AC4411(1) I WANS 28 BOROUGH OF WANSTEAD & WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December 1963 PUBLIC HEALTH COMMITTEE Alderman G. C. E. Dixon (Chairman). Councillor G. E. Tovey (Vice-Chairman). Alderman R. A. Dalton. Alderman D. L. Forbes. Alderman V. E. Stevens. Councillor J. R. Charter. Councillor E. H. Downing. Councillor D. K. L'Estrange. Councillor C. A. F. Webster. 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) (resigned 12.8.63) L. R. B. Parker, M.R.C.S., L.R.C.P., D.P.H. (part time) (appointed 23.9.63) 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) B. M. Rom, M.A.P.H.I. (a) (b) (resigned 11.1.63) Miss M. E. Boocock, (a) (b) R. Swaby, M.A.P.H.I. (a) (b) (appointed 11.2.63) Clerks: Mrs. V. Birkett Mrs. E. Payton Miss T. D. Pennell (part-time) (deceased 21.8.63) H. E. M. Macalaster (resigned 17.11.63) Mrs. M. E. Lush (part-time) (appointed 2.12.63) (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 Combustion Engineering Practice 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 1963. This is the nineteenth report which I have compiled and, owing to the Borough's approaching decease, is likely to be the last but one. As usual, details of the personal health services under the National Health Service Act Part III, which are administered by the County Council and delegated to the Forest Health Area, are presented as also is an account of the School Health Service. Vital Statistics Birth Rate. There was a further increase in the number of births during the year, the total figure being 869 as compared with 844 in 1962. The rate per 1,000 of the population was 14.2 as compared with 13.8. This is well below the national figure of 18.2. Death Rate. The total number of deaths was 746 being 18 fewer than in 1962 when the figure was the highest ever recorded. Death rate per 1,000 of the population was 12.2, this figure being identical with that for the country as a whole. Infant Mortality Rate. This figure indicates the number of deaths in infants under one year per 1,000 live births and amounted to 20.7, that for England and Wales being 21.1. These figures show little variance, that for the Borough in 1962 being 20.2. Causes of Death. As is to be expected, deaths from circulatory disease and from cancer head the list. Cancer deaths numbered 151, seven fewer than in 1962. 152 persons died from coronary heart disease, this figure shows a steady yearly increase and is ten more than in the previous year. There were eight cases of suicide and four fatal road traffic accidents. Infectious Disease There was an outbreak of measles, 504 cases being notified, the number being double that for 1962. 59 cases of dysentery were reported, most of which came from a residential institution for children. One case of typhoid fever occurred in a young man recently returned from Spain where he had been 'living rough'. For the third year in succession there were no cases of poliomyelitis. 1 Clean Air I am pleased to report that, despite very adverse weather conditions in the early part of the year, the operation of the existing Smoke Control Orders has been satisfactorily maintained. During this year No. 4 Area came into operation on October 1st, the Order for the No. 5 Area was made in June and confirmed by the Minister in November, with the operation, October 1st, 1964. No detailed survey was carried out for the No. 5 Area, as from past experience in the first four areas where only approximately 50 per cent of those eligible for grant applied, it was felt that a large amount of work by the Public Health Inspectors was wasted. Inspections are now carried out either on request or when an application for grant is received. National Health Service Act 1946 Part III Services (Essex County Council) An account is given of a scheme by which a Health Visitor attends at the surgery of a partnership of general practitioners. Illustrations of Health Visitor/General Practitioner co-operation are recorded and it is hoped that, despite certain difficulties, this form of close liaison may be extended. It is disappointing to relate that little progress was made for the provision of a modern Health Services Clinic in the Borough. The County Council agreed in principle that a new clinic should be erected on the site of the old clinic building in High Road, South Woodford. During the year the work was given to a private architect, and, at the time of writing, plans are awaiting Ministerial approval. Unfortunately it will not now be possible for the clinic to be erected within the lifetime of the Borough. I would record appreciation to the Public Health Inspectorate and Clerical Staff for their loyalty and help. Finally, my thanks are due to the Chairman and Members of the Public Health Committee for their continued support and for the interest which 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. 19th August, 1964. 2 SECTION A STATISTIC AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,824 Population—Registrar General's estimate mid-year 1962 61,410 Registrar General's estimate mid-year 1963 61,360 Rateable Value £2,985,184 Sum represented by penny rate £12,175 Extracts from Vital Statistics of the Year LIVE BIRTHS Legitimate Males 430 Females 389 Total 819 Illegitimate Males 17 Females 33 Total 50 Total Males 447 Females 422 Total 869 Birth-rate per 1,000 of the estimated resident population 14.2 STILLBIRTHS Legitimate Males 4 Females 2 Total 6 Illegitimate Males 3 Females — Total 3 Total Males 7 Females 2 Total 9 Rate per 1,000 total (live and still) births 14.4 DEATHS Males 342 Females 404 Total 746 Death rate per 1,000 of the estimated resident population 12.2 Deaths from puerperal causes:— Puerperal and post-abortion sepis — Other maternal causes — Deaths of infants under one year of age:— All infants per 1,000 live births 20.7 Legitimate infants per 1,000 legitimate live births 16.1 Illegitimate infants per 1,000 illegitimate live births 80.0 1962 1963 Deaths from Cancer 158 151 „ „ Measles Nil Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) Nil Nil „ „ Road Traffic Accidents 6 4 „ „ Suicide 4 8 „ „ Other Violent Causes 11 11 3 Population The Registrar-General's estimate of the population for 1963 (midyear) was 61,360, a decrease of 50 on the figure for 1962 (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 1963 England and Wales and London (Provisional Figures based on Quarterly Returns) England and Wales London Administrative County Borough of WANSTBAD and WOODFORD (Rates per 1,000 Home Population) Births: Live 18.2 20.0 14.2 Still 0.31 0.32 0.15 Deaths: All Causes 12.2 12.5 12.2 Malignant Neoplasm, Lung and Bronchus 0.52 0.7 0.52 Whooping Cough 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 Tuberculosis 0.06 0.08 0.01 Influenza 0.07 0.05 0.03 Coronary Disease, Angina 2.29 2.36 2.5 Acute Poliomyelitis and Polioencephalitis 0.00 0.00 0.00 Pneumonia 0.78 0.97 0.83 (Rates per 1,000 live births) All causes under 1 year of age 21.1 22.0 20.7 Enteritis and Diarrhoea under 2 years of age 0.53 0.57 — 5 Notifications: England and Wales Borough of Wanstead & Woodford Typhoid Fever 0.01 — Paratyphoid Fever 0.01 — Meningococcal Infection 0.01 — Scarlet Fever 0.37 0.11 Whooping Cough 0.73 0.85 Diphtheria 0.00 — Dysentery 0.67 0.96 Erysipelas 0.04 0.08 Smallpox — — Measles 12.78 8.26 Pneumonia 0.30 0.21 Acute Poliomyelitis (including Polioencephalitis):— Paralytic 0.00 - Non-Paralytic 0.00 - Food Poisoning 0.12 0.15 Rates per 1,000 Total Births (Live and Still) Puerperal Fever and Pyrexia 7.26 25.05 6 Maternal Mortality Abortion Other Total England and Wales 0.07 0.21 0.28 Wanstead and Woodford — — — Causes of Death as given by the Registrar-General, 1963 Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 1 - 1 2. Other forms of Tuberculosis — — — 3. Syphilitic Disease — 2 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other Infective and Parasitic Diseases — 1 1 10. Malignant Neoplasm—Stomach 7 6 13 11. Malignant Neoplasm—Lung & Bronchus 28 4 32 12. Malignant Neoplasm—Breast — 21 21 13. Malignant Neoplasm—Uterus — 2 2 14. Malignant Neoplasm—Others 45 38 83 15. Leukaemia 1 1 2 16. Diabetes 1 3 4 17. Vascular Lesions—Nervous System 38 77 115 18. Coronary Disease—Angina 88 64 152 19. Hypertension with Heart Disease 2 5 7 20. Other Heart Disease 29 60 89 21. Other Circulatory Disease 16 15 31 22. Influenza 1 1 2 23. Pneumonia 20 31 51 24. Bronchitis 22 13 35 25. Other Respiratory Diseases 4 3 7 26. Ulcer of Stomach or Duodenum — 2 2 27. Gastritis, Enteritis and Diarrhoea 2 4 6 28. Nephritis and Nephrosis 3 — 3 29. Hyperplasia of Prostate 2 — 2 30. Pregnancy, Childbirth, Abortion — — — 31. Congenital Malformations 3 1 4 32. Other Diseases 20 36 56 33. Motor Vehicle Accidents 2 1 3 34. All Other Accidents 4 7 11 35. Suicide 2 6 8 36. Homicide and Operations of War — — — Totals, 1963 341 404 745 Totals, 1962 391 373 764 7 Causes of Deaths in Wanstead and Woodford 1952 to 1963 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 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 1 23 37 98 100 142 250 49 39 6 157 764 1963 1 — 13 32 83 115 152 248 51 35 3 164 745 8 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 1,000 Live Births 1963 869 14.2 9 10.3 0.14 14 16.1 18 20.7 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 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 1963 878 - - - - - - 1962 856 — 2 2 — 2.34 2.34 1961 811 - - - - - - 1960 818 - - - - - - 1959 738 - - - - - - Maternal Mortality, Stillbirths and Neo-Natal Deaths Rate per 1,000 Live Births 1963 1962 1961 1960 1959 Maternal Mortality — 2.34 — — — Stillbirths 10.3 14.2 12.5 13.6 25.0 Neo-Natal Mortality 16.1 16.6 11.24 16.1 19.45 During 1963 there were no deaths classified as being due to pregnancy, childbearing or associated therewith. 