LEY 33 Borough of Leyton. HEALTH REPORT FOR THE YEAR 1939. ANDREW W. FORREST, M.A., M.D., Ch.B., D.P.H., Medical Officer of Health, School Medical Officer, :: Medical Superintendent of Isolation Hospital. :: 1 HIS WORSHIP THE MAYOR (Mb. Alderman Reynolds, J.P.), ex-officio Member of Committees. PUBLIC HEALTH COMMITTEE: DISEASES OF ANIMALS ACT COMMITTEE. Chairman : Alderman Mrs. Shimmin. Members : Alderman Bechervaise. „ Mrs. Hammond. ,, Mrs. Mawer. ,, Shimmin, B.Sc. Councillor Bass. „ Bell. „ Bussey. Councillor Mrs. Crown. „ Gowar. „ Hinton, J.P. „ Rayner. „ Rigg. „ Mrs. Warner. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman : Alderman Mrs. Mawer. Members : Alderman Fitzgerald. ,, Mrs. Hammond. „ Mrs. Shimmin. Councillor Mrs. Crown. Councillor Hurry. „ Leonard. „ Quantrell. „ Turner. „ Whatnall. Co-opted Members : Mrs. King. „ Martin. „ Mereday. Mrs. Sortwell. „ Waller. EDUCATION COMMITTEE. Chairman : Alderman Bechervaise. Members : Alderman Fitzgerald. „ Mrs. Hammond. „ Mrs. Mawer. „ Mills. „ Shimmin, B.Sc. ,, Mrs. Shimmin. Councillor Allanson, J.P. Councillor Burrell. „ Hawkins (W. F.). „ Hinton, J.P. „ Pearce. „ Rayner. „ Riog. „ Turner. Co-opted Members : Mrs. Dare. „ King. ,, Ringer. Mr. L. Levy. „ W. C. Russell, J.P. „ F. R. Webber. EDUCATION WELFARE SUB-COMMITTEE. Chairman : Alderman Mbs. Hammond. Members : Alderman Fitzgerald. ,, Mrs. Mawer. „ Mbs. Shimmin. Councillor Burrell. „ Hinton, J.P. „ Rayner. Councillor Rigc. Turner. Mrs. Dare. „ King. „ Ringer. Mr. W. C. Russell, J.P. 2 Borough of Leyton. PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A. MEDICAL—Whole Time. *Forrest, Andrew W., M.A., M.D., M.B., Ch.B., D.P.H., Medical Officer of Health School Medical Officer, Medical Superintendent of Isolation Hospital. *Henderson, Peter, M.D., M.B., Ch.B., D.P.H., Deputy Medical Officer of Health and Deputy School Medical Officer (resigned 31.1.39). *Rennie, James Little, M.B., Ch.B., F.R.K.P.S.(Glasg.), D.P.H., Deputy Medical Officer of Health and Deputy School Medical Officer (commenced 1.5.39). *Menzies, Hilda F., M.D., M.B., Ch.B., D.P.H., Assistant Medical Officer of Health (Maternity and Child Welfare). *Gilchrist, Mary Lyle, M.D., M.B., Ch.B., D.P.H., Assistant Medical Officer oi Health. MEDICAL—Part Time. Kennedy, John, M.B., Ch.B. (Glasg.), Emergency Medical Attendant at Isolation Hospital (died 24.10.39). *Cardell, John Douglas Maoor, M.B., B.S. (Lond.), F.R.C.S. (Eng.), M.R.C.S., L.R.C.P., Ophthalmic Surgeon. *Howell, Bernard Whitchurch, M.B., B.S. (Lond.), F.R.C.S. (Eng.), M.R.C.S., L.R.C.P. (Lond.), Orthopaedic Surgeon. *Brews, Richard Alan, F.R.C.S. (Eng.), M.D. (Lond.), M.S., M.B., B.S., M.R.C.P., (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), Consultant Obstetrician. *Sandiford, Cyril Ratcliffe, M.D. (Manch.), M.B., Ch.B., F.R.C.S. (Ed.), Aural Surgeon. *Elman, Claude, M.D. (Lond.), M.B., B.S., M.R.C.P. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), Physician i/c Heart Clinic. *Jardine, Helen Margaret, M.D. (Aberd.), M.B., Ch.B., M.M.S.A. (Lond.), Medica! Officer i/c Post Natal and Gynaecological Clinic (resigned 30.6.39). *Clark, Annie Simpson, M.B., Ch.B., Medical Officer i/c Post Natal and Gynaecological Clinic (commenced 1.7.39). B. DENTAL SURGEONS. Senior Denial Surgeon. Hall, Arthur Edward, L.D.S. (Liverpool). Dental Surgeons. *Horton, James Ernest, L.D.S., R.C.S. (Eng.) *Grant, David Reginald Brash, L.D.S., R.C.S. (Edin.) C SANITARY INSPECTORS. Senior Sanitary Inspector. *Gray, Edward Henry, Certificate R.S.I., Meat Inspector's Certificate R.S.I. Sanitary Inspectors. *Steeden, Edward James, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Smith, Victor Wynn, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Reeves, Reginald Alfred, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Turbitt, Wilfred, Certificate R.S.I., Meat Inspector's Certificate R.S.I. (resigned 31.12.39). *Reeve, Frederick William, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Barnes, Arthur Edward, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Nightingale, A. G., Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Kluth, Leslie, Certificate R.S.I., Meat Inspector's Certificate R.S.I., Smoke Inspector's Certificate R.S.I. (resigned 10.10.39). *Waring, John Edwin, Certificate R.S.I., Meat Inspector's Certificate R.S.I. (commenced 2.10.39). D. NURSING STAFF. Matron, Borough Isolation Hospital. Ryan, Miss E. (resigned 30.6.39). Murphy, Elizabeth, S.R.N., S.R.F.N. (commenced 1.7.39). 3 Health Visitors. * Bratton, Maud, S.R.N. *Walling, Ethel Winifred, S.C.M., S.R.N., Health Visitor's Certificate R.S.I. *Kitterhing, Margery, S.C.M., S.R.N., Health Visitor's Certificate R.S.I. *Sizer, Agnes, S.R.N., S.C.M., Health Visitor's Certificate R.S.I. *Hughes, Emily Doreen, S.R.N., S.C.M., Health Visitor's Certificate R.S.I. School Nurses. *Crawford, Daisy, S.R.N., Health Visitor's Certificate R.S.I. *Sykes, Martha, S.R.N. *Maye, Marie, S.R.N., Health Visitor's Certificate R.S.I. *Edwards, Ruth, S.R.N., S.C.M. *Stiles, Eleanor, S.R.N., S.C.M. *Corby, Elizabeth, S.R.N. *Acton, Lucy, S.R.N., S.C.M. Municipal Midwives. Roberts, Elizabeth, S.R.N., S.C.M. Daines, Emily, S.R.N.. S.C.M. Thompson, Mabel, S.R.N., S.C.M. E OTHER STAFF. Veterinary Inspector under the Diseases of Animals Act. Scott, Eustace Edward, M.R.C.V.S. Masseuse. *Findlay, Miss A. E., Cert. Chartered Society of Massage, etc. Chiropodists. O'Brien, John, M.I.S.Ch. Stokes, Miss Florence, M.I.S.Ch Orthoptist. *Smith, Miss Glennis. Denial Attendant. *Grimshaw, Miss Peggy. Mortuary Keeper. Miles, Esau George. F. CLERICAL STAFF. Chief Clerk. *Leserve, George Frederick. Clerics. Jacobs, E. E. Softley, W. D. Brighting, G. Halsey, C. S. Freeman, A. L. Thurlow, G. Clarke, J. Ware, F. C. Lamb, E. E. *Hayes, Miss A. *Payne, Miss W. * Proportion of Salary contributed under Public Health Acts or by Exchequer Grants 4 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Mr. Mayor, Ladies and Gentlemen, I submit herewith my Annual Report on the health, sanitary circumstances and vital statistics of the Borough of Leyton during the year 1939, together with my Annual Report to the Education Authority on the work of the school medical service during the year. These reports are drawn up on the lines required by the Ministry of Health and the Board of 'Education. Ministry of Health Circular 1961 of February, 1940, suggests that during the war period Annual Reports of Medical Officers of Health should be materially shortened, that many items which usually appear may be omitted entirely, and that those which should be retained may be dealt with as briefly as possible. In their official Form 6M of December, 1939, the Board of Education recognise that in view of the abnormal conditions arising out of the war, the evacuation and the disturbance and depletion of the regular medical, dental, nursing and clerical staffs, it will not be possible for School Medical Officers to present reports for 1939 on the usual comprehensive scale. Moreover, the urgent need for economy, and especially in the use of paper, makes it desirable to curtail Annual Reports as far as possible. There is an additional, and somewhat less academic reason for curtailing the scope of this Annual Report—the fact that there is a limit to the amount of work which can be undertaken by the Staff of your Health Department. During the year under review there has been imposed on your Medical Officer of Health the responsibility of organising and putting into operation the Air Raid Precautions Casualty Service in the Borough—a task which has been formidable and at times overwhelming. However, with the loyal co-operation of all members of the Staff of the Health Department, who have gladly shouldered extra and onerous duties as their contribution to the national effort, it has been possible to organise, equip and staff the Casualty Service on the lines laid down in a bewildering amount of official circulars, memoranda, handbooks, etc. No reference is made in the body of this Report to the work of the A.R.P. Casualty Service, as the Ministry of Health do not include it among the subjects for inclusion in Annual Reports by Medical Officers of Health. The annual official figures supplied by the Registrar General form the basis on which all calculations of local vital statistics 5 are made. In view of the national emergency the Registrar General has not been able to supply the official figures for the current year, and in consequence the customary annual section dealing with vital statistics has been omitted in this report. It is hoped to incorporate the information in future reports. It is my privilege to acknowledge the support accorded to me by the Chairmen and Members of the Committees concerned with the work of the Health Department, and I have been gratified by the loyal co-operation and industry of the members of my Staff in surmounting the many difficulties which have arisen during the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, 6 SECTION B. GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. NURSING ARRANGEMENTS, CLINICS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE IN THE BOROUGH. The outbreak of war on 3rd September, 1939, necessitated temporary cancellation, modification and re-arrangement of certain health services. Information regarding such alterations will be found in the appropriate section of this Report. Public Mortuary. Number of bodies deposited, death being due to:— Natural causes 72 Suicide 15 Street accidents 5 Other accidents 2 94 Number of Post-mortem examinations performed 87 Number of Inquests held 27 In 67 instances no inquest was considered necessary in view of the post-mortem findings that death was due to natural causes. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. On 1st April, 1934, the Leyton Corporation took over the powers and duties contained in Part IV of the Essex County Council Act, 1933 ; and since that date it has been illegal for any person to carry on an establishment for massage and special treatment in the area without a licence from the Council. Your Council has designated me as the person authorised by Sec. 61 of the Act to enter and inspect premises. In September, 1934, your Council made Byelaws for the regulation of these establishments. These Byelaws deal with fees and charges, advertising, the conduct of the business, and the records to be kept. With regard to conduct of the business, it is laid down that— " A licensed person shall not do, suffer, or permit in the establishment, any act of an indecent or disorderly character, 7 and shall take all necessary steps to exclude from the establishment a customer or any other person who has committed such an act in the establishment. Such licensed person shall not employ or permit or suffer to be in or upon the establishment any person who is of known immoral character, and shall cause all persons in his employ engaged in the establishment to be decently and properly attired, and he shall not permit or suffer the door of any room or place in the establishment for the time being in use for the giving of massage or special treatment to be locked during the period that the patient is therein." But the Byelaws do not prescribe the technical qualifications to be possessed by persons administering any of the forms of special treatment, which include :—(a) massage, manicure or chiropody : (b) radiant heat, light, electric vapour or baths for therapeutic treatment, or (c) other similar treatment. Inasmuch as most of the establishments had been licensed previously by the Essex County Council, I have not recommended you to refuse to licence any person or premises as long as your Byelaws were complied with. Under Sec. 58 of the Act the Council may refuse to grant or renew a licence in respect of any establishment in which massage or special treatment is or may be administered by any person who does not possess " such technical qualifications as may be reasonably necessary," but there has been laid down no standard by which the many and varied types of qualification could be judged. Since 1928 the British Medical Association has drawn attention to the risks to which the public are exposed by the use of special forms of treatment by untrained and unqualified persons. Accordingly the