LEY 37 Borough of Leyton HEALTH REPORT FOR THE YEAR 1943. 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 LEYTON. Mr. Mayoe, Ladies and Gentlemen, I beg to submit my Annual Report as Medical Officer of Health and School Medical Officer for the year 1943. 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 number of births registered during 1943 was 1,595, the birth rate being 18.4 per thousand of the population. With the exception of the year 1941, there has occurred a progressive rise in the birth rate from 11.85 in 1936 to 18.14in the year unde»review. The comparative birth rate for England and Wales was 16.5. The Leyton death rate for 1943 was 14.20 per thousand of the population. This represents an increase in the rate (12.91) for the previous year. The infantile mortality rate (35.73 per thousand live births) is a welcome decrease from the rate (50.27) of the previous year; and compares with a rate of 49 for the whole country. Five Leyton mothers died during the year from diseases or accidents of pregnancy or childbirth, the maternal mortality rate being 3.06. Scarlet fever, measles and whooping cough assumed epidemic proportions during the year, but the number of persons (28) notified to be suffering from diphtheria is the 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 Chairmen and Members of the Committees concerned with the work of the Health Department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, 2 Extract from Vital Statistics for the year 1943. Live Births:— Legitimate Males 782 Females 738 Illegitimate Males 38 Females 37 Totals 1,595 Birth Rate per 1,000 of population 18.14 Stillbirths:— Males 17 Females 21 Rate per 1,000 total (live and still) births 23.27 Deaths:— Males 635 Females 613 Totals 1,248 Death Rate per 1,000 14.20 Number of women dying from diseases and accidents of pregnancy and childbirth :— From Sepsis 1 From other causes 4 Rate per 1,000 total (live and still) births 3.06 Death rate of infants under one year of age:— All infants per 1,000 live births 35.73 Legitimate infants per 1,000 legitimate live births 34.87 Illegitimate infants per 1,000 illegitimate live births 53.33 Deaths from Cancer (all ages) 207 , „ „ Measles (all ages) 0 ,, ,, Whooping Cough (all ages) 0 ,, ,, Diarr-hoea (under 2 years of age) 4 3 TABLE 1. Registered Births, 1943. Leyton. Lea Bridge. Central North. Central South. Forest. Leyton stone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 9 12 6 5 7 8 5 5 5 7 69 February 3 6 3 2 5 5 3 4 2 4 37 March 10 8 6 10 8 15 5 9 8 5 84 April 1 5 3 6 15 9 4 5 2 4 54 May 4 8 3 3 11 8 7 3 4 5 56 June 3 5 10 7 14 9 8 6 9 3 74 July 4 7 6 6 9 4 6 7 12 5 66 August 2 4 — 4 8 5 5 5 6 6 45 September 7 11 5 7 9 10 4 7 4 8 72 October 4 7 5 7 11 2 8 5 2 1 52 November 6 6 5 2 9 7 6 7 8 3 59 December 3 8 7 5 9 3 10 3 7 1 56 Transferables 55 140 81 76 173 128 54 62 60 42 871 Totals 111 227 140 140 288 213 125 128 129 94 1595 4 TABLE 2. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1943. Sex. All Ages. Ages at Death in Years. In Public Institutions in the Distrlc 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 1 1 ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro spinal fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 3. Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 38 ... ... ... ... 6 3 9 10 8 2 ... ... ... F 24 ... 1 ... ... 6 7 1 2 4 1 ... ... ... 7. Other forms of tuberculosis M 6 ... ... 1 1 2 1 1 ... ... ... ... ... ... F 2 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 8. Syphilitic disease M 8 ... ... ... ... 1 ... 1 1 2 3 ... ... ... F 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... 9. Influenza M 10 ... ... ... 1 ... ... ... 1 3 3 2 ... ... F 12 ... ... ... ... ... ... ... 1 2 4 5 ... ... 10. Measles M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious enc phalitis M 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) M 7 ... ... ... ... ... ... ... ... 1 2 4 ... ... 13. Cancer of uterus F 9 ... ... ... ... ... ... ... 1 2 5 1 ... ... 14. Cancer of stomach and duodenum M 23 ... ... ... ... ... ... 1 1 8 7 6 ... ... F 23 ... ... ... ... 1 ... ... 1 6 10 5 ... ... 5 14. Cancer of stomach and duodennm M 23 ... ... ... ... ... ... 1 1 8 7 6 ... ... F 23 ... ... ... ... 1 ... ... 1 6 10 5 ... ... 15. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 24 ... ... ... ... ... ... 2 5 11 3 3 ... ... 16. Cancer of all other sites M 62 ... ... ... ... ... ... 3 10 14 24 11 ... ... F 59 ... ... ... ... ... 1 5 5 12 26 10 ... ... 17. Diabetes M 8 ... ... ... ... ... 1 1 1 2 2 1 ... ... F 5 ... ... ... ... ... ... ... ... ... 4 1 ... ... 18. Intra-cranial vascular lesions M 46 ... ... ... ... ... ... 1 ... 9 18 18 ... ... F 58 ... ... ... ... ... ... 1 3 11 21 22 ... ... 19. Heart disease M 122 ... ... ... ... ... ... 5 7 27 36 47 ... ... F 136 ... ... ... ... ... 3 1 10 11 43 68 ... ... 20. Other diseases of circulatory system M 17 ... ... ... ... ... 1 3 1 4 5 3 ... ... F 21 ... ... ... ... ... ... ... 2 4 6 9 ... ... 21. Bronchitis M 74 ... ... ... 1 ... ... 1 8 17 22 24 ... ... F 39 ... ... ... ... ... 1 ... ... 8 8 22 ... ... 22. Pneumonia M 49 7 1 ... ... ... l 1 1 12 16 10 ... ... F 47 5 2 ... 1 ... l ... 5 5 13 15 ... ... 23. Other respiratory diseases M 13 ... ... ... ... ... l ... 3 2 4 1 ... ... F 5 1 ... ... ... ... ... 1 ... 1 ... 2 ... ... 24. Ulceration of the stomach or duodenum M 12 ... ... ... ... ... ... 4 3 3 2 ... ... ... F 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 25. Diarrhoea (under 2 years of age) M 1 1 ... ... ... ... ... ... ... ... ... ... ... ... F 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 3 ... ... ... 2 ... ... ... ... ... ... 1 ... ... 27. Other digestive diseases M 10 ... ... ... 1 ... ... ... 2 2 3 2 ... ... F. 6 ... ... ... ... ... ... ... ... ... 5 1 ... ... 28. Nephritis M 14 ... ... ... ... 2 2 ... ... 2 5 3 ... ... F 15 ... ... ... ... 2 2 1 2 1 3 4 ... ... 29. Puerperal and post-abortive sepsis. F 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 30. Other maternal causes F 4 ... ... ... ... 1 2 1 ... ... ... ... ... ... 31. Premature birth M 14 14 ... ... ... ... ... ... ... ... ... ... ... ... F 8 8 ... ... ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 7 7 ... ... ... ... ... ... ... ... ... ... ... F 7 6 ... ... ... ... ... ... 1 ... ... ... ... ... 33. Suicide M 4 ... ... ... ... ... 1 ... ... 2 1 ... ... ... F 3 ... ... ... ... ... 1 1 1 ... ... ... ... ... 34. Road traffic accidents M 3 ... ... ... ... ... ... ... 1 ... 2 ... ... ... F 2 ... ... ... ... ... 1 ... ... ... ... 1 ... ... 35. Other violent causes M 16 ... ... ... ... 1 1 2 1 4 3 4 ... ... F 11 1 ... ... ... ... 1 ... 1 2 2 1 2 ... ... 36. All other causes M 68 1 ... ... 2 2 1 2 4 2 13 41 ... ... F 80 2 ... ... 1 2 5 2 6 3 13 46 ... ... Totals M 635 57 5 3 12 30 39 53 103 207 341 398 1794 488 F 613 6 TABLE 3. DEATHS IN WARDS, 1943. CAUSES OF DEATH. Leyton Lea Bridge. 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 ... ... ... ... ... 1 ... ... ... ... ... 2. Cerebro-spinal fever ... ... ... ... ... ... 1 ... ... ... ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria ... ... ... ... ... ... 1 ... ... ... ... 6. Tuberculosis of respiratory system 10 10 5 6 9 6 5 3 7 1 ... 7. Other forms of tuberculosis ... ... ... 1 3 3 1 ... ... ... ... 8. Syphilitic diseases ... 1 ... ... 3 1 1 1 2 1 ... 9. Influenza 3 3 2 1 3 5 2 1 ... 2 ... 10. Measles ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis ... ... ... ... ... ... ... ... ... ... ... 12. Acuteinfeotiousencephalitis ... ... 1 ... 1 ... ... ... 1 ... ... 13. Cancer of buccal cavity and oesophagus (males only) ... ... 3 l 1 1 ... ... ... 1 ... 13. Cancer of uterus ... 2 ... ... 4 2 ... ... 1 ... ... 14. Cancer of stomach and duodenum 4 14 3 2 8 5 2 1 4 3 ... 15. Cancer of breast 3 2 2 3 7 1 2 2 2 ... ... 16. Cancer of all other sites 8 24 12 9 19 15 9 5 14 6 ... 17. Diabetes. 2 3 2 ... 4 ... ... 1 1 ... ... 18. Intra-cranial vascular lesions 7 12 9 13 17 12 6 10 12 6 ... 19. Heart disease 25 33 27 22 37 45 12 22 25 10 ... 20. Other diseases of circulatory system 3 5 3 5 2 9 4 4 1 2 ... 21. Bronchitis 5 17 8 11 19 13 12 8 8 12 ... 22. Pneumonia 10 16 6 11 12 12 6 9 7 7 ... 23. Other respiratory diseases 2 2 ... 5 2 2 1 1 3 ... ... 24. Ulcer of stomach or duodenum 1 2 3 1 ... 1 1 ... 1 3 ... 7 [/$$$]25. Diarrhoea (under 2 years) 1 ... ... ... ... 2 1 ... ... ... ... 26. Appendicitis 1 ... ... ... ... ... 1 ... 1 ... 27. Other digestive diseases 2 4 ... 2 ... 2 1 3 ... 2 ... 28. Nephritis ... 4 5 ... 6 3 2 3 5 1 ... 29. Puerperal and post-abortive sepsis ... ... ... ... i ... ... ... ... ... 30. Other maternal causes ... 1 ... ... 1 1 ... 1 1 ... ... 31. Premature birth ... 2 3 ... 7 3 4 1 1 1 ... 32. Congenital malformations 1 ... 3 ... 5 1 ... 2 2 ... ... 