sewers were carried out during the year 1962, the first being restricted to those areas showing persistent takes in earlier treatments, and the second a treatment over the whole borough. It will be seen from the following table that the second treatment has revealed a considerable re-infestation. This is disappointing as it had been hoped that the use of Warfarin in addition to Arsenic and Zinc Phosphide would effectively control and reduce the infestation. It would appear therefore that consideration will have to be given to using one of the more recently introduced poisons, such as "1080." Reports from other authorities indicate that this poison, which requires expert handling, is giving satisfactory results. Results with comparison with 1961 were as follows:— 1961 1962 1st 2nd 1st 2nd Treatment Treatment Treatment Treatment M.H. treated 313 284 313 1,390 Complete takes 81 45 99 334 Partial takes 5 18 25 34 Warfarin with mould inhibitor was used for the first treatment and Zinc Phosphide for the second. 22 Wasps' Nests 63 wasps' nests were destroyed during the year. Essex County Council Act, 1933, Section 109—Permission to keep caravan on site. No application was received during the year under this Act, or under the provision of the Caravan Sites and Control of Development Act, 1960. Piggery (Eastern Sewage Works site) Reference was made in the report of the Medical Officer for 1961 to breaches of the covenant made with this Council. For years, the occupier had allowed the premises to deteriorate and fall into disrepair, and efforts by Public Health Inspectors to get the premises back into reasonable condition having proved fruitless, the Public Health Committee resolved to take action for the forfeiture of the lease. As a result of the action taken by the Council, the tenant offered to surrender his lease; the offer was accepted and the matter finalised. 23 Noise Abatement Act, 1960 A number of complaints were received during the year which were mostly of a trivial nature, e.g. in one case, singing by young people in a neighbouring house, together with the repair of a car owned by one of the occupants; in another, the playing of a piano. One complaint from the occupiers of a row of houses situated opposite a large bakery caused the Committee and its officers some concern. The bakery with a wide front extending along the arterial road bakes bread all day and night, but it is at night that the large vans load in readiness for early delivery to all parts of London and the Home Counties. Occupiers of the houses alleged that the noise from (a) the loading of racks or trays of bread into the vans and (b) the starting up and driving off of the vehicles disturbed their rest and sleep at night. At an evening meeting on 22nd June between representatives of the residents and the Public Health committee chairman, one of the Ward Councillors and the Chief Public Health Inspector, the residents described the noise made at the bakery during the night and early hours of the morning. They expressed strong feelings against the approval given to the bakery under Planning powers to develop along the road frontage. Acting on the advice given by these representatives, the two Councillors and the Chief Public Health Inspector made observation on a Friday morning between 2 a.m. and 4.30 a.m. but found nothing which could support the claim of nuisance. The occupiers stated that Friday night —Saturday morning was the noisest time. Thirty-two signatures submitted a petition to the Council in September and as an outcome, they were informed that during visits made to these premises at night by members of the Committee and by officers of the Council, no undue noise was heard, having in mind the business use of the premises and that under the circumstances, the Council could take no action, further action could be taken by individuals under the Act. Further complaints were received on various occasions in 1962 and into 1963, but one must wait for the report for 1963 to read of further developments. It can be said, however, that although advised to do so, the occupiers are reluctant to take action themselves against the bakery. Emission of Smoke from Diesel Engine Vehicles There is nothing new to report on this subject, although one anticipates some new law which will help prevent this nuisance. It can, nevertheless, be mentioned that of late some improvement has been noticed in the behaviour of these vehicles. Pet Animals Act, 1951 One shop was added to the register of Pet Shops, making a total of six. All are maintained in a satisfactory condition. 24 Riding Establishments Act, 1939 Two inspections were made by a local veterinary surgeon who reported satisfactory conditions at the two riding establishments. Rag, Flock and Other Filling Materials Act, 1951 There are still no premises registered under the above Act. Petroleum (Consolidation) Act, 1928 Sixty-seven licences to store petroleum and petroleum mixtures were issued. One section of a two compartment tank was found to be leaking and had to be sealed. To compensate for the loss of capacity, the proprietor installed a new tank with increased capacity of 1,500 gallons. The defective tank was not one of some considerable age. One garage not previously selling petrol, installed a tank to hold 3,000 gallons. An application to store 600 gallons was received in the case where a new factory was being erected. The storage accommodation was not provided during the year. A builders' merchant was granted a licence to store 60 gallons of mixture. Sixteen tests were made on tanks over 20 years old. None was found to be defective. Game Licences Six licences to sell game