9 Comparative Statistics of Births, Mortality, etc., 1944 to 1963 Live Births Still Births Deaths Infant Deaths Maternal Deaths Year Population No: Rate* No: Rate† No: Rate* No: Rate§ No: Rate§ 1963 61360 869 14.2 9 10.3 746 12.2 18 20.7 — — 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 — — *Per 1,000 Population. †Per 1,000 Total Births. §Per 1,000 Live Births. 10 SECTION B GENERAL PROVISION OF HEALTH SERVICES 1. Public Health Officers of the Authority 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.ll Thursday, 2.30—4 p.m. George Lane Baptist Church Hall Friday, 2.30—4 p.m. All Saints' Church Hall, Woodford Green Monday, 2.30—4 p.m. 4. Ante-Natal Clinic 118 Hermon Hill, Wanstead Thursday, 2.30—4 p.m. 5. School Clinic, 93 High Road, Woodford Dental—By appointment only. Minor Ailments—Every Friday morning. †Ophthalmic—Wednesday mornings. By appointment only. †Orthopaedic—First Thursday afternoon in each month. By appointment to see Surgeon only. All day Tuesday and Thursday afternoon. For after-treatment by appointment only. 11 Speech Therapy—Monday only during school term. By appointment only. —Wednesday only during school term at 118 Hermon Hill, Wanstead. By appointment only. †Controlled by the North East Metropolitan Regional Hospital Board and delegated to the Forest Group Hospital Management Committee. 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 1963. 9. Funeral Arrangements In three cases the Local Authority was required to make arrangements for the burial of persons during the year 1963. 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 1963. The Borough is supplied mostly with River Lee-derived water from the Lee Bridge works, but there is a small amount of additional water from 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, nor were there any changes in the general scheme of supply to the area during the year, but new service mains were laid in the Borough to the extent of 306 yards. 12 REFUSE AND SALVAGE (a) Refuse Collection and Disposal The collection service was disorganised during the first few days 01 the year because of extremely adverse weather conditions and although the severe weather persisted until early March, after the first few days collection was maintained satisfactorily. In August, 1963, it was necessary to provide an additional small gang for collection purposes because of the increase in bulk and weight of refuse. No special problems occurred in connection with the transportation and disposal of the South Ockenden tip. (b) Salvage The collection of salvage was affected during the early part of the year by adverse weather conditions, but increased collections during the last three-quarters of the year compensated for this. There was very slight improvement in the market for waste paper and towards the end of the year trends showed that there might be a further small improvement in market conditions during the second quarter of 1964. SEWERAGE AND SEWAGE DISPOSAL General Arrangements for sewerage and sewage disposal in the Borough continued to be reasonably adequate although at times there is some flooding at various places as a result of sewers discharging in heavy storms, and the modernisation of Southern Sewage Works which is in progress has not yet been completed. These matters are referred to below. Sewerage (a) Main Drainage and Flood Relief The Consulting Engineers employed by the Council for main drainage and flood relief completed the detailed preparation of schemes (I) Tavistock Road area, (II) South Woodford Station area and (III) George Lane and Gates Corner. Arrangements were made for tenders to be obtained with a view to the work starting in the summer of 1964. The Council continued to be concerned at the effect of heavy storms on properties in the Monkhams Valley and gave particular attention to the problem in Knighton Wood at the head of the existing main surface water sewer. A scheme for a screening pond and ancillary works was agreed with the Conservators of Epping Forest and tenders sought for the work. Previously the scheme for new main drainage in the Monkhams Valley was included as one of the later stages of the main drainage programme but the Council recently decided that because of the flooding occurring from time to time this scheme should be brought forward and the Consulting Engineers were instructed to proceed with preparation of the scheme. 13 1. (b) Snakes Lane West The soil and surface water sewers in the lower section of Snakes Lane West have inadequate capacity and a scheme was prepared for the renewal and enlargement of these sewers, particular attention being given to flooding which occasionally occurs in Linden Crescent and to the future effect of the adjacent comprehensive development area. (c) St. Barnabas Road Screening Chamber This screening chamber, through which the sewage flows from the high level portion of the area served by Eastern Sewage Works, is very old and its structural condition causes increased concern. Also, the present screen requires regular manual cleaning and attention. It was therefore decided that a scheme should be prepared for a new structure and screening arrangments, it being intended that some form of mechanical screening should be adopted to avoid the present unsatisfactory manual system. The preparation of the scheme was well advanced at the end of the year and it is intended to invite tenders as soon as the relevant details have been completed. Sewage Disposal (a) Eastern Sewage Works Following the completion of the second stage of the reconstruction and improvement scheme in 1962, the standard of effluent discharged to the River Roding was generally satisfactory but careful attention had to be given to certain conditions affecting the effluent particularly in times of heavy flow The primary sludge digestion tanks periodically require emptying and cleaning out and this is a major and expensive operation. The work became urgently necessary and was arranged to be undertaken for completion by the end of April, 1964. (b) Southern Sewage Works A tender amounting to £203,000 was accepted for the second stage of the reconstruction and improvement scheme which comprises sludge coilfiltration, renewal of media and equipment in the filter beds, the improvement of storm tanks, the reclamation and landscaping of the old sludge drying beds and adjacent areas, and the provision of improved staff facilities. Work commenced in November, 1963, and was due to last 15 months. 14 SANITARY INSPECTION OF THE AREA The Chief Public Health Inspector reports as follows:— Housing Act, 1957 and 1961 During the inspections in connection with houses let in multiple occupation, a large summer house type of structure was found to be occupied by a family who were without satisfactory provision of water supply and drainage. Such provisions could not be taken to the structure without incurring excessive cost. The Council, after carrying out the procedure set out in Section 16 of the 1957 Act, made a Closing Order, and rehoused the tenant. The Public Health Committee having received a report concerning the bad conditions of two cottages in High Road, South Woodford, made Demolition Orders on them. The tenants were rehoused by the County Welfare Authority and the Borough respectively. One old house badly damaged by fire was reported upon but action under Section 16 was deferred in order that an intending purchaser could consider further whether to acquire it for reconditioning with the view to its occupation by a member of the family. Closing Orders were made on two other properties because of their bad condition and the unreasonableness of the cost involved in putting them back into a habitable condition. Ray Lodge (odd numbers), Globe Road and Avenue Road The Medical Officer of Health made a full report to the Public Health Committee concerning the condition of the dwellings in the area and visits were made by members of the Public Health Committee and Housing Committee. After very careful consideration the Public Health Committee decided that the time was not appropriate to deal with the properties as provided by the demolition sections of the Housing Act with the exception of the four flats previously referred to in this report. Demolition Orders were made on two premises which were let as four self-contained flats. Prosecutions The basement to one of the tall properties in the Wanstead area of the Borough which was let in flats was closed some years ago under the provisions of the Housing Act. It was noticed by the District Public Health Inspector that it was occupied by a family without it being rendered fit. Upon a report being made, the Public Health Committee authorised proceedings against the owner with the result that he was fined ten pounds with five guineas costs. Rent Act, 1957 Two applications were received for Certificates of Disrepair and one application for the cancellation of Certificate. 