LEY 36 Borough of Lepton HEALTH REPORT FOR THE YEAR 1942. ANDREW W. FORREST, m.a., m.d., ch.b., d.p.h., Medical Officer of Health, School Medical Officer. 1 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEY TON. Mr. Mayor, Ladies and Gentlemen, I beg to submit my Annual Report as Medical Officer of Health and School Medical Officer for the year 1942. In accordance with the direction of the Ministry of Health and the Board of Education the Report has been abbreviated as far as possible. The birth rate, 16.09 per thousand of the population, is greater than that (13.31) of the previous year. The comparative rate for England and Wales is 15.8. The general death rate (12.91) shows a decrease compared with that (13.46) of the previous year. The infantile mortality rate (50.27 per thousand live births) compares favourably with the rate of 49 for England and Wales. Three Leyton mothers died during the year due to diseases or accidents of pregnancy or childbirth, the maternal mortality rate being 1.99. During the year there occurred an epidemic of scarlet fever; but the number of notified cases of diphtheria is tle lowest ever recorded. It is with gratitude that I acknowledge the continued loyal co-operation and industry of the members of the staff of the Health Department. It is also my privilege to acknowledge again the support accorded to me by the Chairman and Members of the Committees concerned with the work of the Health Department. 1 have the honour to be, Mr, Mayor, Ladies and Gentlemen, Your obedient servant, Extract from Vital Statistics for the year 1942. Live liirtlis :— Legitimate Males 737 Females 057 Illegitimate Males 28 Females 30 Totals 1,452 Birth Rate per 1,000 of population 10.09 Stillbirths :— Males 27 Females 22 Rate per 1,000 total (live and still) births 32.04 Deaths :— Males 584 Females 539 Totals 1,123 Death Rate per 1,000 12.91 Number of women dying from diseases and accidents of pregnancy and childbirth :— From Sepsis 1 From other causes 2 Rate per 1,000 total (live and still) births 1.99 Death rate of infants under one year of age All infants per 1,000 live births 50.27 Legitimate infants per 1,000 legitimate live births 49.49 Illegitimate infants per 1,000 illegitimate live births 08.90 Deaths from Cancer (all ages) 190 ,, ,, Measles (all ages) 1 ,, ,, Whooping Cough (all ages) 1 „ ,, Diarrhoea (under 2 years of age) 7 TABLE 1. Registered Births, 1942. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 5 5 1 7 4 5 1 7 6 4 45 February 2 4 8 1 6 11 3 6 4 2 47 March 4 3 3 4 7 7 6 4 4 4 46 April 4 7 1 5 8 10 6 6 4 4 55 May 8 5 6 1 4 7 7 4 7 1 50 June 4 6 3 7 10 5 2 4 4 2 47 July 5 6 8 7 10 5 6 6 3 2 58 August 4 9 6 2 10 10 6 4 3 2 56 September 5 4 4 5 8 8 8 6 3 3 54 October 5 6 2 6 10 10 4 9 4 4 60 November 10 7 8 8 7 7 5 6 3 4 65 December 3 10 3 6 9 8 7 5 1 3 55 Transferables 57 171 86 79 166 89 50 27 50 39 814 Totals 116 243 139 138 259 182 111 94 96 74 1452 3 TABLE 2. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN' THE BOROUGH OF LEYTON 1942 Sex. ALL Aoes. Ages at Death in Years. In Public Institutions in the District j Under 1 year. | 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. Not- belonging to District. Belonging to District. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1. Typhoid and paratyphoid fevers M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro spinal fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 40 ... ... ... ... 5 7 9 10 5 3 1 ... ... F 27 ... ... ... ... 9 7 4 5 1 1 ... ... ... 7. Other forms of tuberculosis M 6 ... ... ... 1 2 2 ... ... 1 1 ... ... ... F 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... 8. Syphilitic disease M 8 ... ... ... ... ... ... ... 1 4 3 ... ... ... F 3 ... ... ... ... ... ... ... 1 ... 1 1 ... ... 9. Influenza M 3 ... ... ... ... ... 1 ... 1 ... ... 1 ... ... F 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... 10. Measles M ... ... ... ... ... ...... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only). M 10 ... ... ... ... ... ... ... ... 3 1 6 ... ... 13. Cancer of uterus F 9 ... ... ... ... ... ... ... 3 2 2 2 ... 14. Cancer of stomach and M 26 ... ... ... ... ... 1 ... 3 10 7 5 ... ... denum F 16 ... ... ... ... ... ... ... ... 6 5 5 ... ... 16. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 14 ... ... ... ... ... ... 3 1 4 3 3 ... ... 16. Cancer of all other sites M 69 ... ... ... ... ... ... 6 5 21 26 11 ... ... F 52 ... ... ... ... 1 1 ... 9 16 12 11 ... ... 17. Diabetes M 4 ... ... ... ... ... ... ...... ... 1 2 1 ... ... F 6 ... ... ... ... ... ... ... ... 4 1 1 ... ... 18. Intra-cranial vascular lesions M 55 ... ... ... 1 ... ... 1 2 11 20 20 ... ... F 57 ... ... ... ... ... ... 3 3 8 16 26 ... ... 19. Heart disease M 111 ... ... ... ... ... 2 3 8 25 30 43 ... ... F 143 ... ... ... ... ... 5 2 6 16 32 82 ... ... 20. Other diseases of circulatory system M 18 ... ... ... ... ... ... ... 2 7 4 5 ... ... F 23 ... ... ... ... ... ... ... 4 6 4 9 ... ... 21. Bronchitis M 44 2 ... ... ... ... ... 9 10 14 8 ... ... F 37 1 ... ... ... ... ... ... 1 3 11 21 ... ... 22. Pneumonia M 30 13 ... ... ... ... 1 ... ... 6 6 4 ... ... F 28 7 ... ... ... 1 ... ... 7 3 5 ... ... 23. Other respiratory diseases M 10 2 ... ... 1 1 ... ... 0 2 2 ... ... ... F 6 ... ... ... ... ... 1 1 ... 1 2 1 ... ... 24. Ulceration of the stomach or duodenum M 13 ... ... ... ... 1 ... 3 3 4 2 ... ... ... F 3 ... ... ... ... ... ... ... ... 3 ... ... ... ... 25. Diarrhoea (under 2 years of age) M 5 5 ... ... ... ... ... ... ... ... ... ... ... ... F 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M 3 ... ... ... ... ... ... 2 ... ... ... ... ... ... F 2 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 27. Other digestive diseases M 11 ... ... ... ... ... ... 1 1 ... 6 3 ... ... F 12 ... ... ... 2 ... ... 1 3 1 3 2 ... ... 28. Nephritis M 7 ... ... ... ... 1 ... ... 3 1 2 ... ... ... F 2 ... ... ... ... ... 1 ... ... 1 ... ... ... ... 29. Puerperal and post-abortive sepsis. F 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 30. Other maternal causes F 2 ... ... ... ... 1 ... 1 ... ... ... ... ... ... 31. Premature birth M 12 12 ... ... ... ... ... ... ... ... ... ... ... ... F 7 7 ... ... ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 14 14 ... ... ... ... ... ... ... ... ... ... ... ... F 5 5 ... ... ... ... ... ... ... ... ... ... ... ... 33. Suicide M 7 ... ... ... ... ... 2 2 ... ... 2 1 ... ... F '7 ... ... ... ... ... ... ... ... 2 ... ... ... ... 34. Koad traffic accidents M 7 ... ... ... ... ... ... ... ... 1 4 2 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 5. Other violent causes M 13 ... ... ... ... ... 2 3 2 3 ... 1 ... ... F 11 ... ... ... ... ... 1 ... ... 2 ... 6 ... ... 36. All other causes M 57 1 ... ... 3 ... 0 0 2 10 11 23 ... ... F 64 ... ... ... ... ... 4 4 1 10 11 34 ... ... Totals M 584 73 4 2 8 27 42 60 91 219 252 345 1535 389 F 539 5 TABLE 3. DEATHS IN WARDS, 1942. CAUSES OF DEATH. Leyton Lea Biidge. Central North. Central South. Forest Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward Not Known. 1 2 3 4 5 6 7 8 9 10 11 12 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough ... ... ... ... ... ... ... ... 1 ... ... 5. Diphtheria ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system 5 14 10 5 9 7 4 5 5 3 ... 7. Other forms of tuberculosis ... 2 ... ... ... 1 1 4 ... ... ... 8. Syphilitic diseases 3 ... 1 ... 3 1 ... 1 ... 1 ... 9. Influenza ... 1 1 1 2 ... ... ... ... ... ... 10. Measles ... ... ... 1 ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) ... 1 ... 1 3 1 ... 3 ... ... 1 13. Cancer of uterus ... 2 3 1 1 1 ... 1 ... ... ... 14. Cancer of stomach and duodenum 4 10 5 2 7 6 ... 1 3 2 ... 15. Cancer of breast ... 3 1 ... 5 1 ... 2 1 1 ... 16. Cancer of all other sites 3 22 8 15 22 15 9 11 7 9 ... 17. Diabetes 2 1 ... 1 ... ... 3 1 1 1 ... 18. Intra-cranialvascularlesions 8 27 8 6 19 12 6 8 11 7 ... 19. Heart disease 25 35 25 32 33 40 22 14 15 13 ... 20. Other diseases of circulatory system 2 9 2 1 4 8 5 5 3 2 ... 21. Bronchitis 4 13 3 7 13 17 8 4 7 5 ... 22. Pneumonia 6 13 5 3 8 5 4 3 6 5 ... 23. Other respiratory diseases ... 1 1 4 2 2 1 1 3 1 ... 24. Ulcer of stomach or duodenum 1 ... 1 1 2 4 1 3 ... 3 ... r> 25. Diarrhoea (under 2 years) 1 1 ... 3 ... ... ... ... 1 1 ... 26. Appendicitis ... ... ... 1 2 ... ... ... 2 ... ... 27. Other digestive disea ses 1 5 2 1 5 3 1 3 1 1 ... 28. Nephritis 1 1 ... 1 2 ... 1 1 2 ... ... 29. Puerperal and post-abortive sepsis ... 1 ... ... ... ... ... ... ... ... ... 30. Other maternal causes ... ... ... ... ... ... ... 1 ... ... ... 31. Premature birth 1 4 1 2 1 3 ... 3 ... 1 ... 32. Congenital malformations l 3 1 3 4 1 ... 2 ... 2 ... 33. Suicide ... 2 ... 1 6 ... ... 2 1 1 ... 34 Road Traffic accidents 1 ... 1 3 2 1 ... ... 1 ... ... 35. Other violent causes 3 ... 4 4 1 1 2 6 1 2 ... 36. All other causes 9 15 9 10 21 12 13 8 18 5 1 Totals 81 186 92 110 177 142 83 93 91 66 2 7 TABLE 4. Vital Statistics of Whole District during 1942 and Previous Years. Year. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferables Nett. of Nonresidents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 3 4 5 6 7 8 9 10 11 12 13 1929 1233 1731 13.49 3008 23.4 1751 253 100 57.77 1510 11.76 1930 1199 1757 13.60 2692 20.9 1688 218 81 46.09 1222 9.52 1931 1264 1812 14.09 2872 22.3 1770 263 71 39.18 1365 10.61 1932 1029 1666 13.10 2913 22.7 1808 236 89 53.42 1341 10.54 1933 812 1499 11.91 3070 24.4 1888 286 76 50.70 1468 11.67 1934 819 1454 11.78 2864 23.2 1774 227 64 44.02 1317 10.67 1935 777 1493 12.26 2671 21.9 1789 243 60 40.18 1225 10.06 1936 661 1421 11.85 3028 25.2 2018 262 74 52.07 1272 10.61 1937 653 1420 12.02 3190 27.0 2104 263 75 52.81 1349 11.42 1938 656 1509 12.87 2934 25.0 1938 152 70 46.38 1148 9.79 1939 605 1499 12.90 2951 26.6 1987 278 46 31.65 1242 11.21 1940 645 1353 14.02 3865 40.0 2302 335 50 39.03 1563 16.2 1941 705 1129 13.31 2430 28.6 1288 341 37 38.30 1142 13.46 1942 814 1452 16.69 2373 27.3 1546 296 73 50.27 1123 12.91 8 TABLE 5. Birth-bate, Death-rate and Analysis of Mortality During the Year 1942. Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 Years). Total Deaths under 1 Year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still Births. England and Wales 15.8 0.54 11.6 0.00 0.00 0.01 0.00 0.02 0.05 0.09 5.2 49 ... ... ... ... 126 County Boroughs and Great Towns, including London 17.3 0.66 13.3 0.00 0.00 0.02 0.00 0.03 0.06 0.09 7.5 59 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 18.4 0.62 12.1 0.00 0.00 0.01 0.00 0.02 0.04 0.10 4.8 46 ... ... ... ... London 14.0 0.48 13.9 0.00 0.00 0.01 0.00 0.04 0.02 0.07 8.6 60 ... ... ... ... LEYTON 16.69 0.56 12.91 0.00 0.00 0.01 0.00 0.01 0.00 0.05 4.82 50 84.23 4.45 11.31 ... 9 10 TABLE 6. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1892-1942. Year. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. Infantile Death Rate. 1892 2210 35.08 972 15.4 313 141 1893 2316 36.18 1019 15.7 306 130 1894 2224 31.7 825 11.6 258 116 1895 2292 30.05 1080 14.4 346 150 1890 2372 30.08 926 11.8 326 137 1897 250) 29.3 1011 11.9 356 142 1898 2560 28.4 1125 12.5 374 146 1899 2698 29.0 1262 13.5 420 155 1900 2932 29.32 1179 11.8 410 140 1901 2963 29.63 1243 12.4 404 136 1902 3152 31.52 1183 11.8 336 106 1903 3273 32.08 1112 10.9 322 99 1904 3198 30.07 1370 13.1 444 138 1905 3209 30.05 1177 11.2 303 94 1906 3344 30.9 1327 12.2 382 114.5 1907 3190 26.6 1269 10.6 182 86.6 1908 3071 25.3 1185 9.8 242 78.8 1909 2979 24.6 1208 9.9 244 81.9 1910 3011 24.4 1112 9.0 191 63.4 1911 2931 23.5 1473 11.8 327 116.6 1912 2797 22.1 1343 10.6 223 79.7 1913 2904 22.4 1336 10.3 242 83.3 1914 2800 21.4 1363 10.4 219 78.2 1915 2655 21.3 1510 12.1 225 84.7 1916 2560 19.4 1471 12.1 197 76.9 1917 2005 16.0 1414 12.6 172 85.8 1918 1791 14.3 1723 15.3 161 89.9 1919 2195 17.0 1397 11.3 154 70.16 1920 3168 24.6 1330 10.3 207 65.34 1921 2679 20.86 1290 10.04 182 67.94 1922 2416 18.36 1420 10.79 155 64.16 1923 2328 17.53 1228 9.25 106 45.53 1924 2101 15.74 1325 9.92 110 52.36 1925 2091 15.76 1349 10.16 114 54.51 1926 2022 15.55 1261 9.7 131 64.79 1927 1826 14.16 1322 10.25 80 43.81 1928 1853 14.22 1290 9.90 91 49.10 1929 1731 13.49 1510 11.76 100 57.77 1930 1757 13.69 1222 9.52 81 46.09 1931 1812 14.09 1365 10.61 71 39.18 1932 1666 13.10 1341 10.54 89 53.43 1933 1499 11.91 1468 11.67 76 50.70 1934 1454 11.78 1317 10.67 64 44.02 1935 1493 12.26 1225 10.06 60 40.18 1936 1421 11.85 1272 10.61 74 52.07 1937 1420 12.02 1349 11.42 75 52.81 1938 1509 12.87 1148 9.79 70 46.38 1939 1499 12.90 1242 11.21 46 31.65 1940 1353 14.02 1563 16.2 50 39.03 1941 1129 13.31 1142 13.46 37 38.30 1942 1452 16.69 1123 12.91 73 50.27 11 GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. FOOT CLINIC. Summary of Attendances and Treatment. During the year 6,464 attendances were made, an average of 4.5 attendances per patient. First Attendances (new eases). Subsequent Attendances. Total Attendances. No. Per cent. Average No. of Visits per Patient. Males 109 1.212 1.321 20.45 4.37 Females 441 4.309 4,750 73.49 3.27 Children 73 320 393 6.06 4.73 Total 623 5,841 6,464 4.5 During the year the numbers of persons who received free treatment was 89, 14.28 per cent, of the total number of new cases. First Attendances (new eases). Subsequent Attendances. Total Attendances. Males. Females. Males. Females. Males. es. Old age pensioners 19 45 404 1,070 483 1,124 Unemployed 4 7 57 151 01 158 Widows — 14 — 340 — 360 Totals 23 66 521 1,570 544 1,042 12 SCABIES. The Scabies Order, 1941. In November, 1941, the Minister of Health, being satisfied that scabies is prevalent to such an extent as to prejudice the carrying out of the purposes of the provisions of the Emergency Powers (Defence) Act, 1939, has made the above Order, known as The Scabies Order, 1941 (applicable to England and Wales), front which the following are the chief provisions :— (1) Where a medical officer of health is satisfied, upon information given by a registered medical practitioner or otherwise, that a person is in a verminous condition, he may by notice in writing require the occupier of any premises in which that person is or lias recently been accommodated to permit the inspection of the premises by the medical officer of health or by a person duly authorised by him in that behalf in writing. (2) Where a medical officer of health is satisfied after such inspection that the medical examination of any person who is or has recently been accommodated in the premises is necessary or expedient, he may by notice in writing require that person to present himself, within the period specified in the notice, at a place specified in the notice at which arrangements for such examination are available and to submit himself to examination by the medical officer of health or some other registered medical practitioner. (3) Where a medical officer of health is satisfied, upon such examination or upon a certificate of a registered medical practitioner, that a person is verminous and requires cleansing or treatment, he may— (a) by notice in writing require that person to present himself, within the period specified in the notice at a place specified at which suitable arrangements for the cleansing or treatment of verminous persons are available, and to submit himself to such cleansing or treatment ; and (b) by notice in writing require the cleansing, treatment or destruction of any article specified in the notice which is, or is likely to be, verminous by reason of having been used by, or in contact with, that person, 13 (4) Where any requirement made under this order relates to a child, the parent or guardian or other person for the time being having charge of the child shall do all such things as are necessary for the purpose of securing or facilitating the fulfilment of the requirement, and shall comply with any reasonable request or instructions given for that purpose by or on behalf of the medical officer of health. (5) The medical officer of health or other person by whom premises are inspected in pursuance of this order may require the occupier of the premises to furnish particulars of all persons who are or have recently been accommodated on the premises. (6) The cleansing of a female under this order shall be carried out only by a registered medical practitioner, or by a woman duly authorised by the medical officer of health. The powers given under the provisions of the above Order are not related solely to scabies, but extend to verminous conditions generally since these may lead to similar results. • Arrangements foe Treatment and Control. For some time previous to the issue of the above Order and the accompanying Circular 2517 by the Ministry of Health it had become apparent that there was a considerable increase in the number of persons suffering from Scabies. To deal with these, locally improvised cleansing facilities were adopted at the premises formerly used as a Fever Hospital. These facilities, however, were of a makeshift nature ; and as the premises were in use as an A.R.P. Depot, patients were not afforded the amount of privacy to which they were entitled. Arrangements were therefore made for the establishment of a cleansing station at Ruckholt School. Nurse Jones, formerly a Staff Nurse at Leyton Isolation Hospital, was put in charge. Members of the Leyton Civil Defence Casualty Service were trained to administer treatment under Nurse Jones' supervision. A circular latter regarding the arrangements was addressed to all local medical practitioners ; and the new special clinic was in operation on 1st March. To begin with the only cases treated were patients certified by a doctor to have scabies, and those referred by the Council's medical staff. These cases were seen either at the Town Hall or at the Council Clinics ; but after a time it was found to be necessary for 14 a. member of the medical staff to be in attendance at the cleansing station to inspect cases referred, to supervise treatment, and to see that patients were free from infection before being discharged. Accordingly the arrangements were put in charge of Dr. Rennie, Deputy Medical Officer of Health, who furnished the following observations :— Report by Dr. James L. Rennie. The great majority of cases of scabies and verminous conditions have prior to this year been treated at home. Those who had no home facilities or were exceedingly heavily infested were referred to the cleansing sections of Public Assistance Institutions. During the ten months ending 31st December, 1942, 303 new patients attended for treatment and 270 of these were discharged well. In all, some 1,291 treatments were administered. The large number of treatments per case was due to some patients having very marked septic infections. At first a number of infected persons were unwilling to go to the clinic for treatment, but as the value of adequate treatment became obvious to the public the number declining treatment has (Jecreased. It has been found that the only satisfactory method of eradicating the condition and of preventing further cases is to give treatment to all domestic contacts whether or not they show signs of the disease. The following scheme has been drawn up and is now in operation :— 1. The Deputy Medical Officer of Health attends the clinic two mornings each week to advise the Nurse regarding the treatment of difficult cases. 2. When a case of scabies is notified or referred to the clinic, all members of the household are requested to attend for treatment. If necessary, a circular letter is sent to the head of the household pointing out the necessity of treatment and giving an appointment for each member to attend the clinic. 