were issued during the year. Shops Act, 1950 In the light of changing conditions, one firm (a small multiple with two local shops) decided to close all day on Monday and keep open all day on Thursday. The late day is now on Friday and time of closing 8 p.m. This arrangement is possible because this Council has not made an order regarding half-day closing. Because it was noticed that motor showrooms were keeping open on the recognised early closing day, the firms were informed that an infringement of the Act had been made. Evidence was produced to the Council that it was the wish of motor traders generally that their business should be excepted from the requirement of Section 1 of the Act. It was resolved at the Public Health Committee that the Council, pursuant to the powers conferred upon it by Section 1 (4) of this Act, hereby makes an order such order to be cited as the Wanstead and Woodford (Motor Traders) Half Holiday Exception Order. Infringement—Sunday trading. One motor trader was warned in a lettter that action might be taken against him if he continued to open his showroom on Sundays. Two Public Health Inspectors visited the showroom on a Sunday morning and were shown various cars and were offered a trial run in one of the cars on show by the attendant. This matter was not dealt with until the middle of September, consequently, no further information is available as to future developments. 25 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 licenced by the Essex County Council. Ten such inspections were carried out and no objections were made to the renewal of the licences. Consumer Protection Act, 1961 No infringements of this Act (which deals with standards of protection on various forms of gas, electric and oil heaters) were observed. Five heaters were examined during the year. Swimming Bath water Six samples of water used in swimming baths were examined, both chemically and bacteriologically and found to be satisfactory for swimming purposes. All the baths are in use in schools, the Council not owning a public swimming bath. Public Health Act, 1961. Section 74—Power to reduce number of pigeons and other birds in built-up areas. A report in 1961 (recorded in the report of the Medical Officer of Health for 1961) set out for the Public Health Committee, the extent of the pigeon problem in the borough. Although two shopping areas were affected, these being in George Lane and The Broadway, the Committee decided not to take any action. However, early in 1962, the matter was again raised in Committee by a Councillor and a full report called for. The report gave details of the problem, methods available to reduce the number and the cost involved if shooting was resorted to. In the June Public Health Committee, it was resolved that a quotation from a contractor residing in a neighbouring borough in the sum of £50 be accepted. This contractor exterminated the pigeons by shooting them in the early hours of the morning. He was visited by the Chief Public Health Inspector, when he found that the killing was quick and painless, and the noise negligible, so much so that residents were not disturbed from their sleep. The operations continued from August until well on into the year 1963, although even at the end of the year under review, an improvement could be seen. Weekend School As in previous years, a District Public Health Inspector attended the weekend school organised by the Association of Public Health Inspectors. 26 Inspections carried out by Public Health Inspectors Infectious Disease enquiries, including enquiries in respect of scabies 19 Visits in connection with contacts, disinfection, etc. 1 Enquiries in connection with food poisoning 6 Verminous Premises 6 General Environmental Public Health Drains and Sewers inspected Drain tests applied 661 Stables and manure pits inspected Nil Public Conveniences and Urinals 10 Factories (mechanical) 109 Factories (non-mechanical) 16 Hairdressers' Premises 23 Schools and School Canteens 22 Ditches, Streams and Ponds 8 Open Spaces and Playing Fields 1 Petrol Inspections 309 Shops Act Inspections 149 Outworkers' premises 23 Massage Establishments 10 Pet Animals Act 2 Fairgrounds 1 Swimming Baths 6 Smoke Observations 4 Cinemas etc. 2 Rent Act 6 Tents, Vans and Sheds—Gypsies 8 Heating Appliances (Fireguards) Act and Regulations 5 Licensing Act 19 Smoke Control Areas 4485 Multiple Occupations 20 Miscellaneous 382 SECTION D HOUSING No. of dwellings erected during 1962:— Council 30 Private Enterprise 197 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) 923 (b) Number of inspections made for the purpose 1242 27 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 90 (b) Number of inspections made for the purpose 182 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 93 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 41 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9 and 10 of the Housing Act, 1957:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 46 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 15 (b) By Local Authority in default of owners 1 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 47 (2) Number of dwelling houses in which defects were remedied after service of informal notices:— (a) By owners 41 (b) By Local Authority in default of owners Nil (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 Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 28 Notices served Public Health Act, 1936 Preliminary Statutory Section 93 42 1 „ 24 — 23 "39 1 5 "45 1 2 " 75 1 - Public Health Act, 1961 Section 17 — 2 Housing Act, 1957 Section 9 25 25 Factories Act 1 - FACTORIES ACT, 1937 1. Inspections for the