15 Works in default It was necessary to do work because of the default on the part of the owners, the costs of works being £59 13s. 6d., £40 14s. 0d., and £35 4s. Od. respectively. The work was carried out by a private contractor on behalf of the Council. Overcrowding It was necessary to report one case of overcrowding in a part of a house let in multiple occupation. Authority to serve notices was given by the Public Health Committee and upon these reaching the owner and the occupier possession of the rooms was obtained by the owner and the overcrowding abated. Housing Act, 1961, Part II Houses in Multiple Occupation A considerable amount of work was carried out by the District Public Health Inspectors in connection with properties let in this manner. Most of the work was necessary because of the lack of hot water, food storage cupboards and sinks. Practically all the requirements were met by informal action but it was necessary in one case to obtain the permission of the Public Health Committee to serve a notice on the occupier. Generally speaking, properties let in this manner are kept in good condition and overcrowding is rare. Occupiers are mainly people in business who occupy the rooms as single persons or as married couples. There has been no need to make management orders in connection with Section 12 of the 1961 Act. Removal expenses from unfit houses to Council property Payment to occupiers of unfit premises of expenses incurred by them in removing to Council properties is met in almost all cases by the Council, either in full or in part. One payment of £6 10s. 0d. was made during the year. Factories Act, 1937 There is nothing outstanding to report concerning local factories other than that contained in the tabulated details set out later. This is understandable, bearing in mind that the Borough is chiefly a residential one and the factories largely modern. Public Health Act, 1936 and 1961 Section 24,1936 Act—Public Sewers It was necessary to replace at least six manhole covers because of the broken condition of the existing ones. These manholes served 41 houses. The expense involved was recovered in most cases. 16 Section 39 A notice was served under this Section on account of the broken condition of a soil pipe the work of renewal being carried out by the owner's builder. In investigating the cause of the repeated blocking of the drainage systems serving two adjacent houses, it was found that these systems discharged into a cesspool which in turn discharged into a public sewer (combined drain). Notices were served upon the two owners whose contractor reconstructed the drains and connected them to the sewer by filling in the cesspool and constructing channel way over the filling material. Reconstruction to the drainage system to two blocks of property was carried out by the contractors acting upon the instructions of the Council through the Public Health Department. The larger involving nine houses, the other, seven houses. The cost on the first being £1,200, the second over £700. The length of sewer serving two other houses was also remade, the original line of pipes not only being completely obstructed but was found to be under the flank wall of one of the houses. This necessitated laying the new pipes in a passage-way between the two houses. In reporting upon works put out to tender, there are two aspects to consider and overcome, one is the difficulty experienced in persuading contractors to tender for work which is either by advertisement in local and other papers or by communicating with selected firms. In an endeavour to overcome this difficulty, tender forms have been sent to known contractors when public advertisements have been made and here again the response has been very poor. The second difficulty is in obtaining reasonable priced tenders for one can but notice the extent to which figures have increased and the vast difference which is shown between the lowest and highest tender. Public Health Act, 1961 Section 74—Pigeon Nuisance Wanstead and Woodford suffer in these days, as do many more local authorities, from the nuisance caused by feral pigeons who not only roost and nest on buildings but do considerable damage by fouling paintwork, choking rainwater gutters, etc. The 1961 Public Health Act permitted local authorities to reduce the number of pigeons in their area so in order to continue the work commenced in 1962 the Council re-engaged the contractor used previously. Pigeon populations at The Broadway and George Lane were reduced very considerably, that at The Broadway reduced almost to nothing. It would appear that it is necessary to continue the contract from year to year to keep these pests in check, because in addition to the groups of birds at the areas already referred to small pockets of infestation have sprung up in other parts of the Borough. 17 Rodent Control The Council's sewers were treated on two occasions during the year but unlike the methods used in previous years when Council staff were employed baiting with Zinc Phosphide, Arsenous Oxide, etc., a servicing company was engaged using the "1080" poison. Pre-baiting of the sewer is not carried out, so no check could be made of the amount of bait taken, but the report from the sewage works manager indicated that the number of rat bodies found at the works was far in excess of the number found on the previous occasions when the sewers were previously treated. The time taken by the company was about one week. Surface treatment continued throughout the year by one operative employed on the staff of the Public Health Department. 325 complaints were received and 343 treatments and re-inspections carried out. Wasps' Nests As in previous years the eradication of wasps at a small charge was performed by the Rodent Operative. During the year 119 wasps' nests were destroyed. Noise Abatement Act, 1960 The annual report of the Medical Officer of Health for the year 1962 contained reference to a complaint of noise alleged to come from a large bakery which is situated opposite to a row of dwellings occupied by the complainants. These occupiers alleged that noise was caused (a) from the loading into delivery vans of trays of bread and (b) by starting up and driving off of the delivery vans. Activities of the bakery commenced and continued into the early hours of the morning disturbing, it was alleged, the rest and sleep of the local residents. Observations made in the early hours of the morning with and without the aid of a sound level meter failed to find evidence which could support the claims of the house occupiers. Traffic passing along the arterial road had a much greater effect on the sound level meter than did the sound from the bakery. The Council through the Town Clerk advised, because the Local Authority could find nothing that could justify legal action being taken by them, that the occupiers should take action as provided in the Act. They were reluctant to do this and asked that a deputation be interviewed bv the Public Health Committee, and to this the Committee agreed. After interviewing the deputation and the solicitor acting for the bakery it was resolved that the Chairman, Vice-Chairman and another Committee Member should interview the owner of the bakery and put to him details of the complaints made and the remedies suggested by the residents' deputation. 