3. The Sanitary Inspectors have been given special instruction regarding scabies by the Deputy Medical Officer of Health and act as home visitors. 4. When a patient or contact fails to keep his or her appointment, the Nurse-in-charge notifies the Public Health Department and the District Sanitary Inspector visits the home, explains the need for treatment and arranges a 15 future appointment. Where great difficulty is experienced by the Sanitary Inspector in getting persons to accept treatment, the facts are reported to the Medical Officer of Health. 5. The normal sessions of the clinic are mornings at 9.15 a.m., and afternoons at 2 p.m. Treatments are given by appointment in order to avoid congestion. Evening treatments are given by appointment for the convenience of war workers. Treatment may be arranged on Saturday afternoons or evenings, or on Sundays, but in the interests of fuel economy this is avoided as far as possible. 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 2,250 Miscellaneous inspections 1,271 Re-inspections 6,648 Places of entertainment 13 Schools 41 Stables 69 Urinals 304 Inspections under Rats and Mice (Destruction) Act 3,481 Visits in connection with infectious disease 300 Factories without mechanical power 18 Factories with mechanical power 361 Outworkers' premises 224 Rag and bone dealers 6 Foster-mothers' premises 9 Hairdressers' premises 80 Public Houses 66 Offices 8 Offensive Trades 401 Piggeries 3 16 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 379 Sashcords renewed 89 Plaster repaired 495 Roofs repaired or renewed 477 Guttering repaired or renewed 196 Yards paved 10 Drains relaid or partly re Laid 3 Choked drains cleared 63 New w.c. pans and traps provided 62 Sinks provided 7 W.c. cisterns repaired or renewed 64 Rain water pipes 1repaired or renewed 76 Vent pipes repaired or renewed 37 Sink waste pipes repaired or renewed 77 Stoves repaired or renewed 121 Coppers repaired or renewed 27 Floors repaired 92 Rooms redecorated 367 Windows, sills, etc., repaired 76 Cement work to sink waste gullies repaired 20 Miscellaneous defects remedied 476 Verminous Houses. Number of Council houses Number of other houses Infested. 15 144 Disinfested. 15 144 Rats and Mice (Destruction) Act, 1919. Two hundred and ninety-four complaints regarding rat infestation and 109 complaints regarding mice were received during the year. Biscuits or varnish were issued in most instances. Three thousand four hundred and eighty-one inspections in connection with rats were paid. At approximately 75 per cent, of the premises the source of infestation was definitely traced and the premises freed from rats. The following report was submitted to the Public Health Committee by the Senior Sanitary Inspector. 17 Rats and Mice (Destruction) Act, 1919. The Act states :— " Any person who shall fail to take such steps as may from time to time be reasonably practicable for the destruction of rats and mice on any land of which he is the occupier or for preventing such land from being infested with rats or mice shall be liable on summary conviction to a fine not exceeding five pounds or where he has been served with a notice under this Act requiring him to take such steps not exceeding twenty pounds." It is important to notice that the Act places the responsibility of freeing land—this includes premises—upon the occupier and only on the owner where the land is not occupied. Throughout the year constant attention is given to places where there is, or is likely to be, infestation. Rat complaints are promptly investigated, and every endeavour is made to trace the source of infestation. The procedure is as follows The premises are inspected to find the rat runs and likely nesting places. Where there are drains, these are tested and when found to be defective are repaired or relaid. This is more difficult during the war period. When necessary, buildings are rendered rat proof. Particular attention is given to accumulation of refuse and other material. Food premises are inspected at frequent intervals. Advice is given to the occupier as to the best methods to be adopted, and rat biscuits, traps and varnish are supplied free of charge. Where advisable pre-baiting is carried out. Where the source of infestation cannot at first be found, the premises are kept under further observation. With regard to the rat menace it should be borne in mind that there is no easy or ready solution to the problem. The important factor, when making the enquiries, is time, patience and perseverance. War conditions of many kinds have ' brought increased difficulties. It may be said that the larger part of rat infestation within the Borough, as in most Boroughs, can be located to the public sewers. Possibly when the war is over a concentrated attack might be made to deal with rats in the sewers by " gassing methods." 18 Legislation should also be revised so as to place upon the owner of premises some legal responsibility. Although most owners are willing to co-operate, others are far from helpful in the matter. The following table gives details of complaints during the past eight years :— Year Complaints Inspections Premises Freed No. of 1935 152 287 71 1936 107 417 89 1937 67 375 63 1938 77 573 87 1939 105 433 95 1940 67 375 58 1941 78 529 68 1942 (Up to Aug.) 182 819 95 835 * 3,808 626 * Not including visits to food premises. The above summary over a period of eight years shows that of the total investigations—complaints received—the premises in 75 per cent, of the cases were freed from rats. This I think can be considered to be very satisfactory. As a matter of interest, of the last one hundred complaints received the allocation according to the ten Wards in the Borough is as follows :— Harrow Green 21 Leytonstone 15 Grove Green 13 Cann Hall 9 Forest 9 Lea Bridge 8 Ley ton 8 Wanstead Slip 7 Central South 7 Central North 3 100 Every effort is made by the officers to deal with rat infestation and to try and eradicate, as far as possible, rat infestation within the Borough. 19 A.R.P., Civil Defence, etc. Visits were made to the following :— Air Raid Shelters, Wardens and Fire Guard Posts 296 Food Depots 137 A.R.P. Depots 48 First Aid Posts 9 Decontamination of food; demonstrations, visits, etc 408 HOUSING. Complaints. During the year 1758 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 855 Statutory—Housing Acts Nil Public Health Acts 68 Notices complied with—Informal 789 Statutory— Housing Acts Nil Public Health Acts 30 Legal Proceedings. Proceedings under the Public Health Act were instituted in two cases to abate statutory nuisances. Orders were made ami 16s. costs imposed in each case. 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 Nil Flats Nil (b) With State assistance under the Housing Acts. (i) By the Local Authority :— (а) For the purposes of Part v of the Act of 1936 Nil (б) For other purposes Nil (ii) By other bodies or persons Nil 20 1.—Inspection of Dwelling-houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,250 (b) Number of inspections made for the purpose 8,898 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 104 (b) Number of inspections made for the purpose 151 (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 855 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 789 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 21 V (b) Proceedings under Public Health Acts (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 68 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (а) By owners 30 (б) By Local Authority in default of owners Nil (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 Nil (3) 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 :— Owing to the destruction of premises by enemy action and the movement of occupants rendered homeless, it has not been possible to furnish reliable information with regard to overcrowding. Housing Act, 1936. Information regarding 27 houses and 14 flats was supplied in connection with the " permitted number of persons " in dwellings under the Act. Rent and Mortgage Interest Restriction Act, 1920-1933. No applications for certificates were received. 22 INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year :— Slaughter-houses 170 Butchers 308 Bakehouses 76 Fishmongers 124 Milkshops and dairies 192 Provision shops 548 Dining rooms 170 Ice-cream dealers 87 Greengrocers 170 Fish friers 56 Meat Depots 333 MILK. Dairies and Milkshops. Number of premises on register 185 Premises added to register during year Nil Premises removed from register during year 1 Visits of inspection 192 Bacteriological Examinations. Designated Milk. Licences. No. Granted. No. of Samples taken. Result. Satisfactory. Unsatisfactory. Tuberculin Tested 10 1 1 Accredited 3 — — Pasteurised ... 42 4 4 — Supplementary licences — — — Tuberculin Tested 2 — — Pasteurised 3 — — — Totals 60 5 5 Ice Cream. Premises on Register at 31-12-1942 195 Premises registered during 1942 1 Premises removed from Register during 1942 5 Visits of inspection by Sanitary Inspectors 87 Samples taken for bacteriological examination 5 23 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1942 67 Premises registered during 1942 Nil Premises removed from Register during 1942 Nil MEAT. Slaughter - Houses.