purposes of provisions as to health (including Inspections made by Public Health Inspectors). Premises (1) Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 34 16 - - (ii) Factories not included in (i) to which Section 7 applies 114 114 1 — (iii) Other Premises under the Act (excluding out-workers' premises) — — — — TOTAL 148 130 1 — 2. Defects Found Particulars Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred by H.M. Inspector Want of cleanliness 2 2 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation - - - - Ineffective drainage of floors Sanitary conveniences: - - — — 1 Insufficient 1 1 - - 2 Unsuitable or defective - - - - 3 Not separate for sexes 1 1 - - Other offences — — — - TOTAL 4 4 — — 3. Outwork Number of out-workers in August list required by Section 110(1)(c) Boxes 28 28 30 SECTION E FOOD AND DRUGS Food and Drugs Act, 1955 The following matters were reported to the Public Health Committee who took the action indicated: (a) Complaints (1) Mouldy Sausages The report for 1961 contained reference to a prosecution in connection with the sale of mouldy chipolata sausages. The case was heard at the Stratford Magistrates' Court and was dismissed on a submission by the defence that there was no case to answer. As reported previously, the case was sent to appeal in the High Court. The case was heard before the Lord Chief Justice who allowed the appeal with costs and ordered that the case be remitted to the Magistrates' Court for the hearing to continue. On April 5th, 1962, the Magistrate again heard the case and found that the food sold was not of the quality demanded and accordingly convicted the defending company and imposed a fine of £20 with 10 guineas costs. The defendants appealed to the Sessions Court against the conviction, the appeal being dismissed with costs against the appellant. (2) Loaf of bread with mice No action. Dirt was poppy seeds. excreta (3) Fairy Cake containing glass Fined £5. (4) Cream Bun—glass in filling Fined £10, plus 2 guineas costs. (5) String found in bread roll Warning letter sent. containing spam filling (6) Sausages containing rusty Warning letter sent. pin (7) Pork pie with mould No action. (8) Sausage roll containing Warning letter sent. foreign matter (9) Chicken & Veal pies (2) Fined 10 guineas plus 2 guineas costs. (10) Small Swiss rolls (2) mouldy Fined 10 guineas plus 2 guineas costs (b) Samples No reports on samples taken during the year merited the attention of the Public Health Committee. (c) Bacteriological Samples Desiccated coconut. One sample of desiccated coconut was sent to the laboratories for bacteriological examination and was reported to be of a satisfactory standard. Frozen whole egg. 3 samples were sent for bacteriological examination and were reported by the laboratories to be free from salmonella contamination. 31 Food Hygiene Infringements— Food Hygiene (General) Regulations, 1960 The Public Health Committee agreed to take action against a greengrocer for an offence against Section 23 of the above regulation because he did not keep the corrugated roof of a food room at the rear of the premises in good order. The report to the Committee was made in December and the case heard in 1963. Meat and Food Inspection Frequent inspections of the local wholesale meat depot have been made during the year, and of vans and vehicles using the premises. Considerable preparation of meat at the premises for manufacturing purposes, and the growing export trade in boneless meat, necessitates a close watch being kept on hygienic standards. In general, a satisfactory standard has been maintained. A large consignment of mixed bones to a soup manufacturer were delayed in transit and as will be seen from the following list were dealt with as unfit for human consumption. Two firms within the borough have secured contracts with Education authorities for the supply of meat for school meals over a wide area. It is most desirable that there should be very close liaison between the Education authorities and the local authority on this matter. During the year a large wholesale grocery firm moved into its new depot in Roding Lane. This has added considerably both to the general duties under the Food Hygiene Regulations, and the inspection of foods, particularly tinned goods. It will be observed, also from the following list, that the number of tinned goods dealt with shows a large increase on past years, and it is likely that time devoted to this aspect of the work will increase in the future. The bacon curing plant at these premises was not completed during the year, but it is anticipated that it will come into full operation during 1963. This is a very modern plant incorporating equipment to prevent the emission of smoke and odours to the atmosphere, and its operation is awaited with considerable interest. The following is a list of food surrendered during the year 1962 because of unsound conditions:— MEAT, Fresh MEAT, Tinned Beef 1,695 lbs. Corned Beef 550 lbs. Lamb 20 lbs. Chicken 22 lbs. Mutton 31 lbs. Ham 424 lbs. Ox Kidneys 30 lbs. Jellied Veal 82 lbs. Ox Tongues 86 lbs. Pork 219 lbs. Chickens 84 lbs. Pork Luncheon Meat 322 lbs. Mixed Bones 11 tons 3 cwt. Ox Tongues 86 lbs. Other Foods Stewed Steak 63 lbs. Cereals 3 lbs. Prunes 150 lbs. Miscellaneous Tinned Foods Eggs 5 1,808 tins 32 A list of food sampled is given below: Almond Marzipan 1 Apples 10 Apple Tart 1 Aspirins 1 Bacon 1 Baking Powder 1 Blackcurrant & Glycerine Pastilles 1 Blackcurrant Juice Cordial 1 Butter 3 Cheese spread with shrimp 1 Cherry Cough Linctus 1 Chicken Croquette 1 Chocolate Fingers 1 Chopped Ham 1 Chopped Ham with Pork 1 Chopped Roast Turkey 1 Christmas Pudding 1 Cocoa 1 Coffee 1 Concentrated Gingerade 1 Currant Pudding 1 Custard Powder 2 Danish Salami 1 Desiccated Coconut 1 Double Cream 2 Fairy Cakes 1 Fruit Cake 1 Fruitarian Luncheon 1 Glace Cherries 1 Glycerine & Thymol Pastilles 1 Ground Almonds 1 Ground Ginger 2 Ground White Pepper 1 Ham & Chicken Roll 1 Horseradish Relish 1 Instant Coffee 1 Jam Sandwich Biscuits 1 Jelly 1 Lancashire Rarebit 1 Lemon, Glycerine & Apeccac. 