18 After the Council representatives reported at the subsequent Committee Meeting it was resolved by the Public Health Committee that residents be informed (a) "that the Committee is not prepared to take legal proceedings under the Noise Abatement Act 1960 and (b) of steps taken by the Council to inform the bakery of the complaints made and the remedies suggested by the residents". No legal action was taken by the residents themselves as provided for in the Act. Arising out of a complaint from a resident in the Wanstead Area the Public Health Committee authorised proceedings to be taken under the Good Rule and Government Byelaw against an ice cream vendor for sounding chimes on his vehicle to the annoyance of residents. He was fined £2 and 2 guineas costs. Other complaints of noise were of trivial nature. Emission of Smoke from Diesel Engine Vehicles Following on the remarks made in the 1962 report to the effect that some slight improvement had been noticed in the behaviour of these vehicles it can be reported again that some great improvement was seen, this is no doubt due to a new law concerning the position of certain fuel controllers on the vehicles. It is hoped that the improvement will be maintained. Pet Animals Act, 1951 The six previously issued licences were renewed for a further year. Riding Establishments Act, 1939 A veterinary surgeon carried out inspections on the two riding establishments and reported satisfactory conditions at these premises. Rag, Flock and Other Filling Materials Act, 1951 There were no premises registered under this Act. Essex County Council Act, 1952 Section 103 Two applications were registered as Hawkers of Food under the provisions of this Act. Petroleum (Consolidation) Act, 1928 The Chief Inspector acting under this Act attended the mid-week school at Attingham Park, Shrewsbury, organised by the Committee of the West Midlands Petroleum Act Group. The lectures were well chosen and presented by speakers known to be authorities on various aspects of the work, and those attending must have benefited from the information and demonstrations given. Sixty-five licences to store petroleum and petroleum mixtures were issued. The licence to one filling station was increased by 3,000 gallons, one station installed a petroiler, and one manufacturing firm was granted a licence to store 1,500 gallons. Twenty-one tests were applied to tanks over 20 years old. None were found to be defective. 19 Game Licences Six licences to sell game were issued during the year. Shops Act, 1950 An offence by the proprietor of a motor show room, selling secondhand cars, was reported to the Public Health Committee on two occasions on account of his premises being open for business on Sundays. The Committee, after the first report, instructed the Town Clerk to send a warning letter to the proprietor who ignored it, consequently when the second report was made the Town Clerk was instructed to take proceedings, which he did, and at the Magistrate's Court in October a fine of £15 was imposed, the Council being granted 8 guineas costs. No offences were observed in so far as closing times were concerned and it can be noted that shops close well before the time of closing set out in the Shops Act. 214 inspections were made during the year 1963. Essex County Council Act, 1933 Massage and Special Treatment Establishments Ten visits were made to these premises, all of which were reported to the Essex County Council as being in a satisfactory condition. Consumer Protection Act, 1961 Six visits were made and heaters tested but no infringements were found and it would appear from observations that manufacturers are now working strictly to the requirements of the Act regarding the shielding of the heating elements and burners. Swimming Bath Water Six samples of water used at schools for swimming purposes were examined by the laboratories. In five cases the reports were satisfactory and because the sixth was not up to standard a further sample was obtained after the school had been advised of the first result. This second sample was reported to be satisfactory. The short period of time during which the schools' swimming pools are in use make the examinations of the water difficult. However, the fact that the water is examined helps those responsible for the pools to maintain a standard of water suitable for swimming purposes. 20 Inspections carried out by Public Health Inspectors Infectious Disease enquiries 54 Visits in connection with contacts, disinfection, etc. 3 Enquiries in connection with food poisoning 14 Verminous Premises 17 General Environmental Public Health Drains and Sewers inspected Drain tests applied } 1085 Stables and manure pits inspected 2 Public Conveniences and Urinals 8 Factories (mechanical) 102 Factories (non-mechanical) 20 Hairdressers' Premises 24 Schools and School Canteens 53 Ditches, Streams and Ponds 7 Open Spaces and Playing Fields 1 Petrol Inspections 301 Shops Act Inspections 214 Outworkers' premises 57 Massage Establishments 10 Pet Animals Act 13 Fairgrounds 1 Swimming Baths 7 Smoke Observations 2 Cinemas, etc. 1 Rent Act 10 Tents, Vans and Sheds—Gypsies 7 Heating Appliances (Fireguards) Act and Regulations 6 Licensing Act 22 Smoke Control Areas 2118 Multiple Occupations 11 Street Vendors, Hawkers, etc. 13 Miscellaneous 414 SECTION D HOUSING No. of dwellings erected during 1963:— Council 52 Private Enterprise 70 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) 1044 (b) Number of inspections made for the purpose 1415 21 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 76 (b) Number of inspections made for the purpose 161 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 (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 48 2. Remedy of Defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 76 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 32 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 7 (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 151 (2) Number of dwelling houses in which defects were remedied after service of informal notices:— (a) By owners 56 (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 2 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders ..... 2 22 Notices served Public Health Act, 1936 Preliminary Statutory Section 93 169 1 „ 24 — 68 „ 39 — 26 „ 45 — 1 „ 75 — — Public Health Act, 1961 Section 17 — 1 Housing Act, 1957 Section 9 48 32 23 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 20 - - (ii) Factories not included in (i) to which Section 7 applies 115 115 - - (iii) Other Premises under the Act (excluding out-workers' premises) — — — — TOTAL 149 135 — — 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 - — - - Overcrowding — — - - Unreasonable temperature — — - - Inadequate ventilation - - - - Ineffective drainage of floors - - - - Sanitary conveniences: 1 Insufficient 1 1 — - 2 Unsuitable or defective — — — - 3 Not separate for sexes — — — - Other offences — — — - TOTAL 1 1 — - 3. Outwork Number of out-workers in August list required by Section 110(l)(c) Boxes 18 18 24 CLEAN AIR The Smoke Control Officer reports:— During 1963 two major events, very closely connected with Clean Air, occurred. Firstly the very severe weather which started in 1962, continued for some time into 1963, and placed a considerable strain upon the fuel suppliers and distributors. Whilst the vast majority of fuel merchants did their best under most difficult circumstances, a very small minority took advantage of the situation to increase the price of pre-packed smokeless fuels. There is little doubt that as a result of the bad winter with solid fuel shortage and delays in delivery, a large number of residents became more interested in alternative methods of heating, in particular by means of gas room heaters and small bore central heating. The second major event was the issue of Memo 69/63 by the Ministry of Housing and Local Government in December which notified local authorities that in view of the rapid technological changes in the gas industry affecting the future production of gas coke, an immediate review of current arrangements under the Clean Air Act 1956 was being instituted. The Minister of Power carried out a comprehensive reassessment of the probable availability of the different smokeless fuels, and published his conclusions in a White Paper. Briefly, as a result of the changes, the supply of gas coke—which in the past had been regarded as the basic solid smokeless fuel—would not increase. Whilst supplies would be available for existing Smoke Control areas, the fitting of large numbers of coke burning open fires in future areas would create a shortage. To encourage the use of fuels other than open fire smokeless fuel, the Minister proposed widening the grant arrangements so that reasonable grants could be paid for room heaters (solid and gas), under-floor draught fires, electric storage heaters and suitable oil heaters. The Public Health Committee agreed to make the higher grants available in Smoke Control Area No. 5 although this Order had been confirmed before the issue of Memo 69/63. It was felt that this would contribute towards keeping open-fire fuels available for the existing smoke control areas, for those in proposed smoke control areas who wish to retain an open fire and for those residents outside smoke control areas who already have suitable appliances. Whilst this change necessitates heavier total expenditure on Clean Air, the range of appliances now eligible for grant gives a much higher heating efficiency than an open fire. So that in addition to the main object of cleaning the atmosphere the payment can also be regarded as an improvement grant which enables a considerable number of residents to enjoy greatly improved heating in their homes. 