33. Suicide 1 ... ... ... ... 1 ... 1 4 ... ... 34 Road Traffic accidents 2 ... ... 1 1 1 ... ... ... ... ... 35. Other violent causes 2 4 ... 3 4 3 1 1 1 8 ... 36. All other causes 13 29 12 14 23 16 11 8 12 10 ... Totals 106 190 109 111 198 167 86 89 115 77 ... 8 TABLE 4. Vital Statistics or Whole District during 1943 and Previous Years. Year. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferahlea Nett. of Nonresidents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. N umber. 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 1373 27.3 1546 296 73 50.27 1123 12.91 1943 871 1595 18.14 2769 31.5 1810 289 57 35.73 1248 14.20 9 Birth-rate, Death-rate and Analysis of Mortality During the Year 1943 Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage or Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Eever. 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 16.5 0.51 12.1 0.00 0.00 0.02 0.00 0.03 0.03 0.37 5.3 49 .. ... ... ... 126 County Boroughs and Great Towns, including London 18.6 0.63 14.2 0.00 0.00 0.02 0.00 0.03 0.04 « 0.36 7.9 58 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 19.4 0.61 12.7 0.00 0.00 0.02 0.00 0.03 0.04 0.37 4.4 46 ... London 15.8 0.45 15.0 0.00 0.00 0.02 0.00 0.03 0.02 0.27 10.4 58 ... ... ... ... LEYTON 18.14 0.43 14.20 0.01 0.00 0.00 0.00 0.00 0.01 0.25 2.5 35 84.71 2.96 12.33 ... 10 TABLE 6. Comparative Statistics of Bikths, Mortality, Etc. LEYTON, 1892-1943. 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 1896 2372 30.08 926 11.8 326 137 1897 2501 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 1943 1595 18.14 1248 14.20 57 35.73 11 GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. FOOT CLINIC. Mr. O'Brien, Senior Chiropodist, left the Foor Clinic in February, 1943, to join H.M. Forces, and the vacancy was not filled until 19th April, 1943. The duties of Temporary Senior Chiropodist were taken over on that date by Miss F. B. Maclean, M.I.S.Ch. At a later date, on 14th August, 1943, Mrs. Turnbull, Assistant Chiropodist, left to join H.M. Forces. At the end of August Miss Hunter, M.I.S.Ch. was appointed to assist on Mondays and Wednesdays. On 12th October Mr. N. Pay took over duties on Tuesdays, Thursdays and Fridays, leaving only one Chiropodist on the Saturday session. By diminishing the time allocated to each patient an effort was made to overtake the arrears of appointments which had accumulated owing to shortage of staff, and in this way the time patients had to wait for appointments was reduced by a fortnight. Despite the shortage of staff the number of treatments given to patients during the year was only 626 less than those of the previous year. Summary of Attendances and Treatment. The number of patients who attended for treatment was 1,176; and the total treatments given were 5,838. The average number of attendances per patient was 4.96. First Attendances (new cases). Subsequent Attendances. Total Attendances. Average No. of Visits per Patient. Males 93 993 1,086 5.29 Females 293 3,830 4,123 4.27 Children 98 531 629 6.40 Total 484 5,354 5,838 4.96 During the year the numbers ot persons who received tree treatment was 32. 6.61 ner cent, of the total number of new cases. The following figures show the attendances of patients who received free treatment. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males. Females. Males. Females. Males. Females. Old age pensioners 10 21 289 956 299 977 Unemployed — 1 12 40 12 41 Widows — — — 18 - 18 Totals 10 22 301 1.014 311 1.036 12 SCABIES. My last Annual Report contains information regarding the Scabies Order, 1941, and the arrangements made under the provisions of that Order for the treatment and control of Scabies. The special clinic at Ruckholt School is available for treatment daily, and sessions as required are arranged in the evenings and during week-ends. The routine course of treatment is two baths, followed by thorough application of Benzyl Benzoate Emulsion (25 per cent-.). In some very mild cases among contacts one routine treatment may be found to be sufficient; but the preponderating majority requires at least two treatments. Many patients gave histories of having had scabies for many months, and it was only when the infection became septic that advice was sought. In such cases, more than two treatments were required for the eradication of symptoms. Attendances at Special Clinic. Number of patients treated 1,154 Children 522 Adults 632 Number of patients who had One routine treatment 1,154 Two „ „ 1,068 Three ,, „ 228 Four „ „ 40 Total Treatments 2,490 CIVIL AMBULANCE SERVICE. » Prior to the outbreak of war the Borough Civil Ambulance Service had been under the control of Leyton Fire Brigade and manned by Fire Brigade personnel. After the absorption of the local Fire Brigade in the National Fire Service the Home Office issued a Circular in which it was stated that it would not be possible for the National Fire Service to carry on any ambulance duties for which Fire Brigades were responsible ; and that it would therefore be necessary to make other arrangements which would free for fire fighting duties any members of Fire Brigades who were employed on ambulance work. 13 The Ministry of Health suggested that the best arrangement to be made for the period of the present emergency would be to transfer the ambulances to the A.R.P. Ambulance Service for the purpose of manning, accommodation, and servicing. The Ministry of Health issued a Circular in which this view was confirmed, and in which the following suggestions were made as being the most satisfactory method of dealing with the matter:— (i) That Ambulances should be attached to a Civil Defence Ambulance Depot in the same locality as the Fire Brigade Station in which they have been based in the past. (ii) That suitable trained male or female staff, who are fully qualified and experienced in first aid, should always be available to man the ambulances; and that satisfactory arrangements should be made to ensure that telephone calls can be received and an ambulance sent out without delay at any time during the day or night. (iii) That the Ambulances should be used for conveying air raid casualties when no vehicles of the Civil Defence Ambulance Service proper are available. (iv) That the Ambulances should be removed from the Fire Station premises and be maintained and serviced in the same way as the Civil Defence Ambulances; but that, in view of their special equipment, they should be garaged under cover and that where suitable existing accommodation is not available proposals to provide special accommodation should be submitted to the Senior Regional Officer for approval. In September, 1942, your Council, in response to the instructions of the Government Departments, decided that a garage with sleeping accommodation and rest room be built in Auckland Road; and that the civil ambulances be manned by members of the Civil Defence Ambulance Service. At a later date the Ministry of Health declined to sanction the inclusion of sleeping accommodation and a rest room in the new garage building. In May, 1943, the Council authorised the Medical Officer of Health to take charge of the Civil Ambulance Service, which was transferred to the control of the Emergency Committee. On 1st October, 1943, the Council's three civil ambulances and ' 7 equipment were transferred from Harrow Green Fire Station to the new Auckland Road Garage; and since that date they have been operated by members of the Civil Defence Ambulance Service. 14 The following table gives particulars of the cases transported by the ambulances during the period 1st October to 31st December, 1943:— October November December Total Maternity Cases 28 21 29 78 Accident and Illness 46 46 46 138 Transfers, Hospitals, etc. 104 91 143 338 • 178 158 218 554 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 3,349 Miscellaneous inspections 1,224 Re-inspections 8,199 Places of entertainment 12 Schools 47 School Canteens 11 Stables 36 Urinals 176 Inspections under Rats and Mice (Destruction) Act 3,052 Visits in connection with infectious disease 446 Factories without mechanical power 18 Factories with mechanical power 351 Outworkers' premises 160 Rag and bone dealers 4 Foster-mothers' premises 10 Hairdressers'premises 44 Public Houses 54 Offensive Trades 86 Piggeries 3 15 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 459 Sash cords renewed 119 Plaster repaired 559 Roofs repaired or renewed 465 Guttering repaired or renewed 203 Yards paved 9 Drains relaid or partly relaid 29 Choked drains cleared 44 New w.c. pans and traps provided 51 Sinks provided 8 W.c. cisterns repaired or renewed 98 Rain water pipes repaired or renewed 60 Vent pipes repaired or renewed 13 Sink waste pipes repaired or renewed 65 Stoves repaired or renewed 197 Coppers repaired or renewed 29 Floors repaired 134 Rooms redecorated 442 Windows, sills, etc., repaired 86 Cement work to sink waste gullies repaired 33 Miscellaneous defects remedied 290 Verminous Houses. Infested. Disinfested. Number of Council houses 6 6 Number of other houses 197 197 Rats and Mice (Destruction) Act, 1919. Ministry of Food—Infestation Order 1943 S. R. & O. 680. Special attention has been given throughout the year in the enforcement of the above. Additional work and responsibility was given to Local Authorities by the Infestation Order, 1943, S.R.