1 Lemon 1 Lemon curd tart 1 Lemon Jelly 1 Lemonade Crystals 1 Liver Sausage 1 Luncheon Meat 1 Malt Vinegar 1 Minced Beef 5 Mint 1 Mint Jelly 1 Mixed Peel 1 Olive Oil 1 Pearl Tapioca 1 Piccalilli Mustard Pickle 1 Plain Flour 1 Pork Luncheon Meat 2 Pork Pie 1 Pressed Beef 1 Quick Flan 1 Rose Hip Syrup 1 Sago 2 Sauce 1 Saveloys 1 Spam 1 Stewed Steak 1 Stuffed Pork Meat Roll 1 Sugared Straws 1 Sweet Pickle 1 Tea 3 Tomato Ketchup 1 Tomato Paste 1 Vegetable Curry with Rice 1 White Pepper 1 95 33 The Milk (Special Designation) Regulations, 1960 Three Licences were transferred to the new owners of three previously licensed premises. Five samples of milk were taken all of which were reported as satisfactory Manufacture, Storage and Sale of Ice Cream Two applications for premises to be registered for the storage and sale of ice cream were received and considered by the Public Health Committee. Both were granted. Ice Cream (Bacteriological Examination) 33 samples of ice cream were obtained and the results were as follows: Ministry of Health's Provisional Grading Gride Grade Grade Grade Taken I II III IV Nos. 33 30 1 1 1 Per cent 100 90.91 3.03 3.03 3.03 The unsatisfactory sample appeared to be due to the condition of the scoop. 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.l.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., 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., Thresh House, Verulam Street, Gray's Inn Road, W.C.1. The Department is appreciative of the help given by these two laboratories during the year. 34 The food premises in the District may be classified as follows:— Confectioners (cakes, pasties) 31 Grocers 80 Greengrocers 37 Butchers 33 Confectioners and Tobacconists 67 Restaurants and cafes 40 Fishmongers 15 Dairies and Milkshops 10 Miscellaneous 65 of these 128 are registered for the storage and sale of ice cream; 59 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. Inspection of Food Premises and Vehicles Butchers' Shops, Stalls, etc. 79 Wholesale Butchers' Depots 63 Fish Fryers 6 Hotels, Boarding Houses, Etc. 12 Bakehouses 61 Fishmongers 35 Grocers 160 Restaurants and Cafes 90 Dairies and Milkshops 9 Greengrocers 61 Ice Cream Premises 45 Street Vendors 6 Food and Drugs Sampling 95 Ice Cream Sampling 33 Milk Sampling 5 Other Premises 181 Food Hygiene Regulations 210 1151 35 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease during the year, together with the number and percentages of cases admitted to hospital and the number and percentage of deaths. Disease Total Notified Removed to Hospital Per cent Removed to Hospital Deaths Deaths per cent of cases Notified Smallpox - - - - - Scarlet Fever 16 — — — — Diphtheria - - - - - Pneumonia 10 5 50 — — Cerebro-Spinal Fever - - - - - Acute Poliomyelitis - - - - - Acute Polioencephalitis — — — — — Encephalitis Lethargica - - - - - Dysentry 10 — — — — Puerperal Pyrexia 35 35 100* — — Paratyphoid Fever — — — — — Enteric or Typhoid Fever - - - - - Meningococcal Infection — — — — — Erysipelas 2 — — — — Measles 251 1 .39 — — Whooping Cough 7 — — — — Ophthalmia Neonatorum 1 1 100* — — Food Poisoning 2 — — — — *These cases all occurred in hospital 36 These cases of infectious disease have been divided into age incidence and set out in the accompanying table:— Disease All Ages Under 1 yr. 1-4 yrs. 5-9 yrs. 10-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65 & Over Scarlet Fever 16 — 3 9 2 2 — — — Pneumonia 10 — 2 1 — — 2 1 4 Typhoid Fever - - - - - - - - - Dysentery 10 — 1 — 2 1 5 1 — Acute Poliomyelitis - - - - - - - - - Puerperal Pyrexia 35 — — — — 15 20 — - Erysipelas 2 — — — — — — 1 1 Measles 251 — 100 141 6 1 3 — — Whooping Cough 7 — 5 — — 1 1 — — Ophthalmia Neonatorum 1 1 - - - - - - — Meningococcal Infection - - - - - - - - - Food Poisoning 2 — — — — 2 — — — TOTALS 334 1 111 151 10 22 31 3 5 Poliomyelitis During 1962 no confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups. 37 38 POLIOMYELITIS INCIDENCE IN WAN STEAD AND WOODFORD, 1942- 1962 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 1942 49850 - - - - - - - - - - - 1943 50010 - - - - - - - - - - - 1944 46670 - - - - - - - - - - - 1945 48230 4 0.082 — — 4 — — — — — — 1946 57570 1 0.017 - - - 1 - - - - - 1947 60280 10 0.165 2 — 1 1 2 4 — — - 1948 61150 1 0.016 - - - - 1 - - - - 1949 62010 9 0.144 — 1 — 4 3 1 — — - 1950 62460 14 0.224 — 5 2 3 3 1 — — — 1951 61850 — — — — — — — — — — — 1952 61880 8 0.129 — 1 1 4 — 2 — — — 1953 61540 13 0.211 — — 4 3 3 3 — — — 1954 61550 6 0.097 — — 3 1 — 1 1 — — 1955 61380 12 0.190 1 3 5 — 2 1 — — — 1956 61130 1 0.016 1 - - - - - - - - 1957 60970 5 0.079 1 — — 1 2 1 — — — 1958 61220 1 0.016 - - 1 - - - - - - 1959 61620 2 0.033 — 2 - - - - - - - 1960 61500 2 0.032 — 1 — — — 1 — — — 1961 61230 - - - - - - - - - - - 1962 61410 - - - - - - - - - - - Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1962. Age Periods New Cases Deaths Pulmonary N on-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 year - - - - - - - - 1-5 years 1 1 — — — — — — 5-10 years - - - - - - - - 10-15 years - - - - - - - - 15-20 years 2 - - - - - - - 20-25 years - - - - - - - - 25-35 years 3 1 - - - - - - 35-45 years — 1 - - - - - - 45-55 years 1 — — — — 1 — — 55-65 years 4 - - - - - - — 65 and over — 2 - - - - - - TOTALS 11 5 — — — 1 — — 16 Nil 1 Nil 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. 