25 As last year, I have divided the work into three main groups:— (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 continued measurement of pollution as part of the National Survey by means of two daily volumetric instruments, one at Croft Lodge Close, Snakes Lane, Woodford Green, and the other at Oakhall Court, Wanstead. Both instruments are fitted with eight port valves which automatically change every twenty-four hours, thus ensuring complete records over week-ends and holiday periods. Details of average yearly figures since the instruments were installed are given below. The figures are expressed in micrograms per cubic metre. Woodford (Croft Lodge Close) Year 1955 1956 1957 1958 1959 1960 1961 1962 1963 Smoke Average for year 190 180 170 190 130 113 98 126 87 Average for winter months 320 290 310 273 190 163 178 206 144 Average for summer months 60 70 50 65 43 63 44 45 29 Highest daily recording 150 1120 2050 1080 1080 670 720 2392 603 Year 1955 1956 1957 1958 1959 1960 1961 1962 1963 Sulphur Dioxide Average for year 157 172 172 200 172 160 124 149 118 Average for winter months 229 257 266 245 283 222 195 221 171 Average for summer months 85 86 60 134 71 106 77 77 65 Highest daily recording 1086 1144 1973 1133 1856 984 652 2503 864 Wanstead (Oakhall Court) Year 1955 1956 1957 1958 1959 1960 1961 1962 1963 Smoke Average for year — — — — 150 115 101 111 87 Average for winter months — — — — 250 178 194 179 141 Average for summer months — — — — 50 51 40 42 33 Highest daily recording — — — — 1200 1020 752 1560 589 Year 1955 1956 1957 1958 1959 1960 1961 1962 1963 Sulphur Dioxide Average for year - - - - 217 163 126 147 142 Average for winter months — — — — 315 229 207 222 213 Average for summer months — — — — 71 97 71 72 71 Highest daily recording — — — — 1307 1410 710 1619 1268 26 It is pleasing to note the continued reduction in smoke pollution, which is confirmation of the effectiveness of smoke control areas aided by the voluntary change to smokeless fuels by persons living outside smoke control areas. There still appears to be no economic solution to the removal of sulphur, but at least the reduction in smoke helps in the dispersal of sulphur gases. (b) Smoke Control Areas Four areas covering 8,258 premises and 1,499 acres are in operation. I give below details of applications received, grants approved and paid in the four areas:— Smoke Control Smoke Control Smoke Control Smoke Control Area No. 1 Area No. 2 Area No. 3 Area No. 4 Applications for approval of works 438 853 1,014 774 Grants approved £3,016.10.2 £7,403.11.2 £9,321.19.4 £7,016.7.6 Claims received 399 744 894 383 Amount of claims paid £2,614.3.2 £6,880.19.0 £8,268.7.0 £3,230.7.5 In 7 cases, 100 per cent grant was paid to persons in receipt of National Assistance, and whose applications were supported by the Manager of the National Assistance Board. As mentioned in the foreword to this report no detailed survey was carried out in the No. 5 area, the estimated costs being worked out on figures obtained from the first four areas. Details of the areas are as follows:— Acreage 698 Dwellings (including Council houses) 4,052 Industrial premises 61 Commercial premises 109 Other premises 12 It was estimated that the cost of replacing and adapting existing fireplaces would be £40,375. The Order was submitted to the Minister and was confirmed in November with date of operation 1st October, 1964. As the confirmation of the Order was followed closely by Memo 69/63, mentioned earlier, applications for grant were held over until the Public Health Committee reached a decision. All residents were then notified that increased grants were available for the installation of room heaters (solid and gas), electric storage heaters, under-floor draught fires and suitable oil fires. 27 Subsequent applications showed a marked trend towards gas room heaters, with some interest in solid fuel room heaters, but little in electric storage heaters. As the latter appliances have only recently come onto the market, they are not so well known as the gas and solid fuel heaters. There are still, of course, a number of people who prefer the open fire despite its low efficiency. In previous annual reports persons who wish to continue burning solid fuel have been advised to consider fitting either a closed or openable room heater. This advice is repeated as not only is the appliance of higher efficiency but also a wider range of smokeless fuels can be burned. Gas room heaters are now firmly established and give satisfactory service, whilst it is felt that once electric storage heaters using electricity at off-peak rates become wider known they too will play a considerablt part in clearing the atmosphere and improving home heating. Other Matters— Industrial Premises 10 notifications of intention to install new furnaces have been received during the year and 3 cases "prior approval" of the plant was given. Close liaison has been maintained with the Borough Engineer's department regarding the height of new chimneys for industrial boilers. Recommendations are based on the Memorandum on Chimney Heights issued by the Ministry of Housing and Local Government where appropriate. The increased use of oil fuel with its higher sulphur content, emphasises the importance of ensuring that the flue gases are discharged at a reasonable height. Conferences Two meetings of the Joint Conference of local authorities in South West Essex were held during the year, one at Leyton and the other at Woodford. Matters of general interest to the local authorities concerned were discussed. 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. 4 during a week in April. Once again considerable interest was shown and help given by the Federation representatives. 28 SECTION E FOOD AND DRUGS The Chief Public Health Inspector reports:— Food and Drugs Act, 1955 The following matters were reported to the Public Health Committee who took the action indicated:— (a) Complaints (1) A can of rice pudding purchased at a local shop was alleged to have caused food poisoning. The rice was prepared and canned by a well known firm, at the factory in the north of England. Investigations made at the factory by the Medical Officer of Health of that area indicated that conditions of manufacture were satisfactory. Suspicion, therefore, fell upon the condition of the tin which was examined by the makers who said that a minute fault existed in a seam, the fault, although being sufficiently minute as to prevent liquid escaping, could admit bacteria. The Public Health Committee, after very carefully studying legal reports of the Town Clerk, authorised proceedings to be taken. Proceedings were instituted against both the manufacturers and the shop-keeper with the result that (a) the charge against the former was dismissed and (b) the shop-keeper was found guilty of selling a can of rice pudding unfit for human consumption but was granted an absolute discharge with 20 guineas costs awarded to the Council. *(2) A sample of Linctus found to be deficient in chloroform was reported to the Public Health Committee, who, acting on the advice of the Public Analyst agreed that a warning letter be sent to the manufacturers and the shop-keeper. (3) Proceedings were taken against a dairy for selling margarine with mould on its surface. The firm were fined £5 with 3 guineas costs awarded to the Council. (4) Action was taken against a greengrocer for an offence against Regulation 23 of the Food Hygiene (General) Regulations 1960 because the food room was not kept in such good order, repair and condition as to enable it to be effectively cleansed. The roof in the premises was so rotted and defective that it was impossible to clean the underside of it. The case was deferred when heard by the magistrate on the first occasion in order to allow the greengrocer to make amends. On the second hearing the Magistrates, when told that the work had been done satisfactorily, gave an absolute discharge to the offender and awarded 3 guineas costs to the Council. (5) A warning letter was sent to the shop-keeper who manufactured and sold a chocolate eclair which it was alleged by the purchaser to contain mould when purchased. 29 (6) Because the purchaser of an apple tart containing a piece of metal did not wish to attend court the Public Health Committee decided that no action should be taken against the manufacturer. (7) A warning letter was sent to the baker of a loaf of bread which contained a piece of wood or basket cane. (8) Fried Haddock No action. (9) Tea bags containing insect No action. (10) Piece of pie containing egg alleged to be bad No action. (11) Bridge Roll containing dirt No action. (12) Orange Squash containing Absolute discharge. 