British Medical Association—in conjunction with the Society of Apothecaries, the Chartered Society of Massage and Medical Gymnastics, the Society of Radiographers, the Association of Dispensing Opticians, and the Chiropody Group Council— has instituted and formed the Board of Registration of Medical Auxiliaries (Incorporated 1936). This Board prescribes not only the course of training, but also the examination standard to be possessed by candidates for approved certificates and diplomas, and publishes the official National Register of Medical Auxiliary Services containing the names, addresses and particular qualifications of persons holding Approved Qualifications in medical auxiliary work. 8 In order to safeguard against the exploitation of specialised forms of medical auxiliary work by persons of inadequate training, I recommend that in future licences be granted only to persons possessing technical qualifications recognised and approved by the Board of Registration of Medical Auxiliaries. There are in the Borough file establishments for massage and special treatment, all of which have been inspected during the year. FOOT CLINIC. The number of patients who attended the Foot Clinic in 1939 showed a decrease of 490. The number of treatments to patients decreased from 8,756 to 6,181; the reasons being (a) the closing of the clinic from September 2nd to September 27th (inclusive) ; (b) the decrease in the number of children suffering from plantar warts as compared with 1938. The number of children attending with plantar warts in 1938 was 337. In 1939 the number decreased to 113. This is an increase of 41 cases in the number who attended in 1937, showing more advantage is being made of the facilities for treatment available. Summary of Attendances and Treatment, 1939. A. All Ages. During the year 6,181 attendances were made, an average of 4.56 attendances per patient. .first Attendances (new cases). Su bsequent Attendances. Total Attendances. Average No. of Visits per Patient. No. Per cent. Males 108 3,595 3,703 59.91 2.73 Females 319 1,232 1,551 25.09 1.14 Children 137 790 927 15.00 .61 Total 564 5,617 6,181 4.56 During the year the numbers of persons who received free treatment was 135, 23.94 per cent. of the total number of new cases. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males. Females. Males. Females. Males. Females. Old age pensioners 38 50 758 1,149 796 1,189 Unemployed 11 15 122 262 133 277 Widows — 21 — 765 — 786 Totals 49 86 880 2,176 929 2,262 9 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTIONS OF THE AREA. Inspections. The table below gives a summary of the Inspections made by the Sanitary Inspectors :— Number of dwelling-houses inspected 2,611 Number of house-to-house inspections 852 Miscellaneous inspections 573 Re-inspections 8,659 Piggeries 1 Places of entertainment 8 Schools 21 Stables 218 Public Conveniences 87 Urinals 110 Inspections under Rats and Mice (Destruction) Act 433 Visits in connection with infectious disease 270 Factories without mechanical power 142 Factories with mechanical power 309 Offices 54 Outworkers' premises 651 Rag and bone dealers 12 Foster-mothers' premises 56 Hairdressers' premises 125 Public Houses 28 Nature of Work Executed and Improvements Effected in Dwelling-houses and other Premises under the Provisions of the Housing and Public Health Acts. Dampness remedied 684 Sashcords renewed 206 Plaster repaired 942 Roofs repaired or renewed 751 Guttering repaired or renewed 345 Yards paved 165 Drains re laid or partly relaid 257 Choked drains cleared 16 New w.c. pan and traps provided 77 10 Sinks provided 93 w.c. cisterns repaired or renewed 45 Rain water pipes repaired or renewed 174 Vent pipes repaired or renewed 42 Sink waste pipes renewed 166 Stoves repaired or renewed 249 Coppers repaired or renewed 33 Floors repaired 324 Rooms redecorated 1,775 Windows, sills, etc., repaired 644 Miscellaneous defects remedied 1,513 Drainage—The drains of 257 houses were reconstructed. In some instances the reconstruction related to portions of the public sewers, and in these cases, the work was carried out by the staff of the Borough Engineer and Surveyor's Department, the expenses incurred thereby being recovered from the owners. Verminous Houses. Infested. Disinfected. Number of Council houses 25 25 Number of other houses 220 220 Eradication of Bed Bugs. (See Annual Report, 1938.) Rag Flock Acts, 1911-1928. There are no premises within the Borough where rag flock is known to be manufactured. Shops Act, 1934—Sanitary Conveniences. Exemption certificates—in accordance with the provisions contained in the Shops Act, 1934 (Section 10, subsection 2)— were granted in respect of sanitary conveniences at two premises. Smoke Abatement. Forty-nine observations were kept on factory chimneys throughout the district. It was found necessary to issue eight letters of caution. It was not found necessary to take any statutory action. Rats and Mice (Destruction Act), 1919. Four hundred and thirty-three visits were paid in connection with complaints received, and rat biscuits were issued to the occupiers of 105 premises. At 95 premises the source of rat infestation was definitely traced and the premises freed of rats. 11 SECTION D. HOUSING. Complaints. During the year 1,133 complaints of nuisances were received and investigated. The nature of the complaints included sanitary defects in houses, drains choked or defective, premises infested with vermin, etc. Notices. Notices served—Informal 1,335 Statutory—Housing Acts Nil Public Health Acts 83 Re-drainage 110 Notices complied with—Informal 1,567 Statutory— Housing Acts 6 Public Health Acts 60 Re-drainage 126 Housing. Number of houses erected during the year:— (a) Total (including numbers given separately under (6)). (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons: Houses 3 Flats 26 (b) With State assistance under the Housing Acts. (i) By the Local Authority:— (a) For the purposes of Part v of the Act of 1936 Nil (6) For other purposes Nil (ii) By other bodies or persons Nil I.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,611 (b) Number of inspections made for the purpose 11,270 12 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 852 (b) Number of inspections made for the purpose 3,738 (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 1,335 II.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action taken by the Local Authority or their officers 1,567 III.—Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (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 83 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 60 (b) By Local Authority in default of owners Nil 13 (c) Proceedings under Sections 11 and 13 of the Housing Act 1936:— (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 (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil IV.—Housing Act, 1936. Part IV—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 130 (2) Number of families dwelling therein 130 (3) Number of persons dwelling therein — Adults 708 Children 224 (b) Number of new cases of overcrowding reported during the year 2 (c) (1) Number of cases of overcrowding relieved during the year 28 (2) Number of families concerned in such cases 28 (3) Number of persons concerned in such cases : Adults 154 Children 39 Housing Act, 1936. Information regarding 281 houses and 238 fiats was supplied in connection with the " permitted number of persons " in dwellings under the Act. Proceedings against the owner of four houses in respect of non-compliance with the provisions of the Act relating to a statement of the "permitted number of persons" in relation to the houses were withdrawn on the owner paying the Council's costs of 10s. 6d., and undertaking to insert the necessary entries forthwith. 14 Demolition. In accordance with the provisions of the Housing Act, 1936, the Local Sanitary Authority—acting on official representations made by the Medical Officer of Health—has continued to deal with the demolition and clearance of existing slum property in the area. Scheduled for demolition in 1937, and demolished in 1939:— 590, 592 and 594, High Road, Leyton, E.10. Scheduled for demolition in 1938, and demolished in 1939:— 35, Kingston Road. 9a and 10, Forest View. 99 and 101, Harrow Road. Schedided in 1937 and not yet demolished :— 596, High Road, Leyton, E.10. Scheduled in 1938; offers to carry out repairs accepted and repairs not yet completed:— 103 and 105, Harrow Road. Repair of Unfit Houses. In nine instances it was found necessary to take legal proceedings for non-compliance with a notice served to remedy a nuisance in accordance with the Public Health Act, 1936:— (1) The occupier of a house was summoned, and an order was made to carry out the necessary work within 14 days. (2) In two cases the owners were required to pay £1 1s. 0d. costs, and orders were made for the necessary work to be carried out within 14 days. (3) In two cases the owners were fined £2 0s. 0d. with £1 1s. 0d. costs, and orders were made for the necessary work to be carried out within 21 days. (4) Proceedings against the owner of four houses were withdrawn on the owner paying the Council's costs of £2 2s. 0d. and undertaking to carry out the necessary work within seven days. 15 House-to-House Inspection. The houses in the under-mentioned roads have been inspected during the year:— Chad wick Road. Chesterfield Road (part). Dames Road. Goldsmith Road (part). Holloway Road. Leigh Road. Morris Road. Newport Road. Norman Road (part). Popple ton Road (part). Sidmouth Road (part). Stanmore Road. Sunnyside Road. Wallwood Road (part). The number of dwelling-houses inspected and recorded under Housing Consolidated Regulations was 852. Rent and Mortgage Interest Restriction Act, 1920-1933. No applications for certificates were received. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year:— Slaughter-houses 1,858 Butchers 808 Bakehouses 132 Fishmongers 107 Milkshops and dairies 41-1 Provision shops 308 Dining rooms 211 Ice-cream dealers 217 Greengrocers 216 Fish friers 95 16 MILK. Dairies and Milkshops. Number of premises on register 240 Premises added to register during year 18 Premises removed from register during year 23 Visits of inspection 414 As the result of inspection infringements were found at 11 premises, and the necessary action was taken in each case. Nine persons were found to be retailing designated milk although not licensed in that respect, and cautions were given in each case. Bacteriological Examinations. Undesignated Milk.—Forty-one samples were taken. Designated Milk. Licences. No. Granted No. of Samples taken Result. Satisfactory Unsatisfactory Tuberculin Tested 10 _ Accredited 3 — — — Pasteurised 59 12 12 — Supplementary Licences – – – – Tuberculin Tested 2 — — — Pasteurised 1 — — — Totals 75 12 12 – Milk Supplied to Schools. Included in the designated milk samples listed above is one sample of milk taken in course of delivery to a school. This sample proved satisfactory. Ice Cream. Premises on Register at 31-12-1939 218 Premises registered during 1939 37 Premises removed from Register during 1939 16 Persons on Register at 31-12-1939 224 Persons registered during 1939 37 Persons removed from Register during 1939 16 Visits of inspection by Sanitary Inspectors 217 Samples taken for bacteriological examination 18 Thirty-seven premises were registered for the manufacture, storage or sale of ice cream during the year. 17 MEAT. Slaughter-Houses.