& O. 680 dated 6th May, 1943. Instructions by the Ministry of Food for the treatment of sewers were carried out by the Public Health Department in conjunction with the Borough Surveyor and Engineer's Department. Treatment of the sewers was commenced on 6th December, 1943; and the first treatment, which involved the baiting of 600 manholes, was completed on 17th January, 1944. Difficulty was experienced in obtaining labour for the work, and the shortage of sewer men limited the number of squads whicl^ could be used. 16 Personnel of the National Fire Service were engaged as part-time assistants. Details of the work, giving statistics, were passed to the Ministry of Food, who state that the estimated number of rats destroyed was 8,000 in the first treatment. Records of the second treatment, which involved the baiting of over a thousand manholes, will be given in the next Annual Report. The Ministry of Food's recommended pre-baiting methods, and their advice in the use of poisons and bait bases, have been successfully used; and this Department has found the methods practicable. Pamphlets dealing with the rat menace were distributed, and posters exhibited, throughout the Borough. Varnish and traps were supplied to occupiers where few rats were suspected. Prebaiting and poisoning was used where infestation was greater. It was found that through the publicity the general public had become more "rat conscious," and much time was given by the staff in the giving of advice and assistance to troubled occupiers. Although figures at times may be misleading, it is felt that some progress in rat diminution was accomplished. It should be noted, however, that, with a reservoir of rats such as in the sewers, continuous killing of the vermin is essential, since periodical reductions of their number increases the available food supply for the survivors. Special attention has been given to all food premises. The following gives in summary form the action taken:— Complaints received and investigated 335 Premises found to be infested 287 Enquiries made 3,025 Sewer manholes baited (first treatment)* 600 Approximate number of baits laid 3,000 Approximate number of rats destroyed 8,000 *The second treatment will be included in 1944 Report. The percentage of complaints received (335), according to the ten wards, is as under:— Harrow Green 9.8 per cent. Leytonstone 14.3 „ Grove Green 9.5 ,, Cann Hall 12.5 „ Forest 9.2 ,, Lea Bridge 13.7 „ Leyton 10.1 ,, Wanstead Slip 8.7 ,, Central South 5.9 ,, Central North 6.3 ,, 17 A.R.P., Civil Defence, etc. Visits were made to the following :— Air Raid Shelters, Wardens and Fire Guard Posts 36 Food Depots 56 A.R.P. Depots 9 First Aid Posts 5 Decontamination of food; demonstrations, visits, etc 348 Emergency Water Supply 39 HOUSING. Complaints. During the year 2,340 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 929 Statutory—Housing Acts Nil Public Health Acts 147 Notices complied with—Informal 1,128 Statutory— Housing Acts Nil Public Health Acts 120 Legal Proceedings. Proceedings under the Public Health Act were instituted in three cases to abate statutory nuisances. Orders were made and costs imposed in each case. Housing. Number of houses erected during the year :— (а) Total (including numbers given separately under (b)). (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons : Houses Nil Flats Nil (б) 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 (b) For other purposes Nil (ii) By other bodies or persons Nil 18 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) 3,349 (6) Number of inspections made for the purpose 11,548 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 1,179 (6) Number of inspections made for the purpose 1,494 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (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 929 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 1,128 III.—Action under Statutory Powers during the Year:— (а) 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 (б) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 147 * 19 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 120 (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 (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 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. Requisitioning for Families Inadequately Housed. (Ministry of Health Circular No. 2845.) The Circular was issued in August, 1943. A survey of known unoccupied houses was carried out, and the following is a summary of the number of premises visited and the results obtained :— Unoccupied premises visited ... ... ... 474 Reports prepared ... ... ... ... ... 407 Negotiations still in progress ... ... ... 67 Premises occupied as result of negotiations ... 222* Premises found to be unsuitable ... ... 70 Premises unoccupied owing to war damage ... 99 Owner returning to occupy or let ... ... 16 *Of this number 16 were requisitioned by the Council. 20 Unavoidable delay in requisitioning premises by the Council, or in bringing pressure to bear upon the owner to let unoccupied premises, was caused through inability to trace the whereabouts of owners and in many cases to the reluctance of owners to answer enquiries. Housing Act, 1936. Information regarding 92 houses and 36 flats was supplied in connection with the "permitted number of persons" in dwellings under the Act. House-to-House Inspection. Houses in the undermentioned roads have been inspected during the year:— Angle Street. Carlisle Road. Church Road. Crescent Road. Grange Road. Junction Road. Shaftesbury Road. Temple Street. Wood Street. Rent and Mortgage Interest Restriction Act, 1920-1933. Two applications for certificates were received, and granted. INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year:— Slaughter-houses . 47 Butchers 243 Bakehouses 43 Fishmongers 80 Milkshops and dairies 159 Provision shops 437 Dining rooms 160 Greengrocers 105 Fish friers 26 Meat Depots 215 21 MILK. Dairies and Milkshops. Number of premises on register 185 (Owing to restrictions imposed by rationing, there are only now 76 premises from which milk is sold.) Premises added to register during year Nil Premises removed from register during year 1 Visits of inspection 159 Bacteriological Examinations. Designated Milk. Licences. No. Granted. No. of Samples taken. Result. Satisfactory. Unsatisfactory. Tuberculin Tested 10 1 1 — Accredited 3 — — — Pasteurised 42 13 9 4 Supplementary Licences - - - - Tuberculin Tested 2 — — — Pasteurised 3 — — Totals 60 14 10 4* *Letters of warning sent. Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1943 67 Premises registered during 1943 Nil Premises removed from Register during 1943 Nil MEAT. Slaughter - Houses.—There are six licensed slaughterhouses in the Borough, and 47 inspections of these slaughter houses were made. Twelve pigs were inspected and found to be free from disease. English meat sold by retail within the Borough is from animals slaughtered at Regional slaughterhouses which are situated outside the Borough. Slaughter of Animals Act, 1933. One person was licensed as a slaughterman during the year. 22 Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 6 Dairies, Milkshops and Dairymen 185 Butchers'shops, Stalls and Provision shops 291 Hairdressers'Premises 52 Fish friers 17 Offensive Trades. Rag and Bone dealers 3 Tripe boiler 1 Diseases of Animals Acts and Orders. During the year Orders were issued as under:— Anthrax Order, 1938. Bullock 1 Cows 2 Pig 1 Swine Fever Order, 1938. 