5 guineas glass costs to Council. (b) Samples *Of the samples taken during the year one report merited the attention of the Public Health Committee. Meat and Food Inspections Although there is no slaughter house within the Borough, with the pressure of two wholesale food depots, it naturally follows that a considerable amount of time is spent in food inspection. It will be seen from the following list of surrendered foods that condemnation, particularly in tinned goods, has now reached sizeable proportions. One bacon curing plant has generally worked satisfactorily except for some teething troubles which are unavoidable in a complicated mechanical plant. No evidence or complaint of smoke or odours emanating from the plant have been received or voiced. The following is a list of food surrendered during the year 1963 because of unsound condition:— MEAT, Fresh MEAT, Tinned Beef 933 lbs. Corned Beef 1,120 lbs. Lamb Trimmings 10,276 lbs. Ham 676 lbs. Mutton 34 lbs. Jellied Veal 126 lbs. Ox Kidneys 14 lbs. Pork 163 lbs. Pigs Kidneys 6 lbs. Pork Luncheon Meat 632 lbs. Lamb 34 lbs. Ox Tongues 52 lbs. Bacon 38 lbs. Stewed Steak 58 lbs. Pigs Spleen 28 lbs. Miscellaneous Tinned Foods Pork 95 lbs. 6,248 tins Veal 42 lbs. Frozen Foods—262 packets 30 A list of foods sampled is given below:— Apricot Yoghurt 1 L.15 Linctus 2 Bacon 2 Liver Sausage 1 Batter Flour 1 Lobster Paste 1 Beer Sausage 1 Malt Vinegar 3 Beef Suet (shredded) 1 Margarine 2 Blackcurrant Drink 2 Marzipan 1 Bread Sauce 1 Milk 1 Butter 7 Minced Beef 1 Cocktail Cherries 1 Minced Chicken in Jelly 1 Coconut 1 Mint Sauce 2 Coffee and Chicory Essence 2 Mint in Vinegar 1 Coffee 1 Mixed Spice 1 Cornflour 1 Munchmallow Biscuits 1 Corn Oil 1 Nescafe 1 Corned Beef 1 Olive Oil 1 Cranberry Jam 1 Pineapple Milk Syrup Shake 1 Creamed Horseradish 1 Plain Flour 2 Currants 1 Pork Luncheon Meat 1 Dried Mint 1 Potted Beef in Butter 1 Essence of Rennett 1 Quick Jel 1 Eucalyptus Oil 1 Ravioli in Tomato Sauce 1 Frying Oil (groundnut) 1 Sausage Rolls 1 Gees Linctus 1 Scotch Egg 1 German Mustard 1 Seafood Dressing 1 Glucodin 1 Sliced Onion 2 Glycerin, Honey and Lemon 1 Strawberry Jam 1 Grapefruit 1 Stuffed Olives 1 Grated Cheese 1 Sultanas 1 Ground Almonds 1 Syrup of Lemon, Glycerine Ground Cloves 1 and Honey Ground Ginger 3 Tartar Sauce 1 Ground Garlic 1 Tea 3 Haslet 1 Tomato Chutney 1 Honey 2 Tomato Ketchup 1 Horseradish Sauce 3 Tomato Paste Influenza Cold Mixture 1 Vic Cough Syrup 1 Lard 3 White Pepper 2 Lemon Curd 1 Yeast Extract Zinc and Caster Oil Cream 1 102 31 The Milk (Special Designation) Regulations, 1960 Four Licences were transferred to the new owners of four previously licensed premises. Seventeen samples of milk were taken all of which were reported as satisfactory. Manufacture, Storage and Sale of Ice Cream Three 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) Six samples of ice cream were obtained and the results were as follows: Ministry of Health's Provisional Grading Grade Grade Grade Grade Taken I II III IV Nos. 6 5 — — *1 Per cent 100 83.3 — — 16.7 *It was not possible to obtain a further sample owing to the shop being closed. 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., Gordon Miles, Esq., B.Sc., F.R.I.C., F.R.S.H., R. F. Rackham, Esq., B.Sc., M.R.S.H., & E. English, Esq., B.Pharm., B.Sc., F.R.I.C.,) of Thresh House, Verulam Street, Gray's Inn Road, W.C.I. The Department is appreciative of the help given by these two laboratories during the year. 32 The food premises in the District may be classified as follows:— Confectioners (cakes, pastries) 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 131 are registered for the storage and sale of ice cream; 60 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. 92 Wholesale Butchers' Depots 77 Fish Fryers 3 Hotels, Boarding Houses, Etc. 7 Bakehouses 47 Fishmongers 36 Grocers 181 Restaurants and Cafes 97 Dairies and Milkshops 5 Greengrocers 86 Ice Cream Premises 14 Street Vendors 9 Food and Drugs Sampling 107 Ice Cream Sampling 6 Milk Sampling 17 Other Premises 171 Food Hygiene Regulations 9 33 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 7 — — — — Diphtheria - - - - - Pneumonia 13 — — — — Cerebro-Spinal Fever - - - - - Acute Poliomyelitis - - - - - Acute Polioencephalitis - - - - - Encephalitis Lethargica - - - - - Dysentry 59 1 1.6 — — Puerperal Pyrexia 22 22* 100 — — Paratyphoid Fever - - - - - Enteric or Typhoid Fever 1 1 100 — — Meningococcal Infection - - - - - Erysipelas 5 — — — — Measles 504 — — — — Whooping Cough 52 1 1.9 — — Ophthalmia Neonatorum - - - - - Food Poisoning 9 — — — — * These cases all occurred in hospital 34 These cases of infectious disease have been divided into age incidence and set out in the accompanying table:— Disease All Ages Under l yr. 1-4 yrs. 5-9 yrs. 10-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65 & Over Scarlet Fever 7 — — 6 1 — — — — Pneumonia 13 — 1 — — — 2 4 6 Typhoid Fever 1 — — — — 1 — — — Dysentery 59 — 24 3 — 20 2 3 7 Acute Poliomyelitis - - - - - - - - - Puerperal Pyrexia 22 — — — — 12 9 1 — Erysipelas 5 — — — — 1 1 1 2 Measles 504 15 263 199 24 2 1 — — Whooping Cough 52 5 27 17 1 — 2 — — Ophthalmia Neonatorum - - - - - - - - - Meningococcal Infection - - - - - - - - - Food Poisoning 9 — 2 1 — — 1 3 2 TOTALS 672 20 317 226 26 36 18 12 17 Poliomyelitis During 1963 no confirmed cases of poliomyelitis were notified. The accompanying table shows the cases notified in previous years classified under age groups. 35 POLIOMYELITIS INCIDENCE IN WANSTEAD AND WOODFORD, 1943-1963 Year Population No. Notified Notification Rate Age Group Deaths Death Rate Under 1 1-5 5-10 10-15 15-25 25-45 Over 45 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 - - - - - - - - - - - 1963 61360 — — - - - - - - - - - 36 Tuberculosis The following table shows particulars of new cases of tuberculosis and of deaths from the disease in the Borough during 1963. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 year - - - - - - - - 1-5 years - - - - - - - - 5-10 years - - - - - - - - 10-15 years - - - - - - - - 15-20 years — — 1 — — — — — 20-25 years - - - - - - - - 25-35 years 1 1 - - - - - - 35-45 years 3 — — — 1 — — — 45-55 years 4 1 - - - - - - 55-65 years 2 1 - - - - - - 65 and over — 1 - - - - - - TOTALS 10 4 1 — 1 — — — 14 1 1 Nil 15 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. 37 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 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 1963 14 0.23 1 0.02 15 0.25 1 0.02 — 1 0.02 Rates per 1,000 population The register shows that at the end of the year:— 14 (16) Pulmonary and 1 (Nil) non-Pulmonary cases were notified during the year. 9 (17) cases were transferred into the District. 3 (1) cases were restored to the register. 1 (Nil) Pulmonary and Nil (1) non-Pulmonary died during the year. 19 (28) other cases were removed from the register. 616 (609) cases remained on the register at the close of the year. The figures in brackets are the comparable figures for 1962. 38 SECTION G PART III SERVICES FOREST HEALTH AREA SUB-COMMITTEE Membership 1963/64 Nominated by:— Name Chingford Borough Council Councillor Mrs. O. M. Game Councillor S. J. Silk 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 J. Fisher Council Councillor Mrs. V. L. M. Martin Councillor W. S. North Councillor E. G. Perry Epping Urban District Council Councillor N. G. Barber Waltham Holy Cross Urban Councillor P. M. Pennell District Council Epping and Ongar Rural Vacancy District Council Appropriate Hospital Mrs. A. J. Morris Management Committees Executive Council for Essex Mr. W. C. Redbond 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 39 CARE OF MOTHERS AND YOUNG CHILDREN Health Services Clinics In my last report I referred to the steps taken by the County Council as local health authority to include in their draft ten-year development plan a proposal to erect a health services clinic in the Borough. It is gratifying to note that some positive action to achieve this aim is being taken, and draft plans are in the course of being prepared to enable the project to be commenced. The Clinic is to be erected as an all-purpose one on the site of the existing School Clinic in the High Road, South Woodford, and will incorporate two dental suites. Child Welfare Clinics The seven Child Welfare Clinics in the Borough are held in hired halls, some of them somewhat old. The new health services cliric will enable at least one of these halls to be relinquished; steps are also in hand to take over a former County Primary School for health service purposes, which should improve the facilities still further. The greatest co-operation exists with general medical practitioners. Attendances at the Child Welfare Clinics during 1963 numbered— 13,883. 