39 40 Year Notifications Total Notifications Total Notification Rate Deaths Total Deaths Total Death Rate Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary No. Rate No. Rate No. Rate No. Rate 1943 38 0.75 14 0.27 52 1.39 19 0.37 5 0.09 24 0.47 1944 43 0.92 13 0.27 56 1.19 16 0.34 4 0.08 20 0.43 1945 47 0.97 11 0.22 58 1.22 14 0.29 5 0.13 19 0.39 1946 50 0.86 7 0.12 57 0.99 28 0.48 4 0.06 32 0.55 1947 39 0.64 7 0.11 46 0.76 20 0.33 1 0.01 21 0.34 1948 38 0.62 5 0.08 43 0.71 16 0.26 3 0.04 19 0.34 1949 50 0.80 14 0.22 64 1.03 19 0.30 2 0.03 21 0.34 1950 41 0.65 4 0.06 45 0.72 14 0.22 1 0.02 15 0.24 1951 42 0.68 7 0.11 49 0.79 10 0.16 3 0.05 13 0.21 1952 47 0.76 4 0.06 51 0.82 10 0.16 - — 10 0.16 1953 48 0.78 4 0.06 52 0.84 3 0.05 2 0.03 5 0.08 1954 38 0.61 6 0.10 44 0.71 2 0.03 1 0.02 3 0.05 1955 25 0.42 11 0.17 36 0.59 3 0.03 1 0.02 4 0.05 1956 30 0.49 2 0.03 32 0.52 6 0.09 1 0.02 7 0.11 1957 26 0.42 1 0.01 27 0.43 2 0.03 1 0.01 3 0.01 1958 32 0.52 2 0.03 34 0.55 3 0.05 - — 3 0.05 1959 18 0.29 — — 18 0.29 4 0.06 1 0.02 5 0.08 1960 24 0.39 2 0.03 26 0.42 7 0.11 - — 7 0.11 1961 14 0.23 2 0.03 16 0.26 1 0.02 - — 1 0.02 1962 16 0.26 — - 16 0.26 1 0.02 - — 1 0.02 Rates per 1,000 population The register shows that at the end of the year:— 16 (14) Pulmonary and Nil (2) non-Pulmonary cases were notified during the year. 17 (17) cases were transferred into the District. 1 (1) case was restored to the register. Nil (Nil) Pulmonary and 1 (1) non-Pulmonary died during the year. 28 (24) other cases were removed from the register. 609 (604) cases remained on the register at the close of the year The figures in brackets are the comparable figures for 1961. SECTION G PART III SERVICES FOREST HEALTH AREA SUB-COMMITTEE Membership 1962/63 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 M.B.E. Councillor Mrs. I. E. C. Haselden Councillor Mrs. M. J. Thorp Councillor J. A. Vane Chigwell Urban District Councillor G. Castleman Council Councillor D. F. Ellis Councillor W. S. North Councillor E. G. Perry 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 Mr. G. M. Williams One vacancy 41 CARE OF MOTHERS AND YOUNG CHILDREN Health Services Clinics The need for a modern all-purpose Health Services Clinic in the Borough has been felt for very many years, and this matter has been given some degree of priority during the year, for the County Council have included in their draft ten-year development plan the proposed erection of such a clinic, complete with two dental suites, during the financial year 1963/64. Child Welfare Clinics Attendances at Child Welfare Clinics have again increased during the year, in spite of the sessions being held in somewhat old, hired premises. The Doctors and Health Visitors, with their willing groups of voluntary helpers have continued to endeavour to satisfy the public in all the preventive aspects of family health. It is interesting to note the increased attendance at these Clinics in this Borough when the national trend shows a decrease. The maximum co-operation with general practitioners is maintained and in one instance a health visitor attends a general practitioner's own "Well-Baby" clinic. The following are the attendance figures for 1962 at the seven child welfare clinics:— Baptist Church Hall, Aldersbrook 1.417 Ashton Playing Fields, Woodford Bridge 2,304 St. Barnabas Church Hall, Snakes Lane 3,879 St. Mary's Memorial Hall, S. Woodford 2,881 Cromwell Hall, Nightingale Lane. Wanstead 2,114 Baptist Church Hall. George Lane, S. Woodford 3,188 All Saints' Church Hall, Woodford Wells 1,491 17,274 42 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 private dwelling, are required to be registered with the Local Health Authority. It has been apparent during the year that the demand by parents of young children for play groups and nursery classes where these children can have the companionship of others, is increasing. 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 6 191 Child Minders 1 6 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 68 attendances during the year. 43 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 Service. 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. This is the first full year in which a charge for vitamin tablets and cod liver oil has been made, and the charge for orange juice increased. The introduction of these charges showed a reduction in the take-up of cod liver oil and, to some extent, orange juice. My sincere thanks are largely due to the Women's Voluntary Service members for the great assistance they give by undertaking this service. VITAL STATISTICS Borough of England and Wanstead & Woodford Wales Live birth rate per 1,000 population 13.8 18.0 Still birth rate per 1,000 population 0.19 0.35 Infant Mortality Rate per 1,000 20.2 21.6 NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1962 14 infants died in the first four weeks of life, a rate of 16.6. 