—There are eight licenced slaughterhouses in the Borough, and 1,858 inspections of these slaughterhouses were made. Carcases and Viscera Inspected :— Animals Inspected. London Co-operative Society Abattoir. Other SlaughterHouses. Cattle 7,879 767 Calves 111 176 Swine 26,704 857 Sheep 21,378 3,789 56,072 5,589 SUMMARY OF CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 8,646 Nil 287 25,167 27,561 Number inspected 8,646 Nil 287 25,167 27,561 All diseases except Tuberculosis :— Whole carcases condemned 51 Nil 4 26 145 Carcases of which some part or organ was condemned 4,049 Nil 12 4,166 4,407 Percentage of the number inspected affected with disease other than tuberculosis 47.42 Nil 5.57 16.65 16.51 Tuberculosis only:— Whole carcases condemned 47 Nil Nil Nil 138 Carcases of which some part or organ was condemned 881 Nil Nil Nil 2,630 Percentage of the number inspected affected with tuberculosis 10.73 Nil Nil Nil 10.04 Slaughter of Animals Act, 1933. Thirty-five persons were licensed as slaughtermen during the year. 18 Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 8 Dairies, Milkshops and Dairymen 240 Butchers' shops, Stalls and Provision shops 278 Ice Cream dealers 224 Chimneys—other than private dwelling-houses approximately 100 Hairdressers'Premises 104 Offensive Trades. Rag and Bone dealers 4 Fish friers 30 Tripe boiler 1 Fat melter 1 Fat extractor 1 Gut scraper 1 Bone boiler 1 Blood boiler and blood drier 1 An application to continue the trades of tripe boiler, fat melter, fat extractor, gut scraper, bone boiler, blood boiler and blood drier was received, and permission given to carry on the trades for a further twelve months. Four applications to continue the trade of a fish frier were received and permission given for a further limited period. One application for the permission of the Council to establish the trade of a fish frier was made and granted. Ninety-five inspections were made of the premises where fish frying is carried on. Contagious Diseases of Animals Acts, 1894-1927. One hundred and thirty licences were issued in respect of the movement of:— Cattle 417 Sheep 1,655 Pigs 1,803 Calves 76 from other areas into this district for the purpose of slaughter. 19 Food and Drugs Act, 1938. Prior to 1st October, 1939, the County Council was the Authority responsible for the administration of the Food and Drugs Act, but on and after that date the Leyton Corporation took over the responsibility for the administration of the Act and the enforcement of its provisions. Section 66 of the Act states that:— " Every Food and Drugs Authority shall appoint in accordance with the provisions of this section one or more persons (in this Act referred to as ' public analysts ') to be analysts of foods and drugs within their area," and in accordance with the provisions of this section your Council have appointed—with the approval of the Ministry of Health— Dr. Bernard Dyer, D.Sc., F.I.C., and Mr. George Taylor, F.I.C., as joint public analysts in the Borough of Leyton. The number of samples taken for analysis under the provisions of this Act to the 31st December was 14, as follows :— Samples Samples analysed. unsatisfactory. Milk 8 1 Butter 2 — Lard 1 — Soup Powder 1 — Custard Powder 1 — Seidlitz Powder 1 — 14 1 I am indebted to the Chief Inspector (Mr. A. Horsnell) for the following information regarding samples taken in Leyton during the period 1st January to 30th September, 1939. Samples of milk taken 8 Samples of butter taken 19 Other samples 123 20 SECTION F. FACTORIES. THE FACTORIES ACT, 1937. Basement Bakehouses. In accordance with the Act a report was submitted relating to the result of an examination which had been made of the basement bakehouses used as bakehouses at the date of the passing of the Factories Act, 1937, and in respect of which a certificate of suitability had been issued by the Council under the Factories and Workshops Act, 1901. The Council decided that one basement bakehouse was suitable as such as regards construction, height, light, ventilation and hygienic respects, and that a notice be given that the certificate issued in respect thereof should continue to operate so long as such bakehouse may otherwise lawfully be used but without prejudice to the power of the Council to revoke the certificate as the result of a subsequent examination. With regard to the other four basement bakehouses, the Council decided that these premises were not suitable for use as such and that notice be given that the certificates issued in respect thereof should cease to have effect after the expiration of a period of 12 months. The owner of two basement bakehouses appealed against the Council's decision. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH. Including inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories with mechanical power 351 36 – Factories without mechanical power 178 5 – Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) – – – Total 529 41 — 21 2. DEFECTS FOUND. Particulars. (1) Number oi Defects. Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) No. of defects in respect of which prosecutions were instituted. (5) Want of cleanliness 48 128 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 2 3 — — Ineffective drainage of floors 1 1 — — Sanitary Conveniences : Insufficient 2 4 — — Unsuitable or defective 5 14 — — Not separate for sexes — — — — Other offences— (Not including offences relating to Home Work, etc.) 14 38 — — Total 72 188 — — OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937). Nature of Work. (1) Instances. (2) Notices served. (3) Prosecutions. (4) Nil Nil Nil — 22 ISOLATION HOSPITAL. During the last Great War (1914-1918) Leyton Temporary Isolation Hospital—a corrugated iron structure—was found to afford no protection to patients and staff from splinters, and was evacuated during the latter part of that war. In August, 1939 I was instructed to arrange for the evacuation of all patients and staff from the Isolation Hospital in the event of emergency ; and on 31st August, 1939, all patients were transferred to Walthamstow Fever Hospital. In accordance with the official instructions regarding medical arrangements in evacuation and reception areas, I communicated with the County Medical Officer of Health, the Medical Officer of Health, Walthamstow, and the Medical Superintendent, Waltham Joint Fever Hospital—offering the services of the Leyton Isolation Hospital nursing and domestic staff for duty in these hospitals, if required. Owing, however, to the exceptionally low incidence of infectious diseases at the outbreak of hostilities and since, these hospitals have not required any additional assistance. Two assistant nurses were seconded to the reception area for duty at an improvised hospital at Chelmsford, where they have been serving since 6th October, leaving matron and nine nurses, who have been on duty (in shifts of 12 hours) at the first aid posts in the Borough since the outbreak of hostilities. The hospital cook has been on duty at High Road Baths first aid post, acting as cook to the nursing and domestic staff billeted there. Two non-resident laundresses have been on duty at the Isolation Hospital laundry, where they are employed doing the laundry work for the nursing staff and for the first aid posts. In addition, A.R.P. blankets are being washed at the Hospital laundry. One non-resident seamstress is employed at the Isolation Hospital on work connected with the A.R.P. Casualty Services. Two wardmaids have been serving in the reception area at a Special Home for schoolchildren near Braintree, leaving three resident maids and one non-resident maid for duty at aid posts. The three Hospital porters are employed on gate dutiss, looking after hospital premises and equipment, and working the steam disinfector. In addition to the ordinary steam disinfection for infectious diseases, A.R.P. personnel blankets are being disinfected. 23 The two Hospital ambulance drivers are on duty for the conveyance of patients to Hospital ; and for the removal of bedding, clothing, etc., for steam disinfection. In the event of air raids, the male staff will be allocated duties in connection with the A.R.P. Casualty Services. Statistical Returns 1939. Admissions :— At all Ages. Under 1 year. 1 and under 5yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 35 yrs. 35 and under 45 yrs. 45 yrs. & upwards Scarlet Fever 147 — 30 97 11 9 Diphtheria 119 — 2 99 7 11 — — Totals 266 — 32 196 18 20 — — The total number of patients admitted during the year was 266, as compared with 355 during the previous year. SCARLET FEVER. Of 233 persons notified during the year 147 (63 per cent.) were admitted to Leyton Isolation Hospital for treatment. Of that number 71 were males and 76 females. The average period of treatment in hospital was 25.73 days. 1935 1936 1937 1938 1939 Number of cases notified 409 367 309 293 233 Number of cases treated in Leyton Isolation Hospital 260 232 212 204 147 Percentage 63% 63% 68% 69% 63% Deaths in Hospital 0 2 0 0 1 Hospital case fatality Nil. 0.86% Nil. Nil. 0.68% DIPHTHERIA. Of 148 persons notified during the year, 119 (80 per cent.) were admitted to Leyton Isolation Hospital. Of that number, 44 were males and 75 females. 44 were males and 75 females. The average period of treatment in hospital was 35.89 days per case. 1934 1935 1936 1937 1938 1939 Number of cases notified 257 276 231 161 188 148 Number treated in Leyton Isolation Hospital 193 188 187 136 151 119 Percentage 75% 68.1% 80% 84% 80% 80% Deaths in Hospital 10 6 9 4 1 3 Hospital case fatality 5.18% 3.19% 4.81% 2.94% 0.66% 2.52% 24 Deaths.—Three deaths due to diphtheria occurred in Leyton Isolation Hospital during the year, the following being the relevant particulars :— Sex. Age. Cause of Death. In Hospital. M. 3 years Diphtheria 12 days M. 4 „ Diphtheritic Laryngitis, Broncho pneumonia ... 5 „ F. 5 „ Laryngeal Diphtheria ... 2 Massage and Special Treatment. The Council's Masseuse, Miss Findlay, attends at the Isolation Hospital during one morning per week, and the following list shows the numbers of the different types of patients dealt with. Number of Number of patients treated, treatments. Under School Age 12 14 School Children 61 131 Adults 12 15 85 160 25 MATERNITY AND CHILD WELFARE. At the outbreak of war the Council's Maternity and Child Welfare Clinics were closed temporarily in order to safeguard against the possibility of exposing to air raids expectant and nursing mot hers and young children congregated at the Welfare Sessions. An additional consideration was the fact that the Clinic Medical Officers and Health Visitors were all allocated for duty at First Aid Posts in order to deal with the air raid casualties expected at that time. After about a fortnight's freedom from air raids steps were taken to visit at their homes such mothers and children as were found to require special consideration and treatment. By 2nd October it was possible to relieve the members of the medical, nursing and clerical staff from duties in connection with the local A.R.P. Casualty Services during the day-time, and to resume the following clinic sessions at the two Council Health Centres (Leyton Green and Park House) :— Infant Welfare Two sessions per week at each Centre. Ante-Natal One regular session at each Centre per week, and additional sessions by appointment as required. This arrangement was found to work very satisfactorily, and by the end of the year under review these clinic sessions were being well attended. INFANT WELFARE. Notification of Births.—Fourteen hundred and one notifications of births were received during the year. By medical practitioners 468 By midwives 933 By parents and others Nil. During the year under review, the total attendances at the Council's Infant Welfare Centres were 15,219, a decrease of 3,362 compared with the figure (18,581) for the previous year. The number of children examined by the Clinic Medical Officers was 5,919 as compared with 7,040 examined during the previous year. 26 TABLE 1. ATTENDANCES, EXAMINATIONS, ETC., 1939. Leyton Green. Park House. All Centres p.m. Mon. p.m. Wed. a.m. Fri. p.m. Fri. p.m. Mon. a.m. Tues. p.m. Tues. p.m. Thurs. Under 1 year— 1 st attendances 184 242 24 92 167 30 168 177 1,084 Subsequent attendances 1,352 2.393 428 1,236 1,560 220 1,714 1,595 10,498 Total attendances 1,536 2,635 452 1,328 1,727 250 1,882 1,772 11,582 1-5 years— 1st attendances 26 32 42 24 15 28 20 196 Subsequent attendances 430 624 427 241 543 243 431 502 3,441 Tot al attendances 456 656 469 250 567 258 459 522 3,637 Total attendances, both age groups 1,992 3,291 921 1,578 2,294 508 2,341 2,294 15,219 Average attendance per session 45.27 71.54 27.90 49.31 67.47 15.87 53.20 48.80 48.77 Number examined by clinic M.O. 821 1,045 602 597 869 318 797 870 5,919 Average numberexamined per doctor per session 18.65 22.71 18.24 18.65 25.55 7.93 18.11 18.51 15.76 Number weighed 1,992 3,271 911 1,576 2,290 484 2,331 2,294 15,149 27 Health Visitors. During the year the Health Visitors have made 16,635 visits to homes, as follows :— (а) To expectant mothers :— First visits 308 Total visits 328 (б) To children under 1 year of age :— First visits 1,461 Total visits 7,041 (c) To children between the ages of 1 and 5 years :— Total visits 9,266 Dental Treatment. During the normal period of the year, two sessions per week— one at Park House and one at Leyton Green—were devoted to Maternity and Infant Welfare work. In addition, a half session on alternate Saturday mornings was held at each Clinic for general anaesthetic cases. All cases referred to the dental department were seen, routine conservative work was carried out, and dentures supplied to nursing mothers. A brief resume of the work done up to the end of August can be seen in the attached table :— Expectant Mothers. Children. Patients treated 82 137 Attendances 210 259 Extractions 313 277 Fillings 38 85 Other dental operations 50 10 Advice only 15 28 Anaesthetics— General 63 71 Local 11 37 Dentures supplied— Full upper and lower 6 Partial upper and lower 1 Full upper and partial lower 1 Partial upper 7 Partial lower 1 16 28 Orthopaedic Treatment. Primary Examinations.