-—There are seven licensed slaughterhouses in the Borough, and 170 inspections of these slaughter houses were made. Carcases and Viscera Inspected:— Animals Inspected. Regional Slaughter-house. Cattle 543 Calves — Swine 374 Sheep 5631 6,548 SUMMARY OF CARCASES INSPECTED AND CONDEMNED. Cattle. Sheep and Lambs. Pigs. Number killed at Regional Slaughterhouse 543 5,631 374 Number inspected at Regional Slaughterhouse 543 5,631 374 All diseases except Tuberculosis:— Whole carcases condemned Nil Nil Nil Carcases of which some part or organ was condemned 101 411 21 Percentage of the number inspected alfected with disease other than tuberculosis 35.17 7.29 5.61 Tuberculosis only :— Whole carcases condemned 2 Nil 3 Carcases of which some part or organ was condemned 59 Nil 82 Percentage of the number inspected affected with tuberculosis 11.23 Nil 24.06 24 Slaughter of Animals Act, 1933. Twenty-nine persons were licensed as slaughtermen during the year. Premises and Occupations which can he Controlled by By-Laws and Regulations. Premises. Slaughter-houses 7 Dairies, Milkshops and Dairymen 185 Butchers'shops, Stalls and Provision shops 291 Ice Cream dealers 195 Hairdressers' Premises 61 Fish friers 22 Offensive Trades. Rag and Bone dealers 3 Tripe boiler 1 Fatmelter 1 Fat extractor 1 Gut scraper 1 Bone boiler 1 Blood boiler and blood drier 1 Fifty-six inspections were made of the premises where fish frying is carried on. Diseases of Animals Acts and Orders. During the year Orders were issued as under:— Anthrax Order, 1938. Bullocks 2 Sheep 2 Horses 2 Parasitic Mange Order, 1938. Horse 1 25 Food and Drugs Act, 1938. The number of samples taken for analysis under the provisions of this Act from 1st January to the 31st December was 163, as follows:— Samples analysed. Samples unsatisfactory. Anti-gas Ointment 12 3* Arrowroot 1 — Butter 2 — Bismuth of Magnesia 1 — Beef Cubes 1 — Blackcurrant Syrup (compound 1 — Chicken and Ham Cutlet 1 — Cream Doughnuts 1 — Chocolate Slice 1 — Cocoa 2 — Chocolate (drinking) 1 — Coffee 2 — Cinnamon 1 — Cheese Powder 1 — Coffee and Chicory Extract 1 — Cream Splits 1 — Custard Powder 2 — Camphorated Oil 1 — Castor Oil 2 — Chest and Lung Balsam 1 — Coffee Powder 1 — Cream Substitute 1 — Egg Substitute 5 1* Essence of Rennet 1 — Essence of Raspberry 1 — Eggs (dried) 1 — Fruit Sauce 2 — Fruit Drinks 3 — Fruit Flavoured Drink 1 — Grape Fruit Squash 1 — Glycerine, Lemon and Ipecacuanha Mixture 1 — Glycerine Substitute 1 — Ginger (ground) 1 — Hypophosphites, Compound Sy rup of 1 — 26  Samples analysed. Samples unsatisfactory. Headache Powder 1 — Herbal Ointment 1 — Horseradish Cream 1 — Jam 1 — Jam Buns. 1 — Lard 1 — Luncheon Meat 1 — Lemon Flavour 1 — Lemon and Barley Syrup 1 — Lemon Squash 2 — Lung Syrup 1 — Lemons, pulverised 1 — Lemonade Powder 2 — Lime Juice Quench 1 — Milk 16 — Malt, Milk and Eggs 1 — Margarine 3 — Mineral Water 1 — Magnesia Tablets 1 — Meat Paste 1 — Mustard 1 — Nutmeg, ground 1 — Orange Juice, concentrated 1 — Orange Crush 2 — Orange flavouring 1 — Pea Nuts 1 — Pancake Mixture 1 — Pepper 3 — Petroleum Jelly 1 — Rose Hip Syrup 1 — Sulphur Ointment 6 — Salad Oil 2 — Sardines in Oil 1 — Sauce 1 — Sausages 9 — Sausage, preserved 4 — Sausage meat 1 — Spice, mixed 2 — Stuffing, sage and onion substitute 1 __ 27  Samples analysed. Samples unsatisfactory. Self raising flour 1 — Semolina 1 — Salmon and Shrimp Paste 1 — Sandwich Paste 1 — Saccharin Tablets 2 1* Stomach Powder 1 — Tomato Sauce 1 — Veal and Ham Rissole 1 — Vinegar 5 — Vanilla Spread 1 — Vitamin Tablets 4 — Yorkshire Pudding, etc., Mixture 1 — Yeast Tablets 1 — Zinc Ointment 1 — Zoleine Oil 1 — Yeast Spread 1 — Yorkshire Pudding 1 — Yorkshire Pudding Mixture with Egg 2 — 163 5 * Antt-gas Ointment. Three unsatisfactory samples reported to Ministry. * Saccharin Tablets. Verbal warning given. * Ego Substitute Powder. Verbal warning given. 28 FACTORIES. THE FACTORIES ACT, 1937. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 399 7 — Factories without mechanical power 56 1 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) — — — Total 455 8 — 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness 12 12 — Sanitary Conveniences:— Insufficient 3 3 Dirty — — — Other Offences — — — Total 15 15 — OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937). Nature of Work. Instances. Notices served. Prosecution (1) (2) (3) (4) Nil Nil Nil — 29 MATERNITY AND CHILD WELFARE. INFANT WELFARE. Notification of Births.—Twelve hundred and seventyseven notifications of births were received during the year. By medical practitioners 389 By midwives 888 By parents and others — During the year under review, the total attendances at the Council's Infant Welfare Centres were 11,760, an increase of 3,594 compared with the figure (8,106) for the previous year. The number of children examined by the Clinic Medical Officers was 3,631 as compared with 2,627 examined during the previous year. Health Visitors. During the year the Health Visitors have made 15,217 visits to homes, as follows:— (a) To expectant mothers:— First visits 319 Total visits 354 (6) To children under 1 year of age:— First visits 1,316 Total visits 7,270 (c) To children between the ages of 1 and 5 years:— Total visits 7,593 30 TABLE 7. ATTENDANCES, EXAMINATIONS, etc.. 1942. Leyton Green. Park House. All Centres. Under 1 year— 1st attendances 529 470 999 Subsequent attendances 4,039 3,921 8,560 Total attendances 5,168 4,391 9,559 1-5 years— 1st attendances 77 91 168 Subsequent attendances 1,048 985 2,033 Total attendances 1,125 1,076 2,201 Total attendances, both age groups 6,293 5,467 11,760 Average attendance per session 62.30 53.07 57.64 Number examined by clinic doctor 1,980 1,651 3,631 Number weighed 6,288 5,467 11,755 51 Dental Treatment. Report by Senior Dental Surgeon (Mr. A. E. Hall). I am pleased to be able to record good attendances at the dental sessions held for expectant mothers and children under school age. The biggest increase in work being the number of dentures supplied to mothers, a total of 26 dentures being supplied to 26 mothers, the largest number ever recorded here. The need for these dentures being inversely proportional to the soundness of the patients natural teeth, I would like to be able to record that " no dentures were supplied as none were needed." Dentures are required however even amongst patients who have had regular dental inspections and treatment in school, partly due to the fact that with few exceptions no provision is made to continue treatment after the child leaves school, a deficiency we all hope to see remedied by a more comprehensive public dental service after the war. The attached table gives some idea of the work carried out under this heading :— Exspeotant Mothers. Children. Patients treated 124 110 Attendances 366 184 Extractions 715 275 Fillings 63 73 Other dental operations 100 12 Advice only 92 42 Anaesthetics— General 122 81 Local 37 9 Dentures supplied— Full upper and lower 8 Full upper 2 Full upper and partial lower 4 Partial upper 4 Partial upper and lower 5 Full lower and partial upper 1 Additions or alterations 2 26 32 Orthopaedic Treatment. Primary Examinations.—During the year 13 children were referred from the Infant Welfare Clinics to the Council's Orthopaedic Surgeon. Re-examinations.—In addition to the 13 new cases mentioned above, 38 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—Sixty-two children made 357 attendances for special treatment by the Council's Masseuse (Miss Findlay). Provision of Surgical Appliances.—Twenty-eight 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 30 pre-school children, who made 61 attendances for examination and treatment. Artificial Sunlight Treatment. Number of cases treated 47 Total number of attendances 1,054 Convalescent Home Treatment. Children. During the year 5 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. Arrangements were made for three mothers and their babies to have periods of convalescence following confinement. 33 Ophthalmia Neonatorum. No. of Cases Notified. Treated At Home. In Hosp. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. 4 2 2 4 — — — Infant and Foetal Mortality. The following figures show the variations in the infantile and neo-natal mortality rates and in the number of stillbirths during the last five year period. Year. Births. Deaths under Mortality Rates per 1,000 Live Births Stillbirths. 1 year. 4 weeks. Infantile. Neo-natal. 1938 1509 70 43 46.38 28.56 41 1939 1499 46 27 31.65 18.57 35 1940 1353 50 28 39.03 21.85 45 1941 1129 37 20 38.30 20.70 31 1942 1452 73 43 50.27 29.61 49 34 TABLE 8. Infantile Mortality, Year 1942—Ages. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Smallpox Chickenpox Measles ] Scarlet fever Whooping cough Diphtheria and croup Influenza Tuberculous meningitis Abdominal tuberculosis Other tuberculous diseases Meningitis (not tuberculous) ] Convulsions 1 Laryngitis Bronchitis 1 1 3 Pneumonia (all forms) 1 5 8 1 20 Diarrhoea 2 2 2 Enteritis 1 1 1 4 Gastritis Syphilis Rickets Suffocation, overlying Injury at birth 6 1 7 7 Atelectasis 3 3 3 Congenital malformations 2 1 3 3 6 Premature birth 19 19 19 Atrophy, debility and marasmus 1 2 3 Other causes 1 1 1 1 3 Totals 34 4 3 2 43 15 9 3 3 73 Nett Births registered during Legitimate ... 1,394 Nett Deaths registered during Legitimate infants ... 09 the calendar year Illegitimate ... 58 the calendar year Illegitimate infants ... 4 35 TABLE 9. Infantile Mortality During the Year 1942—Wards. CAUSE OF DEATH. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Total Deaths under 1 Year. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... 1 ... ... ... ... ... ... ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and croup ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... 1 ... 1 Convulsions 1 ... ... ... ... ... ... ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 ... 1 ... ... 1 ... ... 3 Pneumonia (all forrns) 4 3 1 ... 3 1 ... ... 3 2 ... 20 Diarrhoea ... ... ... 1 ... ... ... ... ... 1 ... 2 Enteritis ... 1 ... 2 ... ... ... ... 1 ... ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... 1 ... 4 ... ... ... ... ... 7 Atelectasis ... ... ... ... ... 1 ... ... 1 ... ... 3 Congenital malformations 1 2 1 1 ... ... ... ... ... 1 ... 6 Premature birth 1 4 1 2 4 3 ... ... ... 