1 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 119. Samples analysed. Samples unsatisfactory. • Aspirin Tablets 2 Arrowroot 1 - Butter 1 - Black Pudding 1 - Beans in Brine 1 - Cocoa 3 - Cordial, Raspberry Flavour 1 - Curry Powder 1 Camphorated Oil. 1 - Celery Salt 1 - Coffee 1 23 ] Samples analysed. Samples unsatisfactory Egg Powder Substitute 1 — Essence, Lemon Flavouring 1 — Fruit Sauce i — Gripe Mixture 1 — Gelatine 3 1 Glycerine Substitute 1 — Grape Fruit Squash 2 — Glycerine, Honey and Lemon with Ipecacuanha 1 Jam 2 — Lemonade Powder 3 1 Lemon Substitute 1 — Lemon and Ipecacuanha Mixture 1 — Milk 37 7 Milk, Skimmed 1 — Margarine 1 — Malt Extract Tablets 1 — Nutmeg, ground 2 — Nerve Tonic 1 — Pepper 7 — Plums in Syrup 1 — Phosphorus, Quinine and SteeS Tonic Elixir 1 _ Ruby Wine 1 1 Sweetening Tablets 1 — Sausages 11 1 Sausage meat 5 — Spice, mixed 1 — Saccharin Tablets 1 — Salad Oil I — Sulphur Ointment 2 — Sausages, preserved 1 — Turpentine 1 — Vinegar 5 — Whisky 3 — Wine, Non-alcoholic 1 — Yorkshire Pudding Mixture 1 — 119 11 24 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 373 5 — Factories without mechanical power 39 1 — Other Premises under the Act (including works of building' and engineering construction but not including outworkers' premises) — — — Total 412 6 — 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness 5 5 — Sanitary Conveniences:— Insufficient 4 4 — Dirty — — — Other Offences — — — Total 9 9 — OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937). Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Nil Nil Nil —. 25 MATERNITY AND CHILD WELFARE. INFANT WELFARE. Notification of Births.—Thirteen hundred and Forty-one notifications of births were received during the year. By medical practitioners 324 By midwives 1,017 By parents and others — During the year under review, the total attendances at the Council's Infant Welfare Centres were 14,864, an increase of 3,104 compared with the figure (11,760) for the previous year. The number of children examined by the Clinic Medical Officers was 4,186 as compared with 3,631 examined during the previous year. Health Visitors. During the year the Health Visitors have made 17,422 visits to homes, as follows:— (a) To expectant mothers:— First visits 312 Total visits 349 (b) To children under 1 year of age:— First visits 1,567 Total visits 8,496 (c) To children between the ages of 1 and 5 years:— Total visits 8,577 26 TABLE 7. ATTENDANCES, EXAMINATIONS, etc., 1943. Leyton Green. Park House. All Centres. Under 1 year— 1st attendances 569 558 1,127 Subsequent attendances 5,635 5,509 11,144 Total attendances 6,204 6,067 12,271 1-5 years— 1st attendances 62 68 130 Subsequent attendances 1,215 1,248 2,463 Total attendances 1,277 1,316 2,593 Total attendances, both age groups 7,481 7,383 14,864 Average attendance per session 76.33 70.31 73.22 Number examined by clinic doctor 2,074 2,112 4,186 Number weighed 7,147 7,215 14,362 27 Dental Treatment. The attached table gives some idea of the work carried out:— Expectant Mothers. Children. Patients treated 133 82 Attendances 343 139 Extractions 599 175 Fillings 71 55 Other dental operations 121 16 Advice only 71 30 Anaesthetics— General 108 57 Local 40 6 Dentures supplied— Full upper and lower 8 Full upper 5 Full upper and partial lower 1 Partial upper 2 Partial upper and lower 5 21 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, 29 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—Fifty-three children made 253 attendances for special treatment by the Council's Masseuse (Miss Findlay). Provision of Surgical Appliances.—Thirty-four children were supplied with surgical appliances on the recommendation of the Orthopaedic Surgeon. 28 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 59 pre-school children, who made 94 attendances for examination and treatment. Artificial Sunlight Treatment. Number of cases treated 67 Total number of attendances 959 Convalescent Home Treatment. « Children. During the year 1 child, recommended by the Clinic Medical Officers, was sent to a Convalescent Home by the Maternity and Child Welfare Authority through the agency of the Invalid Children's Aid Association. Nursing Mothers. Arrangements were made for twelve mothers and their babies to have periods of convalescence following confinement. Ophthalmia Neonatorum. No. of Cases Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hosp. 3 3 — 3 — — — 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. 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 1943 1595 57 36 35.73 22.57 38 29 TABLE 8. Infantile Mortality, Year 1943—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) ... ... ... ... ... ... 2 1 ... 3 Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... 6 l ... 12 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 1 1 ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital malformations ... 2 ... ... 2 1 1 ... ... 4 Premature birth 16 4 ... ... 21 1 ... ... ... 22 Atrophy, debility and marasmus ... ... ... 1 1 ... ... ... ... 1 Other causes 4 ... ... 1 5 2 ... ... ... 7 Totals 25 8 1 2 36 8 10 3 57 Nett Births registered during the calendar year Legitimate 1,520 Illegitimate 75 Nett Deaths registered during the calendar year Legitimate infants 53 Illegitimate infants 4 30 TABLE 9. Infantile Mortality During the Year 1943—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 ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and croup ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... 1 ... 1 ... ... ... ... ... ... 3 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all formn) ... 2 l 2 1 3 ... ... 2 1 ... 12 Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 1 ... ... ... ... 2 ... ... ... ... ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... 1 ... ... 1 ... 2 Atelectasis ... ... ... ... 2 ... ... ... ... ... ... 2 Congenital malformations ... ... 1 ... ... 1 ... ... 1 ... ... 4 Premature birth ... ... 3 ... 7 3 ... 1 1 1 ... 22 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... 1 ... ... ... 1 Other causes ... ... 1 ... 3 1 ... ... 2 ... ... 7 Totals 3 4 7 2 15 10 5 3 6 2 ... 57 31 Public Health Act, 1936. Child Life Protection. On 1st January, 13 foster mothers and 13 children—and at the end of the year 10 foster mothers and 11 children—were subject to inspection. The Council's Child Protection Visitors made 61 visits of inspection during the year. Summary, Year 1943. Number of nurse children on Register, 1st January 13 Number of nurse children notified by foster mothers during the year ... 11 Nurse children removed:— To parents or relatives 6 To another foster mother 1 With foster mother to another area 2 Adopted 2 To institutions 1 Evacuated under Government Soheme — Attained 9 years of age 1 Removed—No trace — Died — Number of nurse children on Register on 31st December 11 Ante-Natal Clinics— Attendances.—During 1943, the attendances were :— First Subsequent Attendances. Attendances. Total. 580 1,296 1,876 The average number in attendance at the Ante-Natal Clinics held at the Council's two Centres during 1943 was 12.10 per session. The number of home visits made by Health Visitors to expectant mothers during the year was 349. Maternity Beds. One hundred and sixteen patients were admitted during 1943 under the terms of the agreement with the Mothers' Hospital, Clapton and Queen Mary's Hospital, Stratford. Public Health Act, 1936. Registration of Nursing Homes. There are two registered nursing homes in the Borough. Since the last report, one home closed down owing to the death of the Proprietor. These institutions were inspected on 11 occasions. 32 Home Helps. Under the Council's scheme for the provision of home helps, 199 applications, 35 of whom made application in 1942, for home helps were dealt with. In 150 cases home helps were provided, 4 of these cases having the charges remitted in accordance with the Council's scale. In the 49 remaining cases, 19 made other arrangements for the confinement, and 30 cases had not been confined at the end of the year. Puerperal Pyrexia. Eighteen cases of puerperal pyrexia were notified during the year. The causes of pyrexia were considered to be:— Absorption of pelvic haematoma 1 Pelvic infection 1 Pleurisy in pregnancy 1 Influenza 1 Caesarean Section 1 Local uterine infection 5 Mastitis 1 Not known 4 Endometritis 2 Retained products 1 18 Obstetric Consultant. The advice of the Council's Consultant Obstetrician was sought on one occasion during the year. Maternity Mortality. There were 5 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 fifty-two such notifications were received. 33 Fees paid to Doctors under Section 14 (1) of the Midwives' Acts, 1918. Two hundred and forty-four 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 £415 4s. 6d. Post-Natal and Gynaecological Clinic. The following figures show in statistical form the attendances during 1943:— Leyton Green. Number of Sessions 14 Letters of Invitation 164 First Attendances 117 Re-attendances 85 Report by De. Anne S. Clark, M.B., Ch.B. During the year 14 sessions of the Post-Natal and Gynaecological Clinic were held. The number of new patients who attended was 117, out of 164 who received appointments to attend (= 71.34 per cent.). Of these, 105 were post-natal (i.e., they had had a confinement within the previous three months); and 12 were gynaecological. The disposal of these cases was as follows Discharged after one attendance 57 Re-attended for examination and treatment 60 The total number of attendances was 201. The average attendance per session was 14.35—with a maximum of 24 and a minimum of 7. Free medical prescriptions were issued in 35 cases at a total cost of £6 12s. 4d.; and 11 prescriptions were issued for payment by the patients. 