—During the year 22 children were referred from the Infant Welfare Clinics to the Council's Orthopaedio Surgeon. Re-examinations.—In addition to the 22 new cases mentioned above, 51 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—Seventy children made 213 attendances at Knotts Green Special School for special treatment by the Council's Masseuse (Miss Findlay). Provision of Surgical Appliances.—Thirty-seven children were supplied with surgical appliances on the recommendation of the Orthopaedic Surgeon. Special Eye Clinic. During the year the Council's Ophthalmic Surgeon (J. D. Magor Cardell, M.B., F.R.C.S.) had referred to him by the Clinic Medical Officers 29 pre-school children, who made 45 attendances for examination and treatment. Artificial Sunlight Treatment. Number of cases treated 100 Total number of attendances 1,404 Convalescent Home Treatment. Children. During the year 27 children, recommended by the Clinic Medical Officers, were sent to Convalescent Homes by the Maternity and Child Welfare Authority through the agency of the Invalid Children's Aid Association. Nursing Mothers. Six mothers were sent away for a period of convalescence after they had had their babies. Ophthalmia Neonatorum. No. of Cases Notified. Treated Vision. Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. in Hosp. 6 1 5 6 — — — 29 Public Health Act, 1936. Child Life Protection. On 1st January, 29 foster mothers and 30 children—and at the end of the year 23 foster mothers and 24 children—were subject to inspection. The Council's Child Protection Visitors made 161 visits of inspection during the year. Summary, Year 1939. Number of nurse children on Register, 1st January 30 Number of nurse children notified by foster mothers during the year 26 Nurse children removed :— To parents or relatives 16 To another foster mother 2 With foster mother to another area ... 2 Adopted... 2 To institutions ... 2 Evacuated under Government Scheme 7 Number of nurse children on Register on 31st December 24 Ante-natal Clinics— Attendances.—During 1939, the attendances were :— Centre. First Attendances. Subsequent Attendances. Total. Park House Clinic, 272 531 803 Leyton Green Clinic 227 494 721 499 1,025 1,524 The average number in attendance at the Ante-Natal Clinics held at the Council's two Centres during 1939 was 13.60 per session. The number of home visits made by Health Visitors to expectant mothers during the year was 308. Maternity Beds. In addition to the 499 expectant mothers who attended the Council's clinics, 155 attended the Out-patient Department of Queen Mary's Hospital, Stratford, for ante-natal supervision, and subsequently had their confinements in the Margaret Lyle Wards of the hospital. 30 On the outbreak of war the Leyton Council's arrangement with Queen Mary's Hospital, Stratford, for the provision of maternity beds in the Margaret Lyle Maternity Wing of the Hospital ceased to operate as the Maternity Wing was then closed in order to provide for the reception of air raid casualties. After that date the only local Hospital with available maternity beds was Forest Gate Hospital, which is administered by the Public Assistance Committee ; and arrangements were made for the admission to that institution of Leyton expectant mothers who were considered to require institutional treatment and care. In November your Council entered into an agreement with the Mother's Hospital, Clapton, for the provision of maternity bed accommodation on the following terms :— Total cost per bed for fourteen days : Five guineas for first confinements. Four guineas for subsequent confinements. Any case kept in hospital more than fourteen days is charged at the rate of 6s. Od. per additional day. Nursing Homes Registration Act, 1927. There are three registered nursing homes in the Borough. These institutions were inspected on 9 occasions. Home Helps. Under the Council's scheme for the provision of home helps, 141 applications for home helps were dealt with. In 102 cases (15 of whom made application in 1938), home helps were provided, 22 of these cases having the charges remitted in accordance with the Council's scale. In the 54 remaining cases, 27 made other arrangements for the confinement, and 27 cases had not been confined at the end of the year. Puerperal Pyrexia. Twenty-two cases of puerperal pyrexia were notified during the year. 31 The causes of pyrexia were considered to be :— Acute bronchitis I Puerperal sepsis 2 Post partum haemorrhage 1 Local uterine sepsis 4 Urinary infection .5 Mastitis 4 Infection of perineal sutures 1 Coryza 1 Not known 3 22 Obstetric Consultant. The advice of the Council's Consultant Obstetrician was sought on two occasions during the year. Maternity Mortality. There were four maternal deaths of Leyton residents during the year. The cause of death was as follows :— Puerperal sepsis 1 Puerperal eclampsia 1 Post partum haemorrhage 2 4 Medical Aid. In accordance with the Rules of the Central Midwives' Board, a midwife must notify the Local Supervising Authority within 36 hours of every occasion on which she sends for medical aid. Sixtyone such notifications were received. Fees paid to Doctors under Section 14 (1) of the Midwives' Acts, 1918. One hundred and thirty-three accounts were received from general medical practitioners for assistance rendered to midwives under the provisions of this section. The total amount paid to medical practitioners during the year was £181 4s. 6d. 32 Assisted Milk Supply. As it is a condition of grant that the mothers or infants must attend the Authority's Centres—unless when unable to attend, in which case the home is visited by a Health Visitor—all mothers and infants in receipt of milk free or at reduced price are under medical supervision. Year. Pints of Fresh Milk. Packets of Dried Milk. Cost to Council. £ s. d. 1935 63,192 762 862 13 5 1936 64,624 356 757 12 8 1937 61,598 395 824 11 11 1938 78,352 736 1,106 2 9 1939 71,728 930 1,042 15 4 Post-Natal and Gynaecological Clinic. The following figures show in statistical form the attendances during 1939 :— Leyton Green. Park House. Total. Number of Sessions 14 16 30 Letters of Invitation 470 353 823 First Attendances 165 119 284 Re-attendances 70 50 120 Report by Dr. Anne S. Clark, M.B., Ch.B. During the year 34 sessions of the Post-Natal and Gynaecological Clinic were held. The number of new patients who attended was 284, out of 823 who received appointments to attend (= 34.5 per cent.). Of these, 226 were " post-natal " (i.e., they had had a confinement within the previous three months); and 18 were " gynaecological." The disposal of these cases was as follows ;— Discharged after one attendance 149 Re-attended for examination and treatment 135 Referred with letter to medical practitioners 10 Referred to hospital 4 33 The total number of attendances was 403. The average attendance per session was 11.8—with a maximum of 19 and a minimum of 5. Free medical prescriptions were issued in 37 cases at a total cost of £5 6s. Od. ; and 51 prescriptions were issued for payment by the patients. The following arc the main conditions which have been found on examination :— Subinvolution of the uterus 28 Retroversion of the uterus 60 Defective perineum 13 Cystocele and rectocele 22 Cervical erosion 6 Vaginitis 8 Ovarian cyst 1 Fibroid 1 Pregnancy 2 Cervical polypus 1 Marked anaemia 29 Birth control 33 SECTION G. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SMALLPOX. During the year 1938 no case of smallpox occurred in the area. ENTERIC FEVER. No case of enteric fever occurred during the year. SCARLET FEVER. Year. Cases Notified. Deaths. Case Fatality per cent. 1935 409 1 0.24 1936 367 o 0.54 1937 309 0 0.00 1938 293 0 0.00 1939 233 1 0.43 From these figures it will be seen that during the last five years there has been a progressive fall in the incidence of scarlet fever. 34 The disease continued of the mild type to which wc have become accustomed during recent years. One death was certified as due to scarlet fever. Treated in Hospitals :— Leyton Isolation Hospital 147 Walthamstow Isolation Hospital 12 L.C.C. Hospitals 1 Whipps Cross Hospital 1 161 Treated at home 74 235 The following shows the particulars regarding the one death certified as due to scarlet fever during the year :— Date of Death. Sex. Age. Cause of Death. Where death occurred. 15.5.39 M. 6 Septic Meningitis. Scarlet Fever. Isolation Hospital. DIPHTHERIA. Year. Cases Notified. Deaths. Case Fatality per cent. 1935 276 8 2.89 1936 231 11 4.7o 1937 161 7 4.31 1938 188 o 1.06 1939 148 3 2.02 Treated in hospitals— Leyton Isolation Hospital 119 L.C.C. Hospitals 1 Walthamstow Isolation Hospital 9 Plaistow Fever Hospital 1 Whipps Cross Hospital 15 West Ham Isolation Hospital 1 146 Treated at home 2 148 35 The following list shows the particulars regarding the three deaths certified as due to diphtheria during the year. Date of Death. Sex. Age. Cause of Death. Where death occurred. 22.1.39 M. 4 Diphtheritic Laryngitis. Broncho Pneumonia. Isolation Hospital. 25.3.39 F. 5 Laryngeal Diphtheria. Isolation Hospital. 21.7.39 M. 3 Diphtheria. Isolation Hospital. ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. Immunisation by Private Medical Practitioners. Number of private medical practitioners who applied for supplies of toxoid-antitoxin 11 Number of children immunised 12 Record of Attendances during 1939. The following figures give particulars regarding the children dealt with at the municipal diphtheria immunisation clinics during 1939. The figures refer only to children who have finished—or failed to complete—the full course of innoculations during the year. Children who had commenced—but had not yet completed—the course at the end of the year will be shown in the report for next year. Under 2 yrs. 2-5 years. 5-10 years. 10-15 years. Total. Number of children who attended for immunisation 46 47 83 9 185 ,, ,, who completed course 45 46 82 9 182 ,, „ naturally immune – – – – – „ „ immune after one injection – – – – – „ „ immune after 2 injections 43 44 69 5 161 ,, ,, immune after 3 injections 2 2 „ ,, immune after 4 injections 2 8 3 13 ,, ,, immune after 5 injections – – – – – ,, ,, immune after 6 injections 5 1 6 Removed from district —. 1 1 — 2 Failed to attend for Final Schick Test „ ,, Schick Reading 1 — — — 1 „ „ after 1 injection — — — — — Total number of Attendances during 1939 185 194 412 46 837 36 During the previous year (1938) the number of children who attended for immunisation was 552, and the total number of attendances made during that year was 2,467. From these figures it is evident that there has been a marked decrease (66.0 per cent.) in the number of children who attended during 1939. Incidence of Diphtheria Among Protected Persons. It is not claimed that artificial immunisation will prevent a person from infection by diphtheria organisms. What is claimed is that successful artificial immunisation will prevent the immunised person from developing the dangerous toxsemic manifestations of diphtheria. During 1939, two Leyton children, who had been immunised previously, were notified to be suffering from diphtheria. previously, were notified to be suffering from diphtheria. The following table gives in summary form the information regarding these cases. Age. Sex. Date of Immunisation. Schick Test Negative. Date of Notification. Swab Results. T=Throat. N=Nose. E=Ear. 4 yrs. M. 19.2.37 23.11.37 4.4.39 T— N— Not clinical diphtheria (Laryngeal obstruction) 9 yrs. F. 28.8.36 22. 