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. A growing demand by parents of young children for play groups and nursery classes where these children can have the companionship of others has resulted in an increasing number of registrations under the Act during the year. The number of premises and child minders in the Borough registered with the County Council is: Premises No. of children Premises 8 223 Child Minders 3 16 Women's Welfare Clinic Contraceptive advice is given on medical grounds on receipt of a doctor's certificate. This advisory session is held monthly at 118 Hermon Hill, 86 attendances being made during the year. 40 WELFARE FOODS The distribution of Welfare Foods continued on the lines indicated in my previous reports, 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. My sincere thanks are due to the Women's Voluntary Service members for the great assistance they give by undertaking this service. VITAL STATISTICS Borough of Wanstead & Woodford England and Wales Live birth rate per 1,000 population 14.2 18.2 Still birth rate per 1,000 population 0.14 0.31 Infant Mortality Rate per 1,000 20.7 21.1 NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1963 14 infants died in the first four weeks of life, a rate of 16.1. CARE OF PREMATURE INFANTS During 1963 24 premature infants were born to residents in the Borough, 1 of these births taking place at home and 23 in hospital or nursing home. The child born at home was alive at the end of one month. Of the 23 born in hospital or private nursing home 22 survived. MIDWIFERY Miss A. Williams, S.R.N., S.C.M., Q.I., H.V. Cert., Non-Medical Supervisor of Midwives, reports as follows:— Four whole-time midwives undertook the midwifery in the Borough of Wanstead and Woodford, and the nursing of early hospital discharges of midwifery cases from local maternity units. All staff had alternate weekends off duty and a week-day off. 7 Part II Pupil Midwives received their training in the Borough during the year, with good results. 278 confinements were attended. 193 patients received Gas and Air analgesia. 71 patients received Trilene analgesia. 203 patients received Pethedine or Pethelorfan. 41 Ante-Natal Clinics There were 709 attendances at the Ante-Natal Clinic, 118 Hermon Hill, E.18. The sessions are held weekly and all the Midwives are in attendance, 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. HEALTH VISITING (Section 24) The Superintendent Health Visitor, Miss C. M. W. Court, A.R.R.C., S.R.N., C.M.B., H.V. Cert., reports as follows:— An additional Health Visitor commenced duty on the 6th May, making six Health Visitors in the Borough. Requests from hospital to visit aged persons are numerous and the closest co-operation is maintained with both General Practitioners and Hospitals serving the Area. Mothercraft Classes for expectant mothers, combined with Relaxation Classes, are carried out on three sessions per week. The Health Visitors also lecture to various Associations when requested. The practice of Student Nurses from Wanstead Hospital being given practical training in the Public Health field has continued. The following table sets out statistically the work of the Health Visitors in the Borough during 1963:— Infants 0-5 years (first visits) 1,784 Infants 0-5 years (total visits) 3,439 Aged and infirm 453 School children 132 Other visits 450 In my report for 1962 I mentioned the scheme of co-operation between one of the Health Visitors and a general practitioner partnership in the Borough, and the attendance of this member of the staff at the doctors' "Well-Baby" Clinic. 42 This scheme has now been running for nearly two years and I am grateful to the General Practitioner concerned and the Health Visitor for a detailed report on the working of the scheme, extracts of which are set out below:— The doctors and the Health Visitor meet at least once a week and the former have brought to the notice of the Health Visitor such patients or families whom they thought could be assisted by her. The Health Visitor, armed with such information as was necessary, has then visited the home or the person concerned. Almost always she has been welcomed and her assistance received with gratitude. During the two years there has been in this way direct co-operation in over 100 cases of social need. These have ranged from the common problems of childhood and old age to the more complicated and intimate affairs of personal or family life. For some of these latter problems the following solutions have been evolved: 1. Priority housing has been obtained to bring together an otherwise separated family and the members concerned encouraged to start again. 2. Housing repairs have been obtained for a family who had moved from one part of the Borough to another. 3. Recuperative holidays have been arranged for at least two elderly people. 4. Two children who were involved in problem families have been helped by admission to Boarding Schools. 5. The N.S.P.C.C. Inspector has been put in touch with a suitable case which resulted in a prosecution. 6. Play activities and playmates have been arranged for one or two lonely or difficult children. 7. Neighbourly care of children or visiting of old people have been encouraged in a number of cases. 8. The British Red Cross Society, local branch, has co-operated in a number of cases requiring transport. Apart from this, an Old People's Birthday Visitation Scheme has been commenced though this is not yet in full swing and a Toddler and Baby Clinic has recently been started at the Practice Premises. All those involved have enjoyed the experience of sharing the social care of their patients and they know that the help given has been appreciated by the recipients. 43 HOME NURSING (Section 25) The Superintendent of District Nurses, Miss A. Williams, S.R.N., S.C.M., Q.I., H.V. Cert., reports as follows:— Again a good general nursing service has been maintained during the year 1963 by five whole-time District Nurses, one part-time nurse and one whole-time male nurse. The work mainly undertaken by all the nurses during the year has been care of the chronic sick with a good proportion of blanket bathing to elderly and infirm. The male nurse's work is much appreciated, particularly with heavy male patients. Good co-operation has again been maintained with Langthorne Hospital for the care of patients, on the six weeks basis. This arrangement is a great benefit to the patients' relatives and the nursing staff. A number of Student Nurses from Wanstead Hospital have been taken into the homes of the patients to see the work of the District Nurse. Number of new cases 568 Number of visits 22,777 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 oral poliomyelitis vaccine. Vaccination and immunisation is carried out largely by the family doctor although it is available also at all the Child Welfare Clinics. In the case of adults a special session is arranged, where necessarv. at the School Clinic. 44 The following statistical information is supplied on the programme carried out during the year:— Poliomyelitis Oral Vaccine Primary Course 910 3rd dose 309 4th dose 421 Salk Vaccine Primary Course 111 3rd injection 322 4th injection 75 Diphtheria/Tetanus/Whooping Cough Primary Courses Under 5 years of age 683 5-15 years of age 24 Re-inforcing injections 135 Diphtheria/Tetanus Primary Courses Under 5 years of age 2 5-15 years of age 27 Re-inforcing injections 25 Diphtheria Primary Courses Under 5 years of age 35 5-15 years of age 14 Re-inforcing injections 161 Tetanus Primary Courses Under 5 years of age 12 5-15 years of age 50 over 15 years of age 24 Whooping Cough Primary Courses Under 5 years of age 19 Re-inforcing injections 6 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 105 111 25 80 321 Re-vaccination — 7 31 317 355 45 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 4,410 Attendances: New Contacts 151 Old Contacts 753 Total—Contacts, Notified, Observation 4,880 B.C.G. Vaccinations 85 New Cases Notified 28 Notified Cases transferred in 27 Notified Cases transferred out 15 Deaths 9 Discharged Disease Arrested 2 In my Report of the work of the Chest Clinic during recent years, I have been happy to announce the continued fall in the numbers of tuberculous notifications and in 1962 only twenty new patients were discovered to be suffering from this disease. At the same time, I have constantly reiterated the need for maintained vigilance, in spite of the decline in mortality and notification returns and have emphasised that we must never become complacent in our fight to wipe out what, at one time, was described as "the greatest Public Health problem of this Century". Perusal of the statistics shows that the number of new cases discovered during 1963 has arisen to twenty-eight—a timely warning that we in the Public Health and Chest Clinics Services must never relax our efforts in the control of Tuberculosis. Each year, this Report has included a few details of cases of interest in the field of Tuberculosis. Here are four cases which again emphasise the importance of continued contact supervision at the Clinic. A husband developed Tuberculosis and was admitted to Harts Hospital. His daughter, aged 2, was found to have primary lung Tuberculosis and was transferred to the Children's Unit, Black Notley Hospital. The remainder of the family kept under Clinic supervision and six months later his wife was found to have Pulmonary Tuberculosis: she also had to be admitted for treatment. 