34 The following are the main conditions which have been found on examination:— Subinvolution of the uterus 11 Retroversion of the uterus 15 Defective perineum 2 Cervical erosion 6 Vaginitis 3 Pregnancy 3 Birth control 15 Record of Cases attended by Council Midwives, 1943. Midwives (8) employed by Council *(4) 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 186 441 627 (6) As Maternity Nurses 26 58 84 Ante-natal Visits 512 1,964 2,476 Ante-natal Examinations 1,614 2,917 4,531 Post-natal Visits 3,768 9,823 13,601 *An additional Midwife was appointed in September, 1943. WAR-TIME DAY NURSERIES. The two War-time Day Nurseries established in the Borough in 1942 have been well attended during the year. The following table is a record of the number of children accommodated in the two Nurseries during the year:— 35 WAR-TIME DAY NURSERIES — AVERAGE DAILY ATTENDANCE, 1943. Month. Knotts Green Nursery. Ellingham Road Nursery. Mondays to Fridays Saturdays Average total attendances. Mondays to Fridays. Saturdays Average total attendances. Under 2 years. Over 2 years. Under 2 years. Over 2 years. Mon. to Fri. Sats. Under 2 years. Over 2 years. Under 2 years. Over 2 years. Mon. to Fri. Sats. January 13.23 18.90 6.40 4.80 32.13 11.20 11.48 20.38 8.40 14.00 31.86 22.40 February 13.30 25.65 7.25 10.00 38.95 17.25 10.20 11.60 6.75 6.00 21.80 12.75 March 13.22 27.78 7.00 11.50 41.00 18.50 8.95 16.91 4.50 8.25 25.86 12.75 April 15.47 29.66 10.33 12.00 45.13 22.33 9.95 19.47 7.33 9.66 29.42 16.99 May 11.19 27.66 8.40 11.00 38.85 19.40 14.57 31.19 6.80 13.80 45.76 20.60 June 8.95 32.57 4.50 12.50 41.52 17.00 14.61 32.23 7.50 19.75 46.84 27.25 July 10.32 34.45 5.80 12.60 44.77 18.40 13.18 31.59 6.66 16.00 44.77 22.66 August 10.24 34.95 5.00 11.00 45.19 16.00 11.47 35.14 5.25 17.25 46.61 22.50 September 11.95 37.68 7.25 14.25 49.63 21.50 10.68 36.77 4.75 20.25 47.45 25.00 October 11.05 38.86 5.80 16.60 49.91 22.40 11.71 36.52 5.00 21.20 48.23 26.20 November 10.13 35.36 3.00 12.75 45.49 15.75 12.27 30.58 5.50 15.25 42.85 20.75 December 9.77 34.00 3.00 13.00 43.77 16.00 10.90 27.59 7.00 12.66 38.49 19.66 Average for Year 11.56 31.45 6.14 11.83 43.02 17.97 11.66 27.49 6.28 14.50 39.16 20.79 36 Admission or Children. The following table supplies, in summary statistical form, information regarding applications for admission and their disposal during the first year since the opening of the Nurseries:— Knotts Green. Ellingham Road. Total. Number of mothers who submitted applications for admission of children 210 185 395 Number who failed to accept vacancies offered 38 13 51 Number of children withdrawn 80 72 152 Number of children on the Register 60 58 118 Number of mothers with two children in attendance 5 6 11 Number of applicants still awaiting admission 34 48 82 The periods during which these children attended were :— Less than 1 week 48 children ,, ,, 4 weeks 36 „ » 8 ,, 27 „ More than 8 ,, 41 „ 152 children The reasons for the withdrawal of these children were After an attack of infectious disease (chiefly measles, whooping cough and pneumonia.) 46 Mother not at work 31 Removals 23 Child alleged to be fretting 18 Child now attending school 5 Miscellaneous reasons... ... 29 Withdrawal of Children. Since the Nurseries were opened (i.e. during the first year), some 152 children, who were accepted for admission and were actually in attendance, have been withdrawn. 37 Attendances of Children. It was somewhat unfortunate that the nurseries were opened at a time when measles, scarlet fever, whooping cough and chicken pox were epidemic. In spite of the fact that the prime function of these nurseries is to release married women for industry, there are certain fundamental public health precautionary measures (e.g., exclusion of children with infectious or suspiciously infectious illness ; quarantine, etc.) which must be enforced in the public interest even although their enforcement may keep the mothers at home for a time. Infectious disease and its prevention in a day nursery is a serious problem requiring constant vigilant attention if the nursery is to be kept from degenerating into a hotbed of infection. The following figures show the average attendances throughout the year. It should be realised that a few months elapsed before each Nursery received its full complement of children. These figures compare favourably with those of other areas throughout the country. Average Daily Attendance Monday to Friday (inclusive). Percentage of Accommodation (50). Knotts Green 37.39 74.78% Ellingham Road 32.88 65.76% 38 or her children. In many cases it was obvious that admission would be a mistake, and frequently mothers who had stressed the importance of having their children admitted, immediately left them for the shortest possible time in the nursery. It will be remembered that two children from one family in Wanstead were admitted urgently last January on the direct instruction of the Ministry of Health. They were in poor condition on admission, and before admission it was obvious that the arrangement would prove unsatisfactory. They were in the nursery less than two weeks. By the end of that time the mother had changed her job twice, and then decided she would give up work until the next summer. It is impossible to check how often the mothers change their jobs. Sometimes it is only discovered by chance, when perhaps the mother is wanted urgently and is not found at the address she has given. One mother has changed her job five times. It cannot be denied that the war-time nurseries, as at present arranged, encourage the " careless " mother to evade her responsibilities to her children. On examining the children during the winter months I have been struck by the fact that children were attending the nursery who ought to have been at home in bed—usually with bronchial catarrh. The records show that these mothers have been advised by the Matrons, often on more than one occasion, that the children were not fit to be admitted. I have seen worse cases of chronic malnutrition in the nurseries in twelve months than I have seen at the Child Welfare Clinics in twelve years. The most obvious case was a child of thirteen months, weighing 13 lbs. (the average weight of a four months old baby) whose mother has moved to and from the North of England. The children of women who are continually moving from one part of the country to another are always a problem to Maternity and Child Welfare Departments. Pre-war they consisted mainly of families in which the father was in irregular employment. Now, in an area like this, their number is increased by families who have moved from poorer areas of the East End of London. The table of those children who have left the nurseries in the first year shows over 20 of these transfers in and out of the district—children of whom the health visitors had no record until their mothers applied for their admission to the nursery—this does not represent the total of this "shifting population" whose mothers have made use of the nurseries. Some who removed their children after a very shdrt time and left no message, and others whose children left after an illness, were subsequently 39 discovered to have left the district. It is obvious that these mothers who keep moving about cannot be of much use in industry, because they must be continually changing from one job to another. The Essential Works Order cannot be applied in practice to the mother with young children because she is a volunteer in industry. In some cases, where the child's name remains on the register of the day nursery for a number of months, it cannot be assumed that the mother is working throughout that time. The two following cases are examples :— (1) 12th October Admitted. 14th October Absent. I6th November Returned. 17th November Absent and withdrawn. 18th January Re-admitted. 20th January Absent—left. 8th March Re-admitted. 17th March Absent without excuse. Name removed from register. (2) 1st September Admitted. 2nd September Absent, mother ill. 2nd October Returned to nursery. 30th November Absent, father home on leave. 15th December Returned to nursery. 