1 ... 19 Atrophy, Debility and Marasmus ... ... ... 2 ... ... ... ... ... ... ... 3 Other causes ... ... 1 1 1 ... ... ... ... ... ... 3 Totals 8 10 5 12 8 10 2 6 6 6 ... 73 3fi Public Health Act, 1936. Child Life Protection. On 1st January, 13 foster mothers and 14 children—and at the end of the year 13 foster mothers and 13 children—were subject to inspection. The Council's Child Protection Visitors made 76 visits of inspection during the year. Summary, Year 1942. Number of nurse children on Register, 1st January 14 Number of nurse children notified by foster mothers during the year 15 Nurse children removed:— To parents or relatives 9 To another fosier mother 4 With foster mother to another area 1 Adopted — To institutions — Evacuated under Government Scheme — Attained 9 years of age 1 Removed—No trace — Died 1 Number of nurse children on Register on 31st December 13 Ante-Natal Clinics— Attendances.—During 1942, the attendances were:— First Attendances. Subsequent Attendances. Total. 647 1,187 1,834 The average number in attendance at the Ante-Natal Clinics held at the Council's two Centres daring 1942 was 11.32 per session. The number of home visits made by Health Visitors to expectant mothers during the year was 354. Maternity Beds. One hundred and forty-two patients were admitted during 1942 under the terms of the agreement with the Mothers' Hospital, Clapton. Public Health Act, 1936. Registration of Nursing Homes. There are three registered nursing homes in the Borough. These institutions were inspected on 12 occasions. 37 Home Helps. Under the Council's scheme for the provision of home helps, 227 applications, 26 of whom made application in 1941, for home helps were dealt with. In 166 cases home helps were provided, 6 of these cases having the charges remitted in accordance with the Council's scale. In the 61 remaining eases, 22 made other arrangements for the confinement, 1 removed from the district, and 38 cases had not been confined at the end of the year. Puerperal Pyrexia. Twenty-six cases of puerperal pyrexia were notified during the year. The causes of pyrexia were considered to be:- Pyelitis 2 Puerperal Septicaemia 1 Pneumonia 1 Bronchitis 2 Caesarean Section 1 Local uterine infection 3 Mastitis 2 Not known 9 Engorgement of breasts 2 Stillbirth 1 Retention of membrane 1 Infection following manual removal of placenta 1 26 Obstetric Consultant. The advice of the Council's Consultant Obstetrician was not sought during the year. Maternity Mortality. There were 3 maternal deaths of Leyton residents during the year. 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. Two hundred and forty-three such notifications were received. 38 Fees paid to Doctors under Section 14 (1) of the Midwives' Acts, 1918. Two hundred and 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 £366 12s. Od. Pre-natal Clothing Coupons. On 21st July, 1941, the Ministry of Health in Circular 2437 requested Local Authorities to undertake the distribution of clothing coupons to expectant mothers. From the 1st January until the end of the year, 1,607 expectant mothers were issued with the required coupons. Post-Natal and Gynaecological Clinic. The following figures show in statistical form the attendances during 1942 :— Leyton Green. Number of Sessions 16 Letters of Invitation 159 First Attendances 106 Re-attendances 86 Report by Dr. Anne S. Clark, M.B., Ch.B. During the year 16 sessions of the Post-Natal and Gynaecological Clinic were held. The number of new patients who attended was 106, out of 159 who received appointments to attend (= 62.89 per cent.). Of these, 85 were post-natal (i.e., they had had a confinement within the previous three months); and 21 were gynæcological. The disposal of these cases was as follows:— Discharged after one attendance 40 Re-attended for examination and treatment 66 The total number of attendances was 193. The average attendance per session was 12.06—with a maximum of 19 and a, minimum of 9. Free medical prescriptions were issued in 50 cases at a total cost of £6 4s. 11d and 22 prescriptions were issued for payment by the patients. 39 The following are the main conditions which have been found on examination :— Subinvolution of the uterus 12 Retroversion of the uterus 17 Defective perineum 2 Cervical erosion 14 Vaginitis 3 Prolapsed uterus 2 Marked anaemia I Birth control Inflamed adnexa 10 2 Record of Cases attended by Council Midwives, 1942. Midwives (8) employed by Council (3) E.C.N. A. (5) Midwives employed by the E.C.N.A. under arrangement made with the Local Supervising Authority in pursuance of Sec. 1 of the Midwives' Act, 1936. Total Cases attended:— (a) As Midwives 190 381 577 (b) As Maternity Nurses 18 53 71 Ante-natal Visits 532 1,725 2,257 Ante-natal Examinations 1.744 2,240 3,984 Post-natal Visits 3,704 10,219 14,023 WAR-TIME DAY NURSERIES. In accordance with the provisions contained in Ministry of Health Circular 2388, and Circular 1553 of the Board of Education, issued in May 1941, two War-time Day Nurseries were established in the Borough. The Ministry of Labour refused the first application by this Authority to provide War-time Day Nurseries; and after prolonged negotiations with the Government Departments concerned the first of the two Nurseries (Knotts Green) was opened by the Mayor on the 13th July, 1942. The second Nursery (Ellingham Road) was opened by the Mayor on the 10th August, 1942. Each Nursery accommodates 50 children, 40 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SMALLPOX. During the year no case of smallpox occurred in the area. ENTERIC FEVER. During the year no case of enteric fever occured in the area. CEREBRO-SPINAL MENINGITIS. 7 oases were notified during the year. MEASLES. Of the 1,102 cases of measles notified during t he year, one died. WHOOPING COUGH. One death occurred among the 128 notified eases of whooping couch. SCARLET FEVER. Year. Cases Notified. Deaths. Case Fatality per cent. 1938 293 0 0.00 1939 233 1 0.43 1940 87 0 0.00 1941 64 1 1.56 1942 318 0 0.00 DIPHTHERIA. Year. Cases Noticed. Deaths. Case Fatality per cent. 1938 188 0 1.06 1939 148 3 2.02 1940 55 0 0.00 1941 44 1 2.27 1942 39 0 0.00 ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. Immunisation by Private Medical Practitioners. Number of private medical practitioners who applied for supplies of toxoid-antitoxin 16 Number of children immunised 67 Record of Attendances during 1942. The following figures give particulars regarding the children dealt with at the municipal diphtheria immunisation clinics during 41 1942. 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. 6-10 years. 10-15 years. Total. Number of children who attended for immunisation 294 688 676 153 1,811 who completed course 289 663 656 145 1,753 immune after 2 injections 287 645 640 139 1,711 immune after 3 injections 1 15 3 5 24 immune after 4 injections 1 3 13 1 18 Removed from district 3 7 9 4 23 Failed to attend for Final Schick Test 2 12 5 3 22 ,, „ after 1 injection — 6 6 1 13 Total number of Attendances during 1942 1,013 2,762 2,666 598 7,039 A record number of children completed the course of immunisation against diphtheria during the year. The total of 1,753 completed cases exceeded the previous maximum in 1936 by 485 cases. In addition to this, the number in course of treatment at 31st December was larger than in any previous year. The proportion of children under five years in 1936 was 21 per cent., while in 1942 it rose to 54 per cent. This increase in immunisation of pre-school children is very gratifying as diphtheria is very fatal among them and it is highly desirable that preventive treatment should be given at or as soon as possible after the child's first birthday. Report by Dr. J. L. Rennie—Deputy Medical Officer of Health. In 1940, 1,353 births were registered in Leyton. The corresponding figure for 1941 was 1,129. It will be noted, however, that in 1941 only 433 children under five years were immunised and in 1942 952 (289 being under two years). These figures show clearly that there is still a large number of young children unprotected against diphtheria. The increase in the immunisation of young children has been brought about partly by the propaganda of the Ministry of Health, National broadcasts by Medical Officers were always followed by an increase in the number of applications for immunisation. The untiring efforts of Health Visitors and School Nurses in this 42 Borough, while visiting homes, at clinics and in schools have contributed in no small measure to the steady flow of applications of parents for the immunisation of their children. The school teachers have also afforded much valuable help in the campaign. In order that teachers might have the opportunity of acquainting themselves with the scientific reasons for immunisation and thereby being in a better position to advocate preventive inoculation to parents I arranged with the Director of Education to give lectures to school teachers after school hours. The lectures were repeated four times, and many teachers attended. A definite increase in the number of school children attending the Clinics took place after the lectures, and many of the children were accompanied by their pre-school brothers and sisters. In this way the teachers helped to guide many young children to the immunisation clinics. Children at War-time Day Nurseries who had not been immunised were given treatment. The figures are included with the Clinic figures. Since 1941 Alum Precipitated Toxoid (A.P.T.) supplied by the Sector Laboratory on behalf of the Ministry of Health has almost completely replaced Toxoid Antitoxin Flocules (T.A.F.) as the immunising agent. This material is very excellent and 98 per cent, of children are immune after two small injections. 