44 CARE OF PREMATURE INFANTS During 1962, 49 premature infants were born to residents in the Borough, 3 of these births taking place at home and 46 in hospital or nursing home. All 6 born at home were alive at the end of one month. Of the 46 born in hospital or private nursing home 38 survived. MIDWIFERY There were three practising Midwives in the Borough of Wanstead and Woodford for the first part of the year, and on 24th April, 1962, Miss R. M. Beresford was appointed as a Relief Midwife. Arrangements have now been made for all staff to have alternate week-ends off duty and a week-day off. Ten Part II Pupil Midwives have received their training in the Borough during the year with satisfactory results. Supervision of the Part II Midwifery Training is undertaken by Miss A. Williams, S.R.N., S.C.M., Q.I., H.V.Cert., Non-Medical Supervisor of Midwives. No. of confinements attended 235 173 patients received Gas and Air analgesia 44 patients received Trilene analgesia 200 patients received Pethedine or Pethelorfan 45 Ante-Natal Clinics There were 755 attendances at the Ante-Natal Clinic, 118 Hermon Hill, E.18, 163 higher than in 1961. The sessions are held weekly by the Midwives, working in close co-operation with the patient's own doctor Relaxation 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. These classes have continued to retain their popularity with expectant mothers, many expressing their appreciation of the advice they have been given and the help it has been when put into practice at the time of their confinement. General medical practitioners are continuing to advise their patients to attend these classes at which the opportunity is also taken to give short talks on preparation for the confinement and on personal hygiene for mother and infant. Local Obstetric Liaison Committee Four meetings of the Local Obstetric Liaison Committee, on which the Medical Officer of Health serves, were held during the year. This Committee was formed in accordance with a recommendation of the Cranbrook report and its membership is composed of representatives of the hospital, local health authority and general practitioner representatives services. 46 HEALTH VISITING (Section 24) The Superintendent Health Visitor, Miss C. M. W. Court, A.R.R.C., S.R.N., S.C.M., H.V. Cert reports as follows:— The five health visitors have continued to maintain the closest co-operation both with the general medical practitioners and with the hospitals serving the area. They have continued to visit hospitals to discuss with the medical staff various cases and have also consulted with the Psychiatric Social Workers at the Child Guidance Clinic. The practice of student nurses from Wanstead Hospital being given practical training in the public health field has continued, and one County sponsored student health visitor has also undertaken her practical work in the Borough. The following table sets out statistically the work of the Health Visitors in the Borough during 1962:— Expectant mothers (first visits) 179 Expectant mothers (re-visits) 152 Infants under one year (first visits) 774 Infants under one year (re-visits) 1,289 Infants 1-5 years (first visits) 107 Infants 1-5 years (re-visits) 1,699 Stillbirth enquiries 15 Infant deaths 10 Tuberculosis patients 1,096 Aged and infirm 489 Day Nursery applications 23 School children 224 Other visits 234 Inefective calls 1,108 7,399 47 HOME NURSING (Section 25) The Nursing Superintendent of District Nurses, Miss A. Williams, S.R.N., S.C.M., Q.I., H.V. Cert., reports as follows:— A good nursing service has been given to the patients in the Borough during the year 1962 by the five whole-time General District Nurses and the one part-time nurse who was appointed on the 24th April, 1962. A great deal of the work undertaken by the nurses during the year has been the care of the elderly and chronic sick patients. Good cooperation has been maintained with Langthorne Hospital for the care of patients on the six weeks in and out basis. This system is working well and is a great help to the patients' relatives and to the nursing staff. Student Nurses from Wanstead Hospital have been taken into the homes of the patients throughout the year to get an insight into the domiciliary work. Number of new cases 629 Number of visits 29,781 Last offices performed - Advisory or Casual visits 453 48 VACCINATION AND IMMUNISATION Intensive propaganda both in the form of leaflets and birthday cards, as well as by the personal approach from the health visitors and the medical officers attending the Child Welfare Clinics, is maintained to ensure that all infants are immunised and in order to maintain the vaccinal state of the public. The County Council are using for this purpose combined antigens and during 1962 introduced the Oral Poliomyelitis Vaccine which is so much easier to administer. Vaccination and immunisation is carried out largely by the family doctor although it is available also at all the Child Welfare Clinics, and in the case of adults, where necessary, by special sessions arranged at the School Clinic. The following statistical information is supplied on the programme carried out during the year:— Poliomyelitis Oral Vaccine Primary Course 185 3rd dose 487 4th dose 321 Salk Vaccine Primary Course 925 3rd injection 1,459 4th injection 860 Diphtheria/Tetanus/Whooping Cough Primary Courses Under 5 years of age 318 5 to 15 years of age 6 Re-inforcing injections 63 Diphtheria/Tetanus Primary Courses Under 5 years of age 14 5 to 15 years of age 13 Re-inforcing injections 27 49 Diphtheria Primary Courses Under 5 years of age 231 5 to 15 years of age 13 Re-inforcing injections 247 Tetanus Primary Courses Under 5 years of age 20 5 to 15 years of age 45 over 15 years of age 33 Whooping Cough Primary Courses Under 5 years of age 43 Re-inforcing injections 5 Vaccination against Smallpox The number of persons vaccinated or re-vaccinated was:— Under 1 1-4 years 5-14 years 15 or over Total Primary 609 400 1,192 554 2,755 Re-vaccination — 154 1,784 5,770 7,708 50 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. D. 