1st February Absent—mumps. Withdrawn. In the first case the child attended 14 days over a period of five months. In the second, the child was away for six weeks, and left finally at the end of five months. Both were removals into the district, and both had verminous heads on admission, suggesting a low standard of maternal care. The other striking fact brought out by the figures of children who have already left the nurseries is the high proportion who left following an attack of infectious disease. Of those who were in attendance over two months, half did not return following an attack of infection. The time of opening the nurseries was probably unfortunate—towards the end of the summer, while measles, scarlet fever, whooping cough and chicken pox were epidemic in the Borough. This meant that the children who were admitted in poor condition had not time to have their nutrition built up by good food and open air conditions, before the shorter and wetter days necessitated having them inside more, and exposing them to more 40 concentrated and prolonged doses of infection. There is isolation accommodation for one child in each nursery, and mothers proved most unwilling to stay away from work to keep a child with a cold at home. Catarrhal conditions of the respiratory tract are most deadly to the young child ; and the dangerous risk of a cold developing into pneumonia, or of pneumonia complicating measles, or whooping cough, is undoubtedly increased by exposing the child with a cold to the weather conditions of early morning and evening, particularly in the cold, wet period of the year. Medical Officers of Welfare Authorities were warned by the Chief Medical Officer of the Ministry of Health in February that the nutritional condition of children in nurseries, particularly of the 1-2 year age group, was in certain areas less good than it should be. Ministry of Labour officials have now admitted that better production is obtained from two mothers working part-time than from one working whole time. It would seem opportune to urge for a reduction in the hours which nurseries remain open. If women with young children were employed in the morning only, the afternoon shifts to be worked by women without young children, it would be likely to increase production, the health of the mothers and young children would improve, and as a mother working 4-6 hours would leave her child in the nursery not more than eight hours, less staff would be required in the nurseries, and less fuel would be used for lighting and heating. In November, 1943, letters were received from the Ministry of Health to the effect that representation had been made by the Ministry of Labour and National Service that additional Nursery accommodation was required in this Borough. The Maternity and Child Welfare Committee considered very thoroughly all the aspects of the representation, and recommended (a) the erection of a new Nursery on a suitable site in the Lea Bridge area, and (b) the extension of existing accommodation at Ellingham Road Nursery. These proposals have been sent to the Ministry of Health and are being considered. 41 INFESTATION BY HEAD LICE. Ministry of Health Circular 2831. The above Circular, issued by the Ministry of Health, draws attention to action which might be taken by Welfare Authorities within the scope of their present powers to assist mothers and young children in the promotion of cleanliness and good habits in the elimination of verminous conditions, and Medical Officers of Health are instructed to include in their Annual Reports an account of steps taken in pursuance of the Circular. Suggestions Contained in Circular. (a) That health visitors, midwives and all whose duty and privilege it is to help and advise expectant mothers will lose no opportunity of impressing upon them the importance of cleanliness and freedom from vermin in addition to the other matters affecting the health and welfare of themselves and of the baby to be born. (b) Talks to mothers at the Centres as well as home visits should help in the educational side. (c) Suitable combs might be provided, for sale or on loan at the clinics. (d) For severe cases of infestation, the preparation known as Lethane Hair Oil is recommended. (e) Each health visitor's district should again be classified, and health visitors should give more attention to children from 2-5 years and to homes known to be unsatisfactory. (f) That health visitors should visit homes about tea-time so that help may be given to the mothers in establishing the right hygienic routine in washing, care of hair and teeth, use of the lavatory, the taking of a proper morning meal, etc. Local Arrangements. (a) Doctors, health visitors and midwives have been in the habit of impressing the importance of cleanliness and freedom from vermin on mothers attending the Council's clinics and during home visits. (b) Mothers are advised that the hair of young children should be kept short. 42 (c) For many years it has been the practice to lend suitable combs at the Council's clinics to mothers found to require them. (d) For some time supplies of Lethane Hair Oil have been available at clinics. (e) As a matter of routine, health visitors have always given relatively more attention to homes and mothers considered to be unsatisfactory in their standard of maternal care ; but it has never been considered necessary to re-classify the homes in each health visitor's district. (f) It is rather difficult to understand why visits should be made to homes about tea-time. General Observations. It is estimated that about 5 per cent. of Leyton mothers are habitually verminous. Such chronic offenders in matters pertaining to cleanliness generally refuse to admit the presence of vermin when demonstrated either in their own or their children's heads ; and very often they resent, in no uncertain terms, attention being called to the fact. It is not difficult to imagine the type of reception a health visitor would be likely to receive from such an overworked mother of a large family if the health visitor began offering advice while the mother was preparing tea. 43 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. 2 cases were notified during the year. MEASLES. 479 cases of measles were notified during the year. WHOOPING COUGH. 91 cases of whooping cough were notified during the year. SCARLET FEVER. Year. Cases Notified. Deaths. Case Fatality per cent. 1939 233 1 0.43 1940 87 0 0.00 1941 64 1 1.56 1942 318 0 0.00 1943 386 0 0.00 DIPHTHERIA. Year. Cases Notified. Deaths. Case Fatality per cent. 1939 148 3 2.02 1940 55 0 0.00 1941 44 1 2.27 1942 39 0 0.00 1943 28 1 3.57 ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. Immunisation by Private Medical Practitioners. Number of private medical practitioners who applied for supplies of toxoid-antitoxin 13 Number of children immunised 38 44 Municipal Clinic. Prior to 1941 the immunising agent in use was Toxoid Antitoxin Flocules (T.A.F.). In 1941 this agent was replaced, except in adult cases, by Alum Precipitated Toxoid (A.P.T.) supplied by the Sector Laboratory on behalf of the Ministry of Health. As it was found that 98 per cent. of children were immune after two inoculations by A.P.T., in 1943 steps were taken to dispense with the final Schick test of susceptibility. By so doing it was possible to complete the protection of a much greater number of children. The routine course of immunisation is an initial dose of 0.2 c.c. A.P.T., followed by a second dose of 0.5 c.c. four weeks later. RETURN FOR THE YEAR 1943. Age 1-5 years. Age 5-15 years. Total. 1. Number of children who completed the course of immunisation during the year 1,758 2,625 4,383 2. (a) Approximate estimated child population at end of year 5,200 9,750 (b) Percentage of child population considered to be immunised at end of year 53.25 80.75 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 toxæmic manifestations of diphtheria. During 1943 three Leyton children, who had been immunised 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. Date of Notification. Swab Results T=Throat. N=Nose. E=Ear. Diagnosis. 10 F 10.5.41 9. 2.43 T — Vincent's Angina. N — 4 M 1.8.41 17. 4.43 T — Not Diphtheria. 8 M 31.8.37 28.10.43 T + Mild 45 TUBERCULOSIS. Notifications—One hundred and eighteen patients were notified for the first time in 1943 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 51 50 101 Non-Pulmonary Tuberculosis % 11 6 17 62 56 118 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1943:— Pulmonary. Non-Pulmonary. total M. F. Total. M. F. Total. Number on Register at commencement of year 282 203 485 28 40 68 553 Number first notified during the year 51 50 101 11 6 17 118 Number of cases entered in Register otherwise than by Notification 14 8 22 2 1 3 25 Number removed from the Register during the year 59 43 102 9 7 16 118 Number remaining at the end of the year 288 218 506 32 40 72 578 Details of cases removed from the Register during the year:— Died 42 21 63 7 2 9 72 Removed from the district 16 21 37 2 2 4 41 De-notified 1 1 2 — 3 3 5 Deaths.—Seventy deaths from tuberculosis were recorded. 