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 toxaemic manifestations of diphtheria. During 1942 two Leyton children, who had been immunised previously, wero 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. 7 yrs. F. 21.6.41 3.12.41 13.2.42 - Tonsillitis 6 yrs. M. 20.5.41 13.10.41 24.2.42 N + Mild clinical diphtheria T + 43 TUBERCULOSIS. Notifications.—One hundred and four patients were notified for the first time in 1942 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 64 27 91 Non-Pulmonary Tuberculosis 7 6 13 71 33 104 During the year it was found possible to remove from the tuberculosis register the names of 2 children and 9 adults in whom evidence of active disease had ceased to exist. The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1942 :— Pulmonary. Non-Pulmonary. TOTA L M. F. Total. M. F. Total. Number on Register at commencement of year 269 217 486 32 44 76 562 Number first notified during the year 64 27 91 7 6 13 104 Number of cases entered in Register otherwise than by Notification 18 17 35 2 5 7 42 Number removed from the Register during the year 69 58 127 13 15 28 155 Number remaining at the end of the year 282 203 485 28 40 68 553 Details of cases removed from the Register during the year:— Died 43 29 72 6 3 9 81 Removed from the district 22 26 48 7 8 15 63 De-notified 4 3 1 — 4 4 11 Deaths.—Seventy-five deaths from tuberculosis were recorded. 44 The following table gives particulars regarding the new eases which have occurred during the year:— Age Periods. New Cases. Pulmonary. Non-Pulmonary. M. F. M. F. 0 — — 1 1 — 1 5 1 2 2 10 1 1 — 15 8 7 2 — 20 5 7 — 1 25 15 8 — — 35 13 1 2 — 45 8 2 1 — 55 9 1 1 65 and upwards 3 1 — — Totals 62 29 9 4 Institutional Treatment. During 1942 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 60 41 5 Nil 106 Children 1 1 3 2 7 45 TABLE No. 10. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1942. 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 39 3 7 1 4 3 8 4 1 7 1 ... ... Erysipelas 39 7 7 19 ... Scarlet Fever 318 2 15 13 51 65 132 23 3 9 5 ... Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B 91 ... ... ... ... 1 1 1 15 35 14 20 ... T.B. Others 13 1 4 1 2 l 2 2 ... Pneumonia 83 1 5 3 1 3 8 3 3 15 11 24 ... Ophthalmia Neon. 5 4 ... 1 ... ... ... ... ... ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 26 ... ... ... ... ... ... ... 2 23 1 ... ... Cerebrospinal Meningitis 7 1 2 ... ... ... 1 ... ... 3 ... ... ... Poliomyelitis 5 ... ... ... 1 1 1 1 ... 1 ... ... ... Enc. Lethargiea ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 3 ... 2 ... ... 1 ... ... ... Measles 1102 28 144 127 184 261 333 20 2 2 ... 1 ... Whooping Cough 128 13 20 27 „ 31 18 2 ... ... ... 1 ... Totats 1859 52 193 172 258 365 508 55 28 104 41 ... 16 46 TABLE 11. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1042. DISEASE. Total. Ley ton. Lea Bridge. Central North. Centra] South. Forest. I.eytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 89 1 6 5 1 11 2 2 3 4 4 37 Erysipelas 39 4 6 4 4 5 6 2 3 3 2 4 Scarlet Fever 318 25 04 41 49 61 8 10 24 18 18 l69 Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B 91 10 19 10 8 15 3 6 6 9 5 ... T.B. Others 13 1 2 1 2 3 1 1 2 ... Pneumonia 83 6 27 7 5 20 6 2 4 3 3 30 Ophthalmia Neon 5 ... ... 1 1 ... 1 ... ... 1 1 1 Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 26 1 6 ... 3 5 2 2 2 3 2 16 Cerebrospinal Meningitis 7 ... 2 2 ... 1 2 ... ... ... ... 7 Poliomyelitis 5 1 3 ... ... ... ... ... ... 1 ... 5 Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 3 1 1 ... ... 1 ... ... ... ... Measles 1102 67 206 69 121 149 52 149 98 115 76 22 Whooping Cough 128 5 30 20 31 21 10 2 4 1 4 7 Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... Totals 1859 122 371 159 224 289 94 179 145 159 117 300 47 SCHOOL MEDICAL SERVICE. GOVERNMENT EVACUATION SCHEME. Assuming a continuing decline in the school roll, an approximate roll as at 31st March, 1942, would be 11,900. Estimated figures showing the present distribution (December, 1942) of these children are given below:— (a) In Leyton Over 5 years 8,317 Under 5 years 740 (b) Evacuated:— (i) In two National Camps—as from April, 1940. (Central Schools, etc.) ... 277 (ii) In reception areas or removed 2,566 11,900 Normal (full-time) schooling, which was resumed in the Borough on 15th July, 1940, has been maintained since that time. ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1612 Second Age Group 677 Third Age Group 721 Total 3,010 Of 3,010 children who were examined in the code age-groups 2,563 (or over 85 per cent.) were accompanicd by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 3,827 comparing with 3,032 during the previous year. Re-inspections. The number of re-inspections during 1942 was 6,572. 48 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 1,612 245 15.2 Second Age Group 677 121 17.8 Third Age Group 721 162 22.4 Total (Code Groups) 3,010 528 17.5 Unclean liness and Verminous Conditions.—At the special inspections held by the school nurses, 990 children were found to be unclean out of a total number of 17,439 examined (i.e., 5.6 per cent. Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 1,238 21 14 Capworth Street 1,869 66 9 Cann Hall Road 1,000 37 13 Church Road 1,029 38 7 Connaught Road 1,139 45 8 Downsell Road 1,283 97 18 Davies Lane 1,375 65 12 Farmer Road 774 17 3 Goodall Road 1,086 55 14 Kjrkdale Road 476 17 4 Lea Bridge Road 105 5 1 Mayville Road 1,483 170 58 Norlington Road 1,383 53 8 Newport Road 1,073 25 7 Ruckholt Road — — — Sy bourn Street 1,032 25 3 St. Joseph's 245 11 4 Trumpington Road 649 39 12 Tom Hood 81 — 1 Knotts Green 119 8 — Total 17,439 794 196 Number of individual children found unclean ... 990 of whom ... 196 were referred to the Minor Ailments Clinics. 49 Report bv Dr. Mary L. Gilchrist. One thing has been noticed at the School Minor Ailments Clinic which is different from peacetime. There has been a great increase in "skin complaints." Urticarial conditions seem to go septic and be more resistant to treatment than they used to be ; and a very severe type of " Bulbous Impetigo " on the hands has been a source of great trouble at the clinics. The following table shows that it is not due to the increase in scabies cases, though with the fear of scabies in mind, manv persons with very slight skin conditions who would not have attended the clinic previously, now come for advice. Total M inor Ailment cases. Scabies. Impetigo. Other Skin Conditions. No. % No. % No. % 1938 2,890 66 2.3 164 5.6 479 16.5 1939 2,043 84 4.1 70 3.4 354 17.3 1940 944 47 4.9 55 5.8 265 2.8 1941 1,329 83 6.2 84 6.3 355 26.7 1942 1,985 160 8.0 94 4.7 660 33.2 The rise in the number of scabies cases had begun before the war, though our impression of the numbers coming to the clinic is greater than that here recorded. This is probably due to the fact that when a child is brought to the clinic suffering from scabies, mother is also examined along with any children under school age. Persons other than school children do not appear in the school clinic records, though the whole family is ordered treatment. Similarly, when one school child attends alone and is found to have scabies, brothers and sisters are directed for treatment at the Scabies Clinic without having to attend first at the school clinic. The diagnosis of scabies is not always easy. So many people have heard of increased incidence of scabies, and that sulphur ointment is good treatment, that it was very often difficult to decide what the original skin condition had been as it was already complicated by sulphur dermatitis. The introduction of benzyl benzoate lias helped considerably in removing the difficulty of further treatment where sulphur has been ineffectively used for a long time. 50 Differential diagnosis between urticaria and cheiropomphylyx was often difficult too. Out of 91 scabies cases seen at Park House Centre, five were first diagnosed as cheiropomphylyx and four as urticaria. In the same period 56 cases of urticaria, and 17 of cheiropomphylyx attended the clinic. Ten cases, first suspected of being scabies, were in the end considered as merely urticaria. Treatment. Various forms of treatment were used during 1942. The experience of 1941 had shown that beta naphthol ointment was not very efficacious. Of 14 cases of scabies treated with it in 1941, seven showed no improvement and three had recurrences some weeks after apparently clearing up. Although sulphonil was subsequently reported in the medical press to have no sarcopticidal properties, 38 cases were treated with it when it first came out as a remedy and in only two cases did scabies recur. The remaining 53 cases were treated with benzyl benzoate emulsion, 18 carrying out the treatment at home, and 35 at the Scabies Clinic. 51 Rutttrn of Defects found by Medical Inspection in the Yeah ended 31st Decembeb, 1942. Detect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin Ringworm—Scalp ... ... ... ... Body ... ... 10 ... Scabies 6 1 166 ... Impetigo 3 ... 94 ... Other diseases (non-T.B.) 12 2 717 ... Eye Blepharitis 15 ... 45 ... Conjunctivitis 1 ... 56 ... Keratitis ... ... ... Corneal Opacities ... ... 7 ... Defective Vision 132 12 81 ... Squint 39 1 46 ... Other conditions 15 ... 174 ... Ear Defective Hearing 4 8 31 ... Otitis Media 13 3 81 ... Other Ear Diseases 12 5 118 ... Nose & Throat Chronic Tonsilitis only 24 27 73 ... Adenoids only 6 14 6 ... Chronic Tonsilitis & Adenoids 23 33 4 2 1 Other conditions 14 3 259 ... Enlarged Cervical Glands (non-T.B.) 15 11 68 ... Defective Speech 12 7 5 1 Heart and CircuJation Lungs Heart DiseaseOrganic 2 1 6 2 Functional 3 21 5 1 Anaemia 12 I 72 ... Bronchitis Other non-T.B. Diseases 35 13 9 29 73 96 1 Pulmonary— Tuberculosis Definite ... ... 1 ... Suspected ... 2 ... ... Non- Pulmonary— Glands 2 1 3 ... Bones and Joints 1 ... 