46 A mother was admitted to Hospital with Pulmonary Tuberculosis. Routine check-up on her family revealed that her two children were suffering from primary lung Tuberculosis and both were sent to Black Notley Hospital. Lung Tuberculosis was found in a Clinic patient and he was admitted to Harts Hospital. Seven months later, active tuberculosis disease was discovered in his son's chest. Finally, one patient, examined as a contact to his wife, who died of Tuberculosis, did not keep under Clinic supervision. He was admitted as an emergency case with extensive Tuberculous disease four years later. These cases all illustrate the value of continuous contact examination, dull and routine though it may be. They also emphasise the fact that one negative check-up is not sufficient, the disease can develop months, even years, later. The Wanstead and Woodford Tuberculosis Care Association is a very active Organisation, which fully recognises the changing aspects of Tuberculosis and diseases of the chest. At their Annual General Meeting in 1963, it was agreed that in future, financial aid and assistance would be given to all cases of chest disease in need of help who attended the Wanstead and Woodford Chest Clinic. As a result of this important change of policy, the Association has now altered its name to that of the Chest Care Association. In the field of thoracic surgery, there is a very close link between the Clinic and the Thoracic Department of the London Hospital, where patients are quickly admitted for treatment. Finally, a very real liaison exists between the Medical Officer of Health and his Department, the School Health Medical Service, the Housing Department and the Chest Clinic, which results in our patients getting maximum help at a time when they require it most. Miss R. Harrington, Honorary Secretary to the Wanstead and Woodford Care Association has informed me that 51 individual patients have received help during the year which included extra nourishment vouchers, payment of debts, fares to enable relatives to visit patients in hospital, contribution towards cost of holiday' for patient and family, provision of transport to Victoria Station for convalescent patient, provision of a room heater, and Christmas Gifts. The year was quite a success financially. The Christmas Seals receipts were £20 more than the previous year. The social activities included Dances, Whist Drives, Coffee Mornings, Jumble Sales and Carol Singing, which were all very successful in raising money. Total expenditure on grants during the year was £324 17s. 7d. and excess of income over expenditure was £180 16s. 5d. Because of the improved financial position, it was decided at the Annual General Meeting, held in November, to change the name of the Association to "The Wanstead and Woodford Chest Care Association", to widen the field of activities to include the care of patients suffering from Chest Diseases other than Tuberculosis. 47 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 8 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 a domiciliary service; as many as possible of these cases are conveyed to the clinic by transport, either by ambulance or by voluntary workers. 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 maintained the service of Home Helps to those within the Borough who have been in need of general household assistance through old age, chronic or acute illness, maternity needs and accidents. There have also been homes provided with the service where it has been necessary for the mother of the home to enter hospital and the children have needed care and attention in her absence. The year, commencing with its intensity of winter months, held severe problems in maintaining the service, particularly for the elderly and their shopping necessities. Throughout these months the domestic staff gave cheerful and loyal service, many walking several miles when transport was delayed. At the close of the year the following patients were receiving domestic service:— Aged patients 302 Maternity cases 6 Patients under 65 years of age 50 Acute sick 2 Family with mother in hospital 1 Family with young twins necessitating help for temporary period 1 Calls upon the service have been received from hospitals as patients are discharged to their own homes and from the Health Visitors and District Nurses. 48 The constant co-operation of the Women's Voluntary Service with "Meals on Wheels", so often with only overnight notification, has been appreciated by the service, and also the willing supply of any outstanding needs of a patient. There are 88 Home Helps covering domestic duties in the Borough. SCHOOL HEALTH SERVICES 1963 WANSTEAD AND WOODFORD 1. School Medical Inspections There was no change in the arrangements for the periodic examination of pupils attending maintained schools, the details being as follows:— 1. As entrants (5-6 years) 616 2. After admission to Secondary Schools (11-12 years) 579 3. 14-15 year age group 562 4. Others 17 5. Specials (at request of Head Teacher, Teacher, Parent, School Nurse, etc.) 18 6. Re-examination (i.e., follow-up of a defect previously noted) 481 TOTAL (all groups) 2273 2. Cleanliness Surveys 6974 pupils were inspected, only 6 being found to have some head infestation. In no case was it necessary to issue a cleansing order as parents, upon following instructions issued by the School Nurse, were able to clear the infestation. From the commencement of the Summer Term, 1963, it was decided that Cleanliness Survey would no longer be carried out in Junior and Secondary Schools but that Health Visitors would contact Schools at the beginning of each term and inspect children of families known to be sub-standard and also any children referred by the Head Teacher. 3. B.C.G. Vaccination of School Children The acceptance rate to this scheme showed a rise for the fourth year in succession, reaching 72.6 per cent in 1963. B.C.G. Vaccination was offered to 803 pupils of 13 years of age, acceptances numbering 583. 49 4. Tuberculosis Case Finding amongst School Entrants The response to this scheme inviting parents to allow a Skin Test on their child shortly after school entry, showed a most satisfactory upward trend, to 78 per cent (70 per cent in 1962). Of the 377 children tested, a positive reaction was noted in 5; these were referred to the chest physician for investigation but no matters of significance were discovered. 5. Child Guidance Service The Child Guidance Clinic at Walthamstow remains the centre for children from this Borough who are deemed in need of psychiatric treatment. Whilst there is a waiting list, the fullest co-operation is given in respect of cases which are recommended as urgent. 6. Defective Hearing The clinic nurse responsible for carrying out hearing tests resigned and the consequent delay whilst training her successor, resulted in a temporary halt to the good progress being made in the scheme to test the hearing of all new entrants. However, it was possible to deal with cases referred specially by Head Teachers, School Medical Officers or the Educational Psychologists, the details being as follows:— (i) Children to be considered 'at risk' (i.e., suspected to have some loss of hearing) Total No. referred 25 Results of test:— Normal hearing 18 For observation (in 1963) — To ENT Consultant 7 Result of ENT Examination:— No defect 3 Remove tonsils and/or adenoids 3 Some loss of hearing but no treatment required 1 7. School Clinic A School Medical Officer continued to attend each Friday morning at 93 High Road, South Woodford, when special cases were seen for a variety of reasons, e.g., referral to Child Guidance Clinics, Hearing Tests, examinations for employment, etc. 50 8. School Dental Service Whole-time service continued to be provided at the Clinic at 93 High Road, South Woodford, a summary of the work carried out is given at Appendix 'A'. 9. Speech Therapy The Speech Therapist attends at 93 High Road, South Woodford, on Mondays, and at 118 Hermon Hill, South Woodford, on Wednesdays. During the year a total of 150 sessions were held in which 69 pupils made a total of 848 attendances. A cure was effected in 21 cases; those under treatment at the end of the year numbering 39, the remaining 9 cases having failed to continue to attend for treatment. 10. Specialist Services The Clinic at 93 High Road, South Woodford, continues to be used, by arrangement with Essex County Council, for the provision of Ophthalmic, Orthoptic, Orthopaedic and Physiotherapy services under the auspices of the North East Metropolitan Regional Hospital Board. 51 APPENDIX "A" Dental Inspections and Treatment: Number of pupils inspected (periodic and specials) 1686 Number found to require treatment: (a) Periodic 653 (b) Specials 200 Total 853 Attendances made by pupils for treatment Fillings: Permanent Teeth 1241 Temporary 317 Total 1558 No. of Teeth Filled: Permanent Teeth 1110 Temporary 269 Total 1379 Extractions: Permanent Teeth 8 Temporary 239 Total 247 Administration of anaesthetics: (a) Local 15 (b) General 82 Total 97 Other Operations: (a) Permanent Teeth 173 (b) Temporary 76 Total 249 52