46 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 1 — 2 1 5 — — 2 — 10 1 — 1 1 15 8 5 — — 20 8 8 1 2 25 18 20 2 1 35 7 11 1 — 45 3 5 1 — 55 5 — 1 1 65 and upwards — 1 — — Totals 51 50 11 6 Institutional Treatment. During 1943 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 45 39 3 1 88 Children 1 Nil Nil 5 6 47 TABLE No. 10. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1943. 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 28 1 1 2 5 2 8 4 ... 3 2 ... ... Erysipelas 44 ... 1 ... ... 1 ... ... 1 12 8 15 ... Scarlet Fever 386 2 14 39 59 76 146 30 7 8 3 2 ... Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 101 ... 1 ... ... ... ... 1 13 54 18 13 ... T.B. Others 17 ... 1 ... 1 1 2 2 ... 6 1 3 ... Pneumonia 123 1 6 4 2 4 7 9 1 21 18 36 14 Ophthalmia Neon. 5 5 ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 18 ... ... ... ... ... ... ... 1 15 2 ... ... Cerebrospinal Meningitis 2 ... ... ... ... 1 ... ... ... 1 ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 8 ... ... 1 ... 2 1 2 1 ... 1 ... ... Measles 479 14 85 64 104 84 105 10 10 3 ... ... ... Whooping Cough 91 8 21 12 22 12 15 1 ... ... ... ... ... Totals 1302 31 130 122 193 183 284 59 34 123 53 69 21 48 TABLE 11. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1943. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 28 ... 7 3 ... 1 3 3 5 3 3 25 Erysipelas 44 1 11 7 7 4 4 2 1 3 4 8 Scarlet Fever 386 19 70 41 50 55 28 17 39 31 36 165 Pemphigus Neon ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 101 13 14 5 11 17 6 9 11 7 8 56 T.B. Others 17 3 5 2 3 2 1 1 4 Pneumonia 123 18 51 5 12 15 7 4 3 4 4 46 Ophthalmia Neon. 5 ... ... 1 ... 1 ... ... 1 ... 2 ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 18 1 5 1 2 2 5 ... ... 1 1 15 Cerebrospinal Meningitis 2 ... 1 ... ... ... ... 1 ... ... ... 1 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 8 ... ... 4 2 1 ... ... ... l ... 5 Measles 479 23 95 69 94 44 38 29 24 36 27 16 Whooping Cough 91 12 42 8 6 11 3 3 4 2 6 Totals 1302 90 301 144 184 153 97 68 86 91 88 347 49 SCHOOL MEDICAL SERVICE. GOVERNMENT EVACUATION SCHEME. Assuming a continuing decline in the school roll, an approximate roll as at 31st March, 1943, would be 11,500. Estimated figures showing the present distribution (December, 1943) of these children are given below:— (а) In Leyton Over 5 years 8,968 Under 5 years 792 (b) Evacuated:— (i) In National Camp at Itchingfield—as from April, 1940. (Central Schools, etc.) 175 (Owing to decrease in numbers the Camp at Tilford was discontinued in May, 1943, and the children whose parents so desired were transferred to Itchingfield.) (ii) In reception areas or removed 1,565 11,500 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 1177 Second Age Group 888 Third Age Group 844 Total 2,909 Of 2,909 children who were examined in the code age-groups, 2,373 (or over 81 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 3,874 comparing with 3,827 during the previous year. Re-inspections. The number of re-inspections during 1943 was 7,006. 50 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 1,177 220 18.68 Second Age Group 888 183 20.60 Third Age Group 844 206 24.40 Total (Code Groups) 2,909 609 20.93 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 1,077 children were found to be unclean out of a total number of 22,364 examined (i.e., 4.8 per cent. Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 1,964 48 10 Capworth Street 1,878 90 17 Cann Hall Road 695 29 6 Church Road 1,204 39 7 Connaught Road 1,217 40 5 Downsell Road 1,363 63 19 Davies Lane 2,062 75 21 Farmer Road 1,471 26 2 Goodall Road 1,203 54 14 Kirkdale Road 377 7 1 Lea Bridge Road 185 2 1 Mayville Road 1,909 197 37 Norlington Road 1,955 59 15 Newport Road 1,823 63 11 Sybourn Street 1,498 27 10 St. Joseph's 380 11 8 Trumpington Road 994 38 10 Knotts Green 186 10 5 Total 22,364 878 199 Number of individual children found unclean 1,077 of whom 199 were referred to the Minor Ailments Clinics. 51 Return of Defects found by Medical Inspection in the Year ended 31st December, 1943. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) ■ Skin Ringworm—Scalp ... ... 3 ... Body ... ... 13 ... Scabies 4 1 140 ... Impetigo 1 ... 112 ... Other diseases (non-T.B.) 13 2 788 1 Eye Blepharitis 8 ... 38 ... Conjunctivitis 2 ... 118 ... Keratitis ... ... ... ... Corneal Opacities ... ... 2 ... Defective Vision 176 40 194 ... Squint 34 1 83 ... Other conditions 9 ... 33 ... Ear Defective Hearing 2 5 25 ... Otitis Media 22 10 170 1 Other Ear Diseases 10 12 156 ... Nose & Throat Chronic Tonsilitis only 19 28 115 ... Adenoids only 4 7 6 ... Chronic Tonsilitis & Adenoids 20 15 72 1 Other conditions 19 2 298 1 Enlarged Cervical Glands (non-T.B.) 11 10 61 ... Defective Speech 4 9 14 ... Heart and Circulation Heart Disease— Organic 1 2 7 ... Functional 1 15 3 ... Anaemia 3 ... 62 ... Lungs Bronchitis 39 12 74 ... Other non-T.B. Diseases 9 12 69 1 Tuberculosis ^Pulmonary— Definite ... ... ... ... Suspected ... 2 2 ... Non-Pulmonary— Glands 1 2 2 ... Bones and Joints ... 1 1 ... Skin ... ... ... ... Other Forms ... 2 2 ... Nervous System Epilepsy 2 1 4 ... Chorea ... ... 4 l Other conditions 8 8 59 ... Deformities Rickets 1 ... ... ... Spinal Curvature ... ... ... ... Othe Forms 150 23 109 ... Other Defects and Diseases 86 20 2,423 3 Totals 659 242 5,262 9 52 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 3,489 children attended the clinics, and 13,227 attendances were registered. Defective Vision—Of the 2,909 children subjected to routine code group inspection in the schools, 195 (6.7 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 753 children, who made 988 attendances for examination and treatment. Report by the Authority's Ophthalmic Surgeon (J. D. Magor Cardell, M.B., B.S., F.R.C.S.). During the year 871 children were referred, from various sources, to the eye clinic. This represents about 9.0 per cent. of the school population. Notice should be taken of the large proportion of the total 871 cases which is due to squint. The figure works out at 19 per cent. Since orthoptic training plays a large part in rehabilitating these cases, it is understandable that the Orthoptic Clinic is very busy. The report of this Clinic is presented herewith. The percentage of the school population afflicted with myopia appears to be approximately 2.4 per cent. This figure is one that has varied little since my first report made about 17 years ago. The factors governing the incidence of myopia have not yet been thoroughly elucidated, but the figures, in my opinion, reflect a satisfactory condition of the eye-health of the children of Leyton. I would add that the satisfactory working of the Clinic would be impossible without the willing co-operation of Miss Montague Smith, the School Nurses and Teachers 53 Squint Clinic. Report by Orthoptist (Miss G. Montague Smith). The attendance at the Orthoptic Clinic are steadily increasing and have been since the outbreak of war. Operation cases now can be dealt with very promptly thanks to arrangements with Whipps Cross and King's College Hospitals. There is still a waiting list for patients requiring orthoptic treatment, so these cases have to be kept under observation until there is a vacancy. Yearly Attendances 1,801 New Cases 43 Old Cases. 112 Cases attending for preliminary tests and re-checking 78 Of these 78— 3 have left school. 15 are on the waiting list. Unsuitable for treatment 1 Failure to attend regularly 7 Cases treated for Amblyopia (defective vision) 24 Of these 24— 2 have already commenced orthoptic exercises. 12 are waiting for a vacancy for orthoptic exercises. Cases treated with Orthoptic Exercises 45 Of these 45—10 are still on treatment 5 are waiting for operation 11 are resting from treatment 19 are discharged. Of the 19 discharged cases:— 4 are completely cured 7 are practically cured 2 are improved but unfinished (one left district—one died) 4 are cosmetic results 2 are unresponsive. 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 519 274 312 143 298 65.48 Cann Hall 234 174 127 100 177 77.97 Capworth 206 387 104 203 178 57.98 Church 77 361 44 216 164 63.07 Connaught ... ... ... ... ... ... Davies Lane ... ... ... ... ... ... Downsell 254 137 151 110 140 53.63 Farmer 391 90 261 47 179 58.11 Goodall 179 162 109 101 84 40.00 Kirkdale 67 51 29 22 46 90.19 Knotts Green 34 29 13 13 19 73.07 Lea Bridge 28 33 12 19 10 32.25 Mayville ... ... ... ... ... ... Newport 541 166 326 88 303 75.60 Norlington 168 450 70 281 246 70.08 Ruckholt ... ... ... ... ... ... Sybourn 365 184 219 98 179 56.46 St. Joseph's ... ... ... ... ... ... Tom Hood 13 15 6 14 14 70.00 Trumpington 143 167 98 115 95 46.79 3,219 2,680 1,881 1,570 2,132 61.77 Report by the Authority's Senior Dental Officer (A.E. Hall, L.D.S.) It is pleasing to note that the number of teeth extracted shows a decrease when compared with the previous year. At the same time the number of children treated, and the amount of conservative work done, shows an increase. This is all to the good, as any relative increase in the number of fillings compared with extractions shows a better dental condition of the children when seen at school inspection, and may be in part due to an increase in the dental consciousness of parent or child. Owing to the gradually increasing number of children in attendance since 1939-41, the period between successive dental inspections has lengthened slightly. 