2 ... Skin ... ... ... ... Other Forms ... 2 ... ... Nervous System Deformities Epilepsy 2 ... 3 ... Chorea ... ... 10 ... Other conditions 12 9 43 ... Rickets 4 1 1 ... Spinal Curvature 1 1 1 ... Other Forms 74 24 67 ... Other Defects and Diseases 88 24 1,960 3 Totals 586 252 4,422 9 52 MEDICAL TREATMENT. Minor Ailments Clinic. Attendances. During the year 3,322 children attended the clinic, and 11,421 attendances were registered. Defective Vision.—Of the 3,010 children subjected to routine code group inspection in the schools, 163 (5.4 per cent.) were found to be suffering from some eye defect requiring treatment. Special Eye Clinic.— During the year, the Ophthalmic Surgeon had referred to him .340 children, who made 699 attendances for examination and treatment. Report by the Authority's Ophthalmic Surgeon (J. D. Magor Cardell, M.B., B.S., E.R.C.S.). The number of children seen in the Eye clinic has increased with the return of more children to the Borough. Owing to the unstable figure representing the School population it is not possible to draw any exact comparison between the eye defects of the past and previous years. Broadly speaking the myopia has not increased noticeably and the usual healthy eye condition of the average school child of the Borough has not been affected adversely by War conditions. Some difficulty has been experienced in obtaining operative treatment for squints owing to the closing of many ophthalmic beds in London. That difficulty has now been very largely overcome. The work of the Orthoptic Clinic increases and assumes a more important role in the treatment of the children with squint. In this 1 am ably and loyally assisted by Miss Montague Smith. Squint Clinic. Report by Orthoptist (Miss G. Montague Smith). As in the case of the previous year there has again been a marked increase in attendances at the Orthoptic Clinic. In order to decrease the waiting list and increase the number of children 53 attending, the Council has now decided to hold two additional clinic sessions per week. Last year 1 had occasion to mention the length of time cases requiring operation had to wait owing to the difficulty of finding hospital beds for such cases. I am pleased to be able to report that at last beds have been found for these cases requiring operations for squint and the waiting list of cases requiring surgical treatment is gradually diminishing. I. Number of attendances made 1,298 Number of children attending clinic 141 (New cases 50. Old cases 91) Tests only 40 Unsuitable for treatment 1 Failed to attend 3 Transferred 1 Waiting for operation 5 Waiting list 22 II. Treated for defective vision (Amblyopia only) 19 Cured 5 Unresponsive 2 Still under observation 12 III. Treated with orthoptic exercises 22 Complete cure with steroscopic vision 2 Straight in glasses with partial stereoscopic vision 3 Straight with fusion only 1 I mproved appearance 3 Straight after operation, but no binocular vision 6 Straight after operation but some binocular vision 4 Failed to improve, or develop binocular- vision 3 IV. Still under observation or treatment 22 54 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 417 212 277 129 241 59.35 Cann Hall ... ... ... ... ... ... Capworth 156 331 108 243 195 55.55 Church 38 293 19 190 101 48.32 Connaught 116 292 74 178 137 54.36 Da vies Lane 401 153 220 98 177 55.66 Downsell 229 179 148 124 143 52.57 Farmer 694 150 420 78 317 63.65 Good a 11 177 159 103 96 80 40.20 Kirkdaje ... ... ... ... ... ... Knot ts Green 31 27 20 21 23 56.09 Lea Bridge 18 25 10 8 9 50.00 Mayville 149 363 81 247 179 54.57 Newport 495 108 286 61 244 70.31 Norlington 93 441 42 262 209 68.75 Ruck holt 93 52 51 26 52 67.53 Sy bourn 348 179 210 92 197 65.23 St. Joseph's 124 107 71 63 58 43.28 Tom Hood ... ... ... ... ... ... Trumpington 155 136 86 85 96 56.14 3.734 3,207 2,226 2,001 2,458 58.15 Report by the Aijthobity's Senior Dental Officer (A. E. Hall, L.D.S.) Since August 1st, 1942, the Dental Officer seconded to the Essex County Authority for part-time service with the evacuated School children has returned to full-time service in Leyton, but in spite of this the increase in the number of children attending Schools in the Borough has resulted in a lengthening of the period between successive Dental Inspections. Increase in Sound Dentition in 5 Year Old Children. It is very pleasing to note the increase in naturally sound dentitions (as distinct from those rendered sound by extraction and/or filling) in this age group, which would appear to bear some relation to the comparative absence of cheap confectionery as these children would not normally have consumed many sweets or sticky cakes before the time their scarcity became pronounced. 55 A similar improvement was noted during the last War and seems to be connected with this decrease in sugar consumption together with a more plain diet. Statistical tables appended show the amount and nature of treatment carried out during the year. Orthopaedic Clinic. Following the destruction by enemy action of the Orthopaedic and Artificial Sunlight. Clinic Centres at Knotts Green Special School, arrangements were made for the clinics to be held at Leyton Green Health Centre ; and sessions have been held there regularly since March, 1941. The following figures show the number of school children examined and treated during the year. Examinations. Primary examinations 40 He-examinations 126 r Treatment. Number of children who attended for 126 Attendances made 1,340 Surgical Appliances- The following have been supplied :— Caliper splints-—Leg sockets to boots 1 pair Tunnels to boots and valgus T straps ... 9 ,, Alteration to caliper splints 1 Minor surgical alterations to boots and shoes 37 ,, Aural Clinic. The following table shows the relevant particulars regarding the Leyton School children who attended the Aural Clinic for treatment during 1942. Artificial Sunlight Clinic. Number of children attending 124 Attendances made 2,542 56 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 1 ... ... ... ... ... ... 5 (ii) „ Catarrhal „ „ 2 ... ... ... ... ... ... ... 2 (iii) Chronic Suppurative Otitis Media due to :— 1. Tympanic Sepsis ... ... ... ... ... ... ... 1 1 2. „ „ and Granulations ... ... ... ... ... ... ... ... ... 3. „ „ and Polypi... ... ... ... ... ... ... ... ... ... 4. ,, ,, and previous Mastoid Operation ... 1 ... ... ... ... ... ... 1 5. Other causes ... ... ... ... ... ... ... ... ... (iv) Mastoid Disease (previous operation) ... ... ... ... ... ... ... ... ... (v) Partial Deafness due to :— 1. Nerve Deafness ... ... ... ... ... ... ... ... ... 2. Tonsils and Adenoids 1 ... ... ... ... ... ... ... 1 3. Retraction of Membrana Tympani 1 ... ... ... ... ... ... ... 1 4. Scarring ... ... ... ... ... ... ... ... ... 5. Catarrhal Rhinitis 3 ... ... 3 ... ... ... ... 6 6. Wax ... ... ... ... ... ... ... ... ... 7. Other Causes 1 ... ... ... ... ... ... ... 1 (vi) Nasal Cases :— 1. Hypertrophic Rhinitis 2 ... ... 2 2 ... ... ... 6 2. Sinusitis 2 ... ... ... 2 ... ... ... 4 3. Atrophic Rhinitis ... ... ... ... ... ... ... ... ... 4. Deviated Septum 4 1 ... ... ... ... ... 1 6 5. foreign Rody ... ... ... ... ... ... ... ... ... 6. Polypus ... ... ... ... ... ... ... ... ... (vii) Tonsils and Adenoids 9 22 ... 1 ... ... 1 ... 33 (viii) Other Diseases or Defects 5 ... ... 2 ... ... ... ... 7 Totals 34 25 ... 8 4 ... 1 2 74 57 PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN. Mentally Defective Children. Statutory Medical Examinations. During the year, some 100 children were referred for statutory medical examination. As the result of examination these 100 children were classified as follows :— Idiots 0 Imbeciles 1 Moral defectives 0 On attaining 16 years of age—for supervision under the M.D. (Notification of Children) Regulations 1 Certified to Local Education Authority as feebleminded 7 Remained under certificate 15 Certificate withdrawn 7 Dull and backward 18 Backward 10 Borderline cases—to be re-assessed in six months ... 8 Intelligence Normal—Educational failures 14 ,, ,, Behaviour problems 12 Cases under certifying age 7 100 Report by Dr. Mary L. Gilchrist. It will bo noticed that there is a considerable increase in the number of children submitted for Statutory Medical Examination this year. The increase can be traced to the effect of the war on the education of the children, and is not due to any sudden deterioration in the mental condition of the school children. The majority of the backward children (I.Q's between 83 per cent, and 100 per cent.) and the educational failures (I.Q's above 100 per cent.) fall in the 7—8 year and 10—II year age groups. 