1.37 10.1.39 T— N— Not clinical diphtheria (Tonsillitis). TUBERCULOSIS, Notifications.—One hundred and seven patients were notified for the first time in 1939 as suffering from tuberculosis. The number was made up as follows :— Males. Females. Total. Pulmonary Tuberculosis 56 42 98 Non-Pulmonary Tuberculosis 3 6 9 59 48 107 During the year it was found possible to remove from the tuberculosis register the names of 3 children and 10 adults in whom evidence of active disease had ceased to exist. 37 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1939 :— Pulmonary. N on-Pulmonary. TOTAL M, F. Total. M. F. Total. Number on Register at commencement of year 282 233 515 46 49 95 610 Number first notified during the year 56 42 98 3 6 9 107 Number of cases entered in Register otherwise than by Notification 10 16 26 4 7 11 37 Number removed from the Register during the year 60 62 122 14 11 25 147 Number remaining at the end of the year 288 229 517 39 51 90 607 Details pf cases removed from the Register during the year:— Dipd 30 24 54 4 3 7 61 Removed from the district 26 36 62 8 3 11 73 De-notified 4 2 6 2 5 7 13 Deaths.—Sixty-one deaths from tuberculosis were recorded. The following table gives particulars regarding the new cases which have occurred during the year :— Age Periods. New Cases. Pulmonary. Non-Pulmonary. M. F. M. F. 0 – – – – 1 – – – – 5 – 3 1 – 10 2 1 2 15 __ 2 1 1 20 3 7 1 25 12 8 — — 35 10 10 2 45 13 7 — — 55 5 3 — 65 and upwards 11 2 – – Totals 56 42 3 6 38 Institutional Treatment. During 1939 the following Leyton patients were sent to sanatoria or other institutions for the treatment of Tuberculosis :— Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Total. Adults 57 45 3 3 108 Children 4 5 7 4 20 39 TABLE No. 2. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1939. DISEASE. At All Ages Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and up Smallpox — — — — — — — — — — — — — Diphtheria 148 1 5 8 11 8 66 26 5 16 2 — — Erysipelas 45 — — — — 2 4 10 5 17 7 Scarlet Fever 233 — 3 10 19 20 106 47 11 14 3 Pemphigus Neon. — — — — — — — — — — — — — Pulmonary T.B. 98 — 1 2 — — 2 2 10 40 20 17 4 T.B. Others 9 — 1 — — — 3 2 1 2 — — — Pneumonia 83 5 25 3 6 26 4 2 5 4 3 Ophthalmia Neon. 6 6 — — — — — — — — — — — Enteric Fever 1 — — — — — — — — 1 — — — Puerperal Pyrexia 20 — — — — — — — 1 19 — — — Cerebrospinal Meningitis 3 — — — — — 1 1 — — — — 1 Poliomyelitis 3 — 1 — — 2 — — — — — — — Enc. Lethargica — — — — — — — — — — — — — Dysentery 10 — 3 — 3 1 2 — — 1 — — — Measles 2 1 1 — — — — — — — — — — Whooping Cough 4 — — 1 — 1 2 — — — — — — Totals 665 13 40 24 39 58 188 80 37 107 33 34 12 40 TABLE 3. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1939. DISEASE. Total. Leyton. Lea Bridge. Central North. Centra] South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox — — — — — — — — — — — — Diphtheria 148 7 23 10 6 29 12 33 14 4 10 146 Erysipelas 45 3 8 6 3 8 4 4 3 4 2 14 Scarlet Fever 233 25 47 23 26 37 20 15 22 6 12 159 Pemphigus Neon. — — — — — — — — — — — — Pulmonary T.B. 98 4 13 6 10 14 11 19 2 13 6 — T.B. Others 9 o 2 — 2 — — — 1 2 — — Pneumonia 83 5 25 3 6 26 4 2 5 4 3 50 Ophthalmia Neon. 6 — 2 — — 1 2 1 — — — 4 Enteric Fever 1 — 1 — — — — — — — — — Puerperal Pyrexia 20 4 1 1 5 5 1 2 1 — — Cerebrospinal Meningitis 3 1 I 1 — — — — — — — — Poliomyelitis 3 — — — 1 1 — — — — 1 2 Enc. Lethargica — — — — — — — — — — — — Dysentery 10 — 1 — — 4 — 1 1 — 3 6 Measles 2 — — — — 1 . — 1 — — — — Whooping Cough 4 1 1 1 — — — — — — 1 — Totals 665 48 128 51 55 126 58 77 50 34 38 381 41 SCHOOL MEDICAL SERVICE. GOVERNMENT EVACUATION SCHEME. On 1st and 2nd September, 1939—just prior to the outbreak of hostilities—some 4,493 Leyton school children were evacuated by rail to billeting areas in the County of Essex. During the first three weeks of the war all members of the Authority's School Medical and Nursing Staff were fully occupied on work in connection with the Council's A.R.P. Casualty Service arrangements in Leyton. As the result of requests for medical and dental supervision by Leyton Teachers in the Reception Area, on 22nd September your Director of Education and School Medical Officer, along with Dr. Mary Gilchrist, visited Chelmsford in order to confer with the County Director of Education and County School Medical Officer with reference to the supply of Medical and Nursing assistance. After full consideration of the whole question it was agreed that the following members of the Leyton Education Authority's Staff should be seconded for duty with the County Council in the area in which Leyton school children were billeted :— School Medical Officer (Dr. Mary Gilchrist). Dental Surgeon (Mr. Horton). School Nurses (Misses Stiles, Edwards and Corby). Dental Attendant (Miss Grimshaw). It was also agreed that Leyton Education Authority should transfer for the use of the County Council one complete set of dental equipment for the use of the Dental Surgeon. These suggestions were approved by the Chairman of the County Education Committee and the above members of your School Medical Staff were transferred for duty in the reception area on 25th September, 1939. A special report by Dr. Mary Gilchrist (see page 61, et seq.) gives some indication of the medical inspection and treatment carried out by her in the reception area from 25th September until 31st December, 1939. 42 SCHOOLING FOR NON-EVACUATED SCHOOL CHILDREN At the outbreak of war on 3rd September, 1939, compulsory education was suspended, and it was not until 15th November, 1939, that Leyton Schools were re-opened for voluntary education. Minor Ailment Clinics. It was found that some form of medical supervision and treatment was required by Leyton school children who were not transferred to the Reception Area, and on 26th September the two School Minor Ailment Clinics were re-opened. School Nurses were in attendance each morning at these Clinics, but Doctors were in attendance during only two sessions per week. The number of children attending these Minor Ailment Clinic sessions was not sufficient to occupy the whole of the time of the School Doctor in attendance, and it was decided to carry out diphtheria immunisations and special medical examination in addition to the ordinary work of the Clinics. At Park House Clinic, which was also used as a First Aid Post, the School Nurse also acted as the nurse in charge of the Post. School Nurses visited the homes of defective children within the Borough, and where necessary, advised them to attend the Clinics for advice. Special Clinics. As the result of experience at the Minor Ailment Clinics it was found necessary to re-open the following Special Clinics on the dates mentioned :— Orthopaedic Clinic ... 30th November, 1939. Aural Clinic ... ... 4th December, 1939. Ophthalmic Clinic ... 6th December, 1939. The Special Heart Clinic had not been resumed at the end of the year. ROUTINE MEDICAL INSPECTION. On 15th November, 1939, the Authority's Public Elementary Schools in Leyton were opened for a modified form of instruction. Senior and Junior pupils attended School for two hours daily and Infants for 1½ hours daily. The number of pupils attending increased gradually until the month of December, when over 5,000 were in attendance. 43 In view of the short period of daily attendance it was very difficult to arrange for these routine medical inspections in school premises, and arrangements were, therefore, made to conduct the routine medical inspections at the Council's Health Centres at Leyton Green and Park House. Routine medical inspection of pupils born in 1926 was commenced on 6th December, 1939. In order to interfere as little as possible these inspections were arranged at such times as the children were not receiving instruction in School. Uncleanliness inspections were carried out on the school premises by the School Nurses. The abnormal conditions arising out of the war, the large scale evacuation of Leyton school children, and the allocation of school medical service staff to additional duties in connection with the A.R.P. Casualty Service, have all contributed to making the year 1939 one of exceptional difficulty. By virtue of the close relationship existing between your Health Department and your Education Office, and with the cordial co-operation of your Director of Education and Evacuation Officer (Mr. Staton) and his staff, it has been possible to provide adequate school medical services both in Leyton and in the Reception Area. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1,211 Second Age Group 1,239 Third Age Group 168 Total 2,618 Of 2,618 children who were examined in the code age-groups, 2,393 (or over 91 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 5,108 comparing with 7,108 during the previous year. Re-inspections. The number of re-inspections during 1939 was 5,565. 44 The Findings of Medical Inspection. Number of Individual Children found at Routine Medical Inspection to require treatment (excluding defects of nutrition, uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups— Entrants 1211 177 14.6 Second Age Group 1239 185 14.9 Third Age Group 168 34 20.2 Total (Code Groups) 2618 396 15.1 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 775 children were found to be unclean out of a total number of 17,923 examined (i.e., 4.3 per cent.). Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 1,923 18 5 Capworth Street 1,762 92 26 Cann Hall Road 630 3 2 Church Road 1,460 81 12 Connaught Road 476 11 — Downsell Road 1,143 49 9 Davies Lane 1,155 25 5 Farmer Road 1,341 39 9 Goodall Road 1,080 35 4 Kirkdale Road 169 5 2 Lea Bridge Road 205 8 1 Mayville Road 1,010 95 17 Norlington Road 1.174 53 10 Newport Road 765 9 1 Ruckholt Road 203 3 3 Sybourn Street 1,282 36 9 St. Joseph's 477 19 13 Trumpington Road 849 17 3 Tom Hood 456 10 — Knotts Green 363 32 4 Total 17,923 640 135 Number of individual children found unclean 775 of whom 135 were referred to the Minor Ailments Clinics. 45 Return of Defects found by Medical Inspection in the Year ended 31st December, 1939. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin Ringworm—Scalp ... ... 6 ... Body ... ... 14 ... Scabies 1 ... 84 ... Impetigo ... ... 71 ... Other diseases (non-T.B.) 9 3 355 1 Eye Blepharitis 23 1 61 ... Conjunctivitis ... ... 87 ... Keratitis ... ... 2 ... Corneal Opacities ... ... 3 ... Other conditions 3 ... 129 1 Defective Vision 92 38 74 l Squint 26 5 25 1 Ear Defective Hearing 2 5 37 3 Otitis Media 12 19 117 ... Other Ear Diseases 5 3 120 ... Nose & Throat Chronic Tonsiritis only 77 81 170 1 Adenoids only 4 12 3 1 Chronic Tonsiiitis and Adenoids 18 16 44 3 Other Conditions 13 7 179 1 Enlarged Cervical Glands (non-T.B.) 28 23 162 1 Defective Speech 4 3 7 ... Heart and Circulation Heart Disease— Organic ... 2 16 ... Functional 2 20 8 2 Anaemia 1 1 59 2 Lungs Bronchitis 19 13 65 ... Other non-T.B. Diseases 5 22 61 2 Tuberculosis Pulmonary— Definite ... ... ... ... Suspected ... 2 4 ... Non-Pulmonary— Glands 1 ... 2 ... Bones and Joints ... ... 1 ... Skin 1 ... ... ... Other Forms ... 2 1 ... Nervous System Epilepsy 2 ... 8 ... Chorea ... ... 26 ... Other Conditions 2 10 60 ... Deformities Rickets 5 1 ... ... Spinal Curvature 3 ... 1 ... Other Forms 36 16 80 ... Other Defects and Diseases 53 18 1,945 11 Totals 447 323 4,087 31 46 MEDICAL TREATMENT. Minor Ailments Clinic. Attendances. During the year 3,564 children attended the clinic, and 11,594 attendances were registered. Defective Vision.—Of the 2,618 children subjected to routine code group inspection in the schools, 144 (5.5 per cent.) were found to be suffering from some eye defect requiring treatment. Of 5,108 children referred for special inspection, 381 (7.4 per cent.) manifested some eye defect requiring treatment. Special Eye Clinic.