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 4,182 Attendances : New Contacts 157 Old Contacts 726 Total—Contacts, Notified and Observations 4,298 B.C.G. Vaccinations 76 New cases notified 20 Notified cases transferred in 17 Notified cases transferred out 30 Deaths 6 Discharged Disease Arrested 7 The progressive fall in the number of new cases of pulmonary tuberculosis is very encouraging. In my previous reports, I have always advocated that to achieve the ultimate objective of the elimination of tuberculosis, constant vigilance must be exercised and it is imperative that we maintain an organised and comprehensive anti-tuberculosis scheme. This is the continued aim of our Clinic. I would call to mind the pre-war Tuberculosis Dispensaries, happily now renamed Chest Clinics. The original functions of a Dispensary were:— (1) Receiving house and centre of diagnosis. (2) Clearing house and centre for observation. (3) Centre for curative treatment and supervision of Domiciliary cases. (4) Centre for examination of contacts. (5) Centre for "after care". (6) Informaion bureau and educational centre. The continuing decline in mortality and notification rates of tuberculosis is due to social advances and preventive measures, as well as the great progress made in diagnostic and therapeutic methods. While tuberculosis still claims our attention, its reduced incidence means that we can apply all the above mentioned functions of the old Tuberculosis Dispensary to develop a complete service, which will embrace all aspects of chest disease. Every type of acute or chronic inflamatory lung infection is now the concern of our Clinic, together with their social significance on the patient, his family and the general community. The local General Practitioner is making ever increasing use of the facilities of the Chest Clinic and referring cases of bronchitis, emphysema, pneumonia, asthma, bronchiectasis and lung and bronchial cancers, for investigation and treatment. Many cases of heart disease also attend, presenting symptoms such as cough, breathlessness, thoracic pain and haemoptysis. 51 The Wanstead and Woodford Chest Clinic is closely connected with the Chest Unit of Harts Hospital and as a result, patients are quickly admitted. Special emphasis is laid on the need for health and hygiene education and a large number of informative pamphlets and booklets on such subjects as bronchitis, lung cancer, tuberculosis, B.C.G. Vaccination and chest remedial exercises, are issued free to our patients. Special mention must be made of the Physiotherapy Department, where the chronic lung sufferer is shown the methods of achieving postural drainage and is taught chest remedical exercises, to improve his ventilatory capacity. A more recent development is the setting up of an Allergic Diagnostic Clinic, which is of great value in the treatment of asthma, hay fever and other sensitisation chest disorders. The following cases illustrate the work of the Chest Clinic A child, aged 1 year 11 months, was examined as a contact to his uncle, who was a case of acute pulmonary tuberculosis. This child was found to be suffering from primary lung tuberculosis. Prolonged Clinic observation is necessary for close contacts. In 1960, a husband was notified and treated for active lung tuberculosis. Two years later, his wife was also found to have the same condition. This was discovered by routine chest examination and further investigation showed that a young nephew also had developed a primary infection. A girl aged 6 had a positive Skin Test at school annd was referred for complete investigation. Fortunately, no treatment was required. When, however, her father was examined, he was found to have old-standing tuberculosis and continued supervision at the Clinic, finally resulted in the detection o' a positive sputum. The above case illustrates the value of the Skin Testing routine carried out by the School Medical Service and the close liaison which exists with the Chest Clinic. School children found to have positive Skin Tests in these Tuberculin Surveys, are referred to the Clinic for full investigation and every effort is made to get the parents and other members of the family to attend. Miss R. Harrington, who has taken over the work of Honorary Secretary to the Wanstead and Woodford Tuberculosis CaTe Association from Mrs. N. L. Carter, has informed me that during the year the total income of the Association from all sources has amounted to £502 12s. 8d. and during the year 44 individual patients have received help of various kind, including vouchers for extra nourishment, Christmas gifts, fares to enable relatives to visit patients, settlement of Hire Purchase accounts and payment of debts. A total of £463 6s. 7d. was expended on the work of the Association during the year. Income from sale of Seals, from donations and from special functions arranged by the Association continues to be satisfactory. 52 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. CHIROPODY Two chiropodists have continued to provide a service which covers the whole of the Borough with the exception of the Woodford Bridge district, patients from the latter district obtaining treatment through arrangements made by the Old People's Welfare Association. Whilst the service is adequate for those who are able to attend the two clinics at which sessions are held, little can be done to provide an adequate domiciliary service. It is still most difficult to obtain the services of chiropodists qualified in accordance with the requirements of the Ministry of Health. Treatment is confined to persons of pensionable age and certain priority categories such as the physically handicapped. DOMESTIC HELP SERVICE The Domestic Help Service has continued to provide service for cases within the Borough requiring it on account of acute and chronic illness. In addition immediate help has been made available