55 Orthopaedic Clinic. The following figures show the number of school children examined and treated during the year. Examinations. Primary examinations 46 Re-examinations 129 Treatment. Number of children who attended for 161 Attendances made 1,213 Surgical Appliances. The following have been supplied:— Surgical boots 2 single Caliper splints and sockets to boots 2 pairs Leg iron 1 Arm induction splint 1 Repairs and alterations to splints 5 Minor surgical alterations to boots 65 Artificial Sunlight Clinic. Number of children attending 128 Attendances made 3,069 Aural Clinic. The following table shows the relevant particulars regarding the Leyton School children who attended the Aural Clinic for treatment during 1943. 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 8 11 ... ... ... ... ... 1 20 (ii) „ Catarrhal „ „ 5 ... ... ... ... ... ... ... 5 (iii) Chronic Suppurative Otitis Media due to:— ... ... ... ... ... ... ... ... ... 1. Tympanic Sepsis 2 ... ... ... ... ... ... 1 3 2. „ „ and Granulations 5 1 ... ... ... ... ... 1 7 3. „ „ and Polypi 1 ... ... ... ... ... ... ... 1 4. „ „ and previous Mastoid Operation ... ... ... ... ... ... ... ... ... 5. Other causes ... 1 ... ... 1 ... ... ... 2 (iv) Mastoid Disease (previous operation) ... ... ... ... ... 2 ... ... 2 (v) Partial Deafness due to:— ... ... ... ... ... ... ... ... ... 1. Nerve Deafness ... ... ... ... ... ... ... ... ... 2. Tonsils and Adenoids 2 4 ... ... ... ... ... ... 6 3. Retraction of Membrana Tympani 1 1 ... ... ... ... ... ... 2 4. Scarring 3 ... ... ... ... ... ... ... 3 5. Catarrhal Rhinitis 5 2 ... ... 2 ... ... ... 9 6. Wax ... ... ... ... ... ... ... ... 2 7. Other Causes 1 ... ... ... ... ... ... ... 1 (vi) Nasal Cases:— ... ... ... ... ... ... ... ... ... 1. Hypertrophic Rhinitis ... ... ... ... ... ... ... ... ... 2. Sinusitis 2 1 ... ... ... ... ... ... 3 3. Atrophic Rhinitis ... ... ... ... ... ... ... ... ... 4. Deviated Septum 7 1 ... ... 1 ... ... ... 9 5. Foreign Body ... ... ... ... ... ... ... ... ... 6. Polypus 1 ... ... ... ... ... ... ... 1 (vii) Tonsils and Adenoids 8 37 ... ... ... ... ... ... 45 (viii) Other Diseases or Defects 1 2 ... ... ... ... ... ... 3 Totals 52 61 ... 2 4 2 ... 3 124 57 PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN. Mentally Defective Children. Statutory Medical Examinations. During the year, some 84 children were referred for statutory medical examination. As the result of examination these 84 children were classified as follows:— Idiots 1 Imbeciles 3 On attaining 16 years of age—for supervision under the M.D. (Notification of Children) Regulations 5 Certified to Local Education Authority as feebleminded 11 Remained under certificate 4 Certificate withdrawn 2 Dull and backward 15 Borderline cases—to be re-assessed in six months 9 Cases under certifying age 4 Behaviour problems:— With average intelligence 21 Below ,, ,, 3 Above „ „ 6 84 Knotts Green Special School for Mental Defectives. Admitted 7 Discharged 7 Physically Defective Children. Knotts Green Open Air School. Admitted during the year 17 Discharged 12 58 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1943 was:— Ordinary Meals. Milk Meals. Free 810 2,178 For payment 5,352 — Totals 6,162 . 2,178 Number of meals supplied:— Ordinary Meals. Milk Meals. Free 154,200 467,921 For payment 519,757 — Totals 673,957 467,921 The above figures relate to the financial year ended 31st March, 1944. 58 PUBLIC ELEMENTARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections. a. Routine Medical Inspections. Number of Code Group Inspections:— Entrants 1,177 Second Age Group 888 Third Age Group 844 Total 2,909 b. Other Inspections. Number of Special Inspections 3,874 Number of Re-inspections 7,006 Total 10,880 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 Total. Percentage of children found to require Treatment. Entrants 2 218 220 18.68 Second Age Group 72 111 183 20.60 Third Age Group 102 104 206 24.40 Total (Prescribed Groups) 176 433 603 20.93 Other Routine Inspections — — — — Grand Total 176 433 609 20.93 60 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. % Entrants 1,177 144 11 733 62 291 24 9 0.7 Second Age Group 888 136 15 613 69 134 15 5 0.5 Third Age Group 844 153 18 524 62 162 19 5 0.5 Other Routine Inspections — — — — — — — — — Total 2,909 433 15 1,870 64 587 20 19 0.7 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1943. TREATMENT TABLE. Group I.—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 1 — 1 (2)Other 2 — 2 Body 13 — 13 Scabies 140 — 140 Impetigo 111 — 111 Other skin diseases 778 — 778 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 259 — 259 Minor Ear Defects 288 — 288 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 999 — 999 Total 2,591 — 2,591 61 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor 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) 607 40 647 Other defect or disease of the eyes (excluding those recorded in Group I.) 140 140 Total 747 40 787 • Under the Authority's Scheme. Otherwise. Total. No. of Children for whom Spectacles were:— (a) Prescribed 510 40 550 (b) Obtained 508 42 550 TABLE III.—contd. • Group III.—Treatment of Defects of Nose and 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) 129 250 11 2 61 23 17 — 6 1 28 2 67 24 (1)Tonsils only. (2) Adenoids only. (3) Tonsils and adenoids. (4) Other defects of the nose and throat. 62 TABLE IV. Dental Inspection and Treatment. (1) Number of children who were:— (a) Inspected by the Dentist:— Aged: 3 47 Total 6,560 Age Groups 4 271 5 563 6 695 7 727 8 729 9 643 10 673 11 628 12 584 13 669 14 318 15 13 16 Specials (Casuals) 917 Grand Total 7,477 (b) Found to require treatment 4,740 (c) Actually treated 2,382 (2) Half-days devoted to Inspection 47½ Treatment 726½—Total 774 (3) Attendances made by children for treatment 5,257 (4) Fillings, Permanent Teeth 2,877 Temporary ,, 409—Total 3,286 (5) Extractions, Permanent Teeth 627 Temporary ,, 4,143—Total 4,770 (6) Administrations of general anaesthetics for tions 1,461 (7) Other operations, Permanent Teeth 199 Temporary ,, 36—Total 235 63 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 22,364 (3) Number of individual children found unclean 1,077 (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 — TABLE VI. Blind and Deaf Children. (1) (2) (3) (4) At a Public Elementary School. At an Institution other than a Special School At no School or Institution. Total not receiving suitable Education. Blind Children — — — — Deaf Children — — — — 64 SECONDARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections. a. Routine Medical Inspections. Number of Code Group Inspections:— County High School for Boys 72 „ „ „ Girls 76 Total 148 Number of other Routine Inspections b. Other Inspections. Number of Special Inspections 81 Number of Re-inspections 86 Total 167 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 76 16 21.05 County High School for Boys 72 10 13.88 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 76 15 19.7 47 61.8 14 18.4 ... ... County High School for Boys 72 6 8.3 65 90.2 1 1.3 ... ... 65 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 2 — 2 Impetigo — — — Other skin diseases 11 — 11 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 8 — 8 Minor Ear Defects 3 — 3 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 16 — 16 Total 40 — 40 table III,—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as minor allnents.—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) 47 33 80 Other defect or disease of the eyes (excluding those recorded in Group I.) 17 — 17 Total 64- 33 97 Total number of children for whom spectacles were prescribed— (а) Under the Authority's Scheme 41 (b) Otherwise — 66 TABLE IV. Dental Inspection and Treatment. (1) Number of children who were:— (a) Inspected by the Dentist:— Aged: Age Groups 11 97 Total 676 12 152 13 135 14 97 15 114 16 57 17 22 18 2 Specials (Casuals) Nil Grand Total 676 (b) Found to require treatment 489 (c) Actually treated 284 (2) Half-days devoted to Inspection 4 Treatment 66—Total 70 (3) Attendances made by children for treatment 471 (4) Fillings, Permanent Teeth 714 Temporary „ Nil—Total 714 5) Extractions, Permanent Teeth 179 Temporary ,, 37—Total 216 (6) Administrations of general anaesthetics for extractions 79 (7) Other operations, Permanent Teeth 65 Temporary ,, Nil—Total 65