— During the year, the Ophthalmic Surgeon had referred to him 776 children, who made 901 attendances for examination and treatment. Report by the Authority's Ophthalmic Surgeon (J. D. Magor Cardell, M.B., B.S., F.R.C.S.). The work of the Eye Clinic has been disturbed by the outbreak of hostilities and the evacuation of school children. The analysis of cases seen by me during the past year is therefore in no way comparable with that of preceding years. Many children had, however, returned to their homes and so the Clinics, which were interrupted in September, were resumed in December. From the figures at my disposal I regard the average health of the school children's eyes to be well up to normal. The work of the Orthoptic Clinic for squint, which is the subject of a separate report, has once more proved of the greatest assistance to me and has enabled mothers and children to avoid frequent travelling to London to obtain this special form of treatment. Squint Clinic. Report by Orthoptist (Miss P. Montague Smith). The following figures show the number and disposition of cases dealt with at the special squint clinic during the year. Number of children who attended clinic 153 Number of attendances made 715 Observation cases—no detectable squint Left district 4 47 Refused or discontinued treatment 2 Unsuitable for treatment 3 Previously discharged patients attending periodically for tests 30 Treated for defective vision 14 Cured 3 Improved 5 No improvement 3 Seen once only 3 Treated for squint 32 Cured Stereoscopic vision 4 11 Cosmetic only 7 Rest from active treatment 6 Still under treatment 15 Awaiting treatment 31 As the squint clinic was temporarily suspended at the outbreak of war, the figures above relate only to the first nine months of the year. School Dental Service. Findings of Dental Inspection. The following table shows in statistical form the results of school dental inspection in individual schools and over the whole area. School. Number inspected. Number referred for treatment. Number accepting treatment. Percentage of acceptances. Boys. Girls. Boys. Girls. Canterbury 225 118 145 86 155 67.1 Cann Hall ... ... ... ... ... ... Capworth ... ... ... ... ... ... Church 108 490 77 384 268 58.1 Connaught 31 114 21 71 60 65.2 Davies Lane 512 226 424 163 315 53.6 Downsell ... ... ... ... ... ... Farmer ... ... ... ... ... ... Goodall ... ... ... ... ... ... Kirkdale 40 41 19 25 32 72.7 Knotts Green 105 81 76 63 68 48.9 Lea Bridge 56 56 40 39 50 63.3 Mayville 115 421 70 323 55 14.0* Newport 593 106 408 69 341 71.5 Norlington 142 608 111 487 440 73.5 Ruckholt 247 196 175 163 224 66.2 Sybourn 447 232 351 168 381 73.4 St. Joseph's 122 101 96 79 103 58.8 Tom Hood Trumpington 133 406 94 302 279 70 45 2,876 3,196 2,107 2,422 2,771 45.6 * Children were evacuated before forms could be returned. 48 REPORT BY THE AUTHORITY'S SENIOR DENTAL OFFICER (A. E. HALL, L.D.S.) In reviewing the work of the School Dental Service in the Borough of Leyton during the year 1939 we are faced with two distinct periods ; the one consisting of that portion of the year prior to the outbreak of hostilities ; and the second that since the war commenced, when a complete re-arrangement of our existing facilities became necessary. The first part of the year was one of unrestricted progress. The schools in the Borough were divided into three groups, and one group was allotted to each Dental Officer. Inspection and treatment were carried out in these schools, commencing with those schools in which the longer interval had elapsed since the last inspection. At the commencement of the war, work was well up to date in the elementary schools of the Borough, and had we been free to continue, all the schools would have been inspected and treated during 1939. As in some schools a period of over twelve months had already elapsed since the last inspection, it would not have been possible to say that each school was receiving annual reinspection and treatment until some date in 1910. Pre-War Period. Elementary Schools. Of the twenty elementary schools in the Borough, the following eleven had been inspected before they closed for the Summer Holiday Norlington, Ruckholt, Trumpington, Davies Lane, Newport, Mayville, Sybourn, Knotts' Green, Lea Bridge, St. Joseph's and Church Road. Appended is a brief analysis of the amount of dental treatment carried out within the Borough for the elementary school children during the normal period of the year, i.e., from January to end of August, 1939. Number of children inspected 5,503 Specials 1,096 Grand total 6,599 49 Found to require treatment 4,162 Actually treated 3,404 Half-days devoted to Inspection = 28 Treatment =782½ Total 810 Attendances made by children for treatment 6,413 Fillings. Permanent teeth =3,750 Temporary teeth = 384 Total 4,134 Extractions. Permanent teeth =1,052 Temporary teeth =4,976 Total 6,028 Administrations of general anæsthetics for extractions 1,476 Other operations. Permanent teeth =435 Temporary teeth =208 Total 643 Secondary Schools. During this period treatment was carried out for the pupils of the two Secondary Schools which were inspected during November and December, 1938, the findings of which were reported in the Borough of Leyton Health Report, 1938, Table V, page 200. This work occupied a considerable amount of time during the first quarter of the year, not only due to the amount of work found to be necessary, but also due to the fact that the time required to treat these children is very often twice that required for an equivalent number of the younger elementary school schildren. In this connection several interesting tables are appended, one showing the percentage incidence of dental caries in the various age groups, another showing the condition of some of the worst mouths, largely brought about by the absence of regular annual inspection and treatment in these two schools; and a third showing the distribution of unsaveable and saveable permanent teeth in the mouths of girls and boys in these schools. These tables will show how, in the absence of a complete scheme of dental treatment throughout a child's school life, the work carried out during the earlier years can be largely wasted, and how provision for dental supervision and treatment between the school leaving age and the time the adolescent becomes eligible for National Health Insurance Dental Benefit (approximately 4 years) is a vital and long overdue necessity. 50 Percentage incidence of Dental Caries in Leyton Secondary School Pupils. Boys. Age Group. Number examined. Sound condition. Percentage found to require treatment. 11 95 20 78.9 per cent. 12 95 9 90.5 „ 13 83 14 83.1 „ 14 94 23 75.5 „ 15 86 4 95.3 „ 16 36 2 94.4 „ 17 20 2 90 „ 18 3 — 100 „ Girls. 11 89 12 86.51 „ 12 76 19 75 ,, 13 80 10 87.5 „ 14 77 6 92.2 „ 15 79 5 93.6 „ 16 11 1 90.0 „ 17 2 1 50 „ 18 4 — 100 „ Worst Cases of Dental Disease. Boys. Case. Permanent Extractions. Permanent Fillings. Age. No. 1 W.C. — 10 16 „ 2 A.C. 6 4 16 „ 3 D.L. 4 6 15 ,, 4 D.A. 4 10 15 „ 5 R.A. 1 8 16 „ 6 P.B. 2 8 12 „ 7 A.D. 6 6 15 „ 8 E.D. 2 7 13 „ 9 J.E. 4 4 15 „ 10 P.F. 4 9 13 „ 11 D.W. — 7 16 51 Girls. Case. Permanent Extractions. Permanent Fillings. Age. No. 1 E.F. 3 6 14 „ 2 J.D. — 8 15 „ 3 PH. 4 7 12 ,, 4 D.L. 4 6 12 „ 5 M.P. 3 6 16 „ 6 J.T. — 9 16 „ 7 D.W. 2 6 15 „ 8 D.Y. 4 5 15 The unsaveable permanent teeth, which numbered 307 in the mouths of 171 secondary school children who attended for extraction of teeth, were distributed as follows :— 88 children had 1 unsaveable permanent tooth each. 49 children had 2 unsaveable permanent teeth each. 20 children had 3 unsaveable permanent teeth each. 11 children had 4 unsaveable permanent teeth each. 1 child had 5 unsaveable permanent teeth. 2 children had 6 unsaveable permanent teeth each. The saveable permanent teeth which numbered 1,210 in the mouths of 447 secondary school children who attended for conservative treatment were distributed as follows:— 102 children had 1 saveable permanent tooth each. 133 children had 2 saveable permanent teeth each. 103 children had 3 saveable permanent teeth each. 61 children had 4 saveable permanent teeth each. 24 children had 5 saveable permanent teeth each. 12 children had 6 saveable permanent teeth each. 5 children had 7 saveable permanent teeth each. 3 children had 8 saveable permanent teeth each. 2 children had 9 saveable permanent teeth each. 2 children had 10 saveable permanent teeth each. 52 War Period. Mr. Grant left for service with the Army Dental Corps on September 1st, 1939, and hostilities caused a complete cessation of dental work from September 4th until September 19th. On Tuesday, 19th September, 1939, one dental surgery was re-opened for the reception of urgent dental cases. On 24th September, 1939, Mr. Horton (Dental Surgeon) and Miss Grimshaw (Dental Attendant) were seconded to the County of Essex to work for evacuated Leyton children in the Epping, Ongar and Harlow districts. Leyton. About this time the dental staff with the assistance of Miss Payne and Miss Hayes, visited the homes of many children who had been under treatment which was not completed at the time of evacuation ; and also the homes of those children who had been dentally inspected in school, but whose treatment had not at that time been commenced. Approximately 400 such visits were made. Many of these children had been evacuated but where the child was found to be at home the parent was invited to have the child's necessary dental treatment carried out, and if willing was given an appointment there and then to attend the Clinic. The appointments were suitably spaced to ensure that not more than one or two children with their parents were on the clinic premises at one and the same time. As a result of this procedure the attendances increased considerably, and it was found possible for the one remaining dental officer to divide his time between Park House Clinic and Leyton Green Clinic in the proportion of roughly 2.5 : 1, so arranging his attendances as to coincide with the attendances of Dr. Rennie at each clinic. Thus any children referred by the Medical Officer for dental treatment were able to receive it the same morning and any patient found to be needing a general anaesthetic was able to receive it by the kind co-operation of Dr. Rennie at the end of his minor ailment clinic. This system was found to work exceedingly well until the number of attendants, and the number for general anaesthetics, had grown to reach almost normal proportions for one dental officer. Thus it was that one session per week was set apart for general anaesthetic cases at each clinic. 53 On 15th November, 1939, some of the schools in the Borough were re-opened ; and it was found possible to commence inspection of the non-evacuated children in those schools that had not had a dental inspection earlier in the year. Acceptances for dental treatment came in rapidly, and until the end of the year almost full numbers were seen at the various sessions. Thus it will be seen that, in spite of the general upheaval, it has been possible to accomplish a considerable amount of dental work. Reception Area. Turning our attention to the dental treatment of Leyton children evacuated to the County of Essex, we came across many difficulties which, although foreign to us in an Urban area, are nevertheless often found in County dental schemes. Firstly, one must realise that children in county areas are usually scattered over great distances, and that a dental officer can visit an area probably only once during the year. Any children not treated during the period of this visit must repair to a local practitioner for the relief of pain, or even travel to some nearby town to obtain treatment. Secondly, it sometimes happens that children from some small village school must make a bus journey to attend a dental clinic being held in a school in some other village, or small town. This, in a time of reduced bus services in rural areas, in bad weather, and in the absence of parents, with consequent reliance on voluntary help, all make added and sometimes insuperable difficulties in the way of children obtaining treatment. Again, some parents who in the past have always accepted treatment for their children when in Leyton, have declined to have them treated away from the Borough and in their absence. The following figures give some idea of the dental work carried out for our evacuated children in the County of Essex by Mr. Horton. Number of children examined 1,816 Found to require treatment 498 Half-days to inspection 28 ,, ,, ,, treatment 77 Total 105 Attendances made by children for treatment 336 Fillings, Permanent teeth 293 Temporary ,, 10 Total 303 54 Extractions, Permanent teeth 52 Temporary ,, 194 Total 240 General anaesthetics for extractions 83 Other operations, Permanent teeth 77 Temporary teeth 21 Total 98 Dental Health Education. During the early months of 1939 preliminary arrangements were made with the Dental Board of the United Kingdom for a lecture and demonstration on dental hygiene to be given to all the senior pupils in the schools of the Borough shortly after the Summer holiday, which arrangement we were unfortunately unable to carry out. Finally, I should like to thank the medical staff', nurses, teachers and clerical staff for their kind and willing co-operation at all times during the year. ORTHOPEDIC CLINIC. The following figures show the number of school children examined and treated during the last five years. Examinations. 