in all maternity cases requiring this service. There are 104 domestic helps working in the Borough, and nearly 450 cases of acute and chronic illness alone were receiving help at the end of the year. In addition night attendance has been arranged in eight cases during the year in order to provide a relative with the very necessary break from continual day and night nursing. The 'Meals on Wheels' service run by the Women's Voluntary Services has continued to assist by augmenting the statutory service provided, and by the use of an additional van it has been possible to provide a hot meal for the elderly on four days a week. 53 SCHOOL HEALTH SERVICES 1962 WANSTEAD AND WOODFORD 1. School Medical Inspections Periodic examination of pupils attending schools maintained by the Local Education Authority continued throughout the year, the figures for each group being as follows:— 1. As entrants (5-6 years) 551 2. After admission to secondary schools (11-12 years) 573 3. 14-15 year age group 954 4. Others 22 5. Specials (at request of Head Teacher, Teacher, parent, school nurse etc.). 8 6. Re-examination (i.e. follow-up of a defect previously noted) 372 TOTAL (all groups) 2480 2. Cleanliness Surveys School nurses carried out inspection of 6,8% pupils of whom only eight were found to have some head infestation. All were satisfactorily cleansed by the parents following instruction given by the school nurse. The system of observing known offenders more frequently than the twice yearly routine survey continued. 3. B.C.G. Vaccination of School Children I am pleased to report a further increase to 70% in the acceptance rate to this scheme for the vaccination of 13 year old pupils and it is hoped that this upward trend of the past three years will continue. B.C.G. vaccination was offered to 748 pupils, acceptances numbering 522. 4. Tuberculosis Case Finding Among School Entrants This scheme, in which parents are invited to consent to a skin test being given at the time of their 5 year old child's first routine medical, continued to operate. The response which showed a slight increase over last year (70% as against 68.6%), can be regarded as satisfactory. 449 children were tested of whom 12 gave a positive re-action to the test. In order that family contacts could be investigated, details were sent to the Chest Physician but in no case was anything of significance discovered. 54 5. Child Guidance Service There has been no change in the arrangements for Psychiatric treatment of school children from this Borough who continue to be referred to the Child Guidance Centre, High Street, Walthamstow. These is a lengthy waiting list for treatment and conditions are not regarded as satisfactory, the load on the clinic being greater than that with which it can cope. 6. Defective Hearing Testing of the hearing of infant children attending school for the first time has continued although, due to the demands on the time of the audiometric nurse is still not as comprehensive as would be desired. In the two categories a total of 221 pupils were tested, the results being as follows:— (i) Children to be considered 'at risk' (i.e. suspected to have some loss of hearing) Total No. referred 55 Results of test:— Normal hearing 26 For observation (in 1963) 21 To ENT Consultant 8 Result of ENT Examination No defect 2 Remove tonsils and/or adenoids 3 Some loss of hearing but no treatment required 3 Routine tests (5-6 year age group) Number tested 166 Normal 139 Referred to School Medical Officer 27 The twenty seven children seen by the School Medical Officer were re-tested with the following results:— Normal hearing 17 Re-test in 1963 10 55 7. School Clinic The weekly session held by the School Medical Officer at 93 High Road, South Woodford, resulted in 440 pupils being examined. A summary of the defects found is given at Appendix "A". 8. School Dental Service A full-time service is provided at the clinic at 93 High Road, South Woodford, the work carried out being summarised at Appendix ‘B’. 9. Speech Therapy Speech therapy in the Borough is provided at 93 High Road, South Woodford, and 118 Hermon Hill, South Woodford, the Speech Therapist attending each centre for one whole day per week. The total number of attendances during the year was 993 involving 81 individual pupils. 40 pupils were still under treatment at the end of the year. 10. Specialist Services Ophthalmic, Orthoptic, Orthopaedic and Physiotherapy services remain the responsibility of the North East Metropolitan Regional Hospital Board. By arrangement with the Essex County Council these services are provided for school children at the clinic at 93 High Road, E.18. 56 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 15 3 Eyes (a) Vision 14 5 (b) Squint 1 1 (c) Other 2 - Ears a) Hearing 14 6 (b) Otitis Media - - (c) Other - - Nose or Throat 1 - Speech 27 6 Cervical Glands - - Heart and Circulation 1 - Lungs - 2 Development (a) Hernia - - (b) Other 1 1 Orthopaedic (a) Posture 2 1 (b) Flat Foot 5 - (c) Other 18 1 Nervous System (a) Epilepsy - - (b) Other 3 1 Psychological (a) Development 23 1 (b) Stability 2 1 Other 11 2 57 APPENDIX “B” Dental Inspections and Treatment: Number of pupils inspected (periodic and specials) 3527 Number found to require treatment: (a) Periodic 1652 (b) Specials 300 Total 1952 Attendances made by pupils for treatment Fillings : Permanent teeth 1489 Temporary 427 Total 1916 No. of Teeth Filled : Permanent Teeth 1376 Temporary 383 Total 759 Extractions : Permanent Teeth 31 Temporary 480 Total 511 Administration of anaesthetics: (a) Local 27 (b) General 181 Total 208 Other Operations : (a) Permanent Teeth 378 (b) Temporary 166 Total 544 58