58 These children, who should have had no great difficulty in learning to read and do arithmetic, were working well below their capacity— indeed so much so that they were referred as possible mental defectives. In the 7 to 8 age group none of them had been to school for any prolonged period of time—either through evacuation, half-time schooling owing to shortage of staff, accommodation, or repeated absences through illness. They had not had the fundamentals of education, though they were expected to have had it. Similar broken schooling due to war conditions affected the 10 to 11 year old group. There they had been given the early stages of teaching in the infant school; but at the critical period of learning, namely, seven years, they had been evacuated or their school closed and when re-opened, half-time education only given. The unsettled nature of the child's environment in the first 2 J years of the war affects practically all children, but those with any emotional defect go under badly and the result is now coming out in educational failure in school and difficult behaviour. The problem does not grow less as the war continues, school classes get larger, although these children demand more and more individual attention from their teacher. In the older age groups behaviour problems predominate— mainly boys whose homes have been broken up either by fathers serving in the Forces or by mothers out at work. These difficult children are also backward in school work in the majority of cases. As they do not get satisfaction in school, they try to get it in other ways. Where possible, advice from. Child Guidance Clinics has been obtained, but the usefulness of these Clinics is much diminished by their distance from the Borough and the long journeys necessary to get there. Knotts Green Special School for Mental Defectives. Admitted 13 Discharged 12 Physically Defective Children. Knotts Green Open Air School. Admitted during the year 30 Discharged 23 59 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1942 was :— Ordinary Meals. Milk Meals. Free 766 1,043 For payment 4,394 — Totals 5. Mil) 1,643 Number of meals supplied :— Ordinary Meals. Milk Meals. Free 106,158 364,087 For payment 342,147 — Totals 448,305 364,087 The above figures relate to the financial year ended 31st March, 1943. NUTRITION. The following table shows in statistical form the average heights and weights (inches and lbs. respectively) of " intermediate " and " leaver " groups during the last five years :— Group. Date. Boys. Girls. No. examined. Av. Ht. Av. Wt. No. examined. Av. Ht. Av. Wt. " Intermediates " 1938 613 49.8 59.2 610 49.5 57.2 (8—0 years). 1939 623 50.18 58.68 616 52.39 58.25 1940 269 50.7 60.8 280 49.6 58.2 1941 223 49.8 58.0 242 49.7 56.1 1942 49.8 58.7 342 49.9 57.9 " Leavers " 1038 014 59.0 93.4 586 59.9 95.6 (12—13 years). *1939 85 60.0 95.03 83 00.54 100.32 1940 310 60.3 90.6 239 6J.0 97.3 1941 264 59.21 92.25 279 59.34 92.8 1942 351 59.1 92.0 370 59.5 94.0 * Reduction in numbers due to evacuation, 60 Observations by Dr. Mary Gilchrist. The figures for the average heights and weights of children aged 8—9 years and 12—13 years do not reveal any significant deterioration compared with pre-war figures. There is a slight drop in weight of the " Leaver " group, and in the height of the girls in that group, but as the figures in normal times show yearly fluctuations it is not possible to attribute these falls to the war. The heights and weights of the entrants into the schools could not be compared with those of previous years. Evacuation has so interfered with the medical examination of the " entrants " group that the -1942 figures are not comparable with those of other years. Many children were being examined for the first time as " entrants " at the age of 6 and 7 years. What the effect of school dinners has been upon the general nutrition of children it is too early yet to say. It was not until July, 1942, that school canteens had been established in all schools. The genera] impression of teachers who have most to do with the school meals is that the children have really benefited from them, and they are becoming more popular. Certain individual children, especially those from neglected homes, have shown most benefit. Another group who have done well are children who were neurotically " fussy " or " fussed over " at meals time. Children who " never eat anything " at home settle down quite happily to school dinners. I think we can say that no marked deterioration has been revealed owing to the war-time diet, and with so many families— once well below the poverty line through long spells of unemployment, and now " better off " than before the war—it seems quite likely that the poorer nourished sections of the population are actually better fed than in peace time. 61 PUBLIC ELEMENTARY SCHOOLS. STATISTICAL APPENDIX. TABLE 1.—Returns of Medical Inspections, a. Routine Medical Inspections. Number of Code Group Inspections :— Entrants 1612 Second Age Group 677 Third Age Group 721 Total 3,010 b. Other Inspections. Number of Special Inspections 3,827 Nuniber of Re-inspections 6,572 Total 10,399 c. Children Found to Require Treatment. Number oi' individual children found at Routine Medical Inspection to require treatment (excluding defects of Nutrition, Uncleanlineas and Dental Diseases). Group. For Defective Vision (excluding Squint). For all other Conditions Total. Fercentage of children found to require Treatment. Entrants 7 238 245 15.2 Second Age Group 34 87 121 17.8 Third Age Group 91 71 162 22.4 Total (Prescribed Groups) 132 396 528 17.5 Other Routine Inspections — — — — Grand Total 132 396 528 17.5 62 TABLE II. Classification of tkb 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). I). (Bad). No. % No. % No. % No. % Entrants 1612 151 9 1101 68 344 21 16 0.9 Second Age Group 677 75 11 435 64 161 24 6 0.9 Third Age Group 721 147 20 456 63 116 16 2 0.3 Other Routine Inspections - - - - - - - - - Total 3,010 373 12 1.992 66 121 21 24 0.8 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1942. TREATMENT TABLE. Group 1.—Minor Ailments (excluding Uncleanliness, for which see Table V). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin-— Ringworm— Scalp—(1) X-ray treatment — — — (2) Other 1 — 1 Body 10 — 10 Scabies 160 — 160 Impetigo 94 — 94 Other skin diseases 660 660 Minor Eye Defects— (External and other, but excluding cases falling in Group 11.) 255 255 Minor Ear Defects 183 — 183 M iscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 622 — 622 Total 1,985 — 1,985 63 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as mlnor allments.— group I.). Defect or Disease. Number of Defects dealt with. Under the Authoritj^'s Scheme. Otherwise. Total. (1) (2) (3) (4) Errors of refraction (including squint) 444 35 479 Other defect or disease of the eyes (excluding those recorded in Group I.) 129 129 Total 573 35 008 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom Spectacles were :— (a) Prescribed 375 35 410 (b) Obtained 371 39 410 TABLE III—conta. Group III.—Treatment of Defects of Nose akti Throat. Number of Defects. Received Other Forms of Treatment. Total Number Treated. Received Operative Treatment. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) S4 142 1 9 31 13 — 1 3 — 1 10 34 13 (1) Tonsils only. (2) Adenoids only. (3) Tonsils and adenoids. (4) Other defects of the nose and throat. 64 TABLE IV. Dental Inspection and Treatment (1) Number of children who were :— (a) Inspected by the Dentist:— Aged : Age Groups 3 52 Total 6.941 4 241 5 523 6 656 7 797 8 698 9 676 10 725 11 805 12 732 13 721 14 309 15 6 16 ... Specials (Casuals) 823 Grand Total 7,764 (b) Found to require treatment 5,060 (c) Actually treated 2,251 (2) Half-days devoted to Inspection 53 Treatment 792—Total 845 .3) Attendances made by children for treatment 5,149 (4) Fillings, Permanent Teeth 2,514 Temporary „ 240-Total 2,754 (5) Extractions, Permanent Teeth 746 Temporary ,, 4,439 -Total 5,185 (6) Administrations of general anaesthetics for extractions 1,503 (7) Other operations, Permanent Teeth 311 Temporary ,, 65 -Total 376 65 TABLE V. 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 17,439 (3) Number of individual children found unclean 990 (4) Number of children cleansed under arrangements made by the Local Education Authority — (5) Number of cases in which Legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under the School Attendance Bye-laws — TABLE VI. Blind and Deaf Children. (1) At a Public Elementary School. (2) At an Institution other than a Special School (3) At no School or Institution. (4) Total not receiving suitable Education. Blind Children — — — — Deaf Children — — — — Mentally Defective Children. Total number of children notified during the year ended 31st December, 1941, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 1 66 SECONDARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections, a. Routine Medical Inspections. Number of Code Group Inspections:— County High School for Boys 374 ,, ,, ,, Girls Nil Total 374 Number of other Routine Inspections — b. Other Inspections. Number of Special Inspections 59 Number of Re-inspections 75 Total 134 Children Found to Require Treatment. Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) County High School for Girls — — — County High School for Boys 374 34 9.0 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. % No. % No. % No. % County High School for Girls Nil ... ... ... ... ... ... ... ... County High School for Boys 374 38 10.2 333 89.0 3 0.8 ... ... 67 TABLE III.—Return of Defects Treated during the Year. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm— Scalp—(1) X-ray treatment — — — (2) Other — — — Body — — — Scabies — — — Impetigo — — — Other skin diseases 8 — 8 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 4 — 4 Minor Ear Defects — — — Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 11 — 11 Total 23 — 23 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as mlnor ailments.—group I.). Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Errors of refraction (including squint) 59 22 81 Other defect or disease of the eyes (excluding those recorded in Group I.) 9 — 9 Total 68 22 90 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 59 (b) Otherwise 22 68 TABLE IV. Dental Inspection and Treatment. (1) Number of children who were :— (a) Inspected by the Dentist :— Aged : Age Groups 11 53 Total 395 12 95 13 102 14 84 15 54 16 3 17 4 18 Specials (Casuals) Nil Grand Total 395 (b) Eound to require treatment 252 (c) Actually treated 177 (2) Half-days devoted to Inspection 2 Treatment 57—Total 59 (3) Attendances made by children for treatment 293 (4) Fillings, Permanent Teeth 316 Temporary ,, Nil—Total 346 (5) Extractions, Permanent Teeth 95 Temporary „ 35—Total 130 (6) Administrations of general anaesthetics for extractions 40 (7) Other operations, Permanent Teeth 37 Temporary ,, Nil—Total 37