1935 1936 1937 1938 1939 Primary examinations 105 99 89 112 62 Re-examinations 249 230 236 249 172 Treatment. 1935 1936 1937 1938 1939 Number of children who attended for 231 257 209 255 244 Attendances made 2,109 2,188 1,832 1,413 1,245 55 Admission to Hospital and Operations. During the year four children were admitted to hospital and the following surgical operations were performed. 1. Reduction—Upper epiphysis femur. Plaster of Paris applied 1 2. Reduction—Head of radius. Plaster of Paris applied 1 3. Removal—Left cervical rib 1 4. Removal—Exostosis foot, R 1 Surgical Appliances. The following have been supplied:— Caliper splint (leg) 1 Surgical boots 1 pair Wedges, valgus pads, stiffening boots 2 pairs Minor alterations to ordinary boots 124 pairs Alterations and repairs to surgical boots, splints and appliances 4 Genu valgum brace, R. and L. Tunnels and wedges to boots 1 pair ARTIFICIAL SUNLIGHT CLINIC. The administration of ultra violet light treatment was performed by the Authority's Masseuse (Miss A. E. Findlay) under the supervision of Dr. Henderson and his successor, Dr. Rennie (Deputy School Medical Officer). On account of the war the activities of this clinic had to be suspended temporarily and the figures which follow represent the work done up to 31st July, 1939. The total number of cases was 189, the number of new ones was 120, and the total attendances amounted to 4,020. 95 children were re-examined after at least three months' treatment. Of these 80 (84 per cent.) had either improved or were cured, 14 (15 per cent.) derived no benefit from treatment and 1 (1 per cent.) was worse. No. of Cases. No. of New Cases. Attendances. 1935 110 74 3,310 1936 222 142 5,674 1937 263 177 5,519 1938 337 222 6,783 1939 216 124 4,213 56 AURAL CLINIC. Report by the Aural Consultant (Mr. C. R. Sandiford. F.R.S.C.). This work, which was suspended at the outbreak of war, was begun again in December. The only point of note, and this has been a most noticeable feature, has been the improved condition of children suffering from various catarrhal conditions of the ear, nose or throat following their enforced prolonged absence from school ; and it is reasonable to assume that lack of re-infection due to their not having been grouped together in class-rooms, on the one hand, and on the other, increased facilities for being out in the open air of the streets and parks, have jointly been responsible for this effect. It would seem to show that four walls and a roof, however well ventilated, are from certain points of view essentially unhealthy. It is urged that as much as possible be made of every hour of daylight and sunshine, to build up the greatest possible resistance for next winter against a probable severe influenzal type of epidemic, due partly to black-out, alterations in diet, and general strain. It has now been arranged to keep in hospital those children requiring removal of tonsils and adenoids for one night before operation, and for two nights afterwards. One slight apparent disadvantage of this system will be examined during the coming year, and either substantiated or disproved. 57 AURAL CLINIC. School Cases. Nature of Disease. Still under treatment. Recommended Hospital treatment. Recommended Special School. Discharged as cured. Discharged as improved. Discharged as no treatment required Discharged as left district. Discharged as left school. Totals. (i) Acute Suppurative Otitis Media 4 — — 4 1 — — — 9 (ii) ,, Catarrhal ,, ,, 3 — — 2 — — — — 5 (iii) Chronic Suppurative Otitis Media due to:— 1. Tympanic Sepsis 3 — — 2 2 — — — 7 2. ,, ,, and Granulations 1 — — — 1 — — — 2 3. ,, ,, and Polypi — — — — — — — — — 4. „ „ and previous Mastoid Operation 2 — — 1 1 — — — 4 5. Other Causes 2 — — 1 1 — — — 4 (iv) Mastoid Disease (previous operation) — 1 — — — — 1 — 2 (v) Partial Deafness due to:— 1. Nerve Deafness 2 — — — — — — — 2 2. Tonsils and Adenoids 1 1 — — 1 — — — 3 3. Retraction of Membrana Tympani 2 — — — — — — — 2 4. Scarring 2 — — — 3 — — 1 6 5. Catarrhal Rhinitis 11 — — 3 1 — — — 15 6. Wax — — — 1 — — — — 1 7. Other Causes 1 — — 1 — — — — 2 (vi) Nasal Cases:— 1. Hypertrophic Rhinitis 2 — — — 3 — — — 5 2. Sinusitis — — — — — — — — — 3. Atrophic Rhinitis 2 — — 1 1 — — — 4 4. Deviated Septum 3 1 — — 3 —: — — 7 5. Foreign Body — — — 2 — — — — 2 6. Polypus 1 — — — — — — — 1 (vii) Tonsils and Adenoids 8 16 — 11 — 1 — — 36 (viii) Other Diseases or Defects 12 1 — 8 3 — — — 24 Totals 62 20 — 37 21 1 1 1 143 58 HEART CLINIC. Report by Physician in Charge of Heart Clinic (Dr. A. C. Elman). Owing to the outbreak of hostilities it was possible to hold only 8 sessions during 1939, the last one on July 15th, 1939. Nevertheless, during these first 6| months, 87 attendances were made. These included 25 children seen for the first time. In all, 52 children were seen during 1939 of whom, of course, several made more than one visit The following is a table showing the defects found:— Normal 11 Doubtful 16 Congenital Morbus Cordis 4 Mitral Regurgitation 15 Mitral Stenosis 5 Adherent Pericardium 1 52 Of the above children, I have to report with regret that two have died—one of Mitral Stenosis and one of Coarctation of the Aorta (Congenital Morbus Cordis). The cases described as doubtful may become normal or become worse, but they are in a group which is most important to observe frequently. In addition to examinations and observations at the Clinic, 31 children received medicines. The following is a table illustrating further investigations or/ and treatment undertaken in respect of these cases during 1939:— Admitted to Hospital 7 Dental Treatment 4 Throat Treatment 3 Haemoglobin % Estimations 12 Orthopaedic Treatment 1 Admitted to Heart Home 1 Received Ultra Violet Treatment 2 May I thank the Nursing Staff at the Clinic for their excellent assistance, and Dr. Forrest for his most helpful collaboration. 59 PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN. Mentally Defective Children : Statutory Medical Examinations. During the year, some 63 children were referred for statutory medical examination. As the result of examination these 80 children were classified as follows :— Idiots 1 Imbeciles 5 Moral defectives 0 On attaining 16 years of age—for supervision under the M.D. (Notification of Children) Regulations 11 Certified to Local Education Authority as feebleminded 6 Remained under certificate 18 Certificate withdrawn 1 Dull and backward 16 Borderline cases—to be re-assessed in six months 4 Normal 1 63 Knotts Green Special School for Mental Defectives. Admitted 3 Discharged 21 On roll at end of year 50 Physically Defective Children. Knotts Green Open Air School. Accommodation is provided for 150 physically defective children. Admitted during the year 14 Discharged 44 ,, —on withdrawal of certificates 34 ,, —on removal from district 7 ,, —on reaching statutory leaving age 3 On roll at end of year 141 60 PHYSICAL TRAINING. I am indebted to the Director of Education for the following information regarding the description of arrangements for physical training in the Authority's Elementary Schools :— The work of the year under review includes that carried out before the Government Evacuation Scheme and the progress of Physical Training in the Reception Area. Teachers' Courses. During the Spring Term courses of instruction were conducted by the Organisers of Physical Training for teachers in Infant, Junior, Senior and Central Schools. All aspects of the appropriate teaching of Physical Training in the schools were covered by the courses. As a result, a fuller understanding of the aims and a more effective application of the principles of Physical Education is apparent in the work of the schools. The enthusiasm with which the teachers entered into the Schemes made the holding of the courses a real pleasure. A short course in Central European Dancing was arranged by the County Education Authority. This was held in the Borough of Leyton and was attended by several of the women teachers. This was the first opportunity that the teachers had of learning something of this particular approach to dancing, and much interest was aroused. Footwear, Clothing and Storage. The policy of providing plimsolls for every child in the Borough was completed by the inclusion of the Infant schools in the scheme. At the same time, clothing for Physical Training purposes was supplied to the Senior and Central Schools, thereby enabling first and second year children to be equipped in this respect. Additional storage lockers were provided for the increased supply of clothing. Organised Games. By arrangement with the owners, the ground formerly used by the Essex County Cricket Association was rented for organised games during school hours on certain days of the week during the summer months, and proved a valuable addition to the facilities for organised games in the Borough. 61 With the co-operation of the Borough Surveyor, some of the tennis courts in the Coronation Gardens were made available for use during school mornings. The near-by schools were afforded the necessary equipment, and the experiment of introducing tennis into the organised games proved successful. The part of the Oliver Road Playing Field (old Ballast Pit), which had been grass sown and fenced off ready for use, would have been brought into the general scheme for organised games after the summer holidays had it not been for the outbreak of war. Swimming. In connection with the two-year course of swimming as a recognised feature of the curriculum in top years of Junior schools and first years of Senior schools introduced in 1938, additional instruction was provided for the second year scholars for this season. Voluntary Organisations. The good work of the Schools' Football, Net Ball and Cricket associations was continued as in previous years, and the Leyton Schools' Sports Association again successfully held their annual meetings. Several schools also held their individual Sports meetings. The Leyton Schools' Swimming Association were unable to hold their annual galas on account of the outbreak of war. Evacuation. Where facilities were available, physical training, including organised games, was carried out in the full sense. In other cases work designed to maintain and improve posture and response was taken regularly, even under difficult conditions. The teachers are to be congratulated on their adaptability and zeal in the strange circumstances. GOVERNMENT EVACUATION SCHEME. Medical Arrangements in Reception Area. Report by Dr. Mary Gilchrist. There were over 4,000 children from Leyton in Essex rural areas, but this number had fallen considerably by Christmas-time. By 31st December some 3,053 Leyton children had been medically inspected. The only districts not visited were Chelmsford and a few isolated villages where not more than 6 children were billeted. During that period (i.e., from 25th September to 31st December, 1939) 1,460 Essex County Council children (including some from West Ham and Wood Green) were also examined. 62 The examinations were conducted primarily in order to discover and treat children suffering from contagious or infectious disease such as ringworm, scabies, impetigo, uncleanliness, defects of eyes or ears, etc. Any other defects affecting the health or happiness of the children were attended to, and in some cases visits were made to billets and contact was kept with the County Medical and Nursing Staff as far as possible. The following table gives some idea of the conditions found :— Leyton Children Essex Children (or other Evacuees). Number of children examined 3,053 1,460 Skin : Ringworm—scalp 2 — Scabies 10 — Impetigo 28 5 Eye : Blepharitis and styes 28 20 Conjunctivitis 4 3 Squint 1 — Heads : Uncleanliness 112 30 Ear : Otitis Media 14 8 Nose and Throat: Chronic Tonsilitis and Adenoids 16 62 Enlarged Cervical Glands (non-T.B.)... 15 — Tuberculosis : Non-Pulmonary Glands 1 quiescent Nervous System : Enuresis 58 — Other Defects and Diseases 80 75 The following remarks are based on purely general impressions. I should like to deal with the problems which have aroused most interest or publicity in the lay and medical press. Uncleanliness : Leyton, in common with most areas, has in each school children from groups of families which are a constant source of worry to the school nurses. These children are excluded from school again and again on account of uncleanliness. It needed only five weeks without supervision during the school vacation to make them a virulent source of infection to their cleaner school fellows, and a train journey in crowded carriages plus a week's freedom in the country to spread vermin to children never infected before. Add to this the fact that foster parents, unaccustomed to give the constant care to children's heads which clean mothers do give in poorer districts of this city, and one can understand the rapid spread of verminous conditions. Many of our parents brought their children home because of this fact. Body vermin are very seldom found among Leyton children, and the only case of bug infestation which arose was due to a second-hand suitcase bought the day before evacuation. The problem of dealing with chronic offenders should be tackled much more vigorously, and the clumsy procedure of prosecuting for non-attendance at school should be amended in some way so that more direct action is possible. Impetigo : There is not a great incidence of this skin complaint among Leyton children nowadays, and the distribution of the cases in Essex was rather interesting. The infant departments of two schools, widely separated, had a number of very severe cases, mainly around the knees. One senior school in another area had a 63 similar type of infection. Yet the junior departments of the same schools in different parts of Essex did not suffer at all from this complaint. In my opinion this shows that the school children did not take the infection with them. This opinion is corraborated by the fact that, among the children left behind in Leyton, the incidence of impetigo was exceptionally low. Scabies : This complaint has shown, in common with other parts of the country, a rising incidence in the last few years. Children who remained in Leyton also suffered a good deal from this complaint, although they are not included in these returns as they were not at school when they were treated at the School Clinics. A large number of children were considered to be suffering from scabies and treated with sulphur ointment when all they had was urticaria or cheiroporapholyx. The sulphur treatment only irritated the condition and caused a secondary dermatitis which was very difficult to eradicate. The eating of too many apples, and the prevalence of gnat bites, complicated the incidence of conditions mistaken for scabies. Enuresis : Accurate incidence figures were very difficult to obtain. By the time the School Medical Officer reached the schools, many children had been sent home. A great many of these were probably suffering from temporary enuresis due to fear. One could not assess the percentage incidence of this defect among elementary school children owing to the changing numbers of the evacuees. Children blamed for being bed-wetters in one billet never gave trouble in a new billet, and vice versa. It was a common thing to be told by Head Teachers that bed-wetting was " rampant," but when they were asked to give the actual names of offenders the numbers dwindled in a startling fashion. PROVISION OF MEALS. The provision of meals to children attending the elementary schools is undertaken by the Education Authority under powers granted by Sections 82-85 of the Education Act, 1921. The average number of children fed per week :— Prior to evacuation (2.9.1939) ... ... 415 After evacuation (4.9.1939 to 31.3.1940) ... 26 The number of individual children fed under the Authority's arrangements during 1939 was as follows :—- ] Ordinary Meals. Milk Meals. Free 545 1,722 For payment 47 — Totals 592 1,722 Number of meals supplied :— Ordinary Meals. Milk Meals. Free 46,470 225,841 For payment 2,102 — Totals 48,572 225,841 The above figures relate to the financial year ended 31st March, 1940. 64 PUBLIC ELEMENTARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections, a. Routine Medical Inspections. Number of Code Group Inspections :— Entrants 1,211 Second Age Group 1,239 Third Age Group 168 Total 2,618 B. Other Inspections. Number of Special Inspections 5,108 Number of Re-inspections 5,566 Total 10,674 C. Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding defects of Nutrition, Uncleanliness and Dental Diseases). Group. For Defective Vision (excluding Squint). For all other Conditions recorded in Table II.A. Total. Percentage of children found to require Treatment. Entrants 1 176 177 14.4 Second Age Group 75 110 185 14.9 Third Age Group 16 28 44 26.1 Total (Prescribed Groups) 92 314 406 15.5 Other Routine Inspections — — — — Grand Total 92 314 406 15.5 65 TABLE II Classification of the Nutrition of Children Inspected during the Year in the Routine Aoe Groups up to 31st August, 1939. Ago Groups. No. of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly Subnormal). D. (Bad). No. % No. % No. °/ /o No. % Entrants 1,211 97 8.01 908 74.9 200 16.5 6 0.5 Second Age Group 1,239 184 14.8 819 66.1 219 17.6 17 1.3 Third Age Group — — — — — — — — — Other Routine Inspections — — — — — — — — — Total 2,450 281 11.5 1,727 70.5 419 17.1 23 0.9 TABLE III. BLIND CHILDREN. At Public Elementary Schools. At Other Institutions. At no Sohool or Institution. Total. — 1 — 1 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 17 17 66 TABLE IV.—Return of Defects Treated during the Year ended 31st December, 1939. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. (1) Number of Defects treated or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm— Scalp—(1) X-ray treatment 2 — 2 (2) Other 4 — 4 Body 14 — 14 Scabies 84 — 84 Impetigo 70 — 70 Other skin diseases 354 — 354 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 268 — 268 Minor Ear Defects.. 232 — 232 M iscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,015 — 1,015 Total 2,043 — 2,043 TABLE IV.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments.—Group I.). Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. . (2) Otherwise. (3) . (4) Errors of refraction (including squint) 681 44 725 Other defect or disease of the eyes (excluding those recorded in Group I.) 163 — 163 Total 844 44 888 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom Spectacles were :— (a) Prescribed 481 44 525 (b) Obtained 474 51 525 67 TABLE IV.—contd. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Other Forms of Treatment. (4) Total Number Treated. (5) Received Operative Treatment. Under the Authority's Scheme in Clinic or Hospital. (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) 46 6 21 2 3 — 6 1 49 6 27 3 81 166 (1) Tonsils only. (2) Adenoids only. (3) Tonsils and adenoids. (4) Other defects of the nose and throat. TABLE I V.—contd. Group IV.—Orthopedic and Postural Defects. Under the Authority's Scheme. Otherwise. Total number treated. Residential treatment with education. (1) Residential treatment without education. (2) Non-residential treatment at an orthopaedic clinic. (3) Residential treatment with education. (1) Residential treatment without education. (2) Non-residential treatment at an orthopaedic clinic. (3) No. of children treated 1 3 247 2 5 250 68 TABLE V. Dental Inspection and Treatment (1) Number of children who were :— (a) Inspected by the Dentist:— Aged : 3 39 4 165 5 484 6 562 7 647 8 656 Age Groups 9 670 Total 6,072 10 688 11 602 12 615 13 574 14 339 15 18 16 13 Specials (Casuals) 1,177 Grand Total 7,249 (b) Found to require treatment 5,706 (c) Actually treated • 4,194 (2) Half-days devoted to Inspection 30 Treatment 639½—Total 669½ (3) Attendances made by children for treatment 7,230 (4) Fillings, Permanent Teeth 4,042 Temporary „ 425—Total 4,467 (5) Extractions, Permanent Teeth 1,263 Temporary ,, 5,929—Total 7,192 (6) Administrations of general anaesthetics for extractions 1,787 (7) Other operations, Permanent Teeth 534 Temporary ,, 229—Total 763 69 TABLE VI. Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 3 (2) Total number of examinations of children in the Schools by School Nurses 17,923 (3) Number of individual children found unclean ... 775 (4) Number of children cleansed under arrangements made by the Local Education Authority — (5) Number of cases in which Legal proceedings were taken :— (а) Under the Education Act, 1921 — (b) Under the School Attendance Bye-laws — STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1939, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total number of children notified : 6. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School : 1 (6) Imbeciles 5 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 5 6 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases Note.—No child should be notified under Article 3 until the Board have issued a formal certificate (Form 308M) to the Authority. — — 4. Children who in addition to being mentally defective were blind or deaf Note.—No blind or deaf child should be notified without reference to the Board—see Article 2, proviso (ii). — — Gkand Total 10 7 70 SECONDARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections. a. Routine Medical Inspections. Number of Code Group Inspections :— County High School for Boys 248 „ „ „ „ Girls 149 Total 397 Number of other Routine Inspections — B. Other Inspections. Number of Special Inspections 177 Number of Re-inspections 93 Total 370 71 Children Found to Require Treatment. Group. (1) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) County High School for Girls 229 70 30.6 County High School for Boys 390 77 19.7 619 147 23.7 TABLE II Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups. No. of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly Subnormal). D. (Bad). No. 0/ /o No. % No. % No. % County High School for Girls 149 27 18.1 1ll 74.5 11 7.4 ... ... County High School for Boys 248 56 22.5 183 73.9 9 3.6 ... ... Total 397 83 20.9 294 74.1 20 5.0 ... ... 72 TABLE 3.—Return of Defects Treated during the Year ended 31st December, 1938. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness). Disease or Defect. (1) Number of Defects treated or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin—- Ringworm— Scalp—(1) X-ray treatment — — — (2) Other — — — Body — — — Scabies — — — Impetigo — — — Other skin diseases 7 — 7 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 7 — 7 Minor Ear Dejects 4 — 4 M iscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 14 — 14 Total 32 — 32 TABLE 3.—conid. Group 11.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments.—Group I.). Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Errors of refraction (including squint) Other defect or disease of the eyes (excluding those recorded in Group I.) 50 11 16 66 11 Total 61 16 77 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 41 (b) Otherwise 16 73 TABLE 4. Dental Inspection and Treatment. (1) Number of children who were :— (a) Inspected by the Dentist:— Aged : 11 12 — 13 — Age Groups 14 — Total Nil 15 — 16 — 17 — 18 — Specials (Casuals) 3 Grand Total 3 (b) Found to require treatment 3 (c) Actually treated 376 (2) Half-days devoted to Inspection Nil Treatment 80—Total 80 (3) Attendances made by children for treatment 1,056 (4) Fillings, Permanent Teeth 1,120 Temporary ,, Nil—Total 1,120 (5) Extractions, Permanent Teeth 308 Temporary ,, 134—Total 442 (6) Administrations of general anaesthetics for extractions 165 (7) Other operations, Permanent Teeth 192